Symptoms of posttraumatic stress, depression, and anxiety as predictors of suicidal ideation among South African university students

Excessive internet use as a risk factor for suicide ideation among university students in Malawi: A cross-sectional study

Background

Covid 19 has fast-paced the use of technological innovations, mainly the internet. However, Internet use can lead to several behavioral and psychological conditions, such as cyberbullying and distorted relationships, which could lead to suicide ideation. Suicide is the second leading cause of death among young adults.

Aim

To assess the association between Internet addiction and suicide ideation among university students in Malawi. Furthermore, to assess the factors associated with suicidal thoughts among Malawian college students who surf the World Wide Web.

Methods

This cross-sectional study utilized secondary research and used data available from https://data.mendeley.com/drafts/xbfbcy5bhv. Internet addiction was measured using the Internet Addiction Test. The dependent variable includes suicide ideation. Binary logistic regression was used to analyze the relationship between the dependent and independent variables. The value of p < 0.05 was considered statistically significant.

Results

Out of the 620 participants, 514 (82.2%) were aged between 15 and 24. The majority were males 401 (64.7%). The mean IAT score was 46.08 (SD = 14.60). The IAT score was 44.81 (SD = 13.85) among males and 48.40 (SD = 15.65) among females (p = 0.003). About 341 (55%) of students use the internet excessively. Suicide ideation was prevalent among 101 (16.3%) of the students. Suicide ideation was significantly associated with internet addiction. (p < 0.001). The odds of developing suicidal thoughts increased about 3 times among excessive internet users compared to average users (OR = 2.91, 95% CI = 1.213-7.018). However, age, gender, discipline, and year of study were not associated with suicide ideation.

Conclusion

The study suggests that internet addiction affects suicide ideation mainly through distorting social relationships. School settings should increase awareness regarding the safe use of the internet to ensure a balance between online and real-life interactions and curb suicide.

Student intentions to engage instructors in mental health-related conversations: An application of the theory of planned behavior

OBJECTIVE

Considering that college students experience mental health issues and college counseling centers are overwhelmed, this study identifies instructors as a potential mental health resource for students. This study utilizes the theory of planned behavior to investigate the relationship between students' attitudes, injunctive and descriptive norms, perceived behavioral control, and their intentions to engage their instructors in mental health conversations.

PARTICIPANTS

Participants were 311 undergraduate students at a small, private university in Southern California.

METHODS

Participants were recruited through a Communication subject pool and completed an online survey about engaging instructors in these conversations.

RESULTS

Results of a regression analysis indicate that all theoretical constructs positively predict students' intentions to discuss mental health with an instructor.

CONCLUSIONS

By providing insight into students' intentions to utilize instructors as mental health resources on campus, these findings yield practical implications for better preparing universities and their faculty to engage in students' mental health.

It's very difficult to set the boundaries, it's human nature to want to respond: exploring health professions educators' responses to student mental health difficulties through a positioning theory lens

By virtue of their teaching role and contact with students, health professions (HP) educators are often the first point of connection for students who are experiencing mental health difficulties. Educators are increasingly expected to include some form of pastoral care in their role. Mental health-related interactions with students may have a negative emotional impact on educators, particularly when roles and expectations are not clearly defined and where boundaries are not managed effectively. Using positioning theory as a lens, this study explored how educators experienced such interactions and how this manifested in positions, storylines, and speech acts. Interviews were conducted with 27 HP educators at a faculty of medicine and health sciences. Reflexive thematic analysis using inductive coding identified themes corresponding to the nearing, weighted, ambivalent, and distancing positions participants adopted in relation to students with mental health difficulties. There was fluidity in and between positions, and more than one position could be occupied simultaneously; participants each moved through different positions in response to different relational situations. Multiple storylines informed these positions, representing how moral- and care-informed responsibility intersected with responsiveness to make certain actions possible or impossible. Normative and personal value narratives were evident in storylines, in many cases underscored by care or justice ethics. The value of positioning theory in facilitating reflective faculty development initiatives for educators engaged in these interactions is discussed.

Psychosocial stress, adult suicidal ideation, and the mediating effect of poor sleep quality during the COVID-19 pandemic in South Africa

OBJECTIVES

South Africa instituted one of the world's strictest lockdowns during the COVID-19 pandemic, which generated heightened conditions of psychosocial stress and posed widespread mental health risks. Despite the elevated burdens of suicidal behaviors and risk of psychiatric disease in the country, few studies have examined the impacts of psychosocial stress from the pandemic on suicidal ideation in South Africa. This study examined the association between psychosocial stress experienced under the COVID-19 pandemic and adult suicidal ideation, as well as degree to which sleep quality and duration mediated this relationship.

METHODS

An online survey assessed experiences of COVID-19 psychosocial stress, sleep quality and duration, and suicidal ideation in a sample of 189 South African adults during the second and third waves of the COVID-19 pandemic. A causal inference framework for mediation analysis was used to assess the degree to which sleep quality and duration explained the association between COVID-19 psychosocial stress and suicidal ideation.

RESULTS

Suicidal ideation was reported in 21% of adults. Adults described having moderate sleep quality and an average of 6.9 hours of sleep per night. COVID-19 psychosocial stress significantly predicted adult suicidal ideation in fully adjusted models. Sleep quality, but not sleep duration, significantly mediated the association between COVID-19 psychosocial stress and suicidal ideation, accounting for 25.9% of the total effect.

CONCLUSIONS

Poor sleep quality may play an important role in exacerbating the alarming stress-induced mental health effects of the COVID-19 pandemic. Further research is necessary to understand the underlying sleep dynamics and associated psychological and neurobiological processes that perpetuate adult suicidal ideation.

Molecular pathways underlying sympathetic autonomic overshooting leading to fear and traumatic memories: looking for alternative therapeutic options for post-traumatic stress disorder

The sympathoadrenal medullary system and the hypothalamic-pituitary-adrenal axis are both activated upon stressful events. The release of catecholamines, such as dopamine, norepinephrine (NE), and epinephrine (EPI), from sympathetic autonomic nerves participate in the adaptive responses to acute stress. Most theories suggest that activation of peripheral β-adrenoceptors (β-ARs) mediates catecholamines-induced memory enhancement. These include direct activation of β-ARs in the vagus nerve, as well as indirect responses to catecholamine-induced glucose changes in the brain. Excessive sympathetic activity is deeply associated with memories experienced during strong emotional stressful conditions, with catecholamines playing relevant roles in fear and traumatic memories consolidation. Recent findings suggest that EPI is implicated in fear and traumatic contextual memories associated with post-traumatic stress disorder (PTSD) by increasing hippocampal gene transcription (e.g., Nr4a) downstream to cAMP response-element protein activation (CREB). Herein, we reviewed the literature focusing on the molecular mechanisms underlying the pathophysiology of memories associated with fear and traumatic experiences to pave new avenues for the treatment of stress and anxiety conditions, such as PTSD.

Association between physical activity levels and anxiety or depression among college students in China during the COVID-19 pandemic: A meta-analysis

BACKGROUND

This meta-analysis aimed to investigate the links between the level of physical activity and the risk of anxiety or depression among college students in China during the Coronavirus Disease 2019 pandemic.

METHODS

Eligible studies were searched from the PubMed, Embase, and Web of Science databases. The associations between them were assessed with odd ratio (OR) and 95% confidence interval (CI). The heterogeneity of the included studies was evaluated and subgroup analysis was performed. Sensitivity analysis was executed using leave-one-out method. Publication bias of included studies was evaluated. Ten studies with moderate quality were included.

RESULTS

Physical activity levels of college students were associated with reduced risk of depression (OR [95%CI] = 0.69 [0.58, 0.82], P < .001) and anxiety (OR [95%CI] = 0.71 [0.62, 0.80], P < .001). The measurement scale of depression or anxiety and whether multi-factor correction was performed or not did not influence the pooled results. The pooled results of depression and anxiety were stable and were not significantly influenced by a single study. No publication bias was observed in the included studies reporting depression and anxiety.

CONCLUSION

The physical activity level of college students is negatively correlated with anxiety and depression in China during the pandemic. During the Coronavirus Disease 2019 pandemic, it is necessary to strengthen the construction of university physical education courses. As an organized form of physical activity, physical education classes are a necessary and effective way to increase physical activity among college students.

Mental health implications of suicide rates in South Africa

Mental health challenges are a severe issue that could lead to suicide if not properly addressed. South Africa has a significant burden of mental health issues, which contributes to the soaring rate of suicide. Adequate mental health-care provision could reduce the high suicide rate in South Africa. Since the apartheid regime, the country has made a series of efforts to improve mental health. This study aimed to review and examine available literature on mental health and suicide issues in South Africa and demonstrate the policy implications. This study adopted a narrative review approach. Electronic databases (PubMed, Scilit, Google Scholar and Semantic Scholar) were used to identify published articles in the English language with crucial search terms that included mental health, South African mental health policy, South Africa, suicide and policy. Literature suggests that at the provincial level, there are no adequate mental health policies, and the implementation of the country's mental health policy is faced with many challenges, such as a shortage of professionals and finances. The review also showed that task sharing and counselling have been pilot-tested and shown to be effective methods for the prevention of mental illness and promotion of positive mental health. This study concludes that the mental health treatment gap still exists in South Africa, and this needs to be tackled using effective, multi-level counselling interventions and policy initiatives. Adequate mental health-care provision and effective implementation of mental health policy could reduce the high rate of suicide in South Africa.

Associations between psychological distress and facets of mindfulness: Implications for campus-based university wellness services

OBJECTIVES

To investigate associations between components of psychological distress and five facets of mindfulness (i.e. observing; describing; acting with awareness; non-reactivity; non-judging).

PARTICIPANTS

Students from a university in South Africa (n = 174).

METHODS

This cross-sectional study assessed psychological distress and mindfulness using the K10 and Five Facet Mindfulness Questionnaire. Multivariate regression analysis identified associations between psychological distress and facets of mindfulness, controlling for demographics.

RESULTS

Prevalence of psychological distress was 56.9% (95% CI 49.2%-64.4%). Acting with awareness, non-reactivity, and non-judging predicted significantly lower psychological distress, whereas observing and describing did not. Acting with awareness was the only facet of mindfulness that consistently predicted lower levels of negative affect, fatigue, nervousness, and agitation.

CONCLUSIONS

Acting with awareness appears to be a key component of psychological wellbeing. To advance theory and practice, future research should consider why and how various facets of mindfulness predict lower psychological distress and its components among university students.

Prevalence and correlates of 30-day suicidal ideation and intent: Results of the South African National Student Mental Health Survey

Background. Although suicide prevention is recognised as a priority among university students in South Africa (SA), it is unclear whatproportion of students require urgent indicated interventions and what the characteristics are of these students.Objective. To assess the prevalence and sociodemographic correlates of 30-day suicidal ideation, frequency of ideation and self-reported intention to act on ideation in the next year among a national sample of SA university students.Methods. Self-report cross-sectional data were collected online from students (N=28 268) at 17 universities across SA as part of the national student mental health survey. Students reported suicidal ideation in the past 30 days, frequency of ideation and intention to act on ideation in the next year. Data were weighted within institutions by gender and population group, and across the four main types of universities (historically white, historically disadvantaged, technical and distance learning) to correct for response rate discrepancies. Prevalence was estimated with these weighted in the total sample and across types of universities. Poisson regression with robust error variances was used to investigate associations of sociodemographic characteristics with ideation and intention to act on suicidal ideation. Results are reported as relative risks (RRs) with design-based 95% confidence intervals (CIs).Results. Thirty-day prevalence of suicidal ideation was 24.4% (standard error (SE) 0.3), with 2.1% (SE 0.1) and 4.1% (SE 0.1), respectively,reporting suicidal ideation all/almost all the time, or most of the time. A total of 1.5% (SE 0.1) of respondents reported being very likely to act on their suicidal ideation, while 3.9% (SE 0.2) were somewhat likely, 8.7% (SE 0.2) were not very likely and 85.8 (SE 0.5) either reported no suicidal ideation or that they were not at all likely to act on this ideation. Risk of suicidal ideation with high intent in the total sample was elevated among females (RR 1.9, 95% CI 1.3 - 2.7) and gender non-conforming students (RR 4.3, 95% CI 1.4 - 13.0) relative to males, black African students compared with white students (RR 3.6, 95% CI 1.9 - 7.1), students whose parents did not progress to secondary school compared with students whose parents had a university education (RR 1.6, 95% CI 1.0 - 2.5) and sexual minority students compared with heterosexual students (RR 1.9, 95% CI 1.3 - 2.6). Among students with 30-day ideation (controlling for frequency of ideation), only two of these predictors of high intent remained significant: identifying as black African (RR 2.7, 95% CI 1.4 - 5.1), and having parents with less than secondary education (RR 1.5, 95% CI 1.0 - 2.1).Conclusion. Scalable suicide prevention interventions are needed to reach the large number of SA students who report suicidal ideation with intent.

Stress, anxiety, and depression in social work students from Peru

OBJECTIVE

To report the magnitude of symptoms of stress, anxiety, and depression in Social Work Students (SWS) from Peru and the stressors associated with each illness. Moreover, to validate the DASS-21 tool (Spanish version) with a Peruvian SWS sample.

METHOD

Quantitative study that applied the DASS-21 scale to a sample of 152 Peruvian SWS. Sociodemographic data and college stressors over stress, anxiety, and depression were modelled with factorial analysis, multiple regressions, ANOVA, and t-tests. Descriptive statistics were also used. The research started in August 2018 and end in February 2019.

RESULTS

The study concludes that 48% of Peruvian SWS suffer from severe or extremely severe symptoms of stress, anxiety, or depression. Female students are the most affected by these illnesses. The DASS-21 Spanish version was validated in a new sample of Peruvian SWS. The profile of the SWS from Peru is reported.

CONCLUSION

Peruvian SWS are suffering symptoms of stress, anxiety, and depression at different levels. There are college stressors that increase the symptoms of stress, anxiety, and depression in these students.

Posttraumatic stress disorder and risk of suicidal behavior: A systematic review and meta-analysis

INTRODUCTION

This study conducted a systematic review and meta-analysis of the association between posttraumatic stress disorder (PTSD) and (i) death by suicide, (ii) attempted suicide (AS), and (iii) suicidal ideation (SI).

METHODS

The systematic review identified seven studies on PTSD and suicide, 33 studies for AS, and 20 studies for SI. A series of stratified meta-analyses were conducted to estimate pooled effects, in addition to meta-regression to investigate sources of heterogeneity.

RESULTS

A higher relative risk of suicide was evident among those diagnosed with PTSD (RR = 2.09 [95% confidence interval (CI): 1.11-3.94]), with strongest associations among combat veterans (RR = 3.97, 95% CI 2.22-7.10). A lower relative risk of suicide among those with PTSD and co-morbid psychiatric conditions was evident (RR = 0.74, 95% CI 0.63-0.86). A strong association between PTSD and attempted suicide (RR = 4.05, 95% CI 3.14-5.23) and suicidal ideation (RR = 2.91, 95% CI 2.22-3.82) was also found, with a consistently strong association among those with co-morbid psychiatric conditions and non-clinical cohorts.

CONCLUSION

This review found a strong association between PTSD and death by suicide, attempted suicide, and suicidal ideation, and also suicide among veteran populations. Early identification and treatment of PTSD across both clinical and non-clinical cohorts should be a priority for suicide prevention.

The mental health of university students in South Africa: Results of the national student survey

BACKGROUND

We estimate 30-day prevalence of 11 common mental disorders among a representative sample of university students in South Africa and explore disparities in student mental health across historically segregated institutions and marginalised groups.

METHODS

Cross-sectional data collected in self-report surveys of students (n = 28,268) from 17 universities were weighted to adjust for differences in survey responses. Poisson regression was used to estimate risk ratios (RRs).

RESULTS

Prevalence estimates were highest (21.0-24.5 %) for two anxiety disorders (social anxiety disorder, PTSD) and two disruptive behavior disorders (eating disorder, ADHD). Prevalence estimates were higher for any anxiety disorder (37.1 %) and any disruptive behavior disorder (38.7 %) than for any mood disorder (16.3 %) or any substance use disorder (6.6 %). Prevalence estimates varied significantly by historical segregation status of institutions (F₃ = 221.6, p < .001), with prevalence consistently highest in Historically White Institutions (HWIs). Across all institutions, risk of any disorder was lower among oldest than younger students (RR = 0.7, 95%CI = 0.7-0.8), and elevated among gender non-conforming (RR = 1.3, 95%CI = 1.1-1.4), female (RR = 1.2, 95%CI = 1.1-1.2), and sexual minority (RR = 1.2, 95%CI = 1.2-1.3) students. Black students attending HWIs had elevated risk of any disorder relative to White students.

LIMITATIONS

Reliance on self-report measures together with relatively low and variable response rates across institutions limit generalizability of results.

CONCLUSIONS

Modest risks associated with sociodemographic factors suggest a need to focus on mental health of female, gender nonconforming and sexual minority students at all universities along with Black students attending HWIs.

Probable depression and its correlates among undergraduate students in Johannesburg, South Africa

BACKGROUND

Depression is associated with high rates of morbidity and mortality. Globally, depression is higher among university students than the general population-making it a significant public health problem. Despite this, there is limited data on the prevalence in university students in the Gauteng province, South Africa. This study determined the prevalence of screening positive for probable depression and its correlates among undergraduate students at the university of the Witwatersrand, Johannesburg, South Africa.

METHODS

A cross-sectional study, using an online survey was conducted among undergraduate students at the University of the Witwatersrand in 2021. Patient Health Questionnaire (PHQ-2) was used to assess the prevalence of probable depression. Descriptive statistics was computed and conducted bivariate and multivariable logistic regression to identify factors associated with probable depression. Age, marital status, substance use (alcohol use, cannabis use, tobacco use, and other substance use) were included in the multivariable model apriori determined confounders and other factors were only added if they had a p-value <0.20 in the bivariate analysis. A p-value of 0.05 was considered statistically significant.

RESULTS

The response rate was 8.4% (1046/12404). The prevalence of screening positive for probable depression was 48% (439/910). Race, substance use, and socio-economic status were associated with odds of screening positive for probable depression. Specifically reporting white race (adjusted OR (aOR) = 0.64, 95% CI: 0.42, 0.96), no cannabis use (aOR = 0.71, 95% CI: 0.44-0.99), higher spending power in the form of having the most important things but few luxury goods (aOR = 0.50, 95% CI: 0.31, 0.80) and having enough money for luxury goods and extra things (aOR = 0.44, 95% CI: 0.26-0.76) were associated with lower odds of screening positive for probable depression.

DISCUSSION

In this study, screening positive for probable depression was common among undergraduate students at the University of the Witwatersrand, Johannesburg, South Africa and associated with sociodemographic and selected behavioral factors. These findings call for strengthening the awareness and use of counselling services among undergraduate students.

The relationship between depression symptoms and academic performance among first-year undergraduate students at a South African university: a cross-sectional study

Background:

South African universities face a challenge of low throughput rates, with most students failing to complete their studies within the minimum regulatory time. Literature has begun to investigate the contribution of well-being, including mental health, with depression among students being one of the most common mental disorders explored. However, locally relevant research exploring associations between depression and academic performance has been limited. This research hypothesizes that the presence of depression symptoms, when controlling for key socio-demographic factors, has an adverse impact on student academic outcomes and contributes to the delay in the academic progression of students.

Methods:

The study used a cross-sectional design. Data were collected in 2019 from first-time, first-year undergraduate students using a self-administered online questionnaire. In total, 1,642 students completed the survey. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depression symptoms. Data on students’ academic performance were obtained from institutional records. Bivariate and multivariate regression analyses were used to examine associations between depression symptoms and academic performance.

Results:

Most participants (76%) successfully progressed (meeting the requirements to proceed to the second year of university study). Of the participants, 10% displayed symptoms of severe depression. The likelihood of progression delay (not meeting the academic requirements to proceed to the second year of university study) increased with the severity of depression symptoms. Moderate depression symptoms nearly doubled the adjusted odds of progression delay (aOR = 1.98, 95% CI: 1.30-3.00, p = 0.001). The likelihood of progression delay was nearly tripled by moderate severe depression symptoms (aOR = 2.70, 95% CI:1.70–4.36, p < 0.001) and severe depression symptoms (aOR = 2.59, 95% CI:1.54–4.36, p < 0.001). The model controlled for field of study, financial aid support as well as sex and race.

Conclusion:

Higher levels of depression symptoms among first-year university students are associated with a greater likelihood of progression delay and may contribute to the low throughput rates currently seen in South African universities. It is important for students, universities and government departments to recognize student mental wellness needs and how these can be met.

Depression and anxiety of medical students at Kunming Medical University during COVID-19: A cross-sectional survey

An isolation strategy was used to control the transmission and rapid spread of COVID-19 in Yunnan. As a result, students were supposed to stay at home and disrupted their outside activities. It led to a detrimental influence on students' mental health. The purpose of this study was to investigate the prevalence and risk factors of depression and anxiety among medical students and to provide ideas for the prevention of depression and anxiety in medical students. A cross-sectional survey was conducted among 2,116 medical students at Kunming Medical University from July 8 to July 16, 2020. Participants' demographic and living conditions were collected. Depression and anxiety were measured using the Patient Health Questionnaire 9 and General Anxiety Disorder-7, respectively. Uni- and multivariate logistic regression analyses were performed to detect risk factors associated with depression and anxiety. The prevalence rates of depression and anxiety among medical students were 52.5 and 29.6%, respectively. Depression was more likely to be caused by low grades, lack of physical exercise, drug use, irregular diet, extensive screen time on mobile phones, being greatly affected by the COVID-19 pandemic, and inadaptability to offline courses. Anxiety was more likely to be caused by lack of physical exercise, drug use, irregular diet, and inadaptability to offline courses. Depression and anxiety are highly comorbid. Our study showed predictive factors for depression and anxiety and identified a major mental health burden on medical students during the COVID-19 outbreak. More targeted measures should be taken to improve the mental state of students to reduce the incidence of depression and anxiety.

Longitudinal associations between multiple mental health problems and suicidal ideation among university students during the COVID-19 pandemic

BACKGROUND

Recent research suggested that COVID-19-related multiple mental health problems were associated with an increased risk for suicidal ideations (SIs), but population-based data demonstrating these associations are scarce. This study aimed to estimate the cumulative effects of psychological risk factors on SIs during the outbreak and remission periods of COVID-19 using a cumulative risk model, as well as sex differences.

METHODS

A total of 68,685 college students in China participated in the survey during two phases of the pandemic (T1 and T2). Mental health risks (acute stress, depression, anxiety, insomnia, and obsessive-compulsive symptoms) and sociodemographic characteristics were measured at T1, and SIs were assessed at T1 and T2. Hierarchical regression analysis was used to determine the combined effect of multiple mental health problems on SIs at T1 and T2.

RESULTS

The prevalence of SIs increased from the early periods of the COVID-19 pandemic (7.6%) to the later periods (10.0%). Depression was a powerful risk factor for SIs during the COVID-19 pandemic. Individuals with >3 mental risks would be most likely to experience rapidly increasing SIs during the early periods of the COVID-19 pandemic. Sex exerted different effects on the cumulative risk model of SIs.

CONCLUSIONS

Interventions, such as mental health education and improving utilization of student support services, should be implemented. There is a crucial need for early intervention and prevention efforts aimed at males with greater than three mental health problems.

Suicidal Thoughts, Depression, Post-Traumatic Stress, and Harmful Alcohol Use Associated with Intimate Partner Violence and Rape Exposures among Female Students in South Africa

While ample evidence from high-income country settings indicates the prevalence and risk factors for multiple mental ill-health symptoms in student populations, evidence from low- and middle-income higher education settings remains limited. We determined the frequency, associations, and structural pathways between mental health outcomes and possible risk factors among a sample of 1292 predominantly Black African and female students ages 18-30 years, enrolled at nine purposefully selected public universities and Technical Vocational Education and Training (TVET) campuses. We measured and created a mental ill-health latent outcome consisting of depressive symptoms, post-traumatic stress disorder (PTSD), and suicidal thoughts. We also measured traumatic exposures including childhood trauma, recent intimate partner violence (IPV), non-partner rape, and other life traumatic events. We used structural equation modelling to analyse data. We found that 50% of the surveyed students binge drank, 43% reported depressive symptoms, 9% reported PTSD symptoms, and 21% had suicidal thoughts. Students' experiences of childhood trauma, food insecurity, other traumatic events, non-partner rape, and IPV impacted the mental ill-health latent. IPV experiences mediated the relationships between experiences of childhood trauma or other trauma and the mental ill-health latent, and the relationship between binge drinking and other life traumatic events. Non-partner rape mediated the relationship between food insecurity and the mental ill-health latent. Binge drinking directly impacted non-partner rape experience. The findings substantiate the need for campus-based mental health promotion, psychosocial services and treatments, and implementation of combined interventions that address the intersections of violence against women and mental health among students in South Africa.

Compassion-Focused Therapy: Proof of Concept Trial on Suicidal Ideation and Cognitive Distortions in Female Survivors of Intimate Partner Violence With PTSD

This proof of concept trial aimed to assess the pre-post differences in suicidal ideation and cognitive distortions in the compassion-focused therapy (CFT), and to compare the psychological improvement in the experimental group to a control group. A total of 42 women suffering from PTSD due to exposure to intimate partner violence (IPV) were randomized to the experimental and control groups (21 per group). All participants completed the questionnaires of suicidal ideation and cognitive distortions as pretest measures. Subjects of the experimental group received 8 CFT sessions, while the controls did not receive any therapy. Then, all subjects responded to the questionnaires of suicidal ideation and cognitive distortions as the posttest measures. Data were analyzed using one-way repeated measures MANOVA. Subjects of the experimental group indicated a greater reduction in post-test scores of suicidal ideation and its subscales including passive suicidal ideation, preparation for suicide, and active suicidal ideation when compared to the controls. Moreover, the subjects of the experimental group indicated a greater reduction in the post-test scores of cognitive distortions than controls. These results provide support for a larger trial focusing on the efficacy of CFT on psychological outcomes of PTSD following exposure to IPV. This intervention has the potential to be deployed at higher scales for IPV-affected women with PTSD.

Prevalence and Factors Associated with Suicidal Ideation Among University Students in Bangladesh

This study aimed to determine the prevalence of and factors associated with suicidal ideation among university students in Bangladesh. We collected cross-sectional data from 407 students aged between 18 and 27 years at Jahangirnagar University (Dhaka, Bangladesh), using a convenience sampling technique. Of the total sample, 13.8% reported having suicidal ideation during the past 12 months. In multiple logistic regression analysis, being female, being a fifth-year student, lower socioeconomic status, exposure to traumatic events, family suicide history, and depression were associated with suicidal ideation. The findings emphasize the need for appropriate support services for university students with a focus on mental health wellbeing and suicide prevention.

Prevalence of Internet Addiction and its Correlates Among Regular Undergraduate Medicine and Health Science Students at Ambo University. Cross-Sectional Study

Introduction:

Internet addiction (IA) is causing academic failure, decreased concentration ability, and a negative affective state. In Ethiopia, studies conducted on IA were limited; therefore, this study aimed to assess its prevalence and risk factors among medicine and health science (MHS) students of Ambo University.

Materials and Methods:

This study was a cross-sectional study and included MHS students of Ambo University from July 15 to August 15, 2021. Data were collected using a self-administered questionnaire after receiving informed consent from study participants. The results were analyzed using the statistical software for social sciences version 24. Bivariate and multivariate logistic regressions were performed to explore the relationship between IA and dependent variables.

Results:

Of the 253 participants who participated in the study, 201 (79%) were found to have an IA. Having one’s own computer, Internet access at home and an email account were 2 times more risky to develop IA compared to their counterparts with AOR = 2.615 (95% CI = 1.118-5.956) with a P value of .022, AOR = 2.154 (95% CI = 1.054-4.405) with a P value of .35 and (=2.154 (95% CI = 1.054-4.405 with a P value of .035 respectively. Additionally, those who use the Internet for news were 2.5 times more likely to develop IA compared to those who do not (AOR = 2.551 (95% CI = 1.225-5.349) with a P-value of .013). The use of the Internet for scientific research and education reduces IA by 0.7 times (AOR = 0.323 (95% CI = 0.120-0.868) with a P value of .025).

Conclusions:

The prevalence of IA was found to be high in this study. Therefore, strategies are needed to minimize the prevalence of this problem.

Enabling Self-Directed Academic and Personal Wellbeing Through Cognitive Education

BACKGROUND

The international crisis of declining learner wellbeing exacerbated by the COVID-19 pandemic with its devastating effects on physical health and wellbeing, impels the prioritization of initiatives for specifically enabling academic and personal wellbeing among school learners to ensure autonomous functioning and flourishing in academic and daily life. Research emphasizes the role of self-directed action in fostering wellbeing. However, there is limited research evidence of how self-directed action among school learners could be advanced.

AIM

We explore the effectiveness of an intervention initiative that exposes teachers to foregrounding Cognitive Education - the explicit and purposeful teaching of thinking skills and dispositions to learners that would advance self-regulated action - to establish the latent potential of the intervention for assisting learners to develop self-regulating abilities that progressively inspires increased self-directed action.

METHOD

We illuminate the qualitative outcomes of an exploratory pilot study with a heterogeneous group of willing in-service teachers from two public primary schools (n = 12), one private primary school (n = 3), and one pre-school (n = 2) in South Africa who received exposure to an 80-h intervention that comprised seven study units. The article delineates the experiences of the teachers concerning their participation in the intervention as reflected in their written reflections, as well as their perceptions about the value of the intervention probed with semi-structured one-on-one interviews after completion of the intervention.

RESULTS

The findings revealed that exposure to the intervention holds benefits for equipping teachers with teaching strategies to create classroom conditions that nurture the development of thinking skills and dispositions that are important for self-regulating, and ultimately self-directing academic and personal wellbeing.

CONCLUSION

Cognitive Education is a form of strengths-based education that can play an indispensable role in enabling self-directed academic and personal wellbeing among school learners.

Validation of the patient health questionnaire-9 and the generalized anxiety disorder-7 in Lithuanian student sample

BACKGROUND

The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder Questionnaire- 7 (GAD-7) are short screening instruments used for detection of depression and anxiety symptoms in various settings, including general and mental health care as well as the general population. The aim of this study is to evaluate psychometric properties and factorial structure of the PHQ-9 and the GAD-7 in a sample of Lithuanian university students.

METHODS

1368 students (mean age 22.5±4.8) completed the PHQ-9 and the GAD-7 questionnaires online; after the completion of the survey, students were asked to provide phone contact for an additional interview. Eligible students were approached later by trained interviewers and completed The Clinical Interview Schedule-Revised for assessment of depressive and anxiety disorders.

RESULTS

Results showed that the PHQ-9 and the GAD-7 are reliable screening tools for depression and anxiety (Cronbach alpha 0.86 and 0.91, respectively). The one-factor structure of the PHQ-9 and the GAD-7 was confirmed by the Confirmatory Factor Analysis. A cut-off of ≥10 for the PHQ-9 resulted in 71% sensitivity and 66% specificity recognizing students with increased risk for mood or anxiety disorder. For the GAD-7, a cut-off ≥9 resulted in 73% sensitivity and 70% specificity recognizing students at risk. The PHQ-9 was sensitive but not specific in recognizing students with depressive disorders. The sensitivity and specificity of the GAD-7 in differentiating students with generalized anxiety disorders were low.

CONCLUSIONS

The PHQ-9 and the GAD-7 have sufficient formal psychometric properties, but their clinical utility as diagnostic tools for recognition of depressive and anxiety disorders in students is limited. Due to low specificity and high false positive rates, both scales are recommended only as an initial screening tool for recognition of subjects with increased risk of mental disorders, however positive cases should be later assessed using more comprehensive instruments.

An Examination of Sexual Victimization, Self-Injurious Behaviors, and Suicidality Among Female College Students

Many studies have established a relationship between suicidal ideation and sexual victimization, particularly among women; yet, few have looked specifically at samples of college students or at the potentially mediating effects that several risk factors and coping mechanisms related to sexual victimization may have on suicidality. The current study sought to examine the relationship between reported sexual victimization and suicidality, and more specifically the mediating role that depression and nonsuicidal self-injury had on this relationship. Data were collected from a random sample of 732 female college students attending a Midwestern public university. Path analysis results indicate that while sexual victimization did not have a direct effect on suicidality, it did have an observable and significant mediating indirect effect on suicidality. The current study informs both our theoretical understanding of how victimization affects college women's lives and our capacity to develop and implement effective prevention and intervention programs for college students.

Mental Well-Being in UK Higher Education During Covid-19: Do Students Trust Universities and the Government?

This paper draws upon the concept of recreancy to examine the mental well-being of university students during the Covid-19 pandemic. Briefly, recreancy is loss of societal trust that results when institutional actors can no longer be counted on to perform their responsibilities. Our study of mental well-being and recreancy focuses on the role of universities and government regulators within the education sector. We surveyed 600 UK students attending 161 different public higher education providers in October 2020 during a time when many UK students were isolated in their residences and engaged in online learning. We assessed student well-being using the Short Warwick-Edinburgh Mental Well-being Scale (scored 7–35) and found the mean score to be 19.9 [95% confidence interval (CI) 19.6, 20.2]. This level of well-being indicates that a significant proportion of UK students face low levels of mental well-being. Structural equation modeling (SEM) analysis indicates that high recreancy—measured as a low trust in universities and the government—is associated with low levels of mental well-being across the student sample. While these findings are suggestive, they are also important and we suggest that government and university leaders should not only work to increase food and housing security during the Covid-19 pandemic, but also consider how to combat various sector trends that might intensify recreancy.

The Loneliness-Life Satisfaction Relationship: The Parallel and Serial Mediating Role of Hopelessness, Depression and Ego-Resilience among Young Adults in South Africa during COVID-19

Recently, with the onset of the COVID-19 pandemic, several lockdown and stay-at-home regulations have been implemented worldwide. In this regard, loneliness has been identified as the signature mental health consequence of this pandemic. The aim of this study is to explore the associations among loneliness, hopelessness, depression, ego-resilience and life satisfaction in a random sample of young adults (N = 337) at a university in the Western Cape of South Africa. Parallel and serial mediation analysis supported the hypothesis that loneliness is associated with hopelessness, which in turn is associated with depression, and that ego-resilience mediates the association between all the negative indices of psychological well-being and life satisfaction. These findings suggest that mental health interventions that boost ego-resilience and target loneliness may help in dealing with the mental health consequences of COVID-19.

The effectiveness of an integrated counseling program on emotional regulation among undergraduate students with depression

Purpose

This study investigated the effectiveness of a new counseling program integrating cognitive behavioral therapy and acceptance and commitment therapy to promote emotional regulation (ER) among undergraduate students with depression.

Design/methodology/approach

An interventional mixed method design was employed with the development of a qualitative method-based program using experimental and qualitative research. The sample consisted of 792 third-year undergraduate students at a public university in Bangkok. A total of 34 students with depression voluntarily enrolled and were divided into 2 groups. The 17 students in the experimental group received integrated counseling, while those in the control group received brochures. The effectiveness was evaluated using the self-assessment section on the ER scale and the Beck Depression Inventory form before and after counseling. When the program ended, qualitative research was conducted using in-depth interviews. In terms of quantitative research, the data were analyzed using one-way MANOVA and the qualitative research data used content analysis.

Findings

The mean scores for ER and depression in the experimental group before and after counseling were significantly different (p-value <0.05). Results were also significantly different from the control group (p-value <0.05). Students with depression showed improvements in ER in all six components after joining the program, including awareness, clarity, acceptance, impulse, goals and strategies.

Originality/value

Integrated counseling is an effective program that can increase ER and reduce depression among adolescents and can be an alternative program for depressive patients or other mood-regulating problems to promote ER.

Prevalence and factors associated with suicidal ideation amongst college students in the Nelson Mandela Bay Municipality, South Africa

Background

Suicidal behaviour amongst college students constitutes a significant social and public health problem globally. This study determined the prevalence and associated factors of suicidal ideation amongst students of higher education in the Nelson Mandela Bay Municipality (NMBM), South Africa.

Methods

In this institution-based cross-sectional study, a multistage cluster sampling of 826 participants, drawn from a college in NMBM, was conducted from January to March 2020. Data were collected with a standardised self-administered questionnaire. Multivariable logistic regression analysis was used to identify the factors associated with suicidal ideation.

Results

Participants’ ages ranged from 18 to 24 years, with a mean age of 20.49 years (standard deviation, 1.88 years). The lifetime prevalence of suicidal ideation and plans in the preceding 12 months were 24.5% and 9.6%, respectively. The odds of suicidal ideation were higher in students who experienced bullying (adjusted odds ratio [AOR], 1.89; 95% confidence interval [CI], 1.35–2.65), mental illness (AOR, 1.89; 95% CI, 1.35–2.65), a history of sexual assault (AOR, 2.50; 95% CI, 1.20–5.21) and experience of sexual assault by or to a close family member (AOR, 1.69; 95% CI, 1.01–2.82). Underlying chronic illness was associated with a twofold risk for suicidal ideation in both sexes.

Conclusion

About a quarter of the students sampled at the college had experienced suicidal ideation and some had had suicidal plans in the preceding 12 months. Screening for the identified risk factors amongst the student population coupled with prompt interventions would mitigate the risk of suicide in the study population.

Measuring mental health and well-being of South African undergraduate students

BACKGROUND

Increased investment in optimal student mental health and well-being has been noted by universities around the world. Studies show the need for contextually relevant, granular understandings of specific aspects of student mental health and well-being.

METHODS

A survey was conducted at two time points - at the beginning and end of the academic year - at a large, urban university in South Africa. The Mental Health Continuum-Short Form, the Flourishing Scale, and the Fragility of Happiness Scale were used in the testing of undergraduate students from a variety of scientific disciplines. Two separate comparisons were made, based on the baseline data (n = 551) and the follow-up data (n = 281). In Comparison 1 (baseline, n = 443; follow-up, n = 173), two independent, biographically (very) similar groups were compared. Comparison 2 (n = 108) compared the results from the baseline and follow-up of the same group of students who completed the instruments at both time points.

RESULTS

Results indicate a significant decline in mental health and well-being for both groups (independent and dependent) over the course of the academic year. Both follow-up groups were found to have lower psychological, emotional and social well-being, psychological flourishing, and reduced mental health, in comparison with the baseline groups.

CONCLUSIONS

The statistically significant decreases in the mental health and well-being of participants in this study indicate the need for substantive interventions to support student mental health and well-being. Strong foci for well-being interventions should include self-efficacy, sense of direction, meaning and creating a sense of belonging.

Suicide among university students: prevalence, risks and protective factors

Background: Research evidence on suicide in Ghana so far has focused mostly on suicide in the adult population and less work on the younger population such as university students and other vulnerable groups such as children, youth and the aged. Aims: This study was conducted to determine lifetime and current prevalence of suicidal ideation or attempts and identify the associated risks and protective factors among university students in Ghana. Methods: Using a cross-sectional design, 1003 university students (507 males and 496 females) with a mean age of 20.5 years (SD = 5.95) were administered questionnaires that measured suicide, psychological distress, self-esteem and subjective wellbeing. Results: We found the following prevalence rates of suicidal behaviours: ideations 15.2%, attempted 6.3%, death wishes 24.3% and suicidal plan 6.8%. Psychological distress was a risk factor for both suicidal ideation and suicidal attempt. Subjective wellbeing was protective of suicide attempt while self-esteem was protective of suicidal ideation. Conclusions: These findings underscore the need for school-based mental health-promoting programmes that enhance young people's self-esteem, reduce psychological distress and boost subjective wellbeing.

Effects of Physical Activity on the Stress and Suicidal Ideation in Korean Adult Women with Depressive Disorder

Depressive disorder is common in many adult women in the world. It was found that depressive disorder was related to stress and suicidal ideation in Korean adult women with depressive disorder. Physical activities were effective to solve this mental disorder. Thus, the purpose of the study was to investigate the effects of physical activity (PA) on the stress and suicidal ideation of Korean adult women with depressive disorder. A sample of 1315 Korean adult women who have depressive disorder was collected, and the Korea National Health and Nutrition Examination Survey (KNHANES) was used to determine this purpose of the study. The complex samples in frequency analysis were used to identify the characteristics of the participants. The logistic regression in the complex sample design was conducted to investigate the effects of PA on the stress and suicidal ideation in Korean adult women with depressive disorder. The effects of flexibility exercise on the stress in Korean adult women with depressive disorder showed the odds ratio (OR) value of 1.434 (OR = 1.434, 95% CI = 1.043–1.973, p < 0.05). The effects of flexibility exercise on the suicidal ideation in Korean adult women with depressive disorder presented the OR value of 0.682 (OR = 0.682, 95% CI = 0.496–0.937, p < 0.05). Based on the results, the participants who did flexibility exercises were likely to have less stress and suicidal ideation than the Korean adult women with depressive disorder who did not participate in flexibility exercise. In conclusion, the flexibility exercise has played an important role in reducing and preventing stress and suicidal ideation in Korean adult women with depressive disorder.

Epidemiology of non-fatal suicidal behavior among first-year university students in South Africa

Supplemental data for this article can be accessed on the publisher's website.We used a cross-sectional web-based survey and discrete-time survival analysis with person-year as unit of analysis and retrospective age-of-onset reports to estimate prevalence and predictors of suicidal ideation, plan, and attempt, and transitions from ideation to plan and attempt among South African university students (n = 1402). The lifetime prevalence of ideation, plan, and attempt were 46.4% (n = 650), 26.5% (n = 372), and 8.6% (n = 120), respectively. Multiple temporally primary mental disorders predicted subsequent onset of suicidality and transitions from ideation to plan and attempt. Results highlight the need for campus-based suicide prevention in South Africa, vulnerability of historically disadvantaged students, and the importance of promoting mental health in suicide prevention.

The relationship between post-traumatic stress disorder and suicidal ideation among shidu parents: the role of stigma and social support

BACKGROUND

Losing an only child is a particularly traumatic and heartbreaking event for parents, which can trigger a lot of emotional responses, including PTSD and suicidal ideation (SI). The objectives of this study were mainly to identify predictors of SI and examine the interactions of PTSD with stigma and social support on SI among shidu parents.

METHODS

A total of 507 shidu parents from Shenyang, China were included in this cross-sectional study. Bivariate logistic regression analyses were conducted to explore risk or protective factors associated with SI. Interactions of PTSD with stigma and social support on SI were also examined by bivariate logistic regression analyses.

RESULTS

The prevalence of SI among shidu parents was 11.24%. PTSD (OR = 2.23, p < 0.05) and stigma (OR = 4.66, p < 0.01) were positively associated with SI. Social support was negatively associated with SI (OR = 0.90, p < 0.01). For individuals with PTSD, the presence of stigma was more likely to lead to SI. For individuals with PTSD, an increased level of social support was less likely to lead to SI.

CONCLUSIONS

SI is a serious issue among shidu parents. Stigma aggravated the effect of PTSD on SI, while social support buffered the effect of PTSD on SI among shidu parents.

Prevalence and sociodemographic correlates of common mental disorders among first-year university students in post-apartheid South Africa: implications for a public mental health approach to student wellness

Background

There is growing awareness of the need for effective prevention, early detection, and novel treatment approaches for common mental disorders (CMDs) among university students. Reliable epidemiological data on prevalence and correlates are the cornerstones of planning and implementing effective health services and adopting a public health approach to student wellness. Yet, there is a comparative lack of sound psychiatric epidemiological studies on CMDs among university students in low- and middle-income countries, like South Africa (SA). It is also unclear if historically marginalised groups of students are at increased risk for mental health problems in post-apartheid SA. The objective of the study was to investigate the prevalence and sociodemographic correlates of lifetime and 12-month CMDs among university students in SA, with a particular focus on vulnerability among students in historically excluded and marginalised segments of the population.

Methods

Data were collected via self-report measures in an online survey of first-year students registered at two large universities (n = 1402). CMDs were assessed with previously-validated screening scales. Data were weighted and analysed using multivariate statistical methods.

Results

A total of 38.5% of respondents reported at least one lifetime CMD, the most common being major depressive disorder (24.7%). Twelve-month prevalence of any CMD was 31.5%, with generalised anxiety disorder being the most common (20.8%). The median age of onset for any disorder was 15 years. The median proportional annual persistence of any disorder was 80.0%. Female students, students who reported an atypical sexual orientation, and students with disabilities were at significantly higher risk of any lifetime or 12-month disorder. Female gender, atypical sexual orientation, and disability were associated with elevated risk of internalising disorders, whereas male gender, identifying as White, and reporting an atypical sexual orientation were associated with elevated risk of externalising disorders. Older age, atypical sexual orientation, and disability were associated with elevated risk of bipolar spectrum disorder.

Conclusions

Despite advances to promote greater social inclusion in post-apartheid SA, students who identify as female, students with atypical sexual orientations, and students with disabilities are nonetheless at increased risk of CMDs, although students who identify as Black and first-generation students are not.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7218-y) contains supplementary material, which is available to authorized users.

Structural equation modeling analysis of social support, coping strategies, depression and suicidal ideation among people living with HIV/AIDS in Changsha, China

INTRODUCTION

People living with HIV/AIDS (PLWHA) have a higher rate of suicide compared to the general population. Psychosocial factors closely correlate with suicidal ideation and it is essential to explain the relationships between related factors among PLWHA.

OBJECTIVES

To establish a structural equation model and examine direct and indirect effects of social support, coping strategy, depression symptoms and suicidal ideation among PLWHA.

PATIENTS AND METHODS

A total of 504 PLWHA completed a set of questionnaires in the HIV clinic of Changsha Infectious Disease Hospital between December 2015 and January 2016.

RESULTS

Among the 504 respondents, a total of 27.2% (n=137) had experienced suicidal ideation in their lifetime. The goodness of fit for the two structural equations model was highly satisfactory. Depression symptoms had a significant direct impact on suicidal ideation (β ₁=0.401, β ₂=0.422), while problem-focused coping (β=-0.067), emotion-focused coping (β=-0.081) and social support (β=-0.137) had a significant indirect effect with suicidal ideation via depression symptoms. Factors of total effects were ranked from large to small as follows: depression, social support, emotion-focused coping and problem-focused coping.

CONCLUSION

Findings provide more understanding of direct and indirect associations between variables, suggesting that depression screening services, and the strengthening of social support and psychological care services among PLWHA can potentially prevent suicide.

Suicidal behaviors and associated factors among university students in six countries in the Association of Southeast Asian Nations (ASEAN)

A large data gap remains on suicidal behaviors among youth in the Association of Southeast Asian Nations (ASEAN) countries, despite the increasing rates of suicide in Asian cultures that may be related to rapid economic changes and the loss of social stability. This study was therefore conducted to explore the prevalence of and factors associated with suicidal ideation and suicide attempts among university students in six ASEAN member states. Data were collected in a cross-sectional survey of 4675 undergraduate university students, mean age 20.6 years (SD=2.7), range of 18-30 years, from Cambodia, Indonesia, Malaysia, Myanmar, Thailand and Vietnam. The overall prevalence of ever suicidal ideation and ever suicide attempt among students in this study was 11.7% and 2.4%, respectively. Different rates of these suicidal behaviors were observed across the countries. In multivariable logistic regression models, suicidal ideation was significantly associated with psychosocial factors including childhood sexual abuse, depressive symptoms, involvement in physical fights, and poor academic performance as well as socio-environmental factors including living with parents or guardians and low involvement in organized religious activity. Suicide attempt was significantly associated with childhood sexual abuse, depressive symptoms, low involvement in organized religious activity and being underweight or overweight. Our findings suggest that individual-level strategies for suicide prevention should be targeted toward students with poor academic performance, mental health problems and a history of adverse childhood experiences. Particular attention should be paid to the role of families that could be a potential stressor in the lives of university students.