Assessing Trends in Physician Assistant Student Depression Risk, Suicidal Ideation, and Mental Health Help-Seeking Behavior

Lessons Learned-A Case for Required Student Services 1:1 Orientation

INTRODUCTION

Both faculty and student learners associated with physician assistant/associate (PA) programs continue to suffer from the effects of the ongoing mental health crisis. Furthermore, student learners may have other personal needs impacting their potential success in PA school (ie, financial, academic, or other). A proactive approach to supporting student learners early in their PA educational journey is warranted.

METHODS

Required 1:1 face-to-face orientations between incoming PA students and a representative from the Office of Wellness and Academic Support (OWAS) were implemented during the first week of PA program orientation. Students were allowed time and space to privately share their individual experiences and concerns as they entered PA school. In addition, the student services representative from OWAS was able to provide customized education on the variety of resources available for students.

RESULTS

The student services representative from OWAS established personal relationships with each of the incoming PA students. Multiple follow-up appointments and referrals were made to various service lines including tutoring, learner accommodations, and mental health counseling.

DISCUSSION

The implementation of required 1:1 face-to-face orientations between incoming PA students and student services during the first week of PA program orientation was highly effective. The primary lesson learned is that a simple, preventative, proactive approach can be extremely impactful if we are willing to view the challenges of student learners in PA education through a different lens.

Stressed and Depressed: Prevalence of Anxiety and/or Depression in Physician Assistant Students

INTRODUCTION

This research highlights the prevalence of anxiety and/or depression among physician assistant (PA) students compared with the general population. It is believed that the results of this study will encourage graduate programs to place a stronger emphasis on the mental health of students and create a more positive learning environment.

METHODS

An original survey was created using questions from Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and several original questions. The survey was distributed using a SurveyMonkey link to directors of all accredited US PA programs. Program directors were asked to distribute the survey to their students. The survey remained open for 6 weeks, after which a cross-sectional statistical analysis was performed to compare the results with national anxiety and depression data in the United States.

RESULTS

There is a statistically significant increase in the rate of occurrence of anxiety and/or depression among PA students compared with the general population. According to survey results, 84.4% of respondents experienced feelings of anxiety and 80.9% experienced feelings of depression while enrolled in PA school. Physician assistant students found the greatest need for anxiety and depression treatment during the didactic portion of their program.

DISCUSSION

When compared with the national population, the level of anxiety in PA students was found to be 65.3% higher and the levels of depression in PA students to be 72.5% higher. These results should encourage PA programs and health care providers to take action regarding the mental health of future providers.

An Analysis of Mental Health Representation in the Technical Standards of Physician Assistant Programs

ABSTRACT

The purpose of this descriptive research project was to examine the technical standards of physician assistant (PA) programs for mental health keywords, phrases, and themes. Each program's standards were analyzed, and keywords, phrases, and major themes were extracted and compared. The results demonstrate that most US PA programs include language related to mental health in their technical standards including theme areas of emotional health, emotional stability, mental health, emotional well-being, and stress management. No patterns between the wording of mental health content and accreditation status emerged. Given the increasing proportion of mental health diagnoses among the general population, and, by extension, applicants to PA training programs, institutions are encouraged to re-evaluate their technical standards to ensure they remain current and appropriate and contain language inclusive of mental health domains such as emotional stability, emotional health, and stress management.

Foundational Skill-Building in a Novel Well-being Curriculum

INTRODUCTION

Mental illness and decreased well-being are pervasive throughout physician assistant (PA) training, and the accreditation standards require a wellness curriculum. The purpose of this study was to determine if a mandatory, multifaceted virtual wellness curriculum can mitigate the decline in well-being experienced by first-year PA students.

METHODS

First-year PA students from 5 programs (n = 259) participated in a 16-week asynchronous virtual course. The course integrated evidence-based content on vulnerability and stigma, mindfulness and decentering, and reflective writing. Total weekly content averaged 30-60 minutes and was presented in multiple formats including recorded lectures and panels, readings, and discussion forums. Students completed anonymous pre- and postsurveys, and ordinary least squares (OLS) regression with a fixed effect for each school was used for data analysis.

RESULTS

In total, 157 of 259 (60.6%) students completed both surveys with matching unique identifiers. The majority of students (73.6%; 134/182) thought this course had a positive impact on their training as a PA student. Baseline scores were significantly predictive of end-point scores for the PHLMS, OMS-HC-15, SSOSH, RPQ, and UCLA-3 (see Methods section for full names of surveys). Race was significantly predictive of PHLMS and OMS-HC-15 scores; age was significantly predictive of SSOSH scores; and gender was significantly predictive of RPQ scores.

DISCUSSION

For a student with low baseline well-being who is entering a PA program, dedicated curricula focusing on foundational wellness skills can be successful in improving well-being. Future work is needed to more fully characterize the scope and extent of this program's impact on PA learners. Additional efforts are also necessary to optimize the delivery and provide access to PA students nationwide.

Suicide and homicide deaths of PAs: Analysis of the National Violent Death Reporting System

OBJECTIVE

This study describes physician associate/assistant (PA) deaths in the US CDC's National Violent Death Reporting System (NVDRS) from 2003 to 2020.

METHODS

PAs' violent deaths were analyzed and summarized in terms of decedents' numbers and demographics, methods of death, locations of death, and relationships with assailants.

RESULTS

The NVDRS identified 93 suicides and 9 homicides in this period. PAs who died by suicide were mostly White (93.5%) and male (67.7%); mean age was 49.7 years. A third of the PAs who died by homicide were Black; most were female (55.6%), and the mean age was 48.7 years. Firearms (41.7%) were most commonly involved in deaths by suicide, and blunt impact (33.3%) was most commonly seen in deaths by homicide. A plurality (46.1%) of suicides and homicides occurred in the South. Homes (72.5%) were the most frequent location. No homicides were reported in medical settings. Known perpetrators were mainly relatives and male; none were patients.

CONCLUSIONS

Incidence of PA death by suicide or homicide is low relative to the general population. These deaths generally are not related to PAs' work. Delineating the incidence of violent deaths is a step toward informing preventive efforts.

Acknowledging the risk of suicidal ideation, depression, and anxiety in PAs

ABSTRACT

The prevalence of suicidal ideation is unknown and limited information exists about depression and anxiety among physician associates/assistants (PAs). We set out to understand the degree of depression, anxiety, and suicidal ideation in PAs and PA students. In total, 728 PAs and 322 PA students took an online survey. Risk of depression and anxiety were present at higher levels in PA students compared with employed PAs. PA students indicated higher levels of suicidal ideation compared with clinically active PAs. One-third of those with suicidal ideation did not reveal it to anyone; among those who did, 16.2% feared the results of disclosure. This study establishes that PAs and PA students are at risk for suicidal ideation and often bypass help. The COVID-19 pandemic may have led to elevated rates of emotional distress, and longitudinal studies are needed to understand the basis for such ideation and if it is transitory.

A Gift You Give Yourself: A Preemptive Intervention for Student Mental Health

INTRODUCTION

Burnout, stress, and compromised mental health are known issues for clinical trainees. Various interventions have shown efficacy, but they are generally training-based and therefore not practical for "just in time" use when a student is struggling. Stigma surrounding mental health is another challenge to this aspect of wellness.

METHODS

At the beginning of their training, physician assistant (PA) students from 3 cohorts at Butler University wrote short reflections on resiliency and their motivation for training. This, along with an encouraging note from a faculty member, was placed in a box and wrapped. Students then kept the box to open during a time of stress or self-doubt. An anonymous survey about this intervention was sent to these students in April 2021.

RESULTS

Almost all survey respondents remembered the activity and had a positive impression of it. Nearly half opened the gift box during their training, with a majority opening it during the didactic phase rather than the clinical phase. Most of those who opened the gift box viewed it favorably. Participants reported high levels of self-stigma regarding mental health and help-seeking.

DISCUSSION

The gift box intervention was well-received and used by many students. This is a "just in time" intervention to support struggling learners when they need it most, as opposed to most interventions that are more structured in their delivery and use. The high level of self-stigma for mental health help-seeking is a concern and warrants continued investigation.

Factors Influencing Physician Assistant Student Attrition Rates

INTRODUCTION

The aim of this study was to assess factors that influence student well-being and attrition and to compare faculty perceptions to the realities of student experience.

METHODS

Three anonymous online surveys were distributed, one for each group of currently enrolled students, faculty/staff, and attritted students.

RESULTS

Faculty estimated that an average of 12.8% of PA students in their program have considered dropping out in the past 6 months, while 22.9% of students self-reported considering dropping out in the past 6 months. The most frequently cited factors for considering dropping out were mental health and lack of connection to the program. Mental health was the highest cited reason for having taken or having considered taking a leave of absence.

DISCUSSION

Faculty perceptions in this study were incongruent with the actual situations of their students. Mental health issues and a lack of connection to programs were the largest influencers of attrition.

Women's Participation in a Savings Group and Depression: a Community-Based Financial Capability Intervention in Mozambique

Background

As one of the fastest growing community-based financial capability approaches, village savings and loan group (VSLG) is an organized group and formal entity that creates opportunities for participants to save and access financial assets. VSLG has potentially positive impacts on increasing women's financial resources and social support and further improves their mental health. Participation in a VSLG not only increases women's opportunities for asset-building and income generation, but also facilitates trust and promotes social capital development. However, few studies have examined the association between the VSLG participation and women's depression status. To fill the knowledge gap, we examined the association between the VSLG participation and depressive symptoms among low-income women in Mozambique.

Methods

The data was collected as part of the VSLG program evaluation. The study applied a posttest-only comparison group quasi-experimental design and sampled female VSLG participants and non-participants from three sub-villages in the Sofala province, Mozambique. A multi-stage sampling technique was employed, and a total of 205 women were randomly selected, including 105 VSLG participants and 100 non-participants. Depressive symptoms were measured using the short version of the Edinburgh Depression Scale (EDS) with a summative score ranging from 7 to 28. Using the cutoff value at a score of 14, we created a dichotomous depression indicator. Linear and logit models were used to examine the associations of the VSLG participation and the participation duration with the depression score and the presence of depression controlling for demographic variables.

Results

The VSLG participants had a statistically lower mean depression score of 12.2 (SD = 4.4) compared to non-participants (15.0, SD = 4.0, p < .001). The regression analysis suggested that the VSLG participants had a mean depression score of 2.7 lower than the non-participants (p < .001). Nearly 60% of the non-participants reported the presence of depression; however, this percentage is 31% for participants (p < .001). The multivariate logit model indicated the odds of the presence of depression for participants are .34 of that for non-participants. Similar results were obtained when the VSLG program duration was used as an independent variable.

Conclusions

Study findings showed a positive association between the VSLG participation and women's mental health. Future research should further explore the intervention mechanisms and assess how the VSLG participation affects women's mental health. Findings also provided important insights into developing community-based financial capability interventions to improve low-income women's mental health.

Attitudes Towards Mental Health Among Physician Assistant Students with Shared Living Experiences Through Synchronous Videoconferencing

PURPOSE

We tested the hypothesis that physician assistant (PA) students can benefit from exposure to senior PAs who share their living experiences with mental illness.

METHODS

First-year students from 5 PA programs were asked to participate in this mixed methods study. After completing a pre-activity survey, students from 3 programs participated in an intervention consisting of senior PA faculty sharing their mental health experiences, including treatment and recovery. A facilitated discussion followed, and students not exposed to the intervention served as controls. The qualitative component of the study was based on transcripts from 3 focus groups of students in the exposed group.

RESULTS

We recruited 167 students from 5 PA training programs, 112 of whom (67%) completed baseline and endpoint assessments (37 in the exposed group, 75 in the control). The intervention resulted in significant improvements on the Opening Minds to Stigma (OMS-HC, p = 0.002, Cohen's d = 0.38) and Self-Stigma of Seeking Help (SSOSH, p = 0.006, d = 0.31) scales. Change in the OMS-HC was driven by its social distance (p = 0.003) and disclosure (p = 0.02) subscales. No comparable changes were found in the control group. We identified 3 overarching themes: 1) active elements of the intervention; 2) mutuality; and 3) peer relationships.

CONCLUSIONS

Senior PAs sharing their lived experiences with mental illness proved to be an effective anti-stigma intervention for PA students. A candid, intimate, and confidential virtual learning space was feasible through synchronized videoconferencing. Our findings can inform programmatic interventions to address stigma, self-stigma, help-seeking behaviors, and the overall mental health of PA students.