Anxiety, Depression and Academic Performance: A Study Amongst Portuguese Medical Students Versus Non-Medical Students

Awake bruxism behaviors frequency in a group of healthy young adults with different psychological scores

OBJECTIVE

To assess the frequency of awake bruxism (AB) behaviors in a group of undergraduate dentistry students and correlate it with the status of anxiety and depression.

MATERIALS AND METHODS

The frequency of five oral behaviors (i.e., relaxed jaw muscle, teeth contact, mandible bracing, teeth clenching, teeth grinding) was evaluated using a smartphone-based ecological momentary assessment (EMA) approach. The anxiety and depression status was investigated with the four-item patient health questionnaire for anxiety and depression (PHQ-4). ANOVA with Tukey post-hoc test was used to assess the difference in frequency of AB behaviors among the four PHQ-4 groups.

RESULTS

Among the four groups, there was a statistically significant difference in the frequency of relaxed jaw muscle, teeth contact, mandible bracing, and teeth clenching, but not for teeth grinding.

CONCLUSION

Based on this cross-sectional study's findings, psyche seems to have a determinant impact on AB behaviors, which is significantly higher in individuals with anxiety and depression traits.

Correlation research on physical activity and executive function in female college students with subclinical depression

Researchers have found that there may be a correlation between physical activity, executive function, and depression for college students with depression. However, there is limited information available regarding the relationship and interaction between subclinical depression, physical activity, and executive function among college students with subclinical depression. The purpose of this study is to assess the correlation and interaction between subclinical depression, physical activity, and executive function in female college students with subclinical depression. The ActiGraph GT3X was utilized to measure physical activity time, and the colour-word Stroop task was employed to evaluate the executive function of the participants. The findings revealed that female college students with subclinical depression had a significantly lower time for moderate-intensity physical activity compared to healthy female college students. Additionally, the subclinical depression group took significantly longer to complete the colour-word Stroop task compared to the healthy group of female college students. The results of correlation and mediation analyses suggest a negative correlation between BDI-II scores and physical activity time and executive function in female college students with subclinical depression. Moreover, executive function appears to play a partial mediating role in the relationship between physical activity and subclinical depression.

The relationship between mobile phone dependence and academic burnout in Chinese college students: a moderated mediator model

Objective

The aim of this study was to examine the correlation between the level of mobile phone dependence among college students and their experience of academic burnout. Additionally, the study sought to explore the potential mediating effect of study engagement and the moderating role of love.

Methods

During October and December 2023, a cross-sectional study measuring mobile phone dependence, academic burnout, and study engagement among Chinese college students, using the UtrechtWork Engagement Scale-student (UWES-S), College Student Mobile Phone Dependence Questionnaire (CSMPDQ), and Academic Burnout Questionnaire (ABQ). To examine the hypothesis of mediating and moderating effect, SPSS PROCESS was utilized.

Results

The predictive effect of mobile phone dependence on academic burnout was significant (β = 0.410, t = 14.236, p < 0.001), and the predictive effect of mobile phone dependence on academic burnout remained significant when the mediating variable study engagement was introduced (β = 0.308, t = 10.288, p < 0.001), mobile phone dependence had a significant predictive effect on study engagement (β = -0.292, t = -11.639, p < 0.001), and study engagement had a significant positive predictive effect on academic burnout (β = -0.270, t = -9.028, p < 0.001). Love significantly negatively predicted study engagement (β = -0.564, t = -9.641, p < 0.001); and the interaction term for mobile phone dependence and love was significant (β = -0.211, t = -3.688, p < 0.001), indicating a significant moderating effect of love between mobile phone dependence and study engagement.

Conclusion

Mobile phones among college students has been found to have a direct correlation with academic burnout. It can also indirectly contribute to academic burnout by diminishing levels of academic engagement. This indirect relationship is further influenced by love. These findings can help researchers and educators better understand the underlying mechanisms between smartphone dependence and learning burnout in undergraduates.

Sociocultural adjustment and social support as predictors for international medical sciences students' anxiety during COVID-19

BACKGROUND

The prevalence of anxiety is high among international medical sciences students and it increased even more during the COVID-19 pandemic due to different restrictions and social isolation. Successful sociocultural adjustment and social support could be important factors in overcoming those challenges, however, there is a lack of studies which would investigate the role of those factors among inter- national medical students. This study aimed to assess the role of sociocultural adjustment and social support as predictors for international medical students' anxiety during COVID-19.

METHODS

Two measurements were conducted via self-reported questionnaires which consisted of three scales - SCAS, MSPSS and GAD-7. In total, 82 international medical students participated in both measurements in this longitudinal study.

RESULTS

The findings indicated that 37% of international students had symptoms of moderate or severe anxiety during their first year of studies at university. In the second year, during the COVID-19 pandemic and an official lockdown, 35% of international students had symptoms of moderate or severe anxiety. In addition, this study showed that gender and sociocultural adjustment did not play a role as predictors of students' anxiety during the second year of studies. However, this study revealed that social support provided by family during the first year of studies, as well as having friends or family members who had been ill with COVID-19 predicted higher levels of anxiety at second measurement, while sociocultural adjustment was an even stronger predictor of anxiety in the second year of studies of international medical students.

CONCLUSIONS

This knowledge can help to better understand how international medical students felt during the COVID-19 pandemic and what role the above- mentioned factors played in the students' anxiety. As the anxiety level is quite high among international medical students, universities and mental health service providers should take it into consideration and help them to overcome those challenges.

Clinical virtual simulation: predictors of user acceptance in nursing education

BACKGROUND

Using virtual patients integrated in simulators expands students' training opportunities in healthcare. However, little is known about the usability perceived by students and the factors/determinants that predict the acceptance and use of clinical virtual simulation in nursing education.

OBJECTIVES

To identify the factors/determinants that predict the acceptance and use of clinical virtual simulation in learning in nursing education.

METHODS

Observational, cross-sectional, analytical study of the use of clinical virtual simulation in nursing to answer the research question: What factors/determinants predict the acceptance and use of a clinical virtual simulator in nursing education? We used a non-probabilistic sampling, more specifically a convenience sample of nursing degree students. The data were collected through a questionnaire adapted from the Technology Acceptance Model 3. In technology and education, the Technology Acceptance Model is a theoretical model that predicts the acceptance of the use of technology by users.

RESULTS

The sample comprised 619 nursing students, who revealed mean values of perceived usefulness (M = 5.34; SD = 1.19), ease of use (M = 4.74; SD = 1.07), and intention to use the CVS (M = 5.21; SD = 1.18), in a Likert scale of seven points (1-the worst and 7 the best possible opinion). This study validated the use of Technology Acceptance Model 3 adapted and tested the related hypotheses, showing that the model explains 62% of perceived utility, 32% of ease of use, and 54% of intention to use the clinical virtual simulation in nursing by nursing students. The adequacy of the model was tested by analysis of the direct effects of the relationships between the internal constructs (PU-BI, β = 0.11, p = 0.012; PEOU-BI, β = -0.11, p = 0.002) and the direct relations between some of the constructs internal to the Technology Acceptance Model 3 and the external determinants Relevance for learning and Enjoyability. In the proposed model, the external constructs that best predicted perceived usefulness, ease of use, and behaviour intention to use the clinical virtual simulation in nursing were Relevance for learning and Enjoyability.

CONCLUSIONS

These study results allowed us to identify relevance for learning and enjoyability as the main factors/determinants that predict the acceptance and use of clinical virtual simulation in learning in nursing.

The triangle of anxiety, perfectionism, and academic procrastination: exploring the correlates in medical and dental students

INTRODUCTION

Academic procrastination is a common phenomenon among medical science students. This issue can negatively affect the students' academic performance. The aim of this study was to investigate perfectionism and anxiety as potential predictors of academic procrastination in medical and dental students.

METHODS

This cross-sectional study was conducted among medical and dental students of a public medical sciences university in the south of Iran. Students were assessed using the procrastination assessment scale for students (PASS), Tehran multidimensional perfectionism scale (TMPS), and anxiety subscale of the general health questionnaire (GHQ). Predictors of academic procrastination were evaluated using multiple regression analysis with adjustments made for gender and academic semester.

RESULTS

A total of 176 medical and 79 dental students participated in the study. None of the perfectionism components were predictors of academic procrastination. However, anxiety was a significant predictor of academic procrastination in the total sample of students (standardized β = 0.404, p < 0.001), as well as dental (standardized β = 0.356, p < 0.001) and medical (standardized β = 0.478, p < 0.001) students. Anxiety and academic procrastination were both negatively correlated with students' grade point averages.

CONCLUSIONS

The findings of this study suggest that anxiety, as opposed to perfectionism, has a more significant influence on academic procrastination among medical and dental students. Interventions aimed at lowering anxiety may be beneficial for reducing academic procrastination, thereby enhancing the academic performance of the students.

Measurement Properties and Optimal Cutoff Point of the WHO-5 Among Chinese Healthcare Students

Purpose

The World Health Organization-Five Well-Being Index (WHO-5) is widely used to assess subjective well-being. Nevertheless, measurement invariance and optimal cutoff point of the WHO-5 have not been examined in Chinese samples. We aimed to assess measurement properties of the Chinese version of the WHO-5 (WHO-5-C) among healthcare students.

Patients and Methods

A two-wave longitudinal assessment was conducted among 343 Chinese healthcare students from September to November 2022. Measurement properties of the WHO-5-C were assessed through structural validity using confirmatory factor analysis (CFA), measurement invariance using multigroup CFA (MGCFA) and longitudinal CFA (LCFA), convergent validity using correlation analysis with the Self-Rated Health Questionnaire (SRHQ) and Patient Health Questionnaire-4 (PHQ-4), reliability using internal consistency and test-retest reliability, and optimal cutoff point using receiver operating characteristic (ROC) analysis.

Results

The WHO-5-C demonstrated satisfactory structural validity with comparative fit index (CFI) of 0.968 at baseline and 0.980 at follow-up, and adequate measurement invariance in different sociodemographic variables at baseline (gender, age, major, home location, being only child, monthly household income, part-time job, physical exercise, hobby, frequency of visiting home, and stress coping strategy) (CFI changes [ΔCFI] = -0.009-0.003) and over a week (ΔCFI = -0.006-0.000). The WHO-5-C also had good internal consistency (Cronbach's α = 0.907-0.934; McDonald's ω = 0.908-0.935) and test-retest reliability (intraclass correlation coefficient [ICC] = 0.803). Convergent validity was supported by moderate correlations of the WHO-5-C with the SRHQ and PHQ-4. The optimal cutoff point of the WHO-5-C was found to be 50, with an area under the ROC curve of 0.882 at baseline data, with sensitivity of 0.803 and specificity of 0.762 at follow-up.

Conclusion

The WHO-5-C demonstrated adequate measurement properties, especially concerning cross-sectional and longitudinal measurement invariance, with a recommended optimal cutoff point of ≥ 50 for assessing adequate level of psychological well-being in healthcare students.

Prevalence and Risk Factors for Anxiety Symptoms among Student Nurses in Gauteng Province of South Africa

Background: Globally, mental disorders are common among nursing students; therefore, effective prevention and early detection are urgently needed. However, the prevalence rate of anxiety symptoms has not been investigated in South African nursing colleges. Aim: The study aimed to assess the prevalence of anxiety symptoms and their sociodemographic risk factors among nursing students in Gauteng province, South Africa. Methods: This cross-sectional descriptive study was conducted at Chris Hani Baragwanath and SG Lourens nursing colleges in the first week of June 2022. A purposeful sampling technique selected the third- and fourth-year nursing students aged ≥ 18 years registered at the two nursing colleges. The seven-item Generalised Anxiety Disorder scale was used to assess anxiety symptoms. Results: The prevalence of anxiety symptoms was 74.7% (95% confidence interval: 69.9-78.9). Being a student at nursing college B, being in the fourth academic year of study and use of substances were identified as predictors of anxiety symptoms in these nursing students. Conclusions: The prevalence of anxiety symptoms in this study is relatively high, with predictors of developing anxiety being a student at nursing college B, in the fourth academic year and current use of psychoactive substances were predictors of anxiety symptoms. These findings highlight the need to develop interventions and strategies to promote mental health assessments and management to prevent and reduce the problem of mental disorders among nursing students.

Determinants of Poor Mental Health of Medical Students in Portugal-A Nationwide Study

Medical students are a population that is vulnerable to the development of anxiety, depression, and burnout. This observational cross-sectional study sought to assess the levels of distress and identify precipitating factors in all students enrolled in a Portuguese medical school during the academic year of 2022/23. Students (n = 768) were surveyed via validated instruments to measure anxiety, depression, and burnout. Sociodemographic information was also collected through a questionnaire. The study indicated that almost half of this population had depressive symptoms. No differences were found in distress levels between medical schools, and when comparing curricular years, higher levels of distress were found in the pre-clinical years in comparison to the clinical ones. Burnout, being a woman, the existence of physical health problems, homo- and bisexual orientations, affective family problems, problems with relationships in the academic community, difficulties in academic performance, and daily organization were identified as predictors of distress. On the other hand, satisfaction with the social support received and with academic ratings were identified as protective factors. In conclusion, there is a high prevalence of distress in medical students, which is associated with personal, physical, social, economic, and academic factors. The identification of predictive factors of distress may allow for the early identification of vulnerable students and for intervention and prevention strategies to be defined.

Measurement of Exam Anxiety Levels Among Medical Students and Their Association With the Influencing Factors

Introduction Studying medical science is a demanding task, often leading to exam anxiety among medical students. This study aims to measure anxiety levels among medical students and their relationship with gender, age, grades, study time, year of study, and learning methods. Methods It is a cross-sectional study involving third- to sixth-year medical students, who filled in the questionnaire related to the personal data, studying methods, and the Westside Test Anxiety Scale, to estimate the exam anxiety levels before the final examinations of the academic year 2020-2021. Completed questionnaires were reviewed, entered in Microsoft Excel, and analyzed using SPSS.  Results We found a significant association between gender and high-test anxiety (p < 0.001), with a higher prevalence among females (47.9%) compared to males (22.5%). Although non-significant, its prevalence was higher among the 20 years old (34%) and those with a GPA 4.00-4.49 (37.9%). Anxiety decreased as the students progressed to higher years of studies (37.9% in the third year to only 9.1% in sixth year, p=0.073), with the lower incidence among those who studied five days or more per week (26.7%) and no significant difference was observed whether students studying in a group or individually. Though insignificant (p=0.754), learning through textbooks was found to be less stressful (29% vs 33%). Conclusion Our findings suggest that mediocre and female students are more vulnerable to exam high-test anxiety. Progression to senior years and use of textbooks were associated with lower anxiety levels. A cohort longitudinal study to establish an association between specific factors and anxiety levels is recommended.

Exploring female students' perceptions of the use of digital technologies in managing academic stress

Objective

The purpose of this research is to explore the perceptions of female students regarding the implementation of digital technologies for academic stress management. We aim to determine if the contribution of these technologies could offer to female students a better management of the stress related to their studies and thus, a better deployment of strategies to cope with academic difficulties.

Method

A qualitative study using the focus group methodology was conducted. Our inductive and exploratory approach allowed us to focus on the experience and perception of eleven female students from the University of Mons. The cohort was divided into two groups according to their score on the Perceived Stress Scale-10.

Results

The data collected was analyzed using the thematic analysis of which allowed us to identify fourteen sub-themes divided into three axes: coping strategies used to manage academic stress, students' needs to improve their management of academic stress, and the implementation of technology for managing academic stress.

Conclusion

Our results show that the issues present in the academic context lead students to use various coping strategies, some of which are harmful to their physical and mental health. The implementation of digital technologies and biofeedback seems to be an approach that could help students adopt more functional coping strategies and alleviate their daily difficulties in managing academic stress.

Dynamically Changing Mental Stress Parameters of First-Year Medical Students over the Three-Year Course of the COVID-19 Pandemic: A Repeated Cross-Sectional Study

Numerous research results have already pointed towards the negative influence of increased mental stress on educational processes and motivational criteria. It has also been shown that the global public health crisis induced by COVID-19 was related to anxiety symptoms and elevated levels of distress. To holistically elucidate the dynamics of the pandemic-related mental stress of first-year medical students, the associated parameters of three different cohorts were measured at the beginning of the pandemic-related restrictions on university life in Germany (20/21), at the peak of the COVID-19-related restrictions (21/22) and during the easing of the restrictions in the winter term 22/23. In a repeated cross-sectional study design, the constructs of worries, tension, demands and joy were collected from first-year medical students (n = 578) using the Perceived Stress Questionnaire. The results demonstrate significantly increased values of the constructs worries (p < 0.001), tension (p < 0.001) and demands (p < 0.001) at the peak of the pandemic related restrictions compared to the previous and following year as well as significantly decreasing values of general joy of life during the observed period of 3 years (all p-values < 0.001). A confirmatory factor analysis was performed to verify the questionnaire's factor structure regarding the addressed target group during the pandemic (CFI: 0.908, RMSEA: 0.071, SRMR: 0.052). These data, collected over a period of three years, provide information regarding dynamically manifesting mental stress during the COVID-19 pandemic, and refer to new areas of responsibility for the faculties to adequately counteract future crisis situations.

Alcohol Use, Anxiety and Depression among French Grandes Écoles Engineering Students during the COVID-19 Pandemic

In French Grandes Écoles, heavy alcohol consumption seems to be generalized and largely tolerated, leading to particular concerns about Alcohol Use Disorder and harmful alcohol practices among students. The COVID-19 pandemic led to increased psychological difficulties, and two coexisting scenarios seemed to emerge regarding alcohol consumption: A decrease in alcohol consumption linked to the absence of festive events, and an increase in solitary alcohol consumption to cope with lockdowns. The aim of this exploratory study is to investigate the evolution of alcohol consumption, consumption motives and the relationship of these factors to the anxiety and the depression of French Grandes Écoles students during the COVID-19 pandemic, depending on their residential status. After the last lockdown, 353 students completed a questionnaire measuring alcohol consumption, motivation to drink, anxiety and depression during and after the COVID-19 period. Although students confined to campus were more likely to increase their alcohol use, they also presented higher well-being scores than those who lived off campus. A significant proportion of students were aware of their increased alcohol use due to the COVID-19 pandemic, and the motives attributed to their increased consumption highlight the need for vigilance and specialized support facilities.

Impact of COVID-19 on Portuguese Dental Students: A Cohort Study

Introduction: The goal of this study was to assess the impact of COVID-19 on Portuguese dental students on their depression, anxiety, temporomandibular dysfunction, academic degree, and oral behaviors. Methods: The target of this population study was to enroll third-, fourth-, and fifth-year students of the Integrated Master’s degree in Dental Medicine at the Universidade Católica Portuguesa—Faculty of Dental Medicine (Viseu, Portugal) in the academic year 2021–2022. Temporomandibular disorders (TMD) symptoms, oral behaviors, anxiety, and depression were assessed using validated questionnaires. The variables under study were (a) age, gender, marital status, academic level, academic degree, medication, and any existing pathologies; (b) questions related to taste changes or thoughts that would indicate (or not) worsening psychological conditions (anxiety and depression). After data collection (Google Forms®), data were transferred to an Excel file and entered into SPSS® software. A chi-square test allowed the independence between ordinal or nominal variables. The Spearman correlation test was used to analyze the relationship between variables in the study (significant if p ≤ 0.05). Results: 98.2% of the students answered the questionnaire. TMD had a prevalence of 35%, and anxiety and depression a prevalence of 29% and 24%, respectively. The results showed that the female gender was the most affected by psychological and temporomandibular disorders. Statistically significant correlations were identified between variables, such as gender and anxiety, TDM, and depression (respectively, p = 0.0001, p = 0.014, and p = 0.026); between TDM and anxiety and depression (respectively, p = 0.001 and p < 0.001); and between performing oral behaviors and TMD, anxiety, and depression (respectively, p = 0.0001, p = 0.0001, and p = 0.006). The variables, such as age and academic degree, did not establish a statistically significant relationship with TMD, oral behaviors, and the two psychological conditions. Conclusions: It was possible to conclude that there was a moderate prevalence of TMD, anxiety, and depression in the period studied. Moreover, a statistically significant relationship was found between TMD, anxiety, and depression with gender and frequency of OBs; however, no significant association was found for TMD, anxiety, and depression with the age of students and with the academic degree.

Psychological burden in Portuguese university students during the COVID-19 pandemic

Background

University students are a risk population for mental health problems. This study aims to evaluate the psychological burden of the COVID-19 pandemic in Portuguese university students and to uncover factors associated with worse psychological indicators.

Methods

We used an online survey to perform a cross-sectional study that evaluated students' perceptions, lifestyle, and psychological well-being during the pandemic. Depression symptoms and risk were measured by the Patient Health Questionnaire-9, and resilience levels were quantified by the 9-item Resilience Evaluation Scale. Self-perceived levels of anxiety and current mental health status were evaluated.

Results

From a population of around 30,000 students invited to participate, 1751 responses were obtained and 1447 were included. Most students were female (72.3%) and were taking a master's degree (58.4%). The course with more responses was engineering (25.5%), followed by medicine (13.2%). The prevalence rates for higher anxiety levels, depression risk, and low resilience levels were 66.7%, 37.3%, and 24.9%, respectively. The factors associated with better psychological outcomes were being male, spending more time studying, having a job, performing extracurricular activities, physical exercise, and relaxing activities. By contrast, spending more time watching news, difficulty accessing online lectures, and absence of contact with family or friends were associated with worse psychological indicators. Although all courses presented substantial levels of depressive symptoms, architectures/arts, sciences, and humanities scored significantly more in the depression scale. Medicine students had significantly higher resilience levels compared with other courses.

Conclusions

Our findings identify factors associated with worse psychological outcomes and can be used to create protective measures for the mental health of university students during current and future pandemics.

Examining the Indirect Effect of Online Gaming on Depression via Sleep Inequality and Anxiety-A Serial and Parallel Mediation Analysis

Stress-related disorders are highly prevalent among first-year college students. Gaming disorder (GD) is an emerging disorder linked to physical and psychological consequences. We aimed to investigate the mechanism linking GD with anxiety, depression, and sleep disorders among first-year undergraduate students. Four hundred fifty-seven participants were recruited, and the survey included the Internet Gaming Disorder Scale Short-Form (IGDS9-SF), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Pittsburgh Sleep Quality Index (PSQI). Our results showed that female students scored significantly higher than males in anxiety and depression. Furthermore, we found that depression is positively and strongly correlated to anxiety, and both are moderately associated with sleep quality. Gaming is positively related to depression, anxiety, and sleep quality. Interestingly, the health sciences tracks showed lower sleep quality than undergraduates from other tracks. There was a 64% variance in depression explained by many predictors, including anxiety, sleep quality, gaming, painkiller use, and gender. In addition, the mediation models showed that the association between gaming and depression is mediated indirectly by sleep quality, and sleep quality may be mediated directly by anxiety. The first year in college occurs at a critical developmental and professional stage, and our results highlight the need to establish support programs and conduct mental health educational workshops.

High prevalence and risk factors of dropout intention among Chinese medical postgraduates

BACKGROUND

A high attrition rate in medical students has exacerbated the physician shortage in China. However, few studies have explored the risk factors of dropout intention in medical postgraduates. This study compared the prevalence of dropout intention and mental distress between medical and non-medical postgraduates in China and investigated risk factors for dropout intention. This study also explored the impact of medical postgraduates' perception of the Chinese healthcare environment on their mental status and dropout intention.

METHODS

This cross-sectional study was conducted using online questionnaires from October 2020 to April 2021. Convenience sampling was used to recruit postgraduates in different majors. Outcomes included dropout intention and potential risk factors, including mental distress, quality of life, and fatigue. Medical postgraduates were additionally assessed for healthcare environment satisfaction, burnout, career choice regret, and experiences of workplace violence. A logistic regression model was constructed to evaluate the association between dissatisfaction, mental distress, and turnover intention.

RESULTS

A total of 740 medical and 670 non-medical postgraduates participated in the survey. The rates of depression symptoms (33.8% vs. 39.0%, p < 0.001), anxiety symptoms (22.2% vs. 32.4%, p < 0.001), and somatic symptoms (34.7% vs. 42.4%, p = 0.004) were lower in medical postgraduates, while more medical postgraduates (58.4% vs. 48.4%, p < 0.001) reported dropout intention. Dissatisfaction with the healthcare environment (odds ratio [OR]: 1.65; 95% confidence interval [CI]: 1.17-2.34, p = 0.005), career choice regret (OR: 6.23; 95% CI: 4.42-8.78, p < 0.001), and high perceived stress (OR: 2.74; 95%CI: 1.90-3.94, p < 0.001) remained independently associated with turnover intention.

CONCLUSIONS

Mental distress is common among postgraduates, calling for timely interventions. Medical postgraduates reported higher turnover intention. Healthcare environment perception also affected the mental health and dropout intentions of medical students. A decent future income, reduced workload, shorter duration medical training, and better doctor-patient relationships are urgently needed.

The effectiveness of internal cohesion psychotherapy in treating young clients with depression and anxiety disorders: The role of developmental assets in Kosovo context

The positive youth development approach (PYD) is widely used as a meaningful framework to guide research, policy, and intervention, to support young people to develop their full potential. Psychotherapy, on the other hand, is a verbal and psychological procedure that can be a suitable solution to mental health concerns, which are prevalent among youth. This study aimed to explore the potential role of developmental assets in treating clients with depression and anxiety disorders using Internal Cohesion Psychotherapy (ICP). In total, 10 young people who took at least five sessions of ICP were part of this study. In-depth semi-structured interviews were conducted to gather information about clients’ experiences with ICP and their perception/opinions on the presence of developmental assets in their lives. The results confirm the effectiveness of ICP in treating depression and anxiety, while clients acknowledge the role of developmental assets in their psychotherapeutic process. The current study has important theoretical, practical, and research implications. It provides evidence on how clients use their developmental assets in maximizing the effectiveness of the ICP process. The usage of developmental assets to enhance the effectiveness of psychotherapy opens a new path for further research and can serve as a foundation ground for intervention on mental health among youth.

Buffering Effect of Perseverance and Meditation on Depression among Medical Students Experiencing Negative Family Climate

Background and objective: Thirty percent of Thai medical students experienced depression. Two of the crucial factors related to depression involved borderline personality disorder symptoms and adverse family experiences, while positive strengths were documented to prevent depression. This study aimed to investigate the role of perseverance and meditation on depression; Methods: Two hundred and forty−three medical student participants completed the following measurements: the core symptom index (CSI−D) to measure depression, the family climate questionnaire to measure family experience, the personality disorder questionnaire to measure borderline personality disorder symptoms, and the inner strength−based inventory to measure perseverance and meditation. In the analysis, depression served as an outcome, adverse family climate as a predictor and borderline personality disorder symptoms as a mediator. In contrast, perseverance and meditation were moderators in the mediation model. Mediation and moderation analysis using PROCESS was applied for testing the direct and indirect effects; Results: Among all, 49.38% were male, and the mean age was 22.76 years. Borderline personality disorder symptoms significantly mediated the relationship between adverse family climate and depression, B = 0.0608 (95%CI, 0.0301 to 0.1052). The variance explained by the mediation model was 43%. Meditation moderated the relationship between adverse family climate and borderline personality symptoms, whereas perseverance and meditation were found to be significant moderators for borderline personality disorder symptoms and depression. With two moderators in the mediation model, the indirect effect index was B = 0.0072 (95%CI, 0.0002 to 0.0160). The 49% of variances of depression were explained by the moderated mediation model; Conclusion: Borderline personality disorder symptoms are a crucial variable involving depression. Meditation practice has been demonstrated to be a buffer between negative family climate to borderline personality disorder symptoms and depressive symptoms, whereas perseverance buffers the effect of borderline personality disorder symptoms of depression. Further research on cultivating meditation and perseverance should be encouraged among those with negative family experiences.

Exploration of the Role of Relationships and Virtual Learning on Academic Performance and Mental Health

Background

The coronavirus disease 2019 (COVID-19) pandemic caused medical schools to rapidly transition to online/distance learning. Online learning is often associated with poor academic performance, mental health, and student-to-faculty relationships. The purpose of this study is to determine if correlations exist between academic performance, mental health, study location, and student/faculty relationships among medical students.

Methodology

First-year medical students received a survey asking them to reflect on their study location, mental health, and student/faculty relationships during the COVID-19 pandemic. Second- and third-year medical students received a similar survey asking them to reflect on their experiences from the perspective of their first year of medical school (pre-pandemic). The first five exam scores were gathered for all participants. Pearson’s correlation coefficient was calculated between all variables.

Results

Academic performance was found to be positively correlated with both mental health (R = 0.215, p = 0.016) and relationships among students (R = 0.0259, p = 0.004), while negatively correlated with the percentage of time spent studying at home (R = -0.185, p = 0.039). Mental health was additionally found to be positively correlated with relationships to faculty (R = 0.230, p = 0.01) and relationships to students (R = 0.245, p = 0.006).

Conclusions

Academic performance and mental health are correlated with relationships and study location. These correlations may explain the negative outcomes associated with online learning in medical education.

Association of depression symptoms and sleep quality with state-trait anxiety in medical university students in Anhui Province, China: a mediation analysis

BACKGROUND

The prevalence of depression symptoms among medical students is particularly high, and it has increased during the COVID-19 epidemic. Sleep quality and state-trait anxiety are risk factors for depression, but no study has yet investigated the mediating role of state-trait anxiety in the relationship between poor sleep quality and depression symptoms in medical students. This study aims to investigate the relationship among depression symptoms, sleep quality and state-trait anxiety in medical university students in Anhui Province.

METHODS

This was a cross-sectional survey of 1227 students' online questionnaires collected from four medical universities in Anhui Province using a convenience sampling method. We measured respondents' sleep quality, state-trait anxiety, and depression symptoms using three scales: the Pittsburgh Sleep Quality Index (PSQI), the State-Trait Anxiety Inventory (STAI) and the Self-rating Depression Scale (SDS). We analysed the mediating role of STAI scores on the association between PSQI scores and SDS scores through the Sobel-Goodman Mediation Test while controlling for covariates. P < 0.05 was considered statistically significant.

RESULTS

A total of 74.33% (912) and 41.40% (518) of the respondents reported suffering from poor sleep quality and depression symptoms. Sleep quality, state-trait anxiety, and depression symptoms were positively associated with each other (β = 0.381 ~ 0.775, P < 0.001). State-trait anxiety partially mediated the association between sleep quality and depression symptoms (Sobel test Z = 15.090, P < 0.001), and this mediating variable accounted for 83.79% of the association when adjusting for potential confounders. Subgroup analysis further revealed that STAI scores partially mediated the association between PSQI scores and SDS scores in females and rural students and fully mediated the association between PSQI scores and SDS scores in males and urban students.

CONCLUSIONS

This study found that sleep quality and state-trait anxiety have a significant predictive effect on depression symptoms. State-trait anxiety mediated the relationship between sleep quality and depression symptoms, with a more complex mechanism observed among rural and female medical students. Multiple pathways of intervention should be adopted, such as encouraging students to self-adjust, providing professional psychological intervention and timely monitoring, enriching extracurricular activities, and making changes in policies regarding long shifts and working hours.

Mental Health and Physical Activity of Female Higher Education Students during the COVID-19 Pandemic: A Comparative Cross-Sectional Study from Lithuania

During emerging adulthood (EA), higher education medical students undergo a higher risk of anxiety and depression compared to the general population. The aim of this comparative cross-sectional study was to compare the proportions of three mental disorders, namely anxiety, depression and somatisation in terms of their symptoms and self-reported physical activity (PA) levels across the cohorts of biomedical and non-biomedical female students as well as to assess the association between the mental health outcomes and PA use. Between September 2021 and January 2022, a total of 1231 female higher education students aged between 18 and 29 years old were recruited for the study. Severe symptoms of anxiety and depression, as well as unexplained somatic complaints, were suffered by 51.9%, 11% and 23% of female students, respectively. Non-biomedical female students, compared to medicine and health sciences students, were more vulnerable due to the increased prevalence of negative mental health outcomes. The relationship between increased sports activity as a potential trigger for mental well-being and decreased severity of depressive symptoms was identified in the cohorts of both biomedical (adjusted odd ratio (OR_adj) 0.4; 95% confidence interval (CI): 0.1-1.0) and non-biomedical (OR_adj 0.4; 95% CI: 0.2-0.9) female students. The current research highlights the importance of increasing sports activity by involving students in regular physical exercise of specific types for decreasing the severity of depressive symptoms in student-aged female populations.

Daily life stress and the cortisol awakening response over a 13-months stress period - Findings from the LawSTRESS project

The LawSTRESS project is a controlled prospective-longitudinal study on psychological, endocrine, central nervous and genetic predictors of responses to long-lasting academic stress in a homogenous cohort. In this first project report, we focused on the association between daily life stress and the cortisol awakening response (CAR). The CAR, a distinct cortisol rise in the first 30-45 min after morning awakening, is a well-established marker of cortisol regulation in psychoneuroendocrinology. Law students from Bavarian universities (total n = 452) have been studied over a 13-months period at six sampling points starting 12 months prior exam. The stress group (SG) consisted of students experiencing a long-lasting and significant stress period, namely the preparation for the first state examination for law students. Law students assigned to the control group (CG) were studied over an equally long period without particular and sustained stress exposure. To investigate stress related alterations in the CAR, we examined a subsample of the LawSTRESS project consisting of 204 students with 97 participants from the SG (69.1% female, mean age = 22.84 ± 1.82) and 107 from the CG (78.5% female, mean age = 20.95 ± 1.93). At each sampling point, saliva samples for cortisol assessment were collected immediately upon awakening and 30 as well as 45 min later. Perceived stress in daily life was measured by repeated ambulatory assessments (about 100 queries over six sampling points). The time course of perceived stress levels in the two groups differed significantly, with the SG showing an increase in perceived stress until the exam and a decrease thereafter. Stress levels in the CG were relatively stable. The CAR was not significantly different between groups at baseline. However, a blunted CAR in the SG compared to the baseline measure and to the CG developed over the measurement timepoints and reached significance during the exam. Remarkably, this effect was neither associated with the increase in perceived stress nor with anxiety and depression symptoms, test anxiety and chronic stress at baseline. The present study successfully assessed multidimensional stress trajectories over 13 months and it documented the significant burden, law students preparing for the first state examination are exposed to. This period was related to a blunted CAR with presumed physiological consequences (e.g., on energy metabolism and immune function). Mean psychological stress levels as well as the CAR returned to baseline levels after the exam, suggesting a fast recovery in the majority of the participants.

Psychometric validation and cultural adaptation of the Italian medical student stressor questionnaire

Medical students encounter specific stressors that can lead to higher levels of psychological distress compared to their similar aged counterparts who study other subjects. The Medical Student Stressor Questionnaire (MSSQ) was developed to specifically identify stressors among medical students as well as measure the intensity of stress caused by the stressors. However, no Italian version has been validated to date. The aim of this study was to develop an Italian version of the MSSQ (MSSQ-I) and to assess its psychometric properties. The MSSQ has been translated and culturally validated into Italian. All medical students from the University of Brescia were asked to participate in a web-survey in which they were asked to complete the MSSQ-I. For the analysis of the stability over time, participating students were asked to complete again the MSSQ-I after about one month. Among 1754 medical students, 964 completed the MSSQ-I for the validation analyses. A first Confirmatory Factor Analysis and a subsequent Explanatory Factor Analysis outlined a slightly modified factor structure of the scale with five factors instead of six as in the original scale. The internal consistency on the overall scale was high (α = 0.94), as well as the internal consistency of each of the new factors: (α > 0.83 for the first four factors and α = 0.67 for the fifth). External validity analysis confirmed moderate/high concurrent validity. These results suggest that the MSSQ-I can be used as a tool to identify stressors among Italian medical students, although further research is needed to confirm its individual test-retest reliability.

Student achievement prediction using deep neural network from multi-source campus data

Finding students at high risk of poor academic performance as early as possible plays an important role in improving education quality. To do so, most existing studies have used the traditional machine learning algorithms to predict students’ achievement based on their behavior data, from which behavior features are extracted manually thanks to expert experience and knowledge. However, owing to an increase in the varieties and overall volume of behavioral data, it has become more and more challenging to identify high-quality handcrafted features. In this paper, we propose an end-to-end deep learning model that automatically extracts features from students’ multi-source heterogeneous behavior data to predict academic performance. The key innovation of this model is that it uses long short-term memory networks to capture inherent time-series features for each type of behavior, and it takes two-dimensional convolutional networks to extract correlation features among different behaviors. We conducted experiments with four types of daily behavior data from students of the university in Beijing. The experimental results demonstrate that the proposed deep model method outperforms several machine learning algorithms.

Factors associated with post-traumatic stress disorder symptoms in the post-quarantine context of the COVID-19 pandemic in Peruvian medical students

Background

In March 2020, the Peruvian state introduced quarantine as a measure to control the spread of SARS-CoV-2. It has been suggested that being in quarantine is associated with the development of symptoms of Post-traumatic Stress Disorder (PTSD). The present study aims to explore the factors associated with the development of PTSD in a post-quarantine context due to COVID-19 in medical students.

Objectives

To evaluate the factors associated with the development of post-quarantine PTSD symptoms in medical students from a Peruvian university.

Methods

Analytical cross-sectional study. The objective will be developed after the lifting of the quarantine in Peru. Medical students enrolled during the 2020-01 academic cycle of the Peruvian University of Applied Sciences will be included. To collect the outcome variable (PTSD), the Impact of Event Scale - Revised (IES-R) will be used. The associated factors will be collected through a form that will be validated by experts and piloted in the field. The crude and adjusted coefficients will be calculated, using bivariate and multivariate linear regression models, respectively. We will use the “manual forward selection” technique to obtain a final model with minimally sufficient fit. After each model comparison and decision, multicollinearity will be evaluated with the variance inflation factor and matrix of independent variables.

Results

Not having health insurance, having relatives or close friends who contracted the disease and having a lower family income are factors associated with PTSD in the post-quarantine context of the COVID-19 pandemic in medical students at a Peruvian university.

Conclusions

Clinical evaluation is important for medical students with a high probability of having PTSD symptoms. We recommend conducting a longitudinal study to identify causality and other unstudied factors related to PTSD.

Perceived Social Support Promotes Nursing Students' Psychological Wellbeing: Explained With Self-Compassion and Professional Self-Concept

Background

The psychological distress of nursing students is ongoing and getting worse during the coronavirus disease 2019 (COVID-19) outbreak. Numerous calls for future research on exploring the effects of perceived social support would be an effective way to improve nursing students' mental health. However, the pathway(s) between perceived social support and psychological wellbeing (PWB) remain unknown.

Objective

The aim of this study was to explore how self-compassion and professional self-concept mediate the relationship between perceived social support and PWB to explain the theoretical mechanisms of the relationship.

Design

This study is the analytical cross-sectional research based on online self-reports and completed validated measures of perceived social support, PWB, self-compassion, and professional self-concept.

Methods

The Structural Equation Model (SEM) was used to estimate the mediation effects on the relationship between perceived social support and PWB. To examine the directionality of effects, this study also tested the reverse serial mediation model. Multigroup SEM was used to test gender differences in the mediation model.

Results

The results of an empirical study involving 487 undergraduate nursing students verified an integrative model of social support. In addition, no gender difference was found in these associations. These findings suggest that self-compassion and professional self-concept accounted for the association between perceived social support and PWB, and self-compassion was a significant predictor of professional self-concept.

Conclusion

There is a pathway of self-compassion and professional self-concept through which perceived social support may improve PWB. Also, improving nursing students' perceived social support, self-compassion and professional self-concept are beneficial for promoting their mental health. It is meaningful for nursing educators to take measures to develop nursing students' PWB and enhance their professional self-concept.

Mental health of medical students during the COVID19: Impact of studies years

Background

The COVID-19 pandemic had led to severe education disruption in many countries, including for medical students (MS). We aimed to evaluate MS mental health in France and search for a difference depending on studies’ years and clinical activities.

Methods

In a cross-sectional, survey-based study during the first confinement, 668 (8.35%) MS were compared to 7 336 non-medical students (non-MS) (91.65%). The PHQ-9 (≥ 10), the GAD-7 (≥ 8), and the IES-R (≥ 26) were collected to assess depressive, anxiety, and distress symptoms. Multivariable logistic regression analyses were performed.

Results

MS reported significant psychological distress (depressive symptoms: 38.17%, anxiety: 38.77% and distress: 36.83%). Compared to non-MS, they reported less significant depressive (OR, 0.80; 95% CI, 0.67–0.91; P = .007) and distress symptoms (OR, 0.73; 95% CI, 0.62–0.87; P < .001), after taking into account potential confounding variables including COVID-19 diagnosis. First year-MS reported higher rates of significant psychological distress than MS with clinical activities. Moreover, depressive symptoms’ rates were higher among MS with COVID-19 diagnosis (OR, 2.61; 95% CI, 1.21–6.13; P = .016).

Conclusions

Special attention should be offered to first year-MS and MS with COVID-19 diagnosis. Systematic companionship could be implemented for first year MS, and systematic psychiatric/psychological consultations for students with COVID-19 diagnosis.

Association Between Socio-Affective Symptoms and Glutathione and CD4 and CD8 Lymphocytes in College Students

Background: The prevalence of anxiety and depression in young students is associated with biosocial factors and scholastic stress. However, few studies have evaluated emotional-affective symptoms that are related to the immune system and antioxidant parameters in young individuals without diagnoses of affective disorders. Aim: This study aims to assess the relationship between emotional-affective symptoms and glutathione concentrations and CD4 and CD8 lymphocyte counts in college students. Methods: College students (n = 177) completed standardized psychometric instruments, including the Perceived Stress Scale, Hamilton Anxiety Scale, Beck Depression Inventory, Familiar Social and Friends Support Scale, and Rosenberg Scale. Blood samples were biochemically analyzed. Analyses of variance were conducted between four groups according to symptom severity. Results: A considerable prevalence of stress, anxiety, and depression symptoms was observed and negatively correlated with self-esteem and socio-familiar support. Perceived stress was sexually dimorphic. Although biochemical parameters were within reference ranges, glutathione, CD4, and CD8 tended to be lower in participants with anxiety and depression symptoms, which may be of predictive value. Conclusion: The relationship between antioxidant/immune parameters and socio-affective scores is latent in undiagnosed college students who might develop affective disorders. The findings suggest that during the initial development of affective disorders, stress management strategies should be implemented to help college students cope with the academic load and monitor negative changes in their physiological state.

The Hidden Factors Affecting Academic Performance Among Chinese Middle School Students: Traumatic Experience and Posttraumatic Stress Symptoms

Background and Purpose

The role of posttraumatic stress disorder (PTSD) in the path from traumatic exposure (TE) to academic performance (AP) is still not explicitly illustrated. The current study aimed to examine the moderator role of PTSD on the relationship between TE and AP, and then to investigate whether this moderator role is influenced by gender.

Participants and Methods

A sample of Chinese students (n=235) who had experienced the major earthquake of Wenchuan was chosen. PTSD and TE were measured by the Impact of Event Scale – Revised (IES-R) and an earthquake-related experience questionnaire, respectively. AP was collected from their up-to-date general examination. Data for 221 participants (53.4% female; mean age=14.03 years, SD=0.824) were finally included in the analysis. Parsimonious latent-variable interaction analysis and hierarchical regression analysis were adopted to examine the moderator role of PTSD.

Results

The average IES-R score was 27.57 (SD=13.265, range 0–67). The average score for earthquake exposure was 5.86 (SD=2.069, range 1–12). The results showed that both TE and the interaction term of PTSD*TE had significant negative correlations with AP, while PTSD was not associated with AP. Subsequent hierarchical regression analysis found that the relationship of the interaction term and AP was only significant in female students, and a simple slope plot showed a distinct pattern of the moderating effect of PTSD in both genders.

Conclusion

This study supported that PTSD moderated the connection between TE and AP in middle school students who had undergone a major earthquake trauma, which was influenced by gender. Students who experienced major trauma with drastic exposure history and manifested PTSD symptoms need specified intervention to avoid further deterioration in performance in school.

Impact of Postgraduate Student Internships During the COVID-19 Pandemic in China

To understand the impact of the COVID-19 pandemic on postgraduate students' internships in China, 911 students from different regions of China were surveyed through online questionnaires. Among the postgraduate students surveyed, 48.51% of which believed that the pandemic had its greatest impact on colleagues interaction, and 59.60% believed that the pandemic had a strong impact on practical skills. In total, 31.8% of postgraduate internship programs were impacted by COVID-19. The proportions of respondents having severe, moderate, and mild anxiety levels were 1.42%, 4.72%, and 15.92%, respectively; and the rates of severe, moderate, and mild depression were 1.64%, 10.86%, and 21.84%, respectively. ANOVA found that major, degree type, and degree of impact of the pandemic on colleague interactions and improved practical abilities all affected postgraduate mental health. The findings suggest that the mental health of postgraduate students should be monitored during a pandemic, and targeted psychological counseling should be offered. Postgraduate internships should be emphasized as to ensure a smooth internship process during a pandemic period. Psychological counseling and assistance should be provided to those whose internships were affected by the pandemic, and programs should be set up to aid postgraduate students in adapting to the new internship and employment conditions brought on by the "new normal" of pandemic prevention and control.

Body dysmorphic disorder and depression among male undergraduate students in a Malaysian University

INTRODUCTION

Body dysmorphic disorder (BDD) and depression have been reported to be both prevalent among young people worldwide, resulting in serious implications in their quality of life and social functioning. This is worrying especially in men where mental disorders are often overlooked and under-researched. This study aims to determine the proportion of male university students with symptoms suggestive of body dysmorphic disorder and depression, as well as their perception on their body image.

METHODS

In this cross-sectional study, 1,308 male students between the aged of 17-26 years in a private university in Malaysia via self-administered online questionnaire comprising the Patient Health Questionnaire (PHQ)-9, the Body Dysmorphic Disorder Questionnaire (BQQD) and the Body Self-Image Questionnaire (BSIQ), in addition to their sociodemographic parameters. Data analyses were performed with Mann Whitney test, chi square test and Fisher's exact test.

RESULTS

3.3 and 54.2% of the students had symptoms suggestive of BDD and depression respectively, with up to 9.02% of the students reporting having moderate to severe depression. There was a significant association between BDD symptoms and students staying alone, whilst depression was significantly associated with studying in the rural campus. Furthermore, a significant association was demonstrated between presence of BDD and depression symptoms. Most of the students were dissatisfied with their whole body, especially their height.

CONCLUSION

The proportion of BDD and depression symptoms among male students in our university is quite high. Universities and the public health sector should develop better support service targeting male university students.

Impact of Academic Support on Anxiety and Depression of Chinese Graduate Students During the COVID-19 Pandemic: Mediating Role of Academic Performance

INTRODUCTION

The COVID-19 pandemic broke out and has spread globally since 2019. It became a public health concern. This pandemic has brought tremendous changes in students' lives and modes of learning. Graduate students are likely to be more affected as they are a part of a special training program. According to the main-effect model, social support has a positive effect on mental health. The pandemic has exerted a negative impact on the social support of individuals, and as a result, the behavior of a person is more likely to be at risk and has resulted in psychological crisis in people/individuals.

METHODS

A sample of 3137 graduate students responded to the instrument developed to assess the impact of the pandemic on the academic activities and performance, Self-rating Anxiety Scale and Self-rating Depression Scale.

RESULTS

The results showed that: 1) the pandemic impacted the academic support and performance of graduate students in varying degrees, 21% of graduate students experienced anxiety, and 33.9% of graduate students experienced depressive symptoms in varying degrees; 2) academic support variables (ie, academic exchange with mentors and peers) and academic performance variables (ie, data collection and thesis writing) were significantly associated with anxiety and depressive symptoms; 3) the model fitted the data well (RMSEA = 0.029; SRMR = 0.014; TLI = 0.99; CFI = 0.996). The direct effects of academic support on anxiety and depressive symptoms were significant. The impact on academic performance played a mediating role between the impact on academic support, anxiety, and depressive symptoms.

DISCUSSION

Academic support significantly affected academic performance, which in turn affected anxiety and depressive symptoms. So, it implies that, due to the pandemic, the academic support for graduate students had decreased, resulting in deterioration in academic performance, causing anxiety and depressive symptoms.

Impact of COVID-19 on psychological and academic performance of medical students in Saudi Arabia

Background and Objectives:

The COVID-19 pandemic affected the mental health and psychosocial conditions of everyone worldwide according to the WHO. Public health emergencies affect college students and are expressed as anxiety, worry, and fear. The aim of this study was to assess the impact of COVID-19 on the psychological health and performance of medical students.

Design and Settings:

A cross-sectional study using an online survey was done.

Participants and Methods:

Participants were 1591 Saudi medical students. A predesigned questionnaire included questions on demographic characters, GPA, having a relative got COVID-19, how to face sad news and stressors, and satisfaction with online lectures. The Generalized Anxiety Disorder (GAD-7) scale was used that included seven items asking about the degree the participant was bothered by feeling anxious in the last 2 weeks.

Results:

A total of 59.4% of students had various degrees of anxiety. Participant age, unsteady family income, high grade point average (GPA,) satisfaction with the online lectures, and being female were associated with higher GAD-7 scores.

Conclusion:

Mental health of medical students was significantly affected by the COVID-19 pandemic. Psychological support programs for medical students during the pandemic and provision of high-quality distance learning is essential for psychological well-being during the pandemic.

Latent class analysis of depression and anxiety among medical students during COVID-19 epidemic

OBJECTIVE

The novel coronavirus disease 2019 (COVID-19) is a global public health emergency that has caused worldwide concern. The mental health of medical students under the COVID-19 epidemic has attracted much attention. This study aims to identify subgroups of medical students based on depression and anxiety and explore the influencing factors during the COVID-19 epidemic in China.

METHODS

A total of 29,663 medical students were recruited during the epidemic of COVID-19 in China. Depression and anxiety symptoms were assessed using Patient Health Questionnaire 9 (PHQ9) and Generalized Anxiety Disorder 7 (GAD7) respectively. Latent class analysis was performed based on depression and anxiety symptoms in medical students. The latent class subtypes were compared using the chi-square test. Multinomial logistic regression was used to examine associations between identified classes and related factors.

RESULTS

In this study, three distinct subgroups were identified, namely, the poor mental health group, the mild mental health group and the low symptoms group. The number of medical students in each class is 4325, 9321 and 16,017 respectively. The multinomial logistic regression results showed that compared with the low symptoms group, the factors influencing depression and anxiety in the poor mental health group and mild mental health group were sex, educational level, drinking, individual psychiatric disorders, family psychiatric disorders, knowledge of COVID-19, fear of being infected, and participate in mental health education on COVID-19.

CONCLUSIONS

Our findings suggested that latent class analysis can be used to categorize different medical students according to their depression and anxiety symptoms during the outbreak of COVID-19. The main factors influencing the poor mental health group and the mild mental health group are basic demographic characteristics, disease history, COVID-19 related factors and behavioural lifestyle. School administrative departments can carry out targeted psychological counseling according to different subgroups to promote the physical and mental health of medical students.

Effectivity of Psychotherapy Interventions for Anxiety in Medical Students: A Systematic Review

BACKGROUND: The mental health of medical students has long been a topic of concern in many countries. Much research in Europe reported that around 30% of medical students suffered from anxiety. Anxiety disorders have significant physical and emotional consequences. Various studies show that excessive, unmanaged stress related to poor academic performance in medical students leads to cynical personalities, lack of empathy, and suicidal ideas. AIM: This study aimed to identify studies for psychotherapy interventions carried out in medical students and analyze each impact on anxiety level in medical students. METHODS: This systematic review was conducted with evidence sourced from 2000 to 2020. The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study was registered with the Prospective Registering of Systematic Reviews database (Protocol ID: CRD42020180650). RESULTS: Twenty-three studies meet the inclusion criteria, and there are various psychotherapy interventions to deal with anxiety. Most studies reported that students who received mindfulness-based interventions reported lower anxiety, depression, and stress. CONCLUSION: There are various interventions carried out to decrease stress levels, depression, and anxiety in medical students. The most effective psychotherapy was found in cognitive and behavior intervention and mindfulness intervention.

Impact of COVID-19 on the Mental Health of Medical Students in Portugal

(1) Background: The purpose of this article is to assess the impact of the COVID-19 pandemic on the mental health of medical students in Portugal in the period after returning to face-to-face classes during the COVID-19 pandemic, in the 2020/2021 academic year. (2) Methods: We conducted an observational, descriptive, and cross-sectional study, between December 2020 and February 2021 with a representative sample of Portuguese medical students (n = 649), applying an anonymous questionnaire which was composed by a sociodemographic characterization, The Brief Symptoms Inventory-18, The Fear of COVID-19 Scale and the Negative Impact Assessment Scale. For statistical processing, Statistical Package for Social Sciences (SPSS ©) was used. (3) Results: 65.3% of participants said that self-perceived relevant anxiety symptoms, and around 10% said that they had a physical or a mental illness diagnosis. Significant differences (p < 0.05) were found for Fear of COVID-19, Somatization, Anxiety and Overall Mental Health, indicating that women, students from the 1st and last years of training had higher scores. Age, year of training, Fear of COVID-19 and Negative Impact of COVID-19 were significant predictors of overall mental health. (4) Conclusion: In our sample of Portuguese medical students, age, year of training, but mostly fear of COVID-19 and the negative impact of COVID-19 contributed to mental health symptoms.

A study of negative life events driven depressive symptoms and academic engagement in Chinese college students

Negative life events (NLEs) are an important predictor of depressive symptoms (DS). College students experiencing NLEs are at risk of developing DS that could further weaken their academic engagement (AE), while social supports may assuage such negative effect. The aim of this study was to examine the relationship between negative life events, depressive symptoms, and academic engagement, and how the NLE-DS-AE relationship is affected by the level of social support among Chinese college students. To test this hypothesis, we applied data from the Decoding Happiness Gene Cohort Study (DHGCS). Baseline depressive symptoms and academic engagement were measured at the beginning of the first academic year. Approximately 12 months later, negative life events and social support over the past year were assessed retrospectively along with current depressive symptoms and academic engagement. A total of 3629 college students (Age = 18.67 ± 0.82) were included in the study. The prevalence of depressive symptoms was 26.7% and 36.7% in college students at the beginning of the first and second academic year, respectively. Depressive symptoms predicted subsequent academic engagement rather than the reverse based on cross-lagged analyses. Using structural equation modeling analyses, findings revealed a partial mediation effect of social support between negative life events and the development of depressive symptoms, and a partial mediation effect between negative life events and academic engagement. The findings presented negative life events jeopardize the academic engagement via depressive symptoms, while social supports are able to cancel such negative effect among college students under the Chinese cultural context.

Staff SARS-CoV-2 Seroprevalence and Mental Health as Key Factors in University Response to COVID-19 Pandemic

Background: In response to rapid global spread of the newly emerged coronavirus disease 2019 (COVID-19), universities transitioned to online learning and telework to decrease risks of inter-person contact. To help administrators respond to the COVID-19 pandemic and better understand its impacts, we surveyed SARS-CoV-2 seroprevalence among NOVA University employees and assessed community mental health. Methods: Data were collected from voluntary participants at six NOVA University locations, in the Lisbon metropolitan area, from June 15-30, 2020. All subjects provided written informed consent. Of 1,627 recruited participants (mean age 42.0 ± 12.3 years), 1,624 were tested. Prior to blood collection, participants completed a questionnaire that assessed: COVID-19 symptoms during the previous 14 days, chronic non-communicable diseases, chronic medication, anxiety, and depression symptoms. SARS-CoV-2 serology tests were then performed, and results communicated approximately 4 days after blood draw. Participants with positive serology tests were contacted to assess COVID-19 symptoms since February. Results: Estimated prevalence of SARS-CoV-2 IgG antibodies was 3.1% (n = 50), of which 43.5% reported symptoms in the previous 4 months. The Medical School had the highest seroprevalence (6.2%). Participants reported having at least one chronic disease (63.7%), depression-like symptoms (2.1%), and anxiety symptoms (8.1%). Rates of depression and anxiety symptoms were significantly higher in women, with sleep hours and occasional alcohol consumption negatively associated with depression. Male gender, older age, and sleep hours negatively associated with anxiety symptoms. School of employment and presence of comorbidities positively associated with anxiety. Conclusion: By measuring seroprevalence of SARS-CoV-2 antibodies among NOVA employees and assessing subjects' mental health, we aim to help administrators at European public universities in urban areas, such as Lisbon, Portugal, better understand the needs of their communities. This study resulted in implementation of a stricter contingency plan in the Medical School, while other schools continued to follow Government mitigation guidelines. These findings may also guide the development of tailored strategies to ensure physical and mental health of the academic community during this pandemic crisis. We conclude that, together with COVID-19 contingency plans, psychological support services and facilities to help people effectively face pandemic-associated challenges and minimise anxiety and depression should be implemented.

Stigma about mental disease in Portuguese medical students: a cross-sectional study

BACKGROUND

The stigma about mental diseases is common in the population and also in medical students, where it may condition their future practice and the way they deal with these patients.

AIM

To evaluate and characterize the stigma on mental diseases in Portuguese sixth-year medical students, based on a clinical scenario of a classmate suffering from a mental disorder.

METHODS

Observational cross-sectional study, involving sixth-year students of all Portuguese medical schools. We applied an online self-response questionnaire, using the Portuguese version of the Attribution Questionnaire AQ-9, and a vignette of a classmate colleague, presenting mental illness symptoms. Stigma scores were calculated. We used logistic regression to estimate the effect of social determinants on stigma pattern, and we analysed the correlation between 9 variables evaluated by the AQ-9 and total stigma.

RESULTS

A total of 501 participants were included for analysis (69.5% females, median age of 24 years old). Medical students were available to help in the proposed clinical scenario (6.93/9.00; 95%CI:6.77-7.10), if necessary using coercion for treatment (3.85; 95%CI:3.63-4.07), because they felt pity (6.86; 95%CI:6.67-7.06) and they perceived some kind of dangerousness (4.06; 95%CI:3.84-4.28). Stigma was lower in students having a personal history of mental illness (OR:0.498; 95%CI:0.324-0.767; p = 0.002) and in those with positive familial history (OR: 0.691; 95%CI:0.485-0.986; p = 0.041).

CONCLUSION

Our results show the importance of implementing anti-stigma education, to improve medical students' attitudes towards peers living with mental diseases.

The Association Between Dietary Zinc Intake and Health Status, Including Mental Health and Sleep Quality, Among Iranian Female Students

Epidemiological studies have suggested that there is an association between diet and mental health. The aim of the current study was to explore the association between dietary zinc intake and risk of depression, anxiety, and sleep quality distortion among female students of the Semnan University of Medical Sciences in a cross-sectional study. From January through October 2019, 142 female students were randomly selected from the Department of Nutrition and Food Science at the Semnan University of Medical Sciences by simple random sampling. Food frequency questionnaires (FFQs) were used to assess participants' dietary intake over the past 12 months. Depression, anxiety, and sleep quality were examined by the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and Pittsburgh Sleep Quality Index (PSQI), respectively. In the analysis, the crude model was adjusted for total energy intake (kcal), while the model was adjusted for energy intake (kcal), age, economic status, physical activity level, serum vitamin D level, and body mass index. Dietary zinc intake is significantly associated with depression (odds ratio (OR) (95% confidence interval (CI)): 2.34 (0.38-4.30)) and anxiety (OR (95% CI): 3.43 (2.36-4.50)), sleep disorders (OR (95% CI): 3.65 (2.16-5.13)), sleep duration (OR (95% CI): 2.62 (0.39-4.86)), and daytime dysfunction (OR (95% CI): 5.31 (2.84-7.78)) in the model, as well as sleep delay (OR (95% CI): 1.80 (1.05-2.55)) and mental quality of sleep (OR (95% CI): 1.63 (1.10-2.15)) in the crude analysis. This cross-sectional study supports the inverse association between dietary zinc intake and mood disorders, including depression and anxiety, and some indices of sleep disturbance in the Iranian female students. Further cohort or intervention studies are required to draw a firm link between dietary zinc intake and mental health.

Prevalence of Depression in Podiatric Medical Students

BACKGROUND

Although depression and depressive symptoms have been previously explored in various medical student cohorts, there has been a lack of formal investigation among podiatric medical students specifically. The purpose of this study was to identify the prevalence and related characteristics of depression and depressive symptoms in podiatric medical students.

METHODS

A mixed-methods approach was used. Students at a podiatric medical college were asked to complete the Center for Epidemiologic Studies Depression Scale Revised survey electronically each year for 4 consecutive years. Focus group sessions were also conducted to further explore topics related to depression and depressive symptoms.

RESULTS

Surveys were completed by 271 of 539 potential respondents (50.3%). A total of 34.7% of respondents screened positive for depression or depressive symptoms, defined as meeting or exceeding the criteria for subthreshold depressive symptoms on the Center for Epidemiologic Studies Depression Scale Revised. The prevalence was found to be lower in clinical students (third- and fourth-year students) and in students in committed relationships. Themes from the focus group sessions included the following: coping with stress, general health concerns, self-evaluation, action and preparation, and the use of campus resources.

CONCLUSIONS

Depression and depressive symptoms were commonly encountered in this podiatric medical student cohort. Future investigations may consider specific treatment and prevention strategies.

Telepsychiatry and Medical Students: a Promising Mental Health Treatment for Medical Student Use Both Personally and Professionally

PURPOSE OF REVIEW

We review recent findings on the use of telepsychiatry while investigating medical students' perceptions and willingness to use it for their mental health needs. We explore the impact of COVID-19 on medical school curriculums. We also investigate current education in medical schools surrounding telemedicine.

RECENT FINDINGS

Medical students experience symptoms of anxiety at a greater rate than the general population. Major barriers to help-seeking behaviors are the refusal to seek treatment due to fear of incurring negative views from supervising faculty, time constraints, and the cost of counseling services. Those who do use telemental health resources have positive views and believe that it is an effective tool. Medical students are willing to use telepsychiatry for their personal mental health needs and recognize its value as a treatment modality that will be useful for their future patients. The telemedicine field is evolving but many medical school curriculums do not include education on telemedicine.

The impact of women violence on depression among female medical students at Imam Abdulrahman Bin Faisal University, Saudi Arabia

Aims:

The aim of this study was to evaluate the impact of domestic violence on depression among females’ students of Imam Abdulrahman bin Faisal University in the Kingdom of Saudi Arabia.

Settings and Design:

A cross-sectional study conducted from 2019 to 2020.

Methods and Material:

An electronic questionnaire containing biographical data, 2^ndedition of Beck Depression Inventory (BDI), and The NorVold Abuse Questionnaire (NorAQ) was sent to the participants.

Statistical Analysis Used:

Data were analyzed using SPSS version 24 with a statistical significance set at P < 0.05. Tests of significance measured using independent t test and Chi-square test.

Results:

The study included 214 female medical students and 11 interns aged 18 to 26 with a mean of 20.66 ± 1.725 years. Most women (92.4%) were single, and the highest responders (30.2%) were second-year students. Based on The NorVold Abuse Questionnaire (NorAQ), the prevalence of violence was 56.9%. The most common form of violence was emotional abuse (50.2%) and the highest combined types of abuse were emotional and physical abuse (14.7%). Based on BDI scale, the prevalence of depression amongst our sample was 32.9%; it was mild in 14.2%, moderate in 15.6% and severe in 3.1%. None of the types of abuse were significantly associated with depression. However, severe depression was highest amongst students/interns with history of emotional or sexual violence.

Conclusion:

More than half of the participants were subjected to domestic abuse throughout their lives. Emotional abuse was the commonest type followed by physical, sexual, and healthcare abuses, respectively. However, the present study demonstrated no significant association between abuse and depression.

Depression and Anxiety Among Medical Students: A Brief Overview

Depression and anxiety are highly prevalent conditions worldwide. This article reviews the extent of depression and anxiety among medical students and elucidates associated potential risk factors. In comparison to other countries, students from Middle East countries have a higher prevalence of depression. Females suffer from these conditions more commonly than males. Factors associated with these morbidities can be divided into academic and non-academic factors. There is an inconclusiveness of whether medical students experience these symptoms more commonly than their counterparts. The present review provided a cross-sectional picture of the students' psychological well-being, which is crucial to formulate a health policy for preventive and therapeutic purposes.

Help-seeking behaviors for mental health problems in medical students: Studies in Thailand and India

OBJECTIVES

To compare the rate of help-seeking from mental health professionals (MHPs) and other sources of help for mental health problems of medical students in Thailand and India, and explore factors associated with help-seeking from MHPs.

METHODS

Cross-sectional survey-based study was conducted in two medical schools in Thailand and India. Students were asked to rate their preferences for each source of help on a Likert-scale basis. Mental health status was measured by the General health questionnaire-12 (GHQ-12). Attitudes and stigma toward mental illness were collected using the Mental illness clinician's attitude scale: medical student version or MICA v2.

RESULTS

593 students participated in the survey. The percentage of students who chose to seek help from any source was lower in Thailand than in India. 81 % of students in India site chose to seek help from MHPs, compared to 66 % in Thailand site. The risk factors for avoiding seeking help from MHPs in Thailand were history of alcohol use (OR = 1.88, p = .014) and total GHQ score (OR = 1.11, p = .006), whereas having GHQ score ≥ 2 was a significant risk factor in India (OR = 2.20, p = .044). Total MICA score, which reflected overall attitude toward mental illness, was not associated with seeking help from MHPs.

CONCLUSIONS

The rate of help-seeking behaviors for mental health problems and factors associated differed between medical students in Thailand and India. A high GHQ score was a common risk factor of not seeking help from MHPs in both countries.

Prevalence of depression among university students in low and middle income countries (LMICs): a systematic review and meta-analysis

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.