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Wang Y, Wang X, Wang X, Guo X, Yuan L, Gao Y, Pan B. Stressors in university life and anxiety symptoms among international students: a sequential mediation model. BMC Psychiatry 2023; 23:556. [PMID: 37528380 PMCID: PMC10394910 DOI: 10.1186/s12888-023-05046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/23/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Anxiety is a common mental health problem among university students, and identification of its risk or associated factors and revelation of the underlying mechanism will be useful for making proper intervention strategies. The aim of our study is to test the sequential mediation of self-efficacy and perceived stress in the association between stressors in university life and anxiety symptoms. METHODS A cross-sectional study design was adopted and a sample of 512 international students from a medical university of China completed the survey with measurements of stressors in university life, self-efficacy, perceived stress and anxiety symptoms. RESULTS We found that 28.71% of the international students had anxiety symptoms, and stressors in university life were positively associated with anxiety symptoms (β = 0.23, t = 5.83, p < 0.01). Moreover, sequential mediating role of self-efficacy and perceived stress in the association between the stressors and anxiety symptoms was revealed. CONCLUSIONS Our study provided a new perspective on how to maintain the mental health, which suggested that self-efficacy improvement and stress reduction strategies should be incorporated in the training programs to support students.
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Affiliation(s)
- Yue Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, Shenyang, 110022, China
- The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaobin Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, Shenyang, 110022, China
| | - Xuehang Wang
- International Education School, China Medical University, Shenyang, China
| | - Xiaoxi Guo
- International Education School, China Medical University, Shenyang, China
| | - Lulu Yuan
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Yuqin Gao
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Bochen Pan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, Shenyang, 110022, China.
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Michaud K, Suurd Ralph C, Connick-Keefer SJA. Operational stressors, psychological distress, and turnover intentions: The impact of potentially morally injurious experiences. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1906075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Kathy Michaud
- Department of National Defence, Ottawa, Ontario, Canada
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Liu Z, Doege D, Thong MSY, Koch-Gallenkamp L, Bertram H, Eberle A, Holleczek B, Nennecke A, Waldmann A, Zeißig SR, Pritzkuleit R, Arndt V. Distress mediates the relationship between cognitive appraisal of medical care and benefit finding/posttraumatic growth in long-term cancer survivors. Cancer 2021; 127:3680-3690. [PMID: 34196976 DOI: 10.1002/cncr.33684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The objective of this study was to ascertain long-term cancer survivors' (LTCS') appraisal of medical care and how these perceptions may influence their health and well-being, including benefit finding (BF) and posttraumatic growth (PTG). METHODS In total, 6952 LTCS from a multiregional population-based study in Germany completed the Benefit Finding Scale, the Posttraumatic Growth Inventory, the Questionnaire on Stress in Cancer, and self-designed questions on cognitive appraisal of medical care. The authors explored the mediating role of distress between medical care appraisal and BF and PTG and the possible moderation of time since diagnosis in this relationship. RESULTS LTCS' medical care appraisals ("no unresolved/untreated symptoms," "satisfaction with cancer care," and "satisfaction with care for other diseases") were positively associated with BF. PTG was positively associated with "no unresolved/untreated symptoms" and negatively associated with "satisfaction with care for other diseases." Cancer distress partially mediated the associations between appraisals of medical care and BF, between "no unresolved/untreated symptoms" and PTG and between "satisfaction with care for other diseases" and PTG; whereas it totally mediated the association between "satisfaction with cancer care" and PTG. Time was a significant moderator in the model; the negative indirect effect of cognitive appraisal on BF and PTG through cancer distress weakened with longer time since diagnosis. CONCLUSIONS Cancer survivors' medical care appraisal is associated with their perceptions of BF and PTG through distress. Therefore, distress screening could be part of the regular workup to identify distressed cancer survivors who are not satisfied with medical care; these survivors may benefit from interventions to reduce distress and increase BF and PTG.
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Affiliation(s)
- Zhunzhun Liu
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty of Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Daniela Doege
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melissa S Y Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | | | | | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | | | | | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Ferrajão PC, Oliveira RA. Attachment Patterns as Mediators of the Link Between Combat Exposure and Posttraumatic Symptoms: A Study Among Portuguese War Veterans. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gomes AR, Faria S, Vilela C. Anxiety and burnout in young athletes: The mediating role of cognitive appraisal. Scand J Med Sci Sports 2017; 27:2116-2126. [DOI: 10.1111/sms.12841] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
- A. R. Gomes
- School of Psychology; University of Minho; Braga Portugal
| | - S. Faria
- Centre of Mathematics; Department of Mathematics and Applications; University of Minho; Braga Portugal
| | - C. Vilela
- School of Psychology; University of Minho; Braga Portugal
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Gomes AR, Faria S, Lopes H. Stress and Psychological Health: Testing the Mediating Role of Cognitive Appraisal. West J Nurs Res 2016; 38:1448-1468. [PMID: 27330045 DOI: 10.1177/0193945916654666] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study tested the mediating role of primary (e.g., threat and challenge perceptions) and secondary (e.g., coping potential and control perception) cognitive appraisal in the relationship between occupational stress and psychological health. This mediation was tested using a cross-sectional study based on self-reported measures. The total sample consisted of 2,302 nurses, 1,895 females (82.3%) and 407 males (17.7%), who completed an evaluation protocol with measures of occupational stress, cognitive appraisal, and psychological health. To test the mediating role of cognitive appraisal in the relationship between cognitive appraisal and psychological health, we used Structural Equation Modeling (SEM). The results confirmed that primary and secondary cognitive appraisals partially mediated the relationship between occupational stress and psychological health; however, the direct effects of stress on psychological health cannot be ignored. The findings indicated that cognitive appraisal is an important underlying mechanism in explaining adaptation at work.
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Lee JEC, Phinney B, Watkins K, Zamorski MA. Psychosocial Pathways Linking Adverse Childhood Experiences to Mental Health in Recently Deployed Canadian Military Service Members. J Trauma Stress 2016; 29:124-31. [PMID: 26954537 DOI: 10.1002/jts.22085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 11/15/2015] [Accepted: 01/11/2016] [Indexed: 11/12/2022]
Abstract
Multiple pathways have been suggested to account for the relationship of adverse childhood experiences (ACEs) and well-being in adulthood, including interpersonal difficulties, the underestimation of one's sense of mastery, and a greater propensity to experience stressors later in life. This study was conducted to examine the association between ACEs and mental health in Canadian Armed Forces (CAF) personnel, and the possible mediating roles of social support, mastery, and combat stressors in that relationship. The study consisted of a prospective analysis involving 3,319 CAF members upon their return from an overseas deployment. Results were that ACEs were associated with poorer mental health (β = -.14, p < .001) and that approximately 42.6% of this relationship could be explained by the mediating effects of low social support, low mastery, and a greater number of combat stressors. The full model, including the covariates, ACEs, social support, mastery, and combat stressors as correlates of postdeployment mental health, was statistically significant with adjusted R(2) = .28, F(9, 3309) = 141.96, p < .001. On the whole, results suggested that social support, mastery, and life stressors may be possible targets for interventions to minimize the impact of ACEs on later mental health in military personnel.
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Affiliation(s)
- Jennifer E C Lee
- Department of National Defence, Ottawa, Ontario, Canada.,Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - Brigitte Phinney
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
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Prospective Analysis of Premilitary Mental Health, Somatic Symptoms, and Postdeployment Postconcussive Symptoms. Psychosom Med 2015; 77:1006-17. [PMID: 26458235 DOI: 10.1097/psy.0000000000000250] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Many recent studies of service members returning from deployment have focused on the health impacts of mild traumatic brain injury (mTBI), including persistent postconcussive symptoms (PCS). However, cross-sectional study designs have made it difficult to understand the role of mental health in the etiology of persistent PCS. METHODS Participants were 3319 military personnel (primarily men [90%] of 25-34 years [54%]) who had completed health surveys at basic training and after deployment, on average, 4.6 years later. Negative binomial regression was used to assess the association of PCS with demographic covariates, premilitary mental health and somatic symptoms, combat experiences and mTBI during deployment, in addition to postdeployment mental health and non-PCS somatic symptoms. RESULTS Premilitary mental health and somatic symptoms predicted PCS even when adjusting for other variables, yielding an elevated incidence rate ratio (IRR) for posttraumatic stress disorder (PTSD; IRR = 1.23, 95% confidence interval [CI] = 1.06-1.41) and somatic symptoms (mild versus minimal somatic symptoms: IRR = 1.43, 95% CI = 1.31-1.55; moderate/severe versus minimal somatic symptoms: IRR = 1.69, 95% CI = 1.43-2.06), but not for depressive symptoms. When postdeployment mental health and somatic symptom measures were added to the model, the effect of premilitary somatic symptoms remained significant. CONCLUSIONS Findings point to potential etiological contributions of premilitary characteristics, particularly a tendency to experience somatic symptoms and PTSD, as well as mTBI and combat experiences, to the development of PCS. PCS were also strongly related to concurrent postdeployment mental health.
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Trump LJ, Lamson AL, Lewis ME, Muse AR. His and Hers: The Interface of Military Couples’ Biological, Psychological, and Relational Health. CONTEMPORARY FAMILY THERAPY 2015. [DOI: 10.1007/s10591-015-9344-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Settersten RA, Day J, Elder GH, Waldinger RJ. Men's Appraisals of Their Military Experiences in World War II: A 40-Year Perspective. RESEARCH IN HUMAN DEVELOPMENT 2012; 9:248-271. [PMID: 23284272 DOI: 10.1080/15427609.2012.705558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Using data on veterans from the longitudinal Harvard Study of Adult Development (N=241), we focused on subjective aspects of military service. We examined how veterans of World War II appraised specific dimensions of military service directly after the war and over 40 years later, as well as the role of military service in their life course. In addition to examining change in appraisals, we examined how postwar appraisals of service mediated the effects of objective aspects of service, and how postwar psychological adjustment and health mediated the effects of postwar appraisals, on later-life appraisals. Men's appraisals at both time points were generally, but not highly, positive, and revealed remarkable consistency over four decades. Postwar appraisals strongly predicted later-life appraisals and mediated the effects of objective service variables. The effects of postwar appraisals were not carried forward through psychological adjustment or midlife health. Better adjustment, however, was negatively related to later-life appraisals. Results reinforce the idea that how men perceive their military experiences may be more important in predicting outcomes than the experiences themselves. Results are discussed in light of the sample characteristics, the historical context of World War II, and the complexities of appraisal and retrospection.
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