COVID-19 Experiences and Mental Health Among Graduate and Undergraduate Nursing Students in Los Angeles

Mental Health of Nursing Students: A Bibliometric Review Based on CiteSpace Visual Analysis

Background: The mental health of nursing students directly affects their future performance, quality of patient care, and personal development. Therefore, an in-depth understanding of research in this area can assist in implementing effective measures to improve the mental health of nursing students. Aim: This study used bibliometric analyses to identify and analyze articles, authors, journals, and research institutes investigating nursing students' mental health in terms of thematic structure and topic evolution, aiming to provide direction and guidance for future research. Methods: In this retrospective bibliometric analysis, data were downloaded from the Web of Science Core Collection on August 15, 2024. Subsequently, CiteSpace software was employed to analyze the annual number of publications and citations, explore relationships between authors, institutions, countries, and keywords, and summarize research hotspots and frontiers in the field of nursing students' mental health. Results: Articles published from database inception to August 15, 2024, were screened, leading to the retrieval of 3803 relevant articles. The United States of America was the leading country in terms of research output on the mental health of nursing students, with 982 (25.79%) published articles, while the United States Department of Health and Human Services provided the most funding. Furthermore, Happell, B was the most productive author in this field, with 80 published papers. Lastly, Nurse Education Today was the most prolific journal in nursing education. Conclusion: The main recent research trends include the psychological profile of nursing students, intervention strategies for improving the mental health of nursing students, and the influence of educational methods, clinical experience, and humanistic care on the mental health of nursing students. These trends imply that researchers should develop targeted training programs, apply information technology, and implement personalized teaching to enhance the psychological resilience of the nursing student population. Moreover, higher education institutions should provide nursing students with more comprehensive and effective mental health support by maintaining mental health files, strengthening mental health education, providing psychological counseling services, and establishing social support systems.

Relationship of negative life events with depression and anxiety in nursing students: a moderated mediation model of resilience and gender

BACKGROUND

Compared to ordinary student in the same age group, nursing students experience notably higher rates of depression and anxiety. Negative life events (NLEs) and resilience were recognized as risk factors and protective factors, respectively. There is little literature on the complex interaction of these factors among nursing students.

OBJECTIVES

The study aims to explore the potential relationship of NLEs, resilience, and gender with symptoms of depression and anxiety among nursing students.

METHODS

A cross-sectional design was used for this study. A total of 568 participants from three universities in East, South and North China were recruited. Data collection instruments included socio-demographic characteristics, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder Scale, the 10-item Connor-Davidson Resilience Scale, the Adolescent Life Events Self-Rating Scale, and The Pittsburgh Sleep Quality Index. A moderated mediation model was used to analyze the data.

RESULTS

NLEs and resilience significantly related to depression and anxiety (r = -0.289 ~ 0.454, all ps < 0.01). NLEs had a direct effect on depression (B = 0.251, p < 0.001) and anxiety (B = 0.307, p < 0.001). Analysis of mediating effects revealed that NLEs influenced depression (B = 0.02, 95% CI : 0.004-0.041) and anxiety (B = 0.019, 95% CI : 0.004-0.040) through resilience pathways. Additionally, gender was found to have a moderating effect on the direct association of NLEs with anxiety (B = -0.031, p < 0.05), with males showing a greater association.

CONCLUSIONS

The findings suggest that improving resilience may help break the relationship of NLEs with depression and anxiety in nursing students. Additionally, the mental health of male nursing students needs more attention.

Utilizing digital technologies to promote well-being in university students: the 'DigiWell' research protocol

The COVID-19 pandemic has significantly impacted the well-being of university students, particularly those in healthcare and medical programs. Psychological interventions rooted in positive psychology have proven effective in enhancing mental health, with online and digital delivery methods proving to be equally viable. This study aims to enhance mental health among Italian university students through digital interventions, including virtual reality, utilizing a stepped care approach. Specific objectives include implementing online positive interventions for students experiencing mild distress (DigiWell_Step 1), evaluating a Virtual-Reality intervention for moderate distress (DigiWell_Step 2), and identifying students experiencing high distress or optimal well-being. Cluster analyses and linear models will assess intervention outcomes. It is anticipated that students undergoing these steps will experience significant improvements in well-being and distress reduction, with sustained benefits at a three-month follow-up. This research contributes to understanding the efficacy of mental health interventions for university students, leveraging digital technologies to enhance accessibility and user engagement. The integration of digital technologies enhances the cost-effectiveness and engagement of interventions delivered through a stepped care approach tailored to the targeted population.

International students' perspectives on factors impacting psychological well-being and early help-seeking behaviours in undergraduate nursing programs

BACKGROUND

Studying in a foreign country can be accompanied by challenges, including difficulty understanding the curriculum, culture shock, and a new language. These additional challenges place international students at risk and predispose them to developing mental health problems compared to domestic student.

AIMS

This study explores psychological well-being and help-seeking behaviours of international nursing students who commenced their program onshore or in a remote learning capacity.

MATERIALS & METHODS

This paper reports the findings of the mixed-methods study. Research was conducted among international students enrolled in the Bachelor of Nursing programs across multiple campuses at two Victorian universities in 2022. Data was collected using a survey questionnaire with open-response questions and incorporated a validated Student Stress Survey.

RESULTS

Findings indicated that international students require support financially and to settle in Australia upon arrival. Participants highlighted that they require additional support to keep up with academic workloads and require further academic support tailored for international students. There was no patient or public contribution in the design, conduct, analysis or preparation of this manuscript.

DISCUSSION & CONCLUSION

Participants highlighted that they require additional support to keep up with academic workloads and require further academic support tailored for international students. There was no patient or public contribution in the design, conduct, analysis or preparation of this manuscript.

How did student district nurses feel during the COVID-19 pandemic? A qualitative study

BACKGROUND

The COVID-19 pandemic placed a huge strain on healthcare services around the world, including community services. Students also faced substantial disturbance to educational programmes. Student district nurses are usually employed members of staff and can be recalled to the workforce, whereas pre-registration students cannot.

AIMS

This paper explores the feelings and experiences of student district nurses during the first UK national lockdown of the COVID-19 pandemic. An interpretative phenomenological approach was taken.

METHOD

A semi structured 1:1 interview and focus group was held via zoom in July 2020. A total of eight student district nurses, who were all registered adult nurses, took part. Data was analysed using the Braun and Clarke model to identify themes.

RESULTS

The findings related to their experience of being a community adult registered nurse on the frontline, while also being a student district nurse. Three themes were identified from the analysis: anxiety and uncertainty, management of risk and teamwork.

CONCLUSION

This study highlights the contribution that community nurses made in the clinical response to the COVID-19 pandemic. It adds to a paucity of literature available from this clinical setting and specifically from the viewpoint of a student district nurse. There is much written on the strains on hospital care, but it should be remembered that district nursing is the service that never shuts its doors because it has reached capacity. This study found that a lack of communication and uncertainty about their future as students contributed to heightened stress and anxiety. Teamwork and camaraderie are a vital aspect of any team and one that can support resilience in times of heightened stress. A lack of face-to-face interaction can lead to team members feeling isolated. Digital technology can be used to reduce this feeling when possible.

Chinese college students' mental health during the first three months of the COVID-19 pandemic: the protective role of family functioning

Background

Various psychological theories suggest that a supportive family environment protects the mental health of young adults during stressful life events. However, evidence is limited regarding the protective role of family support during a major public health crisis.

Objective

To examine the role of family functioning on mental health among Chinese college students during first stage of the COVID-19 pandemic.

Methods

Between January-March 2020, 1,555 college students (44% female, on average 19 years old) from five Chinese universities participated. Participants rated their family functioning on the Family APGAR Index and their mental health on the Psychological Questionnaires for Emergent Events of Public Health, measuring depression, neurasthenia, fear, obsessive-anxiety and hypochondriasis.

Results

Better family functioning was associated with having fewer psychological symptoms. In addition, we identified three mental health profiles related to the severity across the psychological symptoms: Low-level, medium-level and high-level symptom clusters. Latent profile analysis showed that as family function improved, students were, respectively, 16 to 24% more likely to be in the low-level symptom group, compared to being in the medium symptom group or the high-level symptom group.

Conclusion

These results support the notion that family support may act as a psychological buffer for young adults during a large-scale public health crisis like the COVID-19 pandemic.

Can a PERMA model-based positive psychological intervention affect the SIA and SWB of vocational college students majoring in nursing in China?

Aims

The study was conducted to investigate the effects of a PERMA model-based positive psychological intervention on vocational college students' social interaction anxiety and subjective well-being.

Methods

This is an experimental study in which data were collected through self-administered questionnaire. A total of 261 students from four classes at Caofeidian College of Technology without differences in the levels of social interaction anxiety and subjective well-being were selected as the control group and intervention group randomly. Students in the control group received a traditional psychological intervention, while students in the invention group received a PERMA model-based positive psychological intervention. Thereafter, the research team collected data regarding students' social interaction anxiety and subjective well-being.

Results

Based on the result obtained, the mean score for social interaction anxiety in the invention group was significantly lower than those in the control group (42.95 vs. 53.07, p < 0.001) and the mean score for subjective well-being was significantly higher than those in the control group (92.58 vs. 87.26, p < 0.001).

Conclusion

A PERMA model-based positive psychological intervention can effectively relieve the social interaction anxiety of nursing students in vocational colleges, and improve their subjective well-being levels.

Help-Seeking Intentions for Depression from Mental Health Professionals Among Community-Dwelling Persons in Central China

Understanding the intention of community residents to seek help from mental health professionals (MHPs) is essential in targeting interventions that promote the prevention and treatment of depression. This study aimed to investigate the current status of Chinese community populations' depression help-seeking intentions from MHPs and explore factors influencing the intentions. Data were used from a survey conducted in a city in central China (n = 919 aged 38.68 ± 17.34, 72.1% female). Help-seeking intentions, help-seeking attitude, depression stigma, family function and depressive symptoms were measured. The total mean score on the intent to seek help from MHPs was 11.01 ± 7.78 and most of respondents were unwilling to seek professional help. Multiple linear regression showed that participants who were students, held a positive help-seeking attitude and had low personal stigma were more likely to have the intention to seek help from MHPs. It is necessary to utilize effective interventions to improve community residents' intention to seek professional help. These include promoting the importance of seeking professional assistance, optimizing the quality of mental health services and altering residents' prejudice to seeking professional help.

Addressing the Mental Health of Nursing Students During the Pandemic: The Evaluation of a Needs Assessment by a College of Nursing Mental Health Task Force

BACKGROUND

A Mental Health Task Force (MHTF) was developed in a large public college of nursing in the Southeastern United States to address the urgent mental health needs expressed by growing numbers of nursing students related to the coronavirus disease 2019 (COVID-19).

AIMS

The purpose of this study was to report on a needs assessment conducted by the MHTF.

METHODS

The needs assessment study design was a 16-item cross-sectional online survey and four "Town Hall" focus groups with nursing students, faculty, and staff (n = 1-8 participants per group). Survey data were analyzed using descriptive statistics and free-text questions from the survey and focus groups were analyzed using a qualitative descriptive approach.

RESULTS

Undergraduate and graduate students (n = 115) ranging in age from 17 to 50 years completed the survey; 95% female, 94% full-time, 56% employed, 77% White, and 81% in the Bachelor of Science in Nursing program. Eleven students participated in the focus groups. The analysis of the free-text survey questions identified the students' perceived needs. Mental health care was the most frequently requested, followed by faculty check-ins, stress management, and peer support.

CONCLUSIONS

The administration of the survey provided an opportunity for students to communicate concerns and make requests. To address the ongoing effects of the COVID-19 pandemic on nursing students, multi-modal needs assessments should be conducted periodically to identify priority mental health needs.

The impact of core self-evaluation on school adaptation of high school students after their return to school during the COVID-19 pandemic: the parallel mediation of positive and negative coping styles

Background

To explore the direct effect of core self-evaluation and the indirect effects of positive and negative coping styles on school adaptation of high school students after their return to school during the COVID-19 pandemic.

Methods

The Core Self-Evaluation Scale, Simple Coping Style Scale, and School Adaptation Questionnaire were used for the psychometric analysis of 500 high school students (229 males and 271 females) one month after their return to school. The bootstrap method was applied for mediation analysis.

Results

A positive correlation was noted between core self-evaluation and school adaptation (r = 0.56), and the predictive effect was significant (β = 0.43). Core self-evaluation positively predicted positive coping styles, which positively predicted school adaptation, while core self-evaluation negatively predicted negative coping styles, which negatively predicted school adaptation. Positive and negative coping styles played a significant mediating role between core self-evaluation and school adaptation. The mediating effect included the indirect effects generated by two pathways: core self-evaluation → positive coping style → school adaptation (95% CI [0.08-0.19]) and core self-evaluation → negative coping style → school adaptation (95% CI [0.03-0.11]).

Conclusion

There is a positive association between the core self-evaluation and school adaptation of high school students after their return to school during the COVID-19 pandemic. It may directly or indirectly affect the school adaptation of high school students after their return to school through positive or negative coping styles. After returning to school, educators should guide students to view themselves positively, cultivate healthy core self-evaluation, and enable them to have good school adaptation.

Mental Health-Related Barriers and Facilitators to PhD Program Retention among Underrepresented Racial and Ethnic Minoritized (UREM) Nursing Students: A Qualitative Inquiry

Mental health concerns among doctorate (PhD) nursing students may impact program retention, especially among underrepresented racial-/ethnic-minoritized (UREM) students. Understanding mental health concerns among UREM PhD students is necessary to develop retention strategies. We conducted a qualitative secondary data analysis of a descriptive study with focus groups and individual semi-structured interviews. Participants identified as actively enrolled UREM in PhD nursing programs. Conventional content analysis was utilized. Mental health informed retention through the following themes: PhD program pressure and expectations, help-seeking barriers, personal motivations to succeed, and it takes a village: fostering peer support. Implications for nursing faculty are discussed.

The prevalence of post-traumatic stress disorder in college students by continents and national income during the COVID-19 pandemic: a meta-analysis

Introduction

The present study aimed to provide a more accurate representation of post-traumatic stress disorder (PTSD) in college students during COVID-19 by performing meta-analyses by continents, national income, and study majors, and comparing the results with estimated pooled prevalence.

Methods

Based on the guideline of PRISMA, literature was searched in PubMed, Web of Science, and Embase. The prevalence of PTSD was estimated through a random model based on the different continents and levels of national income, as well as study majors, and compared with the pooled prevalence of PTSD among college students.

Results

Totally 381 articles were retrieved from electronic databases and 38 articles were included in the present meta-analysis. The results showed that the pooled prevalence of college students' PTSD was 25% (95% CI: 21-28%). Prevalence estimates of PTSD among college students were statistically significant (p < 0.00001) when stratified with geographical regions, income levels, and study majors. In comparison with the pooled prevalence of PTSD (25%), subgroups of Africa and Europe, lower-middle-income countries, and medical college students possessed higher prevalence estimates.

Discussion

The findings of the study showed that the prevalence of PTSD in college students worldwide during COVID-19 was relatively high and varied in different continents and countries with different income levels. Therefore, healthcare providers should pay attention to the psychologically healthy condition of college students during COVID-19.

University students' use of mental health services: a systematic review and meta-analysis

BACKGROUND

International estimates suggest around a third of students arrives at university with symptoms indicative of a common mental disorder, many in late adolescence at a developmentally high-risk period for the emergence of mental disorder. Universities, as settings, represent an opportunity to contribute to the improvement of population mental health. We sought to understand what is known about the management of student mental health, and asked: (1) What proportion of students use mental health services when experiencing psychological distress? (2) Does use by students differ across health service types?

METHODS

A systematic review was conducted following PRISMA guidelines using a Context, Condition, Population framework (CoCoPop) with a protocol preregistered on Prospero (CRD42021238273). Electronic database searches in Medline, Embase, PsycINFO, ERIC and CINAHL Plus, key authors were contacted, citation searches were conducted, and the reference list of the WHO World Mental Health International College Student Initiative (WMH-ICS) was searched. Data extraction was performed using a pre-defined framework, and quality appraisal using the Joanna Briggs Institute tool. Data were synthesised narratively and meta-analyses at both the study and estimate level.

RESULTS

7789 records were identified through the search strategies, with a total of 44 studies meeting inclusion criteria. The majority of included studies from the USA (n = 36), with remaining studies from Bangladesh, Brazil, Canada, China, Ethiopia and Italy. Overall, studies contained 123 estimates of mental health service use associated with a heterogeneous range of services, taking highly variable numbers of students across a variety of settings.

DISCUSSION

This is the first systematic quantitative survey of student mental health service use. The empirical literature to date is very limited in terms of a small number of international studies outside of the USA; studies of how services link together, and of student access. The significant variation we found in the proportions of students using services within and between studies across different settings and populations suggests the current services described in the literature are not meeting the needs of all students.

Positive and negative mood states mediated the effects of psychological resilience on emotional stability among high school students during the COVID-19 pandemic

This study investigated the parallel mediating effects of positive and negative mood states on the relationship between psychological resilience and emotional stability among first- through third-year senior high school students in China during the challenges of the COVID-19 pandemic. Of 408 questionnaires distributed from April 11 to April 22, 2022, to students at a high school located in Changzhou, Jiangsu, China, 360 were completed correctly and analyzed using a cross-sectional study design. The questionnaire included items from the modified Chinese version of the Psychological Resilience Scale, the Profile of Mood States scale, and the Eysenck Personality Questionnaire Short Scale in Chinese, the latter to assess emotional stability. The mediating effects of mood states on the relationship between psychological resilience and emotional stability were explored by using structural equation modeling and bootstrapping methods. The results indicated that psychological resilience directly affected emotional stability but also indirectly affected emotional stability through the mediating effects of positive and negative mood states. The mediating effect of negative mood states was greater than that of positive mood states. This result differs from that of research conducted prior to the pandemic, which found that compared with the damage caused by negative moods to emotional stability, positive moods more strongly promoted emotional stability. Our findings indicate that high school officials in China should consider strengthening mental health support for students who are taking courses online during home quarantine.

Depressive and anxious symptoms among young adults in the COVID-19 pandemic: Results from monitoring the future

PURPOSE

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is associated with worsening mental health among young adults, but further research is necessary to quantify the associations with depression and anxiety.

METHODS

Using Monitoring the Future data (N = 1244 young adults, modal age: 19, Fall 2020 supplement), we examined internalizing symptoms (Patient Health Questionnaire-8 and Generalized Anxiety Disorder Scale-7 separately), dividing the sample into those without clinically significant scores, significant scores but minimal pandemic-attributed symptoms, and significant scores with substantial pandemic-attributed symptoms. Logistic regression analyses linked demographic factors, pandemic-related experiences, and coping methods to symptom groups.

RESULTS

Internalizing symptoms were highly prevalent, with many occurring among a majority at least several days over the past 2 weeks. Major changes in education, employment, and resource availability predicted elevated symptom risk (e.g., lacking a place to sleep or money for rent, gas, or food led to 4.43 [95% confidence interval: 2.59-7.55] times the risk of high depressive symptoms significantly attributed to the pandemic). High internalizing symptoms were linked to underutilization of healthy coping behaviors, substance use overutilization, and dietary changes. High depressive and anxious symptoms attributed to the pandemic were marked by high levels of taking breaks from the news/social media and contacting healthcare providers.

CONCLUSIONS

The pandemic's associations with young adults' depressive and anxious symptoms warrants urgent attention through improved mental health treatment infrastructure and stronger structural support.

Investigating Effects of COVID-19 Pandemic on the Mental Health of Nursing Students During Remote Learning: An Experience from Dong A University, Vietnam

Introduction

There was a radically changed in nursing education during the nationwide lockdown due to the COVID-19 outbreaks. The transition to remote learning stressed nursing students in many countries, particularly in Vietnam. However, there is still lacking a novel study to describe the mental characteristics of nursing students in detail.

Objectives

To assess the mental health of nursing students, including stress, anxiety, and depression, and to identify the related factors to their mental health during the online study period because of the COVID-19 pandemic.

Methods

A cross-sectional survey was conducted on 540 nursing students at Dong A university using a socio-demographic questionnaire, the Depression, Anxiety, and Stress Scale - 21 Items (DASS-21). Data were analyzed by descriptive statistics and tests, including Mann-Whitney, Kruskal-Wallis, and Spearman's correlation to identify the related factors.

Results

In total 540 participants, nursing students reported stress (N  =  120, 22.2%), anxiety (n  =  195, 36.1%), and depression symptoms (n  =  135, 23.1%). There was a significant relationship between age, work status, married status, number of children, stress, anxiety, and depression (P < 0.01). In addition, our study showed a negative correlation between frequency of physical activity, perceived health and stress (r  =  -0.117; p < 0.01, r  =  -0.127, p < 0.01), anxiety (r  =  -0.133; p < 0.01, r  =  -0.112, p < 0.01), depression (r  =  -0.134; p < 0.01, r  =  -0.135, p < 0.01). A significant relationship was observed between e-learning space and Internet status with mental health (p < 0.05). Especially, there was no association between average online learning time, academic workload, stress, anxiety, and depression (p > 0.05). However, the authors found a positive association between perceived level of stress related to evaluative activities and stress, anxiety, depression (r  =  0.120, p < 0.01; r  =  0.089, p < 0.05; r  =  0.088, p < 0.05).

Conclusion

Nursing students suffered stress, anxiety, and depression during online learning due to the COVID-19 pandemic in the presence of some related factors. Therefore, this study may increase more attention of universities, families, and governments to reduce the stress of nursing students during distance education.