Depression, anxiety, and stress and their association with khat use: a cross-sectional study among Jazan University students, Saudi Arabia

Depression and approach-avoidance achievement goals of Chinese undergraduate students: A four-wave longitudinal study

OBJECTIVE

The study explored the prospective relations between depression and approach-avoidance achievement goals of undergraduate students in China.

METHODS

2473 full-time undergraduates reported their depression and achievement goals annually from the freshman to the senior year. Data were analysed using descriptive statistics, correlation analysis and cross-lagged models.

RESULTS

Students' achievement goals decreased gradually during the first 3 years but rose in the fourth year, and the avoidance goals appeared to be less prevalent than the approach goals over time. Depression was negatively associated with approach goals, whereas positively correlated with avoidance goals. Depression in the freshman and sophomore years resulted in more avoidance goals 1 year later, and the depressive problems in the junior year predicted the decline of approach goals in the senior year.

CONCLUSIONS

The present study highlighted the deleterious effects of depression on the achievement goals of college students.

Individual and community-level factors associated with khat (Catha edulis) use among women of reproductive age in Halaba zone, South Ethiopia: a multilevel mixed effect analysis

Introduction

There is a paucity of data on factors associated with khat chewing among women of reproductive age using multilevel analysis. Furthermore, the effects of some potential factors like stressful life events, knowledge about and attitude toward the effects of khat have been given little attention and are not well understood. Therefore, this study aimed to examine the prevalence and multilevel factors associated with khat use among women of reproductive age in Halaba zone, South Ethiopia.

Methods

A community-based cross sectional study was conducted in Halaba zone from February to July, 2023. Systematic random sampling technique was used to include 1573 study participants. The dependent variable was current khat use, which is operationalized as using khat within 30 days preceding the study. An interviewer administered questionnaire was used for the data collection.

Results

The prevalence of current khat use among women of reproductive age was 65.9% [95%CI (63.5-68.2%)]. Factors significantly associated with khat use were; ages of women 35 and above years [Adjusted Odds Ratio (AOR) = 6.35, 95% CI: (3.62, 11.13)], ever married [AOR = 2.41, 95% CI: (1.10, 5.31)], secondary and above education [AOR = 0.28, 95% CI: (0.15, 0.49)], belong to richer household [AOR = 1.75, 95% CI: (1.12, 2.75)], mass media use [AOR = 3.12, 95% CI: (1.85, 4.81)], low knowledge about khat effects [AOR = 3.12, 95% CI: (1.85, 5.24)], positive attitude towards khat use [AOR = 11.55, 95% CI: (6.76, 19.71)], and strong social support [AOR = 0.43, 95% CI: (0.28, 0.64)] and non-user friend [AOR = 0.31, 95% CI: (0.20, 0.48)]. From the community level variables: rural residence [AOR = 5.06, 95% CI: (1.82, 14.09)] was significantly associated with khat use.

Conclusion

Khat use among women of reproductive age was found to be very high. From individual-level factors: advanced ages of women, secondary and above education, live in the richer wealth quintile, mass media exposure, low knowledge on khat effects, positive attitude towards khat use, strong social support, and from community-level variables: residing in rural area were significantly associated with khat use. Khat use screening for all women of childbearing age, as well as referral to substance use disorder centers for those women identified as having khat use disorder, should become a standard of care in all health facilities.

Salivary Brain-Derived Neurotrophic Factor and Cortisol Associated with Psychological Alterations in University Students

INTRODUCTION

Recent evidence reported mental health issues in university students such as anxiety and depressive symptoms and poor sleep quality. Decreased plasma brain-derived neurotrophic factor (BDNF) levels have been proposed as a biomarker of depressive symptoms, whereas cortisol levels are an index of energy mobilization and stress and have been linked to sleep quality. Given that salivary biomarkers represent an interesting new field of research, the aim of this cross-sectional study was to evaluate salivary BDNF and cortisol levels in university students to assess whether they have associations with psychological disturbances such as anxiety and depressive symptoms, sleep quality, and stress level.

METHODS

Salivary BDNF and cortisol levels were measured by specific immunoassays in 70 students whose mental health was also evaluated on the same day through the evaluation of anxiety and depression symptoms (Goldberg scale), sleep quality (Pittsburg Sleep Quality Index and Athens Insomnia Scale), and stress (self-perceived stress scale) and healthy lifestyle habits (alcohol consumption, smoking, regular exercise, and body mass index) were also measured. Multivariate regression analyses were performed in order to identify the strengths of associations between psychological alterations and the concentrations of BDNF, cortisol, and other variables.

RESULTS

Salivary BDNF levels were significantly higher in students with more depressive symptoms, whereas no significant differences were found for cortisol levels. When performing the binary logistic regression model, BDNF levels are included as a predictor variable for a high-depressive-symptoms burden (p < 0.05). Students with worse sleep quality on the Pittsburg Scale had higher cortisol levels (p < 0.05). The subdomains of sleep latency and sleep medication were those significantly associated with salivary cortisol levels in logistic regression analyses (OR = 15.150, p = 0.028). Sleep medication only appeared to be related to cortisol levels (OR = 185.142, p = 0.019). Perceived stress levels and anxiety symptoms were not associated with BDNF or cortisol levels.

CONCLUSIONS

BDNF could play a key role in the pathophysiology of mood-related disorders, and elevation of its peripheral levels could contribute to protecting neurons from the development of mental illness. Higher salivary cortisol levels measured in the morning are accompanied by poorer sleep quality. More research is needed, focusing on salivary biomarkers of disorders related to depressive symptoms and poor sleep quality as a potential tool for the diagnosis and prevention of mental illness.

The relationship of smartphone addiction with depression, anxiety, and stress among medical students

Introduction

An increasing amount of research has shown a link between psychopathological behaviors such as smartphone addiction, depression, anxiety, and stress. The aim of this study was to assess the association of smartphone addiction with depression, anxiety, and stress.

Methods

A cross-sectional study was conducted between 26th January and 3rd March 2021. The sample was chosen using a convenient sampling technique and Raosoft tool. The survey assessed smartphone addiction using abbreviated versions of the Addiction Scale Short Version, a self-administered questionnaire that has been validated in the English and Arabic languages. Also, Depression and Anxiety Stress Scale was used to measure the level of depression, anxiety, and stress among the university students.

Results

A total of 367 university students from the Medical and Health Sciences College participated. Our findings showed that smartphone addiction exhibited positive correlations with depression (r = 0.375, p < 0.01), anxiety (r = 0.253, p < 0.01), and stress (r = 0.328, p < 0.05). In addition, there was a strong positive correlation between depression and both anxiety and stress (r = 0.731, p < 0.01) (r = 0.778, p < 0.01), respectively. Finally, stress and anxiety showed a positive correlation (r = 0.708, p < 0.01).

Conclusion

When combined, our data offer strong support for a bidirectional hybrid theory that takes into account the link between smartphone addiction and depression, anxiety, and stress. The current study's findings might assist national health authorities in strengthening their efforts to prevent depression, anxiety, and stress associated with the use of modern technology.

Depression Among University Students in Jordan After the COVID-19 Pandemic: A Cross-Sectional Study

Background

University students encounter stressors that make them more susceptible to depression than the general population. Depression negatively impacts mental and physical health. Our study assessed the prevalence of depression among university students in Jordan and its associated predictors after the COVID-19 pandemic.

Methods

We conducted this cross-sectional online survey study in the first quarter of 2022 by sending an online questionnaire to university students aged 18 years and older. This study assessed the symptoms of depression using the Patient Health Questionnaire-9 (PHQ-9). Binary logistic regression analysis was used to identify associated predictors of depression.

Results

A total of 535 university students participated in this study. The mean depression score for the study participants was 13.9 (SD: 7.1) out of 27, representing a moderate level of depression. Among the participants, 26.2% had moderate, 19.3% had moderately severe, and 25.8% had severe depression. Students who drink three or more cups of coffee per day, have had an evaluation of their psychological state by specialists before, and have been diagnosed with any mental illness were more likely to have a higher depression score compared to others (p<0.05). On the other hand, students who were aged 24 years and older and those who practiced regular exercise were less likely to have a higher depression score compared to others (p<0.05).

Conclusion

We found a high prevalence of depression among university students in Jordan. This result is vital for decision-makers to implement a plan to prevent and manage this mental health issue.

Caffeine Consumption and Depression, Anxiety, and Stress Levels Among University Students in Medina: A Cross-Sectional Study

Introduction Caffeine is a psychoactive stimulant frequently found in coffee, tea, energy drinks, and some medications. Various mental health challenges, including stress, anxiety, and depression, commonly affect college students. Moreover, an individual's mental and physical health can be significantly impacted by stress, anxiety, and depression. However, the impact of caffeine on mental health, particularly its association with depressive and anxiety symptoms, remains inconclusive. Thus, this study aimed to evaluate the amount of caffeine consumed by university students and its association with depression, anxiety, and stress levels. Material and method This cross-sectional study was performed on Taibah University students in Medina from both health-related and non-health-related colleges. We used a self-administrated questionnaire composed of four sections: the informed consent section; sociodemographic information; the Depression, Anxiety, and Stress Scale (DASS-21), which assessed the depression, anxiety, and stress levels; and a caffeine-measuring questionnaire, which reported daily caffeine intake in milligrams per day. Result This cross-sectional study examined a 520 convenience sample of Taibah University students with an age range from 17 to 29 years. The majority of the participants were single (95.2%), most of them were female (73.8%), and slightly more than half (51.5%) were recruited from health-related colleges. According to the study's DASS-21 score results, 45.8% of the students had extremely severe stress, 61% had extremely severe anxiety, and 51% had extremely severe depression. The most frequently reported sources of daily caffeine among the participants were Arabic coffee (69.6%), specialty coffee (57.5%), black tea (56.3%), cola (48.7%), and regular coffee (48.5%). The overall daily amount of consumed caffeine ranged from zero to 4276.7 mg/oz. However, no significant association was found between the severity of the DASS-21 score and the daily consumption of caffeine among Taibah University students. Conclusion Our study shows no significant association between the severity of depression, anxiety, and stress and daily caffeine consumption among university students. This proves the opposite of the theory that high levels of caffeine consumption can be correlated to high levels of depression, stress, and anxiety.

Khat chewing and associated factors among public secondary school students in Harar town, Eastern Ethiopia: a multicenter cross-sectional study

Background

Khat is a huge, evergreen tree that grows at high altitudes throughout the Arabian Peninsula and in the region stretching from eastern to southern Africa. Cathinone, cathine, and norephedrine are psychoactive ingredients contained in khat. Ethiopian teenagers, especially those in secondary school, frequently use khat. This use of khat may lead to students frequently missing class and experiencing subpar academic performance. However, the study area lacks information regarding the prevalence of khat use and the factors associated with it.

Objective

This study's primary goal is to determine the prevalence of khat chewing and related factors among secondary school students in public schools in Harar, Eastern Ethiopia, in 2022.

Methods

A multicenter cross-sectional study design was employed from June 01-June 30, 2022, in three public secondary schools in Harar town in a sample of 485 students. Systematic random sampling was used to choose the study sample. Data were gathered using self-administered questionnaires, and the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess khat chewing. Epidata version 4.6 was used to enter the data, while STATA version 14 was used to analyze them. To determine the factors related to khat chewing, bivariate and multivariate logistic regression analysis was conducted, and statistical significance was determined at a 95% confidence level with a P-value under 0.05.

Results

Out of 485 eligible participants, 455 responded to this survey, giving a response rate of 93.8%. Overall, 33.2% (95% CI: 29.2%-37.6%) of the sample's participants reported currently chewing khat. Age ranged from 20 to 25 years (AOR = 2.04; 95% CI: 1.19-3.48), male students (AOR = 7.03; 95% CI: 4.35-12.57), current alcohol user (AOR 6.48; 95% CI: 2.30-18.28), presence of chewer friends (AOR 3.86; 95% CI: 2.38-6.24), and depression (AOR 1.84, 95%CI: 1.02-3.30), were strongly associated with khat chewing at a p-value of < 0.05.

Conclusion

Khat chewing was very common among students in Eastern Ethiopia's public secondary schools. Ages between 20 and 25 years, being a male, being current alcohol users, having chewer buddies, and depression are all significantly linked to khat use. Thus, schools should create and implement audience-specific behavioral change communication to deter and stop students from chewing khat. Additionally, it is important to ban the sale of khat to young adults and adolescents, promote medical care for khat users, and foster peer advocacy for support services.

Is chewing khat associated with mental health disorders? A scoping review of the content and quality of the current evidence base

BACKGROUND

Khat (Catha edulis) is a plant commonly found in the horn of Africa whose leaves are chewed for their psycho-stimulant effects. Several studies have demonstrated the association between khat use and mental health problems. Nevertheless, evidence is mixed and inconsistent, warranting further review of available studies. This scoping review is aimed at investigating the content and quality of evidence base on the associations between khat use and mental health disorders and suggesting avenues for further research.

METHODS

We used a scoping review methodology to map the existing evidence using PubMed, SCOPUS, Embase, and CINAHL databases. Primary studies focusing on the association between any pattern of khat use and any form of mental health disorders are included. The review focused on all age groups, any study design, all geographical locations, and any publication year. The terms used for searching eligible studies include khat, mental disorders, and various alternative terminologies. Narrative review is employed to present findings.

RESULTS

7,121 articles were found, of which 108 were eligible, conducted across 12 different countries. The majority of the studies was done during the last ten years and the studies mostly employed cross-sectional design. About 10 different categories of mental health disorders have been identified as showing associations with khat use. Despite many contradictory findings between the studies, most of the evidence base suggests that khat use is associated with mental health disorders. Non-specific psychological distress is the most frequently mentioned mental health problem (reported in 26.9% of the studies). Khat use as a predictor variable is mostly assessed using a 'yes/no' category, and as a result, dose-dependent effects of khat use on mental health are not given much consideration.

CONCLUSION

Although most of the studies associate khat use with mental health disorders, the causal relationships are inconclusive given the cross-sectional design of the studies, and the presence of potential confounders and several forms of biases. Available studies also report contradictory findings. Further studies are recommended using prospective designs, standardized and valid measures of khat use, and focusing on specific types of mental health disorders.

A comparison of the effects of remote coaching HIIT training and combined exercise training on the physical and mental health of university students

Aim

To compare the differences in the effects of based on remote coached high intensity interval training and combined exercise training on the physical and mental health of university students.

Method

Sixty university students were recruited from Shandong Normal University and randomly divided into HIIT group (n = 30) and AR group (n = 30), with the HIIT group using high-intensity interval training intervention and the AR group using combined exercise (aerobic combined with resistance) training intervention for 8 weeks. Mental health indicators, fitness indicators and body composition indicators were measured at the beginning and end of the intervention.

Results

After 8 weeks, among the mental health indicators, the results of the Symptom Self-Rating Scale (SCL-90) test showed a significant improvement in the HIIT group in terms of total score, somatization, obsessive-compulsive, interpersonal sensitivity, depression, hostility, and psychoticism (p < 0.05); the AR group showed significant improvements in psychoticism (P < 0.05). There were no significant differences between the two groups. The results of the Pittsburgh Sleep Quality Index scale (PSQI) showed a significant difference in sleep efficiency in the HIIT group with an inverse improvement in scores; the AR group showed no significant improvement in each test item. The results of the between-group covariance showed significant differences in sleep efficiency and hypnotic drugs in the HIIT group (p < 0.05). Among the fitness indicators, the HIIT group showed significant improvements in maximum oxygen uptake, grip strength and flexibility (P < 0.05); the AR group showed significant improvements in back muscle strength and flexibility (P < 0.05). The results of the between-group covariance showed significant improvements in maximum oxygen uptake in the HIIT group (P < 0.01). Regarding body composition indicators, there was a significant improvement in Body weight, BMI, Body fat percentage and Waist-to-hip ratio in both the HIIT and AR groups (P < 0.01). There were no significant differences between the two groups.

Conclusion

HIIT and combined exercise training based on remote coaching had some improvement on fitness level and body composition of university students, HIIT was more advantageous in improving aerobic endurance, and HIIT based on remote coaching may have better effect than combined exercise in mental health.

Trial registration

Chinese Clinical Trial Register, ChiECRCT20220149. Registered on 16 May 2022.

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.

Risk factors and digital interventions for anxiety disorders in college students: Stakeholder perspectives

The worldwide prevalence of anxiety disorders among college students is high, which negatively affects countries, schools, families, and individual students to varying degrees. This paper reviews the relevant literature regarding risk factors and digital interventions for anxiety disorders among college students from the perspectives of different stakeholders. Risk factors at the national and societal levels include class differences and the coronavirus disease 2019 pandemic. College-level risk factors include the indoor environment design of the college environment, peer relationships, student satisfaction with college culture, and school functional levels. Family-level risk factors include parenting style, family relationship, and parental level of education. Individual-level risk factors include biological factors, lifestyle, and personality. Among the intervention options for college students' anxiety disorders, in addition to traditional cognitive behavioral therapy, mindfulness-based interventions, psychological counseling, and group counseling, digital mental health interventions are increasingly popular due to their low cost, positive effect, and convenient diagnostics and treatment. To better apply digital intervention to the prevention and treatment of college students' anxiety, this paper suggests that the different stakeholders form a synergy among themselves. The nation and society should provide necessary policy guarantees, financial support, and moral and ethical supervision for the prevention and treatment of college students' anxiety disorders. Colleges should actively participate in the screening and intervention of college students' anxiety disorders. Families should increase their awareness of college students' anxiety disorders and take the initiative to study and understand various digital intervention methods. College students with anxiety disorders should actively seek psychological assistance and actively accept and participate in digital intervention projects and services. We believe that in the future, the application of methods such as big data and artificial intelligence to improve digital interventions and provide individualized treatment plans will become the primary means of preventing and treating anxiety disorders among college students.

The link among academic stress, sleep disturbances, depressive symptoms, academic performance, and the moderating role of resourcefulness in health professions students during COVID-19 pandemic

Background

The rapid shift to virtual learning in response to the COVID-19 pandemic contributed to high academic stress among health profession students. High academic stress was associated with impaired psychosocial well-being and decreased academic performance.

Objectives

The purpose of this study was to assess the relationship between academic stress, anxiety, sleep disturbances, depressive symptoms, academic performance, and the moderating effect of resourcefulness among undergraduate health profession students.

Methods

This descriptive and cross-sectional study included undergraduate health profession students. The primary investigator distributed the study link to all students through the university's Central Messaging Centre, Twitter account, and WhatsApp. The study variables were measured using the Student Life Stress Inventory, the Generalized Anxiety Disorder-7 questionnaire, the Centre for Epidemiology Scale of Depression, the Pittsburgh Sleep Quality Index, and the Resourcefulness Skills Scale. Pearson R correlation and linear regression analysis were utilized for statistical analysis.

Results

Our sample included 94 undergraduate health profession students, 60 % of which were females with a mean age of 21, and the majority were nursing and medicine students. High academic stress, anxiety, sleep disturbances, depressive symptoms, and resourcefulness were reported among 50.6 %, 43 %, 79.6 %, 60.2 %, and 60 % of the participants, respectively. However, no effect of resourcefulness was found on any of the study variables. Instead, academic stress and sleep disturbances were the strongest predictors of depressive symptoms regardless of the level of resourcefulness.

Conclusion

Adequate academic support during virtual learning and tools to early detect subtle signs of high academic stress, anxiety, depression, and sleep disturbance should be routinely utilized by educational institutions. In addition, incorporating sleep hygiene and resourcefulness training in health professions education is highly indicated.

Psychological Status of College Students During COVID-19 Pandemic: A Cross-Sectional Study in Saudi Arabia

PURPOSE

This study aimed to assess the prevalence and associated factors of depression, anxiety, and stress among college students in Saudi Arabia during the COVID-19 outbreak.

METHODS

This cross-sectional study was conducted between February 10th to April 10th, 2021. An online self-administered questionnaire was emailed to college students at a large institution in Saudi Arabia. The questionnaire consisted of sociodemographic, educational backgrounds, and the Depression Anxiety Stress Scale-21 (DASS-21).

RESULTS

The study included 311 university students (62.7% female and 39.3% male). The prevalence of higher than moderate level in each of the depression, anxiety, and stress were (n= 164, 52.7%), (n= 222, 71.4%), and (n= 112, 36%), respectively. Further analysis revealed that females, younger age, history of depression, history of being quarantined by a health authority, and having contact with a confirmed case of COVID-19 were associated with a greater level of depression, anxiety, and stress.

CONCLUSION

Depression, anxiety, and stress were highly prevalent among college students during the outbreak. There was a significant association between demographic characteristics and the DASS 21 score. Researchers are recommended to concentrate their future studies on establishing strategies to enhance students' flexibility and adaptability in the face of future catastrophes.

Predictors of Anxiety, Depression, and Stress among Female University Nursing Students during the COVID-19 Pandemic: A Cross-Sectional Study in Saudi Arabia

Background: Students at universities increasingly struggle with mental health issues such as anxiety, depression, and stress. The present prevalence of these diseases may arise in the event of a crisis such as the coronavirus disease 2019 (COVID-19) pandemic. Aim: To estimate the level of anxiety, depression, and stress in female university nursing students, and to identify predictors for students' anxiety, depression, and stress during the COVID-19 pandemic. Methods: An online cross-sectional descriptive study was conducted using a convenient sample of 115 female university nursing students. The Depression Anxiety Stress Scale (DASS-21) questionnaire was used to assess symptoms of anxiety, depression, and stress. Multivariate linear regression was used to identify predictors of anxiety, depression, and stress. Results: Stress, anxiety, and depression had prevalence rates of 23.7%, 18.5%, and 34.6%, respectively. Significant anxiety predictors included family support, family salary, being diagnosed with chronic illness, and being exposed to patients with COVID-19. Significant correlations were found between family support, family salary, family history of mental illness, and fear of being infected with COVID-19 and depression in female university nursing students. Students' levels of stress were predicted by family support. Conclusion: The level of anxiety, depression, and stress among female university nursing students was determined to be moderate. It is advised that university nursing students receive interventions that support their mental health.

The relationship between walking and depression, anxiety, and stress among a sample from Jazan, Saudi Arabia: A cross-sectional investigation

This study is aiming to investigate the association between walking and depression, anxiety and stress among adults from Jazan, Saudi Arabia. This study was a cross-sectional investigation where data was collected via an online self-administered questionnaire. The questionnaire had 4 components that measured demographics of the sample, presence of depression, anxiety and stress, and walking history. Differences in median scores of depression, anxiety, and stress according to the measured characteristics were tested via the Mann-Whitney U test. Multivariable logistic regression was performed to estimate odds of reporting depression, anxiety, and stress according to the measured characteristics. A total of 472 adult subjects participated in the current study. The median age of the participants was 23 years, and 52% were males. Half of the participants had variable degrees of depression and anxiety while 39% of the participants had variable degrees of stress. Gender appeared to have the strongest influence on level of depression, anxiety, and stress among the recruited sample (odds ratio 1.8, 2.1, 1.6 respectively (P values < .01). Upon stratifying the sample according to gender, marital status seems to have an association with depression, anxiety, and stress among females (P values < .05). Among males, only walking more than 3 days was associated with the reduction of anxiety (P value .005) and depression (P value .06). This study identified gender difference where walking was not associated with mental health among women but relatively associated among males.

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.

Influencing factors, prediction and prevention of depression in college students: A literature review

The high prevalence of depression among college students has a strong negative impact on individual physical and mental health, academic development, and interpersonal communication. This paper reviewed the extant literature by identifying nonpathological factors related to college students' depression, investigating the methods of predicting depression, and exploring nonpharmaceutical interventions for college students' depression. The influencing factors of college students' depression mainly fell into four categories: biological factors, personality and psychological state, college experience, and lifestyle. The outbreak of coronavirus disease 2019 has exacerbated the severity of depression among college students worldwide and poses grave challenges to the prevention and treatment of depression, given that the coronavirus has spread quickly with high infection rates, and the pandemic has changed the daily routines of college life. To predict and measure mental health, more advanced methods, such as machine algorithms and artificial intelligence, have emerged in recent years apart from the traditional commonly used psychological scales. Regarding nonpharmaceutical prevention measures, both general measures and professional measures for the prevention and treatment of college students' depression were examined in this study. Students who experience depressive disorders need family support and personalized interventions at college, which should also be supplemented by professional interventions such as cognitive behavioral therapy and online therapy. Through this literature review, we insist that the technology of identification, prediction, and prevention of depression among college students based on big data platforms will be extensively used in the future. Higher education institutions should understand the potential risk factors related to college students' depression and make more accurate screening and prevention available with the help of advanced technologies.

Weight-Related Status and Associated Predictors with Psychological Well-being among First-Year University Students in Bangladesh: A Pilot Study

University students (especially first-years) not only have to cope with their academic curriculum but also issues such as being away from the home environment and living independently for the first time. Those who do not adapt quickly to these new conditions are likely to be susceptible to physical and psychological vulnerabilities. The present study surveyed first-year Bangladeshi undergraduate students to investigate their weight status (i.e., the prevalence of being normal weight, underweight, overweight, and obese) and the prevalence of depression and associated risk factors. A cross-sectional survey was conducted among 404 first-year university students (aged 18–23 years) residing at a Bangladeshi university. The participants completed a survey examining socio-demographic and behavioral variables, alongside the WHO-5 Well-Being Index. Binary logistic regression was performed to determine significant associations between the variables under examination. Prevalence rates of being normal weight, underweight, overweight, and obese were 66.8%, 20.3%, 9.7%, and 3.2% respectively. Associated predictors of weight-related problems were being female and lack of physical exercise. The prevalence rate of depression was 68.1%. There were no significant gender differences and associated predictors of depression were lack of physical exercise, unsatisfactory sleep quality, excessive internet use, and excessive reading hours. Being underweight, overweight, or being obese alongside the prevalence of depression among first-year university students were high. Findings indicate that first-year university students are a vulnerable group for some physical and psychological problems. Findings recommend the need for intervention programs, alongside adequate and appropriate supportive services for first-year Bangladeshi university students.

Prevalence and Associated Factors of Complains on Depression, Anxiety, and Stress in University Students: An Extensive Population-Based Survey in China

Mental health issues are becoming increasingly prevalent amongst university students. However, research on the psychological profile of the general university population is relatively limited. Thus, this study analyses the current state of university students' psychological conditions; the demographic differences in depression, anxiety, and stress and the influencing factors. The objectives are to provide additional appropriate guidance in mental health for university students with different demographic characteristics. A cross-sectional study of 6,032 university students nationwide was conducted from October 2020 to January 2021. A randomized whole-group sampling method was used to select the study participants, and the 21-item Depression, Anxiety, and Stress Scale (DASS) was used. P < 0.05 in the final model were considered statistically significant. The number of university students with no complain of depression, anxiety, or stress was 3,751 (62.2%). The odds of developing complain of depression were higher amongst anxious respondents (AOR = 23.417, 95% CI: 19.706, 27.826) and senior year (AOR = 2.210, 95% CI: 1.657, 2.947) than their counterparts. Students with "myopia" were 1.263 times more likely to be anxious (AOR = 1.263, 95% CI: 1.042-1.530). In terms of "impaired" or not, impaired is defined as any injury, such as sprain, strain, and fracture, "impaired" university students were 1.321 times more likely to be anxious (AOR = 1.321, 95% CI: 1.064-1.641). Furthermore, history of impairment and myopia increased the odds of stress by 1.305 (AOR = 1.305, 95% CI: 1.022-1.667) and 1.305 (AOR = 1.305, 95% CI: 1.012-1.683), respectively. Myopia, physical-activity-related injury (PARI) and irrational eating habits are risk factors for complain of anxiety and stress. Males, upper grades, low parental education, and irrational eating habits are risk factors for complain of depression. Low physical activity levels are also an influential factor for complain of depression. DASS consists of interchangeable risk factors and multiple complains of DASS may coexist.

Prevalence of COVID-19 Pandemic, Self-Esteem and Its Effect on Depression Among University Students in Saudi Arabia

Background and Aims

University students are commonly identified as susceptible, suffering from higher anxiety, stress, and depression than the overall population. During the Corona Virus Disease pandemic (COVID), education was shifted to the virtual learning environment. Students' ambiguity regarding academic accomplishment, imminent careers, changes in social life, and other concerns all these factors played a role in amplifying their stress levels, anxiety, and depression worldwide. This study investigates university students' self-esteem and depressions after they have been online learning for over 1 year due to the COVID-19 pandemic in Saudi Arabia.

Methods

For this research, an adapted questionnaire of Rosenberg (Self-Esteem Scale) and Zung (Self-Rating Depression Scale) was used to get the responses of the participants of public and private universities in Saudi Arabia during March-April 2021. We received a total of 151 valid responses from respondents. For data analysis, we used descriptive statistics, ANOVA, multiple regression and binary logistic regression.

Findings

The results showed that 75% of the students experienced different levels of depressions, with half (37.5%) having moderate to extreme levels of depression. A total of 41% of students experienced low self-esteem (38% females and 45% males). The regression results indicated depressive symptoms for low self-esteem. Furthermore, results of logistic regression showed that high self-esteem reduces the chances of getting depressive symptoms by 17%. The depressive symptoms were higher in female students than their male counterparts; furthermore, males experienced depressive symptoms less than females by 38%.

Conclusions

Based on the current research results, it is concluded that the presence of the COVID-19 pandemic has dramatically increased the depressive symptoms in students, especially in female students. The findings suggested instant consideration and support for students. It is also suggested to the quest for potential managing policies that have been known and effective during the pandemic. Moreover, training should be provided for students to shift their educational experience mindset to an adaptive mindset, which can help them adapt to the new ways of learning and education.

Risks of khat chewing on the cardiovascular, nervous, gastrointestinal, and genitourinary systems: A narrative review

Khat is an evergreen plant and its fresh green leaves and buds are chewed for several hours a day for its psychostimulant response. This study aimed to review the effects of khat chewing on the body. PubMed was searched for literature on the different aspects of khat chewing to summarize its effects on different body systems. The major effects of khat chewing are those on the cardiovascular system including increased blood pressure, increased heart rate, and increased risk of myocardial infarction. It causes insomnia, stress, depression, hallucination, and increased risk of brain stroke. It causes dental caries, bad oral hygiene, periodontitis, increased oral mucosal ulcers, and increased gingival bleeding and recession. Khat chewing causes loss of appetite, gastritis, constipation, and hemorrhoids, and increased risk of hepatotoxicity and liver cirrhosis. Ultimately, it causes weak micturition, decreased sperm motility and count, and low birth-weight offspring in khat chewing mothers. The published articles about khat chewing in journals indexed in the PubMed was reviewed. Inclusion criteria involved each article available with English language and have a reported new effect of khat chewing.

Academic and non-academic life stressors and their impact on psychological wellbeing of medical students

Objectives

Among medical students, depression, anxiety, and stress (DAS) are key public wellbeing challenges that require epidemiological research. We aimed to evaluate potential sources of these psychological disturbances and assess the contribution of academic and non-academic life stressors in psychological morbidity among medical students.

Methods

This exploratory questionnaire-based survey was conducted in a Saudi Arabian public sector medical college. A total of 231 medical students were enrolled and completed the depression, anxiety, and stress scale-21 (DASS-21) questionnaire.

Results

More than half of the medical students, 129 (55.8%), had depression, 106 (45.9%) students had anxiety, and 87 (37.7%) students had stress. Academic achievement was the largest explanatory factor for depression and stress, whereas bodily appearance constituted the largest explanatory factor of anxiety among the study sample. Academic and non-academic stressors score was significantly associated with depression (adjusted Odds Ratio, aOR = 1.13, 95% CI 1.07–1.19), anxiety (aOR = 1.07, 95% CI 1.03–1.12), and stress (aOR = 1.12, 95% CI 1.08–1.17).

Conclusions

Medical students have a high incidence of negative emotional states. These negative psychological states were explained by academic achievement and bodily appearance. The studied stressors influenced medical students' psychological wellbeing.

Gender Self-Perception and Psychological Distress in Healthcare Students during the COVID-19 Pandemic

The aim of this study was to analyze university Health Sciences students’ self-perception regarding gender stereotypes, and to explore whether there was any association between gender stereotypes and clinical/socio-demographic variables. Methods: This cross-sectional study was conducted with a sample of 252 university students who completed a self-administrated online questionnaire (18.3% males, 81.7% females). We evaluated the self-perception of gender stereotypes as determined using the BSRI-12 questionnaire and explored the association of this measure with the impact of perceived stress measured using a modified scale (PSS-10-C) as well as anxiety and depression according to scores on the Goldberg scale (GADS). Results: According to the students’ self-perception of gender stereotypes, 24.9% self-perceived themselves as feminine, 20.1% as masculine, 24.9% as androgynous, and 30% as undifferentiated. The degree determines self-identification with gender stereotypes. Nursing and Occupational Therapy are studied mostly by women, 28.4% and 45%, respectively, while Physiotherapy is studied mainly by men (71.2%). Females indicated more anxiety (75.7%) and depression (81.7%) than males (52.9% and 67.3%, respectively). In contrast, males developed more stress (88.5%) than females (74.1%). Conclusions: University degree, anxiety, depression, and stress determined self-identification with gender stereotypes. The results of this study indicate that gender roles influence the possibility of developing mental disorders and should be taken into account in future studies.

Khat Use Patterns, Associated Features, and Psychological Problems in a Khat-Treatment-Seeking Student Sample of Jimma University, Southwestern Ethiopia

Background: Khat (Catha edulis) is a traditionally used substance in African and Arab countries that contains the amphetamine-like alkaloid cathinone. Khat use among Ethiopian students is a growing concern. This study aims to describe khat use, psychological problems, and motivation to change and to determine associated factors of khat use among students from Jimma University seeking psychological assistance.

Methods: In a cross-sectional study, a sample of 717 students from Jimma University, southwestern Ethiopia, who seek assistance to reduce khat use were recruited. The study used Amharic and Afaan Oromoo language versions of common psychological instruments and employed them as part of a comprehensive tablet computer-delivered self-report assessment battery, comprising the SRQ-20, the PCL-5, the LEC-5, the AUDIT, and the SOCRATES-khat. In addition, socio-demographic, economic variables, and functioning problems due to severe mental disorders were assessed. The analysis relied on the data of the 575 included participants and used clinical cut-off values to describe this treatment-seeking sample and hierarchical regression models to determine variables associated with khat use.

Results: The sample showed high khat use in the past month (M = 31.55 bundles, SD = 28.53, on M = 15.11 days, SD = 8.54); 17.0% showed highly problematic use. The sample was extremely burdened with comorbid psychiatric problems: 21.6% reported functioning problems due to past mental disorders, 60.2% scored above the cut-off for current common mental disorders, 37.9% screened positive for PTSD, and 47.1% reported hazardous alcohol use. Small to medium intercorrelations between variables were detected, and in hierarchical regression models, higher motivation to change khat use was associated with higher use of the substance.

Conclusions: This study clearly shows the need to develop research instruments, screening methods, and assistance services for khat-using students at Jimma University. Study participants' high mental health burden shows the need for targeted intervention programs that go beyond brief interventions for khat use. Furthermore, the study highlights challenges for implementing such services: the barriers to utilization for females and khat users without comorbid mental health problems.

The Impact of the COVID-19 Pandemic on Students' Mental Health and Sleep in Saudi Arabia

Background: Mental health problems are prevalent among university students in Saudi Arabia. This study aimed to investigate the impact of the COVID-19 pandemic on university students’ mental health and sleep in Saudi Arabia. Method: A total of 582 undergraduate students from Saudi Arabia aged between 18 and 45 years old (M = 20.91, SD = 3.17) completed a cross-sectional online questionnaire measuring depression, anxiety, stress, resilience, and insomnia during the COVID-19 pandemic (2020). Analysis included an independent samples t-test, one-way ANOVA, and Hierarchical regression analysis. Results: Undergraduate students reported high levels of depression, anxiety, and perceived stress and low levels of resilience (p < 0.001) during the pandemic. In addition, students reported experiencing insomnia. A hierarchical regression analysis indicated that lower resilience, high levels of insomnia, having a pre-existing mental health condition, and learning difficulties (such as dyslexia, dyspraxia, or dyscalculia) were significantly associated with high levels of depression and stress. In addition, lower resilience, a high level of insomnia, and pre-existing mental health conditions were significantly associated with high levels of anxiety. Finally, a lower level of psychological resilience and a high level of insomnia were significantly associated with increased levels of depression, anxiety and stress within university students. Conclusion: This study has provided evidence that a lower level of psychological resilience and insomnia were associated with mental health problems among undergraduate students in Saudi Arabia, thus enhancing psychological resilience and interventions to support sleep and mental health are vital to support student well-being outcomes throughout the pandemic.

Irritable Bowel Syndrome: Prevalence and Risk Factors in Jazan Region, Saudi Arabia

Background The prevalence of irritable bowel syndrome (IBS) worldwide remains heterogeneous. In Saudi Arabia, there are insufficient studies on the prevalence of IBS among the general population, yet the prevalence of IBS in certain professional groups has been reported. This study was conducted to determine the prevalence of IBS and its associated risk factors in the Jazan Region of Saudi Arabia. Methods An online cross-sectional study was conducted from January to March 2020 in the Jazan Region of Saudi Arabia, using a multi-stage stratified sampling technique. The data were collected using a web-based validated Rome IV questionnaire. The Rome IV criteria are used to diagnose functional gut disorders, including IBS. Logistic regression analysis was used to determine the odds ratio (OR) with 95% confidence intervals (95% CI) for the selected risk factors. Results The survey included 1554 participants with an overall IBS prevalence of 16%. Women had a higher incidence of IBS than men (55.3% and 44.7%, respectively). IBS-mixed (32.66%) and constipation-predominant (32.25%) were the most common subtypes. In multiple regression analysis, female gender (OR = 1.503, p-value = 0.037), stress (OR = 2.386, p-value = 0.000), anxiety (OR = 1.943, p-value = 0.000), and tobacco smoking (OR = 2.093, p-value = 0.001) showed a statistically significant association with IBS. Conclusions The prevalence of IBS in the southwest region of Saudi Arabia is high. Female sex, tobacco smoking, stress, and anxiety are the major risk factors associated with IBS.

Depression, anxiety and stress among undergraduate students during COVID-19 outbreak and "home-quarantine"

Aim

Many people including students affected physically and psychologically by coronavirus disease (COVID‐19) outbreak and "home‐quarantine." This study aimed at assessing the prevalence and predictors of depression, anxiety and stress among university students in Jordan during "home‐quarantine" due to the outbreak of COVID‐19.

Design

This is a cross‐sectional descriptive study.

Methods

Data were collected from a convenience sample of 1,380 Jordanian university students. A web‐based survey was used to collect data from the participants using the DASS‐21.

Results

The prevalence of depression, anxiety and stress in different levels was 78.7%, 67.9% and 58.7%, respectively, which are higher during “home‐quarantine.” The mean scores of depression, anxiety and stress were at moderate levels. Strong correlations were found between depression, stress and anxiety, with demographic, health‐related, lifestyle variables. Several variables also predicted depression, stress and anxiety.

Mental health research studies in Saudi Arabia for the years 2009-2019; a systematic scoping review

BACKGROUND

An updated systematic scoping review and narrative analysis of all possible mental health studies done during the concerned immediate years clarifies its present condition and status for all professionals, and concerned researchers.

AIMS

To synthesize published mental health research studies in and for Saudi Arabia for the years 2009-2019 with the confidence to evaluate current situation, identify research gaps and limitations (if any), and assist in conceptualizing the forthcoming directions of future mental health research activities.

METHODS

Scoping systematic review and modified narrative analysis were the methods utilized to achieve the aim and objective set for this formal academic endeavor.

RESULTS

Of the 1006 published studies identified from chosen databases, a total of 241 papers were included and had passed the stringent criteria set for the scoping review process. Basic characteristics of the reviewed studies were quantitative survey type with about 101-500 size range of respondents, utilizing non-patients and adults for participants which were common and randomly chosen from selected population, and most research activities were self-funded. Four major research themes were found including a list of research limitations.

CONCLUSIONS

This systematic scoping review identified a wide range of results characterizing the different studies that qualified using pre-determined inclusion-exclusion criteria. Though of increasing publication volume in the past decade, most researches done were quantitative survey type whose themes seemed to show no drastic difference or change from the previous years of output. More variety in research themes would further improve the over-all quality of mental health publications.

Prevalence and determinants of chewing khat among women in Ethiopia: data from Ethiopian demographic and health survey 2016

BACKGROUND

In Ethiopia and other countries in eastern Africa, khat abuse is an increasing public health problem. Levels of use appear to be increasing in women, who are more vulnerable to khat-related problems. However, population-based data are lacking as studies have been small and related to specific settings. This study aimed to contribute to current knowledge on the prevalence of chewing khat and associated factors among women in Ethiopia, using data from the 2016 Ethiopian national demographic and health survey.

METHODS

The 2016 EDHS used a two-stage stratified sampling design to select households. A total of 645 enumeration areas (202 urban and 443 rural) were selected, based on the 2007 Ethiopia Population and Housing Census. In these, 18,008 households were considered, from which 15,683 women were included from individual households. The women were interviewed by trained lay interviewers. Data were tabulated and logistic regression was used to examine mutually adjusted associations, expressed as adjusted odds ratios.

RESULTS

The lifetime prevalence of chewing khat among women was 9.9%. Current khat use was 8.4%, with a mean of 14.2 days of use in the last month. Khat use increased with increasing age, remaining constant after age 35 years, having one child, lower educational level, being Muslim by religion and not pertaining to the lowest wealth index category. Not being in a marital relationship with the most recent sex partner and Protestant religion were protective factors.

CONCLUSION

Lifetime prevalence of chewing khat among women in Ethiopia is substantial and associated with specific sociodemographic risks. These can be used in targeted public health efforts to control the use of khat and reduce the associated health and economic burden.

Depression, anxiety and stress and their associated social determinants in the Saudi college students

Globally, students suffer from stress, anxiety, and depression in higher education and seek counselling since education process has negative impacts on mental health of some students. This study was aimed at measuring the depression, stress, and anxiety and their associated social determinants like (income, education, residence, marital status, and educational difficulties) in undergraduate students of Umm Al-Qura University (UQU). Arabic version of the Depression, Anxiety, and Stress Scale (DASS-21) validated from the original English version instrument by Lovibond and Lovibond (1995) was used; A sample of 373 respondents through clustered sampling was drawn from the five randomly chosen faculties of the University. Data was analyzed by running ANOVA and t-test procedures in SPSS software. The study found that the prevalence of stress, anxiety, and depression in the students was 30%, 60%, and 50% respectively. A statistically significant difference was found in the stress levels of students of different colleges (p=0.000). Students’ stress levels were significantly higher (p=0.000) in the Applied Medical Sciences and in the final year students (p=0.015). Significantly high levels of depression (p=0.000), anxiety (p=0.000), and stress (p=0.000) were found in the students belonging to the poor economic strata. Depression (p=0.038), Anxiety (p=0.022), and stress (p=0.001) were statistically high in the students whose father had a low level of education. Statistically high level (p=0.028) of stress was also found in the students whose mothers had a low level of education. Students who reported educational difficulties had significantly (p=0.001) high levels depression. However, the results of stress, anxiety, and depression in married students and the location of the students’ variables were not found statistically significant. The findings may be useful for informed policymaking in the higher learning institutions and initiation of counseling provisions in the concerned faculties for the distressed students with a view to enhancing their educational outcomes.

Tea in the Morning and Khat Afternoon: Health Threats Due to Khat Chewing

Khat or qat (Catha edulis) is a flowering plant with an Arabic name قات, regularly named as qāt, also is known by various descriptive names, such as Abyssinian tea, Somali tea, Arabian tea, Miraa, Jima, and Kafta in its endemic regions of the Horn of Africa and the Arabian Peninsula. Fresh leaves and tops of khat are chewed or dried and consumed as a tea to attain a state of euphoria and excitement; it also has appetite-reducing effects. Traditionally, khat is used as a socializing habit in Yemen and is also widely cultivated because of its high income. However, in recent years the plant has been reported in England, Wales, Rome, Amsterdam, Canada, Israel, Australia, New Zealand, and the United States. Although it is believed that khat is a relatively low-risk drug, it's associated with an increased risk for various medical complications, including dental and oropharyngeal disease, gastrointestinal, cardiovascular, neuropsychiatric, obstetric, and even can be the cause of cancer. Our goal in this review article is to revise and determine the relationship between chewing khat and its health issues. Additionally, we tried to determine the mechanism involved in health hazards due to consuming the khat.

Anxiety Level of University Students During COVID-19 in Saudi Arabia

COVID-19 is the worst pandemic of this millennium, and it is considered to be the "public enemy number one." This catastrophe has changed the way we live in the blink of an eye. Not only has it threatened our existence and health status, but the damage associated with it could equally affect our economic, social, and educational systems. The focus of this study was on the anxiety level of university students during the COVID-19 pandemic in Saudi Arabia. The study was conducted between March and June 2020. A questionnaire was administered online, and 400 completed questionnaires were returned. In this study, the Zung self-rating anxiety scale was used to determine the anxiety levels among the respondents. The results indicated that about 35% of the students experienced moderate to extreme levels of anxiety. Anxiety was highly associated with age, sex, and level of education. These findings can enlighten government agencies and policy makers on the importance of making prompt, effective decisions to address students' anxiety during the COVID-19 pandemic. Researchers are encouraged to focus their future studies on how to develop strategies to boost students' resilience and enhance their adaptability skills for similar disasters in the future.

The impact of protective psychosocial factors on khat chewing among male medical and dental future health-care providers in Yemen

BACKGROUND/PURPOSE

Khat chewing, a green leaf with amphetamine effects, is a public health concern. Yet, it is prevalent and evident, in the khat belt region, among male students in health faculties. This study aimed to examine whether psychosocial factors have a protective impact on khat chewing among male dental and medical students.

MATERIALS AND METHODS

A cross-sectional study included all students (1457) in second year and above at a Yemeni university. A self-administered questionnaire was used to obtain sociodemographic data and to assess students' psychosocial characteristics namely, depression, resilience and social support (perceived or received [living with or away from family]). Data analysis included descriptive statistics and multivariable logistic regression modelling.

RESULTS

The response rate was 61% (male = 334, female = 547) and the responding students' mean ± SD age was 22.95 ± 1.56 years. Of the respondents 185 (21% [95%CI = 18%-24%]) were current khat chewers (7 [4%] females and 178 [96%] males respectively). In the adjusted model, among male students living away from family was significantly associated with khat chewing (adjusted odd ratio [AOR] = 3.15,95%CI = 1.96-5.07, p < 0.001) and perceived social support was inversely significantly related to khat chewing (AOR = 0.98; 95%CI = 0.96-1.00; p = 0.019).

CONCLUSION

Within the limitation of the study of a single institute, social support whether received (living with family) or perceived appeared to be a protective factor from khat chewing among male medical and dental students. Social support should be enhanced and targeted to discourage khat chewing during the preparation of this future health care force.

Depression, Anxiety, Stress, and Associated Factors among Khat Chewers in Amhara Region, Northwest Ethiopia

Individuals with substance use disorder are prone to develop different psychiatric disorders. Substance abuse and associated problems are of current global concern that leads to mental health disorders which contributed about 14% of the global burden of the disease. It has become an epidemic in some parts of the African region with adolescents being the main victims of the ill health and social effects of substance use. This study is aimed at assessing the prevalence of depression, anxiety, and stress and associated factors among khat chewers in the Amhara region, 2019. A community-based cross-sectional study was done from February 14 to April 15, 2019. A purposive sampling technique was used to enroll the subjects. Data was collected using the face-to-face interview technique using the Depression Anxiety Stress Scale 21 (DASS-21) questionnaire. Descriptive statistics and bivariate and multivariate logistic regression were used to summarize the results. p value < 0.05 was considered statistically significant. A total of 478 participants were enrolled in the study with a response rate of 94.1%. The overall prevalence of depression, anxiety, and stress was 27.4%, 40.6%, and 18.8%, respectively. Around 43% of the respondents develop dependency from khat chewing. Working in a private sector, being self-employed, being jobless, spending 90 to 180 minutes and more, chewing 51-100 g and more, and chewing khat more than once per week were positively associated with stress. On the other hand, being a private sector worker, being jobless, completing secondary education, earning 1001-5000 ETB per month, chewing khat more than once per week, being khat dependent, and the presence of chronic illness were positively associated with anxiety. History of chronic illness and being khat dependent were positively associated with depression. The prevalence of depression, anxiety, and stress was high among khat chewers in the Amhara region. Special attention has to be given to khat chewers since khat chewing will double the burden of mental illness. Proper awareness and evaluation activities will reduce the impact of the problem.

The Prevalence of Depression, Anxiety and Stress and Their Associated Factors in College Students

AIM

To estimate the prevalence of symptoms of depression, anxiety, stress and associated factors in a population of college students.

METHOD

Cross-sectional study of psychological distress measured through the Depression, Anxiety and Stress Scale (DASS-21) in a sample of 1074 college students.

RESULTS

We found a moderate prevalence of depression (18.4%), anxiety (23.6%) and stress (34.5%) symptoms in our study population. Being <21, having problematic Internet use behavior, smoking, presenting insomnia and having a low self-esteem were independently associated with symptoms of depression, anxiety and stress. Being a woman, living with their family, having a stable partner, consuming alcohol frequently and having poor nutritional habits were significantly associated with symptoms of stress; lacking a stable partner was significantly associated with depressive symptoms; and frequent consumption of alcohol was significantly associated with symptoms of anxiety.

CONCLUSION

We found a moderate prevalence of depression, anxiety and stress symptoms in our population. Interventions aimed at promoting mental health among college students should be implemented.

Determinants of Delay in Seeking Malaria Treatment for Under-Five Children at Gambella Town, Southwest Ethiopia: A Case-Control Study

Background

Most of the malaria-related complications in children are due to delay in the treatment-seeking of caregivers. The objective of this study was to identify determinants of delay in seeking malaria treatment for under-five children in Gambella town, Ethiopia.

Methods

A case-control study was conducted in March 2017 among caregivers/parents consecutively included in the study. Data were collected by face-to-face interviews using a structured questionnaire. Descriptive statistics and logistic regression were, respectively, used for descriptive and analytical data analyses. Adjusted odds ratios and 95% CI were, respectively, calculated to assess the strength of association and statistical significance.

Result

A total of 153 cases and 153 control caregivers/parents participated in the study giving a response rate of 100%. The mean age of cases and controls was 29.4 years (SD ± 6.0 years) and 29.63 years (SD ± 7.8 years), respectively. Being housewife (AOR = 2.50; 95% CI: 1.47-4.22), having no history of child mortality (AOR = 3.70; 95% CI: 1.79-7.64), and chewing khat (AOR = 3.50; 95% CI: 1.57-7.68) were significantly associated with delay in seeking malaria treatment for under-five children among the caregivers. Conclusion and Recommendation. Comprehensive community-based malaria prevention and control education should be given for the caregivers in the town giving due emphasis to housewives, khat-chewers, and the caregivers with no story of child death to better promote early malaria treatment-seeking for under-five children.

Anxiety and Its Association with Preparation for Future Specialty: A Cross-Sectional Study Among Medical Students, Saudi Arabia

Background

Anxiety disorders are a significant global health concern with destructive morbidity and mortality. Medical school is a stressful environment worldwide. This study measures the prevalence of anxiety symptoms among clinical-year medical students in Saudi Arabia. As well as to explore its association with students’ sociodemographic factors, academic performance, issues experienced by them during the study of medicine, and their perceived readiness for their future specialties.

Methods

The generalized anxiety disorder (GAD-7) tool along with a sociodemographic questionnaire was distributed to 523 clinical-year medical students (fourth, fifth and sixth years) from the Imam Abdulrahman Bin Faisal University, Saudi Arabia, in this cross-sectional study. Data analysis was performed with SPSS version 23 and it included the Chi-Square or Fisher’s exact tests for bivariate analysis, and the multivariable logistic regression to account for confounders.

Results

The prevalence of anxiety symptoms as measured by the GAD-7 was found to be 31.7%. Of these, 14.3% had severe symptoms. Only 4.4% students went to a healthcare professional and were diagnosed with psychiatric problems. Logistic regression analysis revealed that the odds of anxiety was higher among females and students who had perceived psychological problems. However, students’ grade point average (GPA) and perceived readiness for their future specialty were not statistically significant with anxiety symptoms.

Conclusion

Anxiety was highly prevalent among clinical-year medical students included in this study. This urges periodic mental health screening, proper diagnosis of high-risk individuals in medical schools, and early interventions through confidential access to mental health services.