Prevalence of anxiety, depression and suicidal behaviors among Brazilian undergraduate students: A systematic review and meta-analysis

The prevalence of mental health issues among nursing students: An umbrella review synthesis of meta-analytic evidence

BACKGROUND

The ongoing global student mental health crisis indicates the urgent need for updated research specifically targeting nursing students. Considering their anticipated transition into healthcare professions, their mental well-being is critical, not only for their academic performance but also for the quality of care they will deliver in their professional roles.

OBJECTIVE

To estimate the prevalence of mental health issues among nursing students by synthesizing data from systematic reviews and meta-analyses.

DESIGN

An umbrella review of published prevalence meta-analyses.

REVIEW METHODS

Publication records were retrieved from four databases-PubMed, CINAHL, PsycINFO, and Scopus-up to September 2024. The methodological quality of each meta-analysis was assessed using the A Measurement Tool for the Assessment of Multiple Systematic Reviews (AMSTAR-2). Assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline checklist. A random-effects model was used for the meta-analysis, and the I2 index was employed to assess between-study heterogeneity. Additionally, the Risk of Bias in Systematic Reviews tool was used to assess review quality, including calculation of overlap between primary studies and adherence to GRADE criteria.

RESULTS

Twenty-five meta-analyses, comprising 375 primary studies and a total of 171,828 nursing students, were included, revealing an overall prevalence of mental health issues at 27 % (95 % CI: 25 % - 30 %). Sleep disturbances were the most prevalent at 50 % (95 % CI: 28 % - 72 %), followed by fear at 41 % (95 % CI: 7 % - 75 %), burnout at 32 % (95 % CI: 25 % - 38 %), and depression at 29 % (95 % CI: 21 % - 38 %). Nomophobia/smartphone addiction had a prevalence of 30 % (95 % CI: 12 % - 49 %), anxiety 29 % (95 % CI: 17 % - 40 %), and stress 27 % (95 % CI: 17 % - 37 %). Lower prevalence rates were observed for smoking, eating disorders, post-traumatic stress disorder, and suicidal ideation/attempts. Significant heterogeneity was noted, particularly in the meta-analyses for anxiety, nomophobia/smartphone addiction, and stress.

CONCLUSIONS

Our review identified eleven prevalent mental health issues among nursing students, with sleep disturbances, anxiety, depression, and burnout being the most common. Behavioral issues, such as nomophobia, are also rising concerns. These findings indicate the need for targeted interventions and further research into causal factors (e.g., geographical and cultural contexts), gender disparities (as most studies focused on female students), and resilience-building strategies.

REGISTRATION

The study protocol was uploaded to the Open Science Framework (OSF) at https://doi.org/10.17605/OSF.IO/EN7UX (registered on 28/10/23).

TWEETABLE ABSTRACT

Among nursing students, overall mental health issues are at 27 %. Key concerns include sleep disturbances, burnout, anxiety, and depression. Nomophobia prevalence also warrants further study.

Family intimacy and depression: a comparative study among adolescents in Finland

BACKGROUND

Substantial research has demonstrated the strong influence of family factors on adolescent depressive symptoms. However, the mechanisms underlying this relationship, particularly the moderating effects of sex and sexual orientation, remain unclear.

OBJECTIVES

This study aimed to investigate the direct and indirect effects of family intimacy on depressive symptoms among adolescents, while examining the mediating role of social inclusion and anxiety disorders. Furthermore, it explored how these effects are moderated by sex and sexual orientation.

METHOD

Data from the nationwide School Health Promotion Study in Finland were used (N = 155,166; adolescents aged 14-17 years). The analysis included a multiple mediation model to evaluate the pathways linking family intimacy to depressive symptoms, through social inclusion and anxiety disorders. Moderation analyses were conducted to explore the moderating effects of sex and sexual orientation on these pathways.

RESULTS

Family intimacy had a significant direct negative effect on depressive symptoms. Social inclusion and anxiety disorders were identified as mediators, with social inclusion serving as a significant buffer to depression. Moderation analysis revealed that these effects were stronger for non-heterosexual adolescents and varied by sex, with females showing a stronger impact of social inclusion on depressive symptoms, whereas males were more influenced by the pathway through anxiety disorders.

CONCLUSION

The findings highlight the crucial roles of social inclusion and family intimacy in mitigating depressive symptoms among adolescents. Interventions should prioritize enhancing social inclusion, particularly for non-heterosexual adolescents, and tailor strategies based on sex differences to optimize outcomes.

Prevalence of depression among medical students in Africa: Systematic review and meta-analysis

INTRODUCTION

Depression has become a major health problem that students in a University encounter during their study life. At least one-third and possibly up to one-half of medical students show some form of psychological distress during their medical school. Aggregated evidence is scarce in Africa though there are published articles with various outputs. Therefore, this systematic review and meta-analysis aimed to pool those outputs to draw concert information crucial for devising strategies to tackle depression among students at the University.

OBJECTIVE

To determine the pooled prevalence of depression among African medical students.

METHOD

Original articles about the prevalence of depression among African medical students were searched through known and international databases (PubMed, Scopus, Web of Science, and Cochran Library) and search engines (Google and Google Scholar). Data were extracted using a standard data extraction checklist that was developed according to Joanna Briggs Institute (JBI). The I2 statistics were used to identify heterogeneity across studies. Funnel plot asymmetry and Egger's tests were used to check for publication bias. A Random effect model was used to estimate the pooled prevalence of depression among medical students in Africa. Statistical analysis was conducted using STATA version 11 software.

RESULT

A total of 31 cross-sectional observational studies which provided information about the prevalence of depression among medical students were included in this systematic review and meta-analysis. The overall pooled prevalence of depression among medical students in Africa was 38.80% [95%CI (29.55, 48.05). Being a female medical student was [AOR = 0.25, 95%CI (0.15, 0.42)] and being a second-year medical student was [AOR = 0.26, 95%CI (0.10, 0.68)] times less likely to have depression.

CONCLUSION

Depression affects well over one-third of medical students in Africa. Moreover, this systematic review and meta-analysis revealed that female medical students were less likely to develop depression. Therefore, this result suggested that medical schools or Universities and concerned authorities better offer possible early detection and prevention programs as per the magnitude. Furthermore, there has to be further research to figure out the potential factors perhaps using both qualitative and quantitative research approaches.

Association of Body Image Perception / (Dis)Satisfaction and Symptoms of Eating Disorders in University Students of Health Sciences

We aimed to investigate the association of body image perception / (dis)satisfaction with eating disorders symptoms. We conducted a cross-sectional university-based study with 534 students, aged 18 years or older, from a federal higher education institution specializing in health sciences and located in Southern Brazil in 2023. We evaluated eating disorder symptoms using the Brazilian version of the SCOFF screening tool (≥2 symptoms) and body image using a silhouette scale developed for Brazilian adults. The mean age of the sample (78.3% female) was 23.3 (SD = 6.2) years. The prevalence of eating disorder symptoms was 53.6% (95% CI: 49.3-57.8). In terms of body image, the prevalence of (dis)satisfaction was 64.6% (95% CI: 60.5-68.7) and of body image distortion was 53.4% (95% CI: 49.1-57.6). Students dissatisfied with their body image due to excess weight were 2.16 times more likely to report eating disorder symptoms (PR = 2.16; 95% CI: 1.66-2.80; p < .001). Similarly, students who overestimated their body size were 35% more likely to report eating disorder symptoms (PR = 1.35; 95% CI: 1.12-1.63; p = .002). In conclusion, we found a significant association between body image perception / (dis)satisfaction and symptoms of eating disorders in university students of health sciences.

Validity of the Kessler Psychological Distress scale in Brazilian higher education students

to evaluate of the validity of the Brazilian version of the Kessler Psychological Distress Scale, based on its internal structure, concurrent validity, and predictive validity, for the screening of psychological distress among higher education students.

methodological study with 1,034 participants, using the Kessler Psychological Distress Scale as well as the Self-Reporting Questionnaire. An analysis of the internal structure was conducted using a two-factor confirmatory factor analysis, which evaluated fit indices and hierarchical omega reliability coefficients. A Pearson's correlation test was used to assess concurrent validity, while sensitivity, specificity, areas under the ROC curve and 95% confidence intervals were used to assess predictive validity.

the bifactor model demonstrated excellent fit indices (CFI=1.000; TLI=0.999; SRMR=0.019; RMSEA=0.028; 95%CI: 0.015 - 0.041) as well as high reliability (ωH=0.886). It was observed that there was a strong correlation between the K10 and the SRQ (r=0.813; 95%CI: 0.784 - 0.837). The ideal cut-off point for screening was identified as being higher than 21, with a sensitivity of 85.2% and a specificity of 82.9%.

the structure composed of a general factor, psychological distress, demonstrated a high level of reliability. The scale demonstrated concurrent and predictive validity for the assessment of psychological distress among university students.

Depression and Substance Use Among Brazilian University Students During the COVID-19 Pandemic

The prevalence of depression and substance use changed significantly during the COVID-19 pandemic. The present study explored the association between the use of psychoactive substances and depression in Brazilian university students. This cross-sectional study was conducted between 2021 and 2022. A sample of 1271 students were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Hierarchical multivariate logistic regression models were used to assess the association between tobacco use, alcohol consumption, illicit substance use, and depression. Among the participants, 424 (33.4%; 95%CI 30.7-36) screened positive for depression (PHQ-9 ≥ 10). Alcohol was the most consumed substance. Recent use of illicit substances was associated with depression (adjusted odds ratio [aOR] 1.59; CI 1.02-2.50). The pattern of moderate or high-risk tobacco use (aOR 2.11; CI 1.31-3.42), alcohol use (aOR 3.40; CI 2.29-5.06), and illicit substances (aOR 1.82; CI 1.15-2.89) were associated with higher chances of depression in adjusted models. Findings highlight the importance of implementing support for mental health among university students. These policies are crucial for addressing maladaptive behaviors, such as substance use, and for mitigating psychological distress, such as depression, which has been exacerbated during the pandemic.

Intuitive eating in the COVID-19 era: a study with university students in Brazil

BACKGROUND

The recurrence of weight gain is attributed to the homeostatic regulation of hunger and satiety signals, influenced by metabolic state, nutrient availability, and non-homeostatic mechanisms shaped by reinforced consequences from experiences. In response, Evelyn Tribole and Elyse Resch proposed Intuitive Eating (IE) in 1980, countering restrictive diets. IE, inversely correlated with Body Mass Index (BMI), binge eating, and anxiety/depression symptoms, fosters mind-body-food harmony by recognizing hunger and satiety cues. IE encourages meeting physiological, not emotional, needs, permitting unconditional eating, and relying on internal signals for food decisions. Amidst university students' stress, exacerbated during the COVID-19 pandemic, understanding their eating behavior, particularly intuitive eating levels, becomes crucial.

OBJECTIVE

This study aimed to assess the IE level of Brazilian students during the COVID-19 pandemic.

METHODS

This cross-sectional study, the first to analyze the Intuitive Eating of students in Brazil during the pandemic, was conducted using an online questionnaire.

RESULTS

The sample comprised 1335 students, most of whom were women (82.17%), with a mean age of 26.12 ± 7.9 years, and a healthy nutritional status (57.58%). The mean IE score was 3.2 ± 0.6. A significant association was found between the confinement situation, the type of housing unit, and the IE subscale-Unconditional Permission to Eat (p = 0.043). However, there was no association between the other subscales and the total IE scale. Regarding self-reported mental and eating disorders, the most frequent were anxiety (21.2%), depression (6.5%), and binge eating disorder (BED) (4.7%). IE was negatively associated with BED (B =  - 0.66; p < .001), bulimia nervosa (B =  - 0.58; p < .001), body mass index (BMI) (p < .001) and self-reported anxiety (B =  - .102; p = 0.16). The male sex showed a higher IE score compared with the female sex (p < .001).

CONCLUSION

While no significant association was found between IE and the confinement situation, a significant association was found between housing type and the Unconditional Permission to Eat subscale.

Profiles of mental illness in college students and associated factors: A latent class analysis

Mental illness among university students poses a pressing challenge for educational institutions, urging the need for strategies that foster health and mitigate mental distress, with an emphasis on preventing suicide. Our study sought to discern the profiles of mental illness among college students and explore the factors associated with them. We examined data from 918 students at a Brazilian Federal Institute, utilizing Latent Class Analysis and multinomial regression for our analyses. We identified three distinct mental illness profiles: Anxiety with Low Suicide Risk; Mental Illness with Moderate Suicide Risk; and Mental Illness with High Suicide Risk. We observed a reduced association of these profiles with religious beliefs. Conversely, there was a heightened association with cisgender women, individuals identifying as LGBTQI+, those with learning disabilities, and victims of sexual violence. Our findings underscore the importance of tailored prevention and health promotion programs to enhance student well-being. There's a compelling need to devise mental health strategies tailored to the specific needs of the identified groups, particularly students from the LGBTQI + community, survivors of sexual abuse, and those grappling with learning disabilities.

Suicidal behavior and associated factors among holy water users at Northwest, Ethiopia, 2023: an institution based cross-sectional study

Background

Suicide is a serious cause of mortality that affects families, communities, and the entire country. Because of a lack of national systematic reporting for cause-specific mortality, a high level of stigma, and religious non-acceptance, suicidal behavior is an under-reported and concealed cause of death in the majority of low- and middle-income countries.

Objective

The aim of this study was to assess the prevalence of suicidal behavior and associated factors among holy water users at the Andassa Saint George Monastery, 2023.

Methods

An institution-based cross-sectional study was conducted at the Andassa Saint George Monastery from 5 April to 5 May 2023. A systematic random sampling method was utilized to select 423 study participants and the Suicidal Behaviors Questionnaire-Revised was used to assess suicidal behavior. The data were gathered using the epicollect5 software with a face-to-face interview method then exported to SPSS-25 for analysis. A binary logistic regression model was used and all variables in a bivariate analysis with a p-value of less than 0.25 were entered into a multivariable logistic regression model, and statistical significance was declared at a p-value of less than 0.05.

Results

The prevalence of suicidal behavior among holy water users was 9.7% (95% CI: 7.1-12.4). Being female [2.632 (1.206-5.748)], living alone [2.52 (1.06-5.97)], and having depression [3.03 (1.32-6.99)], epilepsy [3.82 (1.28-11.40)], and diabetes mellitus [3.37 (1.229-9.25)] were significantly associated with suicidal behavior.

Conclusion

In this study, almost 1 in 10 had engaged in suicidal behavior in their lifetime. Several risk factors for suicidal behavior were identified, including being female, living alone, and having diabetes mellitus, epilepsy, and depression.

School belonging and depressive symptoms: the mediating roles of social inclusion and loneliness

BACKGROUND

Loneliness and depressive symptoms are prevalent among Finns.

OBJECTIVES

This study, which analyzes nationwide data from 149,986 students aged 13-18 years in Finland, focuses on the mediating effects of social inclusion and loneliness in the association between school belonging and depressive symptoms.

METHOD AND RESULTS

The analysis of variance showed that boys reported higher levels of school belonging and social inclusion, whereas girls reported higher levels of loneliness and depressive symptoms. Mediation analysis showed that social inclusion and loneliness partially mediated the effect of school belonging on depressive symptoms, but that social inclusion's effect was much greater than loneliness's. By focusing on the moderating role of sex, it was discovered that social inclusion significantly mediated depressive symptoms in girls more than boys.

CONCLUSION

The importance of social inclusion in preventing depressive symptoms was highlighted in the discussion.

Association between drinking behaviors, sleep duration, and depressive symptoms

Excessive alcohol consumption has been consistently linked to depression. This study, utilizing nationwide samples from the Korea National Health and Nutrition Examination Survey (n = 21,440) examined the association between drinking behaviors and depressive symptoms while also exploring the influence of sleep duration on this relationship. Demographic, socioeconomic, and health-related factors were included as covariates in the multivariable logistic regression analysis to assess their relationships with depressive symptoms. Based on their sleep duration, the participants were divided into subgroups to explore how sleep duration affects the relationship between drinking behaviors and depressive symptoms. Moderate alcohol consumption (1-4 times a month) was associated with reduced likelihood of experiencing depressive symptoms in women (p = 0.024), with a similar trend observed among men (p = 0.001). Men who started consuming alcohol before the age of 19 had a higher likelihood of experiencing depressive symptoms (p = 0.048). Only women who consumed more alcohol per occasion (≥ 7 drinks) had higher odds of depressive symptoms (p = 0.001). This study revealed complex factors that influence depressive symptoms, including alcohol consumption and sleep duration. This highlights the importance of tailored interventions based on sleep duration and sociodemographic characteristics for preventing and treating depression.

The role of effective factors on suicidal tendency of women in Turkey

Background/Aim

This study aims to identify the variables that influence the suicidal tendency of women who are married, have had a relationship or are currently in a relationship in Turkey.

Methods

This study uses cross-sectional data from the 2014 Hacettepe University Institute of Population Studies National Research on Domestic Violence Against Women in Turkey. Data from 6,458 women between the ages of 15 and 49 were analyzed in this dataset. Binary logistic regression was used to determine the factors influencing women's suicidal tendencies.

Results

Based on the analysis's findings, age, education level, health status, number of children, the sector in which the spouse/partner works, the drinking status of the spouse/partner, the situation where the spouse/partner fights with another man in a way that involves physical violence, the cheating status of the spouse/partner, the controlling behaviour of the spouse/partner, exposure to various types of violence by both the spouse/partner and someone other than the partner, and the household income level variables were found to be associated with the suicidal tendency of women.

Conclusion

Prioritizing women who are, in particular, between the ages of 15 and 24, live in the south of Turkey, have a high school education, are in poor health, are childless, have low household incomes, live with an unemployed spouse or partner, and are exposed to various forms of violence from their partner or other sources can be achieved more effective results in reducing and preventing women's suicidal behaviors.

Epidemiological profile, temporal analysis, and future projections of suicide cases in rural cities in the extreme south of Brazil

The present study aimed to verify the time series (2000-2017) of death rates by suicide and its associated factors in 4 municipalities in the extreme south of Brazil. Data were obtained through the analysis of medical reports and police report bulletins at the Instituto Médico Legal, in the city of Rio Grande. The suicide rate in the Rio Grande region varied from 4 to 11 suicides per 100,000 inhabitants and it is estimated that by 2030 this rate could reach 16.5 suicides per 100,000 inhabitants. The rural cities of Santa Vitória do Palmar and Chuí present even higher suicide averages when compared to Rio Grande, the most populous city of the four. The death rate from suicide increased gradually in the period analyzed, with the prevalence rising among the youngest and the elderly population. A more comprehensive understanding of the influences of environmental issues on suicidal decisions constitutes an important action that needs to be taken, both because of regional vulnerabilities and the target population identified. Evidence indicates that knowledge of factors affecting individuals residing in this Brazilian region where increased suicide rates are recorded needs to be recognized as a priority.

A comparison of anxiety levels before and during the COVID-19 pandemic

The COVID-19 Pandemic upended the lives of nearly everyone worldwide, and recent studies have reported higher rates of anxiety, depression, and other mental health problems. Using a repeated crosssectional design, the current study compares anxiety levels from a representative sample of college students prior-to and during the COVID-19 Pandemic. Additionally, differences in anxiety prior to and following U.S. approval for use of the Pfizer-BioNTtech COVID-19 vaccine were also compared. Findings indicate that state-anxiety levels did not differ significantly prior to and during the Pandemic as well as before the vaccine and during and after the vaccine (M = 43.01, 44.10, 44.77, respectively). Surprisingly, trait anxiety levels were significantly higher during the Pandemic than before (p = .003), and anxiety levels trend down after the approval of the vaccine, but not significantly (M = 45.10, 48.85, 47.58, respectively). Future research should continue to investigate and compare anxiety levels during the COVID-19 Pandemic.

Suicide risk among undergraduate students in Brazil in the periods before and during the COVID-19 pandemic: results of the SABES-Grad national survey

BACKGROUND

Undergraduate students present high rates of psychological distress, including suicide risk. Due to the coronavirus disease 2019 (COVID-19) pandemic, this scenario may have been aggravated. Thus, the objective of the current study was to evaluate changes in the suicide risk rate from the period before to during the COVID-19 pandemic, as well as the factors associated with this outcome among Brazilian undergraduate students.

METHODS

This was a nationwide survey carried out in Brazil with a cross-sectional design, including two data collection periods: a single-center in-person collection in 2019 and another multicenter online collection in 2020/2021. Data were collected using self-administered instruments. The outcome was a high risk of suicide, measured through the Mini International Neuropsychiatric Interview. Analyses were carried out on data from two periods, i.e. before and during the pandemic (bivariate analysis and interaction tests), and a model of associated factors (multivariate analysis using Poisson regression) was developed including all participating universities distributed in the five regions of Brazil.

RESULTS

In total, 6716 Brazilian undergraduate students participated (996 in 2019 and 5720 in 2020/2021). The prevalence of a high suicide risk rose from 11.3% to 17.0%, especially among women and poorer individuals. The prevalence of a high risk of suicide among Brazilian undergraduates was 19.6% and was associated with several socioeconomic, academic, pandemic, and mental health factors.

CONCLUSIONS

The prevalence of a high suicide risk increased from prepandemic to during the pandemic, appearing to be largely influenced by social determinants, in conjunction with the implications of the COVID-19 pandemic.

Association of Emotional Self-Regulation with Psychological Distress and Positive Functioning Dimensions in Brazilian University Students during the COVID-19 Pandemic

Emotional self-regulation is a relevant factor for human development capable of minimizing emotional difficulties in the face of adverse events, as was particularly useful during the COVID-19 pandemic. The present study aimed to evaluate emotional self-regulation in Brazilian health science university students and its relationship with positive psychology constructs (subjective well-being, hope, optimism, spirituality, self-compassion, and self-efficacy) and psychological distress (depression, anxiety, and stress). This was a prospective, cross-sectional, observational, analytic study of 1062 Brazilian undergraduate students with data collected using self-administered online questionnaires. Students in the first years of their undergraduate degree programs had significantly higher dysregulation scores than those in the final years. Multiple linear regression yielded a model that explained 71.8% of the variation in emotion dysregulation. The correlations of emotion dysregulation were significant and strong, scoring negatively with self-compassion, optimism, and subjective well-being and positively with psychological distress.

The relationship between depression, healthy lifestyle behaviors and internet addiction: a cross-sectional study of the athlete university students in Turkey

Introduction

Mental health research exists for university students in the areas of prevalence and association of depression, internet addiction and healthy lifestyle behaviors. However, the studies examining prevalence rates and these relationships in athlete university students are needed. This study aimed to evaluate the relationship between depression, healthy lifestyle behaviors and internet addiction among athlete university students in Turkey.

Methods

A cross-sectional design was conducted, measuring depression using the Center for Epidemiologic Studies Depression Scale, healthy lifestyle behaviors (HPLP-II), and internet addiction (YIAT-SF). Predictive factors associated with depressive symptoms were estimated using binary logistic regression.

Results

Of the 501 participants, 61.3% were male, with a mean age of 21.45 years (SD: 3.19). Student-athletes were at risk of depressive symptoms (76.4%), internet addiction (34.4%) and had moderate healthy lifestyle behaviors (130.41 ± 22.93). No significant differences were found for age, smoking, time spent on social network, number of sports days, number of social networks use for depressive symptoms (p > 0.05), however significant differences were found for depressive symptoms by sex and living with family status (p < 0.05). Pathological internet addiction (OR: 12.74, 95% CI: 2.91-55.77) and low spiritual growth (OR: 0.854, 95% CI: 0.79-0.92) were found to be predictors of depressive symptoms within the athlete university students (p < 0.001).

Conclusion

The athlete university students are at increased risk for depressive symptoms and internet addiction and decreased healthy lifestyle behaviors. It is essential to establish programs to improve the mental health of students in universities and to strengthen the psychological counseling services offered to students. These findings can assist universities in establishing effective measures to improve mental health outcomes.

Prevalence and factors associated with multimorbidity in adults in Brazil, according to sex: a population-based cross-sectional survey

Introduction

Multimorbidity, defined as the coexistence of two or more chronic diseases in the same individual, represents a significant health challenge. However, there is limited evidence on its prevalence and associated factors in developing countries, such as Brazil, especially stratified by sex. Thus, this study aims to estimate the prevalence and analyze the factors associated with multimorbidity in Brazilian adults according to sex.

Methods

Cross-sectional population-based household survey carried out with Brazilian adults aged 18 years or older. The sampling strategy consisted of a three-stage conglomerate plan. The three stages were performed through simple random sampling. Data were collected through individual interviews. Multimorbidity was classified based on a list of 14 self-reported chronic diseases/conditions. Poisson regression analysis was performed to estimate the magnitude of the association between sociodemographic and lifestyle factors with the prevalence of multimorbidity stratified by sex.

Results

A total of 88,531 individuals were included. In absolute terms, the prevalence of multimorbidity was 29.4%. The frequency in men and women was 22.7 and 35.4%, respectively. Overall, multimorbidity was more prevalent among women, the older people, residents of the South and Southeast regions, urban area residents, former smokers, current smokers, physically inactive, overweight, and obese adults. Individuals with complete high school/incomplete higher education had a lower prevalence of multimorbidity than those with higher educational level. The associations between education and multimorbidity differed between sexes. In men, multimorbidity was inversely associated with the strata of complete middle school/incomplete high school and complete high school/incomplete higher education, while in women, the association between these variables was not observed. Physical inactivity was positively associated with a higher prevalence of multimorbidity only in men. An inverse association was verified between the recommended fruit and vegetable consumption and multimorbidity for the total sample and both sexes.

Conclusion

One in four adults had multimorbidity. Prevalence increased with increasing age, among women, and was associated with some lifestyles. Multimorbidity was significantly associated with educational level and physical inactivity only in men. The results suggest the need to adopt integrated strategies to reduce the magnitude of multimorbidity, specific by gender, including actions for health promotion, disease prevention, health surveillance and comprehensive health care in Brazil.

Effectiveness of training programs based on mindfulness in reducing psychological distress and promoting well-being in medical students: a systematic review and meta-analysis

BACKGROUND

Medical schools have used mindfulness meditation as a strategy to assist students in stress management. This study aimed to seek evidence regarding the effectiveness of mindfulness-based training programs in reducing psychological distress and promoting the well-being of medical students.

METHODS

We conducted a systematic review and meta-analysis. Cochrane Library, Embase, PubMed/MEDLINE, PsycINFO/PsycNet, LILACS/BVS, ERIC (ProQuest), Web of Science, OpenGrey, and Google Scholar were searched for randomized clinical trials published until March 2022, without time or language restrictions. Two authors independently screened the articles, extracted data using a standardized extraction form, and assessed the methodological quality of the included studies using the Cochrane's Risk of Bias 2 (ROB 2) tool and the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.

RESULTS

Of the 848 articles retrieved, 8 met the inclusion criteria. Mindfulness-based training improved the outcomes: mindfulness (small post-intervention effect: SMD = 0.29; 95% CI: 0.03 to 0.54; p = 0.03; I² = 46%; high evidence quality, and small effect at follow-up: SMD = 0.37; 95% CI: 0.04 to 0.70; p = 0.03; I² = 53%; low evidence quality), psychological well-being/health (there was no statistically significant difference between the groups in the post-intervention effect: SMD =  - 0.27; 95% CI: - 0.67 to 0.13; p = 0.18; I² = 76%; moderate evidence quality, and a significant difference at follow-up: SMD =  - 0.73; 95% CI: - 1.23 to - 0.23; p = 0.004; I² = 61%; low evidence quality), and stress (small post-intervention effect: SMD =  - 0.29; CI of 95%: - 0.56 to - 0.02; p = 0.04; I² = 57%; moderate evidence quality, and moderate effect at follow-up: SMD =  - 0.45, 95% CI: - 0.67 to - 0.22, p = 0.0001, I² = 0%, moderate evidence quality). The quality of evidence for the anxiety, depression, and resilience outcomes is low and for the empathy outcome, very low.

CONCLUSION

The results indicate that the students who participated in the mindfulness training perceived improvements in the stress and psychological distress symptoms and improved health perception and psychological well-being. However, the significant heterogeneity among studies should be considered when interpreting these findings.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020153169.

The effect of problem-solving and assertiveness training on self-esteem and mental health of female adolescents: a randomized clinical trial

BACKGROUND

Children and adolescents are the assets of the society and their mental and physical health ensures the future health of next generations. The aim of the current study was to evaluate the effect of problem-solving and assertiveness skill training on improving self-esteem and mental health in high school female students of Isfahan city in 2019.

METHODS

This study was a randomized clinical trial. The target population was 10th grade female high school students in Isfahan city of Iran. 96 students of a female public high school were included in  the study, allocated to two groups, 32 for intervention group and 64 for control group. Six 90-min sessions were considered for problem-solving and assertiveness skill training which included lectures, question and answer, movie displaying, brainstorming and role-play. The Coopersmith Self-esteem Inventory Questionnaire (CSEI) and General Health Questionnaire (GHQ) were used in order to evaluate the variables of the study before and one month after the intervention.

RESULTS

Mean scores of the self-esteem variable changed significantly in the intervention group compared to control group before (25.2 ± 2.905) and after (29.9 ± 4.155) the intervention (p < 0.05). Mean scores of mental health also changed significantly before (27.67 ± 5.42) and after (19.033 ± 4.9) the intervention in comparison with the control group (p < 0.05).

CONCLUSION

The findings of the present study showed that educational intervention based on problem-solving and assertiveness can  enhance self-esteem and mental health in students. Future studies are needed to confirm and determine the structure of these associations. Trial Registration IRCT Code: IRCT20171230038142N9. Registration Date: 07/07/2019. Ethics Code: IR.MUI.MED.REC.1398.130.

Suicidal ideation in college students having major depressive disorder: Role of childhood trauma, personality and dysfunctional attitudes

BACKGROUND

Suicide in college students is a major public health concern. Suicidal ideation (SI) is associated with childhood trauma, personality, dysfunctional attitudes and depressive symptoms, but how they interact to predict SI remains unclear.

METHODS

Using cross-sectional design and convenience sampling method, a survey was conducted among 565 college students having major depressive disorder (MDD). The Childhood Trauma Questionnaire, Eysenck Personality Questionnaire, Dysfunctional Attitudes Scale and Hamilton Depression Scale assessed participants' psychosocial factors. Chi-square test, t-test, Pearson correlation, and Structural Equation Model were used in data analysis.

RESULTS

Overall, 66.02% of participants with MDD had SI. Those with SI showed significant differences in physical abuse, emotional abuse, physical neglect, emotional neglect, psychoticism, neuroticism, extroversion, dysfunctional attitudes and depressive symptoms compared with those without SI. Childhood trauma, psychoticism, neuroticism, extroversion and dysfunctional attitudes affected SI through chain mediation. In addition, depressive symptoms, psychoticism, neuroticism and extroversion directly affected SI.

LIMITATIONS

The convenience sampling method may limit the generalizability of the findings. Results may be biased due to the self-report nature of the data collection procedure, the number of research subjects and differences in suicide risk assessment. The cross-sectional study cannot be used to infer causality.

CONCLUSIONS

The factors of childhood trauma, personality and dysfunctional attitudes affect SI through chain mediation. In addition, depressive symptoms and personality independently predict the occurrence of SI.

Psychological distress among first-year health science students in Taiwan

Background

Objective

Methods

Results

Conclusion

•

Some first-year health science students are at risk of psychological distress.

•

Anxiety and self-harm are common among first-year health science students.

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Students in four-year programs are more likely to experience mental health challenges.

ACT em Grupo para Manejo de Ansiedade entre Universitários: Ensaio Clínico Randomizado

Resumo Estima-se que um a cada cinco estudantes universitários ao redor do mundo apresenta algum tipo de transtorno psicológico, dentre os quais os transtornos de ansiedade são os mais prevalentes. Este estudo consiste em um ensaio clínico randomizado com o objetivo de avaliar a eficácia e efetividade de um protocolo semiestruturado de psicoterapia em grupo baseado nos princípios da Terapia de Aceitação e Compromisso (ACT) para o tratamento de ansiedade entre estudantes universitários. Os participantes foram alocados aleatoriamente entre os grupos intervenção e controle. Os níveis de ansiedade pré e pós-intervenção foram avaliados por meio do instrumento General Anxiety Disorders-7 (GAD-7). A amostra final do estudo foi composta por 15 pessoas, dentre as quais 10 foram alocadas no grupo intervenção e 5, no grupo controle. Os resultados foram analisados de duas formas: a) por protocolo (Per-protocol analysis); e b) por intenção de tratar (Intention-to-treat Analysis). Este tratamento reduziu a sintomatologia ansiosa em 39,7% entre os pacientes que completaram o tratamento (por protocolo, p=0,030) e em 30,8% entre todos alocados para o grupo intervenção (i.e., por intenção de tratar, incluindo os dropouts, p=0,035), enquanto os controles não tiveram redução significativa no mesmo período. Portanto, recomenda-se a utilização deste protocolo dentro do contexto universitário como uma alternativa viável ao acompanhamento individual em situações de transtornos de ansiedade. Pesquisas futuras com amostras maiores podem contribuir na consolidação deste protocolo.

Demographics, Socioeconomic Status, Social Distancing, Psychosocial Factors and Psychological Well-Being among Undergraduate Students during the COVID-19 Pandemic

The COVID-19 pandemic impacted on academic routine because of the social distancing measures. This study examined the relationships of sociodemographic characteristics, social distancing aspects and psychosocial factors on psychosocial well-being among undergraduate students during the social distancing period due to COVID-19. A web-based survey was conducted of undergraduate students at a public university in Brazil (n = 620). Demographics, socioeconomic status (SES), social distancing factors, negative affectivity (DASS-21), sense of coherence (SOC-13), social support and psychosocial well-being (GHQ-12) were measured. The direct and indirect links between was variables was tested using structural equation modelling. The estimated model showed that greater social support, higher sense of coherence and lower negative affectivity were directly associated with better psychological well-being. Female gender, higher SES, not working during the social distancing period and availability of online modules were indirectly associated with psychological well-being through psychosocial factors. Working during the social distancing period and availability of online modules mediated the link of age, gender, SES with psychological well-being. Our findings suggest the need to provide psychological support, online teaching and financial aid to undergraduate students during the social distancing period due to COVID-19 pandemic to improve their psychological well-being.

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.