Association between sedentary behavior and depression among Japanese medical students during the COVID-19 pandemic: a cross-sectional online survey

Sedentary behavior is associated with the mental health of university students during the Covid-19 pandemic, and not practicing physical activity accentuates its adverse effects: cross-sectional study

BACKGROUND

Movement behaviours, such as sedentary behavior (SB) and physical inactivity, have become a public health issue due to their implications for physical and mental health. The literature indicates that the university environment influences the movement behaviors of university students, and the strategies adopted during the pandemic may have favored a decrease in the practice of physical activity and an increase in the time dedicated to SB in this population. We aimed to evaluate the association of SB and moderate to vigorous leisure-time physical activity (MVPA) with presence of symptoms of mental disorders during the COVID-19 pandemic.

METHODS

This is a multicenter survey conducted with undergraduate students from eight Brazilian universities between October 2021 and February 2022 using an online questionnaire. The outcome variable was symptoms of anxiety and depression, assessed by the Depression, Anxiety, and Stress Scale-21. SB was assessed by total sitting time, being that individuals with ≥ 9 h/day were classified with high SB. The practice of MVPA was evaluated based on weekly frequency, duration, and type of exercise. Subsequently, the ratio between the time spent in MVPA (minutes/day) and the time spent in SB (hours/day) was calculated, being considered as cutoff point was the practice of 2.5 min of MVPA for each sedentary hour. To assess the association between the outcome and explanatory variables, multivariable logistic regression was performed.

RESULTS

A total of 8,650 students participated in the study, with an average age of 23.9 years (SD: ± 6.34). In the multivariate analysis, the odds of anxiety symptoms [OR: 1.37 (95% CI: 1.24-1.50)] and depression [OR: 1.61 (95% CI: 1.47-1.77)] were higher in individuals with ≥ 9 h of SB per day. In the analysis of the relationship between MVPA and SB, not engaging in 2.5 min of MVPA per hour of SB increases the odds of anxiety symptoms [OR: 1.44 (95% CI: 1.31-1.58)] and depression [OR: 1.74 (95% CI: 1.59-1.92)].

CONCLUSION

The results suggest that SB is a risk factor associated with symptoms of anxiety and depression and that not engaging in MVPA exacerbates the negative effects of SB.

The effect of replacing sedentary behavior with different intensities of physical activity on depression and anxiety in Chinese university students: an isotemporal substitution model

BACKGROUND

Previous research has suggested that engaging in regular physical activity (PA) can help to reduce symptoms of depression and anxiety in university students. However, there is a lack of evidence regarding the impact of reducing sedentary behavior (SB) and increasing light-intensity PA (LPA) on these symptoms. This study aims to address this gap by using isotemporal substitution (IS) models to explore how substituting SB with LPA or moderate-to-vigorous PA (MVPA) affects depression and anxiety symptoms among university students.

METHODS

The study recruited 318 university students with a mean age of 21.13 years. Accelerometers were used to objectively measure the time spent on SB, LPA, and MVPA, while depression and anxiety symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Self-rating Anxiety Scale (SAS). IS models using multivariable linear regression were employed to estimate the associations between different behaviors and depression and anxiety symptoms when 30 min of one behavior was substituted with another.

RESULTS

In the single-activity model, less SB (β = 0.321, 95% CI: 0.089, 1.297) and more MVPA (β = -0.142, 95% CI: -1.496, - 0.071) were found to be significantly and negatively associated with depression scores, while less SB (β = 0.343, 95% CI: 0.057, 1.014), LPA (β = 0.132, 95% CI: 0.049, 1.023), and more MVPA (β = -0.077, 95% CI: -1.446, - 0.052) were significantly and negatively correlated with anxiety scores. The IS analysis revealed that substituting 30 min of SB with LPA (β = -0.202, 95% CI: -1.371, - 0.146) or MVPA (β = -0.308, 95% CI: -0.970, - 0.073) was associated with improvements in depressive symptoms. Substituting 30 min of SB with MVPA (β = -0.147, 95% CI: -1.863, - 0.034) was associated with reduced anxiety symptoms.

CONCLUSION

Replacing 30 min of SB with MVPA may alleviate depression and anxiety symptoms in university students. Further research is needed to explore the long-term effects of PA interventions on the mental health disorders of this population.

Dynamics of depressive states among university students in Japan during the COVID-19 pandemic: an interrupted time series analysis

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic was reported to have increased depression among university students which was associated with impairments in their campus lives. This study examined changes in depressive states among Japanese university students during the COVID-19 pandemic.

METHODS

A secondary data analysis from a factorial randomized controlled trial involving smartphone-based cognitive-behavioral therapy was performed. Six cohorts (N = 1626) underwent an 8-week intervention during the spring or autumn of 2019-2021, with a 9-month follow-up. We evaluated participants' depressive states weekly using the Patient Health Questionnaire-9 (PHQ-9) during the intervention, with monthly evaluations thereafter. The follow-up periods included Japan's four states of emergency (SOEs) to control COVID-19. Hypothesizing that SOEs caused a sudden worsening of depressive states, Study 1 compared the cohorts' PHQ-9 scores, and Study 2 employed time series analysis with a mixed-effects model to estimate identified changes in PHQ-9 scores.

RESULTS

Although no changes in depressive states were observed in relation to the SOEs, Study 1 identified sudden increases in PHQ-9 scores at the 28-week evaluation point, which corresponded to the beginning of the new academic year for the three autumn cohorts. In contrast, the three spring cohorts did not exhibit similar changes. Study 2 showed that, for all three autumn cohorts (n = 522), the 0.60-point change was significant (95% CI 0.42-0.78; p < .001) at 28 weeks; that is, when their timeline was interrupted.

CONCLUSIONS

While the results do not indicate any notable impact of the SOEs, they highlight the influence of the new academic year on university students' mental health during COVID-19. Trial registration UMIN, CTR-000031307. Registered on February 14, 2018.

The new normal: a review of the impact of COVID-19 on gastroenterology fellowship training

The COVID-19 pandemic had a significant impact on medical education and gastroenterology fellowship training. As a result of the pandemic, a trainee's physical safety, mental health and wellness, clinical and procedural training, and educational opportunities were all potentially altered. Changes necessitated at the start of the pandemic were different than those needed further along in the pandemic course. Fellowship programs were required to modify policies and adapt to changes rapidly to advocate for their trainees and ensure quality education. Much of COVID-19's initial impact on education - decreased endoscopic procedures and the loss of educational conferences - has largely returned to pre-pandemic form. However, other changes made during the pandemic have persisted and likely will continue in the future. This includes a virtual interview format for fellowship matches, a virtual option for many national conferences, and an expansion of simulation training. This article reviews the impact that COVID-19 had on medical education with a specific focus on gastroenterology fellowship. The paper highlights the initial impact of COVID-19, the lingering effects, and discusses the areas needed for further research to best understand the total impact COVID-19 had on our trainees' education.

Three-year evaluation of a program teaching social determinants of health in community-based medical education: a general inductive approach for qualitative data analysis

BACKGROUND

Social determinants of health (SDH) are intricately intertwined with various social and economic factors. Reflection is essential for learning about SDH. However, only a few reports have focused on reflection in SDH programs; most were cross-sectional studies. We aimed to longitudinally evaluate a SDH program in a community-based medical education (CBME) curriculum that we introduced in 2018 based on the level of reflection and content on SDH in students' reports.

METHODS

Study design: General inductive approach for qualitative data analysis. Education program: A 4-week mandatory clinical clerkship in general medicine and primary care at the University of Tsukuba School of Medicine in Japan was provided to all fifth- and sixth-year medical students. Students underwent a 3-week rotation in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. After a lecture on SDH on the first day, students were instructed to prepare a structural case description based on encounters during the curriculum. On the final day, students shared their experiences in a small group session and submitted a report on SDH. The program was continuously improved and faculty development was provided.

STUDY PARTICIPANTS

Students who completed the program during October 2018-June 2021.

ANALYSIS

Levels of reflection were categorized as reflective, analytical, or descriptive. The content was analyzed based on the Solid Facts framework.

RESULTS

We analyzed 118 reports from 2018-19, 101 reports from 2019-20, and 142 reports from 2020-21. There were 2 (1.7%), 6 (5.9%), and 7 (4.8%) reflective reports; 9 (7.6%), 24 (23.8%), and 52 (35.9%) analytical reports; and 36 (30.5%), 48 (47.5%), and 79 (54.5%) descriptive reports, respectively. The others were not evaluable. The number of Solid Facts framework items in reports were 2.0 ± 1.2, 2.6 ± 1.3, and 3.3 ± 1.4, respectively.

CONCLUSIONS

Students' understanding of SDH deepened as the SDH program in the CBME curriculum improved. Faculty development might have contributed to the results. Reflective understanding of SDH might require more faculty development and integrated education of social science and medicine.

Exploring changes in levels and patterns of physical activity in undergraduate medical and nursing students during the COVID-19 pandemic

This study reports the physical activity (PA) levels among medical and nursing students at a university in Bahrain during the COVID-19 pandemic. Through self-selection sampling of an online survey, participants' data on general demographics, PA levels before and during the COVID-19 pandemic and reasons for PA changes were collected. From the 110 valid responses, 70 participants (63%) experienced a decrease in PA during the COVID-19 lockdown. Fear of contracting COVID-19 and lack of motivation were two significant reasons for reduced PA levels (p < 0.001) compared to those who did not experience a decrease in PA. Other factors significantly associated with reduced PA levels include living alone (p < 0.018) or with roommates (p < 0.006) compared to living with family. Having more time available was associated with positive changes to PA levels (p < 0.001). Significant differences in MET-min/week were seen between students who experienced increased PA (median of 1605 MET-min/week) compared to those who experienced a decrease (424 MET-min/week) or no change (1070 MET-min/week) in PA levels (p < 0.001). In conclusion, low PA levels are prevalent within medical and nursing students in Bahrain (51% reported < 600 MET-min/week), with ~2 in 3 students reporting a decrease in PA levels during the COVID-19 pandemic. Support programs and strategies to increase engagement in PA within this population are warranted.