**1. Introduction**

COVID-19 pandemic has set up a "perfect storm" for all population subgroups, students are particularly vulnerable due to their transition to the emerging adulthood with a broad horizon of future [1]. A recent meta-analytical evidence reported a higher proportion of psychological cluster of symptoms among college students amidst COVID-19 pandemic [1]. This unprecedented rise in mental health morbidities during COVID-19 contributed to the suicidal ideations among students [2]. According to the Centers for Disease Control and Prevention (CDC), the suicidal ideation and increase in maladaptive behaviors were among the most common reported outcomes by the persons aged 18–24 years [3]. The mortality associated with increased substance abuse and suicide is termed as "deaths of despair," which is a burgeoning public health concern [4]. A report from the Well Being Trust projects

nearly 75,000 "deaths of despair" may result from the substance abuse and suicides during pandemic [4]. These projections are concerning and underscore the need of developing targeted interventions to improve mental health outcomes of college students. For this, it is critical to explore all dimensions of "despair" in the context of the COVID-19 pandemic for the conceptual mapping [5], which authors attempt to describe in this chapter.

#### **1.1 Despair ("down from hope"): an interwoven concept**

Previous studies conceptualized "despair" as a common pathway or triggering mechanism to other causes of mortality at an individual and community level [5]. These pathways may persist for years and may predispose individuals to the diseases of despair, i.e. addiction and suicidal ideation [5]. The mechanism of interplay between individual and community factors is yet to be understood fully [5]. Despair can intersect across multiple interrelated domains, including cognitive, behavioral, emotional, biological, and social networks [4, 5]. More importantly, despair in the community level may predispose individual to the "deaths of despair," which highlights the need of diffusing protective factors, such as social inclusion, behavioral activation, and reappraisals of difficult situations to prevent "deaths of despair" among college students [5]. Social context of despair is critical especially among college students because they may have a shared exposure with others in a circumscribed set of networks, such as school setting [4, 5]. Next, the social comparison is another yet important dimension, which may contribute to the individual-level despair among students [4, 5]. Undoubtedly, COVID-19 pandemic played a significant role in increasing the prevalence of community factors of despair, including the structural inequities, systemic problems, and economic stagnation, which may have permeated into the individual level of despair [1, 4–6].

## **2. Stressors among college students**

Stress among students during COVID-19 pandemic may stem from environmental pressure, academic workload, and social or interpersonal pressure [7], which form the basis to understand an interwoven concept of "diseases of despair" [7]. The environmental pressure also includes the factors associated with the micro and macro socio-economic dynamics [6].

#### **2.1 Environmental pressure during COVID-19 pandemic**

As an overlay effect of COVID-19 pandemic, economic recession is an important dimension of despair to understand micro and macro socio-economic stressors [6]. Given the strong association between economic recession and suicide, it is vital to study financial stressors or economic determinants of COVID-19 among college students [8]. Job insecurity, uncertainties about future, plummeted job opportunities, job loss and difficulty in securing new jobs stemming from COVID-19 contributed to the adverse psychological outcomes among students [1, 9, 10]. In a Texas based study, above 50% students reported financial difficulties experienced by them or by their loved ones [11]. Every 3 in 10 students reported having limited opportunities for the internships or job placements [11]. A significant proportion of students reported changes in the living environment to be more distractive [11]. The majority of students had fear of contagion and expressed their worries about their family members getting infected with COVID-19 [11].

*"Deaths of Despair" among College Students Amidst COVID-19 Pandemic: A Call for Action DOI: http://dx.doi.org/10.5772/intechopen.102961*

#### **2.2 Academic pressure as a stressor**

The effects of COVID-19 are far ranging and education is not spared [11, 12]. With the sudden transition to the virtual learning, students experience undue academic pressure and poor emotional health [12–15]. Fear of academic year loss was associated with psychological distress and suicidal ideation among students as suggested by previous evidence [13–16]. Black students reported the greater risk of academic failure compared to their white counterparts [14, 15]. Reduced access to technology and electronic devices may explain the socioeconomic and racial dividends, which highlights the need of addressing structural inequities to prevent "deaths of despair" among students [14].

#### **2.3 Social or interpersonal pressure (COVID-19 pandemic: an antisocial event)**

With the institution of social distancing mandates, such as lockdown measures, the rates of social isolation and loneliness have surged among students with limited or no face-to-face interactions [16–18]. This social isolation and loneliness have contributed significantly to the suicidal ideations and subsequent "deaths of despair" among students [16–18]. With the reduced opportunities of in-person interactions, students are relying more on the social media and are getting exposed to the false news or "infodemic" which may act as a triggering mechanism for the suicidal behavior and unhealthy behaviors, i.e. substance abuse ("diseases of despair") [18, 19].
