Depression and its associated factors: perceived stress, social support, substance use and related sociodemographic risk factors in medical school residents in Nairobi, Kenya

Study Protocol for the Residents' Mental Health Investigation, a Dynamic Longitudinal Study in Italy (ReMInDIt)

Medical residents constitute a vulnerable population susceptible to mental health disorders. In Italy, this was evident during the COVID-19 pandemic, when medical residents served on the front line and provided significant support to healthcare services. Therefore, the working group on "Public Mental Health" of the Medical Residents' Council of the Italian Society of Hygiene, Preventive Medicine, and Public Health (S.It.I.) designed the "Residents' mental health investigation, a dynamic longitudinal study in Italy" (ReMInDIt). This longitudinal study aims to assess the mental status of medical residents and to explore potential cause-effect relationships between risk/protective factors (identified among sociodemographic, residency program, and lifestyle characteristics) and mental health outcomes (anxiety and depressive symptoms). Data will be collected from a study population of 3615 residents enrolled in Italian residency programs in public health, occupational medicine, and forensic medicine through an online questionnaire that includes validated tools, requires 10 min for completion, and is disseminated by the residents' Councils. It will be followed by a follow-up administration after 12 months. The ReMInDIt study will play a significant role in generating evidence crucial for enhancing mental health services and promoting protective factors for the mental well-being of this important segment of healthcare professionals.

Social Support, Psychological Strain, and Suicidality: Evidence from Chinese Universities

This study aimed to apply psychological strain theory to explore the relationship between psychological strain and suicidality among Chinese young adults with a moderating effect of perceived social support. A questionnaire was administered with the Multidimensional Scale of Perceived Social Support (MSPSS), Suicidal Behaviors Questionnaire-Revised (SBQ-R), and Psychological Strain Scale (PSS) among 13,250 college students across China. The main determinants of suicidal behavior were examined with multiple linear regression. Two steps of multiple regression were employed to define the moderating effect of social support. A positive relationship between psychological strain and suicidality was reported in the study, and social support was confirmed as a moderating factor between psychological strain and suicidal behavior.

Postgraduate medical trainees at a Ugandan university perceive their clinical learning environment positively but differentially despite challenging circumstances: a cross-sectional study

PURPOSE

The clinical learning environment is an essential component in health professions' education. Data are scant on how postgraduate trainees in sub-Saharan Africa perceive their medical school learning environments, and how those perceptions contribute to their engagement during training, their emotional wellbeing, and career aspirations. This study examined perceptions of postgraduate medical trainees (residents) in a resource-limited setting, regarding their learning environment and explored perceptual contributions to their career engagement during training. The data reported contribute to understanding how clinical learning environments can be improved in low-resource settings in Uganda and elsewhere.

METHODS

This study was done at the Faculty of Medicine of Mbarara University of Science and Technology in Uganda. We used a descriptive cross-sectional design involving sequential mixed methods. Quantitative data were collected using the Postgraduate Hospital Educational Environment Measure (PHEEM). Qualitative data were collected using focus group discussions.

RESULTS

Ninety of the 113 eligible residents responded (79.6%). Of these, 62 (68.9%) were males, 51 (56.7%) were third-year trainees, and the majority (40%) of the residents were aged between 30 and 34 years. Overall PHEEM scored 98.22 ± 38.09; Role Autonomy scored 34.25 ± 13.69, Teaching scored 39.7 ± 13.81, and Social Support scored 24.27 ± 10.59. Gender differences occurred in the perceptions of teaching and social support. Cronbach's alpha coefficient was 0.94 for the overall PHEEM. Five major themes were identified from the qualitative data (trainee support, supervision environment, engagement with overall learning environment, preparation for future practice, and challenges that impede training).

CONCLUSIONS

Overall, this study suggests that postgraduate trainees at the institution perceived the clinical learning environment positively amidst challenges of limited resources. Trainees' insights provided data that propose improvements on a number of domains in the learning environment.

The mediating roles of coping styles and academic burnout in the relationship between stressors and depressive symptoms among Chinese postgraduates

Background

Since few studies have incorporated factors like stressors, coping styles, and academic burnout into the same model to analyze their impacts on depressive symptoms, this research attempts to establish an optimal structural model to explore the direct and indirect effects of these factors on depressive symptoms.

Methods

A total of 266 postgraduates completed questionnaires regarding coping styles, academic burnout, stressors, and depressive symptoms. The path analysis was applied for investigating the roles of coping styles and academic burnout in mediating the relationship between stressors and depressive symptoms.

Results

The total and direct effects of stressors on depressive symptoms were 0.53 and 0.31, respectively. The proportion of the direct effect of stressors on depressive symptoms to its total effect amounted to 58.50%. The indirect effects of academic burnout, positive coping style, and negative coping style on the association between stressors and depressive symptoms were 0.11, 0.04, and 0.03, taking up 20.75%, 7.55%, and 5.66% of the total effect, respectively. The serial indirect effect of positive coping style and academic burnout was 0.02, accounting for 3.77% of the total effect, while that of negative coping style and academic burnout was 0.02, taking up 3.77% of the total effect.

Conclusions

Coping styles and academic burnout chain jointly mediate the relationship between stressors and depressive symptoms among postgraduates. Thus, encouraging postgraduates to tackle stress positively may reduce the likelihood of the development of academic burnout and further reduce depressive symptoms.

Psychometric evaluation of PHQ-9 and GAD-7 among community health volunteers and nurses/midwives in Kenya following a nation-wide telephonic survey

Background

Nurses/midwives and Community Health Volunteers (CHVs) are exposed to chronic stressors putting them at risk of developing mental health problems. This has been exacerbated by the COVID-19 pandemic. There is limited empirical evidence of the burden of mental health problems among health care workers partly due to the lack of adequately standardized and validated measures for use among health care workers in Sub-Saharan Africa. This study aimed to perform the psychometric evaluation of the PHQ-9 and GAD-7 administered to nurses/midwives and CHVs across 47 counties in Kenya.

Methods

Between June and November 2021, a national survey on mental well-being and resilience among nurses/midwives and CHVs was conducted via telephone interviews. The survey had a total sample size of 1907 nurses/midwives and 2027 CHVs. Cronbach's alpha and MacDonalds' omega were used to evaluate the scale's internal consistency. Confirmatory Factor Analysis (CFA) was used to test the one-factor structure of the scales. Multi-group CFA was applied to evaluate the generalizability of the scales across the Swahili and English versions, and among male and female health workers. The Spearman correlation was used to assess the tools' divergent and convergent validity.

Results

The internal consistency of PHQ-9 and GAD-7 was good, with alpha and omega values above 0.7 across study samples. CFA results indicated a one-factor structure of the PHQ-9 and GAD-7 for both nurses/midwives and CHVs. Multi-group CFA showed that both scales were unidimensional across both language and sex. The PHQ-9 and GAD-7 were significantly negatively correlated with resilience and work engagement, supporting divergent validity. The PHQ-9 and GAD-7 were also significantly positively correlated with resilience and work engagement, supporting divergent validity.

Conclusion

The PHQ-9 and GAD-7 are unidimensional, reliable, and valid tools for screening depression and anxiety among nurses/midwives and CHVs. The tools can be administered in a similar population or study setting using either Swahili or English.

Students stress patterns in a Kenyan socio-cultural and economic context: toward a public health intervention

This study aimed at determining the prevalence of stress, different types of stress, their severity and their determinants in Kenyan university, college and high school students. The following tools were administered to 9741 students: (1) Researcher-designed socio-demographic tool, (2) Psychiatric Diagnostic Screening Questionnaire (PDSQ) for psychiatric disorders, (3) WERC Stress Screen for stress, (4) Washington Early Recognition Center Affectivity and Psychosis (WERCAP) screen for psychosis and affectivity, (5) Wealth Index Questionnaire for economic indicators. Descriptive analysis for the prevalence of different types of stress and inferential analysis for stress and independent variables were done. Significant variables (p < 0.05) were fitted into generalized linear model to determine independent predictors. The mean age of the respondents was 21.4 years (range 16-43). Money issues were the commonest stressors while alcohol and drug use were the least. The independent predictors of stress were females, college students and use of gas stove. In conclusion, up to 30% of the students suffer from mild to severe stress. The students experience a wide range of stressors. The most important stressors include money and finances, family related problems and concerns about their future. Our findings suggest a public health approach to create stress awareness in students.