A systematic review of studies of depression prevalence in university students

Online support system for students in higher education: Proof-of-concept study

Background

Providing support to the increasing numbers of students facing mental health difficulties in higher education (HE) can be difficult due to stigma or lack of resources. Alternative and/or complementary sources of support are needed, such as online interventions that are recognised for their therapeutic value and cost-effectiveness.

Objectives

We aim to provide evidence supporting the conceptual and practical value of a newly developed online multimedia intervention system for HE students who face mild to moderate symptoms of anxiety and depression and study-skills difficulties.

Methods

Students from five universities were invited to participate in a cross-sectional proof-of-concept study. Students were invited through the universities’ internal communication channels. Following demonstration of each part of the system, students completed a survey with quantitative and qualitative questions.

Results

Response was largely positive. Positive responses on the features of the questionnaire ranged between 65% and 86%; on the features of the workshops ranged between 57% and 91%; on ‘My place’ ranged between 65% and 79%; on the animated videos ranged between 79% and 92%; and on the overall system ranged between 78% and 89%. Participants indicated areas for improvement and ways in which such improvement could be accomplished; these then guided the development of the system.

Conclusions

The results confirm the need for such a system. It can complement student support services (SSS) by dealing with cases with mild to moderate difficulties, hence allowing SSS to prioritise and effectively address more severe cases. Potentially this method can provide a meaningful alternative to SSS; this is worth investigating further.

Prevalence of Depression in Medical Students at the Lebanese University and Exploring its Correlation With Facebook Relevance: A Questionnaire Study

Background

The prevalence of major depression is particularly high in medical students, affecting around one-third of this population. Moreover, online social media, in particular Facebook, is becoming an intrinsic part in the life of a growing proportion of individuals worldwide.

Objective

Our primary objective is to identify the prevalence of depression in medical students at the Lebanese University Faculty of Medicine, a unique state university in Lebanon, its correlation with the utilization of the interactive features of Facebook, and the way students may resort to these features.

Methods

Students of the Lebanese University Faculty of Medicine were assessed for (1) depression and (2) Facebook activity. To screen for major depression, we used the Patient Health Questionnaire-9 (PHQ-9) scale. To test for Facebook activity, we developed the Facebook Resorting Questionnaire (FbRQ), which measures the degree to which students resort to Facebook.

Results

A total of 365 out of 480 students (76.0%) participated in the survey. A total of 25 students were excluded, hence 340 students were included in the final analysis. Current depression was reported in 117 students out of 340 (34.4%) and t tests showed female predominance. Moreover, PHQ-9 score multiple regression analysis showed that feeling depressed is explained 63.5% of the time by specific independent variables studied from the PHQ-9 and the FbRQ. Depression varied significantly among the different academic years (P<.001) and it peaked in the third-year students. One-way analysis of variance (ANOVA) showed that depression and resorting to Facebook had a positive and significant relationship (P=.003) and the different FbRQ categories had significant differences in resorting-to-Facebook power. The like, add friend, and check-in features students used when resorting to Facebook were significantly associated with depression.

Conclusions

This study showed that depression was highly prevalent among students of the Faculty of Medicine at the Lebanese University. Moreover, Facebook may be a promising, helpful, psychological tool for optimizing the management of depression. Our study brought to bear further questions that now prompt further observation and scrutiny to know more about the high rates of depression in this student population, more so in the part of the world studied, and to the growing role of social media.

Morningness-eveningness and depressive symptoms: Test on the components level with CES-D in Polish students

BACKGROUND

The study aimed to elucidate previously observed associations between morningness-eveningness and depressive symptomatology in university students. Relations between components of depressive symptomatology and morningness-eveningness were analysed.

METHODS

Nine hundred and seventy-four university students completed Polish versions of the Centre for Epidemiological Studies - Depression scale (CES-D; Polish translation appended to this paper) and the Composite Scale of Morningness. Principal component analysis (PCA) was used to test the structure of depressive symptoms. Pearson and partial correlations (with age and sex controlled), along with regression analyses with morning affect (MA) and circadian preference as predictors, were used.

RESULTS

PCA revealed three components of depressive symptoms: depressed/somatic affect, positive affect, interpersonal relations. Greater MA was related to less depressive symptoms in three components. Morning circadian preference was related to less depressive symptoms in depressed/somatic and positive affects and unrelated to interpersonal relations. Both morningness-eveningness components exhibited stronger links with depressed/somatic and positive affects than with interpersonal relations. Three CES-D components exhibited stronger links with MA than with circadian preference. In regression analyses only MA was statistically significant for positive affect and better interpersonal relations, whereas more depressed/somatic affect was predicted by lower MA and morning circadian preference (relationship reversed compared to correlations).

LIMITATIONS

Self-report assessment.

CONCLUSIONS

There are three groups of depressive symptoms in Polish university students. Associations of MA with depressed/somatic and positive affects are primarily responsible for the observed links between morningness-eveningness and depressive symptoms in university students. People with evening circadian preference whose MA is not lowered have less depressed/somatic affect.

PSYCHOLOGICAL TREATMENT OF DEPRESSION IN COLLEGE STUDENTS: A METAANALYSIS

BACKGROUND

Expanded efforts to detect and treat depression among college students, a peak period of onset, have the potential to bear high human capital value from a societal perspective because depression increases college withdrawal rates. However, it is not clear whether evidence-based depression therapies are as effective in college students as in other adult populations. The higher levels of cognitive functioning and IQ and higher proportions of first-onset cases might lead to treatment effects being different among college students relative to the larger adult population.

METHODS

We conducted a metaanalysis of randomized trials comparing psychological treatments of depressed college students relative to control groups and compared effect sizes in these studies to those in trials carried out in unselected populations of depressed adults.

RESULTS

The 15 trials on college students satisfying study inclusion criteria included 997 participants. The pooled effect size of therapy versus control was g = 0.89 (95% CI: 0.66∼1.11; NNT = 2.13) with moderate heterogeneity (I(2) = 57; 95% CI: 23∼72). None of these trials had low risk of bias. Effect sizes were significantly larger when students were not remunerated (e.g. money, credit), received individual versus group therapy, and were in trials that included a waiting list control group. No significant difference emerged in comparing effect sizes among college students versus adults either in simple mean comparisons or in multivariate metaregression analyses.

CONCLUSIONS

This metaanalysis of trials examining psychological treatments of depression in college students suggests that these therapies are effective and have effect sizes comparable to trials carried out among depressed adults.

Symptoms of Alcohol Dependence Predict Suicide Ideation Among Alaskan Undergraduates

Abstract. Background: Previous research has demonstrated an association between alcohol-related problems and suicidal ideation (SI). Aims: The present study evaluated, simultaneously, alcohol consequences and symptoms of alcohol dependence as predictors of SI after adjusting for depressive symptoms and alcohol consumption. Method: A sample of 298 Alaskan undergraduates completed survey measures, including the Young Adult Alcohol Consequences Questionnaire, the Short Alcohol Dependence Data Questionnaire, and the Beck Depression Inventory – II. The association between alcohol problems and SI status was evaluated using sequential logistic regression. Results: Symptoms of alcohol dependence (OR = 1.88, p < .05), but not alcohol-related consequences (OR = 1.01, p = .95), emerged as an independent predictor of SI status above and beyond depressive symptoms (OR = 2.39, p < .001) and alcohol consumption (OR = 1.08, p = .39). Conclusion: Alcohol dependence symptoms represented a unique risk for SI relative to alcohol-related consequences and alcohol consumption. Future research should examine the causal mechanism behind the relationship between alcohol dependence and suicidality among university students. Assessing the presence of dependence symptoms may improve the accuracy of identifying students at risk of SI.

Prevalence of Depression among Chinese University Students: A Meta-Analysis

Background

Depression is a major mental health issue worldwide, and university students with heavy burdens of study are at a high risk for depression. While a number of studies have been conducted regarding depression among university students in China, there is a lack of information regarding the national prevalence of depression among Chinese university students. Therefore, we performed a meta-analysis to statistically pool the prevalence of depression among Chinese university students.

Methods

A systematic search of scientific databases was conducted, including Chinese Web of Knowledge, Embase, PubMed, Wanfang (a Chinese database) and Weipu (a Chinese database) to find relevant publications published between 1995 and December 2015. This was supplemented by a secondary review of the reference lists of all retrieved papers to find additional relevant citations. Studies published in either English or Chinese that provided prevalence estimates of depression in Chinese university students were considered. Prevalence estimates of each eligible study were extracted and pooled in our meta-analysis using a random-effects model.

Results

A total of 39 studies conducted between 1997 and 2015 including 32,694 university students were analyzed. Our results indicate that the overall prevalence of depression among Chinese university students is 23.8% (95% CI: 19.9%–28.5%). Substantial heterogeneity in prevalence estimates was noted. Subgroup analysis revealed that the prevalence of depression among medical students is higher than among other students.

Conclusions

Overall, the prevalence of depression among Chinese university students is exceedingly high. This suggests that it is imperative that more attention be given to the development of appropriate mental healthcare strategies for university students in China.

An interpretative phenomenological analysis of the experience of self-harm repetition and recovery in young adults

Six young adults (aged 19-21 years) with repeat self-harm for over 5 years were interviewed about their self-harm, why they continued and what factors might help them to stop. Interpretative phenomenological analysis identified six themes: keeping self-harm private and hidden; self-harm as self-punishment; self-harm provides relief and comfort; habituation and escalation of self-harm; emotional gains and practical costs of cutting, and not believing they will stop completely. Young adults presented self-harm as an ingrained and purposeful behaviour which they could not stop, despite the costs and risks in early adulthood. Support strategies focused on coping skills, not just eradicating self-harm, are required.

An experimental study exploring the impact of vignette gender on the quality of university students' mental health first aid for peers with symptoms of depression

Background

University students have high rates of depression, and friends are often the most commonly-used source of support for emotional distress in this population. This study aimed to explore students’ ability to provide effective support for their peers with depressive symptoms and the factors influencing the quality of their mental health first aid (MHFA) skills, including students’ gender, course of study, and gender of student experiencing depression.

Methods

Via an online survey, students at two British universities (N = 483) were quasi-randomly allocated to view a video vignette of either a male or female student depicting symptoms of depression. An open-ended question probed MHFA actions they would take to help the vignette character, which were rated using a standardised scoring scheme based on MHFA guidelines.

Results

Students reported low MHFA scores (mean 2.89, out of possible 12). The most commonly reported action was provision of support and information, but only eight (1.6 %) students stated an intention to assess risk of harm. Those studying clinically non-relevant degrees with limited mental health content reported poorer MHFA (p = <0.001) and were less confident about their ability to support a friend with depression (p = 0.04). There was no main effect of vignette gender, but within the group of students on non-relevant courses the male vignette received significantly poorer MHFA than the female vignette (p = 0.02). A significant three-way interaction found that male participants studying non-relevant degrees who viewed a male vignette had poorer MHFA compared to females studying non-relevant degrees who viewed the female vignette (p = 0.005).

Conclusions

Most students lack the necessary MHFA skills to support friends suffering from symptoms of depression, or to help them get appropriate support and prevent risk of harm. Students on courses which do not include mental health related content are particularly ill-equipped to support male students, with male students receiving the poorest quality MHFA from fellow male students on these courses. MHFA training has the potential to improve outcomes for students with depression, and could have a valuable role in reducing the excess risk of harm seen in male students.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2887-2) contains supplementary material, which is available to authorized users.

Trajectories of alcohol use and consequences in college women with and without depressed mood

College students with depressed mood face heightened risk for experiencing drinking-related negative consequences. However, few studies have examined prospective patterns of alcohol consequences among depressed students. In the present investigation, we assessed how first-year college women's trajectories of heavy episodic drinking (HED) and alcohol consequences differed as a function of depressed mood at college entry. Participants were 233 heavy drinking incoming first-year college females (61% White) at a mid-sized West Coast University. Participants completed an online baseline survey, attended a single brief group intervention session, and completed 1- and 6-month post-intervention follow-up surveys. Depressed mood, alcohol consumption, and alcohol consequences were assessed at each time point. We employed latent growth curve analyses. Females with depressed mood, versus without depressed mood, experienced greater levels of alcohol consequences overall, particularly during transitions to college. However, contrary to hypotheses, participants with depressed mood (vs. without) exhibited significantly steeper declining trends in consequences, controlling for treatment condition, age, race, and ethnicity, and despite stable drinking levels, depressed mood, and use of protective behaviors over time. Potential explanations and suggestions for future research are discussed.

An online guided ACT intervention for enhancing the psychological wellbeing of university students: A randomized controlled clinical trial

Stress, anxiety and depression are relatively common problems among university students. This study examined whether an online psychological intervention aiming at enhancing the wellbeing of university students could be an effective and practical alternative for meeting the needs of a university population. University students (N = 68; 85% female; 19-32 years old) were randomly assigned to either a guided seven-week online Acceptance and Commitment Therapy (iACT) intervention or a waiting list control condition (WLC). A between-groups pre-post (iACT vs WLC) design with 12-month follow-up for the iACT participants was conducted. The intervention participants were offered two face-to-face meetings, completed online exercises during a five-week period, and received personal weekly written feedback via the website from their randomly assigned, trained student coaches. Waitlist participants were offered the intervention program soon after the post measurements. Results in this small efficacy trial showed that the iACT participants had significantly higher gains in wellbeing (between group, d = 0.46), life satisfaction (d = 0.65), and mindfulness skills (d = 0.49). In addition, iACT participants' self-reported stress (d = 0.54) and symptoms of depression (d = 0.69) were significantly reduced compared to the participants in the control group. These benefits were maintained over a 12-month follow-up period (within iACT group, d = 0.65-0.69, for primary measures). The results suggest that an online-based, coach-guided ACT program with blended face-to-face and online sessions could be an effective and well-accepted alternative for enhancing the wellbeing of university students.

Who is the Treatment-Seeking Young Adult with Severe Obesity: A Comprehensive Characterization with Emphasis on Mental Health

OBJECTIVE

To characterize treatment-seeking young adults (16-25 years) with severe obesity, particularly mental health problems.

STUDY DESIGN AND PARTICIPANTS

Cross-sectional study of 165 participants (132 women, 33 men) with BMI ≥35 kg/m2 or ≥30 kg/m2 with comorbidities, enrolling in a multidisciplinary obesity treatment program.

METHOD

Data collection at admission of present and life-time health issues including symptomatology of anxiety, depression (Hospital Anxiety and Depression Scale) and attention-deficit/hyperactivity disorder (Adult ADHD Self-Report scale); self-esteem (Rosenberg Self-Esteem Scale), suicide attempts, health-related quality of life (Short Form-36 Health Survey), psychosocial functioning related to obesity (Obesity-related Problems Scale), cardiorespiratory fitness (Astrand's bicycle ergometer test), somatic and psychiatric co-morbidities, cardiometabolic risk factors, and micronutritional status. We used multiple regression analysis to identify variables independently associated with present anxiety and depressive symptomatology.

RESULTS

Mean body mass index was 39.2 kg/m2 (SD = 5.2). We found evidence of poor mental health, including present psychiatric diagnoses (29%), symptomatology of anxiety (47%), depression (27%) and attention-deficit/hyperactivity disorder (37%); low self-esteem (42%), attempted suicide (12%), and low quality of life (physical component score = 46, SD = 11.2; mental component score = 36, SD = 13.9, P<0.001 for difference). Variables independently associated with present anxiety symptomatology (R2 = 0.33, P<0.001) included low self-esteem (P<0.001) and pain (P = 0.003), whereas present depressive symptomatology (R2 = 0.38, P<0.001) was independently associated with low self-esteem (P<0.001), low cardiorespiratory fitness (P = 0.009) and obesity-related problems (P = 0.018). The prevalence of type 2 diabetes was 3%, and hypertension 2%. Insulin resistance was present in 82%, lipid abnormality in 62%, and poor cardiorespiratory fitness in 92%. Forty-eight percent had at least one micronutritional deficiency, vitamin D being the most common (35%).

CONCLUSION

A wide range of health issues, including quite severe mental health problems, was prevalent in treatment-seeking young adults with severe obesity. These are likely to constitute a major treatment challenge, including options relating to bariatric surgery.

EEG alpha frequency correlates of burnout and depression: The role of gender

EEG alpha frequency band biomarkers of depression are widely explored. Due to their trait-like features, they may help distinguish between depressive and burnout symptomatology, which is often referred to as "work-related depression". The present correlational study strived to examine whether individual alpha frequency (IAF), power, and coherence in the alpha band can provide evidence for establishing burnout as a separate diagnostic entity. Resting EEG (eyes closed) was recorded in 117 individuals (42 males). In addition, the participants filled-out questionnaires of burnout and depression. Regression analyses highlighted the differential value of IAF and power in predicting burnout and depression. IAF was significantly related to depressive symptomatology, whereas power was linked mostly to burnout. Moreover, seven out of twelve interactions between EEG indicators and gender were significant. Connectivity patterns were significant for depression displaying gender-related differences. The results offer tentative support for establishing burnout as a separate clinical syndrome.

The Role of Family Environment in Depressive Symptoms among University Students: A Large Sample Survey in China

Objective

To explore the relationship between family environment and depressive symptoms and to evaluate the influence of hard and soft family environmental factors on depression levels in a large sample of university students in China.

Methods

A multi-stage stratified sampling procedure was used to select 6,000 participants. The response rate was 88.8%, with 5,329 students completing the Beck Depression Inventory (BDI) and the Family Environment Scale Chinese Version (FES-CV), which was adapted for the Chinese population. Differences between the groups were tested for significance by the Student’s t-test; ANOVA was used to test continuous variables. The relationship between soft family environmental factors and BDI were tested by Pearson correlation analysis. Hierarchical linear regression analysis was conducted to model the effects of hard environmental factors and soft environmental factors on depression in university students.

Results

A total of 11.8% of students scored above the threshold of moderate depression(BDI≧14). Hard family environmental factors such as parent relationship, family economic status, level of parental literacy and non-intact family structure were associated with depressive symptoms. The soft family environmental factors—conflict and control—were positively associated with depression, while cohesion was negatively related to depressive symptom after controlling for other important associates of depression. Hierarchical regression analysis indicated that the soft family environment correlates more strongly with depression than the hard family environment.

Conclusions

Soft family environmental factors—especially cohesion, conflict and control—appeared to play an important role in the occurrence of depressive symptoms. These findings underline the significance of the family environment as a source of risk factors for depression among university students in China and suggest that family-based interventions and improvement are very important to reduce depression among university students.

Prevalence of Depression Among College-Goers in Mainland China: A Methodical Evaluation and Meta-Analysis

There are no proper statistics available to assess how much of a burden it is to them. This study was conducted to gauge the pooled prevalence and offer evidence in support of few prevention and regulation strategies. A methodical literature search was conducted with the help of the Web of Knowledge, PubMed, Chinese Web of Knowledge, Wanfang, and Chongqing VIP databases. Furthermore, articles published from 2000 to 2014, reporting about the estimated prevalence of depression among college students in mainland China, were covered as well. In this study, a meta-analysis was deployed to approximate the overall prevalence of depression among college-goers in mainland China. A total of 45 studies were conducted on 50,826 participants. The average pooled prevalence of depression was 30.39% (26.38-34.55%). Subgroup analyses showed that 29.45% (22.88-36.48%) were men and 28.65% (23.44-34.16%) were women. Furthermore, 28.10% (22.83-33.70%) were from the northern part and 32.44% (26.67-38.48%) were from the southern. The prevalence of depression was 30.45% (23.96-37.36%) for sample sizes of <500 subjects, 30.99% (25.08-37.23%) for samples with 500 to 1000 people, and 29.54% (33.32-37.33%) in case of samples with >1000 people. Publications between 2000 and 2006 showed a depression prevalence of 8.45% (22.34-35.00%), whereas 30.52% (21.30-40.61%) and 31.79% (27.31-36.45%) were the corresponding values according to publications during 2007 to 2011 and 2012 to 2014. The prevalence of depression among college students in mainland China had reached the world's epidemic level.

Burnout, depression and anxiety in preclinical medical students: a cross-sectional survey

OBJECTIVE

The purpose of this study was to assess the prevalences and correlates of adverse affective states (burnout-, depression- and anxiety-related symptoms) among preclinical medical students.

METHODS

Self-report questionnaires were sent to all preclinical medical students of Leiden University Medical Center (n=1311). Burnout-related symptoms were measured using the Maslach Burnout Inventory-General Survey (MBI-GS), depression and anxiety-related symptoms and vitality using the Symptom Questionnaire-48 (SQ-48). Furthermore, duration of sleep, quality of life (SF-36), need for recovery, happiness and dispositional optimism were assessed and analysed in relation to affective symptoms using regression analysis.

RESULTS

Among the 433 responders (response rate=33.0%), prevalences of self-reported burnout-, depression- and anxiety-related symptoms were 46.0% (n=199), 27.0% (n=117) and 29.1% (n=126), respectively. Independent correlates for burnout-related symptoms were <6 h sleep per night (p=0.02), low happiness (p<0.001) and a high need for recovery (p<0.001). Independent correlates for both depression- and anxiety-related symptoms were low optimism (p<0.001; p<0.001, respectively), low happiness (p<0.001; p=0.001, respectively) and a high need for recovery (p=0.03; p<0.001, respectively).

CONCLUSION

Prevalences for adverse affective states were high among preclinical medical students and mainly associated with personality trait-related factors and need for recovery, rather than work-related factors. These findings suggest that being a medical student increases one's risk to adverse affective states, and should inspire preventative initiatives.

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.

Depression literacy of undergraduates in a non-western developing context: the case of Sri Lanka

BACKGROUND

Research examining the depression literacy of undergraduates in non-western developing countries is limited. This study explores this among undergraduates in Sri Lanka.

METHODS

A total of 4671 undergraduates responded to a survey presenting a vignette of a depressed undergraduate. They were asked to identify the problem, describe their intended help-seeking actions if affected by it and rate the helpfulness of a range of help-providers and interventions for dealing with it. Mental health experts also rated these options, providing a benchmark for assessing the undergraduates' responses.

RESULTS

Only 17.4% of undergraduates recognised depression, but this was significantly lower among those responding in Sinhala compared to English (3.5 vs 36.8%). More undergraduates indicated intentions of seeking informal help, such as from friends and parents, than from professionals, such as psychiatrists and counsellors. However, a majority rated all these help-providers as 'helpful', aligning with expert opinion. Other options recommended by experts and rated as 'helpful' by a large proportion of undergraduates included counselling/psychological therapy and self-help strategies such as doing enjoyable activities and meditation/yoga/relaxation exercises. However, a low proportion of undergraduates rated "western medicine to improve mood" as 'helpful', deviating from expert opinion. Although not endorsed by experts, undergraduates indicated intentions of using religious strategies, highly endorsing these as 'helpful'. Labelling the problem as depression and using mental health-related labels were both associated with higher odds of endorsing professional help, with the label 'depression' associated with endorsing a wider range of professional options.

CONCLUSIONS

The recognition rate of depression might be associated with the language used to label it. These undergraduates' knowledge about the use of medication for depression needs improvement. Health promotion interventions for depressed undergraduates must be designed in light of the prevalent socio-cultural backdrop, such as the undergraduates' high endorsement of informal and culturally relevant help-seeking. Improving their ability to recognise the problem as being mental health-related might trigger their use of professional options of help.

Perceptions and intentions relating to seeking help for depression among medical undergraduates in Sri Lanka: a cross-sectional comparison with non-medical undergraduates

BACKGROUND

This study attempts to understand whether medical undergraduates in Sri Lanka would seek help for depression. This was done by examining their perceptions and intentions relating to seeking help for depression, using the responses of non-medical undergraduates as the baseline for comparison.

METHOD

Medical (n = 620) and non-medical undergraduates (n = 4050) at the University of Colombo responded to a questionnaire which included a vignette about a depressed undergraduate, a depression measure, an open-ended question examining their intentions to seek help if affected by the problem described in the vignette, and scales examining their perceptions about the helpfulness of various help-seeking options for dealing with the problem. The latter items were also administered among mental health professionals to assess expert opinion on dealing with depression. Logistic regression models were used to examine if medical undergraduates differed from non-medical undergraduates in their rates of depression, help-seeking perceptions and help-seeking intentions. These models were also used to examine if being depressed was associated with differences in the help-seeking perceptions and intentions of medical undergraduates.

RESULTS

Medical and non-medical undergraduates did not differ in their odds of being depressed. Overall, the medical undergraduates were more likely to appraise professional help positively. However, they did not differ from non-medical undergraduates in relation to their intentions to seek such help if affected by the problem personally. They were also more likely to indicate their intentions to seek help from parents and family. Furthermore, medical undergraduates who screened positive for Major Depression were less likely to appraise some of the recommended professional and informal help-seeking options as being 'helpful', with only 50 % considering that it was 'unhelpful' to deal with the problem alone. There was also no difference in their help-seeking intentions as compared to those screening negative for Major Depression.

DISCUSSION AND CONCLUSIONS

Although medical training seems to be associated with better help-seeking beliefs, interventions are needed to improve these medical undergraduates' intentions to personally seek professional help for depression. It is concerning that medical undergraduates who are depressed might be less likely to consider it beneficial to seek help and instead, deal with the problem alone.

A systematic review of studies on the prevalence of insomnia in university students

OBJECTIVES

Many studies have shown that insomnia is a common problem among university students, but there are wide variations in the prevalence of insomnia. In this systematic review, we aimed to explore the prevalence of insomnia among university students using scientific and conclusive methods.

STUDY DESIGN

A systematic review is designed to analyze the studies reporting on prevalence of insomnia among university students.

METHODS

Systemic searches were conducted in PubMed, BioMed Central, EBSCO, ScienceDirect, Ovid LWW and Medline databases between January 2000 and July 2014, The Meta analyst software was used to calculate the prevalence rate of each study, the pooled means of prevalence rates and 95% CIs across studies were then calculated and presented.

RESULTS

Seven articles that met the inclusion and exclusion criteria were selected. The overall sample size in the current review was 16,478, with a minimum of 219 and a maximum of 10,322. The prevalence rates of the seven studies ranged between 9.4% (95%CI 8.8-10.0%) and 38.2% (95% CI 35.4-41.1%). Overall, the total students studied with a weighted mean prevalence of 18.5% (95% CI 11.2-28.8%), considerably higher than rates of 7.4% (95% CI 5.8-9.0%) reported in general population.

CONCLUSIONS

This review emphasized that insomnia prevalence in university students is considerably higher than that in general population, suggested that more attention should be paid to insomnia in university students.

Measuring Life Events and Their Association With Clinical Disorder: A Protocol for Development of an Online Approach

Background

Severe life events are acknowledged as important etiological factors in the development of clinical disorders, including major depression. Interview methods capable of assessing context and meaning of events have demonstrated superior validity compared with checklist questionnaire methods and arguments for interview approaches have resurfaced because choosing the appropriate assessment tool provides clarity of information about gene-environment interactions in depression. Such approaches also have greater potential for understanding and treating clinical cases or for use in interventions.

Objective

(1) To argue that life events need sophisticated measurement not satisfactorily captured in checklist approaches. (2) To review life-events measures and key findings related to disorder, exemplifying depression. (3) To describe an ongoing study with a new online measure and to assess its psychometric properties and the association of life events in relation to disorder and educational outcomes.

Methods

The Computerised Life Events Assessment Record (CLEAR) is under development as a tool for online assessment of adult life events. Based on the Life Events and Difficulties Schedule interview, CLEAR seeks to assess life events to self and close others, link these to other events and difficulties, and utilize calendar-based timing, to improve upon checklist approaches.

Results

The CLEAR study is in the preliminary stages and its results are expected to be made available by the end of 2015.

Conclusions

There is currently no sophisticated technological application of social risk factor assessment, such as life events and difficulties. CLEAR is designed to gather reliable and valid life-event data while combating the limitations of interviews (eg, time consuming and costly) and life-event checklists (eg, inability to accurately measure severity and independence of life events). The advantages of using such innovative methodology for research, clinical practice, and interventions are discussed.

Stigmatising attitudes of undergraduates towards their peers with depression: a cross-sectional study in Sri Lanka

BACKGROUND

There is limited research examining mental health-related stigma of undergraduates in non-western developing countries. This study examined stigma of undergraduates in Sri Lanka towards another depressed undergraduate.

METHODS

A hypothetical vignette of an undergraduate suffering from depression was presented. A total of 4650 undergraduates responded to scales assessing their personal stigma towards and desire for social distance from this individual. Exploratory structural equation modelling (ESEM) was performed to determine the dimensionality and loading pattern of the items on these two stigma scales. Multiple linear regressions were used to explore correlates of the identified dimensions of stigma.

RESULTS

Previous findings that the Social Distance Scale forms a single dimension and that the Personal Stigma Scale consists of two dimensions were supported. However, the measurement structure of the dimensions of stigma on the latter scales, labelled 'Weak-not-Sick' and 'Dangerous-Undesirable' , differed from previous work. A high level of stigma in relation to the 'Weak-not-Sick' Scale was observed. However, some correlates associated with lower levels of stigma on this scale, such as being in the Medical Faculty, were associated with higher levels of stigma on the 'Dangerous-Undesirable' and 'Social Distance' scales. In contrast, labelling the problem as a mental health-related problem, with absence of specific psychiatric terminology, was associated with lower levels of stigma on these latter two scales. Exposure to a mental health problem in family or friends or from personal experience was also associated with lower stigma on the Social Distance Scale. However, the effect sizes of these relationships were small.

CONCLUSIONS

The findings highlight differences in the measurement structure and score distribution of the 'Weak-not-Sick' and 'Dangerous-Undesirable' scales when used in different cultural and demographic contexts. The dimensionality of stigma relevant to these scales must always be established prior to their use in different contexts. Furthermore, campaigns targeted at improving knowledge about depression as a real illness and as a psychiatric condition need to ensure that such attempts are not associated with increases in other aspects of stigma.

Gender Differences in the Effect of Depressive Symptoms on Prospective Alcohol Expectancies, Coping Motives, and Alcohol Outcomes in the First Year of College

Problematic alcohol use and risk for dependence peak during late adolescence, particularly among first-year college students. Although students matriculating into college with depressive symptoms experience elevated risk for alcohol problems, few studies have examined the intervening mechanisms of risk. In this study, we examined depressed mood at college entry on prospective alcohol expectancies, drinking motives, and alcohol outcomes during the first year of college, adjusting for pre-college factors. Participants (N = 614; 59% female, 33% non-White) were incoming college students from three universities who completed online self-report surveys prior to matriculating into college and at the end of their first year in college. We utilized path analysis to test our hypotheses. In women, the path that linked depressive symptoms to consequences was primarily attributable to the effect of pre-college drinking to cope on drinking to cope in college, which in turn was associated with alcohol consequences. In men, the effect of depressive symptoms on alcohol consequences in college was independent of pre-college and college factors, thus indicating the need for research that identifies mechanisms of risk in males. Interventions that address coping deficits and motivations for drinking may be particularly beneficial for depressed adolescent females during this high-risk developmental period.

Qualitative Literature Review of the Prevalence of Depression in Medical Students Compared to Students in Non-medical Degrees

PURPOSE

The purpose of this study is to review studies published in English between 1 January 2000 and 16 June 2014, in peer-reviewed journals, that have assessed the prevalence of depression, comparing medical students and non-medical students with a single evaluation method.

METHOD

The databases PubMed, Medline, EMBASE, PsycINFO, and Scopus were searched for eligible articles. Searches used combinations of the Medical Subject Headings medical student and depression. Titles and abstracts were reviewed to determine eligibility before full-text articles were retrieved, which were then also reviewed.

RESULTS

Twelve studies met eligibility criteria. Non-medical groups surveyed included dentistry, business, humanities, nursing, pharmacy, and architecture students. One study found statistically significant results suggesting that medical students had a higher prevalence of depression than groups of non-medical students; five studies found statistically significant results indicating that the prevalence of depression in medical students was less than that in groups of non-medical students; four studies found no statistically significant difference, and two studies did not report on the statistical significance of their findings. One study was longitudinal, and 11 studies were cross-sectional.

CONCLUSION

While there are limitations to these comparisons, in the main, the reviewed literature suggests that medical students have similar or lower rates of depression compared to certain groups of non-medical students. A lack of longitudinal studies meant that potential common underlying causes could not be discerned, highlighting the need for further research in this area. The high rates of depression among medical students indicate the continuing need for interventions to reduce depression.

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.

The origins of repetitive thought in rumination: separating cognitive style from deficits in inhibitory control over memory

BACKGROUND AND OBJECTIVES

Rumination is a major contributor to the maintenance of affective disorders and has been linked to memory control deficits. However, ruminators often report intentionally engaging in repetitive thought due to its perceived benefits. Deliberate re-processing may lead to the appearance of a memory control deficit that is better explained as a difference in cognitive style.

METHODS

Ninety-six undergraduate students volunteered to take part in a direct-suppression variant of the Think/No-Think paradigm after which they completed self-report measures of rumination and the degree to which they deliberately re-processed the to-be-suppressed items.

RESULTS

We demonstrate a relation between rumination and impaired suppression-induced forgetting. This relation is robust even when controlling for deliberate re-processing of the to-be-suppressed items, a behavior itself related to both rumination and suppression. Therefore, whereas conscious fixation on to-be-suppressed items reduced memory suppression, it did not fully account for the relation between rumination and memory suppression.

LIMITATIONS

The current experiment employed a retrospective measure of deliberate re-processing in the context of an unscreened university sample; future research might therefore generalize our findings using an online measure of deliberate re-processing or within a clinical population.

CONCLUSIONS

We provide evidence that deliberate re-processing accounts for some--but not all--of the relation between rumination and suppression-induced forgetting. The present findings, observed in a paradigm known to engage top-down inhibitory modulation of mnemonic processing, provide the most theoretically focused evidence to date for the existence of a memory control deficit in rumination.

Context counts: solitary drinking explains the association between depressive symptoms and alcohol-related problems in undergraduates

INTRODUCTION

According to theory, depressed individuals self-medicate their negative affect with alcohol. Due to isolation and interpersonal difficulties, undergraduates with elevated depressive symptoms may do much of their drinking alone and/or in intimate contexts (e.g., with family or romantic partners) rather than at normative social events (e.g., parties). Evidence suggests drinking in these contexts leads to heavy use and alcohol-related problems. Accordingly, context may be an explanatory mechanism linking depressive symptoms to problematic drinking. This pathway remains understudied in the literature. Our study aimed to examine solitary and intimate drinking as distinct mediators of the depression-problematic drinking association. We hypothesized that depressive symptoms would be positively associated with solitary and intimate drinking which in turn would be associated with elevated alcohol use and related problems.

METHODS

Undergraduates (N=295; 72% women) completed online self-reports.

RESULTS

Consistent with hypotheses, path analyses supported depressive symptoms as a positive predictor of solitary drinking, which in turn was a positive predictor of alcohol-related problems, but not of alcohol use. Counter to hypotheses, depressive symptoms were unrelated to intimate drinking. Interestingly, depressive symptoms were negatively associated with drinking at parties, which in turn led to reduced risk for elevated alcohol use and related problems.

CONCLUSIONS

Our results shed new light on the depression pathway to problematic drinking in undergraduates by considering the role of drinking context. Our findings suggest undergraduates with elevated depressive symptoms are at risk for potentially problematic drinking because they are drinking alone. Solitary drinking represents a malleable target for clinical interventions aimed at reducing risky depression-related alcohol use.

Prevalence and determinants of depressive symptoms among university students in Ghana

BACKGROUND

Over two million Ghanaians suffer from moderate to mild mental disorders but prevalence levels and determinants among university students remains fairly unknown. A better understanding of depression and its determinants is necessary in developing appropriate interventions in this population group.

METHOD

A convenient sample of 270 students from a public university (132 males and 138 females) were interviewed using a questionnaire to record socio-demographic variables, HIV risk behaviours. Depressive symptoms were measured using Centre for Epidemiological Studies Short Depression Scale (CES-D 10). Multiple logistic regression was used to identify the determinants.

RESULTS

The mean age was 22 (SD=2.39). Using a cut-off point of 10 of the CES-D10, the overall prevalence of depression was 39.2%; with 31.1% of mild to moderate depression and 8.1% severe depressive symptoms. Significant predictors included lack of social support, religion not having an impact on life, heavy alcohol consumption and traumatic experiences such as being forced to have sex, physically and sexually abused as a child, and beaten by a sex partner.

LIMITATIONS

Given the cross-sectional nature of the research, the findings are limited highlighting the need for further research. Also, relying on self-report of symptoms could have influenced the outcome. The use of a single university means that there could be regional differences in depression in other universities.

CONCLUSION

Depression occurs in a significant number of students. An appropriate intervention must be implemented to help reduce the burden of depression, especially to those found to be at risk.

Depressive symptoms and social demographic, stress and health risk behaviour among university students in 26 low-, middle- and high-income countries

BACKGROUND

The aim of this study was to determine the prevalence and association between depressive symptoms, sociodemographic, social and health risk variables among undergraduate students in 26 low, middle and high income countries.

METHOD

Using anonymous questionnaires, data were collected from 20222 undergraduate university students (mean age 20.8, SD = 2.8) from 27 universities in 26 countries in Africa, Asia, Caribbean and Latin America.

RESULTS

Overall study participants had a prevalence of 24.0 % moderate and 12.8 % severe depressive symptoms. In multivariate logistic regression, demographic and social variables (being female gender, low organised religious activity, lack of social support and lack of personal control), stressful or traumatic life events (sexual violence and physical child abuse) and health risk behaviour (tobacco use, insufficient brushing of teeth, irregular sleep duration, increased salt intake, infrequent meals a day, heavy internet use and having sustained an injury) were associated with severe depressive symptoms.

CONCLUSION

High rates of depressive symptoms were found. Several risk factors including social and health risk behaviour variables were identified which can be utilised in guiding interventions.

Changes in positive affect and mindfulness predict changes in cortisol response and psychiatric symptoms: a latent change score modelling approach

OBJECTIVE

This study examined whether and how changes in positive affect and mindfulness predicted changes in cortisol secretion and psychological distress in adaptation to examination stress.

DESIGN

A sample of 105 college students completed a questionnaire set and provided salivary samples before (T1), during (T2) and after (T3) an examination period.

RESULTS

Latent change score modelling revealed that T1-T2 and T2-T3 increases in mindfulness were associated with larger T2-T3 decrease in area-under-the-curve ground of cortisol awakening response (CARg), whereas T2-T3 increases in both positive affect and mindfulness were associated with larger T2-T3 decrease in anxiety symptoms (comparative fit index = .96; Tucker-Lewis index = .93-.95; root-mean-square error of approximation = .04-.08; standardised root-mean-square residual = .08-.10). T1-T2 and T2-T3 increases in positive affect were not associated T2-T3 decrease in CARg, whereas T1-T2 increases in positive affect and mindfulness were not associated with T2-T3 decrease in anxiety symptoms.

CONCLUSION

The levels of post-stress recovery from anxiety symptoms could depend on concurrent increases in positive affect and mindfulness, whereas the levels of post-stress decline in cortisol secretion could depend on increases in mindfulness both during and after stress. Directions for translating the present findings into stress management programmes in college settings are discussed.

Social support moderates stress effects on depression

This study examined the moderator effect of social support on the relationship between stress and depression of university students. A total of 632 undergraduate students completed the measures of perceived stress, perceived social support, and depression. Hierarchical regression analysis showed that social support moderated the association between stress and depression. Undergraduate students with high stress reported higher scores in depression than those with low stress with low social support level. However, the impact of stress on depression was much smaller in the high social support group compared with that in the low social support group.

Inflammatory mediators of cognitive impairment in bipolar disorder

OBJECTIVES

Recent studies have pointed to neuroinflammation, oxidative stress and neurotrophic factors as key mediators in the pathophysiology of mood disorders. Little is however known about the cascade of biological episodes underlying the cognitive deficits observed during the acute and euthymic phases of bipolar disorder (BD). The aim of this review is to assess the potential association between cognitive impairment and biomarkers of inflammation, oxidative stress and neurotrophic activity in BD.

METHODS

Scopus (all databases), Pubmed and Ovid Medline were systematically searched with no language or year restrictions, up to November 2013, for human studies that collected both inflammatory markers and cognitive data in BD. Selected search terms were bipolar disorder, depression, mania, psychosis, inflammatory, cognitive and neurotrophic.

RESULTS

Ten human studies satisfied the criteria for consideration. The findings showed that high levels of peripheral inflammatory-cytokine, oxidative stress and reduced brain derived neurotrophic factor (BDNF) levels were associated with poor cognitive performance. The BDNF val66met polymorphism is a potential vulnerability factor for cognitive impairment in BD.

CONCLUSIONS

Current data provide preliminary evidence of a link between the cognitive decline observed in BD and mechanisms of neuroinflammation and neuroprotection. The identification of BD specific inflammatory markers and polymorphisms in inflammatory response genes may be of assistance for therapeutic intervention.

Increased objectively assessed vigorous-intensity exercise is associated with reduced stress, increased mental health and good objective and subjective sleep in young adults

The role of physical activity as a factor that protects against stress-related mental disorders is well documented. Nevertheless, there is still a dearth of research using objective measures of physical activity. The present study examines whether objectively assessed vigorous physical activity (VPA) is associated with mental health benefits beyond moderate physical activity (MPA). Particularly, this study examines whether young adults who accomplish the American College of Sports Medicine's (ACSM) vigorous-intensity exercise recommendations differ from peers below these standards with regard to their level of perceived stress, depressive symptoms, perceived pain, and subjective and objective sleep. A total of 42 undergraduate students (22 women, 20 men; M=21.24years, SD=2.20) volunteered to take part in the study. Stress, pain, depressive symptoms, and subjective sleep were assessed via questionnaire, objective sleep via sleep-EEG assessment, and VPA via actigraphy. Meeting VPA recommendations had mental health benefits beyond MPA. VPA was associated with less stress, pain, subjective sleep complaints and depressive symptoms. Moreover, vigorous exercisers had more favorable objective sleep pattern. Especially, they had increased total sleep time, more stage 4 and REM sleep, more slow wave sleep and a lower percentage of light sleep. Vigorous exercisers also reported fewer mental health problems if exposed to high stress. This study provides evidence that meeting the VPA standards of the ACSM is associated with improved mental health and more successful coping among young people, even compared to those who are meeting or exceeding the requirements for MPA.

Prevalence and correlates of depression among college nursing students in China

This study aims to assess the prevalence of depression and examine potential risk factors correlated to depression among nursing college students in China. Between September and November 2012, a total of 763 college nursing students were randomly selected to participate in a survey, which included the Center for Epidemiologic Studies Depression Scale (CES-D). The result showed that 22.9% (95% CI: 20.0%-25.9%) of participants reported high score on the CES-D (16 or above). Risk factors significantly associated with depression in the univariate analysis were academic performance, academic stress, interest in majors, occupational future, interpersonal relationship, frequency of exercise, self-reported health status, social support, educational level of father, relationship with parents and making decisions without interference by parents. Backward multivariate logistic regression analysis revealed that lower academic stress, and better occupational future were strongly related to lower risk of depression, followed by active use of social support, full making decision power, better relationship with father and higher self-reported health status. The findings suggested that in order to prevent depression among college nursing students, school- and family-based strategies should be developed and implemented.

Computer-delivered and web-based interventions to improve depression, anxiety, and psychological well-being of university students: a systematic review and meta-analysis

BACKGROUND

Depression and anxiety are common mental health difficulties experienced by university students and can impair academic and social functioning. Students are limited in seeking help from professionals. As university students are highly connected to digital technologies, Web-based and computer-delivered interventions could be used to improve students' mental health. The effectiveness of these intervention types requires investigation to identify whether these are viable prevention strategies for university students.

OBJECTIVE

The intent of the study was to systematically review and analyze trials of Web-based and computer-delivered interventions to improve depression, anxiety, psychological distress, and stress in university students.

METHODS

Several databases were searched using keywords relating to higher education students, mental health, and eHealth interventions. The eligibility criteria for studies included in the review were: (1) the study aimed to improve symptoms relating to depression, anxiety, psychological distress, and stress, (2) the study involved computer-delivered or Web-based interventions accessed via computer, laptop, or tablet, (3) the study was a randomized controlled trial, and (4) the study was trialed on higher education students. Trials were reviewed and outcome data analyzed through random effects meta-analyses for each outcome and each type of trial arm comparison. Cochrane Collaboration risk of bias tool was used to assess study quality.

RESULTS

A total of 17 trials were identified, in which seven were the same three interventions on separate samples; 14 reported sufficient information for meta-analysis. The majority (n=13) were website-delivered and nine interventions were based on cognitive behavioral therapy (CBT). A total of 1795 participants were randomized and 1480 analyzed. Risk of bias was considered moderate, as many publications did not sufficiently report their methods and seven explicitly conducted completers' analyses. In comparison to the inactive control, sensitivity meta-analyses supported intervention in improving anxiety (pooled standardized mean difference [SMD] -0.56; 95% CI -0.77 to -0.35, P<.001), depression (pooled SMD -0.43; 95% CI -0.63 to -0.22, P<.001), and stress (pooled SMD -0.73; 95% CI -1.27 to -0.19, P=.008). In comparison to active controls, sensitivity analyses did not support either condition for anxiety (pooled SMD -0.18; 95% CI -0.98 to 0.62, P=.66) or depression (pooled SMD -0.28; 95% CI -0.75 to -0.20, P=.25). In contrast to a comparison intervention, neither condition was supported in sensitivity analyses for anxiety (pooled SMD -0.10; 95% CI -0.39 to 0.18, P=.48) or depression (pooled SMD -0.33; 95% CI -0.43 to 1.09, P=.40).

CONCLUSIONS

The findings suggest Web-based and computer-delivered interventions can be effective in improving students' depression, anxiety, and stress outcomes when compared to inactive controls, but some caution is needed when compared to other trial arms and methodological issues were noticeable. Interventions need to be trialed on more heterogeneous student samples and would benefit from user evaluation. Future trials should address methodological considerations to improve reporting of trial quality and address post-intervention skewed data.

Having mentors and campus social networks moderates the impact of worries and video gaming on depressive symptoms: a moderated mediation analysis

BACKGROUND

Easy access to the internet has spawned a wealth of research to investigate the effects of its use on depression. However, one limitation of many previous studies is that they disregard the interactive mechanisms of risk and protective factors. The aim of the present study was to investigate a resilience model in the relationship between worry, daily internet video game playing, daily sleep duration, mentors, social networks and depression, using a moderated mediation analysis.

METHODS

6068 Korean undergraduate and graduate students participated in this study. The participants completed a web-based mental health screening questionnaire including the Beck Depression Inventory (BDI) and information about number of worries, number of mentors, number of campus social networks, daily sleep duration, daily amount of internet video game playing and daily amount of internet searching on computer or smartphone. A moderated mediation analysis was carried out using the PROCESS macro which allowed the inclusion of mediators and moderator in the same model.

RESULTS

The results showed that the daily amount of internet video game playing and daily sleep duration partially mediated the association between the number of worries and the severity of depression. In addition, the mediating effect of the daily amount of internet video game playing was moderated by both the number of mentors and the number of campus social networks.

CONCLUSIONS

The current findings indicate that the negative impact of worry on depression through internet video game playing can be buffered when students seek to have a number of mentors and campus social networks. Interventions should therefore target individuals who have higher number of worries but seek only a few mentors or campus social networks. Social support via campus mentorship and social networks ameliorate the severity of depression in university students.

Web-based depression screening and psychiatric consultation for college students: a feasibility and acceptability study

Background. A steady rise in the prevalence of depression among college students has negatively affected student quality of life. This study investigates the feasibility and acceptability of a Web-based model, including Skype, to screen and provide psychiatric consultation to depressed college students. Methods. Students completed the 9-item Patient Health Questionnaire (PHQ-9) online; those who screened positive (PHQ-9 ≥ 10) or endorsed any level of suicidal ideation were offered Web-based psychiatric consultation using Skype. After the consultation, students filled out a 7-item satisfaction questionnaire to report on the acceptability of this Web-based method. Results. A total of 972 students consented to the online depression screening and 285 screened positive. Of those, 69 students consented and 17 students successfully completed the psychiatric consultation via Skype. Thirteen (76.4%) students found the interview useful in helping them understand their depression. Fifteen (88.2%) students thought that psychologists and psychiatrists could successfully see patients via videoconferencing. Conclusions. Current online technologies can provide depression screening and psychiatric consultation to college students; those who participated reported a positive experience. Future studies will need to address the low levels of participation among college students and attract students who are underserved, as well as use a videoconferencing platform that adequately protects data confidentiality.

First- and last-year medical students: is there a difference in the prevalence and intensity of anxiety and depressive symptoms?

OBJECTIVE

Medical training is considered a significant stress factor. We sought to assess the prevalence and intensity of anxiety and depressive symptoms in medical students and compare samples of first-year and sixth-year students.

METHOD

This was a cross-sectional study of first- and sixth-year medical students who attended classes regularly. The study instruments were a sociodemographic questionnaire, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI).

RESULTS

A total of 232 students (110 first-year, 122 sixth-year) completed the questionnaires, for a response rate of 67.4%. Overall 50.4% of respondents were male (56.4% of first-year and 45.1% of sixth-year students). Anxiety symptoms were reported by 30.8% of first-year students and 9.4% of sixth-year students (p < 0.001). Female students were more affected by anxiety. There were no significant between-group differences in depressive symptoms.

CONCLUSION

A higher prevalence of anxiety symptoms was found in first-year medical students as compared with sixth-year students. Strategies should be developed to help medical students, particularly female students, manage these symptoms at the beginning of their medical training.

Spiritual well-being and quality of life of Iranian adults with type 2 diabetes

Introduction. Diabetes is a major public health problem. Little is known about the spiritual well-being and its relationship with quality of life (QOL) in Iranian Muslim patients with diabetes. This study investigated the spiritual well-being and QOL of Iranian adults with type 2 diabetes and the association between spiritual well-being, QOL, and depression. Methods. A cross-sectional study was done among 203 patients with type 2 diabetes mellitus in Isfahan, Iran. Quality of life and spiritual well-being were measured using the functional assessment of chronic illness therapy-spiritual well-being (FACIT-Sp). Depression was assessed using the Patient Health Questionnaire-2 (PHQ-2). Descriptive analysis, Pearson's correlation, and multiple regression analysis were performed for statistical assessment. Results. The mean QOL was 61.00 (SD = 9.97) and the mean spiritual well-being was 30.59 (SD = 6.14). Sixty-four percent of our studied population had depressive disorders. There was a significant positive correlation between all QOL subscales and meaning, peace, and total spiritual well-being score. Conclusion. The results of this study showed poor QOL and spiritual well-being and high prevalence of depression in Iranian patients with type 2 diabetes compared to other studies' findings especially western studies. This indicates the need for psychosocial and spiritual support in caring for Iranian patients with diabetes.

Socioeconomic status and the risk of depression among U.K. higher education students

BACKGROUND

Many university students experience some symptoms of depression during the course of their studies but there is evidence that students from less advantaged backgrounds may be more vulnerable.

METHODS

The study was a cross-sectional online survey of 923 undergraduate students attending 6 U.K. Universities in the academic year 2009-2010 who completed a modified version of the Zagazig Depression Scale (ZDS).

RESULTS

Overall, 58.1% of female and 59.9% of male study participants screened positive for depression (ZDS score >10). In the fully adjusted model, final year students (OR = 1.8) who lived in a more deprived area (OR = 2.3) were more likely to report higher rates of depressive symptoms. Additionally, students with high perceived control (OR = 1.6) whose mothers were highly educated (OR = 0.5) and from a family of a high affluence (OR = 0.3) were less likely to suffer from higher rates of depressive symptoms. The relationship between lower social economic status and depression was partly mediated by low sense of control.

CONCLUSION

Students from less advantaged backgrounds are more at risk of depression but a strong sense of control over one's life may be protective.

APPLICATION

Since depression has strong impact on students' learning and quality of life universities should consider confidential screening for mental health problems and provide additional support for students.