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Conteúdo (article):

The mental health of postgraduate students in the context of the COVID-19 pandemic: a scoping review
A saúde mental de estudantes de pós-graduação no contexto da pandemia da covid-19: uma revisão de escopo
La salud mental de los estudiantes de posgrado en el contexto de la pandemia de COVID-19: una revisión de alcance

Author:
Breno Estevam Silva de Souza – brenno.estevam@gmail.com
ORCID: https://orcid.org/0000-0001-5590-7441

Co-Author(s):
Eduarda Gomes Onofre de Araújo - eduardaonofre@gmail.com
ORCID: https://orcid.org/0000-0001-7107-6107
Livian Isabel de Medeiros Carvalho - carvalholivianmed@gmail.com
ORCID: https://orcid.org/0000-0001-7605-1523
Gabriela Salgado Colado - gabriellasalgado@hotmail.com
ORCID: https://orcid.org/0009-0005-4221-3973
Ardigleusa Alves Coelho - ardigleusacoelho@gmail.com
ORCID: https://orcid.org/0000-0001-8869-3793
Sávio Marcelino Gomes - savio.gomes@academico.ufpb.br
ORCID: https://orcid.org/0000-0002-6320-2502
Franklin Delano Soares Forte - franklinufpb@gmail.com
ORCID: https://orcid.org/0000-0003-4237-0184
Cláudia Helena Soares de Morais Freitas - chsmf@hotmail.com
ORCID: https://orcid.org/0000-0003-0265-5396

ABSTRACT
The COVID-19 pandemic significantly impacted public health and society, altering daily life and interpersonal relationships. This study aims to map scientific evidence on the mental health of postgraduate students (master’s and doctoral) during the pandemic through a scoping review, registered on the Open Science Framework (DOI: https://osf.io/jbem6). The PCC acronym (Population, Concept, Context) was used to define the population as postgraduate students, the concept as mental health, and the context as the COVID-19 pandemic. Data collection was conducted in July 2023, resulting in 2,575 articles, of which 23 were selected. Most studies were conducted in North America and China, with a predominance of cross-sectional studies. The results indicate an increase in the prevalence of mental disorders such as anxiety and depression, influenced by the disruption of academic activities. Life satisfaction was positively associated with optimism and negatively associated with depression and stress. It is concluded that the pandemic worsened mental health challenges among students, highlighting the need for inclusive support strategies capable of addressing the diverse needs of this group during and beyond periods of global crisis.
Keywords: Mental Health; Health Postgraduate Programs; COVID-19; Pandemics; Psychological Distress.

RESUMO
A pandemia de covid-19 impactou significativamente a saúde pública e a sociedade, alterando a vida cotidiana e as relações interpessoais. Este estudo objetiva mapear evidências científicas sobre a saúde mental de estudantes de pós-graduação (mestrado e doutorado) durante a pandemia, por meio de uma revisão de escopo e registrada na Open Science Framework (DOI: https://osf.io/jbem6). Usou-se o acrônimo PCC (population, concept, context) para definir a população como estudantes de pós-graduação, o conceito como saúde mental, e o contexto como a pandemia de covid-19. A coleta de dados foi realizada em julho de 2023, resultando em 2.575 artigos, dos quais, 23 foram selecionados. A maioria dos estudos foi realizada na América do Norte e na China, com predominância de estudos transversais. Os resultados indicam aumento da prevalência de transtornos mentais, como ansiedade e depressão, influenciados pela interrupção dos trabalhos acadêmicos. A satisfação com a vida foi positivamente associada ao otimismo, e negativamente à depressão e ao estresse. Conclui-se que a pandemia agravou desafios à saúde mental dos estudantes, destacando a necessidade de estratégias de apoio inclusivas capazes de atender às diversas necessidades desse grupo durante e além de períodos de crise global.
Palavras-chave: Saúde Mental; Programas de Pós-Graduação em Saúde; COVID-19; Pandemias; Esgotamento Emocional.

RESUMEN
La pandemia de COVID-19 ha tenido un impacto significativo en la salud pública y en la sociedad, alterando la vida cotidiana y las relaciones interpersonales. Este estudio tiene como objetivo mapear la evidencia científica sobre la salud mental de los estudiantes de posgrado (maestría y doctorado) durante la pandemia, a través de una revisión de alcance y registrado en el Open Science Framework (DOI: https://osf.io/jbem6). Se utilizó el acrónimo PCC (population, concept, context) para definir la población como estudiantes de postgrado, el concepto como salud mental y el contexto como la pandemia COVID-19. La recogida de datos tuvo lugar en julio de 2023, y dio como resultado 2.575 artículos, de los que se seleccionaron 23. La mayoría de los estudios se realizaron en Norteamérica y China, con predominio de estudios transversales. Los resultados indican un aumento de la prevalencia de trastornos mentales, como ansiedad y depresión, influidos por la interrupción del trabajo académico. La satisfacción vital se asoció positivamente con el optimismo, y negativamente con la depresión y el estrés. Se concluye que la pandemia ha exacerbado los problemas de salud mental de los estudiantes, lo que pone de relieve la necesidad de estrategias de apoyo integradoras capaces de satisfacer las diversas necesidades de este grupo durante los periodos de crisis mundial y más allá de ellos.
Palabras clave: Salud Mental; Programas de Posgrado em Salud; COVID-19; Pandemias; Distrés psicológico.

INTRODUCTION
The World Health Organization (WHO) declared the COVID-19 pandemic in March 2020, prompting the adoption of social distancing measures aimed at minimizing the spread of the coronavirus, the causative agent of the disease. Consequently, academic life was also altered, with classes suspended, restrictions on people’s mobility, among other measures. Although necessary from a public health perspective, these strategies resulted in reduced in-person social interactions and the widespread adoption of information and communication technologies, which negatively impacted mental health. Studies have shown an increase in symptoms of depression, anxiety, and a decline in life satisfaction and lifestyle quality¹,².
The COVID-19 pandemic had a major impact on public health, leading to significant changes in various dimensions of society, influencing how people perceive the world. Its social implications include changes in everyday life, interpersonal relationships within families, schools, and workplaces. Moreover, the pandemic affected economic structures and geopolitics³. A pandemic is not merely a medical phenomenon — it affects individuals embedded in society, causing mental distress, anxiety, stress, stigma, and xenophobia. Isolation, social distancing, the closure of educational institutions, workplaces, places of worship, and entertainment centers led people to remain confined in their homes to break the transmission chain. However, these restrictive measures negatively affected the mental and social well-being of individuals⁴,⁵,⁶.
According to the WHO, primary prevention of mental health is necessary for the general public and specific groups as an essential part of managing the COVID-19 pandemic. This includes all age groups, from youth to adulthood. However, to successfully support mental health, well-being, and social behavior among individuals affected during the pandemic, it is necessary to scientifically understand how people experience this period, how they psychologically react — how they think, feel, suffer, and cope — and how they manage their perception of threat, and how they perceive and regulate their emotions and behaviors²,⁷,⁸.
In this context of human distancing, postgraduate students experienced changes in their lives. Remote work and restricted access to university environments prevented face-to-face interactions with peers and professors, requiring students to adapt to new behavioral rules, increasing uncertainty. Although most students are familiar with digital environments, the sudden shift from in-person to exclusively digital communication became a source of physical and mental strain. The pandemic and its consequences are perceived differently by each individual, depending on their cognitive, emotional, and motivational states⁸,⁹.
Scientific literature has increasingly highlighted concerns about the mental health of university students, especially those in postgraduate programs¹⁰,¹¹. Signs of anxiety, depression, and suicidal ideation were prominent in academic settings¹⁰. Graduate education is especially demanding. The requirements placed on postgraduate students are greater than those for undergraduates. Pursuing a master’s or doctoral degree is challenging due to various factors, such as thesis/dissertation writing, qualification exams, participation in events, coursework requirements, and the need to publish in reputable journals. In addition, students face financial, family, personal, emotional, professional, and marital difficulties, among others. These challenges affect their physical and, most importantly, mental health¹².
Thus, given the theme, the COVID-19 context, and the need to identify and map scientific evidence on the mental health of postgraduate students, the following research question emerges: “What are the scientific findings on the impact of the COVID-19 pandemic on the mental health of postgraduate students stricto sensu (master’s and doctoral)?”

METHODOLOGY
Type of study
This is a scoping review built in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), which aims to map scientific evidence without evaluating methodological quality, considering the breadth, scope, and nature of a given topic¹³,¹⁴.
This type of review allows for mapping the extent, nature, and main concepts that shape the field of knowledge and is particularly useful when topics are complex or not yet fully defined in the literature¹⁵,¹⁷. Unlike systematic reviews, which seek to answer a specific question using methodological rigor and quality criteria, scoping reviews aim to identify knowledge gaps, gather key concepts, and guide future research.
The choice of this approach is justified by the diversity and heterogeneity of the available evidence on the mental health of postgraduate students during the pandemic, requiring an approach that considers both objective and subjective aspects present in the publications¹⁵,¹⁷.
To conduct the review, the structuring recommendations from the Joanna Briggs Institute Manual for Evidence Synthesis¹⁸ were followed, aiming for more rigorous methodological quality in constructing a complete and accurate work. Thus, the first step in the review was to create a protocol describing all methodological steps, which was duly registered on the Open Science Framework (OSF) (DOI:10.17605/OSF.IO/JBEM6) and published in the journal Contribuciones A Las Ciencias Sociales¹⁹.

Eligibility Criteria
To formulate the research question, the PCC acronym (Population, Concept, and Context) was used. Therefore, “Population (P)” was defined as stricto sensu postgraduate students – master’s and doctoral levels – while “Concept (C)” was defined as mental health, focusing on the psychopathologies that most affected this population. Finally, the “Context (C)” was defined to encompass studies discussing the mental health of stricto sensu postgraduate students during the COVID-19 pandemic, in order to answer the following question: “What is the scientific evidence on the COVID-19 pandemic and its relationship with the mental health of stricto sensu postgraduate students (master’s and doctoral)?”
The review included all studies published in English, Portuguese, and Spanish from 2020 onward, including experimental and quasi-experimental studies, analytical observational studies, case-control studies, cross-sectional descriptive observational studies, and qualitative research, provided they were conducted with master’s and doctoral students in any region of the world, without distinction of sex, age, or ethnicity.

Search strategy
The development of the search strategy was supported by a specialist librarian, so that the terms would be adapted to the particularities of each database and achieve better filtering of the results. Thus, the controlled search terms adopted in the strategy were identified in the Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH), and combined with Boolean operators (AND, OR) in the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed, Excerpta Medica Database (Embase), SciVerse Scopus, Web of Science, PsycINFO, and Latin American and Caribbean Health Sciences Literature (LILACS). The search in gray literature was carried out through ProQuest Dissertation and Thesis and Google Scholar. The search strategies used for each database, according to their specificities, are described in Table 1.

Table 1. Search strategies used in the databases, João Pessoa, Brazil, 2023.
Study selection
The searches in the databases were conducted in July 2023, and the files were exported to the software Rayyan®²⁰ for the selection process, which followed the PRISMA²¹ flowchart. Duplicate files were removed, and the search and selection process began, comprising two phases. In phase 1, publications were evaluated by title, abstract, and keywords. In phase 2, a full reading of the files selected in phase 1 was carried out. The process was carried out by two independent reviewers, and for the selection of articles in disagreement, a consensus meeting was held to resolve the divergences. During data collection, a form developed specifically for the research was completed, containing basic information about the eligible studies. The form included: author, title, year of publication, country, journal, study design, objective, participants, data collection technique, results, impacts of COVID-19 on the mental health of master\'s and doctoral students.
The discussion of the results was anchored in the understanding of the mental suffering experienced by master’s and doctoral students as an expression of the ethical-political suffering described by Sawaia (1999)²², seeking not to reduce it to an individual experience or isolated disorders. It is a form of suffering that expresses life in times of COVID-19 and, from an institutional perspective, the formative path in postgraduate education, marked by performance demands, evaluation, and academic productivity, which create pressure.

RESULTS
The data collection process in the databases resulted in 2,575 articles, with 2,384 from white literature and 191 from gray literature. A total of 1,153 duplicates were removed, resulting in 1,422 articles eligible for title and abstract screening. From this screening, 1,325 articles were excluded for not answering the research question, and 97 were selected for full-text reading. After the final reading, 74 articles did not meet the eligibility criteria, leaving 23 articles selected to compose the review.
The study flowchart (Figure 1) shows the selection of the studies and all the reasons for excluding publications during the different phases of the study.

Figure 1: Flowchart showing the article selection process

Figure 2 highlights the geopolitical distribution, showing the countries that conducted the most studies (in darker blue), namely: the United States (9 studies), China (4 studies), Brazil and Hungary (2 studies each). The countries with fewer studies (in lighter blue) are: Germany, Saudi Arabia, Spain, the Philippines, the United Kingdom, and Turkey, each with only one study.
The time frame of the analyzed investigations ranged from 2020 to July 2023, with the highest concentration of studies in the years 2022 and 2023 (8 in each year), corresponding to 69.56% of the selected studies. The design of the studies included in the sample were: cross-sectional (n=21; 91.3%), longitudinal (n=1; 4.35%), and qualitative (n=1; 4.35%).
Knowledge production on the mental health of postgraduate students during the COVID-19 pandemic period was concentrated in North America (USA), with 9 studies (39.13%), and China, with 4 studies (17.39%), totaling 56.52% of the studies.

Figure 2. The COVID-19 pandemic and its relationship with the mental health of stricto sensu postgraduate students, 2023.

In Table 2, we can observe that the main topics addressed by the studies are: epidemiological profile (most frequent mental disorders) and associated factors, main difficulties faced by postgraduate students during the pandemic, self-care practices, and use of health services.
After evaluating the articles based on the research question, it was observed that levels of stress, anxiety, and depression increased during the COVID-19 period, causing greater impacts on the mental health of postgraduate students.
The main results indicate an increase in the prevalence of common mental disorders and associated factors during the COVID-19 pandemic; psychological distress increased throughout the three phases of the pandemic — with varying degrees of anxiety and depression. It was shown that the inability to continue academic work led to increased anxiety and decreased motivation. Other studies showed that life satisfaction and happiness were positively associated with optimism about the future during the COVID-19 pandemic, while depression and stress were negatively associated. There was also an increase in family functioning, coping strategies, and social support, which reduced the level of burnout.

Table 2: Characteristics of the included studies on the COVID-19 pandemic and its relationship with the mental health of postgraduate students stricto sensu

Figure 3 presents the most frequently cited words in the scientific works collected for the composition of this scoping review.

Figure 3. Recurring terms in the selected studies

DISCUSSION
The studies revealed the presence of mental distress caused by the relationship between internet dependency, fear, anxiety, and depression in postgraduate students during the pandemic. This finding also corroborates results from other studies that, by addressing the lack of personal interactions, digital overload, and students’ difficulty maintaining focus in the home environment, identify this entire context as another set of elements reinforcing the potential mental exhaustion experienced by students²³,²⁴.
On the other hand, the study by Varadarajan, Brown, and Chalkley (2021)²⁵ identified positive results regarding adaptation to virtual environments, even in the face of interruptions to research processes and the impact on learning due to the temporary closure of universities.
In the United States, a country where depression and anxiety are among the most prevalent mental disorders, it was found that about 89% of students reported moderate to severe depression, while 76% reported moderate to severe anxiety. Additionally, feelings of loneliness were identified as a risk factor reported by postgraduate students. A correlation between emotional support and the presence of children was also observed as protective elements against depression²³.
Therefore, it can be observed that the educational path in graduate studies is a scenario of ambivalence: on the one hand, it facilitates learning and the development of research that generates knowledge; on the other hand, it presents mechanisms of symbolic control, demands, and, at times, a hierarchy of knowledge and practices among individuals. This scenario becomes productive of suffering, which cannot be explained solely by workload or anxiety about the professional future, but rather presents ethical and political density along the training journey. Denying the existence of suffering in a context of productivity, without considering well-being and self-care, contributes to a process of naturalizing illness²⁶,²⁷.
Furthermore, definitions of social standards of success, happiness, consumption, academic performance, productivity, and productivism are added, which resonate in a process of medicalizing lives and suffering. Thus, paths that deviate from this imposed model are seen as pathological. It is overlooked that experiencing a wide range of feelings and emotions—including anguish—is part of life. On the other hand, postgraduate education does not have to be a place of promoting or sustaining mental illness²⁸.
The mental suffering of postgraduate students cannot be understood solely through statistical indicators; it requires a broader reading that considers the subjective, symbolic, and structural dimensions of this process. Ethical-political suffering, a concept proposed by Sawaia²² in 1999, is a phenomenon caused by the individual\'s social situation, placing them in a position of subordination and/or inferiority. When the social determinants that produce this suffering remain unchanged, it tends to crystallize into a powerful form of suffering, a state in which reactivity prevails over action, reinforcing illness²²,²⁹.
In this sense, the concept of health in this context must be revised—not from a biomedical approach based on symptoms and simple psychophysical imbalances, but from sociocultural and environmental aspects, as an ethical-political process of affirming life and human potential, the diversity of ways of being and their possibilities, within the material and symbolic conditions that limit them²⁷,³⁰.
Thus, based on this theoretical framework, the concept of ethical-political suffering is defined as a way of understanding servitude or the political operation of domination as experience—encounters that entangle us in inadequate ideas and subject us to the desires of others; at the same time, it allows us to remove affects from the psyche and reposition them within the political dynamics of domination and resistance²⁹.
Psychic suffering in academic environments is intensified by affective-institutional detachment³¹. Therefore, psychic suffering is not only influenced by politics, but also reflects structural inequalities, and this could be avoided. From this perspective, suffering is an analytical and practical category within public policy, in the field of human relations and the dimensions of life. In this direction lies the notion of power to act, anchored in Spinoza, situated in the inseparability of body, mind, and affective encounters²³.
Thus, it is essential that educational institutions provide support to promote spaces for dialogue, listening, and assistance, that recognize the uniqueness of each student, in order to prevent and manage psychological disorders when they arise. In this regard, some postgraduate programs played a crucial role during the pandemic, offering support during a time of uncertainty and concern for public health, which correlated positively with students\' optimism²³. However, the scoping review revealed a gap in knowledge regarding mental health care for postgraduate students, specifically concerning the role of academic institutions, highlighting the need for further studies in this area.
Anjos (2022)³² warns about the impacts of the meritocratic and productivist logic that prevails in universities, which dehumanizes bodies and subjectivities, especially in crisis contexts like the pandemic. Academic youth, marked by identity transitions and precarious entry into the labor market, become especially vulnerable to mental suffering in the face of insecurity and constant performance demands.
In the academic context, research indicates that mental health support structures within university campuses are essential for promoting student well-being. These structures offer activities such as counseling, therapy, and support groups, allowing students to discuss mental health issues with qualified professionals²⁶,³³. Additionally, the literature suggests that postgraduate programs that encourage self-care during training can reduce student stress and improve their quality of life.
Given the instability imposed by the pandemic scenario, various aspects of society were affected, such as the availability of job opportunities, suspension of public service exams, and even the allocation of financial resources for investment in postgraduate studies, reinforcing the idea of an uncertain future for students—especially those aiming to pursue an academic career²⁸. For student groups from underrepresented backgrounds in terms of gender, sexual orientation, race, and ethnicity, studies suggest even more negative experiences, related to a sense of belonging and increased perceived threat, exacerbating the impact of the pandemic on these groups³⁴.
In China—a developing country with characteristics very different from Brazil—a correlation was observed between students’ mental health and the way they communicated with their advisors, showing that those studying from home were unable to maintain good communication with their advisors and colleagues, leading to psychological distancing³⁵. In the same geographic context, it was also found that women exhibited more symptoms of anxiety and stress compared to men, and that doctoral students experienced more academic stress than master’s students, although students in general faced severe depression and anxiety, given the difficult circumstances they were in³⁶.
In the Brazilian context, some of the results found in China were repeated, pointing to a greater exposure of women to stress symptoms. These findings make it impossible to separate the object of this study from a gender perspective that considers the role of women in society, who often take on a large number of simultaneous responsibilities³⁷.
Based on the panorama discussed in this study, it is worth highlighting that several stressors contributed to or triggered psychological suffering, gradually compromising mental health. There is also an ambivalence of feelings among students, who, while experiencing enthusiasm and satisfaction from being in the postgraduate environment, also suffer from insecurity, discouragement, restlessness, fear, and anxiety, intensified by a reality previously unknown³⁸.
As strengths of this review, we can mention the number of articles evaluated (23) and the broad mapping of the literature, which included publications from various countries regardless of publication language. As limitations, we highlight that the studies are limited in understanding the problem, as most are cross-sectional, and that other types of research—such as longitudinal studies, evaluations of the impact of public mental health policies, and qualitative approaches—are needed to contribute to and expand the knowledge in this field.

CONCLUSION
The mapping of studies conducted in this scoping review highlights the worsening of mental health challenges faced by graduate students during the COVID-19 pandemic, intensifying concerns previously identified in the academic literature. Even before the global health emergency, the mental health condition of this group was already the subject of study, pointing out risk factors such as financial insecurity, psychological pressures, and the various demands imposed on graduate students. It is concluded that the COVID-19 pandemic not only intensified pre-existing mental health challenges for graduate students but also revealed the urgent need for adaptive and inclusive support strategies capable of meeting the diverse needs of this group during and beyond periods of global crisis.
In this context, suffering is a symptom of social and historical processes and of asymmetries in institutional relations, which produce inequalities, silence subjectivities, and normalize illness. The findings of this review point to the urgent need to develop and strengthen institutional mental health policies in universities, with actions focused on prevention, support, and ongoing care. This involves promoting a collective movement of accountability and coordination within the academic community to build spaces that affirm life and well-being. Mentorship programs, active listening spaces, curricular flexibility in times of crisis, and facilitated access to mental health services should be considered in the strategic planning of institutions. Likewise, spaces for discussing this issue should be included, considering critical humanistic thinking, teamwork and networking, and shared responsibility for care.
Furthermore, the evidence can support national public policies aimed at the well-being of graduate students through the funding of intersectoral actions, expansion of scholarships for living expenses, guaranteed internet access, and the recognition of mental health as a fundamental human right. It may also offer suggestions for measures not only to address the institutional determinants of mental illness but also to uphold the ethical commitment of the State and Graduate Programs to ensuring dignified conditions for education and existence.
REFERENCES
1. Malta DC, Gomes CS, Vasconcelos NM, Barros MBA, Lima MG, Souza Júnior PRB, Szwarcwald CL. Alcohol consumption among adolescents during the COVID-19 pandemic, ConVid Adolescents – Behavior Research. Rev Bras Epidemiol. 2023; 26(Suppl 1): e230007. https://doi.org/10.1590/1980-549720230007.supl.1.1erratum.
2. World Health Organization. WHO Director-General\'s opening remarks at the media briefing on COVID-19 – 25 May 2020. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---25-may-2020 Acesso em 06 de janeiro de 2024.
3. Ramalho S, Martins-Mendes D, Macedo JM, Barros C, Luis C, Sá S, Gestoso Á, Pereira AC, Baylina P, Fernandes R. Unveiling the Path to Resilience: Prioritizing Mental Health, Sleep, and Nutrition in the Post-COVID Era. Healthcare (Basel). 2023;11:2463. https:// doi.org/10.3390/healthcare11172463.
4. Javed B, Sarwer A, Soto EB and Mashwani ZUR (2020) Impact of SARS-CoV-2 (Coronavirus) Pandemic on Public Mental Health. Front. Public Health. 8:292. https://doi: 10.3389/fpubh.2020.00292.
5. Moukaddam N, Shah A. Psychiatrists beware! The impact of COVID-19 and pandemics on mental health. Psychiatric Times, 2020. 37(3):11-12.
6. Torales J, O\'Higgins M, Castaldelli-Maia JM, Ventriglio A. The outbreak of COVID-19 coronavirus and its impact on global mental health. Int. J. Soc. Psychiatry. 2020;66(4):317-320. https://doi: 10.1177/0020764020915212.
7. Bavel JJV et al. Using social and behavioural science to support COVID-19 pandemic response. Nat. Hum. Behav. 2020;4(5):460-471. https://doi: 10.1038/s41562-020-0884-z.
8. Herbert C, El Bolock A, Abdennadher S. How do you feel during the COVID-19 pandemic? A survey using psychological and linguistic self-report measures, and machine learning to investigate mental health, subjective experience, personality, and behaviour during the COVID-19 pandemic among university students. BMC Psychol. 2021 Jun 2;9(1):90. https://doi: 10.1186/s40359-021-00574-x.
9. Greco V., Roger D. Uncertainty, stress, and health. Personality and Individual difference. 2003;34(6):1057-1068. https://doi.org/10.1016/S0191-8869(02)00091-0.
10. Evans TM, Bira L, Gastelum JB, Weiss LT, Vanderford NL. Evidence for a mental health crisis in graduate education. Nat. Biotechnol. 2018 Mar 6;36(3):282-284. doi: 10.1038/nbt.4089.
11. Lipson SK et al. Major Differences: Variations in Undergraduate and Graduate Student Mental Health and Treatment Utilization Across Academic Disciplines. Journal of College Student Psychotherapy. 2015;30(1):23–41. https://doi.org/10.1080/87568225.2016.1105657.
12. Costa EGD, Nebel L. O quanto vale a dor? Estudo sobre a saúde mental de estudantes de pós-graduação no Brasil. Polis. Revista Latinoamericana. 2018; (50):207-227.
13. McGowan J et al. Reporting scoping reviews-PRISMA ScR extension. J. Clin. Epidemiol. 2020;123:177-179. https://doi: 10.1016/j.jclinepi.2020.03.016.
14. Tricco AC et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann. Intern. Med. 2018;169(7):467-473. https://doi: 10.7326/M18-085.
15. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int. J. Soc. Res. Methodol. 2005;8(1):19-32.
16. Levac D, Colquhoun H, O\'Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010; 5:69. doi:10.1186/1748-5908-5-69.
17. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119-26. doi:10.11124/JBIES-20-00167.
18. Peters MDJ et al. Updated methodological guidance for the conduct of scoping reviews. JBI. Evid. Implement. 2021;19(1):3-10. https://doi: 10.1097/XEB.0000000000000277.
19. de Souza BES et al. The mental health of graduate students in the context of the COVID-19 pandemic: a scoping review protocol. Contribuciones a las Ciencias sociales. 17(9), e10486. https://doi.org/10.55905/revconv.17n.9-146.
20. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst. Rev. 2016;5(1):210. https:// doi:10.1186/s13643-016-0384-4.
21. Page MJ et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;29;372:n71. https://doi.org/10.1136/bmj.n71.
22. Sawaia, B. O Sofrimento Ético-Político Como Categoria De Análise Da Dialética Exclusão/Inclusão. In: Sawaia, B. (Org.). As Artimanhas da Exclusão: Análise Psicossocial e Ética da Desigualdade Social. V. 2, P. 96-118, 1999.
23 Lima DA. Educação escolar e saúde mental do estudante no contexto da pandemia: consequências do ensino remoto. Revista Científica Multidisciplinar Núcleo do Conhecimento. 2024;1(1):100. https:// doi: 10.32749/nucleodoconhecimento.com.br/educacao/saude-mental-do-estudante.
24. Karakose T. Assessing the relationships between internet addiction, depression, COVID-19-related fear, anxiety, and suspicion among graduate students in educational administration: A structural equation modeling analysis. Sustainability. 2022;14(9):5356. https://doi.org/10.3390/su14095356.
25. Varadarajan J, Brown AM, Chalkley R. Biomedical graduate student experiences during the COVID-19 university closure. Plos. one. 2021;16(9): e0256687. https://doi.org/10.1371/journal.pone.0256687.
26 Sawaia, B. B. (2003). O sentido ético-político da saúde na era do triunfo da tecnobiologia e do relativismo. In P. Goldenberg, R. M. G. Marsigli M. H. A. Gomes (Orgs.), O clássico e o novo: tendências, objetos e abordagens em ciências sociais e saúde (pp. 83-94). Rio de Janeiro: Fiocruz.
27 . Strappazzon, AL.; Sawaia, B.; Maheirie, K. A liberdade em espinosa como base ontoepistemológica no enfrentamento do sofrimento ético-político. Psicol. Soc., v. 34, p. E242492, 2022.
28 . Xavier, A., Nunes, A.I.B.L., Santos M.S. Subjetividade e sofrimento psíquico na
formação do Sujeito na Universidade. Revista Mal-estar e Subjetividade. v. 8, n. 2, p. 427-451, 2008
29. Bertini FMA. Sofrimento ético-político: uma análise do estado da arte. Psicol. Soc., v. 26, p. 60-69, 2014.
30. Leão TM et al. Sofrimento psíquico na universidade e o campo da Saúde
Mental Coletiva: uma revisão integrativa de 46 anos. Cien Saude Colet 2025; 30:e16382023
31. Andrade, ADS. et al. Vivências acadêmicas e sofrimento psíquico de estudantes de Psicologia. Psicol. cienc. prof., v. 36, p. 831-846, 2016.
32. Anjos, HVM.; Cardoso, A. D. Covid-19, Desigualdades E Privilégios Na Educação Profissional Brasileira. Educ. Real., V. 47, E109351, 2022.
33. Geary MR et al. Psychology doctoral students’ self-care during the COVID-19 pandemic: Relationships among satisfaction with life, stress levels, and self-compassion. Training and Education in Professional Psychology. 17(4), 323–330. https://doi.org/10.1037/tep0000444.
34. Scorsolini-Comin F, Patias ND, Cozzer AJ, Flores PAW, Hohendorff JV. Mental health and coping strategies in graduate students in the COVID-19 pandemic. Rev. Lat. Am. Enfermagem. 2021;29:e3491. https://doi: 10.1590/1518-8345.5012.3491.
35 Syropoulos S, Wu DJ, Burrows B, Mercado E. Psychology Doctoral Program Experiences and Student Well-Being, Mental Health, and Optimism During the COVID-19 Pandemic. Front. Psychol. 2021;12:629205. https://doi: 10.3389/fpsyg.2021.629205.
36. Liang Z, Kang D, Zhang M, Xia Y, Zeng Q. The Impact of the COVID-19 Pandemic on Chinese Postgraduate Students\' Mental Health. Int. J. Environ Res. Public Health. 2021;18(21):11542. https://doi: 10.3390/ijerph182111542.
37. Strappazzon AL, Sawaia B, Maheirie K. A liberdade em Espinosa como base ontoepistemológica no enfrentamento do sofrimento ético-político. Psicol Soc. 2022;34:e242492. doi:10.1590/1807-0310/2022v34242492.
38. Andrade D, Ribeiro IJS, Prémusz V, Maté O. Academic Burnout, Family Functionality, Perceived Social Support and Coping among Graduate Students during the COVID-19 Pandemic. Int. J. Environ Res. Public Health. 2023;20(6):4832. https://doi: 10.3390/ijerph20064832.
39. Yu Y, Tang Q, Shi H, Chen T, Wang Y, Hu H, Yao K. The impact of the COVID-19 pandemic on the mental health and academic performance of medical postgraduates. Front. Public Health. 2022;10:948710. https://doi: 10.3389/fpubh.2022.948710.
40. de Mendonça Glatz ETM et al. A saúde mental e o sofrimento psíquico de pós-graduandos: uma revisão de literatura em teses e dissertações. Revista Educar Mais. 2022;6:255-273. https://doi.org/10.15536/reducarmais.6.2022.2719.
41. Balakrishnan, B., Krishnan Muthaiah, V. P., Peters-Brinkerhoff, C., & Ganesan, M. (2023). Stress, anxiety, and depression in professional graduate students during COVID 19 pandemic. The Educational and Developmental Psychologist. 40(2), 201–213. https://doi.org/10.1080/20590776.2022.2114341.
42. Dong C et al The relationship between psychological distress and professional identity in graduate nursing students during COVID-19: A longitudinal cross-lagged analysis. Annals. of Psychology. 2023;39(1), 137-144.
43. Dutta S et al. An Observational Study to Assess the Impact of COVID-19 on the Factors Affecting the Mental Well-being of Doctoral Students. Trends in Psychology. 2022;1-16. https://doi: 10.1007/s43076-022-00211-5.
44. Hamed R et al. Exercise and Coping Mechanisms in Graduate Occupational Therapy Students during the COVID-19 pandemic and civil unrest period: a descriptive study. 2023;32(3):269–78. doi: 10.1177/10567879231169709.
45. Kee CE. The impact of COVID-19: Graduate students’ emotional and psychological experiences. Journal of human behavior in the social environment. 2021; 31(1-4), 476-488. https://doi.org/10.1080/10911359.2020.1855285.
46. Liang Z et al. The impact of the COVID-19 pandemic on Chinese postgraduate students’ mental health. 2021;18(21):11542. https://doi: 10.3390/ijerph182111542.
47. Naumann, S., Matyjek, M., Bögl, K., & Dziobek, I. (2022). Doctoral researchers’ mental health and PhD training satisfaction during the German COVID-19 lockdown: Results from an international research sample. Sci. Rep. 2022 Dec 22;12(1):22176. https://doi: 10.1038/s41598-022-26601-4.
48. Neves KRT et al. Impacts of COVID-19 on the mental health of graduate students in the health area of a university in Ceará, Brazil. 2023;35:52-63.
49. Oducado RM et al. Personal resilience and its influence on COVID-19 stress, anxiety and fear among graduate students. International Journal of Educational Research and Innovation. 2021;15:431-443. https://doi.org/10.46661/ijeri.5484.
50. Sánchez-Cabrero R. Measuring the relation between academic performance and emotional intelligence at the university level after the COVID-19 pandemic using TMMS-24. Sustainability. 2022;14(6),3142. https://doi.org/10.3390/su14063142.
51. Tu AK et al. Post-traumatic growth in PhD students during the COVID-19 pandemic. Psychiatry Research Communications. 2023;3(1):100104. https://doi: 10.1016/j.psycom.2023.10010.
52. Vempalli S et al. Impact of lockdown and COVID-19 on the learning status of postgraduate students during the pandemic in India: a questionnaire-based study. J. Adv. Pharm. Technol. Res. 2022;13(3):221-225. https://doi: 10.4103/japtr.japtr_115_22.
53. Wang J et al. Effects of the covid-19 pandemic on Chinese graduate students’ learning activities: a latent class analysis. Frontiers in Psychology. 2022;13:877106. https://doi: 10.3389/fpsyg.2022.877106.
54. Wildey MN et al. Exploring graduate student mental health and service utilization by gender, race, and year in school. Am. Coll. Health. 2022;17:1-9. https://doi: 10.1080/07448481.2022.2145898.
55. Zeng Q, Liang Z, Zhang M, Xia Y, Li J, Kang D, Yi D, Wang J. Impact of Academic Support on Anxiety and Depression of Chinese Graduate Students During the COVID-19 Pandemic: Mediating Role of Academic Performance. Psychol. Res. Behav. Manag. 2021;14:2209-2219. doi: 10.2147/PRBM.S345021.