Psychological distress among students from five universities in Sri Lanka

Prevalence of depression among students at a Sri Lankan University: A study using the Patient Health Questionnaire-9 (PHQ-9) during the COVID-19 pandemic

BACKGROUND

The prevalence of mental health disorders is known to be high among university students globally. Currently there are only a few studies on depression among university students in Sri Lanka. The aim of this study was to screen for the prevalence of Major Depressive Disorder (MDD) and other forms of depression, and to evaluate the factors associated with MDD.

METHODS

A cross sectional survey using the Patient Health Questionnaire (PHQ-9) was conducted among 637, second-year students from the faculties of Management Studies & Commerce, Science and Medicine at the University of Jaffna, during the Coronavirus (COVID-19) pandemic. Bivariate associations were assessed using chi-squared tests. Logistic regression was used to evaluate factors associated with any type of ragging.

RESULTS

MDD was considered to have been experienced by 31% of the students. From all three faculties, 70% of the students claimed to have experienced some form of depression ranging from mild to severe. The factor associated with MDD was the students' ethnicity.

CONCLUSION

Due to the high MDD risk among university students, it is imperative to develop psychosocial interventions to ensure early detection of mental health disorders and provide adequate support to safeguard this vulnerable population.

Validating the Medical Students' Stressor Questionnaire (MSSQ) from a Sri Lankan medical faculty

Objectives

The Medical Students' Stressor Questionnaire (MSSQ) is a specific tool to assess the degree of stress in medical students. However, this tool has not been validated in Sri Lanka. Therefore, this study contextually adapted the MSSQ and investigated its validity in the local context.

Methods

A total of 603 medical students, in various phases of their undergraduate training, from the Faculty of Medicine at the University of Colombo, participated in the study. Students who have completed their studies in the faculty for at least six months were included. The self-administered questionnaire was contextually adapted to the local setting and was approved by subject and language experts. Responses were analysed for construct validity (including exploratory factor analysis to estimate factor structure of the scale), sample adequacy, and internal consistency. Data were analysed using the SPSS statistical package.

Results

The mean age of the study cohort was 23.3 ± SD 2.0 years, while 258 (42.8%) were males. The MSSQ scale significantly correlated with the General Health Questionnaire (p<0.001), indicating a strong concurrent validity. The exploratory factor analysis showed that items were loaded appropriately on five new factors, and the Kaiser-Meyer-Olkin measure (0.954) and Bartlett's test of sphericity (p<0.001) showed excellent sample adequacy. The internal consistency of the MSSQ overall (α = 0.95), and each of the new factors: (α > 0.82 for the first four factors and α = 0.54 for the fifth) were satisfactory. The test-retest reliability was high (Pearson's r = 0.918, p<0.001).

Conclusions

The contextually adapted MSSQ is a valid and reliable instrument that can be used in the assessment of stress among medical students.

Triggers for attempted suicide in Istanbul youth, with special reference to their socio-demographic background

OBJECTIVE

Suicidal behavior of young people is a topic of utmost importance because suicide is irreversible, and should be prevented. Knowing about the psychosocial background and the triggering events could help in preventing suicidal behavior. We therefore aimed at identifying psychosocial factors that may trigger suicidal behavior in youth.

METHODS

We analyzed retrospectively the standardized records of 2232 youths aged ≤25 years, who were treated after a suicide attempt at emergency units of public hospitals in Istanbul, Turkey during a period of 1 year. We describe this population according to sex and socio-economic conditions, like educational, occupational, relationship status and link them with their reported reasons for suicide attempts.

RESULTS

The majority of patients were female (81.6%, N = 1822 females, 18.4%, N = 410 males). Independent of their educational and occupational background, patients indicated most frequently intra-familial problems (females 45.8%, males 30.5%), intrapersonal problems (females 19.9%, males 18.5%), and relationship problems (females 11.3%, males 23.9%) as triggering reasons.

CONCLUSIONS

Because intra-familial problems were the most frequently reported triggers of suicide attempts, preventive measures should focus on handling intra-familial conflicts. As sex differences were observed for the second-most common trigger-reasons, prevention should also focus on differentially handling intrapersonal and relationship conflicts better.

Suicidal Behavior and Psychological Distress in University Students: A 12-nation Study

This study investigated the prevalence of suicidal behavior and psychological distress in university students across 12 nations. A total of 5,572 university students from 12 countries were surveyed about suicide ideation, suicide attempts, and psychological distress by means of a self-administered questionnaire. Almost 29% of the samples reported having contemplated suicide and 7% reported attempting suicide. Of the total sample, 51.1% scored above the General Health Questionnaire-12 ≥ 3 cut-off points, 41.6% above the GHQ-12 ≥ 4 cut-off points, and 33.8% scored above the GHQ-12 ≥ 5 cut-off points. While odds of suicide ideation were elevated in Austria and the UK, reduced ORs were detected for China, Italy, Saudi Arabia, Tunisia, and Turkey. Similarly, while odds of suicide attempt were high in Jordan, Palestine, Saudi Arabia, and to some extent in Turkey, reduced ORs were observed for Austria, China, Italy, Japan and the United States. Elevated ORs for psychological distress were seen in Japan, Jordan, Palestine, Saudi Arabia, Tunisia, and Turkey but reduced ORs were noted in Austria, China, Iran, Italy, and the United States. Psychological distress was strongly associated with reports of suicide ideation and attempts. Suicide ideation, suicide attempt, and psychological distress are common in university students but their rates vary depending on the sociocultural context. Due attention should be devoted to the mental health needs of young adults enrolled in higher educational institutions and more cross-cultural research is warranted to better understand the etiology of the observed intersocietal variations in suicidal behavior and psychological distress.

Quantifying and predicting depression literacy of undergraduates: a cross sectional study in Sri Lanka

BACKGROUND

The high rates of depression and low rates of related help-seeking among undergraduates are matters for concern. In response to the need to examine their knowledge about depression and its management, and the dearth of such research from non-western developing countries, this study examined the depression literacy of undergraduates in Sri Lanka.

METHODS

A questionnaire was administered among 4671 undergraduates to examine their depression literacy relating to problem-recognition, measured using a vignette of a depressed undergraduate, and their treatment beliefs measured by assessing their perceptions about the helpfulness of various options of help for the presented problem. Responses for the latter aspect were quantified using a scale comprising the options of help endorsed by Sri Lankan mental health professionals. Regression analysis models were used to identify the correlates of these aspects of depression literacy.

RESULTS

Females, medical undergraduates and those in higher years of study (compared to first-years) were more likely to recognise the problem as depression. The undergraduates obtained a mean percentage score of 76% on the constructed Depression Treatment Beliefs Scale. Scores on this scale were higher among females, medical undergraduates, those who got help for the problem after trying to deal with it alone and those who recognised the problem as depression, as well as those who used other mental health-related labels for this purpose. Scores were lower among undergraduates in years 2-4 (compared to first-years), those with family or friends with the problem and those with higher stigma on a Social Distance Scale. However, the effect sizes of these relationships were small.

CONCLUSIONS

As factors such as gender, discipline, year of study, exposure to depression and stigma are associated with differences in the depression literacy of these undergraduates, concerning their ability to recognise the problem and their related treatment beliefs, these must be considered when designing related educational initiatives. Recognising the problem as depression or the use of other mental health-related labels is associated with better treatment beliefs as per expert consensus, indicating that such labelling could have value for appropriate help-seeking.

Prevalence of depression and its correlates among undergraduates in Sri Lanka

AIMS

There is a dearth of mental health research on undergraduates in Sri Lanka. This study examines the prevalence of depression in a sample of Sri Lankan undergraduates, their exposure to threatening life events and the predictors of their depression.

METHODS

Responses of 4304 undergraduates were obtained on the Patient Health Questionnaire-9 and a measure of exposure to threatening life events, with binary logistic regression models used to identify the demographic and life event correlates of screening positive for Major Depressive Disorder (MDD).

RESULTS

PHQ-9 diagnoses of 'Major' and 'Other' depression were obtained by 9.3% and 13.5% of undergraduates, respectively. A higher likelihood of MDD was seen among those who were older and those living in hostels (compared to home), although no differences were seen between genders or those studying in different faculties. Likelihood of MDD was higher in undergraduates exposed to multiple threatening life events as well as those exposed to physical threat; family deaths; romantic break-ups; a problem with a close associate; educational difficulties; unemployment and domestic violence, and among male undergraduates harassed by another student.

CONCLUSIONS

MDD is prevalent in these undergraduates and universities need to develop services to assist them. Such services may also need to focus on supporting those who have experienced threatening life events, particularly those that arise as a result of being an undergraduate, as these may increase the risk of MDD.

Risk factors for 'small for gestational age babies'

OBJECTIVE

To identify the risk factors for small for gestational age (SGA) babies.

METHODS

The present study was a nested case control study which was carried out by two Medical Officers of Health areas (The field level administrative unit responsible for provision of preventive and promotive health services) in Colombo district. SGA babies were identified using 'weight for gestational age' curves developed for Sri Lankan babies. Newborns of 1,200 pregnant women, who were identified within the first 8 wk of amenorrhea and who delivered in selected hospitals were included in the study. Sample size was calculated as n=167 cases and 4 n=668 controls, with four controls for each case. A case was defined as a newborn whose birth weight was less than the 10th percentile of the weight for gestational age, the control being a newborn whose birth weight was between the 10th and the 90th percentile of the weight for gestational age.

RESULTS

Multivariate analysis identified 7 significant risk factors as, number of live born children=0, inadequate weight gain during pregnancy according to initial BMI, maximum and minimum physical work, mother's pre-pregnant weight less than 38 kg, high level of stress at second trimester, presence of pregnancy induced hypertension (PIH) and inadequate support from husband.

CONCLUSION

The risk factors indicate the directions for planning intervention programs.

The effectiveness of Tai Chi on the physical and psychological well-being of college students: a study protocol for a randomized controlled trial

Background

The physical and mental health of college-age youths tends to continuously decline around the world. It is therefore important to promote health during this period. As a traditional Chinese mind-body exercise, Tai Chi Chuan (TCC) may be an available selection. However for the college student population, the evidence is unclear as to whether TCC can be recommended as an effective exercise for promoting their physical and psychological wellbeing. Therefore high quality, rigorous, prospective, and well-controlled randomized trials are needed to further understand TCC serving as a psychological and physical intervention in college age populations.

Method/Design

We designed a randomized, single-blind, parallel-controlled trial with a sample size of 206 participants. All the participants who meet the inclusion criteria come from Fujian University of Traditional Chinese Medicine (FJTCM). Participants of the TCC training group will receive TCC training at a frequency of five days per week for one hour per day for 12 weeks. No specific exercise will be administered on the participants in the control group. Both physical and mental health outcomes, including balance ability, lower limb proprioception, flexibility, physical fitness, self-efficacy, psychological symptoms, attention span, stress, self-esteem, mood and mindfulness, quality of life, and quality of sleep. Safety outcomes will be evaluated by blinded operators at baseline, 12 and 24-weeks post-intervention.

Discussion

This protocol presents an objective design of a randomized, single-blind trial that will test the effectiveness and safety of TCC on the physical and psychological wellbeing of college students. If the outcome is positive, the results will provide higher quality evidence of TCC on the physical and mental health of college age populations.

Trial registration

Chinese Clinical Trial Registry: ChiCTR-TRC-13003328.

The effect of Baduanjin exercise for physical and psychological wellbeing of college students: study protocol for a randomized controlled trial

BACKGROUND

The physical and mental health of college students tends to continuously decline around the world. Since they are in a significant transition period which presents opportunities and challenges in health promotion, it is important to improve their health in this period. As a traditional Chinese exercise form which combines movements with breath and mind, Baduanjin may be one of the selectable effective exercises. However, evidence of Baduanjin exercise for college students has not been completely established. The primary aim of this trial is to evaluate the effectiveness and safety of Baduanjin exercise for physical and mental health of college students through a rigorous randomization, parallel-controlled design.

METHOD/DESIGN

We will conduct a randomized, single-blind, parallel-controlled trial. A total of 222 college students from Fujian University of Traditional Chinese Medicine who meet the eligibility criteria will be recruited and randomly allocated into Baduanjin training or usual exercise control group. Baduanjin training will last 12 weeks (1 h per day, 5 days per week). The physical and psychological outcomes, including lumbar muscle strength, lumbar proprioception function, physical fitness, as well as self-reported symptom intensity, stress, self-esteem, mood, quality of life, quality of sleep, and adverse events, will be evaluated by blinded outcome assessors at baseline, 13 weeks (at the end of intervention), and 25 weeks (after the 12-week follow-up period).

DISCUSSION

This protocol presents an objective design of a randomized, single-blind trial that aims to evaluate the effectiveness and safety of Baduanjin exercise for physical and mental health of college students. If the outcome is positive, the results will provide higher-quality evidence to better inform the college students regarding their selection about whether to receive such exercise.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: ChiCTR-TRC-13003329. Registration date: 18 July, 2013.

Mental health and behaviour of students of public health and their correlation with social support: a cross-sectional study

Background

Future public health professionals are especially important among students partly because their credibility in light of their professional messages and activities will be tested daily by their clients; and partly because health professionals' own lifestyle habits influence their attitudes and professional activities. A better understanding of public health students' health and its determinants is necessary for improving counselling services and tailoring them to demand. Our aim was to survey public health students' health status and behaviour with a focus on mental health.

Methods

A cross-sectional study was carried out among public health students at 1-5-years (N = 194) with a self-administered questionnaire that included standardized items on demographic data, mental wellbeing characterized by sense of coherence (SoC) and psychological morbidity, as well as health behaviour and social support. Correlations between social support and the variables for mental health, health status and health behaviour were characterized by pairwise correlation.

Results

The response rate was 75% and represented students by study year, sex and age in the Faculty. Nearly half of the students were non-smokers, more than one quarter smoked daily. Almost one-fifth of the students suffered from notable psychological distress. The proportion of these students decreased from year 1 to 5. The mean score for SoC was 60.1 and showed an increasing trend during the academic years. 29% of the students lacked social support from their student peers. Significant positive correlation was revealed between social support and variables for mental health. Psychological distress was greater among female public health students than in the same age female group of the general population; whereas the lack of social support was a more prevalent problem among male students.

Conclusions

Health status and behaviour of public health students is similar to their non-students peers except for their worse mental health. Future public health professionals should be better prepared for coping with the challenges they face during their studies. Universities must facilitate this process by providing helping services targeted at those with highest risk, and developing training to improve coping skills. Social support is also a potentially amenable determinant of mental health during higher education.