Coping flexibility in college students with depressive symptoms

Coping Flexibility: Match Between Coping Strategy and Perceived Stressor Controllability Predicts Depressed Mood

Individual differences in coping responses can predict psychological distress, anxiety, and depression; therefore, it is vital to explore adaptive coping strategies. Recent research suggests that an individual's ability to choose strategies based on the context may be more important than the ability to use any one strategy, an ability termed coping flexibility. For example, problem-focused coping is adaptive for situations of high control, while emotion-focused coping is adaptive for situations of low control. This conceptualization of coping flexibility, termed strategy-situation fit, consists of the match of strategy to situation. The purpose of the present study was to evaluate if daily fluctuations in strategy-situation fit for daily stressors would be associated with daily levels of depressed mood. A seven-day diary study in a sample of undergraduate students (n = 75) was completed. The results of generalized linear mixed models demonstrated that in situations of high stress and high control, more use of emotion-focused coping was related to higher levels of depressed mood. Additionally, in situations of high stress and low control, more use of emotion-focused coping was related to lower levels of depressed mood. These findings suggest that the match between emotion-focused coping and perceived stressor controllability can be a predictor of daily experiences of depressed mood when faced with high-level stressors.

Tattooing Among Combat Soldiers as a Coping Resource With Their Military Service Experiences

This study aims to examine how former combat soldiers use tattoos as a coping resource in response to their military service experiences. Qualitative analysis of semi-structured interviews with eight combat soldiers identified two main themes: (a) the military events and distress as a background story of the tattoos; (b) the tattoos' meaning as a coping resource for military service experiences. The thematic analysis revealed two coping resources which the soldiers utilised through tattooing. The first is the emotional-relief coping resource, which allows combat soldiers to express and process their emotions in response to events experienced during their military service, and helps them reduce feelings of stress. The second is the positive-productive coping resource that enhances positive feelings, serves as an empowering, promoting and strengthening resource, and expresses a transformative process of change. The findings also revealed that both of the coping resources were adaptive coping resources. This study contributes to the limited research on tattooing among combat soldiers, expands the knowledge regarding tattoos as a coping resource with military service, and identifies two types of coping resources utilised by combat soldiers. On a practical level, our findings offer insights for interventions aimed at promoting awareness among combat soldiers about the effectiveness of tattooing.

Unveiling the interplay of medical professionalism, mental well-being and coping in medical students: a qualitative phenomenological study

BACKGROUND

Medical students face significant stress and challenges that impact their professional development by affecting their levels of medical professionalism (MP), coping ability, and mental well-being (MWB). Given the high-stakes environment of medical education, understanding the interplay between these factors is crucial. This study aims to explore undergraduate medical students' lived experiences of MP, coping strategies (CSs), and MWB to inform the development of effective support systems.

METHODS

A qualitative phenomenological study was conducted using Focus Group Discussions (FGDs) to capture the lived experiences of 40 medical students from first, third, and fifth years of study. Participants, selected through purposive sampling, represented diverse backgrounds (with 27 females, 18 fifth-year students, and 30 Malays). Seven FGDs, each with 5-10 participants, were conducted via Zoom©, yielding comprehensive qualitative data. An inductive coding approach was applied through iterative transcript analysis to ensure robust findings.

RESULTS

Analysis revealed two themes related to MWB: 'mental well-being issues,' highlighting persistent mental health challenges, and 'happiness,' illustrating factors that sustain well-being. CSs were categorized into 'positive coping,' including seeking support, and 'negative coping,' such as denial. For MP, two themes emerged: 'inter-medical professionalism,' focusing on communication with others, and 'intra-medical professionalism,' emphasizing ethical self-conduct.

CONCLUSION

The interplay between CSs, MP, and MWB is complex and deeply intertwined. The findings highlight the importance of developing targeted interventions to support medical students in managing stress, maintaining professionalism, and enhancing their mental well-being throughout their training. Future research should further explore these themes to inform policy and curriculum development in medical education.

CLINICAL TRIAL NUMBER

Not applicable.

The Pathway Relationship Between Physical Activity Levels and Depressive Symptoms in University Students Mediated by Cognitive Flexibility

OBJECTIVE

To explore the mediating pathway of cognitive flexibility in the relationship between physical activity and depressive symptoms among university students.

METHODS

A cross-sectional design was used to survey 2537 university students using the Physical Activity Rating Scale-3, Patients' Health Questionnaire, and Cognitive Flexibility Inventory. Data analysis was conducted using independent samples t-test, chi-square test, correlation analysis, one-way ANOVA, and mediation analysis.

RESULTS

A statistically significant negative correlation exists between the intensity of physical activity and depression symptom scores (r = -0.104, p < 0.01). The intensity of physical activity demonstrates a statistically significant positive correlation with controllability (r = 0.109, p < 0.01). A marked negative correlation is observed between depressive symptoms and controllability scores (r = -0.367, p < 0.01). The total effect of physical activity intensity on depressive symptoms was quantified as -0.3542 (95% CI: -0.5439 to -0.1645). The direct effect was found to be -0.2199 (95% CI: -0.3981, -0.0417), while the mediating effect of controllability was calculated to be -0.1343 (95% CI: -0.2145 to -0.0630).

CONCLUSION

Increased engagement in physical activity among university students is associated with a reduction in their depressive symptom scores. Controllability serves as a mediating factor in the relationship between physical activity and depressive symptoms among university students.

Endophenotype 2.0: updated definitions and criteria for endophenotypes of psychiatric disorders, incorporating new technologies and findings

Recent genetic studies have linked numerous loci to psychiatric disorders. However, the biological pathways that connect these genetic associations to psychiatric disorders' specific pathophysiological processes are largely unclear. Endophenotypes, first defined over five decades ago, are heritable traits, independent of disease state that are associated with a disease, encompassing a broad range of neurophysiological, biochemical, endocrinological, neuroanatomical, cognitive, and neuropsychological characteristics. Considering the advancements in genetics and genomics over recent decades, we propose a revised definition of endophenotypes as 'genetically influenced phenotypes linked to disease or treatment characteristics and their related events.' We also updated endophenotype criteria to include (1) reliable measurement, (2) association with the disease or its related events, and (3) genetic mediation. 'Genetic mediation' is introduced to differentiate between causality and pleiotropic effects and allows non-linear relationships. Furthermore, this updated Endophenotype 2.0 framework expands to encompass genetically regulated responses to disease-related factors, including environmental risks, illness progression, treatment responses, and resilience phenotypes, which may be state-dependent. This broadened definition paves the way for developing new endophenotypes crucial for genetic analyses in psychiatric disorders. Integrating genetics, genomics, and diverse endophenotypes into multi-dimensional mechanistic models is vital for advancing our understanding of psychiatric disorders. Crucially, elucidating the biological underpinnings of endophenotypes will enhance our grasp of psychiatric genetics, thereby improving disease risk prediction and treatment approaches.

Associations of coping and health-related behaviors with medical students' well-being and performance during objective structured clinical examination

Objective structured clinical examination (OSCE) is a valid method to evaluate medical students' competencies. The present cross-sectional study aimed at determining how students' coping and health-related behaviors are associated with their psychological well-being and performance on the day of the OSCE. Fourth-year medical students answered a set of standardized questionnaires assessing their coping (BCI) and health-related behaviors before the examination (sleep PSQI, physical activity GPAQ). Immediately before the OSCE, they reported their level of instant psychological well-being on multi-dimensional visual analogue scales. OSCE performance was assessed by examiners blinded to the study. Associations were explored using multivariable linear regression models. A total of 482 students were included. Instant psychological well-being was positively associated with the level of positive thinking and of physical activity. It was negatively associated with the level of avoidance and of sleep disturbance. Furthermore, performance was negatively associated with the level of avoidance. Positive thinking, good sleep quality, and higher level of physical activity were all associated with improved well-being before the OSCE. Conversely, avoidance coping behaviors seem to be detrimental to both well-being and OSCE performance. The recommendation is to pay special attention to students who engage in avoidance and to consider implementing stress management programs.Clinical trial: The study protocol was registered on clinicaltrial.gov NCT05393206, date of registration: 11 June 2022.

Impact of mental and developmental disorders on disability in Japanese university students: A cross-sectional study

OBJECTIVE

This study utilized the World Health Organization Disability Assessment Schedule version 2 (WHODAS 2.0) to identify vulnerable students and explore the impact of mental and developmental disorders on disability.

PARTICIPANTS

A total of 156 undergraduates who visited support service offices at large-scale universities in Japan between April 2018 and March 2020 were included.

METHODS

The 36-item WHODAS 2.0 was administered, and data were gathered regarding mental and developmental disabilities. Mann-Whitney and Kruskal-Wallis tests were conducted.

RESULTS

Parents/guardians typically initiated consultation with student support services. Students whose parents had initiated consultation did not have higher scores in any WHODAS domain except "Life Activities." In every WHODAS domain except "Cognition," the "Mental Disorder" group scored significantly higher than the "No Disorder" group. The addition of "Developmental Disorders" significantly increased WHODAS scores, except in "Mobility."

CONCLUSIONS

The WHODAS is a useful tool for identifying vulnerable students.

The positive effects of positive coping on mental health in college students during the COVID-19 campus lockdown

Objectives

Isolation has been an effective method to control the spread of COVID-19 over the past 3 years. However, lifestyle changes may have a negative impact on mental health. To examine the effects of positive coping on mental health in college students during the COVID-19 campus lockdown, this study conducted an online cross-sectional survey.

Methods

In October 2022, following a prolonged campus lockdown of nearly 3 years, 313 university students from a university in Shandong Province, China, were invited to complete an online questionnaire. The questionnaire comprised a self-administered general situation questionnaire, the Simple Coping Style Scale, and the Hospital Depression and Anxiety Scale.

Results

(1) The analysis of variance revealed a significant main effect of coping Style on depression [F(4,300) = 2.446, p = 0.047] during the COVID-19 campus lockdown. A post-hoc test indicated that college students who engaged in study (p = 0.012) or sports (p = 0.027) during their free time had significantly lower depression scores than those who used the Internet. (2) Independent sample t-tests showed significant differences in positive and negative coping styles among college students in terms of depression (t = 6.891, p < 0.001) and anxiety scores (t = 7.745, p < 0.001). (3) Pearson correlation analysis demonstrated a negative correlation between positive coping style and anxiety (r = -0.378, p < 0.001), and between positive coping style and depression (r = 0.427, p < 0.001). Positive correlations were also found between the negative coping style and anxiety (r = 0.155, p = 0.007), and between the negative coping style and depression (r = 0.190, p < 0.001).

Discussion

The study suggested that fostering positive coping in students can mitigate mental health issues during crises, providing a blueprint for university mental health initiatives during epidemics.

Small and medium enterprises (SMEs) in a pandemic: A systematic review of pandemic risk impacts, coping strategies and resilience

Small and Medium Enterprises (SMEs) are particularly vulnerable to pandemics. Therefore, resilience and adaptation to shocks from pandemics such as COVID-19 are urgently needed. However, despite some coping strategies already in place among SMEs, research on their nature and effectiveness is limited. Thus, it remains unclear how effectively and sustainably documented coping strategies reduce SMEs' vulnerability and increase their resilience to pandemic risk. This article reviews academic literature for evidence of pandemic risk impacts on SMEs, coping strategies in response to these impacts, and the degree to which these strategies reduce SMEs' vulnerability and increase their resilience. According to the literature review, seven essential pandemic risk impacts were identified for SMEs - human movement restrictions, financial constraints, operational challenges, logistics difficulties, delayed business reopening, short-term policy focus and tacit knowledge workers. The study also outlined eleven critical coping strategies, notably structural or physical and behavioural changes. Study analysis reveals that resilience research among SMEs is predominantly conceptual with limited empirical evidence. To conclude, this study urges more adaptation research focused on developing new forms of pandemic risk education for SMEs addressing their complexities.

Mental health status and stressful life events among postgraduate nursing students in Cyprus: a cross-sectional descriptive correlational study

BACKGROUND

Despite prior evidence supporting the association between stressful life events and mental health status, there are limited data on the number and severity of stressful life events and their effects on university students' mental health status. Therefore, the present study aimed to: (a) examine mental health status and subsequent predictors of clinically significant mental distress symptoms, (b) estimate the number and severity of stressful life events, and (c) explore the associations between mental health status, stressful life events (number and severity) and sociodemographic characteristics.

METHODS

This study was descriptive, cross-sectional, and correlational with internal comparisons. A convenience sample of 90 Master of Science in nursing and midwifery students, participated in the study. Participants with a General Health Questionnaire-28 (GHQ-28) total score ≥ 24 were considered to have clinically significant mental distress symptoms. Descriptive and inferential statistics were evaluated, and Pearson's chi-square test for group differences was used to analyse the data. Analysis of variance and t-tests were used for comparisons between two or more groups, and regression analyses were employed to identify the predictors of GHQ-28 scores and clinical mental distress symptoms.

RESULTS

The final sample comprised 90 students (response rate: 97.8%), 33 (36.7%) of whom reported clinically significant symptoms of mental distress. Students with divorced parents [29.92 (± 10.62), p < .05] scored high on the GHQ-28. Participants who had low/no satisfaction with the education system posted higher scores than participants who had high/very high satisfaction [24.82 (± 11.68) vs. 17.93 (± 9.78), p < .05]. In the subscale measuring depressive symptoms, there was a statistically significant gender difference, with men reporting higher scores than females. [3.0± (3.69) vs. 1.60 (± 2.42), p = .034]. In multiple analyses of sociodemographic characteristics and those who scored higher on the Life Events Scale for Students (LESS) scale (≥ 340), the loss of parent/s was associated with the total GHQ-28 score (B=-17.046, p < .001). In multiple analyses, chronic physical disorders or disabilities and numerous stressful life events among students (≥ 8 events) were correlated with higher overall GHQ-28 scores (B = 15.232, p < .005).

CONCLUSION

The high frequency of clinical symptoms of mental distress among postgraduate university nursing students and their correlation with stressful life events highlights the need for university counselling services to provide psychological support strategies to students.

Stress-Buffering Effects of Social Support on Tourism Employees during the COVID-19 Pandemic: A Moderated Mediation Model

Since the beginning of 2020, China's tourism industry has been severely impacted by the COVID-19 pandemic, and domestic tourism revenues have plummeted. Tourism employees have faced reduced working hours, job instability, shut down, and unemployment. In the context of the normalization of epidemic prevention, the tourism industry is recovering slowly and uncertainly, and many tourism employees face increasing employment stress. To investigate the relationship between social support and employment stress among tourism employees, 308 tourism employees were surveyed, and the mediating role of positive coping styles and the moderating role of psychological resilience were examined using structural equation modeling. The results revealed three key findings: social support significantly and negatively influenced the employment stress of tourism employees; positive coping styles significantly mediated the relationship between social support and employment stress among tourism employees; and psychological resilience moderated the relationship between social support and employment stress among tourism employees, as well as moderating the relationship between social support and positive coping style. The current findings help to deepen the understanding of the relationship between social support and employment stress, and they have important implications for alleviating the employment stress of tourism employees in the context of the pandemic.

The influence of resilience on stress reaction of college students during COVID-19: the mediating role of coping style and positive adaptive response

The COVID-19 pandemic was a stressful event for all. It threatened people's physical and mental health. Previous studies have found that resilience can help people deal with stress and difficulties more effectively and prevent them from mental health problems. Coping style mediates the relationship between resilience and psychological well-being. Given the novelty and recency of the COVID-19, it is unknown whether resilience can also protect individuals in new difficulties, and whether the previous effective coping styles can be applied to new situations. The current study aimed to explore the influence mechanism of college students' resilience on negative stress response during the pandemic, and the chain mediation of coping style and positive adaptive response. A questionnaire survey was conducted among 910 college students (Mage = 20.58 years; 41.1% men, 58.9% women) studying in Shanghai by stratified random cluster sampling. At that time, they were in 27 different provinces and cities because of the COVID-19 pandemic lockdown. The research tools included Connor-Davidson Resilience Scale (CD-RISC), Simplified Coping Style Questionnaire (SCSQ), Positive Adaptive Response Questionnaire (PARQ), and Negative Stress Reaction Questionnaire (NSRQ). The results showed that: (1) College students' resilience, coping style, positive adaptive response and negative stress reaction were significantly correlated with each other; (2) Resilience could not directly affect negative stress reaction, but it could affect negative stress reaction through the chain mediation of coping style and positive adaptive response. These findings suggest that resilience enhancement intervention programs need to focus on the cultivation of individual positive coping style; In response to major emergencies such as the COVID-19 pandemic, officials can help people reduce negative stress reaction by disseminating positive coping strategies through the media.

Uso de ansiolíticos e antidepressivos entre estudantes de medicina de uma universidade

Objetivou-se identificar o uso de medicamento ansiolítico e/ou antidepressivo e associá-lo às características dos estudantes de medicina de uma universidade. Trata-se de um estudo com 449 estudantes de medicina no interior do estado de São Paulo. O uso de medicamento antidepressivo e/ou ansiolítico era feito por 24,3% dos estudantes, sendo a maior parte do sexo feminino e cursando os dois primeiros anos da faculdade. Não houve associação entre o uso de medicamento e os fatores como: idade, renda, morar com a família, horas de sono, relação com docentes e ter pai e mãe vivos. Observou-se maior chance de fazer terapia entre os estudantes que usavam medicamento (β=1,12, OR=3,07, p<0,001) e uma menor chance de realizar exercício físico (β=-0,051, OR=0,60, p=0,03). Estratégias para o manejo da depressão e da ansiedade devem ser incentivadas e ações para reduzir o estresse durante o curso devem fazer parte de um programa de apoio das universidades. 

There must be a way out: The consensual qualitative analysis of best coping practices during the COVID-19 pandemic

Despite the continuous efforts to understand coping processes, very little is known about the utilization of best coping strategies during the COVID-19 pandemic. In this study, we aimed to analyze the coping strategies of individuals who scored high on an adaptive coping questionnaire in order to understand the most adaptive coping strategies during the COVID-19 pandemic. We used consensual qualitative analysis in a team of four researchers and one auditor. The convenience sample from which we identified the high scorers comprised 1,683 participants (67% women, 32.35% men, and 0.65% did not report their gender) with a mean age of 31.02 years (SD = 11.99) ranging between 18 and 77 years old. Based on their scoring in the COPE Inventory, nine participants were selected from the sample with the highest scores in coping skills in at least two out of its 15 subscales. In-depth repeated interviews with six participants for the main analysis were conducted, and three were added to check the data saturation. The results showed that the most adaptive coping strategies used during the COVID-19 pandemic could be categorized into four main domains: self-compassion, compassion to others, compassion from others, and mutual compassion. The most frequently mentioned and the most elaborated upon by our respondents was the domain of self-compassion. The most interesting finding was the emergence of the fourth type of compassion, labeled mutual compassion, which referred to deliberate attempts to take care of oneself and others while suffering together in order to elevate the suffering for both. This kind of compassion might arise in the situations of collective suffering, such as a catastrophe or a pandemic and might have the additional benefit of bringing people closer to each other in difficult times.

Variations in mindfulness associated with the COVID-19 outbreak: Differential effects on cognitive failures, intrusive thoughts and rumination

The lockdown due to the coronavirus outbreak in 2019 (COVID-19) has caused psychological distress and cognitive discomfort for emerging adults, who have experienced increased rumination, intrusive thoughts and cognitive failures. States of mindfulness and being in the moment can prevent anxiety and fear associated with the lockdown and alleviate ruminative and automatic negative thinking. This longitudinal study investigated the role of mindfulness before and during the COVID-19 lockdown in protecting a sample of emerging adults from experiencing cognitive failures, intrusive thoughts and rumination and examined how lockdown-related variables-emotions, socio-economic status and housing conditions-influenced this mindfulness profile. The results showed overall more cognitive failures and rumination during lockdown, especially in participants whose mindfulness status diminished. However, these signs of cognitive distress remained stable or decreased among participants who reported improved changes in mindfulness. Financial difficulties and a reduced sense of privacy associated with the lockdown predicted lower stability in mindfulness profiles. The state of being fully aware of what is happening in the present moment may be helpful in reducing cognitive discomfort and psychological maladjustment, especially during stressful times such as lockdowns.

Association between common stressful life events and coping strategies in adults

BACKGROUND

As shown in previous persons that used the effective coping strategies are more aware to recent stressful life events in their live, this study conducted to investigate the main stressful life events and common coping styles in adult's population.

MATERIALS AND METHODS

This cross-sectional study was conducted in 2018. In overall, 345 persons aged 18 years and more by stratified cluster sampling were enrolled in the study. The valid questionnaires including the coping inventory for stressful situations-21, the Holmes-Rahe Stress Inventory, and 28-item General Health Questionnaire (GHQ-28) were used to interview. The analysis of variance and t-student (t-test) was used to determine the association between the two variables. The statistical significance level was considered <0.05.

RESULTS

The top three importance events among 43 stressful items in our study were change in financial state, gain of a new family member, and death of close family member. We found that task-oriented coping (P < 0.001) and avoidance-oriented coping (P = 0.021) significantly more used in males compered to females. According to Holmes-Rahe life stress inventory instructions only 4.7% of participants are prone to getting ill in next 2 years.

CONCLUSION

The results of this study showed a positive relationship between coping styles and lower risk of mental health problems and stressful life events. Hence, activities and training programs aiming to enhance personal approach coping skills is important to reduce of side effects of stressful life events especially those recently exposed to negative life events and stresses.

Post-traumatic Growth and Related Influencing Factors in Discharged COVID-19 Patients: A Cross-Sectional Study

The purpose of this study is to investigate the current state of post-traumatic growth (PTG) and identify its influencing factors in discharged COVID-19 patients. PTG refers to individual experiences of significant positive change arising from the struggle with a major life crisis. This descriptive cross-sectional study used the convenient sampling method to recruit 140 discharged COVID-19 patients in Hunan, China. The results show that the PTG of the discharged COVID-19 patients was positively correlated with self-esteem, post-traumatic stress disorder, coping style tendency, and social support, but negatively correlated with the time from onset to diagnosis. Our findings could provide guidance on improving the psychological state and well-being of discharged COVID-19 patients.

Prevalence and its associated factors of depressive symptoms among Chinese college students during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has caused a mental health crisis around the world. The psychological health of college students also faces great challenges. This study aimed to investigate the prevalence and the related factors of depressive symptoms among Chinese college students.

METHODS

This online cross-sectional survey was conducted via Wenjuanxing platform from March 3-15, 2020 and received 1681 effective questionnaires. Each questionnaire contains the Center for Epidemiologic Studies Depression scale, the Multi-Dimensional Scale of Perceived Social Support, the Herth Hope Index, and the self-designed items. Multivariable logistic regression was conducted to determine the significantly associated factors of depressive symptoms.

RESULTS

The prevalence of depressive symptoms among college students was 56.8%. Sleep problems (OR 2.678, 95%CI 2.094-3.424), family members' going out (OR 1.775, 95%CI 1.089-2.894), perceived more stress for online education (OR 1.642, 95%CI 1.191-2.263), fear of COVID-19 (OR 1.450, 95%CI 1.121-1.876), influence on social interaction (OR 1.354, 95%CI 1.053-1.741) and higher grade (OR 1.378, 95%CI 1.046-1.816) were considered as risk factors of depressive symptoms. Perceived social support (OR 0.354, 95%CI 0.259-0.484), hope (OR 0.052, 95%CI 0.034-0.080), female (OR:0.557, 95%CI 0.427-0.725) and higher monthly disposable income (OR 0.666, 95%CI 0.447-0.993) were identified as protective factors against depressive symptoms.

CONCLUSIONS

There was a high prevalence of depressive symptoms among Chinese college students during the COVID-19 pandemic. It is important to find ways to alleviate the pressure and fear of college students, to provide them with more social support, and to help them adapt to the changes in learning style and lifestyle.

Adjustment to a "New Normal:" Coping Flexibility and Mental Health Issues During the COVID-19 Pandemic

The Coronavirus Disease 2019 (COVID-19) pandemic is an unprecedented health crisis in terms of the scope of its impact on well-being. The sudden need to navigate this "new normal" has compromised the mental health of many people. Coping flexibility, defined as the astute deployment of coping strategies to meet specific situational demands, is proposed as an adaptive quality during this period of upheaval. The present study investigated the associations between coping flexibility and two common mental health problems: COVID-19 anxiety and depression. The respondents were 481 Hong Kong adults (41% men; mean age = 45.09) who took part in a population-based telephone survey conducted from April to May 2020. Self-report data were assessed with the Coping Flexibility Interview Schedule, COVID-19-Related Perception and Anxiety Scale, and Center for Epidemiological Studies Depression Scale. Slightly more than half (52%) of the sample met the criteria for probable depression. Four types of COVID-19 anxiety were identified: anxiety over personal health, others' reactions, societal health, and economic problems. The results consistently revealed coping flexibility to be inversely associated with depression and all four types of COVID-19 anxiety. More importantly, there was a significant interaction between perceived likelihood of COVID-19 infection and coping flexibility on COVID-19 anxiety over personal health. These findings shed light on the beneficial role of coping flexibility in adjusting to the "new normal" amid the COVID-19 pandemic.

Psychological resilience and positive coping styles among Chinese undergraduate students: a cross-sectional study

Background

Psychological resilience and coping strategies have been found to be related to various psychological and mental health problems. Evaluations of the relationship between resilience and coping style among university students are important for developing effective health promotion strategies focused on resilience intervention to benefit students’ health and well-being. The relationship between psychological resilience and coping styles has usually been examined among adults and patients. Very few studies have investigated the relationship between resilience and coping style in university students. The present study aimed to investigate the associations between psychological resilience, students’ characteristics (gender, major and grade) and coping styles among undergraduate students.

Methods

A cross-sectional survey was conducted among undergraduate students in Shandong Province, China. Undergraduate students were randomly selected from 6 universities in 3 cities of the province using a stratified random sampling method. The questionnaire included questions on the participants’ demographic information, including gender, grade and major, measures of psychological resilience and coping style. Coping style was measured by the Simplified Coping Style Questionnaire (SCSQ). The Asian Resilience Scale (ARS) was applied to evaluate undergraduates’ psychological resilience. Multivariable regression analysis was used to examine the relationships between resilience, students’ characteristics and positive coping styles.

Results

A sample of 1743 undergraduates was analysed. The mean psychological resilience score was 70.41. The mean score for positive coping style was 24.72. Multiple regression analysis showed that three factors of psychological resilience, mood control, self-plasticity and coping flexibility, were all significant factors for positive coping styles (regression coefficient = 0.34, 0.35, 0.14, p < 0.01 for the three factors, respectively). Medical students and females had higher scores for positive coping styles than non-medical students and males (p < 0.01).

Conclusions

The research revealed that females and medical students are more likely than males and non-medical students to adopt positive coping styles. Higher psychological resilience is associated with a better positive coping style. The findings suggest that psychological education and health promotion programmes that target strengthening psychological resilience among undergraduate students may help foster positive coping styles to benefit their mental health and psychological well-being.

How to Cope with the Challenges of Medical Education? Stress, Depression, and Coping in Undergraduate Medical Students

OBJECTIVES

Up to 90% of medical students experience stress. Studies have observed a relationship between stress and depression. Coping strategies to deal with stress and depression are of great interest. This study aimed to evaluate the prevalence of stress and depression and the efficacy of coping strategies in undergraduate medical students.

METHODS

This survey was conducted with 589 second-year and sixth-year students in 2017 at the Medical University of Vienna. The questionnaire included a stress and coping questionnaire, depression screening, substance use questionnaire, and questionnaire concerning leisure time activities.

RESULTS

The coping strategies were included in a regression model to assess their predictive value for stress and depression screening scores. The most common stressor was performance pressure overload (92.1%). Overall, 52.4% of the participating students reached critical scores in the depression screening. Positive thinking and active coping were associated with lower stress scores. Positive thinking also was a protective factor against depressive symptoms. Less than 2% of all students reached high-risk values for substance use.

CONCLUSION

Accessible counseling for students in need of psychological care should be provided. Different interventions of positive psychology showed a positive impact on depression screening scores.

Association between oral health-related quality of life and depressive symptoms in Chinese college students: Fitness Improvement Tactics in Youths (FITYou) project

BACKGROUND

This study aimed to investigate a gender-specific association between oral health-related quality of life (OHRQoL) and depressive symptoms in college students, as there are limited relevant studies conducted among youths.

METHODS

In 2017, a cross-sectional study of 3461 Chinese college students was conducted in Shenyang, China. OHRQoL and depressive symptoms were screened by a 14-item oral health impact profile questionnaire and a Self-rating Depression Scale, respectively. A multivariable logistic regression analysis was performed to examine the association of OHRQoL with depressive symptoms.

RESULTS

The number of youths reported to have depressive symptoms was 20.7%. A univariate analysis showed that categories with a OHRQoL score over 6 were more likely to have a higher prevalence of depressive symptoms compared to the category with a score of 0 (male: ORs [95% CI]: 3.10, 2.05-4.68, P < 0.001; female: ORs [95% CI]: 3.11, 2.38-4.05, P < 0.001). Similar results were observed after adjusting for sociodemographic, anthropometric, and lifestyle-related covariates (male: ORs [95% CI]: 3.07, 1.98-4.76, P < 0.001; female: ORs [95% CI]: 2.90, 2.21-3.81, P < 0.001).

CONCLUSIONS

College students who have higher OHRQoL tend to have a lower prevalence of depressive symptoms.

Appraisals of dependent stressor controllability and severity are associated with depression and anxiety symptoms in youth

BACKGROUND AND OBJECTIVES

Stress is well established as a strong risk factor for internalizing psychopathology. Learned helplessness research demonstrates that perceived controllability of stressors affects internalizing symptoms. Furthermore, subjective perceived stress is associated with psychopathology. However, most recent research has focused on measuring the frequency and expert-rated severity of stressful life events despite evidence for the importance of stress perceptions. The present study brings together past and current literatures to investigate the importance of perceived severity and controllability of recent life events in the association between stressors and internalizing symptoms.

DESIGN AND METHODS

We used a revised version of the Adolescent Life Events Questionnaire (ALEQ) that asked participants (ages 13-22, N = 328) to rate the frequency of 65 stressful events typical to youth, as well as the perceived stressfulness and control they felt over each event. Events were categorized prior to analysis as dependent (self-generated), independent (fateful) or neither.

RESULTS

Controllability and severity appraisals were associated with depression and anxiety symptoms, controlling for stressor frequency (which also predicted symptoms), for dependent but not independent stressors.

CONCLUSIONS

These results highlight the importance of controllability and severity appraisals as potential risk factors for internalizing disorders, exposing a potential target for therapy.

Depressive symptoms among first-year Chinese undergraduates: The roles of socio-demographics, coping style, and social support

The prevalence of depressive symptoms among Chinese university students seems to be increasing. However, little research has been conducted in order to examine whether and how socioeconomic factors, coping style and social support affect depressive symptoms among university freshmen. The present study aimed to explore these effects on a sample of freshmen from single- and multi-child households in urban and rural environments. A total of 2,563 university freshmen (883 women, 1,680 men; mean age, 18.27 yr) from three universities in China completed a demographic questionnaire, Patient Health Questionnaire-9, Social Support Rating Scale, and Coping Style Questionnaire. Pearson correlation coefficients suggested that gender and place of origin affected students' coping styles, social support, and depression. Depression was negatively associated with problem-solving and help-seeking, but positively associated with self-blaming, fantasizing, avoidance, and rationalization. Logistic regression showed that depression was predicted by engaging in self-blame and fantasizing, being female, coming from a rural area, being an only child, lacking subjective and social support, having low skills at problem-solving and help-seeking. These findings may help psychological service providers identify first-year students at risk of depressive symptoms and provide them with systematic, gender-specific interventions that pay specific attention to self-blaming and fantasizing coping style.

Measurement Invariance of the Depression Anxiety Stress Scales-21 Across Gender in a Sample of Chinese University Students

The Depression Anxiety Stress Scales-21 (DASS-21) has three 7-item subscales (depression, anxiety, and stress). The current study aims assess the gender-based measurement invariance of the DASS-21 questionnaire in a Chinese university student sample from five different cities. The sample was composed of 13208 participants (62.3% female, mean age of 19.7 years, and SD age = 1.8). Multi-group confirmatory factor analysis supported full measurement invariance for the three subscales. The findings support the measurement invariance of DASS-21 scores across gender. Future research on the DASS should include additional validation across ethnicities and testing of all versions of the DASS.

Inflexibility as a Vulnerability to Depression: A Systematic Qualitative Review

The study of vulnerabilities to depression typically identifies factors that are thought to be universally maladaptive or adaptive. In contrast, researchers recently have theorized that the ability to flexibly engage in different thoughts and behaviors that fit situational demands may be most indicative of psychological health. We review empirical evidence from 147 studies reporting associations between five components of flexibility (set-shifting, affective set-shifting, cardiac vagal control, explanatory flexibility, and coping flexibility) and depression and classify studies according to strength of study design. Evidence from correlational and case-controlled studies suggests cross-sectional relationships, but few prospective studies have been conducted. We discuss limitations of existing studies, identify new directions for programmatic research, and discuss implications that flexibility has for the prevention and treatment of depression.

Sleep and somatic complaints in university students

BACKGROUND

Sleep problems are common among university students. Poor sleep is associated with impaired daily functioning, increased risk of psychiatric symptoms, and somatic complaints such as pain. Previous results suggest that poor sleep exacerbates pain, which in turn negatively affects sleep. The purpose of the present study was to determine prevalence rates, comorbidity, and role of depression as a factor of moderating the relationship between sleep and physical complaints in German university students.

SAMPLES AND METHODS

In total, 2443 German university students (65% women) completed a web survey. Self-report measures included the Pittsburg Sleep Quality Index, three modules of the Patient Health Questionnaire, and a questionnaire on the functional somatic syndromes (FSSs).

RESULTS

More than one-third (36.9%) reported poor sleep as assessed by the Pittsburgh Sleep Quality Index. Somatoform syndrome was identified in 23.5%, and the prevalence of any FSS was 12.8%. Self-reported sleep quality, sleep onset latency, sleep disturbances, use of sleep medications, and daytime dysfunctioning were significant predictors of somatoform syndrome, whereas sleep efficiency and sleep duration influenced somatic complaints indirectly. Moderate correlations were found between stress, anxiety, somatoform syndrome, depression, and overall sleep quality. The effect of somatic complaints on sleep quality was associated with the severity of depression. Anxiety shows direct effects on somatization and depression but only indirect associations with sleep quality.

Depression, Anxiety and Symptoms of Stress among Baccalaureate Nursing Students in Hong Kong: A Cross-Sectional Study

This study examines the prevalence of depression, anxiety and symptoms of stress among baccalaureate nursing students in Hong Kong. Recent epidemiological data suggest that the prevalence of mild to severe depression, anxiety and stress among qualified nurses in Hong Kong stands at 35.8%, 37.3% and 41.1%, respectively. A total of 661 nursing students were recruited to participate in our cross-sectional mental health survey using the Depression, Anxiety and Stress Scale 21. Multiple logistic regression was used to determine significant relationships between variables. Working in general medicine, being in financial difficulty, having sleep problems, not having leisure activity and perceiving oneself in poor mental health were significant correlates of past-week depression, anxiety and stress. Year of study, physical inactivity and family crisis in the past year correlated significantly with depression. Imbalanced diets significantly correlated with anxiety. Stress was significantly associated with a lack of alone time. This is the first study to confirm empirically that clinical specialty, financial difficulties and lifestyle factors can increase nursing students’ levels of depression and anxiety and symptoms of stress. Prevention, including the early detection and treatment of mental disorder, promises to reduce the prevalence of these indicators among this group.

Prevalence of Depression among Chinese University Students: A Meta-Analysis

Background

Depression is a major mental health issue worldwide, and university students with heavy burdens of study are at a high risk for depression. While a number of studies have been conducted regarding depression among university students in China, there is a lack of information regarding the national prevalence of depression among Chinese university students. Therefore, we performed a meta-analysis to statistically pool the prevalence of depression among Chinese university students.

Methods

A systematic search of scientific databases was conducted, including Chinese Web of Knowledge, Embase, PubMed, Wanfang (a Chinese database) and Weipu (a Chinese database) to find relevant publications published between 1995 and December 2015. This was supplemented by a secondary review of the reference lists of all retrieved papers to find additional relevant citations. Studies published in either English or Chinese that provided prevalence estimates of depression in Chinese university students were considered. Prevalence estimates of each eligible study were extracted and pooled in our meta-analysis using a random-effects model.

Results

A total of 39 studies conducted between 1997 and 2015 including 32,694 university students were analyzed. Our results indicate that the overall prevalence of depression among Chinese university students is 23.8% (95% CI: 19.9%–28.5%). Substantial heterogeneity in prevalence estimates was noted. Subgroup analysis revealed that the prevalence of depression among medical students is higher than among other students.

Conclusions

Overall, the prevalence of depression among Chinese university students is exceedingly high. This suggests that it is imperative that more attention be given to the development of appropriate mental healthcare strategies for university students in China.

The interplay of stressful life events and coping skills on risk for suicidal behavior among youth students in contemporary China: a large scale cross-sectional study

BACKGROUND

Stressful life events are common among youth students and may induce psychological problems and even suicidal behaviors in those with poor coping skills. This study aims to assess the influence of stressful life events and coping skills on risk for suicidal behavior and to elucidate the underlying mechanism using a large sample of university students in China.

METHODS

5972 students, randomly selected from 6 universities, completed the questionnaire survey. Logistic regression analysis was performed to estimate the effect of stressful life events and coping skills on risk for suicidal behavior. Bayesian network was further adopted to probe their probabilistic relationships.

RESULTS

Of the 5972 students, 7.64% reported the presence of suicidal behavior (attempt or ideation) within the past one year period. Stressful life events such as strong conflicts with classmates and a failure in study exam constituted strong risk factors for suicidal behavior. The influence of coping skills varied according to the strategies adapted toward problems with a high score of approach coping skills significantly associated with a reduced risk of suicidal behavior. The Bayesian network indicated that the probability of suicidal behavior associated with specific life events was to a large extent conditional on coping skills. For instance, a stressful experience of having strong conflicts with classmates could result in a probability of suicidal behavior of 21.25% and 15.36% respectively, for female and male students with the score of approach coping skills under the average.

CONCLUSIONS

Stressful life events and deficient coping skills are strong risk factors for suicidal behavior among youth students. The results underscore the importance of prevention efforts to improve coping skills towards stressful life events.

The association between stressful life events and depressive symptoms among Cypriot university students: a cross-sectional descriptive correlational study

Background

Previous findings suggest that stressful life events have a causal relationship with depressive symptoms. However, to date little is known concerning the contribution of the number and severity of recent stressful life events on the prevalence of depressive symptoms among university students. The aim of this study was to investigate the prevalence of depressive symptoms and its association with the number and the severity of self-reported stressful life events among university students in Cyprus.

Methods

A descriptive correlational design with cross sectional comparison was used. The CES-D scale was applied for the assessment of depressive symptoms and the LESS instrument for stressful life events. Both scales were completed anonymously and voluntarily by 1.500 students (response rate 85%).

Results

The prevalence of mild to moderate depressive symptoms [CES-D score between 16 and 21] and of clinically significant depressive symptoms [CES-D score ≥ 22] were 18.8% and 25.3% respectively. There were statistically significant differences in clinically significant depressive symptoms by gender, with higher rates among women (x² = 8.53, df = 1, p = 0.003). Higher scores on the LESS scale were associated with more frequent reports of clinical depressive symptoms (x² = 70.63, df = 4, p < 0.001). Similarly, an association was found between the number of life events and clinical depressive symptoms (x² = 40.06, df = 4, p < 0.001). Logistic regression analysis after adjusting for socio-demographic characteristics confirmed that the responders who reported a high number (n = 12–21) of stressful life events during the previous year (OR = 2.64 95% CI: 1.02, 6.83) and a severe degree of stress due to these events (total LESS score > 351, OR = 3.03 95% CI: 1.66, 5.39) were more likely to manifest clinical depressive symptoms.

Conclusions

The high frequency of occurrence of depressive symptoms among Cypriot university students, as well as the strong association with stressful life events, highlights the need for psychological empowerment strategies towards students by institutional counseling services.

Socioeconomic status and the risk of depression among U.K. higher education students

BACKGROUND

Many university students experience some symptoms of depression during the course of their studies but there is evidence that students from less advantaged backgrounds may be more vulnerable.

METHODS

The study was a cross-sectional online survey of 923 undergraduate students attending 6 U.K. Universities in the academic year 2009-2010 who completed a modified version of the Zagazig Depression Scale (ZDS).

RESULTS

Overall, 58.1% of female and 59.9% of male study participants screened positive for depression (ZDS score >10). In the fully adjusted model, final year students (OR = 1.8) who lived in a more deprived area (OR = 2.3) were more likely to report higher rates of depressive symptoms. Additionally, students with high perceived control (OR = 1.6) whose mothers were highly educated (OR = 0.5) and from a family of a high affluence (OR = 0.3) were less likely to suffer from higher rates of depressive symptoms. The relationship between lower social economic status and depression was partly mediated by low sense of control.

CONCLUSION

Students from less advantaged backgrounds are more at risk of depression but a strong sense of control over one's life may be protective.

APPLICATION

Since depression has strong impact on students' learning and quality of life universities should consider confidential screening for mental health problems and provide additional support for students.