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Tan E, Frambach J, Driessen E, Cleland J. Opening the black box of school-wide student wellbeing programmes: a critical narrative review informed by activity theory. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:663-687. [PMID: 37393378 DOI: 10.1007/s10459-023-10261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/18/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Medical schools have a duty of care to support student wellbeing but there is little guidance on how to translate this mandate into practice. Often schools focus on implementing and reporting individual-level interventions which typically only address one aspect of wellbeing. Conversely, less attention has been paid to holistic school-wide approaches towards student wellbeing that address multiple wellbeing dimensions. Thus, this review sought to improve our understanding of how support is mediated within such school-wide wellbeing programmes. METHOD This critical narrative review was conducted in two stages. First, the authors searched several key databases for papers published up to 25th May 2021, using a systematic search strategy and TREND checklist to guide our data extraction process. We later expanded our search to include literature published from the original date to 20th May 2023. Second, the identified articles were critically analysed using activity theory as a theoretical lens to aid explanation. RESULTS We found school-wide wellbeing programmes emphasize social connectivity and building a sense of community. Tutors take a key role in the activity of supporting students' wellbeing. We mapped out the activity system components to describe the complexity of this tutor role. This analysis illustrated: tensions and contradictions in the system which may open up opportunities for change; the importance of context for influencing how system components interact; and that students' trust underpins the whole activity system. CONCLUSIONS Our review shines a light into the black-box of holistic school-wide wellbeing programmes. We identified that tutors play a key role in wellbeing systems but confidentiality is a recurring tension which may jeopardise a wellbeing system. The time has come to investigate these systems in more detail, embracing and exploring the role of context at the same time as looking for common threads.
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Affiliation(s)
- Emmanuel Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
| | - Janneke Frambach
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Erik Driessen
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Feng Y, Meng D, Guo J, Zhao Y, Ma X, Zhu L, Mu L. Bedtime procrastination in the relationship between self-control and depressive symptoms in medical students: From the perspective of sex differences. Sleep Med 2022; 95:84-90. [DOI: 10.1016/j.sleep.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
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Harith S, Backhaus I, Mohbin N, Ngo HT, Khoo S. Effectiveness of digital mental health interventions for university students: an umbrella review. PeerJ 2022; 10:e13111. [PMID: 35382010 PMCID: PMC8977068 DOI: 10.7717/peerj.13111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/22/2022] [Indexed: 01/12/2023] Open
Abstract
Background Poor mental health among university students remains a pressing public health issue. Over the past few years, digital health interventions have been developed and considered promising in increasing psychological wellbeing among university students. Therefore, this umbrella review aims to synthesize evidence on digital health interventions targeting university students and to evaluate their effectiveness. Methods A systematic literature search was performed in April 2021 searching PubMed, Psychology and Behavioural Science Collection, Web of Science, ERIC, and Scopus for systematic reviews and meta-analyses on digital mental health interventions targeting university students. The review protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO [CRD42021234773]. Results The initital literature search resulted in 806 records of which seven remained after duplicates were removed and evaluated against the inclusion criteria. Effectiveness was reported and categorized into the following six delivery types: (a) web-based, online/computer-delivered interventions (b) computer-based Cognitive Behavior Therapy (CBT), (c) mobile applications and short message service (d) virtual reality interventions (e) skills training (f) relaxation and exposure-based therapy. Results indicated web-based online/computer delivered-interventions were effective or at least partially effective at decressing depression, anxiety, stress and eating disorder symptoms. This was similar for skills-training interventions, CBT-based intervention and mobile applications. However, digital mental health interventions using virtual reality and relaxation, exposure-based therapy was inconclusive. Due to the variation in study settings and inconsistencies in reporting, effectiveness was greatly dependent on the delivery format, targeted mental health problem and targeted purpose group. Conclusion The findings provide evidence for the beneficial effect of digital mental health interventions for university students. However, this review calls for a more systematic approach in testing and reporting the effectiveness of digital mental health interventions.
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Affiliation(s)
- Sophia Harith
- Centre for Sport and Exercise Sciences, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Insa Backhaus
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Najihah Mohbin
- Health Promotion Unit, Pekan District Health Office, Pekan, Pahang, Malaysia
| | - Huyen Thi Ngo
- Faculty of Library and Information Science, University of Social Sciences and Humanities/Vietnam National University, Ho Chi Minh City, Vietnam
| | - Selina Khoo
- Centre for Sport and Exercise Sciences, Universiti Malaya, Kuala Lumpur, Malaysia
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Li Y, Jin S, Li Y, Guo F, Luo T, Pan B, Lei M, Liu Y. The Effects of Research Activities on Biomedical Students' Mental Health: A National Cross-Sectional Study. Front Psychiatry 2022; 13:796697. [PMID: 35422724 PMCID: PMC9004543 DOI: 10.3389/fpsyt.2022.796697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/02/2022] [Indexed: 11/27/2022] Open
Abstract
Mental health disorders are prevalent among biomedical students, and scientific research is one of their main activities, yet less is known about the relationship between research activities and mental health among these students. The aim of this cross-sectional study was to assess the associations between research activities and mental health and to identify the potential risk factors for anxiety and depression among biomedical students in China. This study enrolled 1,079 participants between November 2020 and December 2020 from 29 Chinese provinces and collected participants' basic characteristics, work situations, scientific achievements, and potential stress sources via an online questionnaire. Anxiety and depression were evaluated by two widely used scales, the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), respectively. The study also assessed the associations between scientific research duration and mental health. Univariate and multivariate analyses were performed to identify the predictors of anxiety and depression. Among the participants, 39.02% scored as having moderate to severe anxiety, and 37.54% scored as having moderate to severe depression. When the Youden index reached its maximum, the optimal cutoff was 7.17 h for the GAD-7 and 6.83 h for the PHQ-9. After adjustment for confounders, a longer research work duration was significantly associated with a higher anxiety [odds ratio (OR) = 1.32, 95% confidence interval (CI): 1.21-1.44, p < 0.01] and depression (OR = 1.27, 95% CI: 1.17-1.39, p < 0.01). Of all the participants working for 7 h a day, 37.04% had already published at least one paper and 25.93% had at least one Science Citation Index paper. Anxiety and depression are common among biomedical students. The research work duration of 7 h a day is the best cutoff for mental health, and it is associated with acceptable scientific research achievements. Not more than 7 h a day on research is recommended for biomedical students to maintain a balance between mental health and scientific research achievements.
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Affiliation(s)
- Yue Li
- Department of Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shengyang Jin
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ya Li
- Department of Dermatology, Ningxia Yiyang Geriatric Hospital, Yinchuan, China
| | - Fei Guo
- Department of Anesthesiology, Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Ting Luo
- Department of Obstetrics and Gynecology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Bo Pan
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingxing Lei
- Chinese PLA Medical School, Beijing, China.,Department of Orthopedic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Chinese PLA General Hospital, Beijing, China
| | - Yaosheng Liu
- Department of Orthopedic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Chinese PLA General Hospital, Beijing, China
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Zhao Y, Wang W, Wang M, Gao F, Hu C, Cui B, Yu W, Ren H. Personalized individual-based exercise prescriptions are effective in treating depressive symptoms of college students during the COVID-19: A randomized controlled trial in China. Front Psychiatry 2022; 13:1015725. [PMID: 36699477 PMCID: PMC9869038 DOI: 10.3389/fpsyt.2022.1015725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has seriously increased depression prevalence among the public, including Chinese college students. However, many exercise cannot be performed as usual under the stay-at-home order. This study was a 12-week three-arm randomized controlled trial using the intention-to-treat principle, aiming to explore and compare the feasibility and effect of individual-based personalized aerobic-exercise and resistance-training prescriptions on depressive symptoms in college students, and conclude with some recommendations for individual-based exercise prescriptions. METHODS Eighty-six college students with depressive symptoms were randomized into aerobic-exercise (AE), resistance-training (RT), and wait-list control (WLC) groups. Participants in two experimental groups received 12-week personalized AE and RT prescriptions on their individual situations, respectively. No intervention was implemented on participants in the WLC group. Depressive symptoms and physical activity (PA) were measured by Zung Self-Rating Depression Scale (SDS) and International Physical Activity Questionnaire-Short Form (IPAQ-SF), respectively. All data were collected at the baseline, 4, 8, and 12 weeks, and 4-week post-intervention. RESULTS At 12 weeks, 72.09% of depressive participants improved to "normal." Participants exhibited a statistical reduction in SDS in all 3 groups (p < 0.05) at 12 weeks compared to baseline. Follow-up assessments showed no significant increase in SDS at 4-week post-intervention compared to 12 weeks (p > 0.05). The independent t-test revealed significantly lower SDS in AE and RT group than in WLC group (p AE < 0.001 and p RT < 0.05) at 4, 8, and 12 weeks, and 4-week post-intervention. Furthermore, the PA of participants (including total PA and intensities) in both experimental groups represented a significant improvement at 4-week post-intervention compared to baseline (p < 0.05), while no differences were observed in the PA of participants in the WLC group (p > 0.05). CONCLUSION Personalized exercise prescriptions have good feasibility as they can increase adherence to intervention and reduce serious adverse events. Besides, individual-based personalized aerobic-exercise and resistance-training prescriptions result in a similar effect in relieving depressive symptoms and improving physical activity in college students. The individual-based exercise programs performed in 45- to 60- min with progressive moderate-to-vigorous intensity, 3 times/week for at least 12 weeks, may reduce depressive symptoms in college students during the COVID-19.
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Affiliation(s)
- Yuanhui Zhao
- School of Sport Science, Beijing Sport University, Beijing, China.,Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
| | - Wenxing Wang
- School of Sport Science, Beijing Sport University, Beijing, China.,Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
| | - Mengdie Wang
- China Institute of Sport Science, Beijing, China
| | - Fang Gao
- School of Sport Science, Beijing Sport University, Beijing, China.,Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
| | - Chun Hu
- School of Sport Science, Beijing Sport University, Beijing, China.,Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
| | - Bowen Cui
- School of Sport Science, Beijing Sport University, Beijing, China.,Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
| | - Wenlang Yu
- School of Sport Science, Beijing Sport University, Beijing, China.,Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
| | - Hong Ren
- School of Sport Science, Beijing Sport University, Beijing, China.,Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
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Zhang H, Gao H, Zhu Y, Zhu Y, Dang W, Wei R, Yan H. Relationship Between Myopia and Other Risk Factors With Anxiety and Depression Among Chinese University Freshmen During the COVID-19 Pandemic. Front Public Health 2021; 9:774237. [PMID: 34926391 PMCID: PMC8671746 DOI: 10.3389/fpubh.2021.774237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose: To investigate the association of myopia and other risk factors with anxiety and depression among Chinese university freshmen during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This cross-sectional study was conducted at the Tianjin Medical University from October 2020 to December 2020. Ophthalmic examination of the eyes was performed by an experienced ophthalmologist. Detailed information on depression, anxiety, and other risk factors was collected via the Self-rating Anxiety Scale and Self-rating Depression Scale. Results: The overall prevalence of anxiety and depression in our study was 10.34 and 25.13%, respectively. The prevalence of myopia and high myopia as 92.02 and 26.7%, respectively. There were significant associations between anxiety and spectacle power [odds ratios (OR) = 0.89; 95% CI: 0.81–0.98, P = 0.019], sphere equivalent (OR = 0.89; 95% CI: 0.81– 0.98, P = 0.025), sleep time (OR = 0.53; 95% CI: 0.35–0.79, P = 0.002), and body mass index (OR = 0.93; 95% CI: 0.86–0.99, P = 0.047). In the multivariable linear regression models, spectacle power (β = −0.43; 95% CI: −0.68 to −0.19, P = 0.001) and sphere equivalent (β = −0.36; 95% CI: −0.60 to −0.11, P = 0.005) were negatively associated with anxiety scores, whereas axial length (β = 0.54; 95% CI: 0.02–1.07, P = 0.044) was positively correlated with anxiety scores. Every 1 h decrease in sleep time was associated with a 0.12-point increase in depression score. Conclusion: Myopia was associated with anxiety and anxiety scores. The greater the degree of myopia, the higher the anxiety score. However, myopia was not found to be associated with depression. The results highlight the importance of providing psychological support to students with myopia during the COVID-19 pandemic.
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Affiliation(s)
- Hongmei Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Huijuan Gao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yun Zhu
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
| | - Ying Zhu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Weiyu Dang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Ruihua Wei
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
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Rong R, Chen W, Dai Z, Gu J, Chen W, Zhou Y, Kuang M, Xiao H. Improvement of the management of mental well-being and empathy in Chinese medical students: a randomized controlled study. BMC MEDICAL EDUCATION 2021; 21:378. [PMID: 34246265 PMCID: PMC8272356 DOI: 10.1186/s12909-021-02813-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 06/28/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Among Chinese medical students, there is a high prevalence of mental health-related issues and low empathy. Effective strategies to improve this situation are lacking. This study aims to investigate the efficacy of the intervention courses designed to enhance the mental health and empathy of senior Chinese medical students. METHODS A total of 146 3rd - and 4th -year medical students were randomized to an intervention group (n = 74) and a control group (n = 72). A pilot study including 5 pre-clinical students and 5 interns was first carried out to determine the themes and content of the intervention courses. The designed courses were delivered in the intervention group once a month three times, while the control group had no specific intervention. Five self-assessment questionnaires, including the General Self-Efficacy (GSE) scale, Medical Outcomes Study Short Form 8 (SF-8), Patient Health Questionnaire-9 (PHQ-9), Maslach Burnout Inventory (MBI), and Jefferson Scale of Empathy-Health Care Provider Student version (JSE-HPS), were completed by the students before and one month after the courses to evaluate their levels of self-efficacy (SE), quality of life (QoL), depression, burnout, and empathy, respectively. Qualitative data were collected via e-mail two years after the intervention. RESULTS Compared to the control group, the intervention group showed significantly higher scores for empathy (111.0 [IQR 102.0, 118.0] vs. 106.0 [IQR 93.0, 111.5]; P = .01) and QoL (32.0 [IQR 28.0, 35.0] vs. 29.5 [IQR 26.0, 34.0]; P = .04). The rate of depression was significantly lower in the intervention group than in the control group (13.5 % vs. 29.2 %; chi-square test, P = .02). However, no significant differences in self-efficacy (25.6 ± 4.8 vs. 24.3 ± 6.3; P = .16) or burnout (27.0 % vs. 34.7 %; Chi-square test, P = .31) were observed between the two groups. CONCLUSIONS The intervention courses had a positive impact on mental well-being and empathy in senior Chinese medical students, which might help provide novel information for their incorporation into the medical school curriculum. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02645643; Date of registration: 05/01/2016.
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Affiliation(s)
- Rong Rong
- Clinical Trials Unit, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Wei Chen
- Department of Nephrology, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Zihao Dai
- Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Jingli Gu
- Department of Hematology, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Weiying Chen
- Department of Diagnostics, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Yanbin Zhou
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Ming Kuang
- Department of Medical Education, Department of Liver Surgery, College of Basic Surgery, Zhongshan School of Medicine, the First Affiliated Hospital, Sun Yat-sen University, No.58, Zhongshan Road 2, 510080, Guangzhou, People's Republic of China.
| | - Haipeng Xiao
- Department of Medical Education, Department of Endocrinology, Zhongshan School of Medicine, the First Affiliated Hospital, Sun Yat-sen University, No.58, Zhongshan Road 2, 510080, Guangzhou, People's Republic of China.
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Jin T, Sun Y, Wang H, Qiu F, Wang X. Prevalence of depression among Chinese medical students: A systematic review and meta-analysis. PSYCHOL HEALTH MED 2021; 27:2212-2228. [PMID: 34232090 DOI: 10.1080/13548506.2021.1950785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The prevalence of depression continues to increase among medical students in China, and higher than that of other majors, which is a potential risk for medical students and their patients. This study aimed to observe the prevalence of depression in Chinese medical students and also the correlation between them. All cross-sectional studies on the prevalence of depression in Chinese medical students were retrieved from PubMed, Embase, the Cochrane Database of Systematic Reviews, CNKI, and Wanfang. An 11-item checklist recommended by the Agency for Healthcare Research and Quality was adopted to evaluate the methodological quality of the included studies. Software Stata 12.0 was used to analyze the data. Registration: PROSPERO, CRD42020169681. The prevalence of depression among medical students in China was 27%. The subgroup analysis showed significant differences in the prevalence of depression in different regions. The sleep quality was a significant heterogeneous source of depression. Medical students with sleep disorders were more than three times as likely to report depression. The prevalence of depression in Chinese medical students is relatively high, and medical students with sleep disorders are more likely to have depression problems. Regular screening and appropriate intervention are recommended for these mental health problems.
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Affiliation(s)
- Tao Jin
- Department of Internal Medicine, Shuguang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Cardiovascular Department, Cardiovascular Research Institute of Traditional Chinese Medicine, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuanlong Sun
- Department of Internal Medicine, Shuguang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huiying Wang
- Cardiovascular Department, Cardiovascular Research Institute of Traditional Chinese Medicine, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fei Qiu
- Department of Internal Medicine, Shuguang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaolong Wang
- Cardiovascular Department, Cardiovascular Research Institute of Traditional Chinese Medicine, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Meng N, Liu Z, Wang Y, Feng Y, Liu Q, Huang J, Li X. Beyond Sociodemographic and COVID-19-Related Factors: The Association Between the Need for Psychological and Information Support from School and Anxiety and Depression. Med Sci Monit 2021; 27:e929280. [PMID: 33824264 PMCID: PMC8040519 DOI: 10.12659/msm.929280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 02/23/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In addition to sociodemographic and COVID-19- related factors, the needs of school support, including material, psychological and information support, have seldom been discussed as factors influencing anxiety and depression among college students during the COVID-19 pandemic. MATERIAL AND METHODS In this cross-sectional study, 3351 college students from China were surveyed through questionnaires about their sociodemographic and COVID-19 characteristics, the needs of school support, and their experiences with anxiety and depression. RESULTS Anxiety and depression were reported by 6.88% and 10.50% of students, respectively. Married, higher education, non-medical, and urban students had significantly higher risks of anxiety or depression. Additionally, symptoms such as cough and fever, especially when following a possible contact with suspected individuals, quarantine history of a personal contact, going out 1-3 times a week, not wearing a mask, and spending 2-3 hours browsing COVID-19-related information were significantly associated with the occurrence of anxiety or depression. Those who used methods to regulate their emotional state, used a psychological hotline, and who had visited a psychiatrist showed higher anxiety or depression. Those who used online curricula and books, used preventive methods for COVID-19, and who had real-time information about the epidemic situation of the school showed lower anxiety and depression. CONCLUSIONS In addition to sociodemographic and COVID-19-related aspects, students' needs for psychological assistance and information from schools were also associated with anxiety and depression among college students.
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Affiliation(s)
- Na Meng
- Mental Health Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zheng Liu
- Department of Nursing, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Ya Wang
- Department of Nursing, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Yan Feng
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Qin Liu
- Integration of Traditional Chinese Medicine and Western Medicine, Nanchong Central Hospital, Nanchong, Sichuan, P.R. China
| | - Junqiang Huang
- Department of Psychiatry, Chengdu Dekang Hospital, Chengdu, Sichuan, P.R. China
| | - Xiaolin Li
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
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10
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Chang Q, Xia Y, Bai S, Zhang X, Liu Y, Yao D, Xu X, Zhao Y. Association Between Pittsburgh Sleep Quality Index and Depressive Symptoms in Chinese Resident Physicians. Front Psychiatry 2021; 12:564815. [PMID: 34149465 PMCID: PMC8206480 DOI: 10.3389/fpsyt.2021.564815] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/11/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Previous studies have suggested that sleep quality is associated with depressive symptoms. However, associations between overall sleep quality and depressive symptoms in Chinese resident physicians remain unclear. Therefore, we aimed to determine whether overall sleep quality is associated with depressive symptoms in Chinese resident physicians. Methods: This cross-sectional study included 1,230 resident physicians. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression analysis was applied to estimate the associations between the PSQI and PHQ-9. Results: Among all participants, the prevalence of mild (PHQ-9 ≥ 5) and moderate or severe (PHQ-9 ≥ 10) depressive symptoms were 48.28 and 12.93%, respectively. PSQI score was positively associated with PHQ-9 score before and after adjustments of socio-demographic, behavioral, and psychologic confounding factors (all P < 0.0001). After adjustments, the regression coefficients (standard error) between PSQI scores and PHQ-9 scores were 0.95 (0.04), 0.88 (0.09), and 0.96 (0.05) in all participants, men, and women, respectively. Compared to physicians with good sleep quality (PSQI scores ≤ 5), the adjusted odds ratios (ORs) [95% confidence intervals (CIs)] for mild (PHQ-9 ≥ 5) and moderate or severe (PHQ-9 ≥ 10) depressive symptoms in physicians with poor sleep quality were 7.15 (5.44, 9.46) and 6.17 (4.03, 9.71) in all participants, respectively. Conclusions: Our findings suggest that poor sleep quality was associated with a higher prevalence of depressive symptoms in Chinese resident physicians.
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Affiliation(s)
- Qing Chang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Xia
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Song Bai
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xi Zhang
- Department of Graduate Medical Education, Health Service Center of Liaoning Province, Shenyang, China
| | - Yashu Liu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Da Yao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xinrui Xu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuhong Zhao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
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Wang ZH, Yang HL, Yang YQ, Liu D, Li ZH, Zhang XR, Zhang YJ, Shen D, Chen PL, Song WQ, Wang XM, Wu XB, Yang XF, Mao C. Prevalence of anxiety and depression symptom, and the demands for psychological knowledge and interventions in college students during COVID-19 epidemic: A large cross-sectional study. J Affect Disord 2020; 275:188-193. [PMID: 32734907 PMCID: PMC7330560 DOI: 10.1016/j.jad.2020.06.034] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although studies have suggested experiencing the epidemic of severe infectious diseases increased the prevalence of mental health problems, the association between COVID-19 epidemic and risk of anxiety and depression symptom in college students in China was unclear. METHODS A large cross-sectional online survey with 44,447 college students was conducted in Guangzhou, China. The Zung's Self-rating Anxiety Scale (SAS) and the Center for Epidemiologic Studies Depression Scale (CES-D Scale) were used to define the anxiety and depression symptom, respectively. Multivariable logistic regression models were used to analyze the association between COVID-19 epidemic and risk of anxiety and depression symptom. RESULTS The prevalence of anxiety and depression symptom was 7.7% (95% confidence interval [CI]: 7.5%, 8.0%) and 12.2% (95%CI: 11.9%, 12.5%), respectively. Compared with students who reported have not infected or suspected cases in family members and relatives, students who reported having confirmed (OR=4.06; 95%CI: 1.62, 10.19; P = 0.003), and suspected (OR=2.11; 95%CI: 1.11, 4.00; P = 0.023) cases in family members and relatives had higher risk of depression symptom. Additionally, the proportions of students with anxiety and depression symptom reported more demand of psychological knowledge and interventions than those without (P<0.001). LIMITATIONS All the data in this study was collected through online questionnaire, and we did not evaluate the reliability and validity. CONCLUSIONS The prevalence of anxiety and depression symptom was relatively low in college students, but the COVID-19 epidemic-related factors might be associated with higher depression symptom risk.
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Affiliation(s)
- Zheng-He Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Hai-Lian Yang
- Department of Preventive Health, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, China
| | - Yun-Qing Yang
- Department of Preventive Health, Guangzhou Institute of Dermatology, Guangzhou, Guangdong, China
| | - Dan Liu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhi-Hao Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xi-Ru Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Yu-Jie Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Dong Shen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Pei-Liang Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Wei-Qi Song
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiao-Meng Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xian-Bo Wu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xing-Fen Yang
- Food Safety and Health Research Center, School of Public Health, Southern Medical University, Guangdong, China.
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China.
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Akhtar P, Ma L, Waqas A, Naveed S, Li Y, Rahman A, Wang Y. Prevalence of depression among university students in low and middle income countries (LMICs): a systematic review and meta-analysis. J Affect Disord 2020; 274:911-919. [PMID: 32664032 DOI: 10.1016/j.jad.2020.03.183] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/08/2020] [Accepted: 03/29/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Though university years are peak time for the onset of many mental health problems including depression, knowledge on the prevalence of depressive symptoms among university students in low and middle-income countries (LMICs) is limited. This study examined the prevalence of depressive symptoms among university students in LMICs. METHODS We systematically searched PubMed, Web of Science, and WHO Global Health Library for studies published between January 1, 2009 and December 31, 2018. Cross-sectional and longitudinal studies conducted in LMICs (as defined by World Bank), having a sample size≥500 and published in English were identified. Data on study characteristics and prevalence of depressive symptoms was extracted by two investigators. Estimate of prevalence was pooled in meta-analysis using random-effects meta-analysis. Sub-group differences were estimated using mixed-effects meta-analysis and meta-regression. RESULTS Depressive symptoms prevalence data were extracted from 37 studies involving 76,608 individuals in 20 countries. Studies on depression among university students in LMICs were limited, and most were based on non-representative and small study samples. The overall prevalence of depressive symptoms was 24.4% (95% CI, 19.2% -30.5%). Subgroup analysis revealed that the prevalence did not vary by study design, sampling technique, sample size, study major, educational level, economic regions, and screening instrument. LIMITATIONS Only English language studies were included. Included studies were diverse in design, screening tool, and sample size that introduced substantial heterogeneity. CONCLUSION Overall prevalence of depressive symptoms among university students in LMICs was 24.4%, however, finding should be interpreted with caution. Further research is needed to address the issue.
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Affiliation(s)
- Parveen Akhtar
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Shaanxi, China
| | - Lu Ma
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Shaanxi, China
| | - Ahmed Waqas
- Human Development Research Foundation, Pakistan
| | - Sadiq Naveed
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Yixuan Li
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Shaanxi, China
| | - Atif Rahman
- Institute of Life and Human Sciences, University of Liverpool, Liverpool, UK
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Shaanxi, China; Fisher Institute of Health and Well-Being, Department of Nutrition and Health Sciences, College of Health, Ball State University, Muncie, IN, USA..
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Guo J, Meng D, Ma X, Zhu L, Yang L, Mu L. The impact of bedtime procrastination on depression symptoms in Chinese medical students. Sleep Breath 2020; 24:1247-1255. [PMID: 32415501 DOI: 10.1007/s11325-020-02079-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/05/2020] [Accepted: 04/04/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE Depression symptoms are closely related to inadequate sleep and are experienced by medical students at an increased rate. Bedtime procrastination is considered a new, important predictor of sleep deficiency. However, whether there is a correlation between bedtime procrastination and depression symptoms remains unclear. This study aimed to examine the impact of bedtime procrastination on depression symptoms among medical students. METHODS A total of 419 Chinese medical students were invited to participate in this study, and 401 participants (mean age, 19.48 years; range, 17-23 years) were included in the final statistical analysis. Depression symptoms and bedtime procrastination were assessed using the Beck Depression Inventory-II (BDI-II) and the Bedtime Procrastination Scale (BPS), respectively. RESULTS The prevalence of depression symptoms in Chinese medical students was 26.9%. The mean BPS scores were significantly higher in the depressed group than in the non-depressed group. Binary logistic regression analysis identified that bedtime procrastination was an independent contributor to the prevalence of depression symptoms. Further correlation and multiple linear regression analyses demonstrated that the BDI scores were significantly and positively associated with the BPS scores in students without depression, while the BDI scores correlated with male students experiencing depression. CONCLUSIONS Depression symptoms, which become more prevalent among Chinese medical students, are found to independently associate with bedtime procrastination. In particular, the severity of depression symptoms shows a positive correlation with increased bedtime procrastination before developing into depression, and it shows correlation with sex only in a state of depression.
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Affiliation(s)
- Jing Guo
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, No. 850 Huanghe Road, Shahekou District, Dalian, 116029, Liaoning Province, China
| | - Dexin Meng
- Department of Physiology, Jiamusi University, Jiamusi, China
| | - Xiaohan Ma
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, No. 850 Huanghe Road, Shahekou District, Dalian, 116029, Liaoning Province, China
| | - Liwei Zhu
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, No. 850 Huanghe Road, Shahekou District, Dalian, 116029, Liaoning Province, China
| | - Limin Yang
- School of Medicine, Dalian University, Dalian, China
| | - Li Mu
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, No. 850 Huanghe Road, Shahekou District, Dalian, 116029, Liaoning Province, China.
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Tang W, Kang Y, Xu J, Li T. Associations of Suicidality with Adverse Life Events, Psychological Distress and Somatic Complaints in a Chinese Medical Student Sample. Community Ment Health J 2020; 56:635-644. [PMID: 31919657 DOI: 10.1007/s10597-019-00523-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/09/2019] [Indexed: 02/05/2023]
Abstract
The present study aimed to examine the associations of suicidality with psychological distress, somatic symptoms, and stressors in medical school students. We conducted a cross-sectional survey of medical students at a large, top-ranked medical school. A total sample of 662 medical students (269 men) completed a battery of self-reported questionnaire. Of the respondents, 136 (20.5%) reported having suicidal ideation, 40 (6.0%) reported having planned suicide, and 10 (1.5%) reported having attempted suicide during the previous year. Students from rural areas and the 3rd year of study reported higher levels of suicidal ideation than their counterparts. General pain/fatigue was associated with suicidal ideation and planning, while interpersonal difficulties were associated only with suicidal ideation. This study provides evidence linking severe psychological distress, general pain/fatigue, interpersonal stress and psychosocial factors with suicide risk among Chinese medical students which provides targets for future psychological interventions.
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Affiliation(s)
- Wanjie Tang
- Centre for Educational and Health Psychology, Sichuan University, Chengdu, China
- Institute of Emergency Management and Post-disaster Reconstruction, Sichuan University, Chengdu, China
- Mental Health Center, State Key Lab of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yukun Kang
- Mental Health Center, State Key Lab of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Jiuping Xu
- Institute of Emergency Management and Post-disaster Reconstruction, Sichuan University, Chengdu, China.
| | - Tao Li
- Centre for Educational and Health Psychology, Sichuan University, Chengdu, China.
- Mental Health Center, State Key Lab of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
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Thiemann P, Brimicombe J, Benson J, Quince T. When investigating depression and anxiety in undergraduate medical students timing of assessment is an important factor - a multicentre cross-sectional study. BMC MEDICAL EDUCATION 2020; 20:125. [PMID: 32326926 PMCID: PMC7181528 DOI: 10.1186/s12909-020-02029-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/01/2020] [Indexed: 05/30/2023]
Abstract
BACKGROUND Symptoms of depression and anxiety experienced by undergraduate medical students have become a prominent concern. Evidence about students' depression and anxiety including prevalence, trajectory during medical education, gender differences and comparisons with age-matched peers is conflicting. However few studies of medical students' mental health specify the precise time of assessment. Proximity to examinations may be relevant. Precise identification of the time of data collection might help explain contradictory findings and facilitate provision of more timely support. METHODS This study addressed whether: 1)Proximity of final examinations affected students' depression and anxiety symptoms2)Males and females differed in this respect. We analysed data provided by 446 final year students from 6 UK medical schools. These students were a subset of data provided by 14 UK medical schools which participated in an online survey comparing first and final year students and in which final year response rates exceeded 30%. We used the Hospital Anxiety and Depression Scale to assess symptoms of depression and anxiety and the norms to indicate potentially clinically relevant cases. We grouped students into those for whom final exams were imminent i.e. within 2 months of completing the survey (n = 164) and those for whom exams were more distant or had been taken (n = 282). We used parametric and non-parametric tests to compare both groups and gender differences in respect of depression and anxiety sum scores and cases rates. RESULTS For both depression and anxiety male and female students facing imminent final exams recorded greater prevalence and significantly higher mean scores. The effect size of differences for anxiety were large. No substantial gender differences were found for depression. Regardless of the timing of final exams female students recorded both significantly higher mean scores and clinically relevant rates for anxiety. CONCLUSIONS Proximity to final exams negatively affected the mental health of both male and female final year students. The study suggests that there may be times in the undergraduate medical curriculum when additional or targeted support is needed. It also highlights the need for research to provide a greater specificity of context when investigating medical students' mental health.
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Affiliation(s)
- Pia Thiemann
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - James Brimicombe
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - John Benson
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thelma Quince
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Escobar-Padilla B, Márquez-González H, Consejo Y Chapela C, López-Sepúlveda AC, Sepúlveda Vildósola AC. Social Violence Increases the Risk of Suicidal Ideation Among Undergraduate Medical Students. Arch Med Res 2020; 50:577-586. [PMID: 32066037 DOI: 10.1016/j.arcmed.2020.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Depression is highly prevalent worldwide, and may have fatal consequences. Violence is associated to psychopathology and has exponentially increased in some areas of Mexico. Healthcare professionals are vulnerable to increased anxiety, depression, suicide and lately, to violence by organized crime. The aim of the study was to determine the prevalence of anxiety/depression/suicidal ideation and the weight of social violence as a risk factor. METHODS Cross sectional study in three generations of undergraduate medical students at entry to internship year in our institution. All students voluntarily agreed to participate. All of them answered Beck and HAM-A. Two generations also responded Plutchik suicidal risk inventory. Sex, type of university and degree of violence in their geographic areas were also recorded. Prevalence rates were calculated for each outcome. χ2 tests and odds ratio (OR) for bivariate analysis, and Mantel-Hanezel to adjust according to level of violence. RESULTS All of the eligible students responded the anxiety and inventories (n = 8,858), and 6,451 also responded the suicide risk test. Overall, 37.2% displayed severe anxiety, 14.9% moderate/severe depression and 8.5% suicidal ideation. Female sex and private university increased the risk for anxiety and depression. High violence, severe anxiety or depression increased the risk for suicidal ideation. Adjusted by violence zone, female sex, being single and the coexistence of depression were associated with a higher risk for suicidal ideation. CONCLUSIONS Anxiety, depression and suicidal ideation are highly prevalent among premedical interns in Mexico. Living in highly violent areas significantly increases the risk for anxiety/depression/suicidal ideation.
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Affiliation(s)
- Beatriz Escobar-Padilla
- Coordinación de Educación en Salud, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Horacio Márquez-González
- Unidad Médica de Alta Especialidad, Hospital de Cardiología, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Carolina Consejo Y Chapela
- Coordinación de Educación en Salud, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Ana Carolina Sepúlveda Vildósola
- Unidad de Educación, Investigación y Políticas de Salud, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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Meng J, Gao C, Tang C, Wang H, Tao Z. Prevalence of hypochondriac symptoms among health science students in China: A systematic review and meta-analysis. PLoS One 2019; 14:e0222663. [PMID: 31527902 PMCID: PMC6748570 DOI: 10.1371/journal.pone.0222663] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 09/04/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypochondriac symptoms are commonly reported in health science students. With their incomplete medical knowledge, they may compare their own bodily symptoms with disease symptoms during the process of learning, which can lead to mental distress and the need for repeated medical reassurance. OBJECTIVE To estimate the prevalence of hypochondriac symptoms in Chinese health science students. METHODS A systematic literature search was conducted on PubMed, Web of Science, Embase, China National Knowledge Infrastructure, China Biology Medicine disc, and Wanfang Data on July 1, 2018. Additionally, the references of the retrieved papers were searched. Cross-sectional studies published in either English or Chinese that reported the prevalence of hypochondriac symptoms in health science students were included. The selection process was executed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and study quality was assessed with the checklist recommended by the Agency for Healthcare Research and Quality for cross-sectional studies. A random-effects model according to the DerSimonian-Laird method was used to calculate the pooled prevalence. RESULTS Seven cross-sectional studies involving 6,217 Chinese health science students were included. The pooled prevalence of hypochondriac symptoms among health science students was 28.0% (95% CI = 19.0%-38.0%). The symptoms were a little more common in females (30.0%, 95% CI = 19.0%-42.0%) than in males (29.0%, 95% CI = 16.0%-42.0%), but the difference was not significant. No significant differences were found between participants grouped by study year. Only three studies explored the coping styles of students with hypochondriasis, and these revealed a high tendency toward help-seeking behaviors. CONCLUSION Our systematic review and meta-analysis showed a high prevalence of hypochondriac symptoms among health science students, indicating that it is a noteworthy phenomenon. We suggest that counseling and other support services are necessary for health science students.
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Affiliation(s)
- Jingjing Meng
- Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Chang Gao
- Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Chulei Tang
- Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Honghong Wang
- Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Zirong Tao
- Xiangya Hospital, Central South University, Changsha, Hunan, China
- * E-mail:
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18
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Mao Y, Zhang N, Liu J, Zhu B, He R, Wang X. A systematic review of depression and anxiety in medical students in China. BMC MEDICAL EDUCATION 2019; 19:327. [PMID: 31477124 PMCID: PMC6721355 DOI: 10.1186/s12909-019-1744-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/05/2019] [Indexed: 05/16/2023]
Abstract
BACKGROUND Medical students in China face severe depression and anxiety because of their difficult circumstances, such as the long length of schooling, academic pressure, and the stress of clinical practice. Although there have been many empirical studies about depression or anxiety in medical students in China, no previous studies have conducted a related systematic review about this topic in English. This analysis can convey the general findings from China to other areas of the world. METHODS A systematic review and meta-analysis of depression or anxiety in medical students and related determinants were conducted. Three Chinese and three English databases were searched for the review, with no restrictions on language. Articles published between January 1, 2000 and April 1, 2018 were included. RESULTS Twenty-one articles investigating a total of 35,160 individual Chinese medical students were included in this review. The prevalence of depression ranged from 13.10 to 76.21% with a mean of 32.74%, and the prevalence of anxiety ranged from 8.54 to 88.30% with a mean of 27.22%. Based on the meta-analysis, gender, grade level, residence, satisfaction with current major and monthly household income per capita were significantly associated with depression. Grade level and satisfaction with current major were significantly associated with anxiety. Other risk factors were identified and described using a narrative approach. CONCLUSION The mean prevalence of depression was 32.74% amongst medical students in China, whereas the mean prevalence of anxiety was 27.22%. The determinants of depression and anxiety included individual factors, social and economic factors, and environmental factors. More measures should be taken towards at-risk medical students based on the identified risk factors.
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Affiliation(s)
- Ying Mao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, 710049 China
| | - Ning Zhang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, 710049 China
| | - Jinlin Liu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, 710049 China
| | - Bin Zhu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, 710049 China
- Department of Public Policy, City University of Hong Kong, Hong Kong, 999077 China
| | - Rongxin He
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, 710049 China
| | - Xue Wang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, 710049 China
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Sleep duration and self-rated health in Chinese university students. Sleep Breath 2019; 23:1351-1356. [DOI: 10.1007/s11325-019-01856-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/17/2019] [Accepted: 04/23/2019] [Indexed: 01/01/2023]
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Zeng W, Chen R, Wang X, Zhang Q, Deng W. Prevalence of mental health problems among medical students in China: A meta-analysis. Medicine (Baltimore) 2019; 98:e15337. [PMID: 31045774 PMCID: PMC6504335 DOI: 10.1097/md.0000000000015337] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The prevalence of mental health problems in medical students has continuously increased and is higher than the prevalence of mental health problems in students with other majors, which could lead to undesirable consequences for the students and their future patients. In China, the current states of medical education and healthcare workplaces differ in certain areas from those in Western or other Asian countries. However, the mental health status of Chinese medical students has not been systematically analyzed. OBJECTIVES The purpose of this meta-analysis was to summarize the prevalence of mental health problems in Chinese medical students. METHODS All cross-sectional studies that investigated the prevalence of any mental health problem among Chinese medical students were retrieved from the following databases: EMBASE, PubMed, PsycINFO, OVID, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. We accepted each individual trial's inclusion and exclusion criteria for participants. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was adopted to appraise the methodological quality of each study. RevMan (version 5.3) was used to analyze the data. RESULTS Ten cross-sectional studies involving a total of 30,817 Chinese medical students were included. The prevalence of depression, anxiety, suicidal ideation, and eating disorders were 29%, 21%, 11%, and 2%, respectively. Subgroup analysis revealed no significant differences in the prevalence of depression and suicidal ideation between genders and no significant difference in the prevalence of depression between individuals of different ages (20 years and older or younger than 20 years). CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Chinese medical students have relatively high prevalence of depression, anxiety, and suicidal ideation but a low prevalence of eating disorders. Mental health problems in Chinese medical students should be taken seriously, and timely screening of and proper intervention in these mental health problems are highly recommended.
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Affiliation(s)
- Wen Zeng
- Department of Graduate Medical Education
| | | | | | - Qin Zhang
- Department of Graduate Medical Education
| | - Wei Deng
- Department of Psychiatry and Psychiatric Laboratory, West China Brain Research Centre, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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James BO, Thomas IF, Omoaregba JO, Okogbenin EO, Okonoda KM, Ibrahim AW, Salihu AS, Oshodi YO, Orovwigho A, Odinka PC, Eze GO, Onyebueke GC, Aweh BE. Psychosocial correlates of perceived stress among undergraduate medical students in Nigeria. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2017; 8:382-388. [PMID: 29083991 PMCID: PMC5694700 DOI: 10.5116/ijme.59c6.3075] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 09/23/2017] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To assess the prevalence and factors associated with perceived stress among medical students. METHODS A cross-sectional study of students (n=623) selected across eight medical schools in Nigeria. A structured questionnaire obtained socio-demographic characteristics, alcohol use (Alcohol Use Disorders Identification Test), other psychoactive drug use (Drug Abuse Screening Test), anxiety/depression symptoms (Hospital Anxiety Depression Scale) and stress (Perceived Medical School Stress Scale). We performed bivariate analysis using the chi-squared test, t-test and one-way ANOVA, with multiple regression analysis for multivariate testing in analysing the data. RESULTS Most students reported experiencing medical school stress. Female participants were more likely to perceive medical school as competitive (t(621)=1.17, p=0.003), less likely to see medical school as a threat (t(621)=-2.70, p=0.01) or worry about finances (t(621)=-4.80, p=0.001). Nearly a quarter; 21.3% (n=133) and 28.6% (n=178) reported depression and anxiety symptoms respectively. Approximately 4.2% (n=26) were dependent on alcohol, while 14.1% (n=88) had 'low-risk use' for other psychoactive substances. In the multiple regression model, lack of finance (B=2.881, p=0.001), weak adherence to religious faith (B=2.376, p=0.001), anxiety symptoms (B=-2.231, p=0.002), problematic alcohol use (B=5.196, p=0.001) and choice of study influenced by parents (B=-3.105, p=0.001) were predictors of greater perceived stress. CONCLUSIONS Medical students in Nigeria report high levels of stress. Incorporating stress reduction strategies in the medical curriculum, and the input of students in providing feedback regarding the methods and styles of undergraduate medical education is required.
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Affiliation(s)
- Bawo O. James
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Benin City, Nigeria
| | | | - Joyce O. Omoaregba
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Benin City, Nigeria
| | - Esther O. Okogbenin
- Department of Psychiatry, College of Medicine, Ambrose Alli University, Ekpoma, Edo State, Nigeria
| | | | - Abdu W. Ibrahim
- Department of Mental Health, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria
| | | | - Yewande O. Oshodi
- Department of Psychiatry, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - Andrew Orovwigho
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Enugu, Enugu State, Nigeria
| | - Paul C. Odinka
- Department of Psychological Medicine, College of Medicine, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - George O. Eze
- University of Sierra Leone Teaching Hospital, Freetown, Sierra Leone
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Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, Sen S, Mata DA. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA 2016; 316:2214-2236. [PMID: 27923088 PMCID: PMC5613659 DOI: 10.1001/jama.2016.17324] [Citation(s) in RCA: 1124] [Impact Index Per Article: 140.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies. OBJECTIVE To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students. DATA SOURCES AND STUDY SELECTION Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included. DATA EXTRACTION AND SYNTHESIS Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. MAIN OUTCOMES AND MEASURES Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview. RESULTS Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, -0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%. CONCLUSIONS AND RELEVANCE In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.
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Affiliation(s)
- Lisa S Rotenstein
- Harvard Medical School, Boston, Massachusetts2Harvard Business School, Boston, Massachusetts
| | - Marco A Ramos
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Matthew Torre
- Harvard Medical School, Boston, Massachusetts4Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Michael J Peluso
- Harvard Medical School, Boston, Massachusetts5Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Srijan Sen
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor8Department of Psychiatry, University of Michigan, Ann Arbor
| | - Douglas A Mata
- Harvard Medical School, Boston, Massachusetts9Division of MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts10Brigham Education Institute, Boston, Massachusetts
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Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, Sen S, Mata DA. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA 2016. [PMID: 27923088 DOI: 10.1001/jama.2016.17324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies. Objective To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students. Data Sources and Study Selection Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included. Data Extraction and Synthesis Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Main Outcomes and Measures Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview. Results Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, -0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%. Conclusions and Relevance In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.
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Affiliation(s)
- Lisa S Rotenstein
- Harvard Medical School, Boston, Massachusetts2Harvard Business School, Boston, Massachusetts
| | - Marco A Ramos
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Matthew Torre
- Harvard Medical School, Boston, Massachusetts4Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Michael J Peluso
- Harvard Medical School, Boston, Massachusetts5Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Srijan Sen
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor8Department of Psychiatry, University of Michigan, Ann Arbor
| | - Douglas A Mata
- Harvard Medical School, Boston, Massachusetts9Division of MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts10Brigham Education Institute, Boston, Massachusetts
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