Depression, anxiety and stress in different subgroups of first-year university students from 4-year cohort data

The impact of a "clinical adaptation psychoeducation program" grounded in the psychological flexibility model on perceived stress and coping behaviors among nursing students: A randomized controlled experimental study

BACKGROUND

The clinical adaptation psychoeducation program grounded psychological flexibility model (PFMCAP) is consisting of six areas, fills a large gap in the literature regarding the effect of nursing students on perceived stress and coping behaviors in the clinical process.

OBJECTIVES

To determine the effect of PFMCAP on perceived stress and coping behaviors of nursing students.

DESIGN

This was a simple randomized controlled experimental pre-posttest design.

SETTING

This study was conducted with 66 first-year students studying in the nursing department of a university in Türkiye.

METHODS

A simple randomization method (computer-generated random number table) was used. Data were collected with "Sociodemographic Data Form", "Perceived Stress Scale for Nursing Students (PSSNS)" and "Stress-Coping Behaviors Scale for Nursing Students (SCBNS)". PFMCAP was conducted online with first-year nursing students, consisting of a total of six sessions, each lasting 90 min. Data were analyzed using percentiles and frequency distributions, and two-way mixed ANOVA one week after the completion of the PFMCAP.

RESULTS

There was no significant difference between the groups of descriptive characteristics (p > 0.05). Post-test measurements of students in the experimental group's PSSNS total and sub-dimension scores had a significant decrease compared to the control group (p < 0.001). There was no significant difference between the groups in the post-test SCBNS total scores of the students (p > 0.05). However, there was a significant increase in the post-test SCBNS-Staying Optimistic sub-dimension scores in the experimental group (p < 0.001).

CONCLUSION

The impact of PFMCAP on nursing students' perceived stress levels was not limited to only reducing stress levels; it also contributed to an increase in the students' levels of optimism. These findings demonstrate the potential of PFMCAP in supporting nursing students during the clinical adaptation process. It is observed that the integration of PFMCAP into nursing education could assist nursing students in better adapting to clinical practices and effectively managing stress.

Yoga as a therapeutic approach to mental health in university students: a randomized controlled trial

Objectives

The purpose of this study has been to analyze the efficacy of a yoga-based intervention on stress, emotional wellbeing, state anxiety and trait anxiety in university students.

Methods

This study was a randomized controlled trial. The sample consisted of 129 university students, of which 65 underwent a yoga training for 12 weeks and a control group that did not carry out any type of intervention. The primary outcome was stress, which was collected through The Perceived Stress Scale (PSS). The secondary outcomes were emotional wellbeing which was measured through the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), and anxiety through State-Trait Anxiety Inventory (STAI). All variables were measured before and after the intervention.

Results

Participants in the experimental group showed statistically significant improvements in the primary outcome perceived stress (Cohen's d = 0.44) and the secondary outcomes emotional wellbeing (Cohen's d = 0.47), and both state anxiety (Cohen's d = 0.38) and trait anxiety (Cohen's d = 0.80) compared to the control group that did not carry out any type of physical training.

Conclusion

This study demonstrated that a 12-week yoga intervention can significantly reduce perceived stress and anxiety, and improve emotional wellbeing in university students. Initially, the experimental group (EG) reported higher levels of stress and anxiety than the control group (CG), but after the intervention, the EG experienced significant improvements compared to the CG.

Feature group partitioning: an approach for depression severity prediction with class balancing using machine learning algorithms

In contemporary society, depression has emerged as a prominent mental disorder that exhibits exponential growth and exerts a substantial influence on premature mortality. Although numerous research applied machine learning methods to forecast signs of depression. Nevertheless, only a limited number of research have taken into account the severity level as a multiclass variable. Besides, maintaining the equality of data distribution among all the classes rarely happens in practical communities. So, the inevitable class imbalance for multiple variables is considered a substantial challenge in this domain. Furthermore, this research emphasizes the significance of addressing class imbalance issues in the context of multiple classes. We introduced a new approach Feature group partitioning (FGP) in the data preprocessing phase which effectively reduces the dimensionality of features to a minimum. This study utilized synthetic oversampling techniques, specifically Synthetic Minority Over-sampling Technique (SMOTE) and Adaptive Synthetic (ADASYN), for class balancing. The dataset used in this research was collected from university students by administering the Burn Depression Checklist (BDC). For methodological modifications, we implemented heterogeneous ensemble learning stacking, homogeneous ensemble bagging, and five distinct supervised machine learning algorithms. The issue of overfitting was mitigated by evaluating the accuracy of the training, validation, and testing datasets. To justify the effectiveness of the prediction models, balanced accuracy, sensitivity, specificity, precision, and f1-score indices are used. Overall, comprehensive analysis demonstrates the discrimination between the Conventional Depression Screening (CDS) and FGP approach. In summary, the results show that the stacking classifier for FGP with SMOTE approach yields the highest balanced accuracy, with a rate of 92.81%. The empirical evidence has demonstrated that the FGP approach, when combined with the SMOTE, able to produce better performance in predicting the severity of depression. Most importantly the optimization of the training time of the FGP approach for all of the classifiers is a significant achievement of this research.

The role of hope in college transition: Its cross-lagged relationships with psychosocial resources and emotional well-being in first-year college students

INTRODUCTION

College transition is often regarded as the most stressful phase of life by college students. Hence, it is necessary to find ways to help them adjust more smoothly to this transition. Hope, as conceptualized by C. R. Snyder, has been widely studied as a predictor of optimal functioning and has been shown to be associated with better adjustment among college students. This study aimed to shed light on the role of hope in college transition by examining its unique reciprocal relationships with an array of important psychosocial resources and emotional well-being among first-year college students.

METHODS

Data were collected from a sample of Hong Kong college freshmen (N = 433, Medianage = 18 years old, 63.7% female) at two time points. At each time point, participants completed self-reported measures tapping into their levels of hope, psychosocial resources, and emotional well-being. Psychological resources included general and academic self-efficacy, meaning in life, and optimism. Social resources included secure attachment, perceived school environment, and social support. Emotional well-being was operationalized as positive and negative emotions. Cross-lagged panel models were constructed and tested by path analyses.

RESULTS

When autoregression and the effects of other variables were controlled, a greater sense of hope uniquely predicted higher levels of general and academic self-efficacy, greater presence of life meanings, more secure attachment, and more positive and fewer negative emotions. On the other hand, higher levels of meaning in life (both presence and search) and social support uniquely predicted greater hope. Academic hope and presence of life meanings reciprocally predicted one another, whereas other significant cross-lagged relationships were unidirectional.

CONCLUSIONS

The findings suggest interventions that promote hope can be useful in helping college freshmen adjust to the new college environment by enhancing their psychosocial resources and emotional well-being. Such interventions would be more effective if they included elements that boost meaning in life and social support, which are expected to further enhance the perceptions of hope.

Peer mentorship and academic supports build sense of community and improve outcomes for transfer students

The experience of transferring to a 4-year college, especially in STEM programs, can be particularly challenging for students. While much of the onus for preparing students for transfer has been placed on community colleges, the 4-year institutions to which students transfer have critical roles to play. With this in mind, we established the Pre-transfer Interventions, Mentoring, and Experience in Research (PRIMER) program to support students transferring into the biology department at our university. The design of this program is based around the key elements of Schlossberg's Transition Theory, focusing on the support and strategies elements of the theory. Through a weekly academic skill course, peer mentoring, and informal academic and social supports, our goals were for students to increase their involvement in the campus community and to increase their use of academic support resources. We used qualitative and quantitative assessments to compare sense of community and use of campus resources between students who participated in our program and others. We found that students in our program strongly increased their sense of community during the semester compared to other students and used campus resources at a higher rate. Our insights from the PRIMER program can help others in developing programs to support transfer students in biology departments.

The comorbid network characteristics of anxiety and depressive symptoms among Chinese college freshmen

BACKGROUND

This study aimed to investigate the interplay between anxiety and depressive symptoms in Chinese college freshmen using the causal system perspective (CSP), which differs from the traditional common cause perspective (CCP) by providing an alternative explanation by attributing comorbidity to direct interactions among symptoms.

METHODS

A convenience sample of 2,082 Chinese college freshmen (39.51% male, Mage = 18.61) from a normal university completed the Generalized Anxiety Disorder 7-Item Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9). Network analysis was conducted and evaluated as to centrality, stability, node predictability, and bridging features. Moreover, the moderated network model (MNM) was utilized to detect the moderation effects of gender in the comorbidity network.

RESULTS

The network of anxiety and depressive symptoms exhibited stability, characterized by the core symptoms of "restlessness", "lack of energy", and "excessive worry about control", as well as the bridging symptoms of "fearfulness", "sad mood", and "irritability". Notably, the nodes representing "uncontrollable worry" and "difficulty in relaxation" demonstrated the highest predictive power. Gender did not exert any moderating effects on the anxiety and depressive symptom network.

CONCLUSION

These results reinforce that certain anxiety or depressive symptoms are more central than others, and thus play a more vital role in the comorbid network. These findings highlight underlying potential targeting symptoms to consider in future interventions.

The Prevalence of Depression and Anxiety and Its Association with Sleep Quality in the First-Year Medical Science Students

Methods

A total number of 471 freshmen students (NUMS) participated in the study, pinpointing that the data are collected in 2019 and 2020. In line with measuring depression, anxiety, and sleep quality, the Persian Beck Depression Inventory-II, Beck Anxiety Inventory, and Pittsburgh Sleep Quality Index were employed. The associations between depression and anxiety with sleep quality were assessed by using the multiple logistic regression model. All statistical analyses were conducted in STATA14, and the significant level was set at P < 0.05.

Results

The prevalence of depression, anxiety, and poor sleep quality in the study population was 21.4%, 31.9%, and 28%, respectively. Analytical analyses indicated that after adjusting for studied covariates, the odds of poor sleep quality in individuals with depression were 3.5 times higher compared to the counter group (P < 0.001). Moreover, the odds of poor sleep quality in individuals with anxiety were 2.1 times higher compared to the counter group (P < 0.001).

Conclusion

Noticeable proportion of freshmen students suffer from depression and anxiety; in line with such a critical issue, our study found that depression and anxiety had a statistical association with sleep quality in study population. From this respect, it seems that providing essential interventions and psychological counseling services could be constructive for the freshmen medical students.

Predicting anxiety, depression, and insomnia among Bangladeshi university students using tree-based machine learning models

Background and Aims

Mental health problem is a rising public health concern. People of all ages, specially Bangladeshi university students, are more affected by this burden. Thus, the objective of the study was to use tree-based machine learning (ML) models to identify major risk factors and predict anxiety, depression, and insomnia in university students.

Methods

A social media-based cross-sectional survey was employed for data collection. We used Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9) and Insomnia Severity Index (ISI-7) scale for measuring students' anxiety, depression and insomnia problems. The tree-based supervised decision tree (DT), random forest (RF) and robust eXtreme Gradient Boosting (XGBoost) ML algorithms were used to build the prediction models and their predictive performance was evaluated using confusion matrix and receiver operating characteristic (ROC) curves.

Results

Of the 1250 students surveyed, 64.7% were male and 35.3% were female. The students' ages ranged from 18 to 26 years old, with an average age of 22.24 years (SD = 1.30). Majority of the students (72.6%) were from rural areas and social media addicted (56.6%). Almost 83.3% of the students had moderate to severe anxiety, 84.7% had moderate to severe depression and 76.5% had moderate to severe insomnia problems. Students' social media addiction, age, academic performance, smoking status, monthly family income and morningness-eveningness are the main risk factors of anxiety, depression and insomnia. The highest predictive performance was observed from the XGBoost model for anxiety, depression and insomnia.

Conclusion

The study findings offer valuable insights for stakeholders, families and policymakers enabling a more profound comprehension of the pressing mental health disorders. This understanding can guide the formulation of improved policy strategies, initiatives for mental health promotion, and the development of effective counseling services within university campus. Additionally, our proposed model might play a critical role in diagnosing and predicting mental health problems among Bangladeshi university students and similar settings.

Postpartum depression and its relationship with the positive and negative perfectionism

BACKGROUND

Depression is a common mental disorder after childbirth, which has serious consequences for the mother, baby, and family. A wide range of causes, including some personality traits of mothers, are involved in its etiology. Therefore, this study was conducted aiming to determine the factors related to postpartum depression (PPD) and its relationship with positive and negative perfectionism in Qom, Iran.

MATERIALS AND METHODS

This cross-sectional analytical study was conducted on 162 mothers who had been referred to health centers in Qom during 6-8 weeks after normal vaginal delivery (NVD) in 2020. After randomly classifying the health centers, the convenience sampling method was carried out. Data collection tools included social-individual information form, Edinburg Postnatal Depression Scale (EPDS), and Positive and Negative Perfectionism Questionnaire of Terry-Short. The data were analyzed using the Chi-square and Pearson correlation tests and multivariate logistic regression analysis.

RESULT

The prevalence of PPD in this study was 29.6%. The results showed that with the increase in the negative dimension of perfectionism, the chance of PPD in people increases by 14% (OR = 1.14, CI = 1.06-1.21), while there was no significant correlation between the positive dimension of perfectionism and PPD (r = 0.006, P > 0.05). Furthermore, the chance of PPD was higher in student mothers, mothers who had a history of PPD, and unintended pregnancy. Moreover, some factors such as multigravidity, breastfeeding, and not worrying about body image reduce the chance of occurrence.

CONCLUSION

Since mothers' negative perfectionism is associated with PPD, it is recommended to identify perfectionist individuals during pregnancy and after delivery and provide counseling service to them.

Mental health profiles and the related socio-demographic predictors in Hong Kong university students under the COVID-19 pandemic: A latent class analysis

While the COVID-19 pandemic has brought about significant challenges to mental health of university students, there is limited research in this area. Particularly, few studies examined the person-centered mental health symptom profiles such as depression and anxiety and the related socio-demographic predictors. Using Latent Class Analysis (LCA), this study investigated the symptom profiles of depression and anxiety in university students in Hong Kong under the COVID-19 pandemic and the socio-demographic predictors. A total of 978 undergraduate students completed an online questionnaire including socio-demographic factors and measures of depression and anxiety during the summer of 2022. The LCA identified three latent classes: "normal" group, "moderate comorbid depression and anxiety" group and "severe comorbid depression and anxiety" group. Multinominal logistic regression showed that comparing with the "normal" group and the "moderate symptom" group, the "severe symptom" group had higher personal financial difficulties and individual/family member unemployment during the pandemic. In contrast, other socio-demographic factors (age, gender, year of study, living status, and COVID-19 infection status) had no significant association with group status. The study contributes to understanding of person-centered depression and anxiety symptom profiles and the risk role of personal financial difficulty in mental health of university students under the pandemic.

Statistical analysis of mental influencing factors for anxiety and depression of rural and urban freshmen

The freshmen stage is a high incidence period for psychological issues. With the increasing gap between urban and rural areas in China, the mental problems of rural freshmen are more prominent in recent years due to the huge contrast of campus life with their growth environment and other reasons. The concern for the mental well-being of both rural and urban freshman students prompted our comprehensive five-year study (2018-2022) on psychological issues in a group of 12,564 first-year students from dozens of public universities in Shandong province. The investigation employed PPS (probability proportional to size) sampling and was conducted near the the end of the first semester. Using the data gathered, we analyzed and compared the indicators of psychological problems in rural and urban freshmen by Duncan's Multiple Range Test. We also conducted a canonical correlation analysis and pathway analysis to examine the psychological factors that contribute to anxiety and depression in both rural and urban freshmen. According to the findings, rural freshmen exhibit significantly higher levels of anxiety and depression than their urban counterparts. Inferiority, obsession, and internet addiction were identified as the primary influencing factors of anxiety and depression in both rural and urban freshmen. Social phobia was found to be a significant influencing factor for anxiety in rural freshmen, while bigotry was identified as a specific influencing factor for urban freshmen. Furthermore, the results of the path analysis suggest that anxiety plays a crucial role as a mediating factor between the main influencing factors and depression. These results substantially extend former research in this area and have important implications for the development of effective intervention strategies to address anxiety and depression. According to these results, policymakers should assess and intervene of anxiety and depression as a whole, and provide mental health education according to main effect factors of freshmen from rural and urban areas. Detailed policy recommendations are in discussion and conclusion.

Mental health literacy and suicidal ideation among Chinese college students: The mediating role of depressive symptoms and anxiety symptoms

BACKGROUND

Mental health literacy (MHL) is essential to mental health. Symptoms of depression and anxiety are significant antecedents and closely related to suicide among college students. Few studies have explored the mediating role of depressive and anxiety symptoms between MHL and suicidal ideation.

METHODS

5578 college students were included in the analysis. The online Wenjuanxing platform was used to collect data from November 2020 to March 2021. The bootstrapping method was used to test the mediating role of depressive and anxiety symptoms in the links between MHL and suicidal ideation.

RESULTS

Approximately 18.8 % of Chinese college students in our study reported having suicidal ideation. MHL exhibited a significant and negative correlation with depressive symptoms, anxiety symptoms, and suicidal ideation, whereas depressive and anxiety symptoms correlated significantly and positively with suicidal ideation. Compared with the lowest MHL quartile, the 3rd and 4th quartiles of MHL were associated with a significantly lower risk of suicidal ideation after adjusting for various confounding factors. Depressive and anxiety symptoms partially mediated the relationship between MHL and suicidal ideation, and the mediating effect of depressive symptoms was significantly greater than that of anxiety symptoms.

LIMITATIONS

This study was a cross-sectional survey. Future longitudinal studies on this relation are needed.

CONCLUSIONS

Depressive and anxiety symptoms mediate the relationship between MHL and suicidal ideation. Comprehensive school-based specific psychological education programs are needed to improve college students' MHL and change their attitudes toward mental health services.

The Indicator of Emotional Eating and Its Effects on Dietary Patterns among Female Students at Qassim University

Emotional eating (EE) is considered as the inclination to eat in response to emotions and is associated with certain syndromes. In this sense, we explored the indices of EE and its association with dietary patterns among female students at Qassim University in Saudi Arabia. A cross-sectional study of 380 participants (aged 18-29 years, female students) was performed. Anthropometric measurements of the participants were taken, such as height, body mass index, fat mass and hip-waist circumference as well as the Emotional Eating Scale (EES). The classification of the ESS included the thresholds of 44.7, 43.9 and 11.3% for low, moderate and high EE, respectively. Linear regression after adjustment showed that fat intake was a significant predictor of EE (p = 0.031) as well as feelings of enthusiasm. We also observed an interesting indication: fat intake (p = 0.011) and educational level (p < 0.05) were significantly associated with, and could be significant predictors of, EE. The results highlight the importance of emotional eating, its relationship with the consumption of foods that contain fat and understanding how it develops by raising awareness of the importance of healthy food for a healthy lifestyle.

Mental health, self-rated health, risky sexual behaviour, alcohol use, and drug use among students who intend to spend a semester abroad - a cross-sectional study

Aim

Our aim was to investigate potential differences in mental health, self-rated health, risky sexual behaviour, alcohol use, and drug use between (1) Prospective exchange students and campus students separated by sex, and (2) male and female students as a group.

Method

Comparative cross-sectional design using an online survey containing the following instruments: Knowledge, Attitudes, and Sexual Behaviour in Young People in Sweden; Self-Rated Health Questionnaire; and General Health Questionnaire 12. One-hundred and fourteen prospective exchange students and 451 campus students participated in the study.

Results

Male prospective exchange students rated their mental health as being better and had used cannabis more often compared with female prospective exchange students. Male prospective exchange students also rated their mental health as being better than male campus students. Female students, in general, rated their mental health as worse than male students. A larger proportion of male prospective exchange students had sex together with alcohol compared with male campus students, and a larger proportion of female prospective exchange students had sex with a new partner and drank more alcohol compared to female campus students.

Conclusion

The result shows that risky alcohol use and sexually risky behaviour is prominent amongst prospective exchange students. It is possible that they will continue, and even increase their risky behaviour whilst abroad as they find themselves in a new social context, and free from influence of the rules and restrictions that they might have at home. With limited knowledge of the local culture, native language, and in an unfamiliar environment, it is possible that the risks will be enhanced and possibly decrease their health. This highlights the need for proactive interventions, conceivably with some variations in content between sexes.

Trajectories of Perceived Stress among Students in Transition to College: Mindset Antecedents and Adjustment Outcomes

There is growing evidence of a clear association between students' perceived stress and their adjustment to life at college. However, the predictors and implications of distinct changing patterns of perceived stress during the transition to college life are less clear. To address these research gaps, the current study aims to identify distinct patterns of perceived stress trajectories among 582 Chinese first-year college students (M_age = 18.11, SD_age = 0.65; 69.40% female) across the first 6 months upon enrollment. Three distinct profiles of perceived stress trajectories, i.e., low-stable (15.63%), middle-decreasing (69.07%), and high-decreasing (15.29%), were identified. Moreover, individuals who followed the low-stable trajectory showed better distal outcomes (specifically, higher levels of well-being and academic adjustment) 8 months after enrollment than those who followed the other two trajectories. Furthermore, two types of positive mindset (a growth mindset of intelligence and a stress-is-enhancing mindset) contributed to differences in perceived stress trajectory, either independently or jointly. These findings highlight the significance of identifying different patterns of perceived stress among students during the transition to college, as well as the protective roles of both a stress mindset and a mindset of intelligence.

Mixed-mode Zentangle and Pastel Nagomi artwork for improving mental well-being in university students during COVID-19 pandemic - a randomized controlled feasibility trial

Background

University students are identified as a high-risk group for mental health problems. Artworks have been found effective in enhancing individuals' mental well-being in different populations, but none have been conducted on university students. This study was to address this research gap to determine the feasibility and estimate the preliminary effects of Zentangle and Pastel Nagomi on the mental well-being of undergraduate students during the COVID-19 pandemic.

Method

This was a 3-arm randomized controlled trial, with 33 undergraduates allocated to two 8-week artworks (Zentangle or Pastel Nagomi Art group) and a control group. Data were collected at baseline, and weeks 4, 6, 8, and 12. Focus group interviews were conducted at the 12-week follow-up.

Results

The consent and attrition rates were 80.5 and 6.06%, respectively. The attendance rate ranged from 83.3 to 100%. Compared with the control group, the Pastel Nagomi art group had a significant improvement in retaining positive affect at week 6. This retention could be further observed at week 12. Moreover, the Zentangle group had a significant increase in positive affect at week 4, with better retention at week 12. In addition, the within-group analyses showed that the Pastel Nagomi art group had significantly decreased negative affect at weeks 6 and week 12; and the Zentangle group had significantly decreased depression at week 8. The qualitative findings suggested that the intervention resulted in the participants enjoying the artwork process, and being proud of their artwork and personal growth.

Limitation

The study included an imbalance number of online vs. face-to-face sessions, and repeated measures may have affected the results.

Conclusion

The study suggests that both artworks are effective in improving undergraduates' mental well-being and that it is feasible to conduct future large-scale studies (263 words).

A systematic review and meta-analysis of studies exploring prevalence of non-specific anxiety in undergraduate university students

BACKGROUND

Anxiety is a common mental health problem in the general population, and is associated with functional impairment and negative impacts upon quality of life. There has been increased concern about university students' mental health in recent years, with a wide range of non-specific anxiety rates reported worldwide in undergraduate university students. We aimed to explore prevalence of non-specific anxiety in undergraduate university student populations.

METHODS

Four databases were searched to identify studies published between 1980 and 2020 which investigated prevalence of non-specific anxiety in undergraduate university students. Each study's quality was appraised using a checklist. Sub-analyses were undertaken reflecting outcome measure utilized, course of study, location of study, and whether study was before or during the COVID-19 pandemic.

RESULTS

A total of 89 studies - representing approx. 130,090 students-met inclusion criteria. Eighty-three were included in meta-analysis, calculating a weighted mean prevalence of 39.65% (95% CI: 35.72%-43.58%) for non-specific anxiety. Prevalence from diagnostic interview studies ranged from 0.3%-20.8% 12-month prevalence. Prevalence varied by outcome measure used to assess non-specific anxiety, the type of course studied by sample, and by study location. In half the studies, being female was associated with being more likely to have higher non-specific anxiety scores and/or screening above thresholds. Few of the included studies met all quality appraisal criteria.

CONCLUSION

The results suggest that approximately a third of undergraduate students are experiencing elevated levels of non-specific anxiety. Results from sub-analyses have identified some methodological issues that need consideration in appraising prevalence in this population.

Is Satisfaction with Online Learning Related to Depression, Anxiety, and Insomnia Symptoms? A Cross-Sectional Study on Medical Undergraduates in Romania

The objective of this study was to investigate online learning satisfaction in a sample of university students and its relationship with depression, anxiety, insomnia, and the average number of hours spent online. A total of 463 medical students were recruited for an online survey conducted from February to March 2022 with the main objective of estimating online learning satisfaction, while secondary outcomes involved assessing the relationship between online learning and depression, anxiety, insomnia, and the average number of hours spent online. A total of 285 participants were female (71.4%) and the mean age was 20.2 years. The results revealed that depression, anxiety, and insomnia are negatively correlated with overall satisfaction with e-learning. The more time students spent online, the greater the overall satisfaction. There are significant differences regarding student perceptions of interactivity in online learning satisfaction outcomes (p < 0.05, η2 partial Eta Squared-0.284). The opportunity to learn via chat-box presented differences in overall satisfaction while pleasant aspects of online learning, such as “no travel” and “economy”, were related to satisfaction. The students revealed that the higher the psychopathology scores, the less satisfied they were with online learning, while a higher number of hours spent online contributed positively to satisfaction.

Prevalence and variables associated with depression, anxiety, and stress among Chilean higher education students, post-pandemic

Background

Mental health among university students is a public health problem in Chile, understanding that this population is susceptible to mental disorders.

Objective

The present study aimed to determine the prevalence and variables influencing depression, anxiety, and stress in Chilean university students.

Method

A representative sample (n = 1,062) of Chilean university students and a cross-sectional study design were used. Bivariate analysis and multiple logistic regression were performed to identify risk factors associated with symptomatology. They were analyzed using descriptive statistics. A questionnaire with sociodemographic variables was applied in November 2022, in addition to the depression anxiety stress scale (DASS-21), instruments with excellent reliability in this population (α = 0.955; ω = 0.956). On the other hand, the Questionnaire of Problematic Alcohol and Drug Consumption (DEP-ADO) was applied. A descriptive analysis was performed, followed by bivariate analysis and multiple logistic regression using SPSS version 25. The variables showed a value of p <0.05; they were declared statistically significant in the final model. Odds ratios (OR) were adjusted to a 95% confidence interval (95% CI), which was used to determine the independent predictors.

Results

The prevalence of mental health problems in this population was high, with depressive symptoms in 63.1% of the sample; 69.2% with anxiety; 57% with stress; 27.4% with problematic alcohol consumption; and 14.9% with inappropriate marijuana consumption. Some 10.1% of the sample reported daily medication with antidepressants and/or anxiolytics. Concerning significant variables for depression, these were: being female, belonging to sexual, not having children, having problematic marijuana use, and using prescription drugs. Concerning anxiety, the significant variables were being a woman, belonging to sexual minorities, being an adolescent, and consuming prescription medication. Finally, concerning stress, the significant variables were being a woman, belonging to sexual minorities, being a student dedicated exclusively to academic activities, and taking prescription medication.

Conclusion

Chilean university students presented a high prevalence of anxiety, depression, and stress, where being female and belonging to sexual minorities seem to be the variables that have the greatest impact on susceptibility to mental health problems. These results should call the attention of political and university authorities in Chile to improve this population's mental health and quality of life since they are the following professional generation of our country.

A therapist-guided internet-based cognitive behavioral therapy program for Hong Kong university students with psychological distress: A study protocol for a randomized controlled trial

BACKGROUND

University students are at high risk of various mental health problems due to high levels of psychological distress. However, university counseling services are often inadequate to meet their mental health needs due to shortage of mental health professionals, especially in Hong Kong. Internet-based cognitive behavioral therapy (iCBT) has shown similar effects as those of face-to-face CBT in addressing these mental health concerns, but few iCBT programs have been developed for Hong Kong university students.

OBJECTIVE

This study protocol aims to develop and evaluate a culturally and linguistically appropriate iCBT program called "REST Online" to reduce the psychological distress and improve the mental health of Chinese university students in Hong Kong in a randomized controlled trial (RCT).

METHOD

The contents and functionality of the "REST Online" program which includes both web- and app-based versions, are described. A blended mode of service delivery is adopted, with 8 online modules and 2 counseling sessions. Therapist support will be provided by a CBT therapist. A total of 338 Chinese university students with mild to moderate levels of psychological distress will be openly recruited and randomized to three groups: the (1) web-based and (2) app-based "REST Online" groups, and (3) waitlist control group. The program effectiveness is evaluated in psychological distress, depression and anxiety symptoms, and positive and negative emotions and positive and negative thoughts at pre-, post- and 3-month follow-up tests. Linear mixed effect models will be conducted for data analysis.

DISCUSSION

The "REST Online" program is among the first of its kind to address the mental health needs of Hong Kong university students by an internet intervention. Theoretically, this study will provide some empirical evidence for the effectiveness of this iCBT program in the Hong Kong context for Chinese clients. Practically, if proven effective, this program can be provided to local university counselors as an option for service delivery. Strengths and limitations are also discussed.

Sampling investigation and statistical analysis for mental problems of freshmen in Shandong Province

niversity stage, especially the freshmen stage, is a high incidence stage of students' psychological problems. Effective sampling investigation and statistical analysis of freshmen's mental health problems are conducive to solve freshmen's problems and prevent further crises. In the past 4 years (2018-2021), using Chinese college students' mental health screening scale, we have taken probability proportionate to size sampling investigations about the mental problems to 9882 freshmen in 45 public universities in Shandong Province near the end of their first semester. Based on these data, we conducted the comparison of anxiety and depression for post pandemic era vs. pre pandemic era by analysis of variance, and analysed the influencing factors for anxiety and depression by linear regression and canonical correlation analysis. The results indicate the extents of anxiety and depression in post pandemic era are significantly more severe than pre pandemic era. Inferiority complex, obsession and somatization are the main effect factors of anxiety and depression. To the best of our knowledge, this research is the first systematical investigation and analysis for the mental problems among freshmen in the whole Shandong Province before and after the epidemic. The research results are conducive for the mental health counseling and intervention of freshmen's mental problems, and also helpful for policy making and prevention for psychological crisis management.

Chinese International Students' Face Concerns, Self-Stigma, Linguistic Factors, and Help-Seeking Intentions for Mental Health

Chinese international students (CIS) in American universities encounter serious mental health issues, and they also underutilize campus mental health care services. The current study examined several factors which result in this phenomenon, such as Chinese face concerns, self-stigma of seeking help for mental health services, as well as English proficiency and language discrimination. A survey with 433 CIS in multiple U.S. universities was conducted to analyze the relationships between these factors above, help-seeking intentions, and mental health problems (depression and anxiety). The SEM results suggested that face concerns increased the risk of mental health problems such as depression and anxiety and also increased self-stigma toward seeking mental health services. However, face concerns positively influenced help-seeking intentions. The self-stigma had a negative effect on help-seeking intentions. Perceived English discrimination increased mental health problems while English proficiency increased help-seeking intentions. Meanwhile, both linguistic factors above were significantly associated with face concerns. The theoretical and practical implications are discussed to investigate how to address mental health problems among Chinese international students.

Feasibility of Self-Guided Online Cognitive Behavioral Therapy for University Students During COVID-19

Objective: This study aimed to test the feasibility and efficacy of a self-guided online cognitive behaviour therapy (iCBT) for university students in Hong Kong during COVID-19. Method: One group pre-post-test design with convenient sampling was adopted in this study, involving 84 university students who received a newly developed iCBT within an 8 week intervention period. The iCBT offered eight online modules for students to learn the skills of CBT at home through an online platform which was accessible any time anywhere anonymously with technical support only. Standardized assessment tools were used for outcomes assessment at the pre- and post-intervention periods. Results: Three quarters of participants completed all iCBT modules. The results of paired t-tests showed that, after completing the iCBT, participants showed reduction in anxiety, depression, and perceived stress. Conclusion: This study provides preliminary evidences to support the feasibility and efficacy of the self-guided iCBT for university students during COVID-19.

Positive Affect Moderates the Influence of Perceived Stress on the Mental Health of Healthcare Workers during the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has posed a profound psychological impact on healthcare workers. However, the role of positive affect in moderating the effect of perceived stress on the psychological states of healthcare workers remains unknown. This study aimed to analyze the moderating effect of positive affect on the association between stress and the mental health of healthcare workers during the COVID-19 pandemic. This cross-sectional study evaluated the relationships between perceived stress (the Perceived Stress Scale), positive affect (the Positive and Negative Affect Schedule), depression (the Patient Health Questionnaire-9), and anxiety (the Generalized Anxiety Disorder 7-item Scale) during the COVID-19 pandemic in 644 Chinese healthcare workers who completed online self-reports. The results revealed a significant negative association between positive affect and psychological problems, including stress, depression, and anxiety. At the total group level, multiple regression analysis showed that positive affect alleviated the influence of perceived stress on depression, but no significant moderating effect was found for anxiety. In the subgroups divided by perceived stress, the moderating effect of positive affect on depression was only significant in healthcare workers with a high level of perceived stress. These results suggested that positive affect played a moderative role in alleviating the effect of stress on depression among healthcare workers, particularly those with a high level of stress, thus emphasizing the importance of positive affect as an intervention strategy for promoting the mental health of healthcare workers in the context of the ongoing COVID-19 pandemic.

Health sciences students' career commitment, mental health, and physical activity during the COVID-19 pandemic

Objective: To understand the biopsychosocial dimensions of university health sciences students' experiences during the COVID-19 pandemic. Participants: Health sciences students (n = 297) from two universities in July and August 2020. Methods: Participants completed a Web-based survey asking about depression, anxiety, physical activity, coronavirus threat, and career commitment. Results: Moderate or severe depression and anxiety were reported by 28.6% and 31.3% of respondents, respectively. Depression and anxiety were positively correlated with perceived coronavirus threat and negatively correlated with career commitment and strenuous physical activity. A change in career commitment interests during the COVID-19 pandemic was reported by 11% of respondents. Conclusions: Identified factors that could be targeted by universities to support their students and secure career commitment include online learning challenges, ability to secure clinical placements, mental health (anxiety and depression), financial challenges, family pressure, and promotion of physical activity.

Prevalence of depression and anxiety among university students during COVID-19 in Bangladesh: A cross sectional study

Introduction: The COVID-19 outbreak has become a challenging crisis for public health. During the COVID-19 pandemic, the indefinite closure of educational institutions in Bangladesh has a severe impact on the mental health of students. Purpose: The purpose of this study is to investigate factors that might have considerable influence on the mental health of students during quarantine in Bangladesh though they did not explore in previous studies on mental health status during the pandemic. Methodology: A standardized questionnaire was generated using PH9 and GAD7 to measure depression and anxiety levels. A total of 203 responses were collected from university students of Bangladesh through social media. Results: Descriptive statistics found that 37% of the students experienced moderate to severe anxiety while 54% faced moderate to severe depression. Ordinal Logistic Regression analysis found that anxiety is significantly related to gender, students’ current affiliation status in university (e.g., sophomore, masters), and time spent on watching TV while depression was related to family member’s contact with Covid-19, performing multiple activities as hobbies, and spending time in reading and writing. Conclusions: This study adds valuable findings in the existing literature, and it will help Students, university authorities, and government can take productive steps to tackle mental health issues

Perceived stress and depressive symptoms among Chinese college students: A moderated mediation model of biorhythm and ego resilience

Objective

To explore whether biological rhythm disturbance mediates the association between perceived stress and depressive symptoms and to investigate whether ego resilience moderates the mediation model.

Methods

A cross-sectional study was carried out using an online self-report questionnaire distributed to college students from September 2021 to October 2021. Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Severity (PSS-10), the Biological Rhythms Assessment in Neuropsychiatry (BRIAN), and Ego Resilience (ER-96) were used for investigation. SPSS 23 was used for data analyses. The significance of mediation was determined by the PROCESS macro using a bootstrap approach.

Results

Among the participants, 9.2% (N = 1,282) exhibited significant symptoms of depression. Perceived stress was positively associated with depressive symptoms, and biorhythm partially mediated this relationship. The direct and indirect effects were both moderated by ego resilience. Perceived stress had a greater impact on depressive symptoms and biorhythm for college students with lower ego resilience, and the impact of biorhythm on depressive symptoms was also stronger for those with lower ego resilience. Perceived stress had an impact on depressive symptoms directly and indirectly via the mediation of biorhythm.

Conclusion

Schools and educators should guide college students to identify stress correctly and provide effective suggestions to deal with it. Meanwhile, maintaining a stable biorhythm can protect college students from developing depressive symptoms. Students with low resilience should be given more attention and assistance.

Need Satisfaction and Depressive Symptoms Among University Students in Hong Kong During the COVID-19 Pandemic: Moderating Effects of Positive Youth Development Attributes

As studies on the mental health status of university students during the COVID-19 pandemic are almost non-existent in Hong Kong, we examined four research questions in this paper: What is the prevalence of depressive symptoms in university students in Hong Kong? What are the socio-demographic correlates of depressive symptoms? Do need satisfaction and positive youth development (PYD) attributes, including beliefs about adversity, psychosocial competence (resilience and emotional competence) and family functioning predict depression? Do PYD attributes moderate the predictive effect of need satisfaction on depression? We examined the above research questions using the Centre for Epidemiologic Studies Depression Scale Revised (CESD-R) in 1,648 university students in Hong Kong. For PYD attributes, we utilized validated measures of Chinese beliefs about adversity, psychosocial competence (resilience and emotional competence), and family functioning. For need satisfaction, we used a measure derived from two focus group interviews involving university students. Results showed that 48.4% of the respondents (95% confidence interval = [45.9%, 51.1%]) scored 16 or above (i.e., "at-risk" for clinical depression). As predicted, age, gender, student status (local vs. international), and family financial hardship were significant socio-demographic correlates of depressive symptoms. Besides, need satisfaction and PYD attributes negatively predicted depression scores. Finally, multiple regression analyses controlling for gender, age, and student status as covariates showed that all PYD attributes moderated the impact of need satisfaction on depression. The findings reinforce the theoretical proposition that PYD attributes serve as important factors in protecting the mental health of university students during the pandemic.

Prevalence of Post-Traumatic Stress Disorder (PTSD) in University Students during the COVID-19 Pandemic: A Meta-Analysis Attending SDG 3 and 4 of the 2030 Agenda

Background: Most universities around the world have been heavily affected by the COVID-19 pandemic, as declared by the World Health Organization (WHO) in March 2020. Many students were isolated at home and underwent a forced transition from face-to-face learning to e-learning, at least in the first few months. The subsequent months and years were typically characterised by a slow return to normal learning under COVID-19 protocols and restrictions. A potential consequence of the lockdowns, social restrictions and changes to learning is the development of PTSD (post-traumatic stress disorder) in university students, affecting their health and well-being (SDG3) and quality of education (SDG4). Materials and Methods: Medline was searched through PubMed for studies on the prevalence of PTSD in university students from 1 December 2019 to 31 December 2021. The pooled prevalence of PTSD was calculated with random-effects models. Results: A total of six studies were included, across which the prevalence of PTSD among university students was 23%. Meta-regression showed that the prevalence of PTSD was significantly higher with older age, but independent of the percentage of women in a study or its methodological quality. Conclusions: Our results suggest that students suffer from PTSD at a moderate rate. Measures are needed to address the mental health issues of university students that have arisen during COVID-19 all around the world.

Mental Health Status of University Students and Working Professionals during the Early Stage of COVID-19 in Bangladesh

A novel coronavirus disease known as COVID-19 has spread globally and brought a public health emergency to all nations. To respond to the pandemic, the Bangladesh Government imposed a nationwide lockdown that may have degraded mental health among residents, in particular, university students and working professionals. We examined clinically significant anxiety levels with the Generalized Anxiety Disorder (GAD-7) scale and perceived stress levels with the Perceived Stress Scale (PSS-4) in an online cross-sectional study with 744 adults. Approximately 70% of respondents were afflicted with clinically significant anxiety levels, and more than 43.82% were afflicted with moderate or high perceived stress levels. Multivariate logistic regression models showed that postgraduates (OR = 2.78, 95% confidence interval [CI] = 1.03−8.75, p < 0.05) were more likely to experience anxiety than their student counterparts. No such differences emerged for working professionals, however. Living with family members compared to living alone was a risk factor for perceived stress among working professionals (OR = 4.05, 95% CI = 1.45−11.32, p < 0.05). COVID-19 stressors such as financial hardship (OR = 1.84, 95% CI = 1.11−3.05, p < 0.05) and worries of family members’ health (OR = 1.84, 95% CI = 1.12−2.99) were risk factors for anxiety among students. Questionable social media news exposure (OR = 2.99, 95% CI = 1.13−7.92, p < 0.05) contributed to the development of mental stress among working professionals. These findings confirm that effective initiatives and proactive efforts from concerned authorities are necessary to cope with the mental health correlates of the COVID-19 pandemic, including in developing contexts such as Bangladesh.

Association Between Natural/Built Campus Environment and Depression Among Chinese Undergraduates: Multiscale Evidence for the Moderating Role of Socioeconomic Factors After Controlling for Residential Self-Selection

Aim

Evidence on the association between natural-built environments and depression is largely derived from the general population and prone to residential self-selection bias because of the nature of cross-sectional research design. Despite emerging adulthood, which includes the university years, is a critical stage for forming life-long health habits, studies on this topic focusing on undergraduate students are limited. The current study aims to illustrate the underlying mechanisms for how the campus-based environments affect depression in undergraduate students.

Methods

Based on a nationwide representative analytical sample of 22,009 Chinese undergraduates in 2018, we examined participants' reports of depression and campus-centered natural/built environments within multiple buffer sizes including 0.5, 1.0, and 2.5 km. After disentangling residential self-selection, we explored the moderating role of the socioeconomic attributes of undergraduates. The depression outcome was measured by the nine-item Patient Health Questionnaire (PHQ9). Indicators of exposure to green and blue space, transportation infrastructure, and food environments were objectively assessed using different circular buffers around each campus address.

Results

Modeling results indicated that campus neighborhoods with more scattered trees (0.5 km), water (0.5, 1.0, and 2.5 km), and street intersections (1.0 and 2.5 km) were protective against depression. In contrast, those living near denser distributions of outlets serving take-away sweets and fast food (0.5, 1.0, and 2.5 km) were susceptible to depression. These associations were modified by undergraduates' socioeconomic attributes (e.g., grade, Hukou status, and ethnicity) and varied according to geographical scales and exposure metrics.

Conclusion

To deliver effective environmental interventions to curb the prevalence of depression among undergraduate students, further planning policies should focus on the careful conception of the campus-based environment, especially regarding different spatial scales.

Prevalence of anxiety, depression, and stress among students of Jahangirnagar University in Bangladesh

Background and Aims

Anxiety and depression, as well as stress, are well‐known problems observed across the world, particularly among students. This study intends to identify the level of anxiety, depression, and stress among university students and determine its association with their sociodemographic characteristics.

Methods

The primary data were collected from 351 students with the help of a self‐administrated questionnaire consisting of sociodemographic information and contains the Depression, Anxiety and Stress Scale‐21 Items (DASS‐21) instrument over the period December 8, 2019–January 23, 2020. The χ² test is employed to find the association between the status of stress, anxiety, and depression level with selected sociodemographic variables, and confirmatory factor analysis is used to find interrelationships between DASS items.

Results

The results illustrate that no students have an extremely severe level of stress. However, the majority have a mild or moderate level of stress and it is associated with sex and residence (urban or rural). More than 40% of students have extremely severe anxiety. Results reveal that gender, residence (urban or rural), and family type of the students are linked with the anxiety level. The results also suggest that the type of accommodation of the students, their family type, and birth order are related to their depression level at a 5% level of significance. The findings also disclose that female students have more levels of depression, stress, and anxiety than their counterparts.

Conclusion

Considering the finding, the authors think that the university authority should pay a need for greater interest to the mental well‐being of students to enhance their quality of life. Given the harmful impacts of stress on academic performance and health, university administrators should be incorporating anxiety, stress, and depression management training in orientation activities.

Brain Functional Network and Amino Acid Metabolism Association in Females with Subclinical Depression

This study aimed to investigate the association between complex brain functional networks and the metabolites in urine in subclinical depression. Electroencephalography (EEG) signals were recorded from 78 female college students, including 40 with subclinical depression (ScD) and 38 healthy controls (HC). The phase delay index was utilized to construct functional connectivity networks and quantify the topological properties of brain networks using graph theory. Meanwhile, the urine of all participants was collected for non-targeted LC-MS metabolic analysis to screen differential metabolites. The global efficiency was significantly increased in the α-2, β-1, and β-2 bands, while the characteristic path length of β-1 and β-2 and the clustering coefficient of β-2 were decreased in the ScD group. The severity of depression was negatively correlated with the level of cortisone (p = 0.016, r = −0.40). The metabolic pathways, including phenylalanine metabolism, phenylalanine tyrosine tryptophan biosynthesis, and nitrogen metabolism, were disturbed in the ScD group. The three metabolic pathways were negatively correlated (p = 0.014, r = −0.493) with the global efficiency of the brain network of the β-2 band, whereas they were positively correlated (p = 0.014, r = 0.493) with the characteristic path length of the β-2 band. They were mainly associated with low levels of L-phenylalanine, and the highest correlation sparsity was 0.11. The disturbance of phenylalanine metabolism and the phenylalanine, tryptophan, tyrosine biosynthesis pathways cause depressive symptoms and changes in functional brain networks. The decrease in the L-phenylalanine level may be related to the randomization trend of the β-1 frequency brain functional network.

University Staff's Perceptions of Community College Transfer Students' Transition Experiences Within a "2+2" Pathway in an Asian Educational Context

Various countries have alternative pathway policies for 2-year community college graduates to articulate to 2-year university study, forming a "2+2" pathway. However, few studies have explored university staff members' perceptions of this "2+2" transfer pathway and their understanding of transfer students' (TSs) transition experiences. This descriptive qualitative study addressed this research gap. Forty-two academic and supporting staff participated in the focus group interviews. Specifically, the study explored the assets and challenges of the "2+2" pathway from the university staff perspective in Hong Kong. The articulation pathway and TSs are highly recognized for their prior learning, academic performances, and the value of the second chance. However, while the university staff were sympathetic to the challenges filling these transfer pathways, their offering of help was limited by government funding and policies restrictions. It is recommended that policies should be established at government and university levels to recognize and tackle TSs' unique needs to alleviate their heavy workloads through better articulation between community college and university studies. Improving articulation will allow TSs time for social involvement in university life and thus enhance their mental well-being.

The relationship between activities of daily living and psychological distress among Chinese older adults: A serial multiple mediation model

BACKGROUND

Few studies have shed light on the mechanisms underlying the link between activities of daily living (ADL) and psychological distress. This study aimed to explore the multiple mediating roles of loneliness and sleep quality in this relationship among Chinese older adults.

METHODS

A total of 3250 older adults completed the Barthel Index, UCLA 20-item Loneliness Scale, Pittsburgh Sleep Quality Index, and Depression, Anxiety, and Stress Scale Questionnaire. Serial multiple mediation analysis was conducted using Hayes' PROCESS macro.

RESULTS

ADL was found to directly impact psychological distress through three significant mediation pathways: (1) loneliness (B=-0.124, 95% CI=-0.140, -0.109), which accounted for 23.98% of the total effect, (2) sleep quality (B=-0.050, 95% CI=-0.063, -0.039), which accounted for 9.67% of the total effect, and (3) loneliness and sleep quality (B=-0.015, 95% CI=-0.020, -0.012), accounting for 2.91% of the total effect. The total mediating effect was 36.56%.

LIMITATIONS

The cross-sectional design we used limited causal interpretations. Future studies could examine longitudinal changes in outcome measures.

CONCLUSIONS

These findings highlight the role of loneliness and sleep quality as serial mediators of the relationship between ADL and psychological distress. Thus, for the early detection and prevention of psychological distress, it is necessary to conduct loneliness and sleep quality interventions for older adults with ADL limitations.

Perceptions and Challenges of Engineering and Science Transfer Students From Community College to University in a Chinese Educational Context

In Hong Kong, transfer students encounter different challenges unfolding in their transition from community college to university study. However, limited research has been conducted to explore their discipline-specific challenges. To address this gap, in this study three engineering and science faculties were selected from which to collect data through 35 in-depth interviews with transfer students, followed by a thorough thematic analysis. With the concept of in-betweenness, three main themes were identified: (1) "shifted the focus of study" (three sub-themes: (i) academic excellence in community college; (ii) future career in the university; and (iii) university life); (2) "encountered challenges in the transition" (four sub-themes: (i) non-matching program articulation; (ii) heavy study workload and its associated consequences; and (iii) non-specific administration arrangement and support from university); and (3) "students' voices to enhance learning experiences" (four sub-themes: (i) modify the study duration; (ii) improve program articulation; (iii) improve social adjustment; and (iv) overseas exchange). The results of this study indicate the challenges faced by transfer students in their transition from community college to university and have implications for universities to design and implement appropriate strategies to prepare for the future.

The association between sleep quality and psychological distress among older Chinese adults: a moderated mediation model

BACKGROUND

Previous research has found a link between sleep quality and psychological distress. However, the underlying mechanisms of this connection have still not been well explored. The aim of this study was to examine the roles of activities of daily living (ADL), physical activity, and perceived social support in the link between sleep quality and psychological distress among older adults.

METHODS

Three thousand two hundred fifty valid individuals (aged 60 years or above) participated in face-to-face questionnaire-based surveys. Older individuals were assessed using the Pittsburgh Sleep Quality Index, Barthel Index, International Physical Activity Questionnaire, Perceived Social Support Scale, and Depression Anxiety Stress Scale-21. The PROCESS macro developed by Hayes was used to conduct moderated mediation analysis.

RESULTS

In older adults, sleep quality had a substantial direct influence on psychological distress. ADL mediated the association between sleep quality and psychological distress. Physical activity significantly reduced ADL's mediating influence on the relationship between sleep quality and psychological distress. Furthermore, perceived social support moderated the direct relationship between sleep quality and psychological distress, as well as the second half of the mediating effect of the ADL. Moreover, physical activity and perceived social support were preventive factors that might successfully mitigate the detrimental effects of poor sleep quality on ADL and psychological distress.

CONCLUSIONS

The findings contribute to existing understanding by clarifying the fundamental mechanisms that link sleep quality and psychological distress. These results may provide a valuable reference to the Chinese government for improving mental health in older individuals.

Exploring the associations between behavioral health risk factors, abnormal eating attitudes and socio-demographic factors among Chinese youth: Survey of 7,984 vocational high school students in Hunan in 2020

BACKGROUND

This study investigated the associations between behavioral health risk factors (anxiety, depression, stress, insomnia, drinking, smoking) and abnormal eating attitudes among Chinese vocational high school students (CVHSS). Potential moderating relationships were also explored with relevant socio-demographic factors of the student's age, sex, rural or urban community, household income, family type and educational level of the father and mother.

METHODS

A total of 7,984 students from three vocational high schools in Hunan, China completed a questionnaire about their socio-demographic characteristics, alcohol use, smoking, and symptoms of depression, anxiety, stress (21-item version of the Depression Anxiety Stress Scale), insomnia (8-item Athens Insomnia Scale), and abnormal eating attitudes (19-item Chinese version of Eating Attitudes Test).

RESULTS

The prevalence rates for behavioral health problems among these students ranged widely depending on the risk factor: 42.5% insomnia, 41.3% anxiety, 26.2% depression, 14.4% stress, 13.7% drinking, and 8.3% smoking. Additionally, 61.7% of students were at-risk for at least one of these six behavioral health disorders. Abnormal eating attitudes were associated with depression (r = 0.422), anxiety (r = 0.490), stress (r = 0.490), and insomnia (r = 0.375), with all of these relationships being significant (p < 0.01) and large size statistical effects. However, other analyzes found that none of the socio-demographic background factors had meaningful associations with the behavioral health risk factors (0 of 28 tests) and very few background factors were associated with the abnormal eating attitude measures (only 3 of 35 tests). Females had higher levels than males on dieting and bulimia but not on the other two eating attitude components.

CONCLUSIONS

This study determined that behavioral health risk factors (sleep problems and anxiety in particular) were common among high school students in China and that mental health and sleep disorder risks also tended to co-occur in some students with abnormal eating attitudes. Therefore, prevention and early identification programs for behavioral risk factors are needed for this population. It is important to pay more attention to students with abnormal eating attitude-related symptoms, who may have also underlying mental health problems and need further evaluation.

The Mental Health Status and Associated Factors Among Medical Students Engaged in Online Learning at Home During the Pandemic: A Cross-Sectional Study From China

Background: The purpose of this study was to assess the mental health status of medical students engaged in online learning at home during the pandemic, and explore the potential risk factors of mental health. Methods: A cross-sectional study was conducted via an online survey among 5,100 medical students from Wannan Medical College in China. The Depression, Anxiety and Stress scale (DASS-21) was used to measure self-reported symptoms of depression, anxiety, and stress among medical students during online learning in the pandemic. Results: In total, 4,115 participants were included in the study. The prevalence symptoms of depression, anxiety, and stress were 31.9, 32.9, and 14.6%, respectively. Depression was associated with gender, grade, length of schooling, relationship with father, students' daily online learning time, and students' satisfaction with online learning effects. Anxiety was associated with gender, length of schooling, relationship with father, relationship between parents, students' daily online learning time, and students' satisfaction with online learning effects. Stress was associated with grade, relationship with father, relationship between parents, students' daily online learning time, and students' satisfaction with online learning effects. Conclusions: Nearly one-third of medical students survived with varying degrees of depression, anxiety, and stress symptoms during online learning of the COVID-19 pandemic. Gender, grade, length of schooling, family environment, and online learning environment play vital roles in medical students' mental health. Families and schools should provide targeted psychological counseling to high-risk students (male, second-year and third-year, four-year program). The findings of this study can provide reference for educators to cope with the psychological problems and formulate the mental health curriculum construction among medical students during online learning.

Exploring Trends and Differences in Health Behaviours of Health Sciences University Students from Germany and England: Findings from the "SuSy" Project

Objectives: This research aimed to explore the health behaviours of health sciences students over time and across different settings. Methods: A health behaviour surveillance system has been implemented in Hamburg and Manchester among under- and postgraduate health sciences students. Trends among the Hamburg sample were described. In a cross-sectional assessment, health behaviours across both universities were examined using multivariate regression analysis. Results: Between 2014 and 2018, increasing trends in physical activity and cannabis and alcohol consumption were observed in Hamburg (n = 1,366). While fruit and vegetable intake was constantly low, tobacco smoking decreased. No clear trend was observed for stress perception. The comparison (n = 474) revealed that Manchester students had higher odds of smoking, excessive alcohol consumption, and fruit and vegetable consumption; and lower odds of being physically active, and consuming cannabis. No difference in stress perception was observed. Conclusions: Varying trends and potential areas of intervention were identified for health behaviours in Hamburg. The comparison with Manchester students revealed differences in behaviours, which could be further explored to help inform health promotion strategies in both settings.

Mental health condition of college students compared to non-students during COVID-19 lockdown: the CONFINS study

OBJECTIVES

To estimate the effect of student status on mental health condition during COVID-19 general lockdown in France.

DESIGN

Cross-sectional analysis comparing students and non-students recruited in the same study.

SETTING

Participants of the web-based CONFINS study implemented during the general lockdown in France in spring 2020.

PARTICIPANTS

2260 participants (78% women) including 1335 students (59%).

PRIMARY AND SECONDARY OUTCOME MEASURES

Through an online questionnaire, participants declared if they have experienced suicidal thoughts, coded their perceived stress on a 10-points scale and completed validated mental health scales (Patient Health Questionnaire-9 for depressive symptoms, Generalised Anxiety Disorder-7 for anxiety symptoms) during the last 7 days. The effect of college student status on each mental health condition was estimated using multivariate logistic regression analyses. Stratified models for students and non-students were performed to identify population-specific factors.

RESULTS

Student status was associated with a higher frequency of depressive symptoms (adjusted OR (aOR)=1.58; 95% CI 1.17 to 2.14), anxiety symptoms (aOR=1.51; 95% CI 1.10 to 2.07), perceived stress (n=1919, aOR=1.70, 95% CI 1.26 to 2.29) and suicidal thoughts (n=1919, aOR=1.57, 95% CI 0.97 to 2.53). Lockdown conditions that could be potentially aggravating on mental health like isolation had a higher impact on students than on non-students.

CONCLUSIONS

College students were at higher risk of mental health disturbances during lockdown than non-students, even after taking into account several potential confounding factors. A close follow-up and monitoring of students' mental health status is warranted during lockdown periods in this vulnerable population.

Direct and Stress-Buffering Effects of COVID-19-Related Changes in Exercise Activity on the Well-Being of German Sport Students

Maintaining or initiating exercise activity in the COVID-19 pandemic may act as a buffer against the observed stress-related deterioration in well-being, with emotion regulation (ER) discussed as a possible moderator. Therefore, the present study investigated the interaction between stress, exercise activity (EA), and ER on mood. In an online survey, 366 German sports science students (56% women, Mage = 23.04, SD = 2.87) reported their stress levels (general and COVID-19-specific), mood (energy, valence, calmness), EA before and during the pandemic, and use of ER strategies in spring 2020. Pandemic-related change in EA was calculated as residual change. Due to gender differences in mental health and EA, the main and interaction effects were tested in twelve hierarchical regression analyses, separately for men and women. Overall, EA significantly decreased during the pandemic and was positively associated with energy in both men and women. ER was positively associated with women's energy, but negatively with all three mood dimensions in men. Only one three-way interaction appeared significant: in the case of high stress, low levels of EA and high use of ER were associated with the greatest deteriorations in energy in men. Our findings suggest that EA may buffer deteriorations in energy in men with high stress and difficulties in ER.

Comparing Face-to-Face, Emergency Remote Teaching and Smart Classroom: A Qualitative Exploratory Research Based on Students’ Experience during the COVID-19 Pandemic

The COVID-19 pandemic significantly disrupted traditional face-to-face teaching worldwide and forced education institutions to adopt new, online teaching formats to enable students to continue with their studies. This research focuses on students’ perceptions of three teaching different modalities: face-to-face (F2F), Emergency Remote Teaching (ERT) and Smart Classroom (SC), which were implemented in response to the restrictions enforced to combat the spread of COVID-19. A qualitative study based on two user experience techniques, Pocket Bipolar Laddering and Emotional Appraisal, was carried out on a group of second-year ICT engineering university students at La Salle Campus Barcelona. The former technique consists in identifying a maximum of three positive and three negative salient items, while the latter is intended to rate pairs of opposite feelings. In the SC format, saving time on travel to university was considered an advantage of online learning, while disadvantages included less effective instructor–student interaction, distractions when off-campus and teamwork issues. These shortcomings can be addressed by specific online teaching training to develop a more active form of learning and foment student participation. However, both ERT and SC modalities were considered effective solutions to cope with the social and mobility restrictions imposed during the pandemic.

Symptoms of Depression, Anxiety, and Stress and Prevalence of Major Depression and Its Predictors in Female University Students

Depression, anxiety and stress are increasingly concerning phenomena in our society, with serious consequences on physical and mental health. The repercussions may be particularly devastating in particular population subgroups, such as female university students. The purpose of this study was to determine the levels of depression, anxiety, and stress and the prevalence of depression and associated factors, in Spanish university women. A cross-sectional study was conducted with a random sample of 871 students from the Santiago de Compostela University (mean age 20.7 years, SD = 2.8). Information was collected on sociodemographic and academic characteristics; symptoms of depression, anxiety, and stress; diagnosis of major depression; optimism, resilience, social support, life engagement, and five personality domains, using validated instruments. Of the participants, 18.1%, 22.8% and 13.5% presented with severe/very severe levels of depression, anxiety and stress, respectively. A total of 12.9% had major depression. Higher life engagement was associated with lower risk of depression (OR = 0.92, 95% CI 0.87–0.98), while higher levels of neuroticism (OR = 1.20, 95% CI, 1.12–1.28) and openness to experience (OR = 1.08, 95% CI, 1.02–1.14) were associated with greater risk. These findings reveal an alarming percentage of female university students who experience major depression and severe/very severe stress.

A Qualitative Exploration on the Challenges of Transfer Students in an Asian Educational Context

Limited research has been conducted on community college (CC) transfer students’ (TS) experiences in four-year universities, particularly in Asian contexts. To fill this research gap, in this qualitative study, 124 TS from various disciplines in a Hong Kong university participated in 39 focus groups and seven individual interviews. Unlike their Western counterparts, our TS were relatively better prepared and more academically adaptive. Nevertheless, their social integration was restricted by a lack of time for extra-curricular activities, a sense of inferiority and incompetence, and restricted social circles that did not enable interaction with non-TS. These challenges and their implications are discussed. In particular, this study has highlighted differences between the special education systems for CC transfer in Hong Kong and those in Western CC models. The study has also highlighted the study-induced stress, and poor self-perceptions that TS experience, despite their academic abilities.

Association between Mental Health Knowledge Level and Depressive Symptoms among Chinese College Students

This study aimed to explore the association between mental health knowledge level and the prevalence of depressive symptoms among Chinese college students. A cross-sectional study was conducted in six universities in Jinan, Shandong Province, China, and a total of 600 college students were recruited to self-complete a series of questionnaires. The Mental Health Knowledge Questionnaire (MHKQ) was used to investigate the level of mental health knowledge. Depressive symptoms were investigated with the depression subscale of the Depression Anxiety Stress Scale (DASS-21). The prevalence rate of depressive symptoms among college students was 31.2%. Compared with MHKQ scoring in the 1st quartile, college students with MHKQ scoring in the 3rd quartile and in the 4th quartile reported lower levels of depressive symptoms after adjusting for potential confounding factors. Since mental health knowledge level was related to depressive symptoms among college students, increased efforts to promote the level of mental health knowledge in Chinese college students are critical.