Prevalence of depressive symptoms and its correlations with positive psychological variables among Chinese medical students: an exploratory cross-sectional study

Impostor phenomenon and its association with resilience in medical education - a questionnaire study among Swedish medical students

BACKGROUND

Concern over medical students' well-being is a global issue, with studies showing high psychological distress rates. Impostor Phenomenon (IP), i.e., underestimating one's abilities, attributing success to external factors, and feeling like a fraud, has been implicated as one reason behind these troubling findings. Meanwhile, resilience has been suggested to protect against psychological distress. This study aimed to investigate the prevalence of IP and its association with resilience among undergraduate medical students.

METHODS

The Clance Impostor Phenomenon Scale (CIPS), the Brief Resilience Scale (BRS), and sociodemographic questions were completed by 457 medical students registered in their 2-10th semester at a Swedish university. Of the respondents, 62.6% identified as women, 36.1% as men, and 1.3% as others.

RESULTS

The prevalence of IP was 58.4% (defined as CIPS score ≥ 62). According to the CIPS scoring guidelines, 10.3% of participants had low IP, 29.5% moderate, 41.6% frequent, and 18.6% intense IP. Of all participants, almost 90% experienced at least moderate and 60.2% frequent to intense IP. Women had significantly higher CIPS scores and lower BRS scores than men. In contrast, neither attending semester nor age group significantly impacted CIPS scores. Finally, there was a moderate inverse correlation between the level of resilience and the prevalence of IP.

CONCLUSIONS

Our findings suggest that the majority of Swedish medical students feels like an impostor, and of these students, most do so frequently. Furthermore, IP is more prevalent among female students - who also show lower levels of resilience. Moreover, our results indicated that IP could hinder achieving higher resilience. Future longitudinal studies should investigate how gender norms may contribute to IP feelings and explore the potential advantages of counteracting IP and strengthening resilience among medical students. However, targeted interventions addressing individual students' IP and resilience are insufficient. There is also a need to address structural aspects of the educational environment, such as gender stereotypes, that may contribute to IP.

On the correlation between gratitude and resilience in medical students

Objective

Medical students' health and resilience have increasingly been the subject of current research in recent years. A variety of interventions are recommended to strengthen resilience or its known or suspected influencing factors, although the literature shows that the evidence on the effectiveness of the interventions is inconsistent. The present study investigated whether gratitude is a direct protective factor for resilience in medical students or whether resilience factors (optimism, self-efficacy, social support) and stress mediate the effects of gratitude on resilience.

Methods

90 medical students at Witten/Herdecke University took part in the study that determined their gratitude, resilience, optimism, self-efficacy, social support and stress levels using validated questionnaires (GQ-6, RS-25, LOT-R, SWE, F-SozU, PSS). Correlations were analyzed using Pearson correlation coefficients. In addition, a multivariate regression analysis and a path analysis were calculated to determine the direct and indirect effects of gratitude on resilience.

Results

Multivariate regression analysis showed that only optimism, social support and stress were significantly associated with resilience (B=0.48, 95% CI: 0.31, 0.66; B=0.23, 95% CI: 0.01, 0.44 and B=-0.02, 95% CI: -0.03, -0.001, respectively). The direct effect of gratitude on resilience was minimal and not significant in the path analysis. However, there was an indirect effect of gratitude on resilience (B=0.321; p<0.05). Mediation via the optimism variable was mainly responsible for this effect (indirect effect B=0.197; p<0.05).

Conclusion

This study shows that gratitude has only a minimal direct influence on resilience. However, results indicate that optimism as a mediating factor strengthens the resilience of medical students. Against this background, it may be useful to integrate interventions that promote an optimistic attitude into medical studies in order to strengthen the mental health of future doctors in the long term.

The effect of secondhand smoke exposure on self-satisfaction and perceived freedom of life choice

Objective: The present study aims to examine whether secondhand smoke exposure (SHSE) in university students can affect three indices of self-satisfaction related to depression as indiced by appearance, weight, and freedom of life choice. Participants: We collected data from 740 nonsmoking students in the summer of 2018, of which 57.84% were exposed to secondhand smoke. Methods: Depressive symptoms, SHSE, smoking status, weight satisfaction, appearance satisfaction, and freedom of life choice were self-reported via a questionnaire. Results: The generalized linear analyses revealed that SHSE was linked to lower scores of perceived freedom of life choice but not significantly associated with weight nor appearance satisfaction. The mediation analyses indicated that perceived freedom of life choice fully mediated the association between SHSE and depressive symptoms. Conclusions: These findings shed light on the importance of SHSE and its effects on mental health in university students. Preventive strategies should therefore locally target university campuses.

Students' mental health during the pandemic: results of the observational cross-sectional COVID-19 MEntal health inTernational for university Students (COMET-S) study

Introduction

The aim of the study was to search rates of depression and mental health in university students, during the COVID-19 pandemic.

Materials and methods

This is an observational cross-sectional study. A protocol gathering sociodemographic variables as well as depression, anxiety and suicidality and conspiracism was assembled, and data were collected anonymously and online from April 2020 through March 2021. The sample included 12,488 subjects from 11 countries, of whom 9,026 were females (72.2%; aged 21.11 ± 2.53), 3,329 males (26.65%; aged 21.61 ± 2.81) and 133 "non-binary gender" (1.06%; aged 21.02 ± 2.98). The analysis included chi-square tests, correlation analysis, ANCOVA, multiple forward stepwise linear regression analysis and Relative Risk ratios.

Results

Dysphoria was present in 15.66% and probable depression in 25.81% of the total study sample. More than half reported increase in anxiety and depression and 6.34% in suicidality, while lifestyle changes were significant. The model developed explained 18.4% of the development of depression. Believing in conspiracy theories manifested a complex effect. Close to 25% was believing that the vaccines include a chip and almost 40% suggested that facemask wearing could be a method of socio-political control. Conspiracism was related to current depression but not to history of mental disorders.

Discussion

The current study reports that students are at high risk for depression during the COVID-19 pandemic and identified specific risk factors. It also suggested a role of believing in conspiracy theories. Further research is important, as it is targeted intervention in students' groups that are vulnerable both concerning mental health and conspiracism.

Resilience, Positivity and Social Support as Perceived Stress Predictors among University Students

Since the COVID-19 pandemic, researchers have been trying to identify which personal resources can contribute to minimizing the mental health costs in students incurred due to the restrictions that disrupted safety and predictability in their academic lives. The aim of the study was to verify if and how individual factors (resilience and positivity) and socio-environmental factors (social support and nationality) allow prediction of the level of perceived stress. University students (n = 559) from Poland, Serbia, and Italy were surveyed using the Perceived Stress Scale (PSS-10), the Brief Resilience Scale (BRS), the Positivity Scale (PS), and the Interpersonal Support Evaluation List (ISEL-12). Personal resources-positivity, resilience, and support-were found to be positively interrelated and significantly associated with stress levels. Additionally, gender and nationality differentiated stress levels. A general linear model (GLM) showed that levels of perceived stress are best explained by resilience, positivity, tangible support, and gender. The results obtained can strengthen students' awareness of personal resources and their protective role in maintaining mental health, as well as contribute to the creation of prevention-oriented educational activities. Nationality was not a significant predictor of the level of perceived stress, which highlights the universality of examined predictors among university students from different countries and suggests that interventions aimed at enhancing these resources could benefit students across different cultural contexts.

The mediating role of psychological capital in the association between life satisfaction and depressive and anxiety symptoms among Chinese medical students during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Although life satisfaction is a predictor of depressive and anxiety symptoms, the mechanisms underlying this association are poorly understood. This study examined how psychological capital (PsyCap), a positive psychological state, mediated the association between life satisfaction and depressive and anxiety symptoms among Chinese medical students during the COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted at three medical universities in China. A self-administered questionnaire was distributed to 583 students. Depressive symptoms, anxiety symptoms, life satisfaction, and PsyCap were measured anonymously. A hierarchical linear regression analysis was performed to explore the effects of life satisfaction on depressive and anxiety symptoms. Asymptotic and resampling strategies were used to examine how PsyCap mediates the association between life satisfaction and depressive and anxiety symptoms.

RESULTS

Life satisfaction was positively associated with PsyCap and its four components. There were significant negative associations between life satisfaction, psychological capital, resilience, optimism, and depressive and anxiety symptoms among medical students. Self-efficacy was negatively associated with depressive and anxiety symptoms. Psychological capital (a×b = -0.3201, BCa 95% CI: -0.3899, -0.2446; a×b = -0.2749, BCa 95% CI: -0.3817, -0.1996), resilience (a×b = -0.2103, BCa 95% CI: -0.2727, -0.1580; a×b = -0.1871, BCa 95% CI: -0.2520, -0.1414), optimism (a×b = -0.2100, BCa 95% CI: -0.3388, -0.1150; a×b = -0.1998, BCa 95% CI: -0.3307, -0.0980), and self-efficacy (a×b = -0.0916, BCa 95% CI: 0.0048, 0.11629; a×b = 0.1352, BCa 95% CI: 0.0336, 0.2117) significantly mediated the association between life satisfaction and depressive and anxiety symptoms.

LIMITATIONS

This was a cross-sectional study, and causal relationships between the variables could not be ascertained. Self-reported questionnaire instruments were used for data collection, which may have recall bias.

CONCLUSIONS

Life satisfaction and PsyCap can be used as positive resources to reduce depressive and anxiety symptoms among third-year Chinese medical students during the COVID-19 pandemic. Psychological capital and its components (self-efficacy, resilience, and optimism) partially mediated the relationship between life satisfaction and depressive symptoms, and completely mediated the relationship between life satisfaction and anxiety symptoms. Therefore, improving life satisfaction and investing in psychological capital (especially self-efficacy, resilience, and optimism) should be included in the prevention and treatment of depressive and anxiety symptoms among third-year Chinese medical students. Additional attention is needed to pay for self-efficacy in such disadvantageous contexts.

Physical Activity, Dietary Habits and Factors Associated with Depression Among Medical Students of Sindh, Pakistan, During the COVID-19 Pandemic

Objective

To find out the association of physical activity, dietary habits and factors associated with depression among medical students of Sindh, Pakistan, during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

An online cross-sectional study was conducted between June and August, 2020, on medical students from three medical institutions of Sindh, Pakistan. The study comprised three structured questionnaires related to demographic details, physical activity, dietary and sleep habits, COVID-19 pandemic-associated factors and patient health questionnaire, PHQ-9. A total of 864 students completed the questionnaires and participated in the study. The data was analysed on SPSS version 23.

Results

Our study showed that 244 (28.2%) medical students had mild depression, 192 (22.2%) had moderate depression, 80 (9.3%) had moderately severe depression and 80 (9.3%) had severe depression during the COVID-19 pandemic. Out of 864 students, 268 (31%) had no depression. Socioeconomic status, body mass index (BMI), chronic disease/comorbidity, addiction and non-medical prescription drug use were found to be statistically significant predictors of depression among medical students. On multilogistic regression analysis, physical activity, social media/app use and sleeping habits during COVID-19 were associated with depression (p-value < 0.05).

Conclusion

The COVID-19 pandemic adversely affected physical activity and sleeping habits in association with depression among medical students. Promoting healthy eating habits, adequate physical activity, and a healthy lifestyle, particularly among students during lockdowns, is a critical component of coping with mental stress and depression. The findings of this study will aid in future research and campaign design in preparation for future pandemics and lockdowns.

Correlation between Positive Orientation and Control of Anger, Anxiety and Depression in Nursing Students in Poland, Spain and Slovakia during the COVID-19 Pandemic

(1) This study analysed the relationship between positive orientation and subjective control of anger, anxiety and depression in nursing students in Poland, Spain and Slovakia during the pandemic. (2) The survey was carried out by the diagnostic survey method in a group of 756 nursing students in Poland, Spain and Slovakia. The empirical data were gathered using an original survey questionnaire, the Positive Orientation Scale and the Courtauld Emotional Control Scale. (3) It was shown that the positive orientation level in Polish students was significantly lower than in students in Spain (p < 0.0001) and Slovakia (p < 0.0001). Low results for positive orientation were obtained in nearly half (47.18%) of the respondents in the Polish sample, whereas it was 34.18% and 31.18% in the Spanish and Slovak samples, respectively (p < 0.0001). A positive orientation was the most important predictor of emotional control among the nursing students at all the sites (p < 0.0001). (4) Positive orientation has been shown to have a significant impact on emotional control in nursing students during the pandemic. Therefore, it is important to carefully monitor students' mental health during the pandemic to determine the demand for psychological and emotional support.

Association of Covid-19 pandemic-related stress and depressive symptoms among international medical students

BACKGROUND

The outbreak of Covid-19 had negative impacts on the mental stress and induced psychological distress among university students worldwide. This study proposed a moderated mediation model, and hypothesized that the Covid-19 pandemic-related stress was positively related to depressive symptoms among international medical students.

METHODS

An online survey on stress and depressive symptoms of international students was conducted in a medical university. Questions on Covid-19 pandemic-related stress, Patient Health Quesionnaire-9, Simplified Coping Style Questionnaire and the Perceived Social Support Scale were used as measurements, and model analyses were conducted using Hayes' PROCESS macro for SPSS.

RESULTS

It was found that 9.83%, 3.08% and 2.12% students had mild, moderate and severe depressive symptoms, respectively, and the positive association between Covid-19 pandemic-related stress and depressive symptoms was significant (β = 0.27, t = 6.87, P < 0.01). Negative coping was also significantly correlated to depressive symptoms (β = 0.26, t = 6.60, P < 0.01), and partially mediated the association between Covid-19 pandemic-related stress and depressive symptoms. Perceived social support had a negative association with depressive symptoms (β=-0.26, t=-6.25, P < 0.01), played a negative moderating role in the relationship between negative coping and depressive symptoms, and moderated the indirect effect of Covid-19 pandemic-related stress on depressive symptoms via negative coping.

CONCLUSIONS

Results of the study suggested that under the background of continuing pandemic, intervention or prevention of mental health problem is urgently needed for the international students, and depression may be alleviated through reducing negative coping and increasing perceived social support.

Relationship between Resilience and the Impostor Phenomenon among Undergraduate Medical Students

INTRODUCTION

Impostor Phenomenon (IP) is the inability to internalize success and a tendency to attribute success to external causes. Social and institutional support are strategies to avoid the problem, but only partially successful. Resilience has been considered protective against mental health disorders in medical students. This study aims to investigate the association between IP and resilience in undergraduate medical students.

METHODS

Using Clance Impostor Phenomenon Scale (CIPS), Connor-Davidson Resilience Scale (CD-RISC), and a socio-demographic questionnaire, we conducted a cross-sectional, quantitative study with undergraduate medical students.

RESULTS

The study included 425 pre-clerkship medical students of average age of 23.03 years. The prevalence of IP was 47.76% (CIPS ≥ 62 score, as recommended in prior literature.) and there were no differences among age, gender, current semester, religion. The majority student's CD-RISC score was 68.57 ± 14.66 and there was no statistical difference in resilience scale among age, gender, religion and training semester. "Other religions" group was associated with a higher resilience score when compared to "Catholic" or "Non-religious" students. We found an inverse correlation between the level of resilience by CD-RISC and the level of symptoms related to IP by CIPS (ρ = -0.409; p-value < .001).

CONCLUSIONS

Findings from this study suggest that higher levels of resilience are likely protective against IP among undergraduate medical students. Furthermore, the non-inclusion of medical internship students and the cross-sectional design of this study are restraining aspects noticed within the project, suggesting the need for further studies to adjust those limitations.

Association between the dispositional optimism and depression in young people: a systematic review and meta-analysis

The objective of this study was to perform a meta-analysis of publications that reported the association between dispositional optimism and depression during youth, analyzing if the strength of this relationship varied according to potential factors. Systematic searches were carried out in APA PsycNet, Virtual Health Library, Embase, Web of Science, PubMed Central, and Scopus to collect English, Portuguese, or Spanish studies from 2009 onwards. Two reviewers selected the eligible articles, assessed the quality of each study, and extracted the data. For the synthesis of the results, a meta-analytic approach was used. We identified 4077 publications in the initial searches and 22 in the supplementary searches, from which 31 studies remained for analysis once the eligibility criteria were applied. The results showed a statistically significant negative association between dispositional optimism and depression in the young population, age being a factor that modifies the effect measure between these variables. This meta-analysis provides a consistent and robust synthesis on the interaction effect between dispositional optimism and depression in the young population. Based on these findings, early clinical admissions may effectively improve optimistic tendencies in young people, which could help them prevent depressive symptoms or episodes.

Traumatic Distress of COVID-19 and Depression in the General Population: Exploring the Role of Resilience, Anxiety, and Hope

International evidence published so far shows that the COVID-19 pandemic has negatively impacted on global mental health. Specifically, there is some research suggesting that the psychological distress related to depression, anxiety and posttraumatic stress has impacted on the psychological well-being of the general population. Yet, there is limited evidence on the relational paths between COVID-19 traumatic distress and depression. Participants of this cross-sectional study were 456 adults 18 years old or older from the general population (Mean age = 41.2 years, SD = 11.7) who completed an online questionnaire including measures assessing depression, anxiety, resilience, hope and traumatic distress related to COVID-19. Structural equation modelling was applied to examine the proposed mediation model. The results confirmed the proposed model, with traumatic distress of COVID-19, resilience, anxiety and hope explaining a considerable amount of variance (59%) in depression scores. Traumatic distress of COVID-19 was a strong positive predictor of depression, while anxiety, hope and resilience were both joint and unique mediators of this relationship. Exposure to the COVID-19 pandemic is strongly associated with depression in adults of the general population. The co-occurrence of anxiety may negatively contribute to experiencing higher levels of depression, while resilience and hope may act as buffers against depression associated with the impact of this pandemic. Our findings suggest that wide community-based interventions designed to promote resilience, build hope and reduce anxiety may help mitigate depression associated with exposure to the COVID-19 pandemic.

Prevalence of depression among Chinese medical students: A systematic review and meta-analysis

The prevalence of depression continues to increase among medical students in China, and higher than that of other majors, which is a potential risk for medical students and their patients. This study aimed to observe the prevalence of depression in Chinese medical students and also the correlation between them. All cross-sectional studies on the prevalence of depression in Chinese medical students were retrieved from PubMed, Embase, the Cochrane Database of Systematic Reviews, CNKI, and Wanfang. An 11-item checklist recommended by the Agency for Healthcare Research and Quality was adopted to evaluate the methodological quality of the included studies. Software Stata 12.0 was used to analyze the data. Registration: PROSPERO, CRD42020169681. The prevalence of depression among medical students in China was 27%. The subgroup analysis showed significant differences in the prevalence of depression in different regions. The sleep quality was a significant heterogeneous source of depression. Medical students with sleep disorders were more than three times as likely to report depression. The prevalence of depression in Chinese medical students is relatively high, and medical students with sleep disorders are more likely to have depression problems. Regular screening and appropriate intervention are recommended for these mental health problems.

Depression and its correlation with social support and health-promoting lifestyles among Chinese university students: a cross-sectional study

OBJECTIVES

To investigate the prevalence of depression in college students and determine how social support and healthy lifestyle factors are associated with depression in this population.

DESIGN

A cross-sectional design.

SETTING

A comprehensive university in Changsha, Hunan, South China. The study was conducted from May to June 2019.

PARTICIPANTS

A total of 541 students at the comprehensive university.

PRIMARY AND SECONDARY OUTCOME MEASURES

The Zung Self-Rating Depression Scale, Social Support Rating Scale and Health-Promoting Lifestyle Profile-II (HPLP-II) were used to evaluate depression, social support and lifestyles, respectively, and analyse the mutual relationships among them.

RESULTS

Among the 541 participants, 161 (29.8%) experienced depressive symptoms, and there were significant gender-related and academic discipline-related differences in self-rated depression. The average social support score was 38.06 (38.06±7.52). The average HPLP-II score was 71.09 (71.09±11.47). A monofactor analysis showed that depression was correlated with social support and a healthy lifestyle. As demonstrated by logistic regression analysis, being a woman (OR=2.613, 95% CI: 1.541 to 4.43), inadequate social support (OR=0.912, 95% CI: 0.877 to 0.948), poor nutrition (OR=0.87, 95% CI: 0.775 to 0.977) and lack of self-actualisation (OR=0.644, 95% CI: 0.572 to 0.724) were significantly correlated with depression.

CONCLUSIONS

Owing to the high prevalence of depression among Chinese university students, educational institutions must take measures such as providing compulsory mental health education courses and improving the psychological counselling services available to students.

Symptoms of Depression, Anxiety, and Stress and Prevalence of Major Depression and Its Predictors in Female University Students

Depression, anxiety and stress are increasingly concerning phenomena in our society, with serious consequences on physical and mental health. The repercussions may be particularly devastating in particular population subgroups, such as female university students. The purpose of this study was to determine the levels of depression, anxiety, and stress and the prevalence of depression and associated factors, in Spanish university women. A cross-sectional study was conducted with a random sample of 871 students from the Santiago de Compostela University (mean age 20.7 years, SD = 2.8). Information was collected on sociodemographic and academic characteristics; symptoms of depression, anxiety, and stress; diagnosis of major depression; optimism, resilience, social support, life engagement, and five personality domains, using validated instruments. Of the participants, 18.1%, 22.8% and 13.5% presented with severe/very severe levels of depression, anxiety and stress, respectively. A total of 12.9% had major depression. Higher life engagement was associated with lower risk of depression (OR = 0.92, 95% CI 0.87–0.98), while higher levels of neuroticism (OR = 1.20, 95% CI, 1.12–1.28) and openness to experience (OR = 1.08, 95% CI, 1.02–1.14) were associated with greater risk. These findings reveal an alarming percentage of female university students who experience major depression and severe/very severe stress.

Addressing the physician burnout epidemic with resilience curricula in medical education: a systematic review

BACKGROUND

A variety of stressors throughout medical education have contributed to a burnout epidemic at both the undergraduate medical education (UGME) and postgraduate medical education (PGME) levels. In response, UGME and PGME programs have recently begun to explore resilience-based interventions. As these interventions are in their infancy, little is known about their efficacy in promoting trainee resilience. This systematic review aims to synthesize the available research evidence on the efficacy of resilience curricula in UGME and PGME.

METHODS

We performed a comprehensive search of the literature using MEDLINE, EMBASE, PsycINFO, Educational Resources Information Centre (ERIC), and Education Source from their inception to June 2020. Studies reporting the effect of resilience curricula in UGME and PGME settings were included. A qualitative analysis of the available studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using the ROBINS-I Tool.

RESULTS

Twenty-one studies met the inclusion criteria. Thirteen were single-arm studies, 6 quasi-experiments, and 2 RCTs. Thirty-eight percent (8/21; n = 598) were implemented in UGME, while 62 % (13/21, n = 778) were in PGME. There was significant heterogeneity in the duration, delivery, and curricular topics and only two studies implemented the same training model. Similarly, there was considerable variation in curricula outcome measures, with the majority reporting modest improvement in resilience, while three studies reported worsening of resilience upon completion of training. Overall assessment of risk of bias was moderate and only few curricula were previously validated by other research groups.

CONCLUSIONS

Findings suggest that resilience curricula may be of benefit to medical trainees. Resilience training is an emerging area of medical education that merits further investigation. Additional research is needed to construct optimal methods to foster resilience in medical education.

Adverse Childhood Experiences and Psychological Well-Being in Chinese College Students: Moderated Mediation by Gender and Resilience

Adverse childhood experiences (ACEs), including child abuse/neglect and household challenges, are a prevalent social issue that impacts individuals' well-being worldwide. Relatively few ACEs studies orient to the presence of psychological wellness, especially in ethnically Chinese populations. Furthermore, less is known about resilience as a mechanism between ACEs and psychological well-being, in addition to the moderating effect of gender. This study examined the relationship between ACEs and psychological well-being among Chinese college students and the potential mediating and moderating effects of resilience and gender, respectively. A total of 1,871 college students studying social science from 12 Chinese colleges completed an anonymous online survey between late September and early October 2020. Multiple-group path analyses were conducted to examine whether the relationships among ACEs, resilience, and psychological well-being differed as a function of gender. Results suggested that gender moderated the relationships studied. For female students, resilience mediated the association between abuse/neglect and psychological well-being, where abuse/neglect was negatively associated with resilience, which in turn had a negative relationship with psychological well-being. For male students, household challenges were negatively related to psychological well-being through reduced resilience. Based on the findings, various ACE-informed initiatives may be essential to prevent and protect individuals from ACEs. We also call for resilience-based interventions to enhance individuals' resilience and thus strengthen their psychological well-being.

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

Preventing burnout and promoting positive mental health among medical students is important. Relevant research is lacking on positive mental health in medical students, particularly in low- and middle-income countries. We conducted a cross-sectional survey of Sri Lankan students enrolled in a five-year medical program. Measures included the Mental Health Continuum-Short Form, Kessler 10 Psychological Distress Scale, and Oldenburg Burnout Inventory. We investigated relationships between year in program, mental health indicators, and academic performance. Three hundred twenty-seven students participated (35% response rate). Most students had moderate positive mental health (64.8%) and severe psychological distress (40.4%). Final year students reported more psychological distress and burnout than first year students. Female students had higher burnout scores than males. In multivariable models, fourth and fifth year students evidenced lower positive mental health than first year students. Mental health indicators were unassociated with academic performance. Overall, distress rates were higher than those reported among students in other countries. Higher burnout and distress may be driven by increased responsibilities in the final clinical years of training. Bolstering positive mental health through positive emotions, meaning, and social connection may minimize burnout and distress, although extracurricular activities require time. Interventions to reduce medical student distress in Sri Lanka are needed.

Application of a classroom-based positive psychology education course for Chinese medical students to increase their psychological well-being: a pilot study

BACKGROUND

Anxiety and depression have been increasing among Chinese medical students. The psychological well-being of Chinese medical students has become a critical focus of attention for the medical education community. Increasing evidence shows that positive psychology interventions can be effective in the enhancement of psychological well-being, and may help to prevent depressive symptoms in university students. In the present study, we aimed to explore the potential effect of positive psychology education on improving the mental health of Chinese medical students.

METHODS

An 8-week classroom-based positive psychology intervention workshop, which was established as an elective course embedded in the regular school curriculum, was conducted at the School of Medicine, South China University of Technology (SCUT), China. Undergraduate medical students of the institute in year-2 or year-3 of academic study participated in this training course voluntarily. The participants' self-reported data on the hope scale, life satisfaction scale, subjective happiness scale, and depression and anxiety scale were collected and analyzed at pre-course (n = 61) and post-course (n = 49) times. The investigation was also validated with an independent cohort of students who enrolled in the course in the year following the preliminary study.

RESULTS

The analyses showed that the psychological well-being of the participants were improved after the intervention. Their mean scores on the hope scale, life satisfaction scale and subjective happiness scale were significantly improved (P < 0.05), while their symptom levels of depression and anxiety were significantly reduced (P < 0.01). A similar trend was observed in the validation cohort.

CONCLUSIONS

These preliminary findings suggest that positive psychology education holds promise for improving psychological well-being among Chinese medical students. Further investigations with larger and well-controlled sample cohorts may yield more convincing and reliable results.

Prevalence of depression among university students in low and middle income countries (LMICs): a systematic review and meta-analysis

INTRODUCTION

Though university years are peak time for the onset of many mental health problems including depression, knowledge on the prevalence of depressive symptoms among university students in low and middle-income countries (LMICs) is limited. This study examined the prevalence of depressive symptoms among university students in LMICs.

METHODS

We systematically searched PubMed, Web of Science, and WHO Global Health Library for studies published between January 1, 2009 and December 31, 2018. Cross-sectional and longitudinal studies conducted in LMICs (as defined by World Bank), having a sample size≥500 and published in English were identified. Data on study characteristics and prevalence of depressive symptoms was extracted by two investigators. Estimate of prevalence was pooled in meta-analysis using random-effects meta-analysis. Sub-group differences were estimated using mixed-effects meta-analysis and meta-regression.

RESULTS

Depressive symptoms prevalence data were extracted from 37 studies involving 76,608 individuals in 20 countries. Studies on depression among university students in LMICs were limited, and most were based on non-representative and small study samples. The overall prevalence of depressive symptoms was 24.4% (95% CI, 19.2% -30.5%). Subgroup analysis revealed that the prevalence did not vary by study design, sampling technique, sample size, study major, educational level, economic regions, and screening instrument.

LIMITATIONS

Only English language studies were included. Included studies were diverse in design, screening tool, and sample size that introduced substantial heterogeneity.

CONCLUSION

Overall prevalence of depressive symptoms among university students in LMICs was 24.4%, however, finding should be interpreted with caution. Further research is needed to address the issue.

Only Children Were Associated with Anxiety and Depressive Symptoms among College Students in China

This study explored the prevalence of anxiety and depressive symptoms among college students and analyzed the associations between only children and anxiety and depressive symptoms in college students in China. A total of 645 college students, from three universities in Jinan, Shandong, China, were investigated by questionnaire. The self-designed general information questionnaire was used to collect the demographic information such as gender, age, only children or not and so on. The Self-rating Anxiety Scale and Self-rating Depression Scale were used to reflect the psychological state of college students. Binary logistic regression analysis was applied to analyze associated factors of anxiety and depressive symptoms. We have found that there were 25.7% college students with anxiety symptom, 22.2% college students with depressive symptom, and 18.3% college students with a comorbidity of anxiety and depressive symptoms. The prevalence of anxiety symptom, depressive symptom, and comorbidity of anxiety and depressive symptoms in only children was higher than those among non-only children. There were no differences between males and females in anxiety symptom, depressive symptom, and comorbidity of anxiety and depressive symptoms among all college students, only child college students and non-only child college students. Only children were associated with anxiety symptom, depressive symptom, comorbidity of anxiety and depressive symptoms after adjusting potential important confounding factors, such as professional category, grade, parental relationship, parenting style, interpersonal relationship, activity participation enthusiasm, sleeping time, and eating habits. The prevalence of anxiety and depressive symptoms among college students was high. We should pay more attention to the mental health of college students, especially that of only child college students.

Neurostructural correlates of optimism: Gray matter density in the putamen predicts dispositional optimism in late adolescence

Dispositional optimism reflects one's generalized positive expectancies for future outcomes and plays a crucial role in personal developmental outcomes and health (e.g., counteracting related mental disorders such as depression and anxiety). Increasing evidence has suggested that extraversion is an important personality factor contributing to dispositional optimism. However, less is known about the association between dispositional optimism and brain structure and the role of extraversion in this association. Here, we examined these issues in 231 healthy high school students aged 16 to 20 years (110 males, mean age = 18.48 years, SD = 0.54) by estimating regional gray matter density (rGMD) using a voxel-based morphometry method via structural magnetic resonance imaging. Whole-brain regression analyses revealed a significant positive correlation between dispositional optimism and the rGMD of the bilateral putamen after adjusting for age, sex, family socioeconomic status (SES), general intelligence, and total gray matter volume (TGMV). Moreover, prediction analyses using fourfold balanced cross-validation combined with linear regression confirmed a significant connection between dispositional optimism and putamen density after adjusting for age, sex, and family SES. More importantly, subsequent mediation analysis showed that extraversion may account for the association between putamen density and dispositional optimism after adjusting for age, sex, family SES, general intelligence, TGMV, and the other four Big Five personality traits. Taken together, the current study provides new evidence regarding the neurostructural basis underlying dispositional optimism in adolescents and underscores the importance of extraversion as an essential personality factor for dispositional optimism acquisition.

Associations of psychological distress with positive psychological variables and activities of daily living among stroke patients: a cross-sectional study

BACKGROUND

Depression and anxiety result in psychological distress, which can further affect mental status and quality of life in stroke patients. Exploring the associations between positive psychological variables and symptoms of psychological distress following stroke is of great significance for further psychological interventions.

METHODS

A total of 710 stroke patients from the five largest cities in Liaoning Province in China were enrolled into the present study in July 2014. All patients independently completed the questionnaires with respect to psychological distress and positive psychological variables. Depressive and anxiety symptoms were evaluated using Center for Epidemiologic Studies Depression Scale (CES-D) and Self-Rating Anxiety Scale, respectively. Positive psychological variables were evaluated using Perceived Social Support Scale, Adult Hope Scale (AHS), General Perceived Self-Efficacy Scale and Resilience Scale-14 (RS-14). Activities of Daily Living (ADL) was measured using Barthel Index. Factors associated with psychological variables and depressive and anxiety symptoms were identified using t-test, ANOVA, correlation and hierarchical linear regression analysis.

RESULTS

Depressive and anxiety symptoms were present in 600 of 710 (84.51%) and 537 of 710 (75.63%) stroke patients enrolled, respectively. Social support (β = - 0.111, p < 0.001) and hope (β = - 0.120, p < 0.001) were negatively associated with both depressive and anxiety symptoms. Resilience (β = - 0.179, p < 0.001) was negatively associated with depressive symptoms. Self-efficacy (β = - 0.135, p < 0.001) was negatively associated with anxiety symptoms. Hierarchical regression analyses indicated that ADL accounted for 10.0 and 6.0% of the variance of depressive and anxiety symptoms, respectively. Social support, resilience, self-efficacy and hope as a whole accounted for 7.5 and 5.3% of the variance of depressive and anxiety symptoms.

CONCLUSIONS

The high frequency of depressive and anxiety symptoms among Chinese stroke survivors should receive attentions from all stakeholders. Findings suggested that intervention strategies on ADL, social support, hope, resilience and self-efficacy could be developed to improve psychosocial outcomes for stroke survivors.

Empathy, burnout, life satisfaction, correlations and associated socio-demographic factors among Chinese undergraduate medical students: an exploratory cross-sectional study

BACKGROUND

Medical education is widely known to be a demanding process that may cause various mental health problems, such as burnout, which can lead to lowered levels of life satisfaction among medical students. Research shows that empathy is negatively correlated with burnout, but there are few studies on the relationship among empathy, burnout and life satisfaction in medical students. The objective of the present study is to explore the correlations of empathy and burnout with life satisfaction and the associated socio-demographic factors among Chinese undergraduate medical students.

METHODS

In this cross-sectional study, 1271 undergraduate medical students (age 19.42 ± 1.34 years, 36% male) from 1st to 4th grades completed questionnaires including the Interpersonal Reactivity Index Chinese version (IRI-C), the Maslach Burnout Inventory Modified Chinese version (MBI-MC), the Satisfaction With Life Scale (SWLS) and socio-demographic characteristics. Statistical analyses included Student's t-test, one-way ANOVA, post hoc Bonferroni tests, hierarchical linear regression analysis and general linear model-univariate full factorial model.

RESULTS

Over four academic years, medical students' empathy levels declined, but their burnout levels almost plateaued and their life satisfaction levels witnessed an initial fall before a rebound. Empathy was correlated with students' age and grade, and burnout was associated with students' maternal education. Significant differences in life satisfaction were detected with regard to medical students' age, academic year, the number of children in the family, place of residence and parents' educational levels.

CONCLUSIONS

Empathy explained 0.6% of the variance in life satisfaction in contrast to 13.7% of the variance explained by burnout in life satisfaction. Although empathy did not have a main effect on life satisfaction, there was an interaction effect of empathy and burnout on life satisfaction among students of high and low empathy and burnout levels. Students with high levels of empathy and low levels of burnout were most satisfied with life. Medical institutions and related authorities need to find effective measures to enhance students' empathy levels and reduce burnout to improve their life satisfaction.

Resilience: a nationwide study of medical educators

This article was migrated. The article was marked as recommended. Background: Medical educators have the potential to play an important role in addressing resilience issues across the medical education continuum. Yet, limited research has explored this cohort, particularly in the UK context. This study aims to address this gap by exploring resilience and the factors that relate to resilience in UK medical educators. Methods: A cross-sectional online questionnaire was employed. It contained the validated Connor-Davidson Resilience Scale 25 (CD-RISC-25) and the eight-item Patient Health Questionnaire Depression Scale (PHQ-8), for determining medical educator resilience and depression levels respectively. Sociodemographic characteristics were also collected to identify potential factors associated with resilience. Finally, participants identified factors that facilitated or undermined their resilience through open-ended questions. Data were analysed using quantitative (e.g. multiple regression analysis), and qualitative (i.e. thematic framework analysis) approaches. Results: Among 244 UK participants, the mean CD-RISC-25 score was 72.9 and standard deviation 10.3. The PHQ-8 score was the only significant negative predictor identified (B = -1.22, p < 0.001). Other sociodemographic variables examined were not found to be predictors of CD-RISC-25 scores. Educators identified multidimensional factors influencing their resilience, but predominately viewed internal factors as being supportive, and external factors as undermining. Conclusions: Medical educators in this study had resilience levels that were comparable to other population samples. The study also highlights the importance of considering external factors, such as contextual and sociocultural influences, in addition to individual factors when addressing resilience.

Medical student depression and its correlates across three international medical schools

BACKGROUND

Medical students have high rates of depression, anxiety, and burnout that have been found to affect their empathy, professional behaviors, and performance as a physician. While studies have examined predictors for burnout and depression in the United States (US), no study, to our knowledge, has compared depression in medical students cross-culturally, or has attempted to examine the effect of factors influencing rates including burnout, exercise, stress, unmet mental health needs, and region.

AIM

To examine rates of depression in three international cohorts of medical students, and determine variables that may explain these differences.

METHODS

Convenience samples of medical students from three countries (US, China, and a Middle Eastern country whose name remains anonymous per request from the school) were surveyed in this observational study. Using the Patient Health Questionnaire-2 (PHQ-2) and a modified Maslach Burnout Inventory, depression and burnout were examined among medical students from the three cohorts (n = 473). Chi-square test and analysis of variance were used to examine differences in demographics, behavioral, and psychological variables across these three schools to identify potentially confounding descriptive characteristics. Analysis of covariance compared depression and the emotional exhaustion component of burnout identified through Principal Component Analysis across countries. Multiple linear regression was used to analyze the impact of demographic, behavioral, and psychological variables on screening positive for depression.

RESULTS

Medical students from the Middle Eastern country had the highest rates of positive depression screens (41.1%), defined as a PHQ-2 score of ≥ 3, followed by China (14.1 %), and then the US (3.8%). More students in the Middle Eastern school had unmet mental health needs (50.8%) than at the medical school in China (34.8%) or the school in the US (32.8%) (Pearson chi-square significance < 0.05). Thus, PHQ-2 scores were adjusted for unmet mental health needs; however, the Middle Eastern country continued to have the highest depression. Adjusting for PHQ-2 score, medical students from the US scored the highest on emotional exhaustion (a measure of burnout). Demographic variables did not significantly predict medical student depression; however, lack of exercise, unmet mental health needs, stress, and emotional exhaustion predicted nearly half of depression in these cohorts. In comparison to the US, coming from the Middle Eastern country and China predicted higher levels of depression.

CONCLUSION

Depression rates differ in three international cohorts of medical students. Measured factors contributed to some observed differences. Identifying site-specific prevention and intervention strategies in medical student mental health is warranted.

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

BACKGROUND

The prevalence of mental health problems in medical students has continuously increased and is higher than the prevalence of mental health problems in students with other majors, which could lead to undesirable consequences for the students and their future patients. In China, the current states of medical education and healthcare workplaces differ in certain areas from those in Western or other Asian countries. However, the mental health status of Chinese medical students has not been systematically analyzed.

OBJECTIVES

The purpose of this meta-analysis was to summarize the prevalence of mental health problems in Chinese medical students.

METHODS

All cross-sectional studies that investigated the prevalence of any mental health problem among Chinese medical students were retrieved from the following databases: EMBASE, PubMed, PsycINFO, OVID, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. We accepted each individual trial's inclusion and exclusion criteria for participants. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was adopted to appraise the methodological quality of each study. RevMan (version 5.3) was used to analyze the data.

RESULTS

Ten cross-sectional studies involving a total of 30,817 Chinese medical students were included. The prevalence of depression, anxiety, suicidal ideation, and eating disorders were 29%, 21%, 11%, and 2%, respectively. Subgroup analysis revealed no significant differences in the prevalence of depression and suicidal ideation between genders and no significant difference in the prevalence of depression between individuals of different ages (20 years and older or younger than 20 years).

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Chinese medical students have relatively high prevalence of depression, anxiety, and suicidal ideation but a low prevalence of eating disorders. Mental health problems in Chinese medical students should be taken seriously, and timely screening of and proper intervention in these mental health problems are highly recommended.

Prevalence and associated factors of depression and anxiety among doctoral students: the mediating effect of mentoring relationships on the association between research self-efficacy and depression/anxiety

Purpose

Although the mental health status of doctoral students deserves attention, few scholars have paid attention to factors related to their mental health problems. We aimed to investigate the prevalence of depression and anxiety in doctoral students and examine possible associated factors. We further aimed to assess whether mentoring relationships mediate the association between research self-efficacy and depression/anxiety.

Methods

A cross-sectional study was conducted among 325 doctoral students in a medical university. The Patient Health Questionnaire 9 and Generalized Anxiety Disorder 7 scale were used to assess depression and anxiety. The Research Self-Efficacy Scale was used to measure perceived ability to fulfill various research-related activities. The Advisory Working Alliance Inventory-student version was used to assess mentoring relationships. Linear hierarchical regression analyses were performed to determine if any factors were significantly associated with depression and anxiety. Asymptotic and resampling methods were used to examine whether mentoring played a mediating role.

Results

Approximately 23.7% of participants showed signs of depression, and 20.0% showed signs of anxiety. Grade in school was associated with the degree of depression. The frequency of meeting with a mentor, difficulty in doctoral article publication, and difficulty in balancing work–family–doctoral program was associated with both the level of depression and anxiety. Moreover, research self-efficacy and mentoring relationships had negative relationships with levels of depression and anxiety. We also found that mentoring relationships mediated the correlation between research self-efficacy and depression/anxiety.

Conclusion

The findings suggest that educational experts should pay close attention to the mental health of doctoral students. Active strategies and interventions that promote research self-efficacy and mentoring relationships might be beneficial in preventing or reducing depression and anxiety.

Common mental disorders and subjective well-being: Emotional training among medical students based on positive psychology

INTRODUCTION

The prevalence of common mental disorders among medical students is globally high. However, medical students tend to seek less professional help to treat their mental health issues. Hence, ways have been devised to reduce emotional stress in this population.

OBJECTIVE

The current study uses positive psychology techniques to increase subjective well-being (SWB) in order to reduce symptons of common mental disorders (CMD) in medical students (MS).

METHODS

The study comprised two groups: intervention group (n = 37) and control group (n = 32). Throughout seven weeks, the intervention group had meetings focused on emotions, mental health of medical students, gratitude, appreciation, optimism, resilience, qualities and virtues. The control group attended conventional medical psychology classes (psychosomatic aspects in clinical illness, for example).

RESULTS

The intervention group presented average increase by 2.85 points in the positive emotions scale; average increase by 2.53 points in the satisfaction-with-life scale; and average decrease by 1.79 points in the SRQ-20 scale, when it was compared to the control group. The intervention effect size was moderate.

CONCLUSION

Use of techniques to increase SWB may reduce CMD in MS, even if these techniques do not diminish negative emotions.

Are procrastinators psychologically healthy? Association between psychosocial problems and procrastination among college students in Shanghai, China: a syndemic approach

Procrastination has been closely linked to psychosocial health problems, such as depression and anxiety, among college students. However, few studies have focused on the magnifying effects of multiple psychosocial health problems on procrastination. We conducted a cross-sectional study by convenience sampling among 509 college students in Shanghai, China. Logistic regressions were performed to assess the relationship between psychosocial variables and procrastination and to verify the syndemic effect of psychosocial factors. Univariate analyses revealed that self-esteem, depression, and loneliness were associated with procrastination. In multivariate analyses, self-esteem and depression remained significant. College students with four psychosocial problems were approximately 2.5 times more vulnerable to procrastination compared with non-syndemic (have no more than one problem) students. The study indicates that college students with more psychosocial health problems exhibit severer procrastination, which in turn suggests that psychosocial syndemic theory can be applied to procrastination.

The association between ambient air pollution exposure and mental health status in Chinese female college students: a cross-sectional study

The association between exposure to air pollution and mental health has not been adequately studied. Accordingly, this study aimed to explore the association between exposure to ambient air pollution and mental health status among female college students. We performed a cross-sectional study involving female students attending college located in Anshan, a heavy industry city in Northeast China. The investigation was performed using electronic questionnaires including the Symptom Checklist-90 (SCL-90), Pittsburgh Sleep Quality Index (PSQI), Cornell Medical Index (CMI), and general well-being (GWB) scale between March and April 2017. The individual daily average of time spent outdoors in each season was used as an indicator of exposure to ambient air pollution. The association between mental health status and exposure to ambient air pollution was analyzed using general linear regression. Of the 412 female participants, 346 (83.98%) submitted valid questionnaires. Multivariate linear regression indicated that GWB was negatively associated with the SCL-90 score, and annual average daily outdoor time and sleep quality were positively associated with the SCL-90 score. This study demonstrated that exposure to ambient air pollution may be a risk factor for mental health problems among female college students.

Subjective well-being, religiosity and anxiety: a cross-sectional study applied to a sample of Brazilian medical students

Abstract Objective: To assess associations between subjective well-being (SWB), religiosity, anxiety and other factors in a sample of Brazilian medical students from a public university in northeastern Brazil. Methods: The present study followed a cross-sectional, observational, analytical approach. Data were collected by administering a self-applicable questionnaire composed of questions focused on sociodemographic data and based on the Satisfaction With Life Scale (SWL), Positive Affect and Negative Affect Scale (PANAS), Penn State Worry Questionnaire (PSWQ), and the Duke Religiosity Index (DUREL). Results: The sample comprised 417 medical school students (73.54% of all the enrolled students). The medical students assessed presented a medium level of satisfaction with life, low mean positive emotion levels and high anxiety/uneasiness levels. Surprisingly, lower anxiety and intrinsic religiosity (IR) scores were associated with higher scores in the two SWB parameters (positive emotions and satisfaction with life). Furthermore, the factors leisure activities, good sleep quality, financial support, age, and gender were associated with the highest SWB scores (with emotional and cognitive components, or with only one of these two components). Conclusions: Data in the current study corroborated the negative association between SWB and anxiety; however, in opposition to the literature, they also evidenced a negative association between SWB and IR. In addition, the present research signaled the need for creating preventive intervention programs to increase SWB through positive psychological techniques and/or to decrease anxiety by applying, for instance, cognitive-behavioral therapy paradigms and/or mindfulness techniques to medical students.

The four-domain structure model of a depression scale for medical students: A cross-sectional study in Haiphong, Vietnam

Depression is a common mental health problem with a higher prevalence in medical students than in the general population. This study aims to investigate the association between depressive symptoms, particularly those in each domain of the Center for Epidemiological Studies Depression (CES-D) Scale, and related factors. A cross-sectional study was conducted with a random sample of 1319 medical students at Haiphong University of Medicine and Pharmacy in 2016. The CES-D scale and a self-reported questionnaire were used to identify the prevalence of depressive symptoms and related risk factors. Univariate and multivariate logistic regression were performed to assess the risk factors associated with depressive symptoms and the score for each structure factor. Depressive symptoms were observed in 514 (39%) students, including more males than females (44.2% vs 36.9%, p = 0.015). Students whose mothers' highest education level was primary school had a higher prevalence of depressive symptoms than students whose mothers had higher education levels (p = 0.038). There was a significant relationship between depressive symptoms and stressful life events, especially a decline in personal health. A higher correlation was found between the somatic complaints and depressive affect domains. The impacts of risk factors differed for each domain of the depression scale. Only the factor of achieving excellence showed no statistically significant associations with depressive symptoms and the scores on the four domains considered in this study. The high prevalence of depressive symptoms among medical students with risk factors and the impact of these risk factors on each domain of depression scale need further clarification to alleviate depression in students during their medical training.

The factor structure of the Dispositional Hope Scale in hemiplegic stroke patients

BACKGROUND

Hope is an important coping strategy and psychological resource for patients with a chronic illness. Stroke patients are exposed to stressful situations such as limited daily life activities, cognitive impairments and financial burdens.

AIM

This study investigated the factor structure of the Dispositional Hope Scale (DHS) and verified its validity when examining stroke patients.

METHODS

This methodological study used secondary, cross-sectional data analysis to investigate the factors related to participation restriction in chronic stroke patients. The DHS's reliability was assessed by calculating the internal consistency of Cronbach's α. The structure of the DHS was analyzed by confirmatory factor analysis. The one-factor model (Korean version), two-factor model (original version) and bifactor models were compared.

RESULTS

The fit indices provided evidence for the two-factor DHS model among hemiplegic stroke patients. Although the two-factor model was identified as superior by the Akaike information criterion value, both models had strong goodness-of-fit indices. The DHS had an adequate level of internal consistency in measuring hope in stroke patients.

CONCLUSIONS

The DHS is a valid, reliable and useful tool for examining hemiplegic stroke patients. Identifying the psychometric properties of the DHS can help health professionals implement program development for stroke patients.

Hope and Mental Health in Young Adult College Students: An Integrative Review

One in five young adults are diagnosed with a mental illness and many experience psychological distress during their first year of college due to new pressures in academia. The purpose of the current integrative review was to describe and synthesize hope and mental health in young adults in college. PubMed, CINAHL, and PsycINFO were searched for articles published in peer-reviewed journals from 2011-2016. Twenty empirical works were selected for inclusion and five themes emerged: (a) Hope is Associated With Improved Coping, (b) Hope is Associated With Improved Well-Being, (c) Hope is a Moderator Between Depression and Negative Life Events, (d) Hope is a Protective Factor in Suicide, and (e) Hope is a Factor in Healthy Behavior Engagement. Hope may be a protective factor in suicide and negative, self-deprecatory thinking. Further research is needed to determine if increasing hope in young adult college students will decrease the risk of suicide and non-suicidal self-injury, increase healthy behavior engagement, and improve coping and well-being. [Journal of Psychosocial Nursing and Mental Health Services, 55(2), 28-35.].

Identification of common words to improve self-confidence in Japanese students with subthreshold depression

Background Subthreshold depression (StD) is more common than major depressive disorder. Objective The study aimed to identify common words to improve self-confidence in Japanese university students with StD for developing a smartphone application to help those with StD. Methods In this cross-sectional study, words participants used to improve their self-confidence were gathered using self-report questionnaires in 154 university students in Japan. The words used to improve self-confidence were categorized using a computerized text analysis method based on the frequency of appearance. Results Participants were 154 male and females [StD group (n = 82) and healthy control (HC) group (n = 72); median age = 20 years]. A total of 290 words for improving self-confidence were identified. In the StD group, the keywords that appeared with the highest frequencies were "can", "let's try", "good luck", "able", and "don't worry". The keywords that occurred with the highest frequencies (the top eight) were common across both groups. The keywords were grouped into eight categories. The "encouragement" and "praise" categories were found in the responses of more than 80% of participants in both groups. Frequencies of the "determination" and "trust" categories were significantly higher in the StD group than in the HC group. Conclusions We conclude that "can", "let's try", and "good luck" are the most common words that Japanese students with StD use when describing how they improve their self-confidence. Future work will use these common words to develop a smartphone application to help those suffering from StD.

Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis

IMPORTANCE

Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies.

OBJECTIVE

To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students.

DATA SOURCES AND STUDY SELECTION

Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included.

DATA EXTRACTION AND SYNTHESIS

Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression.

MAIN OUTCOMES AND MEASURES

Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview.

RESULTS

Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, -0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%.

CONCLUSIONS AND RELEVANCE

In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.

Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis

Importance

Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies.

Objective

To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students.

Data Sources and Study Selection

Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included.

Data Extraction and Synthesis

Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression.

Main Outcomes and Measures

Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview.

Results

Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, -0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%.

Conclusions and Relevance

In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.