Mental well-being in Sri Lankan medical students: a cross-sectional study

Psychological distress and sleep quality among Sri Lankan medical students during an economic crisis

OBJECTIVES

This study examined the evidence of the prevalence of psychological distress and poor sleep among medical students and its associations during an economic crisis.

DESIGN

This was a cross-sectional study using an online questionnaire. It included the Depression Anxiety Stress Scales and Pittsburgh Sleep Quality Index (PSQI).

SETTING AND PARTICIPANTS

This study included medical undergraduates from a large metropolitan university in Sri Lanka.

PRIMARY AND SECONDARY OUTCOME MEASURES

We assessed the prevalence of psychological distress, sleep quality, and factors associated with psychological distress. To evaluate the associations, we used logistic regression.

RESULTS

The majority (69.2%) had some form of distress (depression, anxiety or stress), while 23% had distress in all three. Anxiety was the most prevalent (50.7%). Poor sleep quality was reported in 41%. The highest contribution to global PSQI was from sleep latency, duration, and daytime dysfunction subscales. In bivariate analysis, sleep quality was directly related to depression (t245.65 = -6.75, p<0.001)., anxiety (t313.45 = -6.45, p <0.001), and stress (t94.22 = -5.14, p <0.001). In multinomial logistic regression models, sleep quality was independently associated with depression, anxiety and stress. In addition, frequent contact with friends was inversely associated with depression and anxiety. Also, social media use was inversely linked to depression, anxiety and stress. Clinical-year students had lower depression and anxiety than non-clinical students. Engaging in mindfulness activities was inversely associated with depression. However, models explained only a moderate amount of variance (Nagelkerke R-squared values were 0.21, 0.18, and 0.13 for depression, anxiety and stress, respectively).

CONCLUSIONS

Poor sleep quality and psychological distress are high among the undergraduates. The findings emphasize the importance of addressing sleep quality and psychological wellbeing in medical undergraduates. Further research with larger and more diverse samples is needed for a more comprehensive understanding of the factors associated with psychological distress among undergraduates.

Psychological disturbances encountered by selected undergraduates studying at the University of Ruhuna, Sri Lanka during the Covid-19 pandemic: a cross-sectional study

University undergraduates are increasingly recognized as a vulnerable population with a higher level of psychological disturbances. During the Covid-19 pandemic, universities closed all over the world, resulting in the psychological well-being of this population being severely affected across the globe. This study examined the prevalence of stress, anxiety, and depressive symptoms encountered by undergraduates of the selected five faculties at the University of Ruhuna in Southern Sri Lanka due to the Covid-19 pandemic, its associated factors, and the correlations between stress, anxiety, and depressive symptoms. An online, cross-sectional, descriptive study was conducted among undergraduates using pre-tested, self-administered questionnaires from the randomly selected five faculties: Allied Health Sciences, Engineering, Humanities and Social Sciences, Management and Finance, and Medicine. Undergraduates were invited to complete the Google Form. Socio-demographic details and a 21-item Depression, Anxiety, and Stress Scale (21-DASS) were used for data collection. Stress, anxiety, and depressive symptoms were evaluated using a Sinhala version of the 21-DASS scale. Ethical permission was granted by the Ethics Review Committee of the Faculty of Allied Health Sciences, University of Ruhuna. Among the 359 undergraduates, the majority were represented by females (62.1%). The mean age of the sample was 23.67 years (SD ± 1.6). Stress, anxiety, and depressive symptoms were found to be prevalent in 53.7%, 41.8%, and 63.8% of undergraduates respectively. Younger and female undergraduates had more impact on psychological issues than their counterparts. It revealed a significant positive correlation between anxiety and depressive symptoms (r = 0.646, p < .001), anxiety and stress (r = 0.868, p < .001), and stress and anxiety (r = 0.786, p < .001). Most undergraduates experienced considerable levels of stress, anxiety, and depressive symptoms during the Covid-19 as increasing stress, anxiety, or depressive symptoms, tend to increase all types of psychological disturbances. The development of mental health among undergraduates is essential and needs innovative strategies to improve the psychological well-being of undergraduates. The initiation of a stress management programme and expanded available counseling services are also important. Further studies are needed to be conducted on the extended topic of how the Covid-19 era is affecting the psychological well-being of undergraduates from different universities (state/non-state), locations, and different study departments.

Measuring mental well-being in Sri Lanka: validation of the Warwick Edinburgh Mental Well-being Scale (WEMWBS) in a Sinhala speaking community

BACKGROUND

Well-being is an important aspect of people's lives and can be considered as an index of social progress. The Warwick Edinburgh Mental Well-being scale (WEMWBS) was developed to capture subjective mental well-being. It is a widely tested measure of mental well-being at the population level and has 14 items and a short-form with 7 items. This study was carried out to culturally validate and adapt the WEMWBS among a Sinhala speaking population in Sri Lanka.

METHODS

A forward and backward translation of the scale into Sinhala was done followed by a cognitive interview. The translated and culturally adapted scale and other mental health scales were administered to a sample of 294 persons between the ages of 17-73 using a paper-based version (n = 210) and an online survey (n = 84). Internal consistency reliability and test-retest reliability were tested. Construct validity, and convergent and discriminant validity were assessed using the total sample.

RESULTS

The translated questionnaire had good face and content validity. Internal consistency reliability was 0.91 and 0.84 for the 14-item and 7-item scales, respectively. Test-retest reliability over two weeks was satisfactory (Spearman r = 0.72 p < 0.001). Confirmatory factor analysis supported a one factor model. Convergent validity was assessed using WHO-5 well-being index (Spearman r = 0.67, p < 0.001), Patient Health Questionnaire (PHQ-9) (Spearman r = (-0.45), p < 0.001) and Kessler psychological distress scale (K10) (Spearman r = (-0.55), p < 0.001).

CONCLUSIONS

The translated and culturally adapted Sinhala version of the WEMWBS has acceptable psychometric properties to assess mental well-being at the population level among the Sinhala speaking population in Sri Lanka.

A study in University of Ruhuna for investigating prevalence, risk factors and remedies for psychiatric illnesses among students

There is no comprehensive study on the mental health of Sri Lankan undergraduate in higher education, as most existing studies have been done for medical students only. It is unknown how academic and environmental factors contribute for the prevalence of psychiatric illnesses. Further, there is no sufficient information on the student/university based remedies to reduce the psychological distress of students. This research is carried out to find the overall psychological distress, well-being, prevalence percentages of psychiatric illnesses, associated risk factors, and student/university remedies to overcome them. We use standard questionnaires to screen for psychiatric illnesses, and we analyze the responses for our own questionnaire using Binary logistic regression analysis to identify demographic factors, academic factors, and environmental factors causing each mental disorder. We use Pearson correlation coefficient to identify correlation between prevalence of each psychiatric illnesses. All 13 psychiatric illnesses were found with a moderate correlation among diseases having a mean prevalence percentage of 28 and a standard deviation of 14.36, despite the prevalence of well-being factors among students and only 8% are clinically diagnosed. 89% of the students were suffering from at least one psychiatric illness and 68% were found to be psychologically distressed. Sets of overall and individual demographic, academic, and environmental risk factors contributing for the prevalence of a psychiatric illness in general and in particular were identified respectively after a binary logistic regression analysis. 61% of the students don’t receive psychiatric help from the university and are using their own remedies. The universities must consider the environmental and academic risk factors associated with psychiatric illnesses and design curriculum, expand resources, and provide counseling services to reduce the impact of risk factors.