Prevalence of mental health problems among medical students in China: A meta-analysis

The interaction between TMEM161B (rs768705) and paranoid personality traits in relation to the risk of major depressive disorder: Results form a longitudinal study of 7642 Chinese freshmen

BACKGROUND

Rs768705 (TMEM161B) is one of the identified single nucleotide polymorphisms related to major depressive disorder (MDD). Paranoid personality traits are independently associated with the risk of MDD. This study aimed to investigate the interaction effect between rs768705 (TMEM161B) and paranoid personality traits on the new-onset risk of MDD in Chinese freshmen.

METHODS

A longitudinal study was conducted among 7642 Chinese freshmen without lifetime MDD at baseline in 2018. 158 new-onset MDD cases were ascertained in 2019. DNA samples were extracted to detect the genotype of rs768705. The diagnostic and statistical manual of mental disorders-IV criteria were used to determine MDD and personality disorder traits. Multiplicative interaction was assessed by logistic regression models. Tomas Andersson's method for calculating biological interactions was used to estimate the additive interaction.

RESULTS

Rs768705(AG) (OR = 1.88, 95 % CI: 1.24-2.83) and paranoid personality traits (OR = 3.68, 95 % CI: 2.57-5.26) were significantly associated with the risk of MDD. The multiplicative interaction model with the product term of rs768705 and paranoid personality trait traits had a significant interaction effect (OR = 4.20, 95 % CI:1.62-10.91). There was also a significant additive interaction effect (RR = 7.08, 95 % CI:4.31-11.65) for the incidence of MDD. Seventy seven percent patients among new MDD cases were attributed to the additive interaction effect between rs768705 and paranoid personality traits.

CONCLUSIONS

Rs768705 (AG) may interact with paranoid personality traits to increase the incidence of MDD among Chinese college students. Schools and psychosocial health organizations should pay more attention to individuals with paranoid personality traits for MDD intervention and prevention.

Mental health and academic performance of college students: Knowledge in the field of mental health, self-control, and learning in college

The aim of this research is to analyze the impact of mental health on the academic performance of junior and senior students studying in a university setting during the 2022-2023 academic year, in the post-COVID period. The study was conducted in Beijing, China, with the participation of 600 students, including 300 first-year students and 300 fifth-year students. DASS (Depression, Anxiety, and Stress Scale) and PHQ-9 (Patient Health Questionnaire-9) questionnaires were employed to measure mental health. The DASS assesses symptoms of depression, anxiety, and stress, while the PHQ-9 specifically evaluates depression severity. Academic performance was evaluated using a 12-point scale, which incorporated various criteria such as exam scores, coursework performance, and participation in extracurricular activities. The research was conducted across five faculties of the university from 2022 to 2023. In the study, fifth-year students demonstrated a higher level of mental health compared to first-year students, with an average DASS score of 27.1 and 24.2, respectively. Interestingly, despite this, first-year students achieved higher academic performance indicators, with an average score of 8.2 compared to 9.8 in fifth-year students. Correlation analysis revealed significant associations between stress, depression, and anxiety levels with academic performance (stress: r = -0.25, p < 0.001; depression: r = -0.20, p = 0.003; anxiety: r = -0.18, p = 0.008). These findings highlight the critical importance of addressing students' mental well-being, particularly in later academic years. Recommendations include implementing support programs and developing online resources for students.

Good learning environment of medical schools is an independent predictor for medical students' study engagement

Background

Study engagement is regarded important to medical students' physical and mental wellbeing. However, the relationship between learning environment of medical schools and the study engagement of medical students was still unclear. This study was aimed to ascertain the positive effect of learning environment in study engagement.

Methods

We collected 10,901 valid questionnaires from 12 medical universities in China, and UWES-S was utilized to assess the study engagement levels. Then Pearson Chi-Square test and Welch's ANOVA test were conducted to find the relationship between study engagement and learning environment, and subgroup analysis was used to eradicate possible influence of confounding factors. After that, a multivariate analysis was performed to prove learning environment was an independent factor, and we constructed a nomogram as a predictive model.

Results

With Pearson Chi-Square test (p < 0.001) and Welch's ANOVA test (p < 0.001), it proved that a good learning environment contributed to a higher mean of UWES scores. Subgroup analysis also showed statistical significance (p < 0.001). In the multivariate analysis, we could find that, taking "Good" as reference, "Excellent" (OR = 0.329, 95%CI = 0.295-0.366, p < 0.001) learning environment was conducive to one's study engagement, while "Common" (OR = 2.206, 95%CI = 1.989-2.446, p < 0.001), "Bad" (OR = 2.349, 95%CI = 1.597-3.454, p < 0.001), and "Terrible" (OR = 1.696, 95%CI = 1.015-2.834, p = 0.044) learning environment only resulted into relatively bad study engagement. Depending on the result, a nomogram was drawn, which had predictive discrimination and accuracy (AUC = 0.680).

Conclusion

We concluded that learning environment of school was an independent factor of medical student's study engagement. A higher level of learning environment of medical school came with a higher level of medical students' study engagement. The nomogram could serve as a predictive reference for the educators and researchers.

Psychiatric Characteristics, Symptoms of Insomnia and Depression, Emotion Regulation, and Social Activity among Swiss Medical Students

Background: Almost by default, young adult students are at increased risk of suffering from mental health issues, and this holds particularly true for medical students. Indeed, compared to the general population and non-medical students, medical students report higher scores for symptoms of depression. For Swiss medical students, research on the associations between psychiatric characteristics and symptoms of depression and insomnia, including cognitive-emotional processes and social activity, has been lacking so far. Given this, the aims of the present study were to relate self-declared psychiatric characteristics to symptoms of depression, insomnia, emotion regulation, and social activity. Methods: A total of 575 medical students (mean age: 22.4 years; 68.9% females) completed an online survey covering sociodemographic information (age and gender), study context (year of study), self-declared psychiatric characteristics and symptoms of depression, insomnia, emotion regulation (cognitive reappraisal vs. emotion suppression), and social activity. Data on insomnia sum scores and categories of historical samples (862 non-medical students and 533 police and emergency response service officers) were used for comparison. Results: Of the 575 participants, 190 participants (33%) self-declared psychiatric issues, such as major depressive disorder; anxiety disorders, including PTSD and adjustment disorders; eating disorders; ADHD; or a combination of such psychiatric issues. Self-reporting a psychiatric issue was related to higher symptoms of depression and insomnia and lower symptoms of social activity and cognitive reappraisal (always with significant p-values and medium effect sizes). Compared to historical data for non-medical students and police and emergency response service officers, medical students reported higher insomnia scores. In a regression model, current self-declared psychiatric issues, female gender, higher scores for insomnia, and lower scores for social activity were associated with higher scores for depression. Conclusions: Among a sample of Swiss medical students, the occurrence of self-declared psychiatric issues was associated with higher scores for depression and insomnia and lower cognitive reappraisal and social activity. Further, insomnia scores and insomnia categories were higher when compared to non-medical students and to police and emergency response service officers. The data suggest that medical schools might introduce specifically tailored intervention and support programs to mitigate medical students' mental health issues. This holds particularly true for insomnia, as standardized and online-delivered treatment programs for insomnia (eCBTi) are available.

Smoking prevalence, exposure to secondhand smoke, and factors associated with smoking among medical, dental, and pharmacy students in a public university in Malaysia

INTRODUCTION

Smoking among medical, dental, and pharmacy students is an issue in every university worldwide, which will impact future smoking cessation services as they are future healthcare providers. This study investigates the smoking prevalence, exposure to secondhand smoke, and factors associated with smoking among medical, dental, and pharmacy students at a public university in Malaysia.

METHODS

The self-administered online survey utilized in this cross-sectional study was derived from the Global Health Professions Students Survey (GHPSS), which involved medical, dental, and pharmacy students. A total of 328 participants completed a questionnaire from June to August 2022, with a response rate of 91.1%.

RESULTS

The overall smoking prevalence was 4.6% among the medical, dental, and pharmacy students who participated in this study; 46.7% of current smokers were exposed to secondhand smoke at home compared to 17.6% of non-smokers (p=0.011); and 66.7% of smokers were exposed to secondhand smoke in public compared to 40.3% of non-smokers (p=0.043). In all, 99.1% of respondents supported the smoking ban and 46.7% of current smokers supported the smoking ban in discos/bars/pubs, compared to 82.0% of non-smokers (p=0.002). Of the participants, 96.6% received lessons on the danger of tobacco, and 65.5% received smoking cessation training. Among factors associated with current smoking was gender; male students had a 19-fold higher likelihood of smoking than female students (adjusted odds ratio, AOR=19.25; 95% CI: 4.25-87.19, p<0.001). In addition, home exposure to secondhand smoke was four times more common for current smokers (OR=4.11; 95% CI: 1.43-11.79, p=0.009).

CONCLUSIONS

Although smoking prevalence was low among the students in this study, there was a higher percentage of them exposed to secondhand smoke at home and in public.

Patterns of Health-Risk Behaviours and Their Associations With Anxiety and Depression Among Chinese Young Adults by Gender: A Latent Class Analysis

This study investigated gender differences in health-risk behaviour patterns among young adults and assessed the associations of anxiety and depression with these patterns. A cross-sectional survey was conducted with 1740 young Chinese adults aged 18-24 years. Latent class analysis (LCA) and multinomial logistic regression were conducted to identify the clusters of health-risk behaviours and their associations with anxiety and depression. Three common patterns were found for both genders: physical inactivity, substance use, and insufficient fruit intake (5.7% for males [M] and 11.6% for females [F]); a sedentary lifestyle only (48.4% for M and 48.9% for F); and a sedentary lifestyle, substance use, and an unhealthy diet (7.6% for M and 20.0% for F). Additionally, two additional unique patterns were found: physical inactivity and unhealthy diet in males (38.3%) and physical inactivity and insufficient fruit intake in females (19.6%). Sociodemographic variables exert different effects on health-risk behaviour patterns as a function of gender. Lower anxiety levels (odds ratio [OR]: 0.892; 95% confidence interval [CI]: 0.823-0.966) and greater depression levels (OR: 1.074; 95% CI: 1.008-1.143) were associated with a sedentary lifestyle, substance use, and unhealthy diet class only in female young adults compared with a sedentary-only class. These findings underscore the need for the implementation of targeted interventions based on gender differences.

Medical Nutrition Education for Health, Not Harm: BMI, Weight Stigma, Eating Disorders, and Social Determinants of Health

Effective nutrition training is fundamental to medical education. Current training is inadequate and can cause harm to students and patients alike; it leaves physicians unprepared to counsel on nutrition, places undue focus on weight and body mass index (BMI), can exacerbate anti-obesity bias, and increase risk for development of eating disorders, while neglecting social determinants of health and communication skills. Physicians and educators hold positions of influence in society; what we say and how we say it matters. We propose actionable approaches to improve nutrition education to minimize harm and pursue evidence-based, effective, and equitable healthcare.

A Process Evaluation of a Mobile App for Medical Students Aimed at Increasing Resilience and Decreasing Stigma in Mental Health

OBJECTIVE

The purpose of this pilot study was to conduct a process evaluation of a mental health and wellness mobile health (mHealth) application for medical students designed to increase resilience and decrease mental health stigma.

METHODS

The customized application, MindfulMEDS, was developed with peer-focused interactive modules specific to medical students within an existing system called Sharpen®. The Sharpen® system contains an extensive library of didactic and experiential mental health and wellness content built specifically to promote evidence-based protective factors for resilience. A mixed-methods approach including surveys and focus groups assessed participant resiliency, perception of mental health within the context of medical school, and evaluation of the app. Assessments were conducted at baseline (n = 66), six months (n = 30), and one year (n = 24). Demographic information was collected once at baseline as a part of the initial survey.  Results: A total of 215 users were registered in MindfulMEDS, consumed 83 courses, and engaged in 1,428 "connect clicks" to community resources and crisis-response supports. Resilience levels did not change significantly between surveys; however, a significant decrease in the perception of mental health stigma associated with utilizing mental health resources was observed. Focus group participants (n = 11) reported the screening tools to be useful, encouraged expansion, and suggested additional reminders to access the app to increase engagement.

CONCLUSION

Findings of this pilot study demonstrate the feasibility of implementing MindfulMEDS (an mHealth app focused on mental health and wellness) among medical students. Students found the app experience valuable, accessed mental health screeners embedded within the app, utilized the app to seek help, and engaged with the app to learn more about mental health. There was also a decrease in mental health stigma observed during the course of the study. Based on these results, we propose that medical schools incorporate mobile-based technology into their mental health support programs.

Music-based therapeutic interventions for medical school students with emotional regulation and mental health: a pre-post cohort study

Purpose

Depression and anxiety are prevalent mental health challenges among college students. Music therapy has shown effectiveness in addressing depressive symptoms and enhancing psychosomatic functioning. This study aimed to evaluate the effectiveness of a 4-step structured music therapy program in improving mood and reducing symptoms of depression and anxiety among medical school students.

Materials and methods

The self-controlled study involved 45 medical school students (21 men and 24 women) aged 18-24 years to examine the prevalence of depression and anxiety, common mental health issues among medical school students. Participants underwent psychological assessment using the Symptom Checklist-90 (SCL-90), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS). An 8-week music therapy intervention, comprising four steps-sociality, interaction, music lessons, and creative expression-was administered.

Results

Before-intervention, 55.6% and 15.6% students were identified as suffering from depression and anxiety respectively. Post-intervention, significant reductions in psychological distress, particularly in the Global Severity Index (GSI) and Positive Symptom Total (PST) on the SCL-90 scale, were observed (P < 0.05). Male students exhibited notable improvements in various psychological symptoms compared to females. Junior grade students demonstrated greater improvements, and clinical medicine students exhibited significant enhancements in specific areas post-intervention.

Conclusion

The structured music therapy program showed promising results in improving mood and regulating emotions among medical school students. Music therapy holds potential as a holistic approach to address mental health challenges in this demographic.

The relationship between childhood psychological abuse and depression in college students: a moderated mediation model

BACKGROUND

Childhood psychological abuse (CPA) are highly correlated with depression among college students, but the underlying mechanisms between variables need further exploration. This study aims to investigate internet addiction as a mediating factor and alexithymia as a moderating factor, in order to further elucidate the potential risk factors between CPA and depression among college students.

METHODS

A self-report survey was conducted among 1196 college students from four universities in three provinces in China. The survey included measures of CPA, internet addiction, alexithymia, and depression. Descriptive and correlational analyses were performed on these variables, and a moderated mediation model was constructed.

RESULTS

CPA was positively correlated with depression among college students, as well as internet addiction with alexithymia. Internet addiction partially mediated the relationship between CPA and depression among college students, while alexithymia strengthened the relationships among the paths in the moderated mediation model.

CONCLUSION

This study provides further insights into the psychological mechanisms underlying the relationship between CPA and depression among college students. Internet addiction serves as a mediating factor in this relationship, while alexithymia may enhance the strength of the relationships among the three variables.

Mental Disorders Among Healthcare Students Attending a Large University Hospital in Milan, Italy

BACKGROUND

The high incidence rates, treatment difficulties, and tendency to become chronic, which subsequently affects personal and occupational functioning, make mental health disorders among the most important public health concerns. In this context, healthcare university students (HS) appear to be more vulnerable to psychological distress than others.

OBJECTIVE

Investigate the prevalence of diagnosed mental illness among different groups of HS to detect students who may be psychologically vulnerable and determine whether the implementation of support interventions is necessary.

METHODS

All HS who had a clinical examination performed by an occupational physician at our occupational health unit between 2021 and 2022 were included in our case series. Data were collected and analyzed as part of the occupational physicians' health surveillance program.

RESULTS

out of 679 HS (507 females, 172 males, aged 22.2±3.9 mean±s.d) undergone clinical examination at our Occupational Health Unit, 36 (5.3%) reported a diagnosed psychiatric illness, and 20 were receiving pharmacological therapy at the time of the visit. A higher prevalence of psychological disorders has been highlighted in females (6.1% vs 2.9% in males) and students of the mental health sector (11.1%) when compared with others. A fit-to-work judgment with prescription was necessary for 16.7% of students with mental diseases. The presence of psychiatric disorders was associated with underweight (27.8%) and higher smoking habit (44.4%).

CONCLUSIONS

These results underline the necessity of improving the current health surveillance protocols, which should also evaluate students' psychological fragility and implement effective intervention strategies to promote their health and wellbeing.

Barriers to mental health service utilisation among medical students in Saudi Arabia

Introduction

Medical students experience high levels of stress, often due to academic demands, which can adversely affect their mental health. However, they frequently hesitate to seek and underutilise available mental health services. This study aimed to assess the perceived need for mental health services and identify the barriers to seeking help among undergraduate medical students.

Materials and methods

This cross-sectional study recruited 480 undergraduate medical students from two main universities in the Eastern Province of Saudi Arabia. Data were collected through an online, self-administered questionnaire that encompassed sections on sociodemographic details, the Patient Health Questionnaire (PHQ-9), perceptions about the necessity for professional mental health care, service utilisation over the past year, and the Barriers to Access to Care Evaluation (BACE-III).

Results

The study found that 33.6% of the participants showed signs of depression. Even though 42.5% expressed a perceived need for mental health services, only 16.2% actually utilised these services in the previous 12 months. In terms of barriers, attitudinal-related barriers received the highest mean score, followed by stigma- and instrumental-related barriers. Notably, students who had previously experienced academic failure and those who had sought mental health services were more inclined to report stigma- and instrumental-related barriers.

Conclusion

Mental health challenges are notably prevalent among undergraduate medical students. Although there is a significant perceived need for professional mental health intervention, the actual utilisation rate remains low. The primary obstacles to seeking assistance are attitudinal and stigma-related barriers.

Is There a Burnout Epidemic among Medical Students? Results from a Systematic Review

Background and Objectives: Medical students represent the ideal target group for promoting mental health and mental wellbeing, being exposed to specific risk factors, such as the content of medical training, the exposure to sickness and death, and a stressful academic routine. Medical students report high levels of cynicism and emotional exhaustion, which represent two of the essential features of burnout syndrome. In this systematic review, studies assessing the levels of burnout among medical students through validated tools worldwide were analyzed. Materials and Methods: A systematic review has been performed in order to identify studies: (1) focusing on samples of medical students; (2) evaluating burnout syndrome using validated tools; (3) providing prevalence data on burnout; and (4) written in English. Results: Out of the 5547 papers initially obtained, 64 were finally included in the analysis. The sample sizes ranged from 51 to 2682 participants. Almost all studies had a cross-sectional design; the Maslach Burnout Inventory and its related versions were the most frequently used assessment tools. The prevalence of burnout, which was stratified based on gender and academic stage, ranged from 5.6 to 88%. Burnout was mostly predicted by thoughts of stopping medical education, negative life events, lack of support, dissatisfaction, and poor motivation. Conclusions: The prevalence of burnout syndrome in medical students is quite heterogeneous, reaching a peak of 88% in some countries. However, several predictors have been identified, including negative life events or poor motivation. These findings highlight the need to develop preventive interventions targeting the future generation of medical doctors, in order to improve their coping strategies and resilience styles.

Analysis of the Psychological Factors Faced by the Final Year College Students of China During Job Interviews and While Choosing Careers

Career choice research has attracted the attention of recruiters and young graduates. The study aims to investigate the psychological factors that influence college students' employment choices. As a result, data for the study were gathered from 250 final-year college students in China via an online questionnaire survey. The study identified the psychological barriers faced by college students during job interviews through interviews with 120 h recruiters. The SPPS tool is used for data analysis. The study identified personal interest, self-efficacy, and self- esteem; social responsibilities; confidence; professional development opportunities; and future orientation as the important psychological factors that influence the career choice of college students. The study also found that the barriers faced by the college students during the interview were anxiety, inferiority complex, cowardice, and pride. Therefore, the study suggests that the college provides job-oriented training for college students' employment choices. The college should take the initiative to provide students with career opportunities and proper training to avoid psychological barriers during interviews.

Sleep disorders and associated factors among medical students in the Middle East and North Africa: a systematic review and meta-analysis

Sleep disturbances like poor and insufficient sleep are common among medical students in the Middle East and North Africa (MENA) countries; however, the extent of medically defined sleep disorders (SDs) remains unclear. This meta-analysis determines SD prevalence and identifies associated factors among medical students in the MENA. PubMed, Web of Science, Google Scholar, and reference lists of included studies were searched (latest search: June 2022). Meta-analyses included 22 studies and were performed using random-effect models. Included studies used self-reported screening tools for assessing SDs and then estimated the proportion of participants at high risk of developing a SD. Central disorders of hypersomnolence were the most prevalent SD [prevalencepooled range: 30.9% (Jordan) to 62.5% (Saudi Arabia)], followed by insomnia disorders [prevalencepooled range: 30.4% (Jordan) to 59.1% (Morocco)], circadian rhythm sleep-wake disorders [prevalencepooled range: 13.5% (Jordan) to 22.4% (Saudi Arabia)], sleep-related breathing disorders [prevalencepooled range: 12.2% (Jordan) to 22.5% (Pakistan)], sleep-related movement disorders [prevalencepooled range: 5.9% (Egypt) to 30.6% (Saudi Arabia)], and parasomnias [prevalencepooled range: 5.6% (Jordan) to 17.4% (Saudi Arabia)]. Female sex, studying in the latter academic years, having anxiety, excessive internet use, and poor academic performance were significantly associated with SDs. SDs are prevalent among MENA medical students. Implementing student-centered interventions targeting high risk groups in medical schools should be considered to improve students' health and wellbeing.

Fathers' mental Ill-health and child maltreatment: A systematic review of the literature

Background

Parental mental ill-health is often described as a risk factor for child maltreatment. Yet the literature commonly foregrounds maternal mental ill-health. To obtain a more complete picture, it is crucial to also understand the associations between fathers' mental health and child maltreatment.

Aim

To provide a narrative synthesis of evidence about the relationship between fathers' mental health and child maltreatment.

Method

Four electronic databases were searched, identifying 5479 citations. 151 studies were brought to full-text review. 37 were included in the study.

Results

Studies revealed mixed evidence for associations between forms of paternal mental ill health and child maltreatment, with stronger evidence for paternal depression and weak or no evidence for PTSD and anxiety. Many confounding factors were identified across the papers.

Discussion

The small number and limited range of good quality studies indicate the need to correct the relative invisibility of fathers within research about mental health and child maltreatment. At present, the available evidence is not sufficient to draw firm conclusions about the association between fathers' mental health and child maltreatment or appropriate policy and practice responses.

Mental health disturbance in preclinical medical students and its association with screen time, sleep quality, and depression during the COVID-19 pandemic

BACKGROUND

Affected by various hurdles during COVID-19, preclinical medical students are at an elevated risk for mental health disturbances. However, the effects of modern mental health problems on preclinical medical students have not been adequately researched. Thus, this study was aimed to identify the proportions and implications of current mental health problems for depression, sleep quality and screen time among Indonesian medical preclinical students during the COVID-19 pandemic.

METHODS

This cross-sectional study was conducted using crowdsourcing between October 2020 and June 2021. During the study period, 1,335 subjects were recruited, and 1,023 datasets were identified as valid. General Health Questionnaire-12 (GHQ-12) was used to measure current mental health disturbances (categorized as without current mental health disturbances, psychological distress, social dysfunction, or both). The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, the Pittsburgh Sleep Quality Index (PSQI) was employed to assess sleep quality, and a questionnaire devised for this study was used to assess screen time length per day. Multivariate data analysis was conducted using SPSS version 24 for Mac.

RESULTS

According to the findings, 49.1% of the 1,023 participants had current mental health disturbances: 12.8% had psychological distress, 15.9% had social dysfunction, and the rest (20.4%) had both psychological distress and social dysfunction. The statistical analysis provided strong evidence of a difference (p < 0.001) between the medians of depression and sleep quality with at least one pair of current mental health disturbance groups, but the difference for screen time was not significant (p = 0.151). Dunn's post-hoc analysis showed that groups without current mental health problems had significantly lower mean ranks of depression and sleep quality compared to groups that had current mental health problems (p < 0.001).

CONCLUSION

Current mental health disturbances during the COVID-19 pandemic were significantly associated with preclinical medical students' depression and sleep quality in preclinical medical students. Thus, mental health programs for this specific population should be tailored to integrate mindfulness therapy, support groups, stress management, and skills training to promote mental wellbeing.

Measurement Properties and Optimal Cutoff Point of the WHO-5 Among Chinese Healthcare Students

Purpose

The World Health Organization-Five Well-Being Index (WHO-5) is widely used to assess subjective well-being. Nevertheless, measurement invariance and optimal cutoff point of the WHO-5 have not been examined in Chinese samples. We aimed to assess measurement properties of the Chinese version of the WHO-5 (WHO-5-C) among healthcare students.

Patients and Methods

A two-wave longitudinal assessment was conducted among 343 Chinese healthcare students from September to November 2022. Measurement properties of the WHO-5-C were assessed through structural validity using confirmatory factor analysis (CFA), measurement invariance using multigroup CFA (MGCFA) and longitudinal CFA (LCFA), convergent validity using correlation analysis with the Self-Rated Health Questionnaire (SRHQ) and Patient Health Questionnaire-4 (PHQ-4), reliability using internal consistency and test-retest reliability, and optimal cutoff point using receiver operating characteristic (ROC) analysis.

Results

The WHO-5-C demonstrated satisfactory structural validity with comparative fit index (CFI) of 0.968 at baseline and 0.980 at follow-up, and adequate measurement invariance in different sociodemographic variables at baseline (gender, age, major, home location, being only child, monthly household income, part-time job, physical exercise, hobby, frequency of visiting home, and stress coping strategy) (CFI changes [ΔCFI] = -0.009-0.003) and over a week (ΔCFI = -0.006-0.000). The WHO-5-C also had good internal consistency (Cronbach's α = 0.907-0.934; McDonald's ω = 0.908-0.935) and test-retest reliability (intraclass correlation coefficient [ICC] = 0.803). Convergent validity was supported by moderate correlations of the WHO-5-C with the SRHQ and PHQ-4. The optimal cutoff point of the WHO-5-C was found to be 50, with an area under the ROC curve of 0.882 at baseline data, with sensitivity of 0.803 and specificity of 0.762 at follow-up.

Conclusion

The WHO-5-C demonstrated adequate measurement properties, especially concerning cross-sectional and longitudinal measurement invariance, with a recommended optimal cutoff point of ≥ 50 for assessing adequate level of psychological well-being in healthcare students.

Lactate Dehydrogenase as a Biomarker in Oral Submucous Fibrosis: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis was planned with the objective of evaluating the level of Lactate Dehydrogenase (LDH) in oral submucous fibrosis patients and in controls and comparing them. For this meta-analysis, we searched Google Scholar, PubMed, Scopus, and Directory of Open Access Journals (DOAJ) databases using a search methodology that included combinations of MeSH terms and keywords and included cross-sectional studies to evaluate the levels of LDH in patients with Oral Submucous Fibrosis (OSMF), Oral Squamous Cell Carcinoma (OSCC) and compared it with the controls. The total number of records identified through database searching was 4161 (n). Analysis of the quality of the studies was done using the National Heart, Lungs and Blood Institute (NHLBI) tool for case-control studies. Twelve case-control studies which matched the inclusion criteria were included after the literature search. The meta-analysis was carried out using R Studio (version 4.1.3, 2022; The R Foundation for Statistical Computing, Vienna, Austria). The pooled estimate that has been calculated from the salivary LDH course for OSMF was 15.35% and from the serum LDH course for OSMF was 6.82%. There was a visual observation of the funnel's plot asymmetry suggesting publication bias. After adjusting the publication bias, the t2 values for salivary and serum LDH were 41% and 14.71%, respectively, which was less than 50%, indicating that the meta-analysis was statistically significant. The evaluation of salivary and serum LDH can be a useful method for early diagnosis of OSMF as well as OSCC. To infer that individuals may have OPMD or OSCC, specific values for salivary and serum LDH must be found in further investigations.

Effect of fear of missing out on learning burnout in medical students: a moderated mediation

Introduction

Learning burnout has a significant negative impact on students' academic performance and professional development, which has been exacerbated by the growing trend of problematic smartphone use, such as smartphone addiction, among young people. Recently, the literature on excessive social media use has revealed a critical role of fear of missing out. Objective The purpose of this study was to examine how fear of missing out affects smartphone addiction and its subsequent effect on learning burnout in college students.

Methods

In Study 1, 352 medical students were recruited to complete a cross-sectional survey. In Study 2, 2,948 college students were recruited to complete a cross-sectional survey. Further in Study 3, 30 medical students were recruited into a mindfulness-based intervention program.

Results

Study 1 preliminarily confirmed that fear of missing out was positively correlated with learning burnout. Study 2 then revealed a moderated mediation model showing that fear of missing out may increase smartphone addiction, which in turn affects their sleep quality and finally leads to learning burnout. This chain mediation model was moderated by the participants' level of mindfulness. To confirm the promoting role of mindfulness, Study 3 further confirmed that mindfulness training indeed can improve smartphone addiction and reduce learning burnout in medical students.

Discussion

Theoretical and practical contributions were discussed, highlighting the effects of fear of missing out on smartphone addiction and a moderating role of mindfulness training.

Common mental health problems in medical students and junior doctors - an overview of systematic reviews

BACKGROUND

Common mental health problems (CMHP) are prevalent among junior doctors and medical students, and the COVID-19 pandemic has brought challenging situations with education disruptions, early graduations, and front-line work. CMHPs can have detrimental consequences on clinical safety and healthcare colleagues; thus, it is vital to assess the overall prevalence and available interventions to provide institutional-level support.

AIMS

This overview summarises the prevalence of CMHPs from existing published systematic reviews and informs public health prevention and early intervention practice.

METHODS

Four electronic databases were searched from 2012 to identify systematic reviews on the prevalence of CMHPs and/or interventions to tackle them.

RESULTS

Thirty-six reviews were included: 25 assessing prevalence and 11 assessing interventions. Across systematic reviews, the prevalence of anxiety ranged from 7.04 to 88.30%, burnout from 7.0 to 86.0%, depression from 11.0 to 66.5%, stress from 29.6 to 49.9%, suicidal ideation from 3.0 to 53.9% and one obsessive-compulsive disorder review reported a prevalence of 3.8%. Mindfulness-based interventions were included in all reviews, with mixed findings for each CMHP.

CONCLUSIONS

The prevalence of CMHPs is high among junior doctors and medical students, with anxiety remaining relatively stable and depression slightly increasing during the COVID-19 pandemic. Future research on mindfulness-based interventions is required for a resilient and healthy future workforce.

PRISMA/PROSPERO

the researchers have followed PRISMA guidance. This overview was not registered with PROSPERO as it was conducted as part of an MSc research project.

Working memory training for reward processing in university students with subsyndromal depression: The influence of baseline severity of depression

Previous studies have tentatively suggested that working memory training (WMT) has the potential to improve reward processing, but it is not known how long this improvement lasts, whether there is a lag effect, or whether it is reflected in neurophysiological indicators. In this study, 40 university students with subsyndromal depression were randomly assigned to a training group or a control group and completed a 20-day working memory training task and a simple memory task, respectively. All participants completed the Temporal Experience of Pleasure Scale (TEPS) and a doors task with electroencephalogram (EEG) signals recorded simultaneously on a pre- and post-test and a 3-month follow-up. The reward-related positivity (RewP) amplitude, theta power, and their differences between conditions (i.e., ΔRewP and Δtheta power, respectively) in the doors task were the primary outcomes, and the score on TEPS was the secondary outcome. The results indicated no group-related effects were demonstrated in primary and secondary outcomes at post-test and 3-month follow-up. Furthermore, the differences in the pre- and post-test in Δtheta power were moderated by the baseline severity of depression. This was primarily driven by the fact that the change values in the control group increased with the severity of depression, while the change values in the training group had high homogeneity. Our findings did not provide support for the effect of WMT on reward processing across the whole sample, but without intervention, there would be high heterogeneity in the change in the cognitive control ability to loss feedback, which is detrimental to individuals with high depression severity.

The worldwide prevalence of self-reported psychological and behavioral symptoms in medical students: An umbrella review and meta-analysis of meta-analyses

OBJECTIVE

Medical students frequently experience a range of stressors, such as demanding academic requirements, competition and rivalry, self-doubt, and financial distress. As a result, they are at risk for psychological and behavioral symptoms (PBS) including: depression, anxiety, and sleep difficulties as well as maladaptive substance use.

METHODS

To determine the degree of risk for these symptoms, 13 databases, without language restriction., were searched.

RESULTS

A total of 32 meta-analyses were included in this umbrella review. A global analysis of all self-reported PBS combined yielded a pooled prevalence rate of 30.3% [26.9%; 33.7%]; 95% PI [2.2%; 58.3%]. The highest reported prevalence was for sleep problems 42.0% [35.6%; 48.4%], followed by stress 41.7% [35.3%; 48.1%], burnout 35.8% [25.7%; 45.8%], anxiety 32.5% [27.9%; 37.1%], depression 32.5% [28.8%; 36.1%], internet addiction 26.0% [5.5%; 46.5%], substance use 25.2% [18.9%; 31.6%], eating disorders 9.8% [1.1%; 18.4%], and suicidal thoughts/gestures/acts 8.9% [4.8%; 12.9%]. The prevalence estimates were deemed acceptable for all PBS.

CONCLUSION

The evidence shows that fully one-third of medical students experience a range of problematic PBS, likely attributable to the demanding and intense study environment, the hierarchical structure of medical training facilities, and the vulnerability of the young adulthood time period. Appropriately targeted assessment and intervention efforts are clearly warranted to decrease the psychological burden of medical student training. PROSPERO Identifier: CRD42023391800. Open Science Network (OSF) Identifier: DOI 10.17605/OSF.IO/SXQYN.

Tobacco usage in India: A meta-analysis of evidence drawn from regional studies between 2010 and 2022

OBJECTIVES

To generate a national and zonal pooled estimate of current tobacco usage (CTU) in any form, as well as stratified gender and tobacco type (smokeless and smoke) specific estimates among the Indian population, utilising evidence from 2010 to 2022.

METHOD

PubMed, Scopus, ScienceDirect, CINAHL and Google Scholar databases were searched for articles on tobacco use among Indian adults published between January 2010 and October 2022. The NIH Quality Assessment Tool was used to assess study quality, and a random-effects inverse-variance method was used to attain a pooled estimate of usage. Heterogeneity was estimated through I2 statistics and prediction intervals, and further subgroup analysis and meta-regression were conducted. A leave-one-out analysis was done to establish the sensitivity of the pooled estimate.

RESULTS

CTU prevalence of any form among the adult Indian population was 35.2% [confidence interval (CI) 25.27-45.92, I2  = 99.7, p < 0.001] between 2010 and 2022 with a wide Prediction interval between 3.19 to 78.74. The regionally drawn estimate for the years 2016-2022 was 44.3% (CI 30.57-58.64, I2  = 99.8, p < 0.01). Highest prevalence was found in the East zone (55.4%) followed by the northeast with 51.8% tobacco consumption. Although residual heterogeneity persisted after subgroup analysis, the variability in estimates showed statistical significance when considering disaggregated estimates across administrative zones and gender-wise consumption. The estimated CTU among males was 54.1%, whereas in females it was 15%. Leave-one-out analysis indicated the findings are reliable and are not dependent on any one study.

CONCLUSION

This review highlights differences in tobacco usage estimates from national-level surveys and regional studies. More regionally representative surveys of tobacco usage to tailormade prevention efforts alongside increased regional efforts improved community-level advocacy and more coordinated and stringent tobacco prevention policy implementation at national and state levels are warranted.

Prevalence of common mental disorders among medical students in China: a systematic review and meta-analysis

Background

The prevalence of mental distress is common for medical students in China due to factors such as the long duration of schooling, stressful doctor-patient relationship, numerous patient population, and limited medical resources. However, previous studies have failed to provide a comprehensive prevalence of these mental disorders in this population. This meta-analysis aimed to estimate the prevalence of common mental disorders (CMDs), including depression, anxiety, and suicidal behaviors, among medical students in China.

Methods

We conducted a systematic search for empirical studies on the prevalence of depression, anxiety, suicide attempt, suicide ideation, and suicide plan in Chinese medical students published from January 2000 to December 2020. All data were collected pre-COVID-19. The prevalence and heterogeneity estimations were computed by using a random-effects model and univariate meta-regression analyses.

Results

A total of 197 studies conducted in 23 provinces in China were included in the final meta-analysis. The prevalence data of depression, anxiety, suicide attempt, suicide ideation, and suicide plan were extracted from 129, 80, 21, 53, and 14 studies, respectively. The overall pooled crude prevalence for depression was 29% [38,309/132,343; 95% confidence interval (CI): 26%-32%]; anxiety, 18% (19,479/105,397; 95% CI: 15%-20%); suicide ideation, 13% (15,546/119,069; 95% CI: 11%-15%); suicide attempt, 3% (1,730/69,786; 95% CI: 1%-4%); and suicide plan, 4% (1,188/27,025; 95% CI: 3%-6%).

Conclusion

This meta-analysis demonstrated the high prevalence of CMDs among Chinese medical students. Further research is needed to identify targeted strategies to improve the mental health of this population.

General health and its relation to the quality of life and alcohol consumption in a Polish cohort of medical students - preliminary results of POLLEK survey

Introduction

First-year students of medicine are at higher risk of stress related to the new environment and study overload. Such factors can play a role and have an impact on their quality of life and general health status which can cause possible problems with alcohol use. The aim of the study is to assess the relationship between mentioned factors in the Polish cohort of first-year medical students.

Materials and methods

The quality of life has been assessed within the WHOQOL-BREF questionnaire, the general health status was assessed via GHQ28, and alcohol consumption was assessed the by AUDIT questionnaire. Due to the lack of signature informed consent and lack of data, 381 (72%) students out of 525 were included in the final analysis.

Result

The majority of the 1-year students were females 68%; (n = 259) vs. 32% (n = 122) males. Half of the students had lowered risk of distress. However, females had a higher risk of having higher scores in GHQ-28 than males. In relation to the assessment of the quality of life, the students with a lower level of distress (<32 points in GHQ-28) had better results in each WHOQOL domain. There was no association between general health status and alcohol use. For the students who had possible problems with alcohol use the OR was 1.15 95% CI (0.73-1.80) and for students who were probably addicted OR was 1.07 95% CI (0.33-3.41).

Conclusion

The total quality of life in first-year Polish medical students is relatively high; however, half of them suffer because of distress and around 30% have some alcohol problems. Females are more likely to have higher GHQ-28 scores than males.

Mental Distress and Professional Commitment among Chinese Medical Postgraduate Students: A Moderated Mediation of Psychological Capital and the Supervisor-Postgraduate Relationship

This study determined the relationship between mental distress and professional commitment among medical postgraduate students, and the roles of psychological capital as a mediator and the supervisor-postgraduate relationship as a moderator. This cross-sectional study recruited 836 medical postgraduate students from eight medical universities and the medical college of comprehensive universities in Guangdong Province, China. Participants were assessed through questionnaires, which covered demographic items, the supervisor-postgraduate relationship scale, the psychological capital questionnaire, the symptom checklist - 90 (SCL -90), and the professional commitment scale. We used descriptive statistics to describe demographics and mental distress and professional commitment scores. Pearson's analysis was used to identify correlations between the variables and the SPSS PROCESS macro was performed to confirm mediating and moderating effects of psychological capital and the supervisor-postgraduate relationship. Mental distress was negatively related with professional commitment (r = -0.262, p < 0.01) and psychological capital (r = -0.442, p < 0.01). Psychological capital was positively associated with professional commitment (r = 0.486, p < 0.01). The confidence interval (CI) suggested that psychological capital mediated the relationship between mental distress and professional commitment (95% CI, -0.198 to - 0.143), and the supervisor-postgraduate relationship had a moderate role between psychological capital and professional commitment (95% CI, 0.069 to -0.212). Hence, educators may refer to these findings to improve professional commitment level among medical postgraduate students.

Prevalence of alexithymia among medical students in Nepal: A cross-sectional study based on a self-administered questionnaire

Background and Aims

Alexithymia is a state in which one cannot comprehend and put their emotions or feelings into words. It is a disturbance that is common among general population as well as people with mental health disorders. Medical students are at higher risk of developing alexithymia due to the extensive nature of their course and clinical postings. The presence of alexithymia is negatively correlated with the self-efficacy of the students eventually affecting self-care and patient care in the future. The aim of this study is to find the prevalence of alexithymia among medical students in Nepal and know its associated factors.

Methods

This cross-sectional study used convenient sampling for selecting responders and the TAS-20 tool for data collection. Data were analyzed by using SPSS 20. Frequency was calculated for all the variables. Prevalence with 95% confidence interval [CI] is reported and the χ ² test is used to see the difference in alexithymia status among different categories of dichotomous independent variables.

Results

Out of 386 students, 380 of them responded. The ratio of male and female was 1.8 with the mean age of 22.22 ± 1.77 years. The prevalence of alexithymia was found to be 22.89% (95% CI, 18.9-27.1). There was no statistically significant difference between the presence and absence of alexithymia among categories of sex, year of study, staying at hostel, involvement in extracurricular activities, involvement in daily exercise/yoga/outdoor sports, and smoking habit.

Conclusion

The prevalence of alexithymia in our study was 22.89% with no association with known factors.

A systematic review and meta-analysis of studies exploring prevalence of non-specific anxiety in undergraduate university students

BACKGROUND

Anxiety is a common mental health problem in the general population, and is associated with functional impairment and negative impacts upon quality of life. There has been increased concern about university students' mental health in recent years, with a wide range of non-specific anxiety rates reported worldwide in undergraduate university students. We aimed to explore prevalence of non-specific anxiety in undergraduate university student populations.

METHODS

Four databases were searched to identify studies published between 1980 and 2020 which investigated prevalence of non-specific anxiety in undergraduate university students. Each study's quality was appraised using a checklist. Sub-analyses were undertaken reflecting outcome measure utilized, course of study, location of study, and whether study was before or during the COVID-19 pandemic.

RESULTS

A total of 89 studies - representing approx. 130,090 students-met inclusion criteria. Eighty-three were included in meta-analysis, calculating a weighted mean prevalence of 39.65% (95% CI: 35.72%-43.58%) for non-specific anxiety. Prevalence from diagnostic interview studies ranged from 0.3%-20.8% 12-month prevalence. Prevalence varied by outcome measure used to assess non-specific anxiety, the type of course studied by sample, and by study location. In half the studies, being female was associated with being more likely to have higher non-specific anxiety scores and/or screening above thresholds. Few of the included studies met all quality appraisal criteria.

CONCLUSION

The results suggest that approximately a third of undergraduate students are experiencing elevated levels of non-specific anxiety. Results from sub-analyses have identified some methodological issues that need consideration in appraising prevalence in this population.

Analysis of Psychiatric Symptoms and Suicide Risk Among Younger Adults in China by Gender Identity and Sexual Orientation

Importance

Younger adults in China who are transgender and gender nonconforming (TGNC) and lesbian, gay, and bisexual (LGB) experience high levels of minority stress (eg, stigma and bullying) and adverse mental health symptoms. However, there is a lack of research documenting mental health disparities compared with their cisgender and heterosexual peers. Studies that disaggregate TGNC and LGB individuals and are conducted in nonmetropolitan regions are also needed.

Objectives

To examine whether younger adult students' psychiatric symptoms and suicide risk vary by sexual orientation and gender identity and identify risk factors within LGB younger adults and TGNC younger adults.

Design, Setting, and Participants

This cross-sectional study surveyed students at 63 universities in Jilin Province, China, between October 24 and November 18, 2021. Analyses were completed May 6, 2022.

Exposures

Gender identity (TGNC vs cisgender) and sexual orientation (LGB vs heterosexual).

Main Outcomes and Measures

Psychiatric outcomes included depression, anxiety, traumatic stress, and nonsuicidal self-injury (NSSI), which were measured by the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Trauma Screening Questionnaire, and self-reported NSSI behaviors. The Suicide Behaviors Questionnaire-Revised was used to assess suicide risk.

Results

The analytic sample included 89 342 younger adults (mean [SD] age, 19.60 [1.75] years), including 51 438 assigned female at birth and 37 904 assigned male at birth. The sample included 2352 individuals who were TGNC, 6501 who were cisgender LGB, and 80 489 who were cisgender heterosexual. Compared with their cisgender heterosexual peers, TGNC and LGB younger adults were more likely to experience increased psychiatric symptoms across categories and suicide risk, as well as more severe forms of symptoms. In particular, overall suicide risk was 43.03% among TGNC individuals, 36.21% among LGB individuals, and 11.70% among cisgender heterosexual younger adults. Controlling for demographic variables and compared with cisgender heterosexual peers, TGNC young adults had higher odds of suicide risk (adjusted odds ratio, 5.38; 95% CI, 4.94-5.86; P < .001) and of past-year NSSI (adjusted odds ratio, 6.55; 95% CI, 5.87-7.30; P < .001). Separate within-group analyses for LGB and TGNC younger adults highlighted the vulnerability of bisexual women and gender nonbinary groups, as well as the relevance of minority stress-related risk factors, including peer bullying and assault and loneliness.

Conclusions and Relevance

This study noted disparities of mental health issues among LGB, transgender, or queer or questioning younger adults in China and suggests a high urgency to address psychological health and prevent suicide in this population. Targeted public health initiatives may be needed to reduce stigma and discrimination, train competent health care professionals, and create affirmative mental health policies and systems of care.

Comparing the Mental Health of Healthcare Students: Mental Health Shame and Self-compassion in Counselling, Occupational Therapy, Nursing and Social Work Students

Poor mental health of healthcare students is a cause for concern in many universities. Though previous research has identified mental health shame and self-compassion as critical in this student group, how these variables differ across different healthcare disciplines remains to be evaluated. Healthcare students (n = 344; counselling, occupational therapy, social work and nursing) completed measures regarding these variables. MANOVA and regression analyses were performed. (1) Counselling and nursing students were more depressed than occupational therapy students; (2) nursing students were more anxious than occupational therapy and social work students; (3) occupational therapy students had more positive attitudes towards mental health than the others; and (4) nursing students worried about their own reputation associated with their family more than counselling students. Self-compassion was the strongest predictor of mental health in all groups; however, the effect sizes varied: largest in nursing and smallest in social work students. Findings will help inform effective interventions for students in each healthcare discipline.

Stress and its impairment of skin barrier function

BACKGROUND

The principal function of skin is to provide a barrier to water loss and percutaneous penetration of exogenous substances. Any compromise of the skin homeostasis can lead to dryness, itchiness, or even pathogenic conditions. This study aimed to explore the relationship among psychological stress, skin homeostasis, sleep quality, and emotion.

METHODS

This prospective observational study was conducted using a random sample of medical students from Shanghai Medical College, Fudan University. A questionnaire including the validated Chinese version of Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI) was distributed. The skin barrier function was measured by the transepidermal water loss (TEWL), hydration of skin. Dermoscopic images of the nose and infraorbital skin were obtained. We compared the skin homeostasis, sleep quality, and emotional state of medical students at different time points of the semester and explored the correlation between the variables.

RESULTS

As the semester progressed, the sleep quality and severity of anxiety of medical students got significantly worse, and they were closely related to the impaired skin barrier function. Both irregular schedule and stress can aggravate dark circles.

CONCLUSIONS

Mental stress can do harm to skin barrier through poor sleep and severe anxiety. The amount of sebum was positively correlated with the severity of anxiety while blackheads are mainly influenced by season change. Dermoscopy has a unique role in assessing blackheads and dark circles.

Anxiety and depressive symptoms of German university students 20 months after the COVID-19 outbreak - A cross-sectional study

BACKGROUND

Given the long duration of the COVID-19 pandemic, monitoring mental health remains important. This study aimed to determine (1) the prevalence of anxiety and depressive symptoms among university students 20 months after the first COVID-19 restrictions and (2) which factors were associated with these outcomes.

METHODS

The cross-sectional COVID-19 German Student Well-being Study (C19 GSWS) collected data of 7025 students at five German universities. Associations between anxiety and depressive symptoms with sociodemographic and other factors were analysed using multivariable logistic regression models.

RESULTS

The mean age of the participants was 23.9 years (SD = 4.9), 67 % were female and 31 % male. The prevalence for depressive symptoms was 29 % (PHQ-2) and 12 % (CES-D 8) and 32 % for anxiety. A complicated relationship status, the lack of a trusted person, and financial difficulties were associated with anxiety and depressive symptoms. University students who were worried about (re-) infection with COVID-19 had a 1.37-times higher chance for reporting anxiety (GAD-2: OR, 95 % CI: 1.09-1.71). Those with pre-existing cardiovascular health conditions had an up to 3.21-times higher chance for reporting depressive symptoms (OR, CESD-D 8, 95 % CI: 1.44-7.14).

LIMITATIONS

The study design is cross-sectional and uses self-reported outcomes.

CONCLUSIONS

Concepts for prevention and counselling to tackle mental health problems in students are needed and programmes should take specific stressors related to the pandemic into account.

Social Support Mediates the Relationship Between Coping Styles and the Mental Health of Medical Students

Purpose

This study aimed to explore the impact that coping styles and social support have on the mental health of medical students by constructing a corresponding structural situation model that reveals the complex relationship between these three factors. In doing so, it seeks to help medication students better manage mental health problems.

Patients and Methods

The online study was conducted between March 6, 2021 and May 6, 2021. A total of 318 participants from multiple medical schools were involved. The general information questionnaire, simple coping style questionnaire (SCSQ), perceived social support scale (PSSS) and symptom checklist 90 (SCL-90) were used to collect relevant information from the subjects by snowball sampling. An independent t-test, ANOVA, Pearson correlation coefficient analysis, and intermediary effect analysis were all used to analyze the relevant data and construct the structural equation model.

Results

There was a significant difference in SCL-90 between medical students and national college students (1.78±0.70, P < 0.001), and the positive rate of mental health status was as high as 40.3%. Sleep quality, regular diet, and positive coping style were positively correlated with mental health (P < 0.01), while negative coping styles and total scores of coping style as well as family, friends, and other sources of social support and total scores of social support were negatively correlated with mental health problems (P < 0.01). Positive and negative coping styles have an impact on mental health through the mediating effect of between social support and coping styles, as well as in the direct pathway.

Conclusion

The mental health status of medical students was significantly poor. Medical schools should thus pay close attention to the mental health status of students and encourage them to develop healthy living habits, optimize coping styles, and establish stable sources of social support to improve their psychological wellbeing.

Association of adverse childhood experiences and depression among medical students: the role of family functioning and insomnia

Background

Few studies have explored the mechanisms linking adverse childhood experiences (ACEs) to depression in medical students. This study aimed to investigate the relationship between ACEs and depression through the serial mediation effect of family functioning and insomnia.

Methods

A cross-sectional survey was conducted with 368 medical students from university in Chengdu in 2021. The participants were asked to complete four self-report questionnaires, including ACEs scale, the family APGAR index, the ISI and PHQ-9. Singe and serial mediation analyses were conducted using structural equation modeling by Mplus 8.3.

Results

ACEs had a significant direct effect on depression (β = 0.438, p < 0.001) and through three significantly indirect pathways: (1) through family functioning (β = 0.026, 95% CI: 0.007-0.060), accounting for 5.9% of the total effect; (2) through insomnia (β = 0.103, 95% CI: 0.011-0.187), accounting for 23.5% of the total effect; and (3) through the serial mediators involving in family functioning and insomnia (β = 0.038, 95% CI: 0.015-0.078), accounting for 8.7% of the total effect. The total indirect effect was 38.1%.

Limitations

This cross-sectional study prevented us from establishing causality.

Conclusion

This study highlights the role of family functioning and insomnia as serial mediators of the relationship between ACEs and depression. Findings help to elucidate the mechanism that underlines the pathway between ACEs and depression in medical students. These findings may indicate developing measures to strengthen family functioning and improve insomnia aiming to reduce depression in medical students with ACEs.

EFFECT OF EXERCISE INTERVENTION AND REHABILITATION ON PATIENTS WITH DEPRESSION

ABSTRACT Introduction: The increase in the number of students experiencing depression severely impacts the physical and mental health of college students. Objective: Explore the effect of an exercise intervention on patients with depression by analyzing its rehabilitation effect. Methods: Physical education combined with extracurricular activities were chosen. The experimental physical education group completed about 45 minutes of low-intensity running, performing physical recovery and rest under teacher guidance. The sport form of extracurricular activity was basketball, twice a week. Physical education combined with extracurricular activities totaled a total of 4 times a week, lasting six weeks. Results: The exercise intervention reduced the participants’ psychological test scores, relieving them of their psychological conditions. The exercise intervention improved somatization factors (obsessive-compulsive, depression, interpersonal, paranoid, anxiety, and negative symptoms). Conclusion: The personalized exercise plan is recommended for students with depression, with the promotion of corresponding physical exercise out of class, aiming to improve students’ psychological state and mental health. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Utilization of dental care services among adult Indian population: A meta-analysis of evidence from 2011-2022

Background: This study aimed to generate a pooled national estimate on dental health care services utilization by the adult population in India from any public or private facility in an effort to highlight the demand and usage for oral health care. Methods: In this meta-analysis, PubMed, ScienceDirect, DOAJ, and Google Scholar were searched using a search strategy that combined MeSH headings and keywords (e.g., "Oral Health", "Dental Health Services", utilization, India, etc.) for articles on dental utilization among Indian adults, published between January 2011 and June 2022. Study quality was assessed using the NIH Quality assessment tool, and a random-effects inverse-variance method was used for pulling utilization proportions. Meta-regression and sub-group analyses were conducted to identify the sources of heterogeneity. Heterogeneity is reported as I². To examine publication bias, the funnel plot, egger's test, and trim-and-fill analysis were performed. Results: From 4012 identified articles, 21 were eligible for inclusion. The pooled dental care utilization amongst Indian adults were found to be 23.96% (confidence interval [CI]: 16.81%- 31.11%, P<0.001, I²=98.93%), and the highest estimate was in South Zone (30.02%, CI: 19.14-40.90, P<0.01, I²=98.63%). Visual inspection of the funnel plot revealed the presence of publication bias (egger's P value 0.02). A mild decrease in utilization estimate was noted through trim and fill analysis (adjusted estimate 17.65%, CI: 8.97-26.33, P=0.03). No significant subgroup effect was found for the variables study zone and conduction years (P value: 0.09 & 0.34 respectively). Conclusion: Future studies should be undertaken to focus on the demand and supply of oral health care services since an evidential gap has been identified due to the uneven distribution of studies available from various regions of India. The heterogeneity can be attributed to the diverse socioeconomic, literacy, and inherent health system performance status.

Qualitative study to explore UK medical students' and junior doctors' experiences of occupational stress and mental health during the COVID-19 pandemic

OBJECTIVES

This qualitative study aimed to explore the occupational experiences of medical students and junior doctors working during the COVID-19 pandemic. In particular, the research sought to identify factors which mediated work stress, barriers to disclosing mental health problems and levels of support medical students and junior doctors received during the pandemic.

DESIGN

This study was a form of thematic analysis and adopted an inductive, 'bottom-up' approach, in which coded categories were derived from rich, descriptive data.

SETTING

Semistructured interviews were conducted online with UK-based medical students and junior doctors. Interviews were recorded, and analysis was done by coding salient quotes into themes.

PARTICIPANTS

The final sample consisted of seven junior doctors and eight medical students, during the summer of 2021.

RESULTS

High levels of occupational stress were identified, which were exacerbated by COVID-19. A number of organisational difficulties associated with the pandemic compounded participants' experiences of work stress. Participants recognised progress towards promoting and managing mental health within the profession but may still be reluctant to access support services. Barriers to disclosure included fear of stigmatisation, concerns about adding to colleagues' workloads, lack of clarity about career implications and mistrust of occupational health services.

CONCLUSIONS

While attitudes towards mental health have improved, medical students and junior doctors may avoid seeking help. Given the immense pressures faced by health services, it is imperative that extra measures are implemented to minimise work-stress, encourage help-seeking behaviours and promote supportive work cultures.

COVID-19 and mental health: A systematic review of international medical student surveys

Background

The medical school curriculum has imposed psychological stressors on students worldwide, some of which may induce feelings of increased depression and anxiety. Meanwhile, the COVID-19 pandemic has exacerbated the feelings of stress, depression, and anxiety that a portion of medical students experience in their daily life. The aim of this systematic review is to gather concrete data from medical schools around the globe, and further evaluate how the COVID-19 pandemic has impacted medical students' mental health.

Materials and methods

Systematic search of data from PubMed, EMBASE, psycINFO, MEDLINE Complete, and Global Health for studies conducted between December 2019 and July 2021 was conducted. Data from 47 different surveys of medical students from various medical institutions throughout the world were included in this review. These surveys, administered in the form of questionnaires that utilized rating scales, measured anxiety, depression, and stress levels in medical students amidst the COVID-19 outbreak.

Results

The COVID-19 outbreak was found to have negative effects on medical students, most notably causing emotional and behavioral changes and detrimental mental health impacts. Higher levels of stress, depression, and anxiety have been found in medical students since the outbreak.

Conclusion

This systematic review highlights the sustained high prevalence of moderate depression, anxiety and stress among medical students during the COVID-19 pandemic. Appropriate support and research on which interventions could mitigate these risks is essential in order to ensure that future physicians are properly cared for, and ultimately have the adequate tools needed to provide high quality and empathetic care to future patients.

Mental Health and Quality of Life among Dental Students during COVID-19 Pandemic: A Cross-Sectional Study

Students are particularly vulnerable from the mental health aspect, which was especially recognized during the COVID-19 pandemic. This study aimed to reveal the impact of COVID-19 on quality of life (QoL) and mental health among dental students. The study was conducted on a sample of 797 students (207 male and 592 female) with an average age of 21.7 ± 2.4, from the School of Dental Medicine, University of Belgrade. The measurements used in the study were the Demographic and Academic Questionnaire, Questionnaire about exposure to COVID-19, COVID-19-Impact on QoL Questionnaire (COV19-QoL), Generalized Anxiety Disorder 7-item (GAD-7) scale, and Patient Health Questionnaire (PHQ-9). The mean total score for COV19-QoL was 2.9 ± 0.9, while the diagnostic criteria of GAD-7 and depression met 19.9% and 31.4% of students, respectively. There was a positive and strong correlation between QoL, anxiety, and depression. During COVID-19, predictors for lower perceptions of QoL were female gender and death of close relatives (p = 0.049, p = 0.005, respectively). At the same time, predictors for GAD were female gender, living in dormitories, and death of close relatives (p = 0.019, p = 0.011, p = 0.028, respectively), while for depression they were year of study, living with parents, and death of close relatives due to COVID-19 (p = 0.012, p = 0.008, p = 0.029, respectively). The study showed that students' QoL and mental health during the pandemic were at high risk.

Examining Childhood Adversities in Chinese Health Science Students Using the Simplified Chinese Version of the Adverse Childhood Experiences-International Questionnaire (SC-ACE-IQ)

Adverse childhood experiences (ACEs) are prevalent, costly, and associated with poor health outcomes in adults. Little is known about ACE prevalence rates or strategies for measuring ACEs among young adults in Mainland China. The aims of this study were to (a) translate the ACE-International Questionnaire (ACE-IQ) into Simplified Chinese, (b) assess the psychometric strength of the Simplified Chinese version of the ACE-IQ (SC-ACE-IQ), and (c) compare SC-ACE-IQ scores calculated using binary and frequency scoring methods. The ACE-IQ was translated from English to Simplified Chinese and evaluated for content validity, criterion validity, and test–retest reliability. Chinese young adults (n = 566) aged 18–38 years who were health science students were recruited in Shanghai, China from May to August 2020. ACE exposures were compared using binary and frequency scoring methods, as proposed by the World Health Organization (WHO). The SC-ACE-IQ has good content validity (S-CVI = 0.89) and test–retest reliability (ICC = 0.88). SC-ACE-IQ scores were associated with depressive (binary: r = 0.26, frequency: r = 0.29; p < 0.001) and anxiety (binary: r = 0.22, frequency: r = 0.24; p < 0.001) symptoms. Higher proportion of participants reported exposure to at least one ACE and four or more ACEs when using the binary scoring method compared to the frequency scoring method. The SC-ACE-IQ is a valid and reliable ACE measure for Chinese health science students. Using frequency methods may underestimate exposure to ACEs among this population. Researchers should carefully select scoring methods for different study populations and purposes.

Independent and joint effects of sleep duration and sleep quality on suboptimal self-rated health in medical students: A cross-sectional study

Objective

Studies on the association between sleep behavior and health often ignored the confounding effects of biorhythm-related factors. This study aims to explore the independent and joint effects of sleep duration and sleep quality on suboptimal self-rated health (SRH) in medical students.

Methods

Cross-sectional study. Proportional stratified cluster sampling was used to randomly recruit students from various medical specialties at a medical university in eastern China. Our questionnaire mainly included information on basic demographic characteristics, SRH, sleep behavior, and biorhythm-related factors. The independent and joint effects of sleep duration and sleep quality on suboptimal SRH were assessed by logistic regression after controlling for potential confounders.

Results

Of 1,524 medical students (mean age = 19.9 years, SD = 1.2 years; 59.1% female), 652 (42.8%) had suboptimal SRH. Most medical students (51.5%) slept for 7 h/night, followed by ≥8 (29.1%) and ≤ 6 h (19.4%). After adjusting for basic demographic characteristics and biorhythm-related factors, compared with students who slept for ≥8 h/night, the adjusted ORs (95%CI) for those who slept 7 and ≤ 6 h/night were 1.36 (1.03, 1.81) and 2.28 (1.60, 3.26), respectively (P < 0.001 for trend); compared with those who had good sleep quality, the adjusted ORs (95%CI) for those who had fair and poor sleep quality were 4.12 (3.11, 5.45) and 11.60 (6.57, 20.46), respectively (P < 0.001 for trend). Further, compared with those who slept for ≥8 h/night and good sleep quality, those who slept ≤ 6 h and poor sleep quality had the highest odds of suboptimal SRH (OR 24.25, 95%CI 8.73, 67.34).

Conclusions

Short sleep and poor sleep quality were independently and jointly associated with higher odds of suboptimal SRH among medical students.

The mediating role of psychological capital in relations between spiritual well-being and mental health among nursing students

BACKGROUND

Nursing students face mental and emotional issues due to the nature of their profession. The role of protective factors such as psychological capital and spiritual well-being is vital in improving mental health. This study investigated the mediating role of psychological capital as a mediator in the relationships between spiritual well-being and mental health in Iran.

METHODS

The present study was descriptive, cross-sectional research conducted on 426 undergraduate nursing students within a four-year educational program in Iran from July to December 2021. The participants were selected via convenience sampling. This research used psychological capital scale, spiritual well-being, and general health questionnaire. The collected data were then analyzed using descriptive tests, Pearson correlation, and a structural equation model.

RESULTS

Spiritual well-being positively affects mental health and psychological capital. Psychological capital also is positively related to mental health. Psychological capital partially mediated the effect of spiritual well-being on mental health.

CONCLUSION

According to the results, High level of spiritual well-being can improve nursing students' mental health and the relationship is partially mediated Psychological capital. Therefore, psychological capital is an important factor in improving nursing students' mental health.

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.

Prevalence and influencing factors of anxiety in medical students during the COVID-19 pandemic

Background and objective

The novel coronavirus disease (COVID-19) pandemic has caused a traumatic impact on the whole world in all aspects including physical health, economic condition, and mental health. Psychological problems are commonly neglected for their inconspicuous symptoms. Little is known about the medical students' psychological status during the COVID-19 pandemic. Our study aimed to investigate the prevalence and influencing factors of anxiety among medical students during the COVID-19 pandemic.

Methods

Two thousand and two medical students were investigated in this cross-sectional study. Zung's self-rating anxiety scale was used to evaluate their anxiety symptoms. A total of 1917 questionnaires were collected, and the response rate was 95.8%.

Results

There were 1735 (90.5%) complete and valid questionnaires. The average SAS standard score was 42.8 ± 11.0. The results indicated that the prevalence of anxiety in medical students was 25.9%. Less social support (OR = 1.4, 95%CI 1.2-1.7) is an independent risk factor of anxiety syndrome, while the female (OR = 0.6, 95%CI 0.5-0.8) is less likely to have anxiety syndrome.

Conclusion

The prevalence of anxiety in medical students is higher during the COVID-19 pandemic. Male students and students with less social support are more likely to have anxiety syndrome. Medical educators and students themselves should take serious steps to prevent, recognize and deal with the anxiety prevalence.

Training of Faculty and Staff in Recognising Undergraduate Medical Students’ Psychological Symptoms and Providing Support: A Narrative Literature Review

Mental illness among medical students in particular, and higher education students in general, is very high. Many measures have been suggested in order to improve the situation, including training members of faculty and staff. However, to the best of our knowledge there seem to be no studies proposing training programmes for medical schools’ faculty and staff in response to recognising students’ psychological difficulties and symptoms in order to provide the relevant support. Also, in cases where such training for supporting medical students with psychological symptomatology exist, the efficacy of the approach employed is not known. By employing a careful literature search according to published guidelines for narrative literature reviews, this study aimed to fill in this identified gap in the literature. From the literature search, 14 articles were included in this review and the results show that no training tailored for faculty and staff in medical schools was identified. However, articles that related to higher education were included because they were useful in providing insights for medicine, and show the following: (a) faculty and staff acknowledged the importance of mental illness among students, (b) many of them discussed with their students psychological symptoms and provided support, (c) they tended to feel unprepared for recognising students’ psychological symptoms successfully and providing support, (d) they embraced the idea of being trained, and (e) any training seemed to be helpful for members of faculty and staff. From the results of this narrative review, we propose the CReATE circular pathway to ensure a sustainable process of training and support for students’ development.

Association of depression symptoms and sleep quality with state-trait anxiety in medical university students in Anhui Province, China: a mediation analysis

BACKGROUND

The prevalence of depression symptoms among medical students is particularly high, and it has increased during the COVID-19 epidemic. Sleep quality and state-trait anxiety are risk factors for depression, but no study has yet investigated the mediating role of state-trait anxiety in the relationship between poor sleep quality and depression symptoms in medical students. This study aims to investigate the relationship among depression symptoms, sleep quality and state-trait anxiety in medical university students in Anhui Province.

METHODS

This was a cross-sectional survey of 1227 students' online questionnaires collected from four medical universities in Anhui Province using a convenience sampling method. We measured respondents' sleep quality, state-trait anxiety, and depression symptoms using three scales: the Pittsburgh Sleep Quality Index (PSQI), the State-Trait Anxiety Inventory (STAI) and the Self-rating Depression Scale (SDS). We analysed the mediating role of STAI scores on the association between PSQI scores and SDS scores through the Sobel-Goodman Mediation Test while controlling for covariates. P < 0.05 was considered statistically significant.

RESULTS

A total of 74.33% (912) and 41.40% (518) of the respondents reported suffering from poor sleep quality and depression symptoms. Sleep quality, state-trait anxiety, and depression symptoms were positively associated with each other (β = 0.381 ~ 0.775, P < 0.001). State-trait anxiety partially mediated the association between sleep quality and depression symptoms (Sobel test Z = 15.090, P < 0.001), and this mediating variable accounted for 83.79% of the association when adjusting for potential confounders. Subgroup analysis further revealed that STAI scores partially mediated the association between PSQI scores and SDS scores in females and rural students and fully mediated the association between PSQI scores and SDS scores in males and urban students.

CONCLUSIONS

This study found that sleep quality and state-trait anxiety have a significant predictive effect on depression symptoms. State-trait anxiety mediated the relationship between sleep quality and depression symptoms, with a more complex mechanism observed among rural and female medical students. Multiple pathways of intervention should be adopted, such as encouraging students to self-adjust, providing professional psychological intervention and timely monitoring, enriching extracurricular activities, and making changes in policies regarding long shifts and working hours.