General Anxiety, Academic Distress, and Family Distress Among Doctor of Pharmacy Students

Analysis of the mental health of pharmacy students at A number of public and private universities in Indonesia

Background

This study examines the mental health of pharmacy students at various state and private universities in Indonesia, as well as the factors that influence it. The low mental health of pharmacy students can be found in a third of some countries. Similar findings occurred in the United States, France, and several Asian countries. However, there has been no research involving various universities in Indonesia to identify the factors that influence their mental health.

Methods

This research used a cross-sectional method involving students from western, central, and eastern Indonesia. It used the DASS-21 (Depressin Anxiety and Stress Scale) and BRS (Brief Resilience Scale) instruments.

Results

The results of the DASS-21 analysis of pharmacy students in Indonesia, the majority reported experiencing normal depression with a score of 3.198, normal anxiety with a score of 1.858, and stress with a score of 3.621. Mental resilience with the BRS instrument: 18 % of state university students reported medium-low, while private university students reported 17.5 % (p < 0.012). Influencing factors vary between public and private universities. Academic pressure is a major trigger, with students tending to seek support from their close friends. These findings provide an in-depth understanding of pharmacy students' mental health conditions in Indonesia, as well as strategies to overcome this problem, such as creating special spaces for mental health-related counselling at both types of universities.

Conclusion

This study confirms the normal prevalence of mental health problems among pharmacy students in Indonesia, especially depression and low mental resilience. The study showed the relationship between depression, anxiety, stress, and mental resilience, indicating that the severity of a mental problem correlates with a decrease in mental resilience. A special room is required for health counselling.

A Multisite, Longitudinal Study Assessing Prevalence of Anxiety in Student Pharmacists

OBJECTIVE

Conduct a multisite, survey-based study assessing rates of self-reported anxiety symptoms among student pharmacists enrolled in the first 3 professional years (PY1 to PY3) of a 4-year Doctor of Pharmacy (PharmD) curricula.

METHODS

This study followed a cross-sectional observational design conducted at Washington State University, College of Pharmacy and Pharmaceutical Sciences (WSU) and the University of Arkansas for Medical Sciences, College of Pharmacy (UAMS). Student pharmacists in PY1 to PY3 of the PharmD curricula were invited to voluntarily complete the Generalized Anxiety Disorder 7-item (GAD-7) scale in order to self-report measures of anxiety. The GAD-7 is a validated 7-item instrument using a 4-point Likert scale.

RESULTS

A total of 2022 surveys were evaluated from PY1-PY3 students at WSU and UAMS over a 5-year period (2019 to 2023). Overall, 882 (43.6%) completed surveys indicated the presence of moderate to severe anxiety according to the GAD-7. When asked about the difficulty of doing work, taking care of things at home, or getting along with other people, 487 (24.1%) respondents indicated "very" or "extremely" difficult using a 4-point Likert scale.

CONCLUSION

Behavioral and mental health support appears to be needed to support students living with symptoms of anxiety that are impacting life activities. Pharmacy educators should consider proactive approaches to improve mental well-being and support skill development related to anxiety management for student pharmacists. Future studies may include measuring change in student pharmacist anxiety over time with targeted interventions and studies to determine impact on reported levels of anxiety.

A Review of Survey Instruments and Pharmacy Student Outcomes for Stress, Burnout, Depression and Anxiety

While the need to measure burnout, stress and mental health among pharmacy students has been emphasized in the literature, there is limited information on which validated scales should be used. The objective of this scoping review was to identify published studies that used validated scales for burnout, stress and mental health among pharmacy students to provide recommendations for implementation at schools/colleges of pharmacy. Thirty-two out of 153 articles published in the United States from 1 January 2000 to 30 September 2022 were included and categorized into studies measuring stress (20), burnout (4) and depression/anxiety (8). The most common validated scales used to assess stress and burnout among pharmacy students were the Perceived Stress Scale (PSS) and the Maslach Burnout Inventory and the Oldenburg Burnout Inventory, respectively. For mental health, anxiety was most commonly investigated using a variety of scales such as the Generalized Anxiety Disorder-7; the Patient Health Questionnaire, 9-item was used to measure depression in two studies. Validity, ease of use, cost and generalizability are important considerations for selecting a scale. The PSS has been studied extensively in pharmacy students and has been correlated with other well-being domains. Studies that measured burnout and mental health (specifically, depression and anxiety) have less published evidence among pharmacy students.

Adverse childhood experiences among doctor of pharmacy students

OBJECTIVE

Adverse Childhood Experiences (ACEs) have demonstrated negative impact on physical, emotional, and cognitive health outcomes. This study aimed to assess prevalence of ACEs among Doctor of Pharmacy (PharmD) students, and their associations with mental health, substance use, academic performance, and sleep patterns.

METHODS

A cross-sectional survey was conducted on PharmD students at a private University. ACE scores, mental health history, substance use, academic performance, and sleep habits were self-reported. Descriptive statistics and chi-square tests were used for analysis.

RESULTS

From 54 participants across all cohorts of students in the curriculum (response rate: 19%), 48% reported ≥4 ACEs. A majority of students reported having been diagnosed with or sought treatment for depression (56%) or anxiety (67%), while 42.9% reported a history of contemplating suicide. Participants with ACE scores of ≥4 were more likely to have sought treatment for depression, any mental health condition, contemplated suicide, or used alcohol for mental health purposes. No differences in academic performance based on ACE scores were found.

CONCLUSION

High numbers of ACEs were common and linked to mental illness, suicidality, and use of alcohol for mental health purposes. While no direct academic impact was found in this small sample size, adopting a trauma-informed approach is crucial to supporting student well-being. Further research in this area is needed to optimize interventions to support academic and professional success among students with ≥4 ACEs.

Depression and Anxiety among Undergraduate Health Science Students: A Scoping Review of the Literature

Background: Health science students in post-secondary institutions experience high levels of depression and anxiety due to increased stress levels, workload, low socioeconomic status, and history of family mental illness, among other factors. Given the significant negative impact that depression and anxiety can have on undergraduate health science students, it is essential to understand the prevalence and correlation of these conditions in this population. In light of this, this scoping review aims to identify, document, and analyze the literature on the prevalence and determinants of anxiety and depression among undergraduate health sciences students and identify gaps in knowledge for future research. Methods: This scoping review was planned and executed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for the Scoping Reviews statement. A comprehensive and systematic search was carried out for five databases, namely MEDLINE, Scopus, EMBASE, CINAHL, and PubMed. Results: From the literature identified by our search strategy, the lowest prevalence for anxiety was 5.8%, and the highest was 82.6%, with a median of 44.25%. The prevalence of depression ranged from a high of 88.8% to a low of 2.1%, with a median value of 34.8%. Our analysis revealed that correlates of anxiety and depression among health science students include sociodemographic factors such as age, sex, gender, relationships, ethnicity, and family history, personal health conditions, and academic and socioeconomic issues. Conclusions: With the high incidence of anxiety and depression among health science students, there is an increasing need to find practical remedies to support these students. It is also essential for policymakers and university authorities to implement interventions such as supportive text messages and other strategies geared toward providing support and improving the psychological well-being of health science students.

Longitudinal assessment of pharmacy student well-being using the well-being index and 5 gears assessment

OBJECTIVE

The objective of the study was to assess the level of pharmacy student well-being during the first 2 years of their didactic education utilizing the Well-being Index (WBI) and 5 Gears assessment.

METHODS

WBI and 5 Gears data were tracked monthly for first- and second-year students enrolled at the Medical University of South Carolina College of Pharmacy from September 2019 to March 2022. Data were collected through monthly RedCap surveys, then de-identified and separated into 4 study cohorts (A-D). Data were analyzed using descriptive statistics.

RESULTS

Responses from 279 students were evaluated. WBI ratings showed variance across the first and second professional years of the program. Students also reported fluctuations in WBI throughout academic years, most often correlating with major events (scheduled breaks, COVID-19 pandemic). Similarly, the 5 Gears assessments results also changed throughout the study period, including variance within and between each academic year.

CONCLUSION

Incorporating well-being assessments into the co-curriculum has allowed us to identify when students are struggling with their well-being, provide tools and resources to help enhance their well-being, and opportunities to discuss struggles with their peers. Colleges of Pharmacy must incorporate holistic approaches to address all aspects of well-being, including consideration of how the curriculum is impacting the student experience as well as institutional approaches to well-being.

Mental Health Problems Among Graduate Students in Turkey: a Cross-Sectional Study

In this study, depression/anxiety and academic distress were investigated among graduate students in Turkey. The study sample comprised 459 graduate students who voluntarily completed an online survey (294 women, 64%). Independent t-tests and multivariate analyses were performed to examine group differences. The results confirmed that depression/anxiety and academic distress scores varied according to sociodemographic variables. Whereas depression/anxiety and academic distress did not show significant differences in terms of gender and place of residence, students who had previously sought psychological help had higher levels of depression/anxiety and academic distress. Younger age, being a master's student, and being single increased the risk of having higher levels of depression/anxiety and academic distress. University counseling centers may benefit from these findings in efforts to identify graduate students at risk and apply appropriate prevention and intervention strategies.

Global prevalence and trend of anxiety among graduate students: A systematic review and meta-analysis

OBJECTIVE

To evaluate the comprehensive prevalence of anxiety among postgraduates and estimate its changes with a meta-analysis.

METHOD

Systematic retrieval to SAGE, ERIC, EBSCO, Wiley, ScienceDirect, ProQuest, PubMed, EMBASE, and Web of Science database was performed for quantitative studies on the prevalence of anxiety among graduate students published before November 22, 2022. The prevalence of anxiety synthesized with random-effects model, and subgroup analysis was conducted by study characteristics (publication year, sampling method, and measurements) and subjects' characteristics (gender, region, and educational level).

RESULT

Fifty studies were included in the meta-analysis, totaling 39,668 graduate students. The result revealed that 34.8% of graduates suffered from the anxiety (95% CI: 29.5%-40.5%). Specifically, 19.1% (95% CI: 15.4%-23.5%) had mild anxiety, 15.1% (95% C: 11.6%-19.6%) had moderate anxiety, and 10.3% (95% CI: 7.2%-14.6%) had severe anxiety. And this prevalence showed a upward trend since 2005. Besides, master students suffered slightly less than doctoral students (29.2% vs. 34.3%), and female had similar anxiety to male (26.4% vs. 24.9%). Due to the COVID-19, the prevalence of anxiety is higher after the pandemic than that before (any anxiety: 34.3% vs. 24.8%). Compared with other countries, students from Saudi Arabia, India, and Nepal were more vulnerable. The results of quality assessment showed that, 5 (10%) were in high quality, 21 (42%) were in moderate to high quality, 21 (42%) were in low to moderate quality, and 3 (6%) were in low quality. But, the studies with low quality tend to report a higher prevalence than that with high quality (40.3% vs. 13.0%), studies with nonrandom sampling tend to report a higher prevalence than that with random sampling (33.6% vs. 20.7%). Although we included the data collected based on the standard scales, there were higher heterogeneity among the measure (Q = 253.1, df = 12, p < .00).

CONCLUSION

More than one-third postgraduates suffered from anxiety disorder, and this prevalence had a slight upward trend since 2005, school administrators, teachers and students should take joint actions to prevent mental disorder of graduates for deteriorating.

Identifying predictors of generalized anxiety among student pharmacists in response to the COVID-19 pandemic

INTRODUCTION

To explore the prevalence of generalized anxiety (GA) among doctor of pharmacy (PharmD) students at an academic institution during the COVID-19 pandemic and use Alderfer's existence, relatedness, and growth (ERG) theory to elucidate which unsatisfied needs are predictive of higher levels of GA symptoms.

METHODS

This was a cross-sectional, single-site survey administered to first- through fourth-year PharmD students from October 2020 to January 2021. The survey tool included demographic information, the validated Counseling Center Assessment of Psychological Symptoms-62 tool, and nine additional questions developed to assess Alderfer's ERG theory of needs. Predictors of GA symptoms were evaluated using descriptive statistics, multiple linear regression, correlation analysis, and multivariable analysis.

RESULTS

A total of 214 of 513 students completed the survey (42%) . Among students, 49.01% had no-clinical, 31.31% had low-clinical, and 19.63% had high-clinical GA symptoms. The relatedness needs, which included feeling disliked, socially disconnected, and misunderstood had the strongest correlation (65%) to GA symptoms and was most associated with GA symptoms (β = 0.56, P < .001). Students who did not exercise experienced more symptoms of GA (P = .008).

CONCLUSIONS

Over 50% of PharmD students met clinical cut-offs for GA symptoms and the relatedness need was most predictive of GA symptoms among students. Future student-centered interventions should aim to create opportunities that increase social connections, build resilience, and provide psychosocial support.

T. MS, Barakat M, Abdelaziz DH, Mansour NO, Thabit AK, Ramatillah DL, Al-Jumaili AA, Syed NK, Adam MF, Hossain MS, Baraka MA, Jose J, Elkalmi R, Chandran S, Singh Dehele I, Elrggal M, Fathelrahman AI. Assessment of mental wellbeing of undergraduate pharmacy students from 14 countries: The role of gender, lifestyle, health-related, and academic-related factors

Background

Pharmacy students will assume future roles as frontline healthcare providers. Therefore, evaluating their current state of mental wellbeing and its associated factors is essential for better planning students' support initiatives. This study aimed to assess mental wellbeing and its associated factors among undergraduate pharmacy students from 14 countries during the pandemic.

Methods

A cross-sectional study was conducted among undergraduate pharmacy students in 14 countries in Asia and the Middle East. The validated Warwick-Edinburgh Mental Wellbeing Scale (the 14-item WEMWBS) was adopted to assess mental wellbeing. Data collection was performed online between February and April 2022. Descriptive and inferential statistics were used as appropriate.

Results

A total of 2,665 responses were received, mainly from females (68.7%) with a higher presence of private universities (59.1%). About 34.9% had low mental wellbeing levels, while 57 and 8.1% had medium, and high levels, respectively. Binary logistic regression showed that males (AOR: 1.34; CI 95%: 1.11-1.61; p < 0.01) and students with no chronic illnesses (AOR: 2.01; CI 95%: 1.45-2.80; p < 0.001) were more likely to have higher mental wellbeing. Also, participants who did not engage in any exercise (AOR: 0.71; CI 95%: 0.52-0.98; p = 0.04) and those in public universities (AOR: 0.82; CI 95%: 0.69-0.97; p = 0.02) were less likely to have higher mental wellbeing. Additionally, students who had interest/passion for pharmacy (AOR: 1.69; CI 95%: 1.07-2.68; p = 0.02), and those who known pharmacists inspired (AOR: 1.81; CI 95%: 1.06-3.12; p = 0.03), were more likely to have higher mental wellbeing compared with those who had no specific reason for their choice to study pharmacy. The participants with excellent (AOR: 1.87; CI 95%: 1.29-2.70; p = 0.001) or very good self-reported academic performance (AOR: 1.57; CI 95%: 1.12-2.22; p = 0.01) were more likely to have higher mental wellbeing compared to those with fair academic performance.

Conclusion

More than a third of the participants had low mental wellbeing. Various demographic, lifestyle, medical and academic factors appeared to affect students' mental wellbeing. Careful consideration of these factors and their integration into the pharmacy schools' plans for student support services and academic advising would be essential to improve students' mental wellbeing.

Targeted Primary and Secondary Preventive Strategies for Depression among Malaysian Pharmacy Students

The global depression burden has remained a challenge throughout the pre- and post-pandemic era. The pandemic effect has led to the spiraling of mental disorders among young people who will be the next generation of leaders. This study aims to identify university students’ sociodemographic, psychosocial and academic backgrounds and performance associated with depression symptoms for the development of primary and secondary preventive strategies for mental health. A cross-sectional study was conducted using an online questionnaire distributed to 19 institutions in Malaysia offering a Bachelor of Pharmacy degree program. The self-rated Depression Anxiety Stress Scale (DASS-42) was used to assess depression symptoms. Pearson’s chi-square test and Fisher’s exact test were used to assess the investigated variables with depression symptoms. Independent T-test and one-way ANOVA were used to compare means of depression score across variables. Binary logistic regression was employed to examine the relationship between the investigated variables and depression symptoms. A total of 610 pharmacy students participated, of which 47% (n = 289/610) were having depression symptoms. Students who smoke nicotine and those who have separated parents, family history of mental illness, and poor academic performance were associated with depression symptoms (p < 0.05). Differences in geographical areas, race and religion also showed significant associations with depression symptoms. Parental marital status, poor academic performance, history of mental illness and comorbidities were statistically predicting depression symptoms (p < 0.05). Primary preventive strategies allowing students to harness healthy coping skills for stress, nicotine-free campaigns and a holistic curriculum are warranted. Secondary measures on mindfulness and compassion skills activities to benefit students who experienced early life crises are highly recommended. Enforcing these targeted strategies in collaboration with health and social sectors should be the primary agenda of universities to ensure their uptake.