ABSTRACT
Background: E-learning was widely used in universities during the COVID-19 epidemic to guarantee students' ongoing education and learning. This systematic review summarizes and synthesizes evidence elucidating the association between e-learning during the COVID-19 pandemic and anxiety among university students. Methods: A systematic search from five databases (PubMed, Wiley, Science Direct, EBSCO, and Scopus) was done, with the last search conducted on the 30th of November 2021. Full-text English articles published from November 2019 to November 2021. Mostly cross-sectional study designs were included, excluding non-peer-reviewed documents and non-English language studies. The data was recorded in the data extraction form, and all seven articles were assessed for quality using the Joanna Briggs Institute (JBI) Checklist for Analytical Cross-Sectional studies. Results: The search yielded seven eligible articles, with a total of 12,481 participants. Four articles aimed to determine the direct association between e-learning and anxiety levels. While three aimed to identify e-learning as a potential stressor during the COVID-19 pandemic, which is associated with anxiety levels. Five different tools were used to measure anxiety in the chosen articles. Four out of seven articles reviewed in this systematic review concluded that e-learning was significantly associated with anxiety. The remaining three found no association. Several factors were found to be associated with anxiety due to e-learning: females, sex/gender minorities, younger students, medical students, and staying alone. Conclusions: University students reported mild to high levels of anxiety during the COVID-19 pandemic. The effect of e-learning on anxiety levels is determined by the diverse socio-demographic backgrounds. Internet connectivity and facilities also contributed to anxiety levels during e-learning. Limitations of this review include selection bias, small sample size, and the cross-sectional study designs, which could not establish a causal relationship. Evidence from stronger study designs is needed to confirm the association and establish a causation link of anxiety due to e-learning methods. © Journal of Public Health and Emergency. All rights reserved.