1 Introduction

Mental health is an essential component of individual and collective health and well-being, representing people’s ability to exercise their human rights, not just the absence of disease [1]. However, under the impact of COVID-19, the global mental health condition has continued to deteriorate [1]. One in seven children and adolescents aged 10–19 years experience mental health issues worldwide, and suicide is the fourth leading cause of death among adolescents aged 15–29 years [2]. Individuals with mental health problems often face human rights violations and discrimination, with severe cases leading to premature death.

Mental health issues are prevalent in all countries, with varying prevalence rates based on sex and age [1]. Moreover, mental health significantly impacts individuals’ performance at school and work, their relationships with family and friends, and their ability to participate in society [3]. However, not all individuals with mental health issues experience low levels of mental well-being [1].

Many students with mental health issues pursue higher education, which may involve various pressures in their lives, including academic and social concerns [4]. Thus, there is a great need for mental health services and support for these students. A prepandemic survey conducted in Canada in 2019 reported that among more than 50,000 university students from 58 institutions, 68.9% experienced extreme anxiety, and 51.6% had experienced depression in the previous 12 months [5]. During the COVID-19 pandemic in the United States in 2021, a survey of more than 30,000 university students from 41 schools reported that 50.8% of the students experienced moderate psychological distress and 22% experienced severe psychological distress [6].

During the COVID-19 pandemic, researchers reported that Thai university students exhibited the highest levels of anxiety, whereas Taiwanese students presented the lowest levels of negative psychological responses [7]. Another study indicated that many Malaysian university students faced mental health issues during the pandemic [8]. In Taiwan, one out of every four university students sought psychological counseling [9].

Students choose to pursue higher education with the expectation that higher qualifications will lead to better job opportunities in the future. Learning workplace skills supports individuals in their daily activities in the workplace and ensures that they will be productive and fulfill the requisite job responsibilities. Workplace skills are generally categorized into two types: soft skills, which include communication, teamwork, critical thinking, among others, and hard skills, such as information technology, data analysis, and other skills that are often acquired through formal education [10]. Therefore, during their university studies, students need to not only focus on their academic courses but also develop their workplace skills. However, university students may encounter challenges with respect to their work performance due to mental health issues [11].

The first COVID-19 case in 2019 marked the beginning of the pandemic [12], a crisis that caused significant harm to people’s mental health. In the first year of the pandemic, the global incidence of depression and anxiety increased by 25%, and the number of people with mental health issues rose by nearly 1 billion [1]. Because of the pandemic, many university students suddenly had to shift from in-person learning to online learning, and the research indicates that this transition had a negative impact on academic performance [13].

According to a report by the United Nations [14], the COVID-19 pandemic created multiple stressors that led to increased or intensified anxiety and distress among individuals who previously experienced few to no such symptoms. Some individuals developed mental health issues, while those already suffering from mental health conditions saw their conditions worsen. During the COVID-19 pandemic, the stress arising from changes in academic responsibilities and daily life also exacerbated the mental health of university students [15, 16]. A study of college students revealed that respondents reported increased anxiety due to the COVID-19 pandemic, citing concerns about family members contracting the virus, financial pressures, and academic disruptions [17].

Social status reflects individuals' education and occupation, influences their thoughts and attitudes, and consequently impacts their behavior [18]. People may seek relative social prestige, a higher economic class, and power in society to highlight their social status and achieve psychological satisfaction [19,20,21]. Education not only allows individuals to build their social networks but it also reflects their social standing [22]. Social status is observed publicly through a person's social mobility, thereby influencing other people’s beliefs about the individual’s level of intelligence. This motivation for status is often magnified into economic inequalities among people from different social backgrounds [23] given that social status affects individuals in the process of acquiring tangible resources and intangible social influence.

According to the United Nations, vulnerable groups include indigenous populations; ethnic, religious, and linguistic minorities; immigrants, refugees, asylum seekers, and internally displaced persons; individuals living in extreme poverty; women; and LGBTQI individuals [24]. In Taiwan, the Ministry of Education classifies university students as vulnerable if they fall into one of the two categories, namely, the culturally disadvantaged, which includes new immigrants and their children; and the economically disadvantaged, which includes students from low- and middle- to low-income households, students with disabilities, students whose parents have disabilities, indigenous students, students from families with special circumstances, and vulnerable students who receive financial assistance [25, 26]. These classifications also constitute the criteria for defining vulnerable students in this study.

In Taiwan, according to statistics from 2022, the tuition fees at private universities were approximately twice as high as those at public universities, and yet, approximately 40% of university students attend public universities, whereas 60% attend private universities. Public universities receive more resources, but many vulnerable students can only attend private universities and face starting salaries approximately TWD 2,000 lower than their counterparts from public universities after graduation [27]. In Taiwan, educational attainment significantly influences employment opportunities. Students with lower social status may choose to continue their university studies to have better job prospects, but this decision often entails higher tuition fees and, in some cases, student loans, as there are relatively few educational resources. After entering the workforce, they may receive lower starting salaries or struggle to find good jobs and thus fall into the trap of the poverty cycle [27].

Vulnerable students at Taiwanese universities can access various resources provided by the Ministry of Education, including tuition assistance, living subsidies, emergency relief grants, accommodation benefits, scholarships, academic counseling funds, peer support funds, career counseling, accommodation and transportation subsidies for those from remote areas attending interviews, etc. [25, 26, 28]. Additionally, universities raise funds to assist these students. In this study, the higher education SPROUT project refers to the external resources provided by the Ministry of Education to support vulnerable students.

Research has shown that being in a marginalized racial group, having low socioeconomic status, being unemployed, and having similar factors are risk factors for negative mental health in adults after disasters, particularly in the postpandemic context [29]. As a consequence, there is increasing concern about the impact of COVID-19 on the mental health of vulnerable populations [30], as the economic repercussions may lead to students losing internship opportunities and low-income students experiencing delays in graduation [31]. Therefore, economically disadvantaged students who faced multiple impacts during the COVID-19 period are in greater need of support from the government, schools, and society [32].

Previous studies have explored the impact of the mental health of workers on their work performance [33, 34], and have confirmed a link between poor mental health and reduced work capacity. Additionally, many studies have investigated the effects of the COVID-19 pandemic on students' mental health and learning outcomes [35,36,37]. Paz et al. [35] synthesize 47 articles and conclude that the COVID-19 outbreak had negative effects on medical students' mental health that resulted in increased levels of stress, depression, and anxiety as well as emotional and behavioral changes. Koh and Daniel [36] analyze 36 articles on teaching strategies implemented by higher education institutions during the pandemic and report that designing replicable online classes, providing online practical skills training, ensuring integrity in online assessments, and implementing student engagement strategies improve the quality of online learning. Meo et al.'s research suggests that isolation among university students led to emotional distancing from family, colleagues, and friends, resulting in decreased overall work performance and reduced study time, and hence, negative effects on learning outcomes [37].

However, despite numerous studies exploring the impact of mental health factors and COVID-19 on education and the recognized need to support disadvantaged students affected by the pandemic [38], there is a paucity of empirical research that comprehensively examines the effects of employability and learning outcomes among students with varying mental health statuses and socioeconomic backgrounds during the pandemic. Furthermore, investigations into the effectiveness of providing appropriate resource support to students in need under the adverse conditions of the pandemic are limited. Therefore, this study significantly contributes to filling this research gap.

This study had several objectives. First, it aimed to investigate the impact of mental health on employability among university students. The second objective was to analyze whether students with different mental health statuses before and after the pandemic were affected differently by various teaching methods with respect to their learning outcomes. The third objective was to explore whether students with different mental health statuses, genders, and social statuses, especially those from vulnerable backgrounds, experienced learning difficulties during the pandemic. Finally, the study aimed to determine whether providing timely resources and support to vulnerable students during the pandemic contributed to improved learning outcomes.

2 Methods

2.1 Samples

This study used secondary data from different databases. The data source was a private university in Taoyuan, Taiwan, which conducted surveys on mental health, employability, learning outcomes before and after the COVID-19 pandemic, and use of scholarships among daytime students. The purpose of administering the psychological health questionnaire was to proactively provide counseling and assistance for high-risk students to support their academic pursuits. The employability survey was aimed at assessing students' individual capabilities and strengths in the workplace. Both questionnaires were administered by the school's psychologists, who personally explained the survey objectives to the students. The age and gender variables used in the study were based on the information provided by the students on their enrollment forms.

Learning outcomes were presented based on the course assessments conducted at Taiwan University from 2021 to 2022, including both in-person and blended teaching approaches in response to the COVID-19 pandemic. In this study, blended teaching refers to a method in which instructors combine online and offline instruction via video conferencing tools or cloud-based smart classrooms as a novel approach for delivering instruction. School-supported financial aid refers to scholarships provided to students with lower social status who voluntarily participated in the higher education SPROUT project and engaged in school activities to receive awards and financial assistance. Survey participants consented and voluntarily completed the questionnaires after being informed of the survey’s purpose.

Before the data analysis, all database information was de-identified. The research project was classified as minimal risk, and the risks to participants were not greater than those encountered by nonparticipants. Following an assessment by the review committee, the project was deemed exempt from review, and an exemption certificate was issued. This project was certified for exemption from the Human Research Ethics Committee at National Cheng Kung University (HREC (Exempt)112–502). The study was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments and comparable ethical standards.

2.2 Measures

The psychological health variables were measured via the Ko Depression Inventory (KDI) [39], which consists of 26 items. This inventory categorizes depressive symptoms into five major domains: mood (e.g., irritability), physical activity (e.g., decreased or increased appetite), behavioral ability (e.g., psychomotor retardation or agitation), cognitive thinking (e.g., pessimism), and motivation (e.g., loss of interest). The options are presented on a 4-point scale ranging from 0 (not feeling low or rarely feeling low) to 3 (feeling low and depressed all the time, unable to improve, and intolerably distressed). Summing the scores of all items, a total score of 0–9 indicates no depressive symptoms, a score of 10–20 suggests mild to moderate depression, and a score of 21 or above indicates a state of high-level depression. The inventory exhibits good reliability and validity [39].

The employability survey questionnaire adopted the UCAN Higher Education Employment Competency questionnaire developed by the Taiwan Ministry of Education [40]. Generic workplace competency refers to the skills required for various professions and are measured across eight categories: communication and expression, continuous learning, interpersonal interaction, teamwork, problem-solving, innovation, work responsibility and discipline, and information technology application. The questionnaire consists of a total of 54 items, with a score of 1 indicating, "I am unable to complete this task and find it difficult to learn," and a score of 5 indicating, "I can perform this task exceptionally well".

2.3 Data analysis

Data analyses were performed via the IBM Statistical Package for the Social Sciences (SPSS) version 18 (Chicago: SPSS Inc.) [41]. This study used different statistical analyses based on different variables and different situations. The variable analysis in this study was conducted using means, standard deviations, chi-square tests, ANOVA, the Scheffe test, Welch's ANOVA, the Games–Howell test, independent sample t tests, paired sample t tests, and regression analysis. A p-value less than 0.05 indicates statistical significance.

3 Results

The survey collected data from 2592 students whose average age was 22.9 (SD ± 0.8) years. Table 1 provides the students’ mental health conditions and their basic characteristics, employability, and learning outcomes. The participants underwent a psychological health assessment, and the majority of the students reported having no depressive symptoms, whereas approximately 15.3% indicated that they experienced severe depressive states.

Table 1 Students’ mental health conditions, basic characteristics, employability, and learning outcomes
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As the severity of their psychological health worsened, the participants perceived that they had weaker workplace competency. There was no significant difference among individuals with different psychological health conditions in the context of face-to-face learning, but learning outcomes varied in the blended learning context. A comparison of learning outcomes before and during the COVID-19 pandemic revealed that students with severe depression experienced the sharpest decline in learning outcomes (75.0 vs. 73.6; p = 0.019). Moreover, during the pandemic, students with severe depression sought counseling more frequently.

A cross-analysis of mental health status and gender revealed that, in the blended learning context, individuals with good mental health, especially women, exhibited better learning outcomes than did men (78.8 ± 12.4 vs. 72.3 ± 14.3; p < 0.001), had fewer absences (14.7 ± 24.1 vs. 25.2 ± 38.3; p < 0.001), and failed fewer subjects (0.9 ± 1.9 vs. 1.4 ± 2.4; p < 0.001). Among those with mild to moderate depression, women also exhibited better learning outcomes than did men (80.2 ± 12.9 vs. 74.0 ± 14.0; p < 0.001), had fewer absences (13.7 ± 28.9 vs. 23.7 ± 35.9; p < 0.001), and failed fewer subjects (0.7 ± 1.7 vs. 1.3 ± 2.5; p < 0.001). Even among those with severe depression, women had better learning outcomes than did men (75.9 ± 14.3 vs. 72.1 ± 14.5; p = 0.031), but there were no statistically significant differences in absences or failed subjects between the genders.

Overall, in the blended learning context, disadvantaged students had lower learning outcomes than did non-disadvantaged students (73.1 ± 16.3 vs. 75.1 ± 13.7; p = 0.048). When the cross-analysis is based on mental health and disadvantaged status, in the blended teaching context, disadvantaged students with good mental health had more absences than did the non-disadvantaged students (33.1 ± 47.0 vs. 20.9 ± 33.1; p = 0.005), while the remaining classifications exhibited no difference. Among the students with mild to moderate depression, the disadvantaged group had poorer learning outcomes than did the non-disadvantaged the group (73.6 ± 15.5 vs. 76.5 ± 13.7; p = 0.037), had more absences (27.7 ± 40.0 vs. 19.2 ± 32.9; p = 0.028), and they also failed more subjects (1.6 ± 3.0 vs. 1.0 ± 2.1; p = 0.041). Among those with severe depression, there were no statistically significant differences between disadvantaged and non-disadvantaged students in terms of learning outcomes, absences, or failed subjects.

With respect to disadvantaged groups, further analysis on the basis of mental health status and gender revealed that among mentally healthy individuals, women had better learning outcomes (77.1 ± 16.1 vs. 69.4 ± 18.0; p = 0.020) and fewer absences (19.3 ± 30.7 vs. 40.2 ± 52.3; p = 0.005). In the case of students with mild to moderate depression, gender was statistically significant only for learning outcomes, with women outperforming men (78.8 ± 15.9 vs. 71.7 ± 15.0; p = 0.029). However, no statistically significant differences between genders were observed among students with severe depression.

Vulnerable students with different mental health statuses who participated in the higher education SPROUT project exhibited improved learning outcomes and failed fewer subjects, as shown in Table 2. Students who received more financial aid had higher academic achievement and failed fewer subjects. Table 3 shows that students with various mental health statuses experienced better learning outcomes after joining the higher education SPROUT project.

Table 2 Relationship between amount of scholarship or financial aid and learning outcomes as well as number of failed subjects among students with different mental health conditions
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Table 3 Relationship between participation in higher education SPROUT project and learning outcomes among students with different mental health conditions
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4 Discussion

This study reveals the impact of mental health on the employability of Taiwanese university students, as well as their learning outcomes under different teaching strategies and varied participation in financial aid programs. This study specifically explored these relationships with respect to vulnerable students and gender. This is the first study in Taiwan to integrate mental health status, workplace and professional competency, and support from assistance programs among university students during the COVID-19 pandemic.

This study investigated students with different mental health issues and examined their perceptions regarding whether they had sufficient knowledge and skills to successfully complete work tasks or improve their personal performance. The results indicated that students with good mental health had the best performance, whereas those with severe depression rated their personal ability as the lowest among the three groups. Students with severe depression perceived that they were less proficient in various skills, including expressing their thoughts effectively for others to understand and comprehending information conveyed by others; efficiently planning and managing their time with a growth mindset; adopting appropriate ways to interact with others on the basis of different situations; actively participating in team tasks; having positive interactions with team members to achieve goals; identifying and systematically solving problems; proposing effective methods to improve systems or processes; understanding and executing personal tasks within the organization while adhering to ethical, regulatory, and integrity requirements; and utilizing information technology to manage information effectively. These findings are consistent with previous studies that reported that students with suicidal ideation had lower problem-solving ability than did those without such thoughts [42]. This suggests that individuals with better mental health are more likely to exhibit personal efficacy and autonomy as well as better ability to interact with others and realize their potential [43].

Additionally, this study revealed that during the COVID-19 pandemic, students continued to seek psychological counseling from their schools. Before the pandemic, there were no statistically significant difference in learning outcomes based on students' mental states when they were attending in-person classes. However, after the pandemic, the transition to virtual learning had varied effects on students’ mental states. Specifically, students with mild to moderate depression had better learning outcomes. Research has indicated that individuals who experienced social anxiety before COVID-19 tend to prefer virtual learning [44], which could explain why the students in this study with mild to moderate depression exhibited improved learning outcomes, as long as they were not further affected by external factors. Conversely, another study noted that some students mentioned that during the pandemic, anxiety and stress motivated them to work harder in their studies, but most students believed that high-risk depressive symptoms were associated with lower academic performance [45]. This study also revealed that the pandemic led to lower learning outcomes among students with severe depression and caused further setbacks in their grades.

In the context of blended learning, gender had a stronger influence on learning outcomes than did mental health status. Compared with men, women outperformed men academically, and among students with mild to moderate depression and those with normal mental health, women received fewer failing grades and had fewer absences. Among the groups with good mental health and severe depression, there were no differences in learning outcomes between non-disadvantaged and disadvantaged students. However, in the mild to moderate depression group, vulnerable students had lower outcomes, with more failing grades and absences. Regarding the impact of gender on learning outcomes during the COVID-19 period, there is no consensus in the current research [46]. A South African study reported that girls lagged behind boys in reading performance [47], whereas other studies reported that girls academically outperformed boys [48, 49]. In this study, female students had better learning outcomes in the blended learning context. However, some research suggests that the pandemic may have led vulnerable families to allocate valuable educational resources to boys, thereby affecting girls' educational performances [50]; however, this study did not find any differences in resource allocation, but rather, it revealed better learning outcomes among girls.

With respect to social status, this study analyzed the possibility for individuals to gradually rise from their disadvantaged position by participating in the higher education SPROUT project and by acquiring resources and transforming them into personal capabilities through the learning process. Students with lower social status do not have an inferior learning nature or diminished abilities. The main obstacles that hinder their learning process are economic and cultural. For example, they may need to spend more time working to meet their living expenses, which limits their ability to fully and freely spend time and economic resources on showcasing their talents. However, for students with lower social status, actively pursuing external offerings, such as participating in school scholarship assistance programs, seeking academic guidance, engaging in competitions, and obtaining the certifications required for employment, can provide these students with additional economic resources. This not only helps them meet their basic living needs but also reduces the time spent on work, allowing them to focus more on academic learning.

The results of this study show that disadvantaged students with different mental health conditions can improve their learning outcomes by participating in the higher education SPROUT project. Such students can significantly reduce the number of failed courses, absences, and leaves of absence. By effectively transferring their time resources from work to learning and acquiring multiple professional skills, they are more likely to obtain job interview opportunities in the future. This, in turn, will enable them to effectively transform their social status.

5 Limitations

This study is limited to data from a single university; thus, it reflects only the performance of students within that specific institution. However, the results align with similar findings in studies conducted in different countries. A limitation is that gender minorities, such as nonbinary individuals, were excluded from this study. Furthermore, the scale used in this study is not a depression and employability questionnaire but rather is specifically designed for the COVID-19 pandemic. Another limitation of this research is the inability to obtain reliability and validity data for the questionnaire items. In addition, the survey is an ongoing test that was initiated before the outbreak, and the timing may have had some influence that this study did not take into account. Therefore future research should examine different time points to study the changes in mental health and students' learning outcomes.

6 Conclusion

Overall, our study revealed that the mental health status of university students influenced their employability and learning outcomes in the context of blended learning. During the pandemic, students from vulnerable backgrounds exhibited lower learning outcomes than did those from nonvulnerable backgrounds. Furthermore, this study found that female students outperformed male students across all groups. During the pandemic, students with poorer mental health sought school counseling and guidance at a higher rate. In situations with limited resources, participating in school support programs helped to improve the learning outcomes of vulnerable students with different mental health statuses. Therefore, in the long run, establishing mental health prevention mechanisms and providing immediate access to schools and external resources are the optimal solutions for supporting student learning.