Persistent (Anxiety and Depression) Affected Academic Achievement and Absenteeism in Nursing Students

Perceived academic anxiety and procrastination among emergency nursing students: the mediating role of cognitive emotion regulation

AIM

Explore the mediating role of cognitive emotion regulation strategies used by nursing students between academic anxiety and procrastination.

DESIGN

A descriptive correlational design was used.

SETTING

This study was carried out in the faculty of nursing at the University of Alexandria.

SAMPLE

The participants in this study were all students enrolled in emergency nursing during the second semester of the academic year 2021-2022 and a convenience sampling of 654 nursing students. The Sobel test was used as a statistical method to determine the significance of a mediation effect by assessing whether the relationship between perceived academic anxiety and procrastination was significantly reduced when cognitive emotion regulation was included, using coefficients and standard errors from regression models to calculate the test statistic.

TOOLS

Academic Anxiety Scale, Academic Procrastination Scale, and Cognitive Emotion Regulation Questionnaire were used to collect data.

RESULTS

The study found that 46.5% of students reported high anxiety levels, with 40.1% perceiving moderate anxiety and only 11.3% experiencing low anxiety. Moreover, 80.4% of nursing students showed moderate academic procrastination. There is a positive correlation between procrastination and academic anxiety, with Adaptive and maladaptive coping strategies mediating this relationship, according to the Sobel test.

CONCLUSION

Based on the results, it can be concluded that there is a complex causal and effect relationship between academic anxiety and procrastination. Nursing students may resort to academic procrastination as a means of coping. Therefore, reducing anxiety, correcting maladaptive behaviors, and enhancing adaptive cognitive and emotional regulation strategies could effectively reduce academic procrastination.

Exploring nursing students' experiences of contemplating self-injury during their clinical practicums: A phenomenological study

AIM

To explore nursing students' thoughts and feelings about self-injuring during their clinical practicums.

BACKGROUND

Unfamiliar clinical environments pose challenges for nursing students, potentially leading to high levels of stress. When students find it difficult to cope with emotional triggers, some contemplate self-injury. Yet, it is rare to explore nursing students' thoughts and feelings related to self-injury during their clinical practicums.

DESIGN

A phenomenological approach was used.

METHODS

Purposive sampling was used and the participants were drawn from nursing students who graduated from universities in Taiwan. In-depth, semi-structured interviews were conducted from August to November 2023. Data saturation was reached after interviewing 15 participants. Colaizzi's seven steps and NVivo software were used for data analysis.

RESULTS

Four themes and 14 subthemes emerged. They were: (1) Sensing an emotional crescendo: participants experienced anxieties about clinical educators, assignments, homework and the clinical practicums and these intensified across time. (2) Physical and mental dysregulation: participants experienced physical discomfort, psychological distress and negative thoughts when subjected to overwhelming pressures during their clinical practicums. (3) Unwholesome self-protective behaviors: participants expressed thoughts of self-injury, engaged in self-injurious behaviors, experienced suicidal ideations and attempted suicide as measures of relieving stress. (4) Compassionate self-protective behaviors: participants coped with stress through emotional voicing, modifying situations to adjust stress, reaching out for help, self-compassion and self-care.

CONCLUSIONS

Findings raise awareness of the need for clinical educators to demonstrate empathy with nursing students who have thoughts of self-injury during their clinical practicums. Further, it is crucial for them to offer timely guidance on the healing process while simultaneously creating nurturing clinical environments wherein students could flourish and grow.

The perception and association between depression and academic stress among female undergraduate nursing students: a cross-sectional study

Introduction

Academic demands and stressors put nursing students at increasing risk of depression. The aims of the study examine the perceived level of depression and academic stress and investigate the association between these variables among nursing students in Saudi Arabia.

Methods

A cross-sectional design was used in this study. Data was collected using depression subscale from DASS-21 scale and the Academic Stress Inventory scale.

Results

A total of 237 students participated in the study. Nursing students perceived normal to mild levels of depression. Students perceived moderate levels of academic stress in all subscales, except for time management and test stress which were high. All academic stress subscales had a positive statistically significant correlation with depression. The regression model explains 49.0% of the variance in the depression scale and indicated that the main significant predictor of depression is studying in group stress, followed by self-inflected stress, study year, and sleep problem. The mean score of depression for first year students was significantly different than students in other study years.

Discussion

Nurse educators should facilitate group formation and teach students about time-management, problem-solving, negotiation, and coping strategies to deal with academic expectations and demanding situations. Understanding the causes, limiting the exposure to negative influences, and seeking support as needed are important. To enhance the quality of sleep, students should maintain a consistent sleep schedule, while avoiding stimulating activities before bedtime. Future research should focus on a longitudinal study and other variables such as quality of life, satisfaction with the quality of teaching, and support from others.

The mediating role of emotional intelligence on nursing students' coping strategies and anxiety during the COVID-19 pandemic

Anxiety among nursing students documented during the COVID-19 pandemic reflected their fear of contracting infections, adhering to the mandatory use of masks in public, engaging in the new experience of distance learning, having financial problems, and so on. The purpose of this study was to examine the mediating role of emotional intelligence (EI) on nursing students' coping strategies and anxiety during the pandemic. This cross-sectional correlational study was conducted in a university in Jordan. An online survey was used to obtain data from a sample of 282 nursing students who had returned to on-campus learning during the summer semester of 2019/2020. The survey held four parts: (a) questions about sociodemographics, (b) the General Anxiety Disorder-7 (GAD-7) scale, (c) the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), and (d) the Brief-Coping Behavior Questionnaire (Brief-COPE). The results showed that EI had a fully mediating role in the relationship between problem-focused coping strategies and anxiety, and it partially mediated the emotion-focused and avoidant/dysfunctional coping strategies and anxiety relationships. Nursing students who used the problem-focused coping strategies had high levels of EI, and with increasing levels of EI, anxiety levels decreased. Promoting the development of EI among nursing students would enable them to manage their emotions effectively and control their anxiety, particularly in new circumstances such as those that occurred during the COVID 19 pandemic.

Global prevalence and trend of anxiety among graduate students: A systematic review and meta-analysis

OBJECTIVE

To evaluate the comprehensive prevalence of anxiety among postgraduates and estimate its changes with a meta-analysis.

METHOD

Systematic retrieval to SAGE, ERIC, EBSCO, Wiley, ScienceDirect, ProQuest, PubMed, EMBASE, and Web of Science database was performed for quantitative studies on the prevalence of anxiety among graduate students published before November 22, 2022. The prevalence of anxiety synthesized with random-effects model, and subgroup analysis was conducted by study characteristics (publication year, sampling method, and measurements) and subjects' characteristics (gender, region, and educational level).

RESULT

Fifty studies were included in the meta-analysis, totaling 39,668 graduate students. The result revealed that 34.8% of graduates suffered from the anxiety (95% CI: 29.5%-40.5%). Specifically, 19.1% (95% CI: 15.4%-23.5%) had mild anxiety, 15.1% (95% C: 11.6%-19.6%) had moderate anxiety, and 10.3% (95% CI: 7.2%-14.6%) had severe anxiety. And this prevalence showed a upward trend since 2005. Besides, master students suffered slightly less than doctoral students (29.2% vs. 34.3%), and female had similar anxiety to male (26.4% vs. 24.9%). Due to the COVID-19, the prevalence of anxiety is higher after the pandemic than that before (any anxiety: 34.3% vs. 24.8%). Compared with other countries, students from Saudi Arabia, India, and Nepal were more vulnerable. The results of quality assessment showed that, 5 (10%) were in high quality, 21 (42%) were in moderate to high quality, 21 (42%) were in low to moderate quality, and 3 (6%) were in low quality. But, the studies with low quality tend to report a higher prevalence than that with high quality (40.3% vs. 13.0%), studies with nonrandom sampling tend to report a higher prevalence than that with random sampling (33.6% vs. 20.7%). Although we included the data collected based on the standard scales, there were higher heterogeneity among the measure (Q = 253.1, df = 12, p < .00).

CONCLUSION

More than one-third postgraduates suffered from anxiety disorder, and this prevalence had a slight upward trend since 2005, school administrators, teachers and students should take joint actions to prevent mental disorder of graduates for deteriorating.

Personal Factors and Clinical Learning Environment as Predictors of Nursing Students' Readiness for Practice: A Structural Equation Modeling Analysis

PURPOSE

It is essential to ensure the readiness for practice among undergraduate nursing students since the purpose of such education is to cultivate competent nurses who deliver high-quality and safe nursing. Astin's theory of student involvement suggests that this is affected by their personal factors and learning environment.

METHODS

We conducted a cross-sectional study between November 16, 2020 and December 21, 2020 which examined personal factors and aspects of the clinical learning environment among senior nursing students (n = 838) enrolled across 54 nursing schools in Korea. The participants were asked to fill out a self-administered online survey, which assessed demographic characteristics, self-esteem, depression, work-life balance, clinical learning environment, anxiety during clinical practicum, and readiness for practice. Readiness for practice was measured using the Casey-Fink Readiness for practice survey. We used structural equational modeling to test our hypothetical model.

RESULTS

The nursing students' readiness for practice was significantly affected by their self-esteem, work-life balance satisfaction, and clinical learning environment. Anxiety during clinical practicum directly influenced their readiness for practice.

CONCLUSION

Increasing self-esteem and work-life balance satisfaction, and improving their clinical learning environment by providing sufficient educational and clinical support, could help facilitate the transition from nursing schools to real-world practice for nursing students.

Structural Relationships between Environmental Factors, Psychological Health, and Academic Performance in Medical Students Engaged in Online Learning during the COVID-19 Pandemic

As a result of the COVID-19 outbreak and the enforced quarantine, universities in Malaysia were required to switch to an online class format. The resulting changes in the environmental factors of students may have had an impact on their psychological health and academic performance. This study aimed to determine the effects of environmental factors and the psychological health of students and examine their structural relationship with academic performance. A cross-sectional design with an online self-reported questionnaire was adopted, and the study was conducted among 207 undergraduate medical students at the Health Campus of Universiti Sains Malaysia. The environmental factors were measured using the lighting-noise-temperature scale and technology scale, while psychological health was assessed using the short version of the General Health Questionnaire and academic performance was determined based on Grade Point Average. Descriptive statistics and structural equation modeling were used for analysis of the data. No significant relationship was found between environmental factors and academic performance, or between environmental factors and psychological health. Nonetheless, the hypothesized structural model provided scientific evidence of an inverse relationship between psychological health and academic performance. These findings could be helpful for academics, health policymakers, and health educators in terms of understanding and promoting psychological wellbeing among university students, as well as improving their academic performance.

Predictors of UK postgraduate researcher attendance behaviours and mental health-related attrition intention

High rates of postgraduate researchers (PGRs) terminate their studies early. This attrition can have detrimental personal consequences, and results in a loss of productivity, and research and innovation for the higher education sector and society as a whole. PGRs are vulnerable to the experience of mental health problems; a factor that appears to be increasing attrition amongst students in the UK. However, investigation of the determinants of problems with PGRs' attendance and influencing intention to discontinue their studies is rare. Here, we consider the relative predictive validity of a set of putative predictors (mental health symptoms, demographic, occupational, psychological, social, and relational) of attendance behaviours (absenteeism, presenteeism, mental health-related intermission) and early attrition intention amongst UK PGRs. Depression, anxiety, and suicidality predicted attendance behaviours and greater attrition intention. Individual demographic and occupational factors predicted all outcomes. Psychological, social and relational factors had less predictive validity, although individual variables in these conceptual clusters did significantly predict some outcomes. Our results suggest that interventions to reduce high rates of mental health problems are likely to improve attendance behaviours, and reduce the extent to which PGRs intermit or consider ending their PhD studies for mental health-related reasons. Initiatives designed to improve supervisory relationships and reduce loneliness may also reduce absenteeism, intermission and attrition intention.

The relationship between depression symptoms and academic performance among first-year undergraduate students at a South African university: a cross-sectional study

Background:

South African universities face a challenge of low throughput rates, with most students failing to complete their studies within the minimum regulatory time. Literature has begun to investigate the contribution of well-being, including mental health, with depression among students being one of the most common mental disorders explored. However, locally relevant research exploring associations between depression and academic performance has been limited. This research hypothesizes that the presence of depression symptoms, when controlling for key socio-demographic factors, has an adverse impact on student academic outcomes and contributes to the delay in the academic progression of students.

Methods:

The study used a cross-sectional design. Data were collected in 2019 from first-time, first-year undergraduate students using a self-administered online questionnaire. In total, 1,642 students completed the survey. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depression symptoms. Data on students’ academic performance were obtained from institutional records. Bivariate and multivariate regression analyses were used to examine associations between depression symptoms and academic performance.

Results:

Most participants (76%) successfully progressed (meeting the requirements to proceed to the second year of university study). Of the participants, 10% displayed symptoms of severe depression. The likelihood of progression delay (not meeting the academic requirements to proceed to the second year of university study) increased with the severity of depression symptoms. Moderate depression symptoms nearly doubled the adjusted odds of progression delay (aOR = 1.98, 95% CI: 1.30-3.00, p = 0.001). The likelihood of progression delay was nearly tripled by moderate severe depression symptoms (aOR = 2.70, 95% CI:1.70–4.36, p < 0.001) and severe depression symptoms (aOR = 2.59, 95% CI:1.54–4.36, p < 0.001). The model controlled for field of study, financial aid support as well as sex and race.

Conclusion:

Higher levels of depression symptoms among first-year university students are associated with a greater likelihood of progression delay and may contribute to the low throughput rates currently seen in South African universities. It is important for students, universities and government departments to recognize student mental wellness needs and how these can be met.

H-FABP Levels and Psycho-Emotional Improvement of CABG Patients during Cardiac Rehabilitation

(1) Background: The heart-type fatty acid-binding protein (H-FABP) is a specific myocardial biomarker and high levels indicate ischemia regardless of patient-reported symptoms. Concurrently, major adverse cardiovascular events and surgery such as coronary artery by-pass grafting (CABG) cause substantial psycho-emotional distress e.g., depression and anxiety. Comprehensive cardiac rehabilitation is, therefore, essential to both physical and psychological recovery. (2) Methods: This is a unicentric, prospective study on 120 consecutive post-CABG patients undergoing a 6-month cardiac rehabilitation program based on physical exercise, Mediterranean diet principles, and Q10 coenzyme antioxidant supplements. H-FABP levels, depression, and anxiety scores (Hamilton HAM-D and HAM-A scales) were monitored after surgery and at 6 months. (3) Results: Mean H-FABP dropped from 60.56 to 4.81. Physical ability increased from 1-2 to 4-5 METS. Mean depression and anxiety improved from 15.88 to 6.96 and from 25.13 to 15.68, respectively. Median scores went down 50% for depression and 9% for anxiety. Explored associations between H-FABP and psycho-emotional status were statistically insignificant. (4) Conclusions: patients adhered to the program and improved significantly in all studied aspects. Clinical significance is discussed in the context of countries like Romania, where such programs are limited by systemic and financial constraints. Further research directions are identified.

Hierarchical Structure of Depression Knowledge Network and Co-word Analysis of Focus Areas

Contemporarily, depression has become a common psychiatric disorder that influences people's life quality and mental state. This study presents a systematic review analysis of depression based on a hierarchical structure approach. This research provides a rich theoretical foundation for understanding the hot spots, evolutionary trends, and future related research directions and offers further guidance for practice. This investigation contributes to knowledge by combining robust methodological software for analysis, including Citespace, Ucinet, and Pajek. This paper employed the bibliometric methodology to analyze 5,000 research articles concerning depression. This current research also employed the BibExcel software to bibliometrically measure the keywords of the selected articles and further conducted a co-word matrix analysis. Additionally, Pajek software was used to conduct a co-word network analysis to obtain a co-word network diagram of depression. Further, Ucinet software was utilized to calculate K-core values, degree centrality, and mediated centrality to better present the research hotspots, sort out the current status and reveal the research characteristics in the field of depression with valuable information and support for subsequent research. This research indicates that major depressive disorder, anxiety, and mental health had a high occurrence among adolescents and the aged. This present study provides policy recommendations for the government, non-governmental organizations and other philanthropic agencies to help furnish resources for treating and controlling depression orders.

Relationships Among Exercise, Mindfulness, Mental Health, and Academic Achievement Among Prelicensure Nursing Students

BACKGROUND

Nursing school is challenging and can be stressful for many students. Nursing students are also susceptible to stress, anxiety, and depression. Exercise and mindfulness-based interventions (MBIs) have been shown to improve mental health outcomes in other populations, but it is not known how these strategies influence academic achievement.

PURPOSE

The purpose of this study was to examine the relationships among exercise, mindfulness, academic achievement, and mental health among undergraduate nursing students.

METHODS

This study used a cross-sectional design that uses correlational, regression, and mediation analyses.

RESULTS

Mindfulness was inversely associated with depression and anxiety and, although not statistically significant, was positively associated with academic achievement. Exercise was not significantly associated with anxiety or academic achievement but was associated with depression.

CONCLUSIONS

Evidence-based interventions that promote mindfulness among nursing students should be implemented to promote mental health and academic achievement, especially because MBIs are cost-effective and convenient alternatives to other psychotherapies.

Predicting Academic Performance: Analysis of Students' Mental Health Condition from Social Media Interactions

Social media have become an indispensable part of peoples' daily lives. Research suggests that interactions on social media partly exhibit individuals' personality, sentiment, and behavior. In this study, we examine the association between students' mental health and psychological attributes derived from social media interactions and academic performance. We build a classification model where students' psychological attributes and mental health issues will be predicted from their social media interactions. Then, students' academic performance will be identified from their predicted psychological attributes and mental health issues in the previous level. Firstly, we select samples by using judgmental sampling technique and collect the textual content from students' Facebook news feeds. Then, we derive feature vectors using MPNet (Masked and Permuted Pre-training for Language Understanding), which is one of the latest pre-trained sentence transformer models. Secondly, we find two different levels of correlations: (i) users' social media usage and their psychological attributes and mental health status and (ii) users' psychological attributes and mental health status and their academic performance. Thirdly, we build a two-level hybrid model to predict academic performance (i.e., Grade Point Average (GPA)) from students' Facebook posts: (1) from Facebook posts to mental health and psychological attributes using a regression model (SM-MP model) and (2) from psychological and mental attributes to the academic performance using a classifier model (MP-AP model). Later, we conduct an evaluation study by using real-life samples to validate the performance of the model and compare the performance with Baseline Models (i.e., Linguistic Inquiry and Word Count (LIWC) and Empath). Our model shows a strong performance with a microaverage f-score of 0.94 and an AUC-ROC score of 0.95. Finally, we build an ensemble model by combining both the psychological attributes and the mental health models and find that our combined model outperforms the independent models.

Anxiety and coping strategies among nursing students returning to university during the COVID-19 pandemic

BACKGROUND

Despite the continued expand of the coronavirus disease 2019 (COVID-19) pandemic, nursing students are returning to on-campus learning and training in clinical settings. The COVID-19 pandemic might constitute a new source of anxiety that increases the already high anxiety levels of nursing students. This study aimed to assess the COVID-19 infection-related anxiety and coping strategies among nursing students returning to university campuses during the COVID-19 pandemic in Jordan.

METHODS

A cross-sectional study was conducted on a sample of 282 nursing students who returned to campus during the summer semester of the academic year 2019/2020. The returning students were invited to complete an online questionnaire consisting of three parts: 1) sociodemographic variables and infection-related information, 2) the Generalized Anxiety Disorder 7 (GAD-7) Scale, and 3) the Brief-Coping Behavior Questionnaire (Brief-COPE).

RESULTS

Of the participating students, 70.6% reported mild to severe anxiety levels. Female students and students who had fears of becoming infected with COVID-19 were found to be at higher risk of anxiety than were other students. A positive correlation was found between students' anxiety levels and their dysfunctional coping strategies, which included denial, behavioral disengagement, venting, and self-blame. Students who had chosen to study nursing willingly used coping planning. Further, other sociodemographic variables and infection-related information were associated with dysfunctional and emotion-focused coping strategies.

CONCLUSIONS

The participating nursing students showed significant COVID-19-related anxiety upon returning to on-campus learning. Unfortunately, the students were found to use some dysfunctional coping strategies which were associated with increased levels of anxiety. The results highlight the important role of universities and nursing faculty members in supporting students emotionally and ensuring their personal safety inside the classroom and in clinical settings.

Suicidal behaviors and university entrance test-related factors: A Bangladeshi exploratory study

PURPOSE

The present study is the first investigating unexplored psychological issues of university entrance test-taking students in Bangladesh.

DESIGN AND METHODS

This cross-sectional study investigates suicidal behaviors and their socio-demographic, admission test-related, and psychopathological risk factors among a total of 911-Bangladeshi university entrance test-takers.

FINDINGS

About 17.7% of the participants report suicidal thoughts, whereas it is 8.0% and 2.5% for suicide plans and suicide attempts, respectively. Significantly higher suicidal thought is observed in the repeat test-taking students compared to the first-time test-takers (20.7% vs. 14.6%, χ ²  = 5.669, p = 0.017), though the suicide plan and suicide attempt are not associated with student status. The suicidal thought risk factors include female gender, urban residence, satisfaction with the mock test, mental disorders etc. PRACTICAL IMPLICATIONS: The present findings warrant implementing initiatives for this suicide-prone cohort, especially for the test-failing students.

Prevalence and changes in depressive symptoms among postgraduate students: A systematic review and meta-analysis from 1980 to 2020

Education actively helps us develop our well-being and health, but postgraduate students are at high risk of depression. The prevalence of depression symptoms varies from 6.2% to 84.7% among them, and its changes throughout the years remains unclear. The present study aimed to estimate the real prevalence of depression symptoms among postgraduate students and the changes from 1980 to 2020. Thirty-seven primary studies with 41 independent reports were included in the meta-analysis (none reports were in high-quality, three were medium-to-high quality, 20 were low-to-medium quality, and 18 were low-quality), involving 27,717 postgraduate students. The pooled prevalence of overall, mild, moderate, and severe depression symptoms was 34% (95% CI: 28-40, I²  = 98.6%), 27% (95% CI: 22-32, I²  = 85.8%), 13% (95% CI: 8-21, I²  = 97.3%), and 8% (95% CI: 6-11, I²  = 81.0%), respectively. Overall, the prevalence of depression symptoms remained relatively constant through the years following 1980 (overall: β = -0.12, 95% CI: [-0.39, 0.15], p = 0.39; mild: β = 0.24, 95% CI: [-0.02, 0.51], p = 0.07; moderate: β = -0.24, 95% CI: [-0.75, 0.26], p = 0.34; severe: β = 0.13, 95% CI: [-0.25, 0.51], p = 0.50). Doctoral students experienced more depressive symptoms than did master's students (43% vs. 27%; Q = 2.23, df = 1, p = 0.13), and studies utilising non-random sampling methods reported a higher prevalence of mild depression and lower moderate depression symptoms than those that used random sampling (overall: 34% vs. 29%; Q = 0.45, df = 1, p = 0.50; mild: 29% vs. 21%; Q = 1.69, df = 1, p = 0.19; moderate: 16% vs. 25%; Q = 1.79, df = 1, p = 0.18; severe: 8% vs. 9%; Q = 0.13, df = 1, p = 0.72) despite these differences was not statistically significant. The prevalence of depression symptoms was moderated by the measurements and the quality of primary studies. More than one-third of postgraduates reported depression symptoms, which indicates the susceptibility to mental health risk among postgraduates. School administrators, teachers, and students should take joint actions to prevent mental disorders of postgraduates from increasing in severity.

Personality and mental health factors associated with performance at university level: A study of business administration students

BACKGROUND

Performance of students at university level may be influenced by various factors.

AIM

In a sample of business administration students, we explored personality, mental health, and life style factors associated with high and low achievers based on their examination grades (Grade A and higher vs. Grade B and lower).

METHODS

We studied personality factors using big five inventory (BFI)-10, anxiety through generalized anxiety disorder-7 screening scale, and depression by patient health questionnaire-9 scale. In open-ended questionnaires, stress, relationship, and drug uses were enquired about.

RESULTS

Considerable proportions of students had anxiety (33%) and depression (41%) at moderate-to-severe level; however, they were not different in the two groups. Higher examination grades were associated significantly with higher scores on conscientiousness factor of BFI-10 and female gender. There was no difference in self-reported stress or substance use between the two groups.

CONCLUSIONS

While conscientiousness was associated with better performance, mental health factors were comparable between higher and lower grades in examination. The results highlight the need for further research on personality and modifiable factors such as stress, anxiety, and depression and to evaluate effectiveness of interventional approaches on academic performance.

Stigmatizing Attitudes Toward Depression Among Male and Female, Medical and Non-medical Major College Students

Background: Stigma is often reported to be a barrier to the treatment and rehabilitation of depression. However, little is known about stigma toward people with depression among college students in China.

Methods: Using a questionnaire with a case vignette describing depression, a total of 1,056 students from nine colleges/universities in Hunan Province of China were included in this study. The questionnaire addressed the attitudes toward depression and the desire for keeping a distance from depressed individuals. The current study explored the stigma attitudes of college students toward people with depression and the desire for social distancing, as well as the gender (male and female) and major (medical and non-medical) differences.

Results: Over half of the respondents agreed that people described in the vignette were “dangerous” (60.7%) and “could snap out of the problem” (58.7%). Compared with female students, males were more likely to agree that “If I had this problem, I would not tell anyone” (7.0 vs. 13.2%, p = 0.001); compared with non-medical students, medical students were more likely to agree that “The problem is a sign of personal weakness” (38.0 vs. 50.0%, p < 0.001). A lot of respondents would be unwilling to “marry into the family of people with depression” (71.1%) or “work closely with them” (45.1%). Compared with male students, females were more unwilling to “work closely with them” (40.3 vs. 47.5%, p = 0.026).

Conclusion: This study found that a high proportion of Chinese college students showed stigma toward and desire for social distancing from people with depression, male students and medical major students showed higher stigma in some subscale items toward people with depression. The present results suggest that more anti-stigma interventions should be applied for Chinese college students to help prevent or reduce stigma attitudes toward people with depression.

Impact of psychosocial factors on academic performance of nursing students in Thailand

Purpose

The purpose of this study is to investigate the psychosocial factors that impact the academic performance of nursing students.

Design/methodology/approach

A cross-sectional study was conducted with 767 nursing students from three nursing colleges in Thailand. Instruments included Counseling Center Assessment for Psychological Symptoms and Rosenberg Self-Esteem Scale. Path model analyses with the maximum likelihood method were utilized to examine the proposed model. Model fit was estimated using multiple indexes, including chi-square/df ratio (χ2/df), comparative fit index (CFI), Tucker-Lewis index (TLI) and the root mean square error of approximation (RMSEA).

Findings

Results indicated that family distress, emotional negativity, self-esteem and substance use were factors that related to nursing students' academic performance. Findings of path analyses indicated that the model demonstrated good fit: χ2 (2, N = 767) = 3.11, p = 0.48; χ2/df = 1.56; CFI = 1.00; TLI = 0.99; RMSEA = 0.027, (90% CI = [0.000, 0.082], PCLOSE = 0.68).

Originality/value

While prior research has examined some facets leading to academic success for nursing students, psychosocial factors have not received adequate attention. This study presents a model of family and individual psychosocial factors that impact academic performance of nursing students along with recommendations to help improve their well-being.

COVID-19-Related Intolerance of Uncertainty and Mental Health among Back-To-School Students in Wuhan: The Moderation Effect of Social Support

The current wave and future trend of the novel coronavirus disease 2019 (COVID-19) has triggered public uncertainty, causing unbearable psychological pressure on people. A cross-sectional online questionnaire was conducted among back-to-school students in Wuhan from 31 August 2020, to 14 September 2020, by using convenience sampling. A total of 1017 participants voluntarily provided sociodemographic characteristics and accomplished the following scales: the Intolerance of Uncertainty Scale (IUS-12), the Social Support Scale (SSQ), the Generalized Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Insomnia Severity Index-7 (ISI-7). Results revealed that the levels of anxiety, depression, and insomnia were moderate, moderate and subthreshold, respectively. A one-way multivariate analysis of variance indicated that those with different attitudes toward the trajectory of the COVID-19 epidemic in China showed significantly different results in anxiety and depression (p < 0.001). Moderation modeling implicated that social support significantly moderated the predictive relationship between intolerance of uncertainty and mental health variables including anxiety and depression, but failed on insomnia. Findings indicate that back-to-school students in Wuhan experience mental health problems and improving social support measures could buffer the effect of intolerance of uncertainty with respect to COVID-19 on mental health.

Anxiety Symptoms Are Associated With Higher Psychological Stress, Poor Sleep, and Inadequate Sleep Hygiene in Collegiate Young Adults-A Cross-Sectional Study

Background: Anxiety symptoms, stress, poor sleep, and inadequate sleep hygiene are common in university students and these affect their learning and increase attrition. However, limited knowledge exists about the inter-relationship between these factors among university students in low-middle income countries. Therefore, this study aimed to investigate the prevalence of anxiety symptoms and their relationship with sleep quality, sleep hygiene practices, and psychological stress. Materials and Methods: A cross-sectional study was conducted with a randomly selected sample of students in Mizan-Aman, Ethiopia. Participants completed a self-administered questionnaire, which included questions about socio-demographics, socio-economic factors, the Leeds Sleep Evaluation Questionnaire-Mizan, Sleep hygiene index, Perceived stress scale-10 (PSS-10), and Generalized anxiety disorder-7 scale (GAD-7). Results: The prevalence of anxiety symptoms was about 22%. Multivariate regression analysis showed that both anxiety status χ²[(13, N = 480) = 82.68, p < 0.001], and increasing levels of anxiety (model adjusted R2 = 0.204, p < 0.001) were associated with greater psychological stress, inadequate sleep hygiene practices, and poor sleep quality scores after adjusting for age, gender, attendance, substance use, years of university education, time spent in athletic activity every day, and frequency of tea/coffee consumption. Conclusion: There was a high prevalence of anxiety symptoms in this study population, and this condition was associated with psychological stress, poor sleep, and inadequate sleep hygiene parameters. These results suggest a need to address the various aspects of mental health and its diverse sleep correlates in university students.

A longitudinal cohort study to explore the relationship between depression, anxiety and academic performance among Emirati university students

BACKGROUND

Many university students experience depression and anxiety, both of which have been shown to affect cognitive function. However, the impact of these emotional difficulties on academic performance is unclear. This study aims to determine the prevalence of depression and anxiety in university students in United Arab Emirates (UAE). It further seeks to explore the relationship between emotional difficulties and students' academic performance.

METHODS

This longitudinal study recruited 404 students (aged 17-25 years) attending one UAE university (80.4% response rate). At baseline, participants completed a paper-based survey to assess socio-economic factors and academic performance, including most recent grade point average (GPA) and attendance warnings. PHQ-9 and GAD-7 scales were used to assess depressive and anxiety symptoms. At six-month follow-up, 134 participants (33.3%) provided details of their current GPA.

RESULTS

Over a third of students (34.2%; CIs 29.7-38.9%) screened for possible major depressive disorder (MDD; PHQ-9 ≥ 10) but less than a quarter (22.3%; CIs 18.2-26.3%) screened for possible generalized anxiety disorder (GAD; GAD-7 ≥ 10). The Possible MDD group had lower GPAs (p = 0.003) at baseline and were less satisfied with their studies (p = 0.015). The MDD group also had lower GPAs at follow-up (p = 0.035). The Possible GAD group had lower GPAs at baseline (p = 0.003) but did not differ at follow-up. The relationship between GAD group and GPA was moderated by gender with female students in the Possible GAD group having lower GPAs (p < 0.001) than females in the Non-GAD group. Male students in the Possible GAD group had non-significantly higher GPA scores. Higher levels of both depression and anxiety symptoms scores were associated with lower GPAs at baseline. PHQ-9 scores, but not GAD-7 scores, independently predicted lower GPA scores at follow-up (p = 0.006). This relationship was no longer statistically significant after controlling for baseline GPA (p < 0.09).

CONCLUSION

This study confirms previous findings that around a third of university students are likely to be experiencing a depressive disorder at any one time. Furthermore, it provides important evidence regarding the negative impacts of emotional difficulties on students' academic performance. The results support the need to consider the mental health of students who are struggling academically and highlight the importance of signposting those students to appropriate support, including evidence-based therapies.

Determinants of depression among nursing students in Cameroon: a cross-sectional analysis

Background

Nursing students are highly susceptible to depression given the heavy workload and clinical demands of the curriculum. Depression has negative impacts on their health and academic performance. This study aimed to determine the determinants of depression amongst nursing students in the English-speaking regions of Cameroon.

Methods

A cross-sectional analysis of 447 nursing students recruited from a combination of state-owned and private nursing institutions in the English-speaking regions of Cameroon from January – April 2018 was carried out. Independent correlates of depression were determined using multivariable regression analysis, with the level of significance set at 95%.

Results

The overall prevalence of depression (Patient Health Questionnaire - 9 > 4) and major depressive disorder (Patient Health Questionnaire - 9 > 9) in these students was 69.57 and 26.40% respectively. Independent correlates of depression were found to be: total Oldenburg Burnout Inventory score (aOR: 1.18; 95% CI: 1.11, 1.25; p value < 0.01); level of studies (aOR: 0.72; 95% CI: 0.55, 0.94; p value = 0.02) and occurrence of a life-changing crises (aOR: 2.13; 95% CI: 1.28, 3.55, p value < 0.01).

Conclusion

The prevalence of depression amongst nursing students in Cameroon is high. Determinants proposed in this study require further assessment to facilitate early identification and management of depression in this high-risk group, in order to limit the negative effects linked with the condition.

Clinical placement anxiety in undergraduate nursing students: A concept analysis

OBJECTIVE

The primary aim of this review was to complete an in-depth analysis of clinical placement anxiety in undergraduate nursing students. Our overall goal was to establish a strong foundation for clinical education strategies and future research on clinical placement anxiety in nursing education.

DESIGN & METHODS

We utilized Walker and Avant's systematic 8-step approach to concept analysis as a framework to develop a comprehensive understanding of clinical placement anxiety in undergraduate students.

DATA SOURCES

A review of existing literature on clinical placement anxiety was conducted using the electronic databases of PubMed, CINAHL, and PsychInfo, as well as a grey literature and snowball search. Search terms included clinical placement, clinical experience, nursing students, undergraduate nursing students, and anxiety.

RESULTS

The literature search resulted in 81 articles that met the inclusion criteria. Five defining attributes were identified: a vague or unknown threat, psychological-emotional responses, psychological-cognitive responses, physiological responses, and unfamiliar environments or situations. Antecedents, consequences, and empirical referents of the concept were also highlighted.

CONCLUSIONS

Insights gleaned from this concept analysis may enhance the ability of clinical nursing educators to effectively prevent and manage student anxiety in the clinical setting. By contextualizing anxiety, we have also validated the importance of further exploration of the anxiety experienced by undergraduate nursing students during their clinical experiences. Thus, this concept analysis establishes the foundation for educational strategies, as well as future research in nursing education.

Relationship Between Mindfulness, Psychopathological Symptoms, and Academic Performance in University Students

It has been shown that a mindfulness construct involving five component skills (observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience) is related to well-being and lessens depression, anxiety, and stress symptoms. This study investigates the relationship between mindfulness, academic performance, and psychopathological symptoms in a sample of Swiss university students during preparation for examinations. A total sample of 150 university students from the psychology department at the University of Geneva were invited to report their mindfulness skills and academic performance, as well as anxiety, depression, and stress symptoms, through self-report measures. Results indicated that the total mindfulness score and the nonreactivity facet of mindfulness were associated with depression scores. Furthermore, mindfulness skills were positively correlated with students' academic performance. Finally, certain demographic variables, such as gender, were linked to the presence of depression, anxiety, and stress symptoms in our sample. The clinical implications of these results are discussed.

Pre-operative depression predicted longer hospital length of stay among patients undergoing coronary artery bypass graft surgery

Purpose: Coronary artery bypass graft surgery (CABG) is a common and remarkably effective treatment for coronary heart disease, improving health status and enhancing quality of life. However, some outcomes after surgery remain unexplained, including psychological factors such as depression. The prevalence rates of pre- and post-operative depression among CABG patients are high, which is associated with negative short- and long-term outcomes. This study explores the impacts of pre-operative depressive symptoms on post-operative hospital length of stay (LOS) among patients undergoing CABG in Jordan. Patients and methods: This was a non-experimental, prospective observational study among 227 CABG patients recruited from 5 hospitals in Amman, Jordan. Depression was measured within an average of two weeks prior and one month after the operation using the Hospital Anxiety and Depression Scale. Length of stay was abstracted from medical records after discharge. Results: The average post-operative LOS was 11.40±10.41 days. The average pre-operative depression level was moderate; 12.76±6.80 and 42.47% complained of varying levels of depressive symptoms. The average post-operative depression level was moderate; 11.11±6.78 and 40.53% complained of varying levels of depressive symptoms. In stepwise regression models, depression scores and female gender were independent predictors that increased post-operative LOS. On the other hand, high income (≥1501$/month) and use of statins had protective effects and decreased post-operative LOS. The model explained 22.4% of the total variance regarding LOS. Conclusion: Pre-operative depressive symptoms increased post CABG LOS. Application of policies and depression assessment protocols prior to CABG by health care providers can identify high-risk groups (eg, females), so appropriate interventions can be designed and implemented to decrease morbidity and mortality.