COVID-19 and mental health among at-risk university students: A prospective study into risk and protective factors

'It's Not Like a One-Way Street': Using Photovoice to Understand How College Students With Intellectual Disability Experience Interdependence

BACKGROUND

Many people view people with intellectual disability primarily as needing help. That perspective limits relationships and can promote discrimination. We sought to better understand social relationships among young adults with intellectual disability.

METHOD

Seven postsecondary students with intellectual disability participated in a photovoice study, sharing photos and stories about giving and receiving help. They participated in individual interviews, a group meeting, and a photo exhibition, and helped identify results and conclusions.

RESULTS

Participants viewed themselves as helpers and recipients of help. Themes were: foundational importance of families; openness to being helped; personal growth through challenging experiences; and tension between wanting to help and risks of helping others. Participants wanted to raise awareness that people with disabilities can help others, educate them about disability, and contribute to research.

CONCLUSIONS

Many young adults with intellectual disability want to contribute to relationships, which are often limited by others' expectations about disability.

Impact of the COVID-19 Pandemic on Youth Substance Use and Substance-Related Risk Factors and Outcomes: Implications for Prevention, Treatment, and Policy

Youth substance use and substance use disorders (SUD) are major public health issues associated with significant societal cost. The coronavirus SARS-CoV-2 (COVID-19) pandemic and pandemic-related lockdowns, school closures, and social distancing dramatically impacted the daily lives of young people worldwide, resulting in major disruptions to normal developmental trajectories and complex (and at times opposing effects) on different SUD risk and protective factors, which contributed to inconsistent outcomes. During the COVID-19 pandemic, substance use prevalence rates decreased in the general population of US youth, but increased for certain vulnerable subgroups. Additionally, overdose deaths related to fentanyl rose significantly among US youth.

Sources of stress among domestic and international students: a cross-sectional study of university students in Amsterdam, The Netherlands

High perceived stress is associated with psychological and academic difficulties among college students. In this study, we aimed to investigate associations of student status (international vs domestic student in the Netherlands) with eight common sources of stress (i.e., financial, health, love life, relationship with family, relationship with people at work/ school, the health of loved ones, other problems of loved ones, and life in general). Participants were 2,196 college students (domestic: n = 1,642, international: n = 554) from two universities in Amsterdam, the Netherlands. Hierarchical linear regression analyses were used to estimate associations of student status with all eight sources of stress. Student status was significantly associated with higher levels of perceived stress in almost all life domains. International student status was significantly associated with higher perceived stress in the domains of financial situation and health of loved ones after adjusting for sociodemographic characteristics, depressive and anxiety symptoms, and other sources of stress. Findings highlight that several differences exist in the magnitude of perceived stress in certain areas between international and domestic students in the Netherlands. Consequently, it is essential to uncover the different needs of college students and develop specific strategies to deliver the most suitable services.

Web-Based, Human-Guided, or Computer-Guided Transdiagnostic Cognitive Behavioral Therapy in University Students With Anxiety and Depression: Randomized Controlled Trial

BACKGROUND

Internet-based cognitive behavioral interventions (iCBTs) are efficacious treatments for depression and anxiety. However, it is unknown whether adding human guidance is feasible and beneficial within a large educational setting.

OBJECTIVE

This study aims to potentially demonstrate the superiority of 2 variants of a transdiagnostic iCBT program (human-guided and computer-guided iCBT) over care as usual (CAU) in a large sample of university students and the superiority of human-guided iCBT over computer-guided iCBT.

METHODS

A total of 801 students with elevated levels of anxiety, depression, or both from a large university in the Netherlands were recruited as participants and randomized to 1 of 3 conditions: human-guided iCBT, computer-guided iCBT, and CAU. The primary outcome measures were depression (Patient Health Questionnaire) and anxiety (Generalized Anxiety Disorder scale). Secondary outcomes included substance use-related problems (Alcohol Use Disorder Identification Test and Drug Abuse Screening Test-10 items). Linear mixed models were used to estimate the effects of time, treatment group, and their interactions (slopes). The primary research question was whether the 3 conditions differed in improvement over 3 time points (baseline, midtreatment, and after treatment) in terms of depression and anxiety symptoms. Results were analyzed according to the intention-to-treat principle using multiple imputation. Patients were followed exploratively from baseline to 6 and 12 months.

RESULTS

In both short-term and long-term analyses, the slopes for the 3 conditions did not differ significantly in terms of depression and anxiety, although both web-based interventions were marginally more efficacious than CAU over 6 months (P values between .02 and .03). All groups showed significant improvement over time (P<.001). For the secondary outcomes, only significant improvements over time (across and not between groups) were found for drug use (P<.001). Significant differences were found in terms of adherence, indicating that participants in the human-guided condition did more sessions than those in the computer-guided condition (P=.002).

CONCLUSIONS

The transdiagnostic iCBT program offers a practical, feasible, and efficacious alternative to usual care to tackle mental health problems in a large university setting. There is no indication that human guidance should be preferred over technological guidance. The potential preference of human support also depends on the scale of implementation and cost-effectiveness, which need to be addressed in future trials.

TRIAL REGISTRATION

International Clinical Trials Registry Platform NL7328/NTR7544; https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON26795.

eHealth tools use and mental health: a cross-sectional network analysis in a representative sample

eHealth tools usage is vital for health care systems and increased significantly after the COVID-19 pandemic, which aggravated mental health issues. This cross-sectional study explored whether sociodemographic characteristics and mental health indices (stress and symptoms of anxiety and depression) were linked to the behavioral intention to use eHealth tools and eHealth tools usage in a representative sample from Poland using a network approach. Measurements were conducted in March 2023 among 1000 participants with a mean age of 42.98 (18-87) years, with 51.50% women. The measures included the behavioral intention to use eHealth tools (BI) based on the UTUAT2; eHealth tool use frequency (use behavior) including ePrescription, eSick leave, eReferral, electronic medical documentation (EMD), Internet Patient Account (IKP), telephone consultation, video consultation, mobile health applications, and private and public health care use; and the PSS-4, GAD-2, and PHQ-2. Furthermore, sociodemographic factors (sex, age, children, relationship status, education, and employment) were included in the research model. Network analysis revealed that mental health indices were weakly related to eHealth tools use. Higher stress was positively linked with mobile health application use but negatively linked to video consultation use. Use of various eHealth tools was intercorrelated. Sociodemographic factors were differentially related to the use of the eight specific eHealth tools. Although mental health indices did not have strong associations in the eHealth tools use network, attention should be given to anxiety levels as the factor with the high expected influence.

Do Social Support and Loneliness Influence Emerging Adults' Mental Health during the First Year of the COVID-19 Pandemic?

Youths' mental health is at a crisis level, with mental health problems doubling in the US since the pandemic began. To compound the mental health crisis, there is a global loneliness epidemic, with emerging adults worldwide experiencing some of the highest rates. One study with two phases examined the influence of social support and loneliness on mental health in US emerging adults during the pandemic, including changes in these relationships over one year. Emerging adults (N = 449) completed online questionnaires via Prolific in May 2020 (Phase 1) and again from January to May 2021 (N = 253; Phase 2). More perceived support was related to reduced loneliness, with family support having the most significant influence. Loneliness mediated the link between perceived support and adverse health outcomes. Higher loneliness predicted more perceived stress and sleep difficulties concurrently and over time. There was a bidirectional relationship between loneliness and depression, such that higher levels of either variable at Time 1 predicted increases in the other over time. Results highlight the detrimental impact of loneliness on emerging adults' mental health.

Mental distress and well-being of university students amid COVID-19 pandemic: findings from an online integrative intervention for psychology trainees

Introduction

University students have been severely affected by the COVID-19 pandemic, as significant changes supervened their academic and social life. To tackle these challenges, several adjustments in the educational methods may be warranted for cultivating a positive environment at higher education institutions. The aim of this study was to investigate the risk and protective factors of students' mental health and well-being as well as their potential for flourishing in an undergraduate clinical psychology course that took place online due to the COVID-19 restrictive measures and incorporated positive psychology exercises as a means to empower young people amid the adverse conditions of the lockdown.

Methods

In total, 124 students attended the course and completed mental health (i.e., DASS-9, HADS, ERQ) and well-being (i.e., MHC-SF, SWLS, PANAS, GQ-6, BRS) measures at two time points (pre-and-post-test), during the first restrictions in Greece (March-June 2020).

Results

According to the results, students aged 18-20 years old reported higher levels of stress [χ² = 14.72, p = 0.002], while students who felt that the quality of their studies had deteriorated [χ² = 6.57, p = 0.038] reported increased levels of anxiety. High levels of depression were correlated with worse relationships with significant others (z = 7.02, p = 0.030 and χ² = 11.39, p = 0.003 for family and friends, respectively), while gratitude and resilience were positively correlated with improved relationships with others, both during and after the lockdown. Factors associated with students' well-being were satisfaction with life and gratitude.

Discussion

These results suggest that well-being enhancement factors may have added value to current educational practices for promoting students' mental health and well-being in times of crisis.

Mental health and wellbeing of further and higher education students returning to face-to-face learning after Covid-19 restrictions

AIM

This study aimed to examine the mental health and wellbeing of further and higher education students and the associating factors after returning to face-to-face (in-person) learning after Covid-19 restrictions.

METHODS

A cross-sectional study informed by student consultations was conducted using a survey design. Mental health and wellbeing were assessed using self-report items on the Depression, Anxiety and Stress Scale (DASS-21) and the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Descriptive statistics and stepwise multiple linear regression analyses were conducted on data collected between December 2021 and June 2022.

RESULTS

N = 1160 students participated; 69.6% between 16 and 25 years, 67.9% studying in the UK, 66.5% studying away from home, 60.2% identified as she/her, 59.8% studying at the undergraduate degree level, 42.5% belonging to non-White ethnic backgrounds, 29.6% identifying as having additional needs and 22.8% as sexual minority. Moderate anxiety (M = 13.67, SD = 9.92) and depression (M = 17.04, SD = 11.56) scores were mainly reported. Wellbeing scores (M = 20.31, SD = 3.93) were lower than the estimate for the pre-pandemic general population. Gender expression, sexuality, age, ethnicity, having additional needs, and level and location of study was associated with mental health or wellbeing. Individual coping styles, levels of self-efficacy and physical activity were also associated with mental health or wellbeing.

CONCLUSIONS

Many students returning to further and higher education after Covid-19 restrictions experienced reduced mental health and wellbeing, and some students were at greater risk. Providing student-centred interventions focusing on self-efficacy, coping styles and physical activity may help improve the mental health and wellbeing of students.

The relationship between dimensions of empathy and symptoms of depression among university students during the COVID-19 pandemic: A network analysis

Background

The relationship between different dimensions of empathy and individual symptoms of depression during the COVID-19 pandemic remains unclear, despite the established link between empathy and depression. The network analysis offers a novel framework for visualizing the association between empathy and depression as a complex system consisting of interacting nodes. In this study, we investigated the nuanced associations between different dimensions of empathy and individual symptoms of depression using a network model during the pandemic.

Methods

1,177 students completed the Chinese version of the Interpersonal Reactivity Index (IRI), measuring dimensions of empathy, and the Chinese version of the Patient Health Questionnaire-9 (PHQ-9), measuring symptoms of depression. First, we investigated the nuanced associations between different dimensions of empathy and individual depressive symptoms. Then, we calculated the bridge expected influence to examine how different dimensions of empathy may activate or deactivate the symptoms of depression cluster. Finally, we conducted a network comparison test to explore whether network characteristics such as empathy-depression edges and bridge nodes differed between genders.

Results

First, our findings showed that personal distress was positively linked to symptoms of depression. These symptoms involved psychomotor agitation or retardation (edge weight = 0.18), sad mood (edge weight = 0.12), trouble with concentrating (edge weight = 0.11), and guilt (edge weight = 0.10). Perspective-taking was found to be negatively correlated with trouble with concentrating (edge weight = -0.11). Empathic concern was negatively associated with suicidal thoughts (edge weight = -0.10) and psychomotor agitation or retardation (edge weight = -0.08). Fantasy was not connected with any symptoms of depression. Second, personal distress and empathic concern were the most positive and negative influential nodes that bridged empathy and depression (values of bridge expected influence were 0.51 and -0.19 and values of predictability were 0.24 and 0.24, respectively). The estimates of the bridge expected influence on the nodes were adequately stable (correlation stability coefficient = 0.75). Finally, no sex differences in the studied network characteristics were observed.

Conclusions

This study applied network analysis to reveal potential pathways between different dimensions of empathy and individual symptoms of depression. The findings supported the existing theoretical system and contribute to the theoretical mechanism. We have also made efforts to suggest interventions and preventions based on personal distress and empathic concern, the two most important dimensions of empathy for depressive symptoms. These efforts may help Chinese university students to adopt better practical methods to overcome symptoms of depression during the COVID-19 pandemic.

Mental Health of Medical Students Before and During COVID-19 Pandemic: a 3-Year Prospective Study

BACKGROUND

Very few studies prospectively analyzed medical students' mental health before and during the COVID-19 pandemic. This study aimed to prospectively evaluate mental health in medical students in 2018, 2019, and 2020 during the COVID-19 pandemic lockdown.

METHODS

All students from first to fourth year were invited to participate in 2018. These students were also invited to participate in the same period in 2019 and 2020 (during the peak of the COVID-19 lockdown). The Self-Reporting Questionnaire (SRQ-20), created by the WHO to investigate 20 nonpsychotic psychiatric symptoms, was used to evaluate common mental disorders. The cut-off for relevant symptom severity for mental distress is seven (SRQ-20 ≥ 7).

RESULTS

In the years 2018, 2019, and 2020, a total of 860 SRQ-20 questionnaires were completed. Overall, mean SRQ-20 scores were 8.2 ± 4.6, and SRQ-20 ≥ 7 frequency was 60.5%. When comparing the years 2018, 2019, and 2020, no differences were found for either SRQ-20 scores (8.4 ± 4.7, 8.2 ± 4.6, and 7.8 ± 4.4, respectively; p = 0.351) or SRQ-20 ≥ 7 frequency (62.2%, 60.9%, and 59.2%, respectively; p = 0.762).

CONCLUSION

In contrast to our initial hypothesis, stable results on mental health measures were found even during the 2020 COVID-19 lockdown. Maintenance of daily routines through distance learning and the continuation of adapted clerkship activities with strict safety measures could have contributed to these results. However, this study points to high overall levels of common mental disorders, especially among women. Further studies should be conducted to understand all the factors responsible for such stability, such as social and economic support, resilience, or even previous high levels of common mental disorders.

Somatic Symptoms, Anxiety, and Depression Among College Students in the Czech Republic and Slovakia: A Cross-Sectional Study

Studying in college can be a challenging time for many students, which can affect their mental health. In addition to academic pressure and stressful tasks, another aggravating factor in student life is the ongoing coronavirus disease 2019 (COVID-19) pandemic. The aim of the study was to examine the prevalence of anxiety, depression, and somatic symptoms in Czech and Slovak college students during the COVID-19 pandemic and to evaluate possible socio-demographic determinants of mental health problems. A total of 3,099 respondents participated in this cross-sectional study (Czech Republic: 1,422, Slovakia: 1,677). The analyzes included the Patient Health Questionnaire for somatic symptoms (PHQ-15), the Generalized Anxiety Disorder instrument (GAD-7), and the Patient Health Questionnaire for depression (PHQ-9). Socio-demographic factors were gender, age, family structure, marital status, form of study, degree of study, year of study, field of study, distance between home and college, residence, and housing during the semester. Among Czech students, prevalence of somatic complaints, anxiety and depression was 72.2, 40.3, and 52%, respectively. Among Slovak students, prevalence of somatic complaints, anxiety and depression was 69.5, 34.6, and 47%, respectively. During the COVID-19 pandemic, the most severe mental health problems were identified in a non-negligible part of the sample (Czech Republic: PHQ-15 = 10.1%, GAD-7 = 4.9%, PHQ-9 = 3.4%; Slovakia: PHQ-15 = 7.4%, GAD-7 = 3.5%, PHQ-9 = 2.7%). Regarding the differences between the analyzed countries, a significantly higher score in somatic symptoms, anxiety, and depression was identified in the Czech Republic. Significant differences in mental disorders were found in most socio-demographic characteristics. The main results of the logistic regression analysis revealed that risk factors for mental health disorders in Czech and Slovak students were female gender, younger age, third degree of study, and study of Informatics, Mathematics, Information and Communication Technologies (ICT). Especially in the case of these high-risk groups of students, public policies should consider a response to impending problems. The findings are an appeal for a proactive approach to improving the mental health of students and for the implementation of effective prevention programs, which are more than necessary in the Czech and Slovak college environment.