Comorbid anxiety and depressive symptoms and the related factors among international medical students in China during COVID-19 pandemic: a cross-sectional study

The effects of childhood trauma on nonsuicidal self-injury and depressive severity among adolescents with major depressive disorder: The different mediating roles of positive and negative coping styles

OBJECTIVE

We aimed to examine whether positive and negative coping styles mediated the influences of childhood trauma on NSSI or depressive severity in adolescents with major depressive disorder (MDD).

METHODS

The Children's Depression Inventory (CDI), the Ottawa Self-Injury Inventory Chinese Revised Edition (OSIC), the short-form Childhood Trauma Questionnaire (CTQ-SF), and the Simplified Coping Style Questionnaire (SCSQ) were evaluated in 313 adolescents with MDD.

RESULTS

MDD adolescents with NSSI had higher CTQ-SF total score, emotional and sexual abuse subscale scores, but lower CDI total and subscale scores compared to the patients without NSSI. The multiple linear regression analysis revealed that emotional abuse (β = 0.075, 95 % CI: 0.042-0.107) and ineffectiveness (β = -0.084, 95 % CI: -0.160 ∼ -0.009) were significantly associated with the frequency of NSSI in adolescents with MDD, but emotional abuse (β = 0.884, 95 % CI: 0.570-1.197), sexual abuse (β = 0.825, 95 % CI: 0.527-1.124) and negative coping style (β = 0.370, 95 % CI: 0.036-0.704) were independently associated with the depressive severity in these adolescents. Furthermore, the mediation analysis demonstrated that positive coping style partially mediates the effect of childhood trauma on NSSI (Indirect effect = 0.002, 95 % bootCI: 0.001-0.004), while the negative coping style partially mediates the relationship between childhood trauma and depressive severity (Indirect effect = 0.024, 95 % bootCI: 0.005-0.051) in adolescents with MDD.

LIMITATIONS

A cross-sectional design, the retrospective self-reported data, the small sample size.

CONCLUSION

Our findings suggest that coping styles may serve as mediators on the path from childhood trauma to NSSI or depressive severity in MDD adolescents.

Psychological status and related factors of resident physicians during the release of COVID-19 pandemic restrictions in China

Background

Resident physicians at the standardized training stage had undergone significant physical and mental stress during the release of the COVID-19 pandemic restrictions at the end of 2022 in China. This study aimed to investigate the psychological status (including anxiety, depression, somatic symptoms, job burnout, and vicarious trauma) of resident physicians and identify its influencing factors under these special periods.

Methods

Survey was conducted one month after the release of the COVID-19 pandemic restrictions on resident training physicians from a tertiary first-class hospital in Zhejiang, China. Resident physicians completed the psychological status questionnaire. Chi-square tests, Mann-Whitney U tests, and logistic regression analyses were used to estimate the group differences and variable associations.

Results

The prevalence of anxiety, depression, and somatic discomfort in this study was 20.88, 28.53, and 41.47%, respectively. Female resident physicians were more likely to experience somatic symptoms [adjusted odds ratio (OR) = 2.36, 95% confidence interval (CI): 1.33-4.18]. Resident physicians with problem-focused coping styles were less prone to psychological health issues [depression (adjusted OR = 0.92, 95% CI: 0.88-0.96), anxiety (adjusted OR = 0.94, 95% CI: 0.90-0.98), somatic symptoms (adjusted OR = 0.93, 95% CI: 0.89-0.97), job burnout (adjusted OR = 0.91, 95% CI: 0.87-0.96) and vicarious trauma (adjusted OR = 0.94, 95% CI: 0.90-0.98)]. Inversely, resident physicians with emotion-focused coping styles and experienced negative life events were more prone to psychological health issues.

Conclusion

Resident training physicians had a high risk of anxiety, depression, and somatic symptoms under the special COVID-19 pandemic restriction release period. Females, with lower training stages, degrees, negative life events, and emotion-focused coping styles had a disadvantaged effect on psychological status. The medical teaching management department needs to monitor and reduce the workload and working hours of resident physicians, ensure sufficient sleep time, and pay attention to the psychological status of resident physicians. By strengthening regular communication and mental health education or intervention, which can help them improve their ability to cope with complex tasks.

Design and effectiveness of an online group logotherapy intervention on the mental health of Iranian international students in European countries during the COVID-19 pandemic

Introduction

The secondary impact of the COVID-19 pandemic, leading to widespread psychological challenges, significantly strained international students' mental health. The present work sought to design and assess the efficacy of an Online Group Logotherapy Protocol, an existential psychology approach developed by Viktor Frankl, to reduce anxiety and depression levels among Iranian international students who were migrants/refugees in different European countries during the pandemic.

Methods

The study recruited 70 students (58 females and 12 males, age range 20-35, 6 EU countries) experiencing moderate levels of anxiety and depression as measured by the Beck Anxiety (BAI) and Depression (BDI) Inventories at pre-test. Half the participants received a short-term closed group intervention comprising 6 online sessions / 90 min of logotherapy. The control group received 6 sessions without specific psychological treatment.

Results

The designed logotherapy sessions consisted of 1. Fundamentals of logotherapy, 2. Existential concerns, 3. Introspection, 4. Self-awareness and growth, 5. Empowering and facing challenges, 6. Meaning of life and conclusions. Five logotherapy techniques were used: Socratic Dialog, Modification of Attitude, Paradoxical Intention, Dereflection, and Logodrama. After the sessions, the post-test MANCOVA analysis showed a more potent effect of logotherapy reducing depression and anxiety than that elicited without intervention. The Eta coefficient suggests that the observed difference explains the effect of logotherapy with a strong power of 89%.

Conclusion

These findings unveil (1) the benefits of online group sessions despite the geographical distance and (2) the relevance of logotherapy effectively reducing depression and anxiety in such complex scenarios where psychological resources and cultural competencies are limited.

A systematic review of studies on stress during the COVID-19 pandemic by visualizing their structure through COOC, VOS viewer, and Cite Space software

Background

The COVID-19 epidemic generated different forms of stress. From this period, there has been a remarkable increase in the quantity of studies on stress conducted by scholars. However, few used bibliometric analyses to focus on overall trends in the field.

Purpose

This study sought to understand the current status and trends in stress development during COVID-19, as well as the main research drives and themes in this field.

Methods

2719 publications from the Web of Science(WOS) core repository on stress during COVID-19 were analyzed by utilizing Co-Occurrence (COOC), VOS viewer, and Cite Space bibliometric software. The overall features of research on stress during COVID-19 were concluded by analyzing the quantity of publications, keywords, countries, and institutions.

Results

The results indicated that the United States had the largest number of publications and collaborated closely with other countries with each other. University of Toronto was the most prolific institution worldwide. Visualization and analysis demonstrated that the influence of stress during COVID-19 on the work, life, mental and spiritual dimensions is a hot research topic. Among other things, the frequency of each keyword in research on stress during COVID-19 increased from 2021 to 2022, and the researchers expanded their scope and study population; the range of subjects included children, nurses, and college students, as well as studies focusing on different types of stress, and emphasizing the handling of stress.

Conclusion

Our findings reveal that the heat of stress research during COVID-19 has declined, and the main research forces come from the United States and China. Additionally, subsequent research should concern more on coping methods with stress, while using more quantitative and qualitative studies in the future.

Network analysis of mental health problems among adults in Addis Ababa, Ethiopia: a community-based study during the COVID-19 pandemic

OBJECTIVE

COVID-19 has negatively impacted mental health of adults globally with increased rates of psychiatric comorbidities. However, network analysis studies to examine comorbidities and correlations between symptoms of different mental disorders are uncommon in low-income countries. This study aimed to investigate the network structure of depression, anxiety and perceived stress among adults in Addis Ababa and identify the most central and bridge symptoms within the depressive-anxiety-perceived symptoms network model.

DESIGN

Community-based cross-sectional study.

SETTING

This study was carried out on a sample of the general population in Addis Ababa during the first year of the COVID-19 pandemic. A total of 1127 participants were included in this study, of which 747 (66.3%) were females, and the mean age was 36 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Symptoms of depression, anxiety and stress were measured using the Patient Health Questionnaire, Generalized Anxiety Disorder Scale and the Perceived Stress Scale, respectively.Network analysis was conducted to investigate the network structure. The centrality index expected influence (EI) and bridge EI (1-step) were applied to determine the central and bridge symptoms. Case-dropping procedure was used to examine the network stability.

RESULT

The sad mood (EI=1.52) was the most central and bridge symptom in the depression, anxiety and perceived stress network model. Irritability (bridge EI=1.12) and nervousness and stressed (bridge EI=1.33) also served as bridge symptoms. The strongest edge in the network was between nervousness and uncontrollable worry (weight=0.36) in the anxiety community. The network had good stability and accuracy. The network structure was invariant by gender and age based on the network structure invariance test.

CONCLUSIONS

In this study, the sad mood was the core and bridge symptom. This and the other central and bridge symptoms identified in the study should be targeted to prevent mental health disorders and comorbidities among adults.

Problematic Internet use and attitudes towards persons with disabilities - cross-sectional research among Polish students

BACKGROUND

Problematic Internet use (PIU) can have detrimental effects on physical, emotional, psychological, and social functioning. Besides well-described PIU correlations in psychological domains such as personality traits, or life satisfaction, and self-assessment, the social aspect of PIU risk also appeared to be important. This study aimed to investigate the association between PIU and attitudes towards persons with disabilities.

METHODS

A total of 595 Polish students aged 18-29 participated in this research by completing the Internet Addiction Test, Multidimensional Attitudes Scale Towards Persons With Disabilities, and personal information form.

RESULTS

The findings revealed that 30.6% of the respondents were at high risk for PIU. Moreover, heightened levels of PIU were more prevalent among male participants and students in technical fields of study than in those in medical and social fields of study. Increased PIU was also associated with more negative attitudes towards persons with disabilities in general and in the domains of emotions and behaviours. Additionally, prior personal contact with individuals with disabilities was related to both PIU rates and attitudes towards persons with disabilities in the domain of emotions and beliefs.

CONCLUSIONS

This study highlights the prevalence of PIU among Polish students and emphasizes the need for preventive measures, particularly targeting male students and those in technical fields of study. The results indicate a relationship between PIU and attitudes towards individuals with disabilities. Further research is required to determine the direction of the relationship. It is recommended that educational programs provide opportunities for interaction with individuals with disabilities to promote understanding and acceptance.

Association between psychological distress and mental help-seeking intentions in international students of national university of Singapore: a mediation analysis of mental health literacy

BACKGROUND

International students encounter a wide range of challenges that can have a significant impact on their mental health. Seeking help is one of the primary means of managing mental health, and more attention is required. This study aimed to investigate the psychological distress(PD), mental health literacy(MHL), and mental help-seeking intentions(MHSI) in international students of National University of Singapore(NUS), to explore the correlation between the three and to verify the mediating role of MHL in PD and MHSI.

METHODS

This cross-sectional study was conducted between May and July 2023 using the Mental Help Seeking Intention Scale(MHSIS), Patient Health Questionnaire-9(PHQ-9), Generalized Anxiety Disorder-7(GAD-7), and Mental Health Literacy Scale(MHLS). 281 international students(177 males, 104 females;) in NUS completed self-report questionnaires. SPSS 25.0 was applied to the data for descriptive analysis, Pearson correlation analysis and stepwise regression analysis. Mediation analysis fully for all potential confounding factors were conducted.

RESULTS

Significant correlations were found between PD, MHL and MHSI. MHLS- knowledge of how to seek professional information(MHLS- H) completely mediated the association of anxiety with MHSI[B=-0.271; 95% confidence interval(CI): (-0.067, 0.0037)]; MHLS- attitude that promote recognition or appropriate help-seeking behavior(stigma)(MHLS- H) partially mediated the association of PD with MHSI[B = 0.104, 95% CI: (0.008, 0.179)]; with mediating effects accounting for 100% and 24.847% of the total effect. In addition, demographic variables such as gender, years in Singapore and residence type mediated both the direct and indirect effect of the mediation model.

CONCLUSIONS

MHL mediated both the direct and indirect effects on the association between PD and MHSI, especially, the mediator of the MHLS- H and MHL-A. It means that MHSI in this population can be improved by increasing MHL and thus the PD. The findings suggest that, such as providing information about how to access to professional services and promoting disorder recognition to the international students, may help them develop their psychological well-being and good mental health care decisions.

Depression and academic engagement among college students: the role of sense of security and psychological impact of COVID-19

Background

The negative consequences of depression in college students have garnered global attention, especially in relation to academic achievement during the COVID-19 pandemic, which need critical assessment.

Aim

This study investigated whether a sense of security mediated the relationship between depression and academic engagement among college students during the pandemic and whether the moderating psychological impact of COVID-19 has a moderating effect on this relationship.

Methods

In this cross-sectional study, we recruited 466 college students from 30 provincial-level administrative regions in China via the Internet and used established scales to measure depression, academic engagement, a sense of security, and the psychological impact of COVID-19. The mediating and moderating effects were tested using the bootstrap method.

Results

Depression was found to negatively influence academic engagement, with a sense of security partially mediating this relationship. Moreover, the psychological impact of COVID-19 was shown to have a moderating effect on this mediating process.

Conclusion

This study could aid in crafting pertinent strategies to mitigate the adverse effects of depression on learning amid unexpected public health crises and foster better mental health among college students.

Sociodemographic and educational factors associated with mental health disorders in medical students of clinical years: A multicenter study in Peru

OBJECTIVE

To identify sociodemographic and educational factors associated with mental health disorders in Peruvian medical students in clinical years.

METHODS

Cross-sectional study. We surveyed students from 24 Peruvian medical schools. We defined negative perception of educational environment as having a Dundee Ready Educational Environment Measure score below 100 points; we defined anxiety and depression as having more than 4 points on the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 scales, respectively. Poisson regression with robust variance was used to assess the association between negative perception of educational environment and mental health alterations.

RESULTS

Among the 808 participants, the prevalence of anxiety and depression symptoms was 77.6% and 67.3%, respectively. Negative perception of the educational environment was 31.6%. The factors associated with anxiety were being male (PR = 0.95, 95% CI:0.91-0.98), previous medical condition (Prevalence ratios PR = 1.10, 95% CI:1.05-1.16), previous diagnosis of coronavirus disease 2019 (PR = 0.93, 95% CI: 0.93-0.94), being from highlands (PR = 1.11, 95% CI: 1.05-1.16), studying at a national university (PR = 0.90, 95% CI: 0.88-0.92), and negative perception of the educational environment (PR = 1.04, 95% CI: 1.03-1.05), while factors associated with depression were being male (PR = 0.94, 95% CI: 0.93-0.95), previous medical condition (PR = 1.12, 95% CI: 1.08-1.17), type of university (national) (PR = 0.95, 95% CI: 0.95-0.96), and negative perception of the educational environment (PR = 1.11, 95% CI: 1.07-1.16).

CONCLUSION

We found evidence that during the COVID-19 pandemic anxiety and depression are prevalent among Peruvian medical students. Sociodemographic factors and negative perception of educational environment were associated with the presence of these conditions.

Sleep and Lifestyle Habits of Medical and Non-Medical Students during the COVID-19 Lockdown

It has been shown that the measures of social distancing and lockdown might have had negative effects on the physical and mental health of the population. We aim to investigate the sleep and lifestyle habits as well as the mood of Croatian medical (MS) and non-medical students (NMS) during the COVID-19 lockdown. The cross-sectional study included 1163 students (21.6% male), whose lifestyle and sleep habits and mood before and during the lockdown were assessed with an online questionnaire. The shift towards later bedtimes was more pronounced among NMS (~65 min) compared to MS (~38 min), while the shift toward later wake-up times was similar in both MS (~111 min) and NMS (~112 min). All students reported more frequent difficulty in falling asleep, night-time awakenings and insomnia (p < 0.001) during lockdown. A higher proportion of MS reported being less tired and less anxious during lockdown compared to pre-lockdown (p < 0.001). Both student groups experienced unpleasant moods and were less content during lockdown compared to the pre-lockdown period (p < 0.001). Our results emphasize the need for the promotion of healthy habits in the youth population. However, the co-appearance of prolonged and delayed sleep times along with decreased tiredness and anxiety among MS during lockdown reveals their significant workload during pre-lockdown and that even subtle changes in their day schedule might contribute to the well-being of MS.