Effort-reward imbalance among students at German universities: associations with self-rated health and mental health

Well-being among university students in the post-COVID-19 era: a cross-country survey

University students have to handle crucial challenges for their future lives, such as succeeding in academic studies and finding attachment figures. These processes could potentially involve their well-being and mental health, with possible sociocultural differences based on the country of study. In order to explore such potential differences, a cross-sectional, multi-center survey was performed involving students from the University of Torino (Italy), Sevilla (Spain), and Lusòfona (Portugal). The survey, conducted from May to November 2023, investigated students' demographic and educational details, socioeconomic status, social support, mental health, academic environment, perceived COVID-19 pandemic impact, and future plans. Demographic profiles showed a predominance of female participants and straight sexual orientation, followed by bisexuality. Italian students showed the lowest levels of mental well-being and the highest rates of mental problems (anxiety and depression) and suicidal risk across the three countries despite the relatively similar profiles of social support. The prevalence of the students' confidence in their professional future is higher in Spain than in Italy and Portugal. This study provides a comprehensive examination of university students' mental health and well-being in three Southern European countries, addressing the major mental health challenges among university students and offering valuable insights for public health purposes.

Depressive Symptoms Among Higher Education Students in Germany-A Systematic Review and Meta-Analysis

Objectives

Higher education students in Germany are vulnerable to depressive symptoms. Despite ample evidence, no comprehensive review has recently been conducted. Thus, our systematic review and meta-analysis aims at describing the extent to which students are affected by depressive symptoms.

Methods

We searched three databases for articles reporting the prevalence rates of depressiveness among students in Germany published between 2002 and 2023. Pooled prevalence rates were calculated using random effects models, both for the overall sample and for subgroups categorized by gender, study setting, assessment instrument, and whether the study was conducted before or during the COVID-19 pandemic.

Results

The search yielded 992 records. After screening, 60 articles remained for data extraction. About one out of five students (21.1%) exhibits depressive symptoms. Pooled prevalence rates differ between subgroups, with higher rates during the COVID-19 pandemic than before (30.6% versus 18.0%) and with females being more affected than their male counterparts (29.0% versus 23.1%).

Conclusion

This review underlines the urgency with which the mental health of students should be addressed at the (higher educational) policy level.

Clinical Trial Registration: PROPSPERO, Identifier CRD42022384066.

Sleep and mental health among Chinese adolescents: the chain-mediating role of physical health perception and school adjustment

OBJECTIVE

Sleep problems and their detrimental effects on adolescents' physical and mental health have received substantial attention. Prior studies have focused mainly on the direct association between sleep and mental health; however, little is known about the underlying mediating mechanism. To address this gap, the present study constructed a chain mediation model to examine the association between sleep deficiency and mental health status in adolescents, by introducing two mediating variables-physical health perception and school adjustment.

METHODS

A sample of 7530 senior high school students completed a battery of self-report questionnaires measuring their sleep duration, mental health status, physical health perception, and school adjustment. Data were collected from the Database of Youth Health at Shandong University. All the measures showed good reliability and validity in the present study. Data were analyzed using SPSS 25.0 and the SPSS PROCESS.

RESULTS

The results were as follows: (1) Sleep duration was significantly associated with physical health perception and mental health. (2) Physical health perception partially mediated the association between sleep and mental health. (3) Physical health perception and school adjustment played a chain mediating role between sleep and mental health. In conclusion, sleep not only directly associated with mental health among adolescents, but also influences mental health by the chain mediating effect of perception of physical health and school adjustment.

CONCLUSION

These findings in the present study contribute to understanding the mechanisms underlying the association between sleep and mental health and have important implications for interventions aimed at improving mental health status among adolescents in China. Our results indicated that promoting adequate sleep duration and improving sleep quality are possible key mental health promotion strategies for adolescents.

Self-care strategies for medical students: an uncontrolled mixed-methods evaluation of a mind-body-medicine group course

BACKGROUND

High stress during medical education and its detrimental effects on student health is well documented. This exploratory evaluation study assesses a 10-week Mind-Body-Medicine student course, created to promote student self-care at Charité Universitätsmedizin Berlin, Germany.

METHODS

During 2012-2019, uncontrolled quantitative and qualitative data were gathered from 112 student participants. Outcomes including changes in perceived stress (PSS), mindfulness (FMI/MAAS), self-reflection (GRAS), self-efficacy (GSE), empathy (SPF), and health-related quality of life (SF-12) were measured between the first (T0) and last sessions (T1). Qualitative data were obtained in focus groups at course completion and triangulated with quantitative data.

RESULTS

Quantitative outcomes showed decreases in perceived stress and increased self-efficacy, mindfulness, self-reflection, and empathy. In focus groups, students reported greater abilities to self-regulate stressful experiences, personal growth and new insights into integrative medicine. Triangulation grounded these effects of MBM practice in its social context, creating an interdependent dynamic between experiences of self and others.

CONCLUSION

After completing an MBM course, students reported reduced perceived stress, increased self-efficacy, mindfulness, empathy and positive engagement with integrative concepts of doctor-patient relationships. Further research with larger randomized confirmatory studies is needed to validate these benefits.

Nursing students' academic conditions, psychological distress, and intention to leave school: A cross-sectional study

BACKGROUND

Psychological distress and intention to leave school are highly prevalent among nursing students. Academic conditions, including psychosocial stressors and school-work-life conflicts, could contribute to psychological distress and intention to leave school.

OBJECTIVE

To explore the associations between academic conditions and 1) psychological distress and 2) intention to leave school.

DESIGN

Cross-sectional correlational design.

SETTINGS

Data collection was performed in February and October 2021 in two nursing schools in Canada: Cegep (publicly funded college, technical degree) and university (bachelor's degree).

PARTICIPANTS

230 nursing students (Cegep 131, university 99).

METHODS

A self-administered online questionnaire assessed academic conditions (psychosocial stressors (Demand-Control-Support, Effort-Reward Imbalance and Overcommitment scales) and school-work-life conflicts (single item)), psychological distress (Kessler-6 scale), intention to leave school, and several covariates. Poisson robust multivariate regression models were built to explore the associations between academic conditions and 1) psychological distress and 2) intention to leave school.

RESULTS

A large proportion of participants experienced high efforts, school-work-life conflicts, overcommitment, and psychological distress (49.5-84.7 %). One out of five participants had had intention to leave school "many times" (Cegep 20.61 %; university 22.22 %). In adjusted analysis, overcommitment and school-work-life conflicts were associated with a higher prevalence of psychological distress (Prevalence ratio = 2.10; 95 % Confidence Intervals = 1.15-3.84 and Prevalence ratio = 2.32; 95 % Confidence Intervals = 1.24-4.32, respectively). Adverse associations were observed between effort-reward imbalance (Prevalence ratio = 2.32; 95 % Confidence Intervals = 1.09-4.94) as well as school-work-life conflicts (Prevalence ratio = 2.40; 95 % Confidence Intervals = 1.05-5.45) and intention to leave school.

CONCLUSIONS

Academic conditions might be risk factors for psychological distress and intention to leave school among nursing students. Interventions targeting modifiable academic conditions might improve nursing students' mental health and retention.

The association between study conditions and hair cortisol in medical students in Germany - a cross-sectional study

BACKGROUND

Medical students often experience high levels of stress due to adverse study conditions, which may have adverse health consequences. Hair cortisol concentration (HCC) has been described as a physiological marker for chronic stress and might thus help to identify students under stress and examine the study conditions being responsible for long-term physiological stress responses. This study therefore investigated the association between study conditions and HCC in a sample of medical students.

METHODS

Fifty-five students from a medical school in Germany completed a paper-based questionnaire and had hair samples collected between May 2020 and July 2021. Study conditions were assessed with student versions of questionnaires based on the Job-Demand-Control-Support model (StrukStud, 25 items) and Effort-Reward Imbalance model (Student ERI, nine items). HCC of two centimeters closest to the scalp were determined by a cortisol luminescence immunoassay. Linear multiple regression analyses were performed to examine associations between study conditions and HCC.

RESULTS

Demands (B = 0.23, p = 0.002), effort (B = 0.12, p = 0.029) and the effort-reward-ratio (B = 0.28, p = 0.007) were positively associated with HCC in separate regression analyses, adjusted for age and sex. Only the association between demands and HCC remained significant when all components of the respective questionnaire were considered in the same model (B = 0.22, p = 0.003).

CONCLUSION

The results suggest that adverse study conditions may be associated with activation of the hypothalamic-pituitary-adrenal axis stress response as reflected by increased HCC. Longitudinal research is needed to confirm these cross-sectional results and examine effects of more prolonged stress due to adverse study conditions.

Associations between Poorer Mental Health with Work-Related Effort, Reward, and Overcommitment among a Sample of Formal US Solid Waste Workers during the COVID-19 Pandemic

Background

Effort-reward imbalance (ERI) and overcommitment at work have been associated poorer mental health. However, nonlinear and nonadditive effects have not been investigated previously.

Methods

The association between effort, reward, and overcommitment with odds of poorer mental health was examined among a sample of 68 formal United States waste workers (87% male). Traditional, logistic regression and Bayesian Kernel machine regression (BKMR) modeling was conducted. Models controlled for age, education level, race, gender, union status, and physical health status.

Results

The traditional, logistic regression found only overcommitment was significantly associated with poorer mental health (IQR increase: OR = 6.7; 95% CI: 1.7 to 25.5) when controlling for effort and reward (or ERI alone). Results from the BKMR showed that a simultaneous IQR increase in higher effort, lower reward, and higher overcommitment was associated with 6.6 (95% CI: 1.7 to 33.4) times significantly higher odds of poorer mental health. An IQR increase in overcommitment was associated with 5.6 (95% CI: 1.6 to 24.9) times significantly higher odds of poorer mental health when controlling for effort and reward. Higher effort and lower reward at work may not always be associated with poorer mental health but rather they may have an inverse, U-shaped relationship with mental health. No interaction between effort, reward, or overcommitment was observed.

Conclusion

When taking into the consideration the relationship between effort, reward, and overcommitment, overcommitment may be most indicative of poorer mental health. Organizations should assess their workers' perceptions of overcommitment to target potential areas of improvement to enhance mental health outcomes.

Self-rated health of university students in Germany-The importance of material, psychosocial, and behavioral factors and the parental socio-economic status

Introduction

Health inequalities start early in life. The time of young adulthood, between late teens and early twenties, is especially interesting in this regard. This time of emerging adulthood, the transition from being a child to becoming an adult, is characterized by the detachment from parents and establishing of an own independent life. From a health inequality perspective, the question about the importance of the socio-economic background of parents is important. University students are an especially interesting group. Many students come from a privileged background and the question of health inequality among university students has not yet been properly studied.

Methods

Based on the National Educational Panel Study (NEPS), we analyzed health inequalities among 9,000 students in Germany (∅ 20 years in the first year of their studies) over a period of 8 years.

Results

We found that most university students (92%) in Germany reported a good and very good health. Yet, we still found substantial health inequalities. Students whose parents had a higher occupational status reported less health problems. Additionally, we observed that health inequalities had indirect impact on health via health behavior, psychosocial resources, and material conditions.

Discussion

We believe our study is an important contribution to the understudied subject of students' health. We see the impact of social inequality on health among such a privileged group like university students as an important sign of the importance of health inequality.

University Fairness Questionnaire (UFair): Development and Validation of a German Questionnaire to Assess University Justice-A Study Protocol of a Mixed Methods Study

Distress is a widespread phenomenon in the general population, but also among university students, associated with poorer learning success and negative health consequences. A source of distress might be the experience of injustice. Theoretical and empirical work in the area of perceived fairness in the workplace ("organizational justice") has shown that perceived unfairness is related to various stress indicators and health outcomes. Preliminary evidence indicates that unfairness matters not only in the work context but also in the university context. However, an adapted and validated tool to assess perceived unfairness in the university context is hitherto missing. The goal of the proposed project is therefore to adapt the construct of organizational justice to the university context and to develop a corresponding questionnaire by means of established scientific procedures. An exploratory sequential mixed-methods design is applied in which qualitative and quantitative methods are combined. A valid and practicable measurement instrument ("UFair" University Fairness Questionnaire) will be developed and tested, and the relationship with various health outcomes will be examined. The UFair questionnaire will be made available free of charge to other researchers.

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

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

A Web-Based Stress Management Intervention for University Students in Indonesia (Rileks): Feasibility Study Using a Pretest-Posttest Design

Background

University students are susceptible to excessive stress. A web-based stress management intervention holds promise to improve stress but is still at a novel stage in Indonesia.

Objective

The aim of this paper was to report the feasibility of the intervention we developed—Rileks—among university students in Indonesia in terms of acceptability and usability, and to propose recommendations for future improvements.

Methods

A single-group pretest and posttest design was used. Participants with scores of 15 or higher on the stress subscale of the 42-item Depression Anxiety Stress Scales were given access to the intervention (N=68). The main outcome measures were the 8-item Client Satisfaction Questionnaire (CSQ-8) score, the System Usability Scale (SUS) score, and intervention uptake. Participants’ experience in each session was evaluated using closed- and open-ended questions for future improvements. Descriptive statistics were used to examine primary outcome and qualitative session evaluations. Participants’ responses to each topic of the open questions were summarized.

Results

The intervention was evaluated as being satisfactory (CSQ-8 mean score 21.89, SD 8.72; range 8-32). However, the intervention’s usability was still below expectation (SUS mean score 62.8, SD 14.74; range 0-100). The core modules were completed by 10 out of 68 participants (15%), and the study dropout rate was 63% (43/68) at postassessment. In general, the module content was rated positively, with some notes for improvement covering content and technical aspects.

Conclusions

This study indicates that Rileks is potentially feasible for Indonesian university students. In order to be optimally applied in such a context and before scaling up web-based interventions in Indonesia, in general, further development and refinement are needed.

International Registered Report Identifier (IRRID)

RR2-10.2196/11493

Understanding Reciprocity Among University Students in Low-Resource Settings: Validation and Measurement Using a Mixed-Methods Approach

Objectives

This study aimed to investigate reciprocity among university students in low-resource settings using a convergent mixed-methods approach in Jordan. The study operationalized the effort-reward imbalance (ERI) model which is a sociological framework used to predict occupational-related health outcomes. The basic theory of ERI model assumes that an imbalance of effort and reward predicts adverse health outcomes.

Methods

The research involved two studies, Study I (n = 833) to quantitatively measure ERI and Study II to collect qualitative data (n = 44) on the drivers of ERI among university students. In Study I, a modified Arabic version of the ERI questionnaire was used. The study measured ERI and investigated the reliability and validity of the Arabic version of the ERI model questionnaire. In Study II, data were collected from focus groups and personal interviews and thematic analysis was used.

Results

The results suggested that ERI was associated with poor academic performance (OR=2.31, 95% CI 1.60–3.32), absenteeism (OR=1.66, 95% CI 1.21–2.27), low exercise level (OR=2.02, 95% CI 1.49–2.74) and poor self-reported health (OR=1.12, 95% CI 1.08–1.30). Three major themes emerged, namely high academic load, financial pressures and negative influence on the students' performance, wellbeing and health to explain effort-reward imbalance.

Conclusions

Results suggest that ERI among university students is multi-faceted and is not bound only to academic-related demands and that the extrinsic factors such as the economic context of Jordan is among drivers of ERI.

Gender moderates the association between chronic academic stress with top-down and bottom-up attention

Research on the relationship between chronic stress and cognition is limited by a lack of concurrent measurement of state-anxiety, physiological arousal, and gender. For the first time, we assessed the impact of these factors on top-down/conscious (simple and choice reaction time) and bottom-up/reflexive (saccadic reaction time) measures of attention using CONVIRT virtual-reality cognitive tests. Participants (N = 163) completed measures of academic stress (effort-reward imbalance; ERI) and state-anxiety while heart-rate variability was recorded continuously throughout the experiment. Gender moderated the association between academic stress with the top-down measures (b = -0.002, t = -2.023, p = .045; b = -0.063, t = -3.080, p = .002) and higher academic stress was associated with poorer/slower reaction times only for male participants. For bottom-up attention, heart rate variability moderated the relationship between academic stress and saccadic reaction time (b = 0.092, t = 1.991, p = .048), and only female participants who were more stressed (i.e., ERI ≥ 1) and displayed stronger sympathetic dominance had slower reaction times. Our findings align with emerging evidence that chronic stress is related to hyperarousal in women and cognitive decrements in men. Our findings suggest that higher ERI and sympathetic dominance during cognitive testing was associated with poorer bottom-up attention in women, whereas for men, academic stress was related with poorer top-down attention irrespective of sympathovagal balance.

Classification of psychiatric symptoms using deep interaction networks: the CASPIAN-IV study

Identifying the possible factors of psychiatric symptoms among children can reduce the risk of adverse psychosocial outcomes in adulthood. We designed a classification tool to examine the association between modifiable risk factors and psychiatric symptoms, defined based on the Persian version of the WHO-GSHS questionnaire in a developing country. Ten thousand three hundred fifty students, aged 6–18 years from all Iran provinces, participated in this study. We used feature discretization and encoding, stability selection, and regularized group method of data handling (GMDH) to classify the a priori specific factors (e.g., demographic, sleeping-time, life satisfaction, and birth-weight) to psychiatric symptoms. Self-rated health was the most critical feature. The selected modifiable factors were eating breakfast, screentime, salty snack for depression symptom, physical activity, salty snack for worriedness symptom, (abdominal) obesity, sweetened beverage, and sleep-hour for mild-to-moderate emotional symptoms. The area under the ROC curve of the GMDH was 0.75 (CI 95% 0.73–0.76) for the analyzed psychiatric symptoms using threefold cross-validation. It significantly outperformed the state-of-the-art (adjusted p < 0.05; McNemar's test). In this study, the association of psychiatric risk factors and the importance of modifiable nutrition and lifestyle factors were emphasized. However, as a cross-sectional study, no causality can be inferred.

Mental Health Status of Canadian Funeral Service Workers at the Beginning of the COVID-19 Pandemic

OBJECTIVE

To describe the mental health situation and job stress levels of Funeral Service Workers (FSW) during the first months of the pandemic.

METHODS

We conducted a cross-sectional study in Canada between May and July 2020. Funeral service professional organizations were asked to spread a questionnaire to their members including job description, assessment of anxiety (GAD-7), depression (PHQ-8), and job stress (effort-reward imbalance questionnaire).

RESULTS

Fifty-eight FSW completed a questionnaire, 32% reported anxiety symptoms (GAD-7 > 10), 29% reported depressive symptoms (PHQ-8 > 10), 31% reported job stress. Women were more likely to report overcommitment (66.7% vs. 31.8%, P = 0.015).

CONCLUSIONS

Levels of anxiety and depression identified in Canadian FSW were higher than those identified in other occupational groups during the first few months of the pandemic.

Mental health among university students: The associations of effort-reward imbalance and overcommitment with psychological distress

BACKGROUND

Mental health problems are highly prevalent among university students, but little is known about their underlying determinants. This study explores mental health among university students, the association between "effort-reward imbalance" (ERI), overcommitment and mental health, and to what extent ERI and overcommitment explain gender differences in mental health.

METHODS

Cross-sectional data were analyzed from 4760 Italian university students. The Kessler Psychological Distress Scale-10 was used to measure self-reported psychological distress, as an indicator of mental health, and the ERI - Student Questionnaire to measure effort, reward and overcommitment. The associations between ERI and overcommitment with psychological distress were estimated with multinomial logistic regression analyses.

RESULTS

78.5% of the respondents experienced psychological distress, with 21.3%, 21.1%, and 36.1% reporting respectively mild, moderate and severe psychological distress. Female students were more likely to report moderate and severe psychological distress. ERI and overcommitment were strongly associated with severe psychological distress with ORs respectively up to 19.9 (95% CI: 12.2-32.5) and 22.2 (95% CI: 16.1-30.7). ERI and overcommitment explained part of the higher odds of severe psychological distress among female students comparing to males, attenuating the ORs from 2.3 (95% CI: 1.9-2.7) to 1.4 (95% CI: 1.2-1.7).

LIMITATIONS

This cross-sectional study was performed on a large, but convenient sample.

DISCUSSION

More than one out of three students reported severe psychological distress. Decreasing ERI and overcommitment may be beneficial in the prevention of psychological distress among university students and may reduce gender differences in psychological distress. Longitudinal studies are needed to further investigate these associations.

The association between depressive symptoms and self-rated health among university students: a cross-sectional study in France and Japan

BACKGROUND

Depressive disorders in University students have risen dramatically in the past few decades to the extent that students' mental health has become a current global public health priority. Obtaining information from University students about their mental health is challenging because of potential embarrassment of disclosing one's concerns and fear of stigmatization. Self-rated health might be a good solution to evaluate mental health state by a simple and neutral indicator. The aim of the study is to investigate the association between depressive symptoms and self-rated health by sex among University students in France and Japan.

METHODS

A cross-sectional study was conducted by using two large cohorts of students aged ≥18 years (n = 5655 in Bordeaux, France and n = 17,148 in Kyoto, Japan). Depressive symptoms (PHQ-2 scale), Likert scale of self-rated health, socio-demographic characteristics and health habits were collected through self-administered questionnaires. Multivariate logistic regression models were performed to describe the association between depressive symptoms and other variables including self-rated health, stratified by sex.

RESULTS

A high score of PHQ-2 (high depressive symptoms) was associated with poor self-rated health in both cohorts independently of all other variables (OR 2.82, 95%CI 1.99-4.01 in France, OR 7.10, 95%CI 5.76-8.74 in Japan). Although the prevalence of depressive symptoms between sexes was different in French students (males 15.4%, females 25.0%, p < 0.001), it was similar in Japanese students (males 3.5%, females 3.3%, p = 0.466), who reported less depressive symptoms than French students. The association between depressive symptoms and poor self-rated health was greater in Japanese females (OR 12.40, 95%CI 7.74-20.00) than in males (OR 6.30, 95%CI 4.99-7.95), whereas the strength of the association was almost similar in French students (OR 2.17, 95%CI 0.86-5.47 in males, OR 2.98, 95%CI 2.03-4.38 in females).

CONCLUSIONS

Depressive symptoms were associated with self-rated health among University students in both countries with slightly differences in sex. Self-rated health would be a simple, reliable and universal indicator for healthcare professionals and University staff to identify students at risk of depression.

[Social Inequalities in Health and Health Behaviors among University Students]

AIM OF THE STUDY

Disease prevention and health science research have focused increasingly on students in recent years. However, students are usually perceived as a homogeneous group. The aim of this article was to examine if there exist health inequalities among students.

METHODS

A nationwide student survey, the so-called NuPhA study, was used to answer this question (n=689, 69.5% female, average age: 22.69 years).

RESULTS AND CONCLUSIONS

We found that socio-economic indicators were associated with health and health behavior. For instance, being a scholarship holder was associated with a better general, mental, and physical health. In particular, subjective social status was positively associated with better general, mental, and physical health as well as higher physical activity. The results indicate that while students initially appeared to form a homogenous group, health inequalities exist among them. This suggests the need for a differentiated view on the student group and the importance of examining and explaining health inequalities among students in depth and to finally reduce them.

Self-perception of physical health conditions and its association with depression and anxiety among Bangladeshi university students

BACKGROUND

Self-perception of physical health conditions is associated with depression and anxiety. Although some recent studies revealed a high prevalence of depression and anxiety among Bangladeshi university students, no study has yet investigated the link between self-perception of physical health and these common psychological disorders. Therefore, this study aimed to explore the association of self-perception of physical health conditions with depression and anxiety among university students in Dhaka, Bangladesh.

METHODS

A cross-sectional study was conducted between August and November 2017 among 897 undergraduate students of Jahangirnagar University, Dhaka through face-to-face interviews using a semi-structured questionnaire. Chi-square test and binary logistic regression analysis were used to examine the association between the variables.

RESULTS

13.9% of the respondents had poor self-rated health (SRH) and 49.9% had self-rated body image (SRBI) dissatisfaction. 25.6% of the students reported to be overweight/obese whereas 18.7% to be underweight. Poor and moderate SRH was found to be significantly associated with students' depression (adjusted odds ratio [AOR]: 6.700; 95% CI: 3.821-11.749 and AOR: 2.155; 95% CI: 1.582-2.934) and anxiety (AOR: 4.365; 95% CI: 2.599-7.332 and AOR: 1.776; 95% CI: 1.270-2.484). Furthermore, SRBI dissatisfaction, underweight SRBI, overweight/obese SRBI, low blood pressure and hypertension were also significantly linked with students' depression and anxiety.

CONCLUSION

Students dissatisfied with their physical health status had higher chances to suffer from depression and anxiety. The findings of this study would create room for further research and could be used to design a comprehensive health program for young students.

Stress among university students: factorial structure and measurement invariance of the Italian version of the Effort-Reward Imbalance student questionnaire

Background

In the last decade academic stress and its mental health implications amongst university students has become a global topic. The use of valid and theoretically-grounded measures of academic stress in university settings is crucial. The aim of this study was to examine the factorial structure, reliability and measurement invariance of the short student version of the effort-reward imbalance questionnaire (ERI-SQ).

Methods

A total of 6448 Italian university students participated in an online cross-sectional survey. The factorial structure was investigated using exploratory factor analysis and confirmatory factor analysis. Finally, the measurement invariance of the ERI-SQ was investigated.

Results

Results from explorative and confirmatory factor analyses showed acceptable fits for the Italian version of the ERI-SQ. A modified version of 12 items showed the best fit to the data confirming the 3-factor model. Moreover, multigroup analyses showed metric invariance across gender and university course (health vs other courses).

Conclusions

In sum, our results suggest that the ERI-SQ is a valid, reliable and robust instrument for the measurement of stress among Italian university students.