Setting-based interventions to promote mental health at the university: a systematic review

Psychometric properties of the Bangla version of the sense of coherence scale among university students in Bangladesh

INTRODUCTION

Sense of coherence is a key concept in psychological science that contributes to mental health by helping people cope with various stressors in their daily lives. A literature review demonstrated the unavailability of a tool for measuring sense of coherence in Bangladesh. This study aimed to translate the 13-item Sense of Coherence scale (SOC-13) into the Bangla language and to examine its validity, dimensionality, and reliability.

METHOD

After translating the SOC-13, a cross-sectional online survey was conducted with 510 undergraduate students at a university in Bangladesh from July to October 2021. Construct validity was assessed through confirmatory factor analysis to analyze the structural validity of the Bangla SOC-13 scale, and by examining correlations with related constructs (self-esteem, well-being, and psychological distress). The alpha coefficient was calculated to examine internal consistency. Data were analyzed using SPSS version 22 and R statistical software.

RESULTS

A total of 320 respondents provided valid responses (response rate: 62.7%). The structural validity of the SOC-13, as examined through confirmatory factor analysis, was consistent across studies (a three-factor structure with an acceptable fit), and convergent validity was evidenced through a statistically significant positive relationships between sense of coherence and both self-esteem and well-being, as well as criterion validity was supported by a significant negative relationship with psychological distress. The internal consistency of the total scores by the coefficient alpha was good (α =  0.74), whereas the alphas of each subscale showed mediocre to fair reliability.

CONCLUSION

The Bangla version of the SOC-13 showed good construct validity, acceptable criterion validity, and good reliability based on overall internal consistency. Thus, it can be used to assess sense of coherence in young adults, although there is scope for further examination.

An Argument for More High-Quality Research Focused on Mental Health in the Post-Secondary Context

We argue that while a substantial proportion of emerging adults are in post-secondary education, there is relatively little consideration of this context within research and policy around youth mental health. The unique challenges young adults face in post-secondary education overlay underlying risk factors experienced by emerging adults. While post-secondary education facilitates social mobility, it also introduces stressors such as academic demands, financial insecurity and social isolation. As we increasingly appreciate the social determinants of mental health and the influence of institutional systems, understanding the post-secondary context offers promise in transforming mental health in emerging adulthood. There are pockets of great practice. However, we argue that targeted efforts are now needed to bring together students, practitioners, policymakers and researchers to drive evidence-informed improvements in mental health within the post-secondary context.

Calm me down, or I'll leave: anxiety and institutional support among Ukrainian academic staff during wartime

BACKGROUND

Mental health conditions among academic staff are a growing global concern, driven by factors such as heavy workloads, job insecurity, and a lack of institutional support. Anxiety, one of the most common mental health problems, is particularly widespread in academia, affecting cognitive function and productivity. In Ukraine, the ongoing war has intensified these challenges, creating unprecedented working conditions for academic staff. This study investigates the prevalence of anxiety among Ukrainian academics during wartime. It explores the impact on their desire to change careers and the perceived effectiveness of institutional mental health support.

METHODS

This cross-sectional study surveyed 429 academic staff from Ukrainian higher education institutions between December 2023 and February 2024. Anxiety levels were measured using the Generalized Anxiety Disorder (GAD-7) scale, while additional questions assessed the desire to change professions and the perceived effectiveness of institutional mental health support. The data were analyzed using chi-squared tests, correlation analysis, and Ordinary Least Squares (OLS) regression.

RESULTS

The findings revealed that 44.3% of respondents experienced moderate (24%) or severe (20.3%) anxiety, reflecting the profound psychological toll of the war. There was a significant relationship between higher anxiety levels and an increased likelihood of considering a career change. While 90.2% of respondents viewed institutional mental health support as important, many felt that the existing programs were ineffective. Greater accessibility to psychological support services was associated with lower anxiety levels.

CONCLUSIONS

The high prevalence of anxiety among Ukrainian academic staff during the war highlights the urgent need for targeted mental health interventions. Institutional mental health support - such as accessible psychological services - is important in the ongoing war conditions. These findings underscore the broader implications of anxiety for the sustainability of Ukraine's educational and scientific sector during wartime and emphasize the need for comprehensive mental health programs tailored to the unique challenges faced by academics in wartime.

Mental health interventions affecting university faculty: a systematic review and meta-analysis

BACKGROUND

While there is growing evidence highlighting the prevalence of mental health concerns among university faculty, few studies have examined mental health interventions in this population. The objective of this systematic review and meta-analysis was to collect and critically appraise the available evidence about the effectiveness of interventions designed to improve the mental health of faculty.

METHODS

A systematic search was conducted by searching PubMed, EMBASE, Scopus, Web of Science, and CINAHL to identify relevant studies published in English language from January 1st, 2000 until October 1st, 2023. The search focused on studies done on academic faculty to describe interventions or support programs aimed at improving mental health outcomes, with comparison of mental health data before and after the intervention and an improvement in mental health as study outcome. A random effect meta-analysis method was used to estimate the effectiveness of interventions on faculty mental health.

RESULTS

Ten publications with 891 participants from 2,217 retrieved records were included. The random effect model showed substantial heterogeneity (I2 = 84.8%, 95% CI: 73.8 - 91.2%, p < 0.001). The pooled SMD was - 1.41 (95% CI: -2.81-0.004) showing a large effect, and it significantly favors the use of intervention for reducing mental health issues among faculty members. The effect size estimates for all included studies ranged from small to large, showing the positive effect of intervention on faculty mental health. Multimodal inference analysis showed that, of the many studied factors for faculty mental health, the region was the most important predictor of intervention effectiveness. However, when the significance of quantitative moderators was tested using meta-regression, age (p = 0.9491) and duration of intervention (p = 0.1284) were not statistically significant.

CONCLUSION

Interventions aimed at enhancing the mental health of university faculty were overall significant; however, individual studies showed heterogeneous results. Making efforts to enhance the mental health of faculty is crucial and has been proven effective; nevertheless, the existing evidence necessitates further research in this area. For interventions to be effective, it is imperative to tailor them to the specific environment and to the unique characteristics of faculty members.

PROSPERO REGISTRATION NUMBER

CRD42023490388.

Professor Hippo-on-Campus: Developing and evaluating an educational intervention to build mental health literacy among university faculty and staff

Objective: The development and evaluation of the Professor Hippo-on-Campus Student Mental Health Education Program, a mental health literacy intervention for post-secondary faculty and staff, is described. It includes 3-hour virtual, asynchronous e-modules and an optional 2-hour, synchronous workshop. Participants: All faculty and staff in a single university were invited to participate (February 2020-January 2021). Methods: Pre-and post-module and post-workshop surveys were conducted, assessing knowledge, attitudes, stigma, behavioral intentions, and confidence. Paired t-tests and regressions assessed change. Satisfaction was assessed through closed and open-ended questions, analyzed descriptively and through qualitative content analysis. Results: Four hundred and fifty staff and faculty completed the pre-survey, 262 completed the post-survey, and 122 completed a workshop survey. Participation resulted in improvements in knowledge, attitudes, stigma, and confidence with high levels of satisfaction. Conclusion: The program provides tailored student mental health training to post-secondary staff and faculty, which appears to increase their mental health literacy.

Mental Health Among First-Year Students Transitioning to University in Australia: A Longitudinal Study

Objectives: Young people attending university for the first time may be at heightened risk of experiencing mental health problems. However, limited research has examined the mental health experiences of this cohort using longitudinal methods. This study aimed to examine mental health symptoms prior to commencing university, estimate changes in symptoms over the course of the first semester of study, and identify factors associated with initial symptom levels and changes. Methods: Australian first-year undergraduate students (N = 340) were recruited via social media and participated in a four-wave online longitudinal study conducted between February and June 2021. Symptoms of depression, anxiety, and psychological distress were assessed at each wave, along with psychosocial and lifestyle factors. Demographic characteristics were assessed at baseline. Results: Latent growth curve models indicated no significant linear change over time for depression (p = .26) or anxiety (p = .83) symptoms. However, a significant effect of time was observed for psychological distress (p = .03), indicating higher distress levels at wave 3 compared to baseline (p = .004). Financial stress, pressure to succeed, difficulty coping, greater loneliness, and more negative social interactions were each significantly associated with higher baseline depression, anxiety, and distress scores. Only greater loneliness and more negative social interactions were found to be associated with a greater increase in depression over time. Conclusion: The findings indicate that transition to university was not generally associated with an increase in poor mental health. However, several factors were associated with poorer mental health immediately prior to university commencement. Assisting students to manage financial distress, facilitating the development of social connections among students with limited social networks and skills training targeting coping and the development of realistic academic expectations may help support student mental health and promote improved wellbeing during transition to university.

The ABCs of mental health at the university: a multi-level intervention design for promoting mental well-being

Background

There is an escalating concern for the mental health of university students being recognized as a high-risk group for psychological distress. Despite research emphasizing the need to integrate mental well-being into higher education, existing interventions primarily focus on challenges and support services, leaving a gap in practical insights for promoting mental well-being at the university as a whole.

Objectives

This paper aims to cover the theoretical and methodological foundations for the design and development of a complex multi-level intervention called the ABCs of mental health at the university (ABC-uni).

Methods

Following the MRC framework for complex interventions, the design and development of a novel complex intervention is described (Phase I). Using the socio-ecological model and incorporating principles from health promotion charters, capacity building, organizational change models, and the principles of the ABCs of mental health a program theory for mental health promotion at the university is proposed. Following this theoretical foundation a logic model outlines the ABC-uni intervention components at structural, community, and individual levels. The components include staff training, campaign materials, a photovoice project, integration of mental well-being literacy into introductory programs, a credit-bearing course, and an online module. Preferably, most of these components are developed and carried out collaboratively with students at the university. As proposed in the logic model expected outcomes encompass heightened awareness, supportive environments, commitment, and accountability, aiming to enhance mental well-being across the entire university. The design and development of the intervention components occur at a Danish public university.

Discussion

This section addresses the strengths and limitations of the design of the ABC-uni intervention. Future research will cover the feasibility phase of each components of the ABC-uni intervention (phase II). The conceptual framework and program theory outlining mental health promotion at the university, along with the detailed description of the intervention components, provides valuable insights for fostering mental well-being in the university community.

High triglyceride-glucose index and HOMA-IR are associated with different cardiometabolic profile in adults from the ELSA-Brasil study

BACKGROUND AND AIMS

Insulin resistance (IR) is a risk factor for several cardiometabolic disorders; however, there is conflicting evidence about the reliability of certain IR markers. In this context, the triglyceride-glucose index (TyG) has been proposed as a surrogate marker for IR. This study aimed to compare the TyG index and homeostasis model assessment of insulin resistance (HOMA-IR).

METHODS AND RESULTS

A cross-sectional analysis was conducted using baseline data from 11,314 adults (aged 35-74 years) from the ELSA-Brasil study. The correlation between TyG and HOMA-IR, their interrater reliability, and their predictive value in identifying metabolic syndrome (MetS) were assessed. The mean TyG and HOMA-IR in our sample were 8.81 ± 0.52 and 2.78 ± 1.58 for men, and 8.53 ± 0.48 and 2.49 ± 1.38 for women, respectively. TyG and HOMA-IR showed a weak to moderate correlation with each other (Pearson's r for men: 0.395 and 0.409 for women, p-value <0.05) and other markers of glycemic metabolism. Additionally, the area under the curve for the prediction of MetS was greater for TyG than HOMA-IR, regardless of sex (TyG: 0.836 for men and 0.826 for women; HOMA-IR: 0.775 for men and 0.787 for women). The concordance between these markers was low (Coheńs kappa coefficient: 0.307 for men and 0.306 for women). Individuals with increased TyG exhibited mainly anthropometrical and glycemic metabolic alterations, whereas those with elevated HOMA-IR displayed mostly lipid-associated metabolic alterations.

CONCLUSION

TyG and HOMA-IR might indicate different profiles of cardiometabolic disorders, showing poor agreement in classifying individuals (normal vs. altered) and a weak correlation. Therefore, further studies are needed to investigate the role of TyG as a surrogate marker of IR.

Investigating changes in student mental health and help-seeking behaviour after the introduction of new well-being support services at a UK university

BACKGROUND

Growing numbers of students now seek mental health support from their higher education providers. In response, a number of universities have invested in non-clinical well-being services, but there have been few evaluations of these. This research addresses a critical gap in the existing literature.

AIMS

This study examined the impact of introducing non-clinical well-being advisers on student mental health and help-seeking behaviour at a large UK university.

METHOD

Survey data collected pre-post service introduction in 2018 (n = 5562) and 2019 (n = 2637) measured prevalence of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), and low mental well-being (Warwick-Edinburgh Mental Wellbeing Scale), alongside student support-seeking behaviour. Logistic regression models investigated changes in outcome measures. Administrative data (2014-2020) were used to investigate corresponding trends in antidepressant prescribing at the onsite health service, student counselling referrals and course withdrawal rates.

RESULTS

Adjusted models suggested reductions in students' levels of anxiety (odds ratio 0.86, 95% CI 0.77-0.96) and low well-being (odds ratio 0.84, 95% CI 0.75-0.94) in 2019, but not depression symptoms (odds ratio 1.05, 95% CI 0.93-1.17). Statistical evidence showed reduced student counselling referrals, with antidepressant prescribing and course withdrawal rates levelling off. Student perception of the availability and accessibility of university support improved.

CONCLUSIONS

Our findings suggest a non-clinical well-being service model may improve student perception of support, influence overall levels of anxiety and low well-being, and reduce clinical need. The current study was only able to examine changes over the short term, and a longer follow-up is needed.

Students' perceptions and experiences of an online well-being programme: a phenomenological study protocol

BACKGROUND

The pandemic has ensued challenges across all sections of the human population such as livelihood and educational changes, which involve the abrupt shift to online learning, immensely affecting the students' well-being. Negative health consequences of e-learning among students stem from the increased demand for new technological skills, productivity, information overload and restriction of students to spend time with their peers.

OBJECTIVE

To explore the experiences of the students from the University of Santo Tomas-College of Rehabilitation Sciences (UST-CRS) who participated in the online well-being programme.

METHODOLOGY

A phenomenological design will be used to determine the participants' perceptions and experiences. Purposive sampling will be used to recruit 8-10 undergraduate students from UST-CRS ages 18-22 years, who participated in the well-being programme, and completed the study's quantitative counterpart. Semistructured, in-depth questions will be used to conduct a focus group discussion. The transcripts will be analysed using thematic analysis via the NVivo V.12 software.

ETHICS AND DISSEMINATION

The study protocol is approved by the UST-CRS Ethical Review Committee (Protocol Number: SI-2022-034 (V.4)). It will be implemented in accordance with the Declaration of Helsinki and the National Ethical Guidelines for Health and Health-Related Research, and Data Privacy Act. Findings will be published in accredited journals and presented in related scientific fora.

REGISTRATION ID

PHRR230214-005419; Philippine Health Research Registry.

A systematic review of peer support interventions for student mental health and well-being in higher education

BACKGROUND

Higher education institutions (HEIs) are seeking effective ways to address the rising demand for student mental health services. Peer support is widely considered a viable option to increase service capacity; however, there are no agreed definitions of peer support, making it difficult to establish its impact on student mental health and well-being.

AIMS

This systematic review aims to better understand and evaluate peer support in HEIs.

METHOD

Five databases, OpenGrey and Grey Matters were searched in May 2021. Included studies were quantitative, longitudinal (with and without a control) or cross-sectional with a control. The vote-counting method was used for synthesis. The risk of bias was assessed with the National Institutes of Health Quality Assessment Tool.

RESULTS

Three types of peer support were represented in 28 papers: peer-led support groups, peer mentoring and peer learning. Peer learning and peer mentoring had more positive, significant results reported for the outcomes of anxiety and stress. Peer-led support groups were the only type targeting students with mental health difficulties.

CONCLUSIONS

The heterogeneity of measures and outcomes prevents firm conclusions on the effectiveness of peer support for mental health and well-being. Most studies were rated 'poor' or 'fair' in their risk of bias. There is not a solid evidence base for the effectiveness of peer support. Nonetheless, HEIs can use the terminology developed in this review for shared discussions that guide more robust research and evaluation of peer support as an intervention.

Self-efficacy in health among university students: the role of social support and place

OBJECTIVE

The aim of this study was to better understand the role of students' living arrangements (on campus, off campus, with and without their parents) on their health self-efficacy.

PARTICIPANTS

A sample of undergraduate students (n = 216) were recruited by using word of mouth and visiting classrooms in a small Atlantic Canadian university.

METHODS

Participants completed a self-report questionnaire measuring health and sleep self-efficacy. Analyses of variance and covariance were used to compare the living arrangements of the students.

RESULTS

Differences between living arrangements were found. Students living on campus had higher health self-efficacy, particularly on the psychological well-being subscale, followed by those living off campus with their parents. Students living off campus without their parents had the lowest scores.

CONCLUSION

This study demonstrated that health self-efficacy varies according to students' living situations, thus illustrating the importance of keeping students' living arrangements in mind when designing health and well-being interventions.

Mental health, study skills, social support, and barriers to seeking psychological help among university students: a call for mental health support in higher education

Introduction

Poor mental health among youths is a complex worldwide issue. Many countries with medium-to-low levels of development, particularly those in Southern Europe, have not introduced appropriate mental health and educational strategies to identify the key factors influencing wellbeing, promote psychological wellbeing, and prevent poor mental health among youths. In response to these trends, we sought to uncover insights for developing interventions for youth mental wellbeing. We assessed mental health, study skills, barriers to seeking psychological help, and perceived social support among Kosovar university students, and investigated their experiences with professional mental health services and their needs and perceptions regarding the importance of professional mental health services on campus.

Methods

The study used a parallel mixed-methods design. Participants included 234 university students. Quantitative data were gathered through validated questionnaires, including the Depression, Anxiety, and Stress Scale, Multidimensional Scale of Perceived Social Support, Academic Anxiety Scale, Study Skills Assessment Questionnaire, and the Barriers to Seeking Psychological Help Scale. Qualitative data on the students' experiences with mental health services and their perceptions regarding the importance of professional university mental health services were explored through open-ended questions.

Results

Most students experienced anxiety and depression, more than half were stressed, and most reported poor or moderate study skills. Lack of trust in mental health professionals was a major barrier to seeking psychological help, followed by difficulties in self-disclosure. Perceived social support and academic anxiety were significant predictors of barriers to seeking psychological help. The participants believed that mental health and academic support from the university would help improve their mental wellbeing, study skills, self-esteem, self-perception, and attitudes toward social support; raise awareness regarding mental health; and help them overcome personal and academic challenges.

Discussion

Our findings highlight the need for more comprehensive and accessible mental health services on campuses. By providing adequate support and resources to address various personal and academic factors that contribute to mental health issues in university students, universities can enhance students' academic success and personal growth.

Analyzing mechanisms of interdisciplinary cooperation in promoting students' health at university

BACKGROUND

Interdisciplinary cooperation among university actors and resulting intersectoral synergies are considered cornerstones in the process of incorporating health promotion practices in everyday university life in order to break down barriers and provide better access to health promotion services. To date, no network of a health-promoting university has been examined regarding the processes underlying tie formation, network emergence, and maintenance.

OBJECTIVES AND METHODS

The goals of this study are to obtain insight into the mechanisms of cooperation between university actors in a health-promoting network and to identify the structural and attributive factors associated with establishing cooperation between actors in the observed network in order to better understand how to build and develop successful networks in the future. For this purpose, a social network analysis was carried out and exponential random graph models were estimated to test corresponding hypotheses.

RESULTS

The network at hand consists of 33 actors (e.g. University Sports Center, General Student Committee) and shows a flat, non-hierarchical structure. Data reveal that attributed competence predicts cooperation (0.32; p < 0.05). Significant homophily effects among student actors (1.31; p < 0.05) and among university actors (0.59; p < 0.05) were found. All structural predictors examined were significant (0.22-5.40; p < 0.05) and are therefore essential in determining the likelihood of cooperation between actors involved in the network.

CONCLUSION

The results of this study provide for a better understanding of the mechanisms of cooperation and can be used to further develop the network at hand (e.g. selection of key actors for information dissemination or integration of peripheral actors). In addition, the findings offer starting points for sustained network development at other universities (e.g. significance of network governance form or goal consensus). Knowing the factors that influence the network structure, here the conditions of cooperation, results in opportunities to encourage empowerment among actors. However, the analysis of the network undertaken does not directly bear on the success of the network.

S., Menon M, Smita G. S., Shini V. S., Jose SE, Mahesh M. M., Shibu K, Sujisha T. G., Jayaprakashan K. P., Kiran P. S., Anil Kumar T. V., Vigneshwari V., Titus U. Framework and Overview of a State-Wide College Mental Health Program in Kerala, India

Background

Mental health issues are common among college students, and structured services have been proven to enhance outcomes. Despite increased enrolment for higher education in India, college mental health services remain sparse. JEEVANI is the first structured state-wide college mental health service in India. This paper describes its framework and provides an overview of its functioning during the initial five months.

Methods

In 2019-2020, the Directorate of Collegiate Education, Government of Kerala, implemented the program in 66 colleges catering to approximately 60,000 students. Qualified counsellors were trained to identify issues and provide interventions and early referrals, using a stepped-care approach. They conducted awareness programs to promote mental health and reduce stigma.

Results

The services were accessed by 2,315 students during the assessment period (October 2019 to February 2020). The beneficiaries were predominantly females (54.1%). Over a third (38.8%) belonged to the lower socio-economic strata, and 2.5% had significant vulnerabilities. Although no syndromal diagnoses were made, anxiety and depression were the most common presentations. The counsellors provided 3,758 individual sessions and facilitated support for students who reported academic difficulties or interpersonal issues. Severe mental illness was detected in 54 students, and referrals for specialist mental health input were initiated in 68.

Conclusion

Describing the framework, sharing the technical material, and providing an overview of its functioning from a resource-constrained setting in India may encourage higher education institutions in low- and middle-income countries to consider similar projects.

Changing the landscape of mental health among college students: a community case study of a course on learning sustainable well-being

Our society is facing an unprecedented mental health crisis, with nearly one in two people being affected by mental health issues over their lifespan. This trend is especially noticeable among college students, who undergo significant shifts in social, familial, and academic responsibilities. Exacerbating the mental health crisis is the fact that students are facing other societal crises (e.g., climate change). And, in a reciprocal fashion, students experiencing poor mental health are less likely to feel resilient enough to tackle these other crises. In response to these colliding societal crises, we need a comprehensive solution that goes beyond the current models of college mental health services. We propose an alternative preventative mental health approach, which aims to prevent the onset of mental health concerns and build resilience in the face of colliding crises. Specifically, we argue that colleges can aid in building mental health resilience by creating for-credit courses that teach students the skills they need to be conscious, responsible, and resilient human beings. Toward this end, we created an experiential, workshop-style, 1 unit, P/NP course, entitled "Learning Sustainable well-being" (LSW), which guides students to explore, improve, and sustain their mental health. The principles taught in this course combine the wisdoms of several disciplines, including mindfulness, psychology, neuroscience, philosophy, religion, poetry, and cinema. The following community case study reflects on the journey of our "LSW initiative," starting from the creation of the course in 2014 to the current mission of scaling up the offering as part of an institution-wide LSW program. To this end, we describe the LSW course modules/content, our pedagogical approach, potential limitations, and then provide data demonstrating its efficacy in improving student well-being. As a final note, we present the challenges we have faced, and the lessons learned, while on this journey. We hope that presenting this community case study will facilitate the growing dialogue across colleges about creating (and perhaps requiring) courses like LSW in order to improve students' mental health and resilience in the context of other colliding crises.

Evolution of 'whole institution' approaches to improving health in tertiary education settings: a critical scoping review

In recent decades, 'whole school' approaches to improving health have gained traction, based on settings-based health promotion understandings which view a setting, its actors and processes as an integrated 'whole' system with multiple intervention opportunities. Much less is known about 'whole institution' approaches to improving health in tertiary education settings. We conducted a scoping review to describe both empirical and non-empirical (e.g. websites) publications relating to 'whole settings', 'complex systems' and 'participatory'/'action' approaches to improving the health of students and staff within tertiary education settings. English-language publications were identified by searching five academic and four grey literature databases and via the reference lists of studies read for eligibility. We identified 101 publications with marked UK overrepresentation. Since the 1970s, publications have increased, spanning a gradual shift in focus from 'aspirational' to 'conceptual' to 'evaluative'. Terminology is geographically siloed (e.g., 'healthy university' (UK), 'healthy campus' (USA)). Publications tend to focus on 'health' generally rather than specific health dimensions (e.g. diet). Policies, arguably crucial for cascading systemic change, were not the most frequently implemented intervention elements. We conclude that, despite the field's evolution, key questions (e.g., insights into who needs to do what, with whom, where and when; or efficacy) remain unanswered.

Understanding and Fostering Mental Health and Well-Being among University Faculty: A Narrative Review

In recent years, there has been increasing recognition of mental health concerns in academia, with stress, burnout, anxiety, and depression being reported among faculty members. The demanding work environment, the need to balance personal and professional duties, and the constant pressure of productivity while navigating multiple tasks of teaching, research, mentorship, professional development, and service all impact the mental health and overall well-being of faculty. Higher education institutions have structurally changed as has the research landscape. These changes as well as faculty-specific and student-specific factors coupled to the effect of the COVID-19 pandemic have led to profound effects on the mental health of academics. This paper is a narrative review of the pertinent literature describing faculty mental health and well-being. It summarizes the available evidence on factors influencing faculty mental health and shows the prevalence of anxiety, depression, stress, and burnout among faculty from various academic fields and along the whole academic ladder. Using a suggested framework that collates the efforts of leaders and faculty, the paper concludes by exploring strategies that promote work-life balance among academics and suggesting effective interventions to improve their mental health outcomes.

Experiences and attitudes towards mental health problems in first year German university students

OBJECTIVES

The study should show how familiar German first year university students are with mental health issues and what their attitudes are regarding mental illness.

METHODS

The study sample consisted of 293 first year German university students (20.37 years ± 1.88), most of them women (82.9%). The majority (77.6%) was studying a social type subject. An additive focus group consisted of four experts. The participants of the quantitative part were recruited at prevention workshops that were offered during the induction week at the beginning of the semester at 15 German universities. Experts of the focus group were recruited by telephone call. In addition to quantitative analysis, we realized a focus group with experts of our target group concerns and university system. For statistical analysis, we used statistic software programme "SPSS" 24 to conduct t-tests. We used content-analytical evaluation to build a category system.

RESULTS

Every fourth participant reported having had a mental health problem. Male participants had a slightly greater desire for social distance (p=0.008; df=288) and slightly stronger stereotypes (p<0.001; df=289).

CONCLUSIONS

The present study shows that first year university students in Germany have substantial experience with mental health problems.

Predictors of perceived stress and quality of life amongst dental master and doctoral students

OBJECTIVES

This study aimed to identify predictors of perceived stress and quality of life (QoL) amongst dental master and doctoral students.

MATERIALS AND METHODS

This is a cross-sectional study with Brazilian students as participants (n = 707). The following instruments were administered: Perceived stress scale (PSS), the WHOQOL-BREF and a socio-demographic questionnaire. A linear regression model was estimated.

RESULTS

The results showed that female was associated with higher scores of PSS and lower scores of QoL. A negative correlation was observed between PSS and all four domains of QoL. Multivariate analysis revealed that the set of selected variables partially explained the variability of PSS score (28%) and the four QoL domains: physical (52%), psychological (62%), social relationships (25%) and environment (37%). The variable number of children, hours of sleep, concurrent work and study, leisure time and physical activity practice were associated with positive changes on QoL, whilst PSS and medication intake with negative. Lower PSS score was associated with the variables age, hours of sleep, leisure time and physical activity.

CONCLUSIONS

Our findings suggest that perceived stress and medication intake due to study are important predictors of lower QoL in dental master and doctoral students, especially in the psychological domain. More hours of sleep, leisure time and physical activity improved both QoL and perceived stress scores and might be feasible coping strategies for these outcomes in this population.

Towards a health promoting university: descriptive findings on health, wellbeing and academic performance amongst university students in Australia

BACKGROUND

Universities are increasingly recognised as institutions where health and wellbeing can be promoted to maximise academic outcomes, career transitions, and lifelong positive health behaviours. There is concern about the mental health of university students and other factors which affect academic outcomes particularly for subgroups such as international students. There are few cohort studies of the breadth of issues that can impact on mental health and academic outcomes for both local and international students. We conducted a baseline prevalence survey of students at a large Australian university covering health, academic, and social determinants of wellbeing. The purpose was to inform the university's new student health and wellbeing framework with a view to follow-up to determine predictors of mental ill-health and academic outcomes in the subsequent year. In this paper we present the baseline prevalence data and report on selected mental health and health care access issues for local and international students.

METHODS

The entire university population as of April 2019 of over 56,375 students aged 18 or above were invited to complete the online survey. Questions explored eight domains: demographic characteristics, general health and wellbeing, mental health, risk taking behaviours, psychosocial stressors, learning and academic factors, social and cultural environment, and awareness of and access to health and wellbeing services. Records of academic results were also accessed and matched with survey data for a large subset of students providing consent.

RESULTS

Fourteen thousand eight hundred eighty (26.4%) students commenced our survey and were representative of the entire student population on demographic characteristics. Three quarters were aged between 18 to 25 years and one third were international students. Eighty-five percent consented to access of their academic records. Similar proportions of local and international students experienced symptoms of a depression or anxiety disorder, however international students were less aware of and less likely to access available health services both inside and external to the university. We also reported on the prevalence of: general lifestyle factors (diet, exercise, amount of daily sleep); risk-taking behaviours (including alcohol, tobacco and other drug use; unprotected sexual activity); psychosocial stressors (financial, intimate partner violence, discrimination, academic stressors, acculturative stress); subjects failed; resilience; social supports; social media use; and health services accessed online.

CONCLUSIONS

This rigorous and comprehensive examination of the health status of local and international students in an Australian university student population establishes the prevalence of mental health issues and other psychosocial determinants of health and wellbeing, along with academic performance. This study will inform a university-wide student wellbeing framework to guide health and wellbeing promotion and is a baseline for a 12-month follow-up of the cohort in 2020 during the COVID-19 pandemic.

Understanding how the university curriculum impacts student wellbeing: a qualitative study

There is increasing pressure within universities to address student mental health. From a whole university or settings-based perspective, this could include curriculum-embedded approaches. There is little research about how this should work or what approaches might be most effective. Semi -structured interviews were conducted with fifty-seven undergraduate students from five disciplines (Psychology, English studies, Nursing, International Politics, and War Studies) to understand students' perspectives. Students reflected on wellbeing module content and, more broadly, on curriculum processes (teaching, pedagogy, assessment) within their degree. Reflexive thematic analysis was applied to transcripts, generating three themes: embedding wellbeing in the curriculum; assessment, challenge, and academic support; and social connection and interaction. The findings provide evidence for teaching, pedagogy, and assessment practices supporting higher education student wellbeing. These align with recommended good teaching practices, such as considering appropriate assessment methods followed by effective feedback. Students saw the benefits of being academically challenged if scaffolded appropriately. Strong peer connection, teacher-student interaction, and communication were crucial to learning and wellbeing. These findings provide implications for future curriculum design that can support learning and wellbeing.

Health-related quality of life of young academics: A cross-sectional survey of universities in Wuhan, China

Objective

This study aimed to assess the health-related quality of life (HRQoL) of young academics in Wuhan, China, and its determinants.

Methods

A multistage stratified cluster sampling strategy was employed to recruit study participants (young academics <40 years old) from 12 universities in Wuhan. A total of 301 respondents returned a self-complete questionnaire that contained the EQ-5D-5L. Multivariate linear and Tobit regression models were established to determine the sociodemographic and job predictors of the visual analogue scale (VAS) score and the EQ-5D utility index, respectively.

Results

The study participants reported a mean VAS value of 79.42 (SD = 10.51) and a mean EQ-5D utility index of 0.915 (SD = 0.090). Anxiety/depression was the most frequently reported problem (65.12%), followed by pain/discomfort (43.52%). Transitioning towards a full professorship in national key universities (p < 0.001), lower income (p < 0.05) and too much pressure for academic promotion (p < 0.001) were significant predictors of lower HRQoL; whereas, maintaining routines in physical activities (p < 0.001), sleep (p < 0.001) and meals (p < 0.001), a good relationship with colleagues and family members (p < 0.001), and social activities (p < 0.01) were significant predictors of higher HRQoL.

Conclusion

Low HRQoL of young academics in China is evident, as indicated by the 7.08 and 0.049 gap in VAS and utility index, respectively, compared to the general population at the same age. Work and career pressures are associated with the low HRQoL of young academics. The findings of this study highlight the importance of work-life balance in promoting HRQoL of young academics in universities in China.

Supporting mental health and wellbeing of university and college students: A systematic review of review-level evidence of interventions

Aims

The review of reviews had three aims: (i) to synthesize the available evidence on interventions to improve college and university students’ mental health and wellbeing; (ii) to identify the effectiveness of interventions, and (iii) to highlight gaps in the evidence base for future study.

Methods

Electronic database searches were conducted to identify reviews in English from high-income OECD countries published between 1999 and 2020. All review-level empirical studies involving post-secondary students attending colleges of further education or universities that examined interventions to improve general mental health and wellbeing were included. Articles were critically appraised using an amended version of the AMSTAR 2 tool. Evidence from the included reviews were narratively synthesized and organised by intervention types.

Results

Twenty-seven reviews met the review of reviews inclusion criteria. The quality of the included reviews varied considerably. Intervention types identified included: mindfulness-based interventions, psychological interventions, psychoeducation interventions, recreation programmes, relaxation interventions, setting-based interventions, and stress management/reduction interventions. There was evidence that mindfulness-based interventions, cognitive behavioural therapy (CBT), and interventions delivered via technology were effective when compared to a passive control. Some evidence suggested that the effects of CBT-related interventions are sustained over time. Psychoeducation interventions do not appear to be as effective as other forms of intervention, with its effects not enduring over time.

Conclusions

The review of reviews located a sizeable body of evidence on specific interventions such as mindfulness and cognitive-behavioural interventions. The evidence suggests that these interventions can effectively reduce common mental health difficulties in the higher education student body. Gaps and limitations in the reviews and the underlying body of evidence have been identified. These include a notable gap in the existing body of review-level evidence on setting-based interventions, acceptance and commitment training, and interventions for students attending colleges in UK settings.

Lifestyle behaviours and mental health and wellbeing of tertiary students during COVID-19 lockdown in Australia: A cross-sectional study

BACKGROUND

Australia experienced significant COVID-19 lockdown restrictions throughout 2020 that had an impact on mental health and disrupted health-promoting lifestyle behaviours. Lockdowns may have exacerbated existing mental health concerns among tertiary students, who experience higher levels of mental health concerns compared to the wider community. This study aimed to investigate the association between modifiable lifestyle factors and wellbeing of students at a Melbourne-based tertiary education institution during COVID-19 lockdown.

METHODS

This quantitative, cross-sectional study was conducted across campuses in Melbourne and Sydney. Data was collected via online questionnaire during the 7th week of a second-wave lockdown. Descriptive statistics were calculated for demographic variables (n = 239). Linear regression models were estimated to determine multivariate associations between lifestyle variables and psychological distress.

RESULTS

Participants were on average 30.98 years old (SD = 9.78), predominantly female, domestic students, undergraduate, not the first member of their family to attend university and living out of family home. Mindfulness, diet quality, sleep quality and moderate-vigorous physical activity (MVPA) were all inversely correlated with psychological distress. Unadjusted and adjusted models show that mindfulness, sleep quality, and MVPA were all independently inversely related to psychological distress. Greater mindfulness, sleep quality and engagement in MVPA were associated with lower psychological distress during COVID-19 lockdowns.

LIMITATIONS

As this study is cross-sectional and we cannot rule out reverse causality.

CONCLUSION

This study highlights the potential for lifestyle focused mental-health promotion delivered through tertiary education institutions to support students in times of crisis as well as more generally.

Key questions: research priorities for student mental health

BACKGROUND

The high prevalence of mental distress among university students is gaining academic, policy and public attention. As the volume of research into student mental health increases, it is important to involve students to ensure that the evidence produced can translate into meaningful improvements.

AIMS

For the first time, we consult UK students about their research priorities on student mental health.

METHOD

This priority setting exercise involved current UK university students who were asked to submit three research questions relating to student mental health. Responses were aggregated into themes through content analysis and considered in the context of existing research. Students were involved throughout the project, including inception, design, recruitment, analysis and dissemination.

RESULTS

UK university students (N = 385) submitted 991 questions, categorised into seven themes: epidemiology, causes and risk factors, academic factors and work-life balance, sense of belonging, intervention and services, mental health literacy and consequences. Across themes, respondents highlighted the importance of understanding the experience of minority groups.

CONCLUSIONS

Students are interested in understanding the causes and consequences of poor mental health at university, across academic and social domains. They would like to improve staff and students' knowledge about mental health, and have access to evidence-based support. Future research should take a broad lens to evaluate interventions; considering how services are designed and delivered, and investigating institutional and behavioural barriers to accessibility, including how this varies across different groups within the student population.

Comparison of Two Approaches to Enhance Self-Esteem and Self-Acceptance in Chinese College Students: Psychoeducational Lecture vs. Group Intervention

Objective

Self-esteem and self-acceptance are not only basic features but also influential factors of mental health. The present study aimed at assessing the effects of psychoeducational lecture and group intervention on self-esteem and self-acceptance in Chinese college students.

Methods

A total of 149 Chinese college students who participated in a mental health course were randomly class-based assigned into the psychoeducational lecture group (n = 62) and the self-focused intervention group (n = 87). The lecture group received 6-session psychoeducational lectures on overview of mental health, campus adaptation, stress adjustment, self-understanding, emotion management, and interpersonal relationships. The self-focused intervention group was treated with self-related group activities involving aspects of self-knowledge, self-feeling, and self-regulation for six sessions. Pre- and post-intervention measurements were taken with Rosenberg Self-Esteem Scale and Self-Acceptance Questionnaire for both groups.

Results

Self-esteem significantly increased in both groups after six sessions. However, the enhancement of self-acceptance was more robust for the self-focused intervention group than the psychoeducational lecture group.

Conclusion

The psychoeducational lecture and self-focused intervention were effective approaches to improve self-esteem for Chinese college students. With respect to self-acceptance, self-focused group intervention might have a more prominent effect.

The contradictions between Canadian capitalist processes and youth mental health: implications for mental health promotion

Understanding how socio-economic processes inter-relate with young people's mental health is important to inform the development of responsive mental health promotion initiatives. Thirty diverse Canadian young people were engaged within a process of social praxis, underpinned by a historical-dialectical ontological perspective, to explore the inter-relation among socio-economic processes and youth mental health and implications for mental health promotion initiatives. Findings show several inter-related contradictory processes within two overarching contradictory dynamics that Canadian youth are navigating as they seek to realize their mental health needs. The first overarching contradictory dynamic is between monetized, private, individualistic, profit-oriented economic processes and young people's need for resources, freedom and time, and inclusive social spaces to enable their mental health needs. Participants' descriptions of their approaches to seeking to realize their mental health needs in this context reflects a second inter-related overarching contradiction between communal and individual approaches to enabling young people's mental health needs. In this context, young people are oriented inward to meet their mental health needs at the individual and inter-personal level, despite the crucial role of socio-economic processes to enabling their mental health needs. Despite varied access to resources, all participants struggled to balance meeting their mental health needs. Implications of these findings entail the need to focus on promoting synergistic relations among young people and socio-economic processes whereby enabling universal access to resources for young people's survival, physical health and comfort is foundational to multi-level mental health promotion initiatives.

Promoting University Students' Mental Health: A Systematic Literature Review Introducing the 4M-Model of Individual-Level Interventions

Objective: The purpose of this study is to systematically review recently published individual student-level interventions aimed at alleviating the burden of mental health challenges faced by the students and/ or at equipping them with coping mechanism that will foster their resilience. Methods: This study relied on a systematic literature review. PubMed dataset was used; the search was confined to the following period: July 2016-December 2020. Results: A total of 1,399 records were identified by the electronic search, out of which 40 studies were included in this study. The authors inductively identified four overlapping categories of interventions across all included articles, and coded them as follows: Mindfulness, Movement, Meaning, and Moderator. Accordingly, each study was linked to at least one of four overlapping categories based on the nature of the intervention(s) under investigation, leading to differing assortments of categories. Conclusions: The 4M-Model generated by this study encourages focusing on devising holistic, university-based interventions that embrace the individuality of students to improve their mental health through elements of mindfulness, movement, meaning, and moderator. Through this focused approach, university counselors are enabled to design interventions that address students' physical, psychological, emotional, and social needs.

COVID-19 and a Call to Adapt Dental Education

Introduction: COVID-19 has harmed the economic, academic, and clinical pursuits of dental educational institutions and dental students. As dental associations, health agencies, and regulatory bodies around the globe announced the need for social distancing and stricter safety measures, some dental schools worldwide have been adapting to accommodate for such changes.

Methods: This review attempts to provide a general picture of the early responses of some dental schools worldwide to the COVID-19 crisis and identify some of the regulations that influenced dental schools' initial decisions. An analytical approach was used to assess changes to dental school curriculums in didactic (academic/non-clinical) and clinical education, examinations, administration, and dental school research. The assessment was based on a web-based search of a variety of online global references including research articles, reviews, letters, press releases, and surveys regarding the early effect of covid-19 on dental education at some dental institutions in the U.S, Europe, and Asia from late February to early July of 2020. The review also offered further recommendations to dental school administrators regarding the future of dental education during the early stages of a pandemic.

Conclusions: Innovations in technology and blended educational methodologies will continue to influence how certain dental schools around the world adapt to the changes caused by COVID-19 and better prepare dental education institutions for potential future public health disruptions.

Clinical significance: Dental schools will need to adapt their education system to improve didactic, preclinical, clinical, administrative, and research components of dental education in response to the changes caused by COVID-19 and future pandemics.

Investigating the Use of Electronic Well-being Diaries Completed Within a Psychoeducation Program for University Students: Longitudinal Text Analysis Study

Background

Psychoeducation has the potential to support students experiencing distress and help meet the demand for support; however, there is a need to understand how these programs are experienced. Web-based diaries are a useful activity for psychoeducation because of their therapeutic benefits, ability to capture naturalistic data relevant to well-being, and appropriateness for text analysis methods.

Objective

This study aims to examine how university students use electronic diaries within a psychoeducation program designed to enhance mental well-being.

Methods

The Science of Happiness course was administered to 154 undergraduate students in a university setting (the United Kingdom). Diaries were collected from the students for 9 weeks. Baseline well-being data were collected using the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). The percentage of negative and positive emotion words used in diaries (emotional tone) and use of words from five life domains (social, work, money, health, and leisure) were calculated using the Linguistic Inquiry and Word Count 2015 software. Random effects (generalized least squares) regression models were estimated to examine whether time, diary characteristics, demographics, and baseline well-being predict the emotional tone of diaries.

Results

A total of 149 students participated in the diary study, producing 1124 individual diary entries. Compliance with the diary task peaked in week 1 (n=1041, 92.62%) and was at its lowest in week 3 (n=807, 71.81%). Compared with week 1, diaries were significantly more positive in their emotional tone during week 5 (mean difference 23.90, 95% CI 16.89-30.90) and week 6 (mean difference 26.62, 95% CI 19.35-33.88) when students were tasked with writing about gratitude and their strengths. Across weeks, moderate and high baseline SWEMWBS scores were associated with a higher percentage of positive emotion words used in diaries (increases compared with students scoring low in SWEMWBS were 5.03, 95% CI 0.08-9.98 and 7.48, 95% CI 1.84-13.12, respectively). At week 1, the diaries of students with the highest levels of baseline well-being (82.92, 95% CI 73.08-92.76) were more emotionally positive on average than the diaries of students with the lowest levels of baseline well-being (59.38, 95% CI 51.02-67.73). Diaries largely focused on the use of social words. The emotional tone of diary entries was positively related to the use of leisure (3.56, 95% CI 2.28-4.85) and social words (0.74, 95% CI 0.21-1.27), and inversely related to the use of health words (−1.96, 95% CI −3.70 to −0.22).

Conclusions

We found evidence for short-term task-specific spikes in the emotional positivity of web-based diary entries and recommend future studies examine the possibility of long-term impacts on the writing and well-being of students. With student well-being strategies in mind, universities should value and encourage leisure and social activities.

Students' perspectives on interventions to reduce stress in medical school: A qualitative study

The mental health of medical students remains to be a matter of concern. Numerous setting-based and individual-based interventions for student mental health have been proposed in the literature. However, the student perspective on those interventions has been largely neglected. This study aims to explore how medical students perceive different interventions and if they desire any additional changes with regard to their studies. Eight focus groups with 71 participants were conducted at a large German medical school. Focus groups were recorded, transcribed and content-analyzed using MAXQDA 18. We found that medical students prefer setting-based interventions. Most proposed interventions were on a setting-based level. For instance, students asked for more information on the university's psychosocial counseling services and for better information management regarding contact persons. Interventions proposed in the literature received mixed reactions: Several participants did not favour a pass/fail grading system. Students considered a peer-to-peer mentoring program for freshmen very helpful. Students had diverse attitudes towards Balint groups. They approved of several self-management courses, most of them being related to time or stress management. Interestingly, the most urgently wanted interventions appear to be rather easy to implement (e.g. a mentoring program). This study explored the medical student perspective on student mental health interventions. Additionally, our study illustrates the benefit and feasibility of involving students early on in the conception of interventions. Further research with a representative sample is needed to obtain broader information on the acceptance of the suggested interventions.

'When They Struggle, I Cannot Sleep Well Either': Perceptions and Interactions Surrounding University Student and Teacher Well-Being

A wealth of evidence has indicated that both students and teachers experience high levels of stress, burnout, and ultimately compromised well-being in the university context. Although numerous studies have investigated well-being among university students, and other studies have addressed well-being among university teachers, these lines of research are often conducted in isolation from one another. This is surprising, as the importance of considering reciprocal links between students and teachers has been suggested in several empirical studies. Additionally, when researching well-being in academia, the conceptualizations tend to differ from study-to-study. The present research therefore investigated how students and teachers conceptualize well-being at the university based on their personal experiences, as well as how student and teacher well-being interact. To examine this, six university students (50% female), and ten teachers (50% female) from Germany and the Netherlands participated in semi-structured interviews. Qualitative analysis using a multistage coding process revealed detailed insights concerning students' and teachers' perceptions of well-being that coincided with positive psychology, resilience, multifaceted, and basic psychological need fulfillment approaches. Moreover, an interaction between students' and teachers' well-being became apparent, including several factors such as the student-teacher relationship that in turn, contributed to both population's well-being. The present findings lend evidence toward a more coherent conceptualization of well-being and are discussed in terms of suggestions for initiatives that simultaneously support both populations, for example, through the student-teacher relationship.

Behavior change due to COVID-19 among dental academics-The theory of planned behavior: Stresses, worries, training, and pandemic severity

OBJECTIVE

COVID-19 pandemic led to major life changes. We assessed the psychological impact of COVID-19 on dental academics globally and on changes in their behaviors.

METHODS

We invited dental academics to complete a cross-sectional, online survey from March to May 2020. The survey was based on the Theory of Planned Behavior (TPB). The survey collected data on participants' stress levels (using the Impact of Event Scale), attitude (fears, and worries because of COVID-19 extracted by Principal Component Analysis (PCA), perceived control (resulting from training on public health emergencies), norms (country-level COVID-19 fatality rate), and personal and professional backgrounds. We used multilevel regression models to assess the association between the study outcome variables (frequent handwashing and avoidance of crowded places) and explanatory variables (stress, attitude, perceived control and norms).

RESULTS

1862 academics from 28 countries participated in the survey (response rate = 11.3%). Of those, 53.4% were female, 32.9% were <46 years old and 9.9% had severe stress. PCA extracted three main factors: fear of infection, worries because of professional responsibilities, and worries because of restricted mobility. These factors had significant dose-dependent association with stress and were significantly associated with more frequent handwashing by dental academics (B = 0.56, 0.33, and 0.34) and avoiding crowded places (B = 0.55, 0.30, and 0.28). Low country fatality rates were significantly associated with more handwashing (B = -2.82) and avoiding crowded places (B = -6.61). Training on public health emergencies was not significantly associated with behavior change (B = -0.01 and -0.11).

CONCLUSIONS

COVID-19 had a considerable psychological impact on dental academics. There was a direct, dose-dependent association between change in behaviors and worries but no association between these changes and training on public health emergencies. More change in behaviors was associated with lower country COVID-19 fatality rates. Fears and stresses were associated with greater adoption of preventive measures against the pandemic.

Post-Secondary Stress and Mental Well-Being: A Scoping Review of the Academic Literature

Post-secondary students have been identified as an at-risk population for chronic stress and poor mental health. We conducted a scoping review of the academic literature surrounding student stress and mental well-being as the first phase of research in the development of Canada’s National Standard for the Psychological Health and Safety of Post-Secondary Students. Major thematic findings included student stress, resilience through effective coping and help-seeking, and programs or strategies to improve campus mental health. Recommendations include a call for increased mental health promotion and mental illness prevention activities that are sensitive to diverse cultures, ethnicities, religions, and sexualities.

A Systematic Umbrella Review on the Epidemiology of Modifiable Health Influencing Factors and on Health Promoting Interventions Among University Students

Background: Universities represent an important setting for health promotion. The unique collective of university students is of particular relevance since they are the leaders, decision-makers, and parents of tomorrow. In this context, modifiable health influencing factors as well as interventions to prevent these, play a crucial role. Therefore, the present umbrella review aims to (i) provide an overview of review articles addressing epidemiological issues (prevalence and determinants) of modifiable health influencing factors in university students and (ii) to provide an overview of review articles addressing the evidence of interventions to promote/enhance modifiable health influencing factors in university students. Methods: A systematic literature search was performed in the databases PubMed, Cochrane Reviews Library und Web of Science according to the PRISMA guidelines. Only systematic reviews and meta-analyses were included. The AMSTAR-2-Tool was used for the quality assessment. Result: The initial search resulted in 10,726 records of which 81 fulfilled the inclusion criteria, with a further distinction in articles with an epidemiological focus (n = 39) and in articles with interventional approaches (n = 42). Topics of the different review articles ranged from physical activity over mental health, substance use, sleep, diet and nutrition, and media consumption. Many review articles had a specific focus on medical and nursing students and originated from the U.S.A., U.K., or China. Discussion: This umbrella review provides an overview of review articles on the epidemiology of modifiable health influencing factors and on the evidence of interventions targeting these factors among university students. Thereby, experts as well as stakeholders in the field could gain insights into crucial target points for health promotion. It identifies research gaps in terms of study region and groups of students.

Project Synergy: co-designing technology-enabled solutions for Australian mental health services reform

Project Synergy aims to test the potential of new and emerging technologies to enhance the quality of mental health care provided by traditional face-to-face services. Specifically, it seeks to ensure that consumers get the right care, first time (delivery of effective mental health care early in the course of illness). Using co-design with affected individuals, Project Synergy has built, implemented and evaluated an online platform to assist the assessment, feedback, management and monitoring of people with mental disorders. It also promotes the maintenance of wellbeing by collating health and social information from consumers, their supportive others and health professionals. This information is reported back openly to consumers and their service providers to promote genuine collaborative care. The online platform does not provide stand-alone medical or health advice, risk assessment, clinical diagnosis or treatment; instead, it supports users to decide what may be suitable care options. Using an iterative cycle of research and development, the first four studies of Project Synergy (2014-2016) involved the development of different types of online prototypes for young people (i) attending university; (ii) in three disadvantaged communities in New South Wales; (iii) at risk of suicide; and (iv) attending five headspace centres. These contributed valuable information concerning the co-design, build, user testing and evaluation of prototypes, as well as staff experiences during development and service quality improvements following implementation. Through ongoing research and development (2017-2020), these prototypes underpin one online platform that aims to support better multidimensional mental health outcomes for consumers; more efficient, effective and appropriate use of health professional knowledge and clinical skills; and quality improvements in mental health service delivery.

The challenges and mental health issues of academic trainees

In the last decade, mental health issues have come to the foreground in academia. Literature surrounding student mental health continues to grow as universities try to implement wellness services and study the mental health of their students. Studies vary greatly in terms of measurement tools, timeframe, sample demographics, as well as the chosen threshold of symptom severity for diagnosis. This review attempts to summarize, contextualize and synthesize papers that pertain to the challenges faced by academic trainees at the undergraduate, graduate and post-graduate level. The evidence for, and against, the common claim of increasing prevalence of mental health issues among students in recent years is discussed. While some studies support this claim, it is difficult to reach a definitive conclusion due to numerous confounding factors such as increased help-seeking behaviour, greater awareness of mental health issues and weak methodology. The prevalence of depression, anxiety, suicidal and self-injurious behaviour, distress and general mental illness diagnoses are discussed. Other issues known to influence mental health, such as sexual assault and bullying, are briefly addressed. Finally, select studies on a few wellness strategies that may improve mental health of trainees, such as mindfulness, are summarised, along with diverse recommendations for individual students, universities, and academia as a whole.

What is good mental health? A scoping review

Promotion of good mental health in young people with and without mental disorders has received little empirical research attention and interventions for improving mental health in young people are not well established. This situation could be explained among other reasons due to the difficulties to define and operationalise what good mental health is. The current manuscript, produced by the European College of Neuropsychopharmacology Thematic Working Group on the Prevention of Mental Disorders and Mental Health Promotion (ECNP TWG PMD-MHP), presents a critical review of the available operationalizations for good mental health. A pragmatic conceptual operationalisation of good mental health is a much-needed step towards more standardised research in this field. Good mental health can be defined as a state of well-being that allows individuals to cope with the normal stresses of life and function productively. Universal and selective interventions are suitable to promote mental health. Core domains that define good mental health encompass: (i) mental health literacy, (ii) attitude towards mental disorders, (iii) self-perceptions and values, (iv) cognitive skills, (v) academic/ occupational performance, (vi) emotions, (vii) behaviours, (viii) self-management strategies, (ix) social skills, (x) family and significant relationships (xi) physical health, (xii) sexual health, (xiii) meaning of life, (xiv) and quality of life. These domains should be widely traceable in the literature and can be used to conduct further empirical research in the field of good mental health. Such data can lead to more robust evidence to identify and establish the pathways to follow in order to improve mental health.

Gender commonalities and differences in risk and protective factors of suicidal thoughts and behaviors: A cross-sectional study of Spanish university students

AIM

To assess gender differences in the association between risk/protective factors and suicidal thoughts and behaviors (STB); and whether there is any gender-interaction with those factors and STB; among Spanish university students.

METHODS

Data from baseline online survey of UNIVERSAL project, a multicenter, observational study of first-year Spanish university students (18-24 years). We assessed STB; lifetime and 12-month negative life-events and family adversities; mental disorders; personal and community factors. Gender-specific regression models and gender-interactions were also analyzed.

RESULTS

We included 2,105 students, 55.4% women. Twelve-month prevalence of suicidal ideation (SI) was 10%, plans 5.7%, attempts 0.6%. Statistically significant gender-interactions were found for lifetime anxiety disorder, hopelessness, violence between parents, chronic health conditions and family support. Lifetime mood disorder was a common risk factor of SI for both genders (Females: OR= 5.5; 95%CI 3.3-9.3; Males: OR= 4.4; 95%CI 2.0-9.7). For females, exposure to violence between parents (OR= 3.5; 95%CI 1.7-7.2), anxiety disorder (OR= 2.7; 95%CI 1.6-4.6), and alcohol/substance disorder (OR= 2.1; 95%CI 1.1-4.3); and for males, physical childhood maltreatment (OR= 3.6; 95%CI 1.4-9.2), deceased parents (OR= 4.6; 95%CI 1.2-17.7), and hopelessness (OR= 7.7; 95%CI 2.8-21.2), increased SI risk. Family support (OR= 0.5; 95%CI 0.2-0.9) and peers/others support (OR= 0.4; 95%CI 0.2-0.8) were associated to a lower SI risk only among females.

CONCLUSIONS

Only mood disorder was a common risk factor of SI for both genders, whereas important gender-differences were observed regarding the other factors assessed. The protective effect from family and peers/others support was observed only among females. Further research assessing underlying mechanisms and pathways of gender-differences is needed.

Evidence of Workplace Interventions-A Systematic Review of Systematic Reviews

Work environment factors are highly correlated with employees' health and well-being. Our aim was to sum up current evidence of health promotion interventions in the workplace, focusing on interventions for the prevention of musculoskeletal disorders, psychological and behavioral disorders as well as interventions for older employees and economic evaluations. We conducted a comprehensive literature search including systematic reviews published from April 2012 to October 2017 in electronic databases and search engines, websites of relevant organizations and institutions. It consisted of simple and specific terms and word combinations related to workplace health promotion based on the search strategy of a previous review. After full-text screening, 74 references met the eligibility criteria. Using the same search strategy, there was a higher proportion of relevant high-quality studies as compared with the earlier review. The heterogeneity of health promotion interventions regarding intervention components, settings and study populations still limits the comparability of studies. Future studies should also address the societal and insurer perspective, including costs to the worker such as lost income and lost time at work of family members due to caregiving activities. To this end, more high-quality evidence is needed.

Impacts of socio-cultural environment and lifestyle factors on the psychological health of university students in Bangladesh: A longitudinal study

BACKGROUND

The psychological health of university students is an issue of utmost concern worldwide. Its consequences include multifaceted outcomes from complex interactions of sociocultural, environmental, and individual lifestyle factors. This research explores the impacts of socio-cultural environment and lifestyle factors on the psychological health of university students in Dhaka, Bangladesh.

METHODS

A 15-month follow-up was carried out among 1140 university students from April 2016 to November 2017. Data were collected by using a pre-developed questionnaire, consisting of socio-demographic information, comprehensive lifestyle information, and psychological health information including a nine-item scale, the Patient Health Questionnaire-9 (PHQ-9) for assessing the level of depression, and a 7-item scale, the Generalized Anxiety Disorder-7 (GAD-7) for assessing the level of anxiety. The collected data were analyzed by using the Statistical Package for Social Sciences (SPSS) software, version 22.

RESULTS

With time, there was a 22.5% increase in the prevalence of provisional depression and a 27.1% increase in the prevalence of anxiety. In terms of demographic factors, findings revealed that students dissatisfied with university culture were significantly more likely to experience depression (B = 5.13, p<0.01, β=0.33) and anxiety (B = 4.69, p<0.01, β=0.34). 'Being female', 'being students of social sciences faculty', 'dissatisfaction with current education, financial condition and future career' were found to be significant predictors of students' psychological disorders. In terms of lifestyle factors, participants with high and excessive recreational screen time were significantly more vulnerable to depression (B = 1.25, p<0.01, β=0.097 and B = 1.75, p<0.01, β=0.12) and anxiety (B = 0.86, p = 0.02, β=0.08 and B = 1.22, p<0.01, β=0.096). Additionally, 'weekly physical inactivity', 'dissatisfaction with daily sleep', 'short and long sleep duration', 'low and high daily meal intake frequency' and 'alcohol consumption' were inextricably linked with students' depression and anxiety.

CONCLUSION

The prevalence of provisional as well as major depressive and anxiety disorders among university students in Bangladesh is significantly high and augmented in nature. This study provides significant information about the adverse impacts of university socio-cultural environment and students' lifestyle factors on their psychological health conditions.

Readiness to change and barriers to treatment seeking in college students with a mental disorder

BACKGROUND

College students have high prevalence of mental disorders and suicidal thoughts and behaviours, and low rates of treatment uptake. This study assesses treatment access, intentions to seek help, and perceived barriers to help-seeking, considering gender and suicidal thoughts or behaviours (STBs) as predictors.

METHODS

Data is from the Ulster University Student Wellbeing study (2015) conducted in Northern Ireland (NI), as part of the WHO World Mental Health Surveys International College Student Project. Participants are 392 new college entrants (162 males (41.3%)/230 females (58.7%)), who all reported some lifetime mental disorder or STBs.

RESULTS

Receipt of treatment was low (37.8%), particularly among males and those with no STBs. Males were less likely to intend to access external professional services and were less likely than females to rate embarrassment (OR = 0.60) or worry about being treated differently (OR = 0.63) as important reasons for not seeking treatment. Those with STBs rated wanting to handle things on their own as a more important barrier those with no STBs (OR = 0.55 for non STBs group) and rated being unsure where to go as a less important barrier than those with no STBs (OR = 1.80 for non STBs group).

LIMITATIONS

Data is correlational and concerns lifetime criteria for mental disorder, with no consideration of current mental status nor disorder type.

CONCLUSIONS

These findings have implications for the active screening and intervention for vulnerable college students, particularly males and those with mental disorders but no STBs.

Interventions for common mental health problems among university and college students: A systematic review and meta-analysis of randomized controlled trials

Common mental health problems (CMHPs), such as depression, anxiety disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) are internalizing disorders with high comorbidity. University and college students are under many stressors and transitional events, and students fall within the age range when CMHPs are at their developmental peak. Compared to the expanded effort to explore and treat CMHPs, there has been no a meta-analysis that comprehensively reviewed the interventions for CMHPs and examined the effects of interventions for CMHPs in college students. The objective of this review is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) examining interventions for CMHPs among university and college students and to estimate their post-intervention effect size (ES), as well as follow-up ES, for depression, anxiety disorder, OCD and PTSD separately. Meta-analytic procedures were conducted in accordance with PRISMA guidelines. We reviewed 7768 abstracts from which 331 full-text articles were reviewed and 51 RCTs were included in the analysis. We found moderate effect sizes for both depression (Hedges' g = -0.60) and anxiety disorder (Hedges' g = -0.48). There was no evidence that existing interventions for OCD or PTSD were effective in this population. For interventions with high number of papers, we performed subgroup analysis and found that cognitive behavioral therapy (CBT) and mindfulness-based interventions were effective for both depression and generalized anxiety disorder (GAD), and attention/perception modification was effective for GAD; other interventions (i.e. art, exercise and peer support) had the highest ES for both depression and GAD among university and college students.

Evaluating the benefits of a youth mental health curriculum for students in Nicaragua: a parallel-group, controlled pilot investigation

BACKGROUND

High rates of mental illness and addictions are well documented among youth in Nicaragua. Limited mental health services, poor mental health knowledge and stigma reduce help-seeking. The Mental Health Curriculum (MHC) is a Canadian school-based program that has shown a positive impact on such contributing factors. This pilot project evaluated the impact of the MHC on mental wellness and functioning among youth in Leon, Nicaragua.

METHODS

High school and university students (aged 14-25 years) were assigned to intervention (12-week MHC; n  =  567) and control (wait-list; n  =  346) groups in a non-randomized design. Both groups completed measures of mental health knowledge, stigma and function at baseline and 12 weeks. Multivariate analyses and repeated measures analyses were used to compare group outcomes.

RESULTS

At baseline, intervention students showed higher substance use (mean difference [MD]  =  0.24) and lower perceived stress (MD = -1.36) than controls (p  <  0.05); there were no other group differences in function. At 12 weeks, controlling for baseline differences, intervention students reported significantly higher mental health knowledge (MD  =  1.75), lower stigma (MD  =  1.78), more adaptive coping (MD  =  0.82), better lifestyle choices (MD  =  0.06) and lower perceived stress (MD = -1.63) (p  <  0.05) than controls. The clinical significance as measured by effect sizes was moderate for mental health knowledge, small to moderate for stigma and modest for the other variables. Substance use also decreased among intervention students to similar levels as controls (MD  =  0.03) (p > 0.05).

CONCLUSIONS

This pilot investigation demonstrates the benefits of the MHC in a low-and-middle-income youth population. The findings replicate results found in Canadian student populations and support its cross-cultural applicability.

Efficacité des interventions en prévention et en promotion de la santé mentale dans les établissements d’enseignement postsecondaire

Le développement d’un problème de santé mentale affecte les étudiants de niveau postsecondaire sur tous les plans et peut mettre leur santé, voire leur survie, en péril. Les problèmes vécus pourraient être atténués, ou même évités dans certains cas, en intervenant plus tôt. Les stratégies en prévention et en promotion de la santé mentale mises de l’avant dans les établissements d’enseignement postsecondaire offrent les plus belles possibilités de rejoindre un grand nombre de jeunes adultes. Cependant, malgré l’intérêt grandissant pour de telles initiatives en milieu scolaire, les méta-analyses et les revues des écrits scientifiques recensés mettent en lumière les difficultés reliées à l’évaluation des stratégies utilisées et aux possibilités de répliquer les interventions, particulièrement en ce qui a trait à la promotion. Les stratégies les plus efficaces sur le plan de l’amélioration de la santé mentale semblent être associées à la supervision d’exercices en lien avec l’intervention telles que les exercices de pleine conscience (mindfulness), les techniques cognitives-comportementales, la relaxation et le développement d’habiletés sociales. Par ailleurs, même si elles présentent une plus grande hétérogénéité, les études impliquant une aide technologique (Web, ordinateur, etc.) démontrent des résultats favorables lorsqu’elles utilisent l’approche cognitive comportementale.