A cross-sectional study of stress and its sources among health professional students at Makerere University, Uganda

Mental health and lifestyle-related behaviors in medical students in a Jordanian University, and variations by clerkship status

BACKGROUND

The rigors of medical education often take a toll on students' mental well-being, resulting in heightened stress, anxiety, depression, somatization, and thoughts of self-harm. This study aimed to determine the prevalence of mental health problems among Jordanian medical students (Yarmouk University), explore the links between mental state and demographic and lifestyle factors, and compare mental health profiles between pre-clinical/pre-clerkship (years 1-3) and clinical/clerkship (years 4-6) students.

METHODS

An online survey was distributed to undergraduate medical students at Yarmouk University. Mental health was measured using validated tools (depression: Patient Health Questionnaire, PHQ-9; eating disorders: SCOFF; Generalized Anxiety Disorder Scale, GAD-7; Somatic Symptoms: Patient Health Questionnaire, PHQ-15; overall stress (single-item measure); ability to handle stress; stressors and coping mechanisms. Data on sociodemographic factors, academic performance, and lifestyle choices, also were collected. Bivariate and multivariable analyses evaluated the associations between academic level and mental health, accounting for sociodemographic and lifestyle factors.

RESULTS

Of the 618 medical students who responded, 48.4% screened positive for depression, 36.7% for anxiety, and 63.6% for high level of stress. Slightly over half experienced somatic symptoms, and 28.6% exhibited signs of eating disorders. Roughly, 26% had suicidal thoughts, as measured by item 9 of the PHQ-9 scale. Low reported rates of healthy behaviors were observed (e.g. balanced diets, 5.7%; vigorous physical activity, 17.0%). Smoking prevalence was 24.6%, notably higher among clinical students. At the multivariable level, stress, insomnia, eating disorders and cigarette smoking were significantly associated with depression, anxiety and somatization. Higher physical activity scores were associated with lower depression risk. Females were significantly more likely than males to fall in more severe somatization categories.

CONCLUSION

This study highlights the need to address the alarming rates of mental health problems among Jordanian medical students. While few significant differences were observed between pre-clinical and clinical students, the high rates of depression, anxiety, stress, and negative health practices in both groups suggest the need for interventions that begin at enrollment as well as during transitions to clinical settings. Prioritizing mental health support and promoting healthier lifestyles among medical students are vital steps toward nurturing resilient, well-rounded future medical professionals.

The effect of mindfulness-based interventions on reducing stress in future health professionals: A systematic review and meta-analysis of randomized controlled trials

Students in health professions often face high levels of stress due to demanding academic schedules, heavy workloads, disrupted work-life balance, and sleep deprivation. Addressing stress during their education can prevent negative consequences for their mental health and the well-being of their future patients. Previous reviews on the effectiveness of mindfulness-based interventions (MBIs) focused on working health professionals or included a wide range of intervention types and durations. This study aims to investigate the effect of 6- to 12-week MBIs with 1- to 2-h weekly sessions on stress in future health professionals. We conducted a systematic review and meta-analysis of randomized controlled trials published in English by searching Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and PsycINFO. We used post-intervention stress levels and standard deviations to assess the ability of MBIs to reduce stress, summarized by the standardized mean difference (SMD). This review is reported according to the PRISMA checklist (2020). We identified 2932 studies, of which 11 were included in the systematic review and 10 had sufficient data for inclusion in the meta-analysis. The overall effect of MBIs on reducing stress was a SMD of 0.60 (95% CI [0.27, 0.94]). Our study provides evidence that MBIs have a moderate reducing effect on stress in students in health professions; however, given the high risk of bias, these findings should be interpreted with caution, and further high-quality studies are needed.

Negative experiences and coping strategies to stressful situations by undergraduate University students during Covid- 19 lockdown period in Uganda

Aim

To describe the negative experiences, coping strategies for stressful situations, and factors associated with COVID-19 worry among undergraduate students at Makerere University during the second COVID-19 lockdown in Uganda.

Methods

Descriptive cross-sectional study at Makerere University. Negative experiences and coping strategies were measured using a semi-structured questionnaire formulated based on literature and findings from previous studies on mental health and COVID-19. Descriptive statistics and measures of association were done using Stata 13.

Results

A total of 301 participants were enrolled. Their median age were 23 years. The majority were male (192, 64.0 %), single (269, 89.7 %,) and on normal academic progress (241, 80.3 %). 48.0 % of the participants were worried about COVID-19. Disruption of students' academics (277, 92.0 %) and financial problems (184, 61.1 %) were the most reported negative experiences. Coping strategies included listening to music (203, 67.4 %), talking to family and friends (191, 63.5 %,) and watching movies (174, 57.8 %). Female students than males (aOR: 2.0, 95% CI: 1.0-45.0, p= 0.118) and students without paid employment than those with paid work (aOR: 2.2, 95% CI: 1.0-5.0, p=0.109) were more worried about COVID-19.

Conclusion

Nearly half of the students were worried about COVID-19, which disrupted their social and academic lives. The students utilized a myriad of coping strategies.

The effect of mobile app-based self-care training on the quality of marital relations and the severity of menopausal symptoms in postmenopausal women: a clinical trial study in Iran

BACKGROUND

Educational interventions for self-care are a necessary solution to help postmenopausal women properly deal with menopausal problems. The present study aimed to investigate the effect of self-care training using an application on the quality of marital relations and the severity of menopausal symptoms in postmenopausal women in Iran.

METHODS

In this study, 60 postmenopausal women selected using the convenience sampling method were divided into two groups, intervention and control, using simple random allocation (lottery). The intervention group used the menopause self-care application for eight weeks in addition to routine care, but the control group only received the routine care. The Menopause Rating Scale (MRS) and the Perceived Relationship Quality Components (PRQC) questionnaire were completed in two stages, before and immediately after eight weeks, in both groups. Data were analyzed using SPSS software (version 16), descriptive (mean and standard deviation), and inferential (ANCOVA and Bonferroni post hoc) statistics.

RESULTS

The ANCOVA results showed that the use of the menopause self-care application decreased the severity of the participants' menopause symptoms (P = 0.001) and improved the quality of their marital relations (P = 0.001).

CONCLUSION

Implementation of a self-care training program through the application helped improve the quality of marital relations and reduce the severity of postmenopausal women's symptoms, so it can be used as an effective method to prevent the unpleasant consequences of menopause.

TRIAL REGISTRATION

The present study was registered at https://fa.irct.ir/ on 2021-05-28 (registration number: IRCT20201226049833N1).

Perspectives on mental health services for medical students at a Ugandan medical school

BACKGROUND

University-based mental health services for medical students remain a challenge, particularly in low-income countries, due to poor service availability. Prior studies have explored the availability of mental health services in high-income countries but little is known about mental health services in countries in sub-Saharan Africa, such as Uganda. Medical students are at a higher risk of developing mental health challenges during their course of study as compared with other students. Thus, there is a need for well-structured mental health services for this group of students. The aim of this study was to explore perspectives on mental health services for medical students at a public University in Uganda.

METHODS

This was a qualitative study where key informant interviews were conducted among purposively selected university administrators (n = 4), student leaders (n = 4), and mental health employees of the university (n = 3), three groups responsible for the mental well-being of medical students at a public university in Uganda. Interviews were audio-recorded, transcribed, and thematically analyzed to identify relevant themes.

RESULTS

The working experience of university administrators and mental health providers was between eight months to 20 years, while student leaders had studied at the university for over four years. We identified five broad themes: (1) Burden of medical school: A curriculum of trauma, (2) Negative coping mechanisms and the problem of blame, (3) The promise of services: Mixed Messages, (4) A broken mental health system for students, and (5) Barriers to mental health services.

CONCLUSION

Distinguishing between psychological distress that is anticipated because of the subject matter in learning medicine and identifying those students that are suffering from untreated psychiatric disorders is an important conceptual task for universities. This can be done through offering education about mental health and well-being for administrators, giving arm's length support for students, and a proactive, not reactive, approach to mental health. There is also a need to redesign the medical curriculum to change the medical education culture through pedagogical considerations of how trauma informs the learning and the mental health of students.

Knowledge, attitude and perceptions of medical students towards mental health in a university in Uganda

BACKGROUND

The prevalence of mental illness among medical students is high. A gap remains on what knowledge should be given to improve the attitudes and perceptions towards mental health. Despite the vast body of literature globally, no study has been conducted in Uganda to assess the levels of knowledge, attitude, and perception among medical students in Uganda.

OBJECTIVE

To determine the level of knowledge, attitude, and perception and their associated factors among medical students in Uganda.

METHODS

A cross-sectional study was done among 259 undergraduate medical students in a public university capturing information on knowledge, attitude, and perception towards mental health. Linear regression analysis was used to determine the factors associated with knowledge, attitude, and perception.

RESULTS

About 77.72% had high knowledge, 49.29% had positive attitudes, and 46.92% had good perceptions of mental health. There was a significant positive relationship between attitude and perceptions towards mental illness. At multilevel analysis, being in year 4 increased the level of knowledge (β = 1.50 [95% confidence interval (CI) = 0.46-2.54], p = 0.005) while a positive history of mental illness worsened perceptions towards mental illness (β = -4.23 [95% CI = -7.44-1.03], p = 0.010).

CONCLUSION

Medical students have a high level of knowledge about mental illness but the majority had poor attitudes and perceptions of mental illness. Exposure to psychiatry knowledge about mental illness in year four increased students' knowledge while prior experience with mental illness conditions was associated with poorer perceptions. The information present in this study can be used by policymakers and future researchers to design future studies and interventions to improve knowledge, perceptions, and attitudes especially among students who have a history of mental illness. Improvements in knowledge, attitude, and perception may improve the mental health services for the future patients of these medical students.

The exploration of a screen model for detecting undergraduates at higher risk for developing psychosis: A cross-sectional study in a medical university

PURPOSE

To examine a screen model for detecting undergraduates with higher risk for developing psychosis (HRDP).

DESIGN AND METHODS

A cross-sectional design with convenience sampling was used. The screen model included exploration stage by self-report scales and confirmation stage by face-to-face interviews.

FINDINGS

A total of 273 students were detected from 4744 surveys during 4 years. Of them, 120 students with HRDP were identified and 7 had been diagnosed as schizophrenia or bipolar disorders at 12-month follow-up.

PRACTICE IMPLICATIONS

This screen model can be used in early detection for undergraduates with HRDP from large general samples.

Psychometric evaluation of the Arabic version of the higher education inventory scale for nursing students

BACKGROUND

Studies in the literature have relied on a single instrument to assess stress levels and sources among nursing students in Jordan and in other Arab countries. Thus, there is a need to develop Arabic versions of psychometrically validated instruments for evaluating a wider range of aspects related to stress and stressors. The Higher Education Stress Inventory (HESI) is an instrument used to assess various aspects of stress and stressors related to higher education in different educational settings and among different student populations. To date, no exploratory or confirmatory factor analyses have been conducted to study the factor structure of the Arabic version of the HESI. Therefore, the current study aimed to evaluate the psychometric properties of the Arabic version of the HESI (Arabic-HESI) among nursing students in Jordan.

METHODS

The structure of the instrument was tested using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and maximum likelihood estimation among a sample of 355 nursing students at five Jordanian universities.

RESULTS

The Arabic-HESI proved to have excellent content validity index (CVI = 0.92). The instrument showed good internal consistency reliability (Cronbach's α = 0.75), as well as for the two emerged factors "challenges" and "dissatisfaction" (Cronbach's α were 0.75, 0.72 respectively). The results support the two-factor model for the Arabic-HESI, as the instrument was found to have robust structure and acceptable goodness-of-fit indices.

CONCLUSION

The Arabic-HESI is a reliable and valid instrument for assessing stress levels and stressors among nursing students in Jordan. Using the shortened version of the HESI to assess stress among nursing students is recommended. Identifying new features of stress and stressors among nursing students in Jordan will enable universities and nursing faculties to better support their students.

Perceived Stress, Depression, and Associated Factors among Undergraduate Health Science Students at Arsi University in 2019 in Oromia, Ethiopia

Background

A mental health problem is a significant cause of overall disease burden globally. Among this problem, stress and depression are the central problems observed among university students due to the transitional nature. Consequently, the problem has an adverse effect on the wellbeing and academic performance of students.

Objective

To assess perceived stress, depression, and associated factors among undergraduate health science students at Arsi University in 2019 in Oromia, Ethiopia.

Methods

An institutional-based cross-sectional study design on undergraduate health science students was employed for the study from February 25 to April 15, 2019. Data were collected by using a self-administered questionnaire of the perceived stress scale (PSS-14) item and Beck depression inventory 21 items.

Result

All of the study subjects were between ages 18 and 30 with a mean age of 20.9 ± 1.83 standard deviation years. The current prevalence of perceived stress among study subjects was 63.5%. Age category, study year, pressure to maintain a good grade, practical attachment, lack of dormitory safety, and the financial problem were identified as significantly associated factors of perceived stress. In addition to this study, results also revealed that the prevalence of depression among students was 4.4% in which thinking about career future prospects was a significantly associated factor.

Conclusion

Stress was a significant problem among study participants where a small proportion of study subjects presented with depression. Comprehensive counseling and guidance aligned with training on awareness creation were recommended.

Mental Distress and Associated Factors Among Undergraduate Engineering Students of Hawassa University, Ethiopia

BACKGROUND

Mental distress is a range of symptoms and experiences of a person's internal life that are commonly held to be troubling, confusing or out of the ordinary. Mental distress often interferes with studying, social interaction, and academic outcomes. Therefore, this study aimed at assessing the prevalence of mental distress and factors associated with it among undergraduate engineering students at Hawassa University.

METHODS

We conducted an institution-based cross-sectional descriptive study on undergraduate engineering students at Hawassa University. We collected the data from January to April 30, 2018, using interviewer-administered Self-Report Questionnaire 20 (SRQ-20) from 341 participants selected by stratified sampling and we performed multiple logistic regression analysis to find factors associated with mental distress.

RESULTS

Out of the total study population, 222 (65.1%) were males, and 172 (50.4%) were age ≥21. We found the prevalence of mental distress using SRQ-20 with a cut-off point ≥8 to be 28.7%. Female students were 2.9 times more likely to have mental distress as compared to male students (AOR= 2.90, 95% CI: 1.52-5.50). Facing financial problem (AOR= 2.20; CI = 1.25-3.85), poor social support (AOR= 2.58, 95% CI: 1.51-4.42), lack of interest in their field of study (AOR=2.57; CI: 1.23-5.38) and unresolved conflict with roommate (AOR= 2.29, 95% CI: 1.08-4.00) were significant predictors of mental distress.

CONCLUSION

This study showed a high prevalence of mental distress among engineering students. So, policymakers, university officials, and parents need to give due attention to engineering undergraduate students for proactive measures.

Prevalence and Factors Associated with Depression among Medical Students at Makerere University, Uganda

BACKGROUND

Depression affects about a third of medical students worldwide. There is paucity of data on depression among medical students in Uganda. The purpose of this study was to establish the prevalence and factors associated with depression among medical students at Makerere University College of Health Science (MakCHS), Uganda.

METHODS

A cross-sectional study was conducted among students pursuing a Bachelor of Medicine and Surgery at MakCHS in May and July 2019. Students were enrolled by consecutive sampling, both online using Google Forms and in person for those unable to access internet. The self-reported Patient Health Questionnaire 9 (PHQ9) was administered to assess depression, defined as a PHQ9 score ≥10. Microsoft Excel 2016 and Stata 16 were used for data analysis.

RESULTS

Overall, 331 valid responses (mean age 23.1±3.3 years) were submitted (response rate 93.8%). In a majority of participants, the prevalence of depression was 21.5% (n=71) of which 64.1% had moderate depression (n=50). On bivariate analysis, year of study, worrying about academic performance, and lectures were significantly associated with depression. On multivariate analysis, worrying about academic performance (aOR 2.52, 95% CI 1.50-4.22; P<0.001) and lectures (aOR 1.89, 95% CI 1.11-3.22; P=0.018) were significantly associated with depression.

CONCLUSION

Depression affects a significant number of medical students at MakCHS. About one in five medical students have depression. Year of study and academic performance were significantly associated with depression. Efforts aimed at identification and evaluation of students at risk, administering appropriate interventions, and follow-up of affected students are vital. Analytical studies aimed at establishing the causative factors and the effects of depression on medical students are recommended.

Prevalence of suicidal behaviour among nursing and midwifery college students in Ghana

AIM

To provide exploratory and descriptive evidence on the prevalence estimate and some demographic correlates of suicidal behaviour among nursing and midwifery college students in Ghana.

DESIGN

We used a cross-sectional survey design.

METHOD

An anonymous survey involving a randomly selected sample of 305 nursing and midwifery college students was conducted in March-May 2017. The Suicide Behavior Questionnaire-Revised was used to assess suicidal behaviour (i.e., ideation, planning, threat and attempt) and suicidal behaviour risk.

RESULTS

The lifetime prevalence of suicide ideations (15.4%; 95% confidence interval [CI] = 0.11-0.20), plans (6.6%; 95% CI = 0.04-0.10), attempts (2.3%; 95% CI = 0.01-0.05), threats (13.4%; 95% CI = 0.10-0.18) and 12-month prevalence of ideations (21.3%; 95% CI = 0.17-0.26) are comparable to estimates found in both high-income and low- and middle-income countries. However, associations between the demographic variables studied and suicidal behaviour risk were not statistically significant.

Lifestyle behaviors and mental health in medical students

Purpose

Recently, there has been a renewed interest in medical students’ mental health. The purpose of this paper is to determine factors associated with psychological distress in medical students and to assess the correlation between major lifestyle behaviours and mental health.

Design/methodology/approach

The authors conducted a cross-sectional questionnaire survey among 530 medical students randomized from a faculty of medicine in 2017. The authors used the 12-item General Health Questionnaire (GHQ-12) and the Simple Lifestyle Indicator Questionnaire (SLIQ) to assess mental health and lifestyle, respectively.

Findings

The mean value of GHQ-12 and SLIQ were 4.1±2.8 and 6.2±1.4, respectively. Bivariate correlation analysis showed that SLIQ was significantly correlated to GHQ-12 (r=−0.26; p<0.001). The prevalence of psychological distress (GHQ-12=4) was 50.1%. The authors found that low/middle financial situation of the family (OR=1.5; CI 95%=[1.1–2.3]), internship level, (OR=1.8; CI 95%=[1.1–3.3]), medium/poor perceived academic performance (OR=2.2; CI 95%=[1.5–3.2]) and medium/poor perceived health status (OR=2.3; CI 95%=[1.5–3.6]) were significantly associated with psychological distress. Multivariate analysis performing logistic regression showed that average and unhealthy lifestyle were independently associated with psychological distress, with an adjusted OR of 3.7 (CI 95%=[1.7–7.7]) and 5.8 (CI 95%=[2.4–14.8]), respectively.

Originality/value

The study highlighted the magnitude and the risk factors of psychological distress in medical students. Unhealthy lifestyle was a potential predictive of mental disorders. These findings provide fundamental information for future researches.

A cross-sectional study of stress and its sources among health professional students at Makerere University, Uganda

Aim

To assess prevalence of stress and its sources among undergraduate health professional students at Makerere University.

Design

This was a descriptive cross-sectional study using quantitative methods of data collection.

Methods

The study was conducted among 258 undergraduate health professional students (Medical, Dental and, Nursing students) at Makerere University. From each programme, students were recruited proportionately, while being selected conveniently from each year of study. Stress was measured using the General Health Questionnaire 12 and stressors assessed using a questionnaire developed from literature. After obtaining ethics approval, data were collected from consenting students. Data collected were analysed using SPSS statistical program.

Results

The prevalence of stress was found to be 57.4% and stressors of academic and psychosocial origin were most frequently reported. The top stressors included; academic curriculum (38%), dissatisfaction with class lectures (30.9%), long distance walk (29.5%), lack of time for recreation (28.9%), performance in examination (28.3%), lack of special guidance from faculty (26.7%) and high parental expectations (26.7%).