Prevalence and sociodemographic correlates of common mental disorders among first-year university students in post-apartheid South Africa: implications for a public mental health approach to student wellness

Thriving beyond the stethoscope: Unveiling positive mental health among medical students at a University in South Africa

Introduction

Medical education presents significant challenges for medical students' mental health. Medical students are a vulnerable group, experiencing higher rates of mental health disorders, which can have implications for their well-being and academic performance. Consequently, evaluating Positive mental health (PMH) has become significant in a contemporary and demanding society, particularly among university students.

Aim

This study aimed to assess the levels of PMH and identify the association between PMH domains and socio-demographic and health related variables among medical students enrolled at a university in South Africa.

Methods

This quantitative, descriptive, and cross-sectional survey was conducted with 144 undergraduate medical students. Data were collected using a multi-dimensional PMH instrument and a sociodemographic and health related questionnaire, from 144 undergraduate medical students. The university's Research and Ethics Committee granted ethical clearance for the study. Results: The data were analysed using IBM SPSS version 29. The majority of the students were older than 20 years (79.2 %, n = 114), had no prior history of psychiatric illness, and had not previously taken any psychiatric medication (94.4 %, n = 136). More than half of the participants were single (66 %, n = 95), identified as Christians (76.4 %, n = 110), received a bursary (78.5 %, n = 113), had families living in rural areas (71.5 %, n = 103) and resided in the university housing (73.6 %, n = 106). Gender (p = 0.01), age (p = 0.02), religious affiliation (p = 0.03), history of psychiatric illness (p = 0.05) and treatment for psychiatric illness (p = 0.05) had a significant influence on the Total PMH score. Male participants reported higher mean scores in most PMH domains, excluding emotional support and spirituality domains. Participants aged between 22 and 23 years reported lower mean scores in Total PMH and most PMH domains. There is a significant difference in mean scores with gender (p = 0.02) and religious affiliation (p = 0.00) in the spirituality domain.

Conclusion

The study results emphasised the complex nature of mental health and provided a rationale for assessing the various aspects of PMH in university students. By implementing evidence-based strategies and providing adequate support, medical schools can better support the mental health and well-being of their students, ultimately cultivating a healthier and more resilient future healthcare workforce.

Design, Develop, and Pilot-Test a Digital Platform to Enhance Student Well-Being: Protocol for a Mixed-Methods Study

BACKGROUND

Well-being is a multidimensional concept and has been extended to many areas. Student well-being has garnered attention over the last decade due to concerns that have been raised. Digital health interventions have the potential to enhance and improve student well-being.

OBJECTIVE

The objective of the study is to design, develop, and pilot-test a digital health platform to enhance student well-being.

METHODS

A sample size of 5000 participants will be recruited across Gujarat and Tamil Nadu, India. Students will be enrolled from Parul University in Vadodara, Gujarat, as well as Panimalar Medical College Hospital and Research Institute, Panimalar Engineering College, Panimalar Institute of Technology, and Panimalar College of Nursing in Chennai, Tamil Nadu. Current undergraduate and graduate students consenting to participate will be recruited using convenience sampling from these institutes. The study will collect baseline data to construct the student well-being index. Based on the risk profile, a random subset of the population will be provided access to the digital health intervention, which will deliver tailored interactive messages addressing the various dimensions of well-being among undergraduate and graduate students. The eligible study participants will be aged 18 years and older, enrolled in these institutes, and willing to give their consent to participate in the study.

RESULTS

The proposed research is an unfunded study. The enrollment of the individuals in the study began in October 2022. Data gathered will be analyzed using SAS (version 9.3; SAS Institute) and results will be reported as 95% CIs and P values.

CONCLUSIONS

The proposed study will help to determine the factors affecting well-being among college students and help in designing digital health interventions to improve the well-being of undergraduate and graduate students.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/39779.

The relationship between boredom proneness, the behavioral inhibition system, and anxiety in college students: variable-centered and person-centered analytic approaches

Objective

To explore the relationship among boredom proneness, the behavioral inhibition system, and anxiety among college students based on variable-centered and person-centered analytic approaches.

Methods

A questionnaire survey was conducted on 1,102 college students from a university in Hebei Province using the Boredom Proneness Questionnaire (BPQ) for College Students, the Behavioral Inhibition System Scale (BIS), and the General Anxiety Disorder-7 scale (GAD-7).

Results

The results reveal that boredom proneness was negatively correlated with scores on the behavioral inhibition system (r = -0.100, p < 0.01), and positively correlated with anxiety (r = 0.457, p < 0.001), while the behavioral inhibition system was positively correlated with anxiety (r = 0.086, p < 0.01). In the variable-centered analyses study, it was found that the behavioral inhibition system partially mediated the association between boredom proneness and anxiety. In the person-centered analyses study, three subtypes were identified: the high boredom-low inhibition group (9.35%), the moderate boredom-inhibition group (66.70%), and the low boredom-high inhibition group (23.95%). Individuals in these subtypes showed significant differences in anxiety scores (F = 4.538, p < 0.05), with the low boredom-high inhibition group scoring the highest.

Conclusion

The results showed that the behavioral inhibition system partially mediates the relationship between boredom proneness and anxiety in college students; boredom proneness and the behavioral inhibition system exhibit group heterogeneity, with distinct classification features closely related to anxiety.

Relationship between Psychosocial Factors and Physical Activity among Undergraduate Students from a South African University

Psychosocial factors such as mental health, motivation, and social support are key determinants of behavior that play a significant role in physical activity participation. Limited studies have investigated the relationship between psychosocial factors and physical activity among university students in Africa. The aim of this study was to determine the relationship between psychosocial factors and physical activity participation among undergraduate university students at a historically disadvantaged university (HDU) in South Africa. This was a cross-sectional study that used convenience sampling (n = 534, majority female, 53.6% with a mean age of 20.69). The study was conducted through an online, self-administered, and hard-copy, valid questionnaire in September 2022. Data on sociodemographic information were collected. Psychosocial factors were assessed using the Depression, Anxiety, and Stress-21 Scale for mental health, the Physical Activity and Leisure Motivation Scale for motivation, and the Perceived Social Support Scale for social support. Physical activity (calculated as MET-min/week) was assessed using the international physical activity questionnaire in short form. Results revealed that almost a third (29%) of undergraduate students were physically inactive, 31.1% were minimally active, and 39.9% were in the health-enhancing category. Physical activity was positively related to stress (r = 0.11, p < 0.05) and anxiety (r = 0.10, p < 0.05). Motivational factors were positively related to psychological condition and others' expectations (r = 0.10, p < 0.05), and depression and others' expectations (r = 0.11, p < 0.05). Results from this study highlighted that psychosocial factors were related to physical activity participation among undergraduate university students. Psychosocial factors should be considered a coping mechanism when implementing health-promoting strategies.

It's very difficult to set the boundaries, it's human nature to want to respond: exploring health professions educators' responses to student mental health difficulties through a positioning theory lens

By virtue of their teaching role and contact with students, health professions (HP) educators are often the first point of connection for students who are experiencing mental health difficulties. Educators are increasingly expected to include some form of pastoral care in their role. Mental health-related interactions with students may have a negative emotional impact on educators, particularly when roles and expectations are not clearly defined and where boundaries are not managed effectively. Using positioning theory as a lens, this study explored how educators experienced such interactions and how this manifested in positions, storylines, and speech acts. Interviews were conducted with 27 HP educators at a faculty of medicine and health sciences. Reflexive thematic analysis using inductive coding identified themes corresponding to the nearing, weighted, ambivalent, and distancing positions participants adopted in relation to students with mental health difficulties. There was fluidity in and between positions, and more than one position could be occupied simultaneously; participants each moved through different positions in response to different relational situations. Multiple storylines informed these positions, representing how moral- and care-informed responsibility intersected with responsiveness to make certain actions possible or impossible. Normative and personal value narratives were evident in storylines, in many cases underscored by care or justice ethics. The value of positioning theory in facilitating reflective faculty development initiatives for educators engaged in these interactions is discussed.

Treatment rates and barriers to mental health service utilisation among university students in South Africa

BACKGROUND

Mental health problems are common and impairing among university students, yet only a minority of students with psychological disorders access treatment. Understanding barriers to treatment is integral to planning services, especially in resource constrained settings like South Africa (SA).

METHODS

Data collected across 17 institutions in the online SA National Student Mental Health Survey were used to: (1) estimate 12-month prevalence of common mental health problems and self-harm; (2) estimate the proportion of students receiving treatments for the various mental health problems; (3) explore barriers to treatment; and (4) investigate sociodemographic predictors of treatment mediated through the various barriers endorsed by students with mental health problems. Prevalence analyses were carried out using cross-tabulations and prediction analyses using modified Poisson regression models.

RESULTS

Prevalence of clinically significant mental health problems is high relative to international comparisons, with the prevalence of severe, mild and moderate symptoms of any disorder and/or self-harm of 24.8% (SD = 0.3), 18.8% (SD = 0.3) and 27.6% (SD = 0.4) respectively. Treatment rates were 35.2% (S.E. = 0.6) among students with mental health problems who perceived need for treatment and 21.3% (S.E. = 0.4) irrespective of perceived need. Treatment rates were highest for mood disorders (29.9%, S.E. = 0.6) and lowest for externalising disorders (23.8%, S.E. = 0.5). Treatment rates were much less variable across disorder types among students with perceived need than irrespective of perceived need, indicating that perceived need mediated the associations of disorder types with received treatment. Adjusting for disorder profile, probability of obtaining treatment was significantly and positively associated with older age, female gender, study beyond the first year, traditional sexual orientation, and diverse indicators of social advantage (full-time study, high parent education, and attending Historically White Institutions). Among students with mental health problems, numerous barriers to treatment were reported adjusting for disorder profile, including lack of perceived need (39.5%, S.E. = 0.5) and, conditional on perceived need, psychological (54.4%, S.E. = 1.0), practical (77.3%, S.E. = 1.1), and other (79.1%, S.E. = 1.1) barriers. Typically, students reported multiple barriers to treatment. Differences in perceived need explained the gender difference in treatment, whereas practical barriers were most important in accounting for the other predictors of treatment.

CONCLUSION

Mental health problems are highly prevalent but seldom treated among SA university students. Although many barriers were reported, practical barriers were especially important in accounting for the associations of social disadvantage with low rates of treatment. Many of these practical barriers are however addressable.

South African university students' experiences of online group cognitive behavioural therapy: Implications for delivering digital mental health interventions to young people

Mental disorders are common among university students. In the face of a large treatment gap, resource constraints and low uptake of traditional in-person psychotherapy services by students, there has been interest in the role that digital mental health solutions could play in meeting students' mental health needs. This study is a cross-sectional, qualitative inquiry into university students' experiences of an online group cognitive behavioural therapy (GCBT) intervention. A total of 125 respondents who had participated in an online GCBT intervention completed a qualitative questionnaire, and 12 participated in in-depth interviews. The findings provide insights into how the context in which the intervention took place, students' need for and expectations about the intervention; and the online format impacted their engagement and perception of its utility. The findings of this study also suggest that, while online GCBT can capitalise on some of the strengths of both digital and in-person approaches to mental health programming, it also suffers from some of the weaknesses of both digital delivery and those associated with in-person therapies.

Mental Health of University Students When Returning to Face-to-Face Classes: A Cross-Sectional Study

Depression, anxiety and stress are multifactorial affective disorders that could manifest through a set of symptoms, both physical and psychological, that affect the quality of life and performance of people who suffer from them. In this sense, the present research had the objective of evaluating depression, anxiety and stress in students of the Faculty of Engineering of a Peruvian public university when returning to face-to-face classes. The research was developed under a quantitative approach and is of a non-experimental design of the descriptive cross-sectional type. The sample consisted of 244 students who responded to the Depression, Anxiety and Stress Scale, an instrument with adequate psychometric properties. According to the results, the students presented low levels of depression and anxiety. However, they showed moderate levels of stress. On the other hand, it was found out that the three variables were directly and significantly related. In the same way, it was found that there were statistically significant differences regarding the levels of depression, anxiety and stress related to gender, age group, family responsibilities and professional career. Finally, it was concluded that there were symptoms of depression, anxiety and stress in students of the Faculty of Engineering of a Peruvian public university when returning to face-to-face classes.

Associations between psychological distress and facets of mindfulness: Implications for campus-based university wellness services

OBJECTIVES

To investigate associations between components of psychological distress and five facets of mindfulness (i.e. observing; describing; acting with awareness; non-reactivity; non-judging).

PARTICIPANTS

Students from a university in South Africa (n = 174).

METHODS

This cross-sectional study assessed psychological distress and mindfulness using the K10 and Five Facet Mindfulness Questionnaire. Multivariate regression analysis identified associations between psychological distress and facets of mindfulness, controlling for demographics.

RESULTS

Prevalence of psychological distress was 56.9% (95% CI 49.2%-64.4%). Acting with awareness, non-reactivity, and non-judging predicted significantly lower psychological distress, whereas observing and describing did not. Acting with awareness was the only facet of mindfulness that consistently predicted lower levels of negative affect, fatigue, nervousness, and agitation.

CONCLUSIONS

Acting with awareness appears to be a key component of psychological wellbeing. To advance theory and practice, future research should consider why and how various facets of mindfulness predict lower psychological distress and its components among university students.

A systematic review and meta-analysis of studies exploring prevalence of non-specific anxiety in undergraduate university students

BACKGROUND

Anxiety is a common mental health problem in the general population, and is associated with functional impairment and negative impacts upon quality of life. There has been increased concern about university students' mental health in recent years, with a wide range of non-specific anxiety rates reported worldwide in undergraduate university students. We aimed to explore prevalence of non-specific anxiety in undergraduate university student populations.

METHODS

Four databases were searched to identify studies published between 1980 and 2020 which investigated prevalence of non-specific anxiety in undergraduate university students. Each study's quality was appraised using a checklist. Sub-analyses were undertaken reflecting outcome measure utilized, course of study, location of study, and whether study was before or during the COVID-19 pandemic.

RESULTS

A total of 89 studies - representing approx. 130,090 students-met inclusion criteria. Eighty-three were included in meta-analysis, calculating a weighted mean prevalence of 39.65% (95% CI: 35.72%-43.58%) for non-specific anxiety. Prevalence from diagnostic interview studies ranged from 0.3%-20.8% 12-month prevalence. Prevalence varied by outcome measure used to assess non-specific anxiety, the type of course studied by sample, and by study location. In half the studies, being female was associated with being more likely to have higher non-specific anxiety scores and/or screening above thresholds. Few of the included studies met all quality appraisal criteria.

CONCLUSION

The results suggest that approximately a third of undergraduate students are experiencing elevated levels of non-specific anxiety. Results from sub-analyses have identified some methodological issues that need consideration in appraising prevalence in this population.

Pattern, barriers, and predictors of mental health care utilization among Egyptian undergraduates: a cross-sectional multi-centre study

BACKGROUND

Mental health disorders are a major public health concern especially among undergraduates, globally and within Egypt. Most individuals suffering from mental illnesses either do not seek care at all or seek it only after a large delay. It is therefore critical to identify the barriers that prevent them from seeking professional help to solve the problem from its roots. Thus, the objectives of the study were to assess the prevalence of psychological distress, the need for professional mental health care, and the barriers to seeking available services among undergraduate students in Egypt.

METHODS

A proportionate allocation technique was used to recruit 3240 undergraduates from 21 universities. Symptoms of psychological distress were evaluated using the Arabic General Health Questionnaire (AGHQ-28) and a score of above nine was used to identify positive cases. The pattern for utilization of mental health care was assessed using a multi-choice question and barriers to mental health care were assessed using the Barriers to Access to Care Evaluation (BACE- 30) tool. Logistic regression was adopted to identify the predictors of psychological distress and seeking professional health care.

RESULTS

The prevalence of psychological distress was 64.7% and the need for professional mental health care was 90.3% of those with psychological distress. The top barrier to receiving professional mental health services was wanting to solve the problem on their own. Logistic regression revealed that female sex, living away from family and positive family history of mental disorders were independent predictors of psychological distress. Students from urban backgrounds were more likely to seek help than students from rural ones. While age above 20 and positive family history of mental disorders were independent predictors for seeking professional help. There is no significant difference between medical and non-medical students in terms of psychological distress.

CONCLUSION

The findings of the study showed there is a high prevalence of psychological distress and a lot of instrumental and attitudinal related barriers to seeking mental health care and highlighted the urgent need to develop interventions and preventive strategies to address the mental health of university students.

The mental health of university students in South Africa: Results of the national student survey

BACKGROUND

We estimate 30-day prevalence of 11 common mental disorders among a representative sample of university students in South Africa and explore disparities in student mental health across historically segregated institutions and marginalised groups.

METHODS

Cross-sectional data collected in self-report surveys of students (n = 28,268) from 17 universities were weighted to adjust for differences in survey responses. Poisson regression was used to estimate risk ratios (RRs).

RESULTS

Prevalence estimates were highest (21.0-24.5 %) for two anxiety disorders (social anxiety disorder, PTSD) and two disruptive behavior disorders (eating disorder, ADHD). Prevalence estimates were higher for any anxiety disorder (37.1 %) and any disruptive behavior disorder (38.7 %) than for any mood disorder (16.3 %) or any substance use disorder (6.6 %). Prevalence estimates varied significantly by historical segregation status of institutions (F₃ = 221.6, p < .001), with prevalence consistently highest in Historically White Institutions (HWIs). Across all institutions, risk of any disorder was lower among oldest than younger students (RR = 0.7, 95%CI = 0.7-0.8), and elevated among gender non-conforming (RR = 1.3, 95%CI = 1.1-1.4), female (RR = 1.2, 95%CI = 1.1-1.2), and sexual minority (RR = 1.2, 95%CI = 1.2-1.3) students. Black students attending HWIs had elevated risk of any disorder relative to White students.

LIMITATIONS

Reliance on self-report measures together with relatively low and variable response rates across institutions limit generalizability of results.

CONCLUSIONS

Modest risks associated with sociodemographic factors suggest a need to focus on mental health of female, gender nonconforming and sexual minority students at all universities along with Black students attending HWIs.

Intention to use digital mental health solutions: A cross-sectional survey of university students attitudes and perceptions toward online therapy, mental health apps, and chatbots

Background

Globally, the high prevalence of mental disorders among university students is a growing public health problem, yet a small minority of students with mental health problems receive treatment. Digital mental health solutions could bridge treatment gaps and overcome many barriers students face accessing treatment. However, there is scant evidence, especially in South Africa (SA), relating to university students' use of and intention to use digital mental health solutions or their attitudes towards these technologies. We aim to explore university 2students attitudes towards and perceptions of digital mental health solutions, and the factors associated with their intention to use them.

Methods

University students from four SA universities (n = 17 838) completed an online survey to assess experience with, attitudes and perceptions of, and intentions to use, digital mental health solutions. We conducted an exploratory factor analysis to identify factors underlying attitudes and perceptions, and then used multivariate ordinal regression analysis was used to investigate the factors' association with students' intention to use digital mental health solutions.

Results

Intention to use digital mental health solutions was high, and attitudes towards and perceptions of digital mental health solutions were largely positive. Importantly, our analysis also shows that 12.6% of users were willing to utilise some form of digital mental health solutions but were unwilling to utilise traditional face-to-face therapies. The greatest proportion of variance was explained by the factor 'Attitudes towards digital technologies' utility to improve student counselling services, provided they are safe'.

Conclusion

SA university students are already engaging with digital mental health solutions, and their intention to do so is high. Certain attitudes and perceptions, particularly concerning the utility, effectiveness, and safety, underlie willingness to engage with these solutions, providing potential targets for interventions to increase uptake.

Psychological distress among first-year health science students in Taiwan

Background

Objective

Methods

Results

Conclusion

•

Some first-year health science students are at risk of psychological distress.

•

Anxiety and self-harm are common among first-year health science students.

•

Students in four-year programs are more likely to experience mental health challenges.

Exploring the association between khat use and psychiatric symptoms: a systematic review

OBJECTIVES

Consumption of the drug khat is high across East Africa and the South-Western Arabian Peninsula despite evidence for its adverse psychiatric effects. This systematic review aims to explore cross-sectional research in the field to determine the strength of the association between khat use and psychiatric symptoms METHODS: Six databases were searched in October 2021-Ovid Medline, Embase, APA PsycINFO, CINAHL, Scopus and Proquest-using the following search terms: "khat" OR "qat" OR "qaad" OR "catha" OR "miraa" OR "mairungi" AND "depression" OR "anxiety" OR "mania" OR "psych*" OR "schiz*" OR "mental" OR "hallucinations" OR "delusions" OR "bipolar". Eligible studies were cross-sectional studies of any population or setting comparing the prevalence of psychiatric symptoms in long term or dependent khat users with non-users. The quality of each study was appraised by the Newcastle-Ottawa scale. A meta-analysis was planned using a random effects model to produce an OR with 95% CIs-using the Mantel-Haenszel method-alongside an I² statistic to represent heterogeneity. The quality of this meta-analysis was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) scoring system.

RESULTS

35 studies were eligible for inclusion (total participants=31 893), spanning 5 countries (Ethiopia, Somalia, Kenya, Saudi Arabia, UK). Meta-analysis suggests that khat use is associated with an 122% increased prevalence of psychiatric symptoms (OR 2.22, 95% CIs 1.76 to 2.79, p<0.00001, GRADE score: 'very low').

CONCLUSIONS

The high heterogeneity of the meta-analysis is likely due to the wide variation between the studies within the evidence base. To perform a more accurate systematic review, further primary studies are needed with standardised measurements of variables, particularly khat consumption.

PROSPERO REGISTRATION NUMBER

CRD42020224510.

Suicidal Thoughts, Depression, Post-Traumatic Stress, and Harmful Alcohol Use Associated with Intimate Partner Violence and Rape Exposures among Female Students in South Africa

While ample evidence from high-income country settings indicates the prevalence and risk factors for multiple mental ill-health symptoms in student populations, evidence from low- and middle-income higher education settings remains limited. We determined the frequency, associations, and structural pathways between mental health outcomes and possible risk factors among a sample of 1292 predominantly Black African and female students ages 18-30 years, enrolled at nine purposefully selected public universities and Technical Vocational Education and Training (TVET) campuses. We measured and created a mental ill-health latent outcome consisting of depressive symptoms, post-traumatic stress disorder (PTSD), and suicidal thoughts. We also measured traumatic exposures including childhood trauma, recent intimate partner violence (IPV), non-partner rape, and other life traumatic events. We used structural equation modelling to analyse data. We found that 50% of the surveyed students binge drank, 43% reported depressive symptoms, 9% reported PTSD symptoms, and 21% had suicidal thoughts. Students' experiences of childhood trauma, food insecurity, other traumatic events, non-partner rape, and IPV impacted the mental ill-health latent. IPV experiences mediated the relationships between experiences of childhood trauma or other trauma and the mental ill-health latent, and the relationship between binge drinking and other life traumatic events. Non-partner rape mediated the relationship between food insecurity and the mental ill-health latent. Binge drinking directly impacted non-partner rape experience. The findings substantiate the need for campus-based mental health promotion, psychosocial services and treatments, and implementation of combined interventions that address the intersections of violence against women and mental health among students in South Africa.

Mental Health and Healthy Habits in University Students: A Comparative Associative Study

There is evidence of increased psychopathology in university students and its relationship with unhealthy lifestyle habits. The objective of this work is to examine the prevalence and differences in psychopathological symptoms and lifestyle in a sample of university students according to educational levels and area of knowledge. A comparative associative study was conducted with 1405 university students. The results indicated significant differences in psychopathology and habits in the different groups. The prevalence of psychopathology found was high, especially depressive and anxious pathologies. This incidence tends to be higher in undergraduates and/or Arts and Humanities, coinciding with those who tend to have poorer lifestyle habits. The promising contributions from this study facilitate the early detection of university students with a risk profile for the appearance or exacerbation of psychopathology, as well as the design of psychological intervention programs aimed at the psychological well-being of this population.

Relação entre Perfil, Hábitos, Vivências Acadêmicas e Resiliência de Universitários

Resumo A falta de recursos para lidar com situações desafiadoras pode dificultar o ajuste do estudante à universidade e aumentar o risco de fracasso acadêmico. Pensando nisso, o objetivo deste estudo foi verificar se há relação entre o perfil, os hábitos de vida, as vivências acadêmicas e a resiliência de graduandos das áreas da saúde e Psicologia. Trata-se de um estudo transversal e inferencial. Participaram 361 graduandos dos cursos de Biomedicina, Educação Física, Enfermagem, Farmácia, Fisioterapia, Medicina, Nutrição, Terapia Ocupacional e Psicologia, matriculados em três instituições federais de Ensino Superior do interior de Minas Gerais. Utilizou-se um questionário sociodemográfico e de hábitos de vida, a Escala de Resiliência e o Questionário de Vivências Acadêmicas - versão reduzida -, respondidos de forma on-line pelos universitários, bem como análises descritivas e correlacionais. Os resultados mostraram resiliência média para a maioria dos universitários e boa adaptação ao contexto universitário, além de relações entre a resiliência e o período cursado, estar em psicoterapia, avaliar positivamente a própria saúde e todas as dimensões das vivências acadêmicas. Conclui-se que a resiliência é uma capacidade importante para enfrentar as demandas da graduação e que é possível desenvolvê-la, especialmente durante o começo da graduação e com a adoção de intervenções focadas no autoconhecimento, na autoeficácia e em boas estratégias de enfrentamento. Desenvolver a resiliência nos estudantes pode colaborar para a promoção da saúde desta população e a redução da evasão no Ensino Superior.

A Web-Based Group Cognitive Behavioral Therapy Intervention for Symptoms of Anxiety and Depression Among University Students: Open-Label, Pragmatic Trial

BACKGROUND

Anxiety and depression are common among university students, and university counseling centers are under pressure to develop effective, novel, and sustainable interventions that engage and retain students. Group interventions delivered via the internet could be a novel and effective way to promote student mental health.

OBJECTIVE

We conducted a pragmatic open trial to investigate the uptake, retention, treatment response, and level of satisfaction with a remote group cognitive behavioral therapy intervention designed to reduce symptoms of anxiety and depression delivered on the web to university students during the COVID-19 pandemic.

METHODS

Preintervention and postintervention self-reported data on anxiety and depression were collected using the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. Satisfaction was assessed postintervention using the Client Satisfaction with Treatment Questionnaire.

RESULTS

A total of 175 students were enrolled, 158 (90.3%) of whom initiated treatment. Among those initiating treatment, 86.1% (135/158) identified as female, and the mean age was 22.4 (SD 4.9) years. The mean number of sessions attended was 6.4 (SD 2.8) out of 10. Among participants with clinically significant symptoms at baseline, mean symptom scores decreased significantly for anxiety (t₅₆=11.6; P<.001), depression (t₆₁=7.8; P<.001), and composite anxiety and depression (t₆₀=10.7; P<.001), with large effect sizes (d=1-1.5). Remission rates among participants with clinically significant baseline symptoms were 67.7%-78.9% and were not associated with baseline symptom severity. High overall levels of satisfaction with treatment were reported.

CONCLUSIONS

The results of this study serve as a proof of concept for the use of web-based group cognitive behavioral therapy to promote the mental health of university students.

Characterizing low effort responding among young African adults recruited via Facebook advertising

Multiple studies have successfully used Facebook's advertising platform to recruit study participants. However, very limited methodological discussion exists regarding the magnitude of low effort responses from participants recruited via Facebook and African samples. This study describes a quasi-random study that identified and enrolled young adults in Kenya, Nigeria, and South Africa between 22 May and 6 June 2020, based on an advertisement budget of 9,000.00 ZAR (US $521.44). The advertisements attracted over 900,000 views, 11,711‬ unique clicks, 1190 survey responses, and a total of 978 completed responses from young adults in the three countries during the period. Competition rates on key demographic characteristics ranged from 82% among those who attempted the survey to about 94% among eligible participants. The average cost of the advertisements was 7.56 ZAR (US $0.43) per survey participant, 8.68 ZAR (US $0.50) per eligible response, and 9.20 ZAR (US $0.53) per complete response. The passage rate on the attention checks varied from about 50% on the first question to as high as 76% on the third attention check question. About 59% of the sample passed all the attention checks, while 30% passed none of the attention checks. Results from a truncated Poisson regression model suggest that passage of attention checks was significantly associated with demographically relevant characteristics such as age and sex. Overall, the findings contribute to the growing body of literature describing the strengths and limitations of online sample frames, especially in developing countries.

Why Do Patients with Mental Disorders Default Treatment? A Qualitative Enquiry in Rural Kwazulu-Natal, South Africa

Although treatment default by psychiatric patients or mental health care users is a global challenge, this behavior is reported to be higher in South Africa. The Manguzi District Hospital in rural Kwa-Zulu Natal Province, South Africa, experiences high rates of treatment default by psychiatric patients. The objective of this study was to determine the reasons for treatment defaulting at Manguzi Hospital, KwaZulu-Natal Province, South Africa. An explorative qualitative design, using in-depth interviews, was conducted with mental health care users who had defaulted out-patient psychiatric treatment. Twenty-one mental health care users were interviewed before data saturation was reached. Nvivo version 11 was used to analyze the qualitative data. Major themes that emerged confirmed that social factors are key contributions to treatment defaulting, and these include denial of the mental disorders; belief that they are cured; lack of, or disintegration of social support; preference for traditional medicine; and flaws in the health care system. Social determinants of treatment outcomes for mental disorders require tailor-made support systems for patients in these rural communities, which include increase in health literacy and attention to the cultural understanding of mental disorders.

Undergraduate psychology student experiences during COVID-19: challenges encountered and lessons learnt

National strategies to manage COVID-19, including lockdown, have caused significant disruption to student learning and to the ways that students engage with staff and peers. The transition to online learning, alongside common anxieties associated with the disease itself, was likely to have affected student mental health. This study explored psychology student mental health experiences during Lockdown Phase 3 at the University of the Witwatersrand. A convenience sample of 160 first- and second-year psychology students completed a questionnaire consisting of the General Mental Health Scale, the Hospital Anxiety and Depression Scale, the Burnout Measure, the Brief Coping Orientation to Problems Experienced, the Connor–Davidson Resilience Scale, and the Generalised Self Efficacy Scale. In addition, six open-ended questions asking students about their experiences and support during this time were included. Descriptive statistics were used to analyse quantitative data, whereas content and thematic analysis was used for the open-ended responses. Results indicated that students’ scores were not elevated on the mental health scales. However, the thematic analysis of responses revealed significant concerns with regard to psychological wellbeing, online learning, and home dynamics. These are discussed with a view to providing recommendations for supporting students in circumstances that may require emergency remote teaching.

Prevalence and factors associated with suicidal ideation amongst college students in the Nelson Mandela Bay Municipality, South Africa

Background

Suicidal behaviour amongst college students constitutes a significant social and public health problem globally. This study determined the prevalence and associated factors of suicidal ideation amongst students of higher education in the Nelson Mandela Bay Municipality (NMBM), South Africa.

Methods

In this institution-based cross-sectional study, a multistage cluster sampling of 826 participants, drawn from a college in NMBM, was conducted from January to March 2020. Data were collected with a standardised self-administered questionnaire. Multivariable logistic regression analysis was used to identify the factors associated with suicidal ideation.

Results

Participants’ ages ranged from 18 to 24 years, with a mean age of 20.49 years (standard deviation, 1.88 years). The lifetime prevalence of suicidal ideation and plans in the preceding 12 months were 24.5% and 9.6%, respectively. The odds of suicidal ideation were higher in students who experienced bullying (adjusted odds ratio [AOR], 1.89; 95% confidence interval [CI], 1.35–2.65), mental illness (AOR, 1.89; 95% CI, 1.35–2.65), a history of sexual assault (AOR, 2.50; 95% CI, 1.20–5.21) and experience of sexual assault by or to a close family member (AOR, 1.69; 95% CI, 1.01–2.82). Underlying chronic illness was associated with a twofold risk for suicidal ideation in both sexes.

Conclusion

About a quarter of the students sampled at the college had experienced suicidal ideation and some had had suicidal plans in the preceding 12 months. Screening for the identified risk factors amongst the student population coupled with prompt interventions would mitigate the risk of suicide in the study population.

Non-Heterosexual Medical Students Are Critically Vulnerable to Mental Health Risks: The Need to Account for Sexual Diversity in Wellness Initiatives

Phenomenon: Mental health problems among medical students are a worrisome issue; recent studies have shown that one-third may be suffering major depressive disorder and one out of ten had suicidal ideation. Few studies have evaluated the association of medical students' mental health and their sexual orientation. This study aimed to evaluate differences in mental health indicators among medical students with diverse sexual orientations at a South American medical school. Approach: This study is a secondary analysis of cross-sectional data obtained through an electronic survey. The survey assessed demographics, academic variables, and several mental health scales and indexes, including: World Health Organization Well-being Index, Satisfaction With Life Scale, Family APGAR (Adaptability, Partnership, Growth, Affection, and Resolve), Self-Reporting Questionnaire, Athens Insomnia Scale, Eating Attitudes Test, and Alcohol Use Disorders Identification Test. Sexual orientation was assessed using self-identification and responses dichotomized as heterosexual and non-heterosexual. Findings: 554 students completed the survey (response rate: 70%). Mean age was 20.6 years, and the sample was 58.7% women. Eighty-two participants (14.8%) self-identified as non-heterosexual; this group comprised mostly males, fewer of whom lived with their family, and more of whom used loans or scholarships to pay university tuition fees. After adjustment for sex and tuition fee payment, non-heterosexual orientation was significantly associated (adjusted Odds Ratios [aOR] above 3.00) with rating mental health as bad, self-perceiving a need for mental health evaluation/treatment, and reporting last-year use of psychiatric medication. Lastly, non-heterosexual respondents reported more frequent psychiatric symptoms (depression/anxiety scores, suicidal ideation, eating disorder symptoms and substance use) with an aOR between 2.17 and 2.51. Insights: This study suggests that self-identified non-heterosexual medical students exhibit worse mental health outcomes evaluated through validated self-report scales and subjective perception of mental health status. This report specifically indicates that non-heterosexual medical students report family dysfunction more often and have less social support, which serve as additional risk factors. Future studies must assess social support, clarify the impact of family and peer support in mental health problems, and explore students' views on their sexual identity and the burden imposed by experiences of discrimination.

High cellphone use associated with greater risk of depression among young women aged 15-24 years in Soweto and Durban, South Africa

BACKGROUND

The ubiquity of cellular phone (cellphone) use in young people's daily lives has emerged as a priority area of concern for youth mental health.

OBJECTIVE

This study measured the prevalence of depression and its association with high cellphone use among youth in Soweto and Durban, South Africa.

METHODS

We analysed cross-sectional, baseline survey data among youth aged 16-24 who participated in a dual-site cohort study, 'AYAZAZI', conducted from 2014 to 2017. The primary outcome was depression using the 10-item Center for Epidemiologic Studies Depression Scale, with a score of ≥ 10 indicating probable depression. Cellphone use was measured via self-reported average number of hours of active use, with 'high cellphone use' defined as daily usage of ≥ 8. Multivariable logistic regression models assessed the independent relationship between high cellphone use and probable depression, adjusting for potential confounders.

RESULTS

Of 425 participants with a median age of 19 years (IQR = 18-21), 59.5% were young women. Overall, 43.3% had probable depression, with a higher prevalence among women (49.0% vs. 34.9%, P = .004). Nearly all (94.6%) owned a cellphone. About one-third (29.5%) reported spending ≥ 8 hours per day using their cellphone (39.3% of women vs. 14.9% of men, P < .001). In the overall adjusted model, youth reporting high daily cellphone use had higher odds of probable depression (aOR: 1.83, 95% CI: 1.16-2.90). In gender-stratified models, high daily cellphone use was associated with probable depression among women (aOR: 2.51, 95% CI: 1.47-4.31), but not among men (aOR: 0.87, 95% CI: 0.35-2.16).

CONCLUSIONS

Among a cohort of South African youth, we found a high prevalence of probable depression and high cellphone use (30%). The findings indicate a need for intersectoral initiatives focused on meaningful mental health support for South African youth to support positive growth and development.

Maltreatment during childhood and risk for common mental disorders among first year university students in South Africa

PURPOSE

Childhood maltreatment elevates risk for common mental disorders (CMDs) during late adolescence and adulthood. Although CMDs are highly prevalent among university students, few studies have examined the relationship between childhood maltreatment and 12 month CMDs in a low- to middle-income countries. This paper describes the prevalence of maltreatment and the relationship between type, number and patterns of maltreatment exposure and 12 month CMDs among first-year university students in South Africa.

METHODS

Maltreatment and CMD data were collected via well-validated self-report scales (corresponding with DSM-IV diagnoses) in a web-based survey of first-year students from two large urban universities (n = 1290) in South Africa. Various multivariate modelling approaches (additive, restrictive interactive and latent class) were used to examine the relationship between maltreatment and CMDs.

RESULTS

Overall, 48.4% of participants reported childhood maltreatment, the most common type being emotional abuse (26.7%). Regardless of the modelling approach used, emotional abuse was the only type of maltreatment independently associated with 12-month diagnoses of major depressive disorder (MDD), generalised anxiety disorder (GAD) or drug use disorder (DUD) even after adjusting for types and number of types of maltreatment. Similarly, students in the latent class reflecting histories of emotional abuse (either alone or combined with physical abuse) were more likely to meet criteria for 12-month MDD, GAD or DUD.

CONCLUSION

Findings confirm the high prevalence of childhood maltreatment among South African students. As this exposure elevates risk for MDD, GAD and DUD, interventions aimed at preventing and treating CMDs among first-year students should address experiences of childhood maltreatment.

Measuring mental health and well-being of South African undergraduate students

BACKGROUND

Increased investment in optimal student mental health and well-being has been noted by universities around the world. Studies show the need for contextually relevant, granular understandings of specific aspects of student mental health and well-being.

METHODS

A survey was conducted at two time points - at the beginning and end of the academic year - at a large, urban university in South Africa. The Mental Health Continuum-Short Form, the Flourishing Scale, and the Fragility of Happiness Scale were used in the testing of undergraduate students from a variety of scientific disciplines. Two separate comparisons were made, based on the baseline data (n = 551) and the follow-up data (n = 281). In Comparison 1 (baseline, n = 443; follow-up, n = 173), two independent, biographically (very) similar groups were compared. Comparison 2 (n = 108) compared the results from the baseline and follow-up of the same group of students who completed the instruments at both time points.

RESULTS

Results indicate a significant decline in mental health and well-being for both groups (independent and dependent) over the course of the academic year. Both follow-up groups were found to have lower psychological, emotional and social well-being, psychological flourishing, and reduced mental health, in comparison with the baseline groups.

CONCLUSIONS

The statistically significant decreases in the mental health and well-being of participants in this study indicate the need for substantive interventions to support student mental health and well-being. Strong foci for well-being interventions should include self-efficacy, sense of direction, meaning and creating a sense of belonging.

Psychiatric epidemiological survey of university students in Botswana: rationale and methods of the Youth Mental Health Study (YMHS)

BACKGROUND

While the burden of disease attributable to mental disorders in low/middle-income countries (LMICs) is lower than high-income countries, there is recognition that the dearth of evidence from the LMICs may underestimate the actual prevalence and burden associated with mental disorders. Such is likely the case for Botswana where there has been no nationally representative data on the prevalence of symptoms of mental disorders or even a subgroup estimation of mental disorders in the country. Thus, the Youth Mental Health Study (YMHS) aims to estimate the prevalence and identify predictors of symptoms of mental disorders among university students in Botswana to add to the evidence and contribute to the country's health service planning.

METHODS

The YMHS is a cross-sectional study of youth (18-29 years) attending six large universities (accounting for nearly half of the tertiary student population) in Botswana. A stratified sampling procedure with proportionate allocation and selection is used to select a representative sample of 1308 participants. An online survey comprising of a battery of reliable and validated self-report measures of symptoms of mental disorders is used. A developmental psychopathology framework is used in identifying the risk factors of mental disorders. Participant recruitment will span over 4 months beginning in February 2020.

ETHICS AND DISSEMINATION

The study has received ethics approval from the University of Botswana Institutional Review Board, and the Ministry of Health and Wellness. Participants will be provided with feedback of their own results. Aggregated findings will be disseminated to stakeholders in the tertiary education and health sector in Botswana, and through peer-reviewed journals, conference presentations and the media.

Inequality and mental healthcare utilisation among first-year university students in South Africa

Background

Addressing inequalities in mental healthcare utilisation among university students is important for socio-political transformation, particularly in countries with a history of educational exclusion.

Methods

As part of the WHO World Mental Health International College Student Initiative, we investigated inequalities in mental healthcare utilisation among first-year students at two historically "White" universities in South Africa. Data were collected via a web-based survey from first-year university students (n = 1402) to assess 12-month mental healthcare utilisation, common mental disorders, and suicidality. Multivariate logistic regression models were used to estimate associations between sociodemographic variables and mental healthcare utilisation, controlling for common mental disorders and suicidality.

Results

A total of 18.1% of students utilised mental healthcare in the past 12 months, with only 28.9% of students with mental disorders receiving treatment (ranging from 28.1% for ADHD to 64.3% for bipolar spectrum disorder). Of those receiving treatment, 52.0% used psychotropic medication, 47.3% received psychotherapy, and 5.4% consulted a traditional healer. Treatment rates for suicidal ideation, plan and attempt were 25.4%, 41.6% and 52.9%, respectively. In multivariate regression models that control for the main effects of mental health variables and all possible joint effects of sociodemographic variables, the likelihood of treatment was lower among males (aOR = 0.57) and Black students (aOR = 0.52). An interaction was observed between sexual orientation and first generation status; among second-generation students, the odds of treatment were higher for students reporting an atypical sexual orientation (aOR = 1.55), while among students with atypical sexual orientations, the likelihood of mental healthcare utilisation was lower for first-generation students (aOR = 0.29). Odds of treatment were significantly elevated among students with major depressive disorder (aOR = 1.88), generalised anxiety disorder (aOR = 2.34), bipolar spectrum disorder (aOR = 4.07), drug use disorder (aOR = 3.45), suicidal ideation (without plan or attempt) (aOR = 2.00), suicide plan (without attempt) (aOR = 3.64) and suicide attempt (aOR = 4.57). Likelihood of treatment increased with level of suicidality, but not number of mental disorders.

Conclusion

We found very low mental healthcare treatment utilisation among first-year university students in South Africa, with enduring disparities among historically marginalised groups. Campus-based interventions are needed to promote mental healthcare utilisation by first-year students in South Africa, especially among male and Black students and first-generation students with atypical sexual orientations.

Epidemiology of non-fatal suicidal behavior among first-year university students in South Africa

Supplemental data for this article can be accessed on the publisher's website.We used a cross-sectional web-based survey and discrete-time survival analysis with person-year as unit of analysis and retrospective age-of-onset reports to estimate prevalence and predictors of suicidal ideation, plan, and attempt, and transitions from ideation to plan and attempt among South African university students (n = 1402). The lifetime prevalence of ideation, plan, and attempt were 46.4% (n = 650), 26.5% (n = 372), and 8.6% (n = 120), respectively. Multiple temporally primary mental disorders predicted subsequent onset of suicidality and transitions from ideation to plan and attempt. Results highlight the need for campus-based suicide prevention in South Africa, vulnerability of historically disadvantaged students, and the importance of promoting mental health in suicide prevention.