Digital mental health literacy -program for the first-year medical students' wellbeing: a one group quasi-experimental study

Mediating role of digital skills and mobile self-efficacy in the stress and academic engagement of Peruvian university students in postpandemic virtual environments

BACKGROUND

Remote education emerged as an option during the COVID-19 pandemic; however, this modality continues to be used by various universities around the world in the postpandemic context. The aim of this study was to determine the mediating role of digital skills and mobile self-efficacy in the influence of stress on the academic engagement of Peruvian university students during remote teaching by COVID-19 using structural equation modeling (SEM).

METHOD

This study involved 1,468 students from nine public and private universities in northern Peru who had undergraduate and graduate distance learning programs.

RESULTS

The results showed that stress negatively influenced academic engagement (β=-0.107*) and digital skills (β=-0.328***). In addition, digital skills (β = 0.470**) and mobile self-efficacy (β = 0.684***) positively influence academic engagement. Similarly, digital skills mediate the relationship between stress and academic engagement (β=-0.154**), and both variables act as sequential mediators in this relationship (β=-0.348***).

CONCLUSION

This study provides a deeper understanding of the factors that influence academic engagement during Remote education and lays the groundwork for the development of interventions and training programs tailored to hybrid learning contexts that promote the well-being and academic success of college students in postpandemic times.

Drinking and mental health in middle adulthood: exploring the impact of wellbeing, mental health literacy, and drinking motives on risk of alcohol dependence

OBJECTIVES

Risky drinking is a concern among UK-based middle-aged adults. We aimed to explore the relationship between risky drinking, drinking motives, wellbeing, and mental health literacy (MHL).

METHOD

Cross-sectional analysis of online survey data completed by 193 UK-based adults aged 40-65 who drank alcohol, incorporating the Alcohol Use Disorders Identification Test (AUDIT); Drinking Motives Questionnaire-Revised (DMQ-R); Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS); Mental Health Literacy Scale (MHLS) and demographic questions.

RESULTS

Coping, enhancement and conformity motives and gender significantly predicted higher AUDIT scores (measuring risky drinking). Enhancement motives were found to mediate the relationship between the self-help component of MHL and AUDIT scores, while coping motives mediated the association between wellbeing and AUDIT scores.

CONCLUSION

Findings support research emphasising the influence of drinking motives on risky drinking and highlights how low wellbeing may interact with coping motives to explain risky drinking among middle-aged adults, particularly men. Interventions supporting individuals to understand the relationship between drinking motives and risky drinking, develop adaptive coping strategies, and address the causes of low wellbeing, may be beneficial. However, as the sample was 84% ethnically White, 64% women, 85% educated to at least undergraduate level, and reported a relatively high mean socioeconomic status (6.98 out of 10), the results may not generalise beyond these groups. Future research should use stratified sampling to increase generalisability, as well as exploring whether alcohol-specific, component-specific, or disorder-specific MHL is associated with risky drinking and wellbeing.

Group-format, peer-facilitated mental health promotion interventions for students in higher education settings: a scoping review protocol

INTRODUCTION

Young people in higher education face various stressors that can make them vulnerable to mental ill-health. Mental health promotion in this group therefore has important potential benefits. Peer-facilitated and group-format interventions may be feasible and sustainable. The scoping review outlined in this protocol aims to map the literature on group-format, peer-facilitated, in-person interventions for mental health promotion for higher education students attending courses on campuses in high and low/middle-income countries.

METHODS AND ANALYSIS

Relevant studies will be identified through conducting searches of electronic databases, including Medline, CINAHL, Scopus, ERIC and PsycINFO. Searches will be conducted using Boolean operators (AND, OR, NOT) and truncation functions appropriate for each database. We will include a grey literature search. We will include articles from student participants of any gender, and published in peer-reviewed journals between 2008 and 2023. We will include English-language studies and all study types including randomised controlled trials, pilot studies and descriptive studies of intervention development. A draft charting table has been developed, which includes the fields: author, publication date, country/countries, aims, population and sample size, demographics, methods, intervention type, comparisons, peer training, number of sessions/duration of intervention, outcomes and details of measures.

ETHICS AND DISSEMINATION

No primary data will be collected from research participants to produce this review so ethics committee approval is not required. All data will be collated from published peer-reviewed studies already in the public domain. We will publish the review in an open-access, peer-reviewed journal accessible to researchers in low/middle-income countries. This protocol is registered on Open Science Framework (https://osf.io/agbfj/).

The Effect of Digital Mental Health Literacy Interventions on Mental Health: Systematic Review and Meta-Analysis

BACKGROUND

Accelerated by technological advancements and the recent global pandemic, there is burgeoning interest in digital mental health literacy (DMHL) interventions that can positively affect mental health. However, existing work remains inconclusive regarding the effectiveness of DMHL interventions.

OBJECTIVE

This systematic review and meta-analysis investigated the components and modes of DMHL interventions, their moderating factors, and their long-term impacts on mental health literacy and mental health.

METHODS

We used a random-effects model to conduct meta-analyses and meta-regressions on moderating effects of DMHL interventions on mental health.

RESULTS

Using 144 interventions with 206 effect sizes, we found a moderate effect of DMHL interventions in enhancing distal mental health outcomes (standardized mean difference=0.42, 95% CI -0.10 to 0.73; P<.001) and a large effect in increasing proximal mental health literacy outcomes (standardized mean difference=0.65, 95% CI 0.59-0.74; P<.001). Uptake of DMHL interventions was comparable with that of control conditions, and uptake of DMHL interventions did not moderate the effects on both proximal mental health literacy outcomes and distal mental health outcomes. DMHL interventions were as effective as face-to-face interventions and did not differ by platform type or dosage. DMHL plus interventions (DMHL psychoeducation coupled with other active treatment) produced large effects in bolstering mental health, were more effective than DMHL only interventions (self-help DMHL psychoeducation), and were comparable with non-DMHL interventions (treatment as usual). DMHL interventions demonstrated positive effects on mental health that were sustained over follow-up assessments and were most effective in enhancing the mental health of emerging and older adults.

CONCLUSIONS

For theory building, our review and meta-analysis found that DMHL interventions are as effective as face-to-face interventions. DMHL interventions confer optimal effects on mental health when DMHL psychoeducation is combined with informal, nonprofessional active treatment components such as skills training and peer support, which demonstrate comparable effectiveness with that of treatment as usual (client-professional interactions and therapies). These effects, which did not differ by platform type or dosage, were sustained over time. Additionally, most DMHL interventions are found in Western cultural contexts, especially in high-income countries (Global North) such as Australia, the United States, and the United Kingdom, and limited research is conducted in low-income countries in Asia and in South American and African countries. Most of the DMHL studies did not report information on the racial or ethnic makeup of the samples. Future work on DMHL interventions that target racial or ethnic minority groups, particularly the design, adoption, and evaluation of the effects of culturally adaptive DMHL interventions on uptake and mental health functioning, is needed. Such evidence can drive the adoption and implementation of DMHL interventions at scale, which represents a key foundation for practice-changing impact in the provision of mental health resources for individuals and the community.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42023363995; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023363995.

Enhancing self-care education amongst medical students: a systematic scoping review

BACKGROUND

Reports of emotional, existential and moral distress amongst medical students witnessing death and suffering of patients during their clinical postings have raised awareness on the need for better psycho-emotional support during medical school. Furthermore, the stress experienced by medical students stemming from the rigours of their academic curriculum underlines the need for greater awareness on mental health issues and better self-care practices across medical training. With such programmes lacking in most medical schools, we propose a systematic scoping review (SSR) to map and address our research question, "what is known about self-care education interventions amongst medical students?".

METHODS

We adopted the Systematic Evidence-Based Approach to guide a systematic scoping review (SSR in SEBA) of relevant articles published between 1st January 2000 and 30th June 2023 in PubMed, Embase, PsycINFO, ERIC, Google Scholar, and Scopus databases. The included articles were independently and concurrently thematically and content analysed, with complementary categories and themes combined using the Jigsaw Approach. The domains created from the Funnelling Process framed the discussion.

RESULTS

A total of 6128 abstracts were identified, 429 full-text articles evaluated, and 147 articles included. The 6 domains identified were definition, topics, pedagogy, influences, outcomes and assessment. Most interventions were promising, though peer-led mindfulness-based interventions showed most promise in enhancing engagement, positively impacting personal wellbeing, and improving patient care. Overall, however, self-care education was poorly recognized, adopted and integrated into curricula.

CONCLUSION

Greater dedicated time and conducive practice environments within medical school curricula is required to enhance medical student wellbeing. Host organizations must ensure faculty are appropriately selected to instil the importance of self-care, be trained to assess and personalize self-care interventions and provide longitudinal assessment and support. Further study into assessing self-care capabilities is required.

Types of Digital Mindfulness: Improving Mental Health Among College Students - A Scoping Review

The pressure of learning on students causes mental health problems in students. This can disrupt the student's academic process. The previous review still focused on the impact of digital mindfulness on students, but did not describe the various types of digital mindfulness on students' mental health. A digital image of mindfulness is needed to be a reference for health workers in providing health services to students. The purpose of this study is to describe types of digital-based mindfulness method to improve mental health in university students. The method used in this study was a scoping review. The databases used were CINAHL, PubMed, and Scopus. Search strategy used PRISMA for Scoping Review with keywords namely mindfulness, digital, mental health, and students. The inclusion criteria in this study were student samples, digital-based mindfulness therapy, randomized control trial and quasi-experiment designs, and publication year in the last 10 years (2014-2023). We found that 11 articles about digital-based mindfulness therapy is effective in improving mental health in college students. The types of digital mindfulness carried out are education, counseling, and meditation. Range of samples are 54-561 university students. In addition, there are also counseling services and therapy training guided by facilitators. Information is presented through video and audio that can be accessed at any time by students. Application development is needed by adding monitoring and evaluation features to monitor student compliance in conducting mindfulness therapy and counseling schedules. Then, the role of health workers through holistic mental health services by involving families can improve the process of developing services for students optimally.

The effectiveness of a health education intervention to reduce anxiety in quarantined COVID-19 patients: a randomized controlled trial

INTRODUCTION

The COVID-19 pandemic is regarded as a serious public health concern that boosts levels of stress and anxiety which could be explained by several reasons, including social isolation. In this regard, we aimed to assess the impact of health education on the anxiety level of COVID-19 patients during the isolation period.

METHODS

This is a randomized controlled trial conducted between February 2021 and June 2021. Patients tested positive for Covid-19 with mild to moderate forms were randomized to Education (n = 267) or control (n = 269). The education group received a phone health education session on day 1 (D1) following the diagnosis. The three components of the health education intervention were an explanation of the coronavirus disease, what to do in the event of complications, and the recommended preventive measures. The two groups received a telephone evaluation of their Hospital Anxiety and Depression scores on D1 and day seven D7 following the positive diagnosis. The primary outcome was the rate of anxiety reduction in each group on D7 based on a HAD-A score ≥ 8. Secondary outcomes were the rate of anxiety reduction on D7 based on a HAD-A score ≥ 11, the percentage of people complying with isolation and the scores of adherences to preventive measures during the isolation in each group.

RESULTS

Hundred and ninety-six patients in the intervention group and 206 patients in the control group completed the study. The sociodemographic, clinical, and initial anxiety level features of the intervention and control groups were comparable at baseline (p ≥ 0.05). On D7, the education group's anxiety level (HAD-A ≥ 8) decreased from 26 to 16.3% (p = 0.013) while in the control group it increased from 19.4 to 22.8% (p = 0.37). Thus, the percentage change in anxiety between D1 and D7 (delta D7 - D1) was - 9.7% in the Education group and + 3.4% in the Control group. Using the HAD-A ≥ 11 thresholds, the percentage of anxiety decreased from 15.3 to 11.2% (p = 0.26) between D1 and D7, while it increased in the control group from 9.7 to 15.7% (p = 0.045). Thus, the education group's change in anxiety (delta D7 - D1) was - 4.1%, while the control group's change was + 6%.

CONCLUSION

During an outbreak, providing health education to quarantined patients may be beneficial to reduce the psychological impact of the disease.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Identifier: NCT05715593, retrospectively registered on 8/02/2023 https://clinicaltrials.gov/ct2/results?term=NCT05715593&Search=Search .

Online programs to strengthen the mental health of medical students: A systematic review of the literature

Medical students have been shown to be vulnerable to mental stress. Strengthening individual protective characteristics can be one cornerstone for promoting medical students' mental health and thereby preventing mental disorders. Online programs are an opportunity to provide appropriate options that have the advantage of being accessible from anywhere, at any time, and with a low entry threshold. This review provides a literature overview of current online programs for medical students. The findings can serve as a point of reference for designing effective online programs for mental health-promotion and mental disorder-prevention in medical curricula. We applied a systematic literature search in PubMed, ERIC, Cochrane, and Web of Science. Programs offered had to be web-based, and the addressed group had to be medical students. Protective individual characteristics for mental health and information on the programs' effectiveness were included in the search. As outcomes, we included mental health, burnout, symptoms of depression, anxiety, and well-being. The search yielded 723 articles; of them, 11 met the inclusion criteria. Programs found were grouped according to their focus: mental health literacy, mindfulness, based on Cognitive Behavioral Therapy, or peer support. Two studies showed significant reductions in perceived stress; one study indicated reduced burnout levels. One program had significant immediate effects on mindfulness, empathy, and resilience; two studies indicated strengthening coping strategies. Two programs were qualitatively assessed as helpful; two studies are ongoing. Nine studies lacked control groups; two randomized controlled trials were ongoing. Only a few online programs with limited evidence of effectiveness were found. They addressed protective individual characteristics, highlighting their importance for mental health. Thus, more health-promoting and mental disorder-preventing programs with high-quality effectiveness studies are necessary. An integration of such programs into curricula would allow for greater utilization and could give greater emphasis to and prioritize mental health in medical education.

A systematic review of the effect of university positive psychology courses on student psychological wellbeing

Educational courses that teach positive psychology interventions as part of university degree programs are becoming increasingly popular, and could potentially form part of university-wide strategies to respond to the student mental health crisis. To determine whether such courses are effective in promoting student wellbeing, we conducted a systematic review of studies across the globe investigating the effects of positive psychology courses taught within university degree programs on quantitative measures of psychological wellbeing. We searched Embase, PsychInfo, PubMed, and Web of Science electronic databases from 1998 to 2021, identifying 27 relevant studies. Most studies (85%) reported positive effects on measures of psychological wellbeing, including increased life satisfaction and happiness. However, risk of bias, assessed using the ROBINS-I tool, was moderate or serious for all studies. We tentatively suggest that university positive psychology courses could be a promising avenue for promoting student wellbeing. However, further research implementing rigorous research practices is necessary to validate reported benefits, and confirm whether such courses should form part of an evidence-based response to student wellbeing.

Systematic review registration

[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=224202], identifier [CRD42020224202].

The Effectiveness of a Leadership Subject Using a Hybrid Teaching Mode during the Pandemic: Objective Outcome and Subjective Outcome Evaluation

Positive youth development (PYD) is an innovative approach to protect students from mental health problems and promote their positive and holistic development. Although there are many studies on the beneficial effects of PYD programs on youth in high school and community contexts, it is not clear whether subjects adopting PYD principles can promote positive development for university students. Moreover, it is unclear whether such subjects are effective under COVID-19, where subjects are commonly taught via the "hybrid" mode (i.e., face-to-face plus online teaching). The present study examined students' changes in the PYD, wellbeing, and desired graduate attributes after they had taken a leadership subject utilizing PYD principles taught by the "hybrid" mode (N = 630). Adopting the one-group pre-test and post-test design (i.e., objective outcome evaluation), we found that students showed significant positive improvement in PYD indicators, wellbeing, as well as desired graduate attributes. Additionally, students had high satisfaction with the course design and teaching staff, and perceived many benefits from this subject based on the subjective outcome evaluation conducted at the end of the subject. Results also showed that students' satisfaction with the curriculum significantly and positively predicted their positive change in PYD indicators, indicating the convergence of subjective outcome evaluation and objective outcome evaluation. The results highlight the positive impacts of the hybrid mode leadership subject with PYD principles in higher education.

Validation of the Mental Health Literacy Scale in French University Students

Background: Mental health literacy is a determinant of mental health, which can facilitate early detection of psychological problems and endorse timely access to care. Instruments to measure mental health literacy exist, but not in French. Assessment of mental health literacy in young adults is essential to tailor appropriate educational interventions promoting psychological wellbeing and preventing mental health problems in this vulnerable population. The aim of this study was to validate the French version of the Mental Health Literacy Scale (MHLS-FR) in university students. Methods: A total of 482 students from the University of Bordeaux, France, completed the translated version of the scale. Collected data were used to validate the MHLS-FR through psychometric analyses: descriptive statistics, item distribution, test-retest reliability, exploratory structural equation model, confirmatory factor analysis, Cronbach’s alpha and McDonald’s omega coefficients, and hypothesis testing. Results: The final scale included 26 items covering 6 dimensions. Cronbach’s alpha and McDonald’s omega coefficients were 0.744 and 0.961, respectively. With test-retest, about 50% of items had intraclass correlation coefficients superior to 0.5. Conclusions: The MHLS-FR can be considered as a valid and reliable instrument for measuring mental health literacy in French students.

The Effectiveness of Mental Health Literacy Curriculum among Undergraduate Public Health Students

Mental health literacy (MHL) plays an important role in public health. Improving MHL can promote mental health at the individual and public levels. To date, no published studies have assessed the effectiveness of MHL curriculum interventions among undergraduate public health students. The participants in this study were undergraduate public health students (n = 48) who were enrolled in an 18-week MHL curriculum for 100 min per week. MHL was assessed using the Mental Health Literacy Scale for Healthcare Students. A paired sample t-test was performed to examine the immediate and delayed effects of the MHL curriculum. The total MHL score significantly improved, and a moderate effect size was found directly after the intervention and six weeks later. There were significant differences in the recognition of mental illness (p < 0.01), help-seeking efficacy (p < 0.05), and help-seeking attitude (p < 0.05) in the five components of MHL between pre- and post-test. Furthermore, significant improvements were obtained for the maintenance of positive mental health (p < 0.05) and reduction of mental illness stigma (p < 0.001) between the pre-test and follow-up. Our findings provide evidence for the development and implementation of an MHL curriculum for public health education.