Adverse Childhood Experiences among Veterinary Medical Students: A Multi-Site Study

Impact of Adverse Childhood Experiences (ACE) and Childhood Protective Factors (CPF) on physical and mental health of medical students of a public sector medical university

The current study aimed to assess the impact of Adverse Childhood Experiences (ACE) and Childhood Protective Factors (CPF) on physical and mental health of medical students of a public sector medical university. An online cross-sectional descriptive study was carried out at a public sector medical university in Lahore, Pakistan from 1 June 2024 to 30 August 2024. The study tool consisted of sociodemographic questions, an Adverse Childhood Experience (ACE) questionnaire, and a Resilience Questionnaire for measuring childhood protective factors and self-reported physical and mental health in the last 4 weeks. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) Version 26.0. A total of 368 medical students participated in the survey of which 125 (33.96%) were male and 243 (66.03%) were females. A higher Childhood Protective Factor (CPF) score significantly predicted good physical health (AOR 1.516, 95% CI 1.085-2.120, p <.01) and excellent physical health (AOR 1.61, 95% CI 1.151-2.263, p <.001). A higher ACE score significantly predicted fair mental health (AOR .767, 95% CI .624-.944, p <.05), good mental health (AOR .746, 95% CI .604-.922, p <.01), and excellent mental health (AOR .746, 95% CI .604-.922, p <.01). Our study shows that ACE was a significant predictor of self-reported mental health but not physical health. However, CPF was a significant predictor of physical and mental health.

The future of flourishing in veterinary medicine: a systems-informed positive psychology approach in veterinary education

Individuals in the veterinary profession are experiencing significant mental health and wellbeing challenges. A holistic view of wellbeing, which encompasses both physical and mental health, underscores their interconnected nature. This integrated approach reduces the artificial separation of wellbeing facets, and highlights how mental states influence not only individuals, but also their interactions with animals, the environment, and others in the workplace. Wellbeing challenges in veterinary medicine may contribute to negative impacts in animal, human, and environmental health. Veterinary education institutions and systems are also experiencing complex challenges as they adapt to rapidly changing societal, workforce, and professional wellbeing related pressures. This review paper explores the field of positive psychology and its application in educational contexts, commonly known as positive education. A thorough exploration of the systems-informed positive education approach and ways in which it can proactively enhance veterinary professional wellbeing from within the veterinary education ecosystem are presented. It is important to recognize that individual self-care, while valuable, cannot compensate for systemic dysfunctions such as poor team dynamics, ineffective leadership, or organizational culture issues. Addressing these systemic factors is critical for creating environments that support sustained flourishing. Positive psychology interventions delivered through the pathways of individuals, groups, and organizations specifically within a veterinary education context are discussed. Limitations, considerations, and proposed measurement strategies are reviewed. The implications of implementing a systems-informed positive psychology approach to enhance wellbeing in veterinary education include creating curriculum and cultures that enable flourishing within veterinary education institutions. Strengthening the individual and collective wellbeing of veterinary professionals has the potential to enhance the quality of care provided to animals, which has myriad positive implications for animal caregivers, their communities, the environment, and society.

Adverse childhood experiences among doctor of pharmacy students

OBJECTIVE

Adverse Childhood Experiences (ACEs) have demonstrated negative impact on physical, emotional, and cognitive health outcomes. This study aimed to assess prevalence of ACEs among Doctor of Pharmacy (PharmD) students, and their associations with mental health, substance use, academic performance, and sleep patterns.

METHODS

A cross-sectional survey was conducted on PharmD students at a private University. ACE scores, mental health history, substance use, academic performance, and sleep habits were self-reported. Descriptive statistics and chi-square tests were used for analysis.

RESULTS

From 54 participants across all cohorts of students in the curriculum (response rate: 19%), 48% reported ≥4 ACEs. A majority of students reported having been diagnosed with or sought treatment for depression (56%) or anxiety (67%), while 42.9% reported a history of contemplating suicide. Participants with ACE scores of ≥4 were more likely to have sought treatment for depression, any mental health condition, contemplated suicide, or used alcohol for mental health purposes. No differences in academic performance based on ACE scores were found.

CONCLUSION

High numbers of ACEs were common and linked to mental illness, suicidality, and use of alcohol for mental health purposes. While no direct academic impact was found in this small sample size, adopting a trauma-informed approach is crucial to supporting student well-being. Further research in this area is needed to optimize interventions to support academic and professional success among students with ≥4 ACEs.

Modeling the social determinants of resilience in health professions students: impact on psychological adjustment

Stressors inherent to training and stemming from the learning environment are associated with high rates of burnout, depression, and mental health problems in health professions students (HPS). There is evidence that disadvantaged or stigmatized groups are particularly affected. These problems not only impact students after graduation but may also have detrimental effects on patient outcomes. Resilience, conceptualized as the process of adapting well in the face of adversity, has inspired an increasing number of interventions aimed at addressing those problems in HPS. These interventions have mostly targeted individual students and their psychological traits while ignoring social and structural factors that may enhance or undermine individual resilience. To address this gap in the literature, the authors reviewed the evidence for psychosocial determinants of resilience and proposed a model inspired by the social determinants of health literature and the "upstream-downstream" metaphor. In this theoretical paper, the authors propose that upstream determinants such adverse childhood experiences and socioeconomic and sociodemographic markers of disadvantage have a direct effect on psychological adjustment and an indirect effect mediated by resilience. Additionally, the authors propose that the institutional downstream drivers of learning environment, social support, and sense of belonging moderate the direct and indirect effects of the upstream determinants on psychological adjustment. Future research should test these hypotheses and gather evidence that may guide the development of interventions. The authors present their model as part of a comprehensive response to recent calls to action to address diversity, equity and inclusion in health professions education.

Relationships between childhood trauma and mental health during the COVID-19 pandemic: a network analysis

Background

Childhood trauma has been found to have an important impact on mental health. However, little is known regarding the intercorrelations between childhood trauma and mental health during the COVID-19 pandemic. This study aimed to investigate such complex interplay between childhood trauma, depression, anxiety, post-traumatic stress level during the COVID-19 pandemic, and fear of COVID-19 using network analysis.

Methods

A total of 1,247 college students were recruited and were asked to complete a series of questionnaires, including the Childhood Trauma Questionnaire, Patient Health Questionnaire, Generalized Anxiety Disorder Scale, Post-traumatic Stress Checklist-Civilian version, and Fear of COVID-19 Scale. The Gaussian graphical model with the scores of the questionnaires as nodes was estimated. The partial correlations between nodes were calculated as edges. Moreover, network comparison tests were conducted to compare the network patterns between participants with high levels of childhood trauma and low levels of childhood trauma.

Results

Childhood trauma was found to be connected to depression, anxiety, and post-traumatic stress level. The node of childhood trauma exhibited the strongest strength and the highest expected influence in the network. Participants with high levels of childhood trauma and participants with low levels of childhood trauma showed comparable network structure and global strength.

Conclusion

Our findings revealed a complex network pattern between childhood trauma and different mental health problems, indicating that childhood trauma might be a risk factor for mental health during the COVID-19 pandemic.

Challenging suicide, burnout, and depression among veterinary practitioners and students: text mining and topics modelling analysis of the scientific literature

Background

Worldwide, veterinary practitioners and students are reported to be at higher risk of suicide, burnout, and depression compared to other occupational groups. The aim of the current study was to apply text mining and topic modelling analysis on scientific literature regarding suicide, burnout, and depression among veterinary practitioners and students to extract meaningful and synthetic information. These statistical approaches can be used to comprehend more in deep the phenomena involving veterinarians and veterinary students and to suggest the potential changes needed in admission to veterinary school, veterinary curricula, and post-graduation initiatives as preventive actions.

Results

A systematic search protocol was set up to identify scientific literature that published on the topic from 1985 to 2019. Two-hundred-eleven records were selected with abstracts/texts submitted to text mining and topic modelling analysis. Student, stress, work, anim*, and euthanasia resulted the most frequent terms. Topics modelling allowed to differentiate groups of words and papers in 3 areas of interest: 1) students’ difficulties encountered during their studies that increase stress and anxiety impairing their psychological health; 2) exposure to death and euthanasia as risk factor for mental health; and 3) need of support among those providing medical and health care, and of supportive group work to cope with such profession.

Conclusion

Based on the most frequent words included in the clouds and on the contents of the papers clusterised in them, some suggestions are interfered. It is emphasized that the veterinary curricula should include courses that prepare them early to deal with animal death and post-death grief of pet owners, to handle ethical dilemmas and moral stressors, to communicate with clients and staff members, to work in team, to balance work-family life and to promote individual and team resources. Specific courses for veterinary practitioners could keep them updated on their new roles and ways to handle them among functioning as potential feedbacks to monitor their psychological wellbeing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12917-021-03000-x.

The Association Between Adverse Childhood Experiences and Burnout in a Regional Sample of Physicians

OBJECTIVE

Little research has occurred in physicians on the prevalence of adverse childhood experiences (ACEs) and their potential correlation with burnout. The authors hypothesized that there would be a relationship between burnout levels and ACE scores, with physicians reporting more burnout being likely to have higher ACE scores.

METHODS

Three hundred physicians completed the ten-question ACE scale and two burnout scales, the Mini-Z, and two items from the Maslach Burnout Inventory.

RESULTS

One hundred and thirty eight (46%) of the physicians were positive on one or the other of the two burnout measures, and 49% of the respondents were positive for at least one ACE, while 9% were positive for four or more ACEs. The most common ACEs reported by the group were having a family member being depressed, being mentally ill, or attempting suicide (22%). The burnout measures correlated strongly with each other (r = 0.68, p < .001), and separate logistic regression models revealed that the physicians with an ACE score of 4 or more had more than two and half times the risk of burnout on either burnout scale measured.

CONCLUSIONS

In this group of physicians, almost half reported experiencing ACEs, and half reported symptoms of burnout. The research hypothesis, which physicians reporting more burnout would be more likely to have higher ACE scores, was supported. It is possible that ACEs are a vulnerability factor in physicians for the development of burnout. This possibility and potential protective factors should be further studied.

A descriptive study of adverse childhood experiences and depression, anxiety, and stress among undergraduate nursing students

BACKGROUND/SIGNIFICANCE

The 10-point Adverse Childhood Experiences (ACEs) score measures childhood exposure to traumatic events. An ACEs score of 4 or higher has been associated with long-term physical and mental health problems, and increased mortality. It is unclear if the rates of undergraduate nursing students experiencing ACEs is different from the general population, and what impact ACEs has on nursing students' depression, anxiety and stress.

PURPOSE

The purpose of this study was to assess the rate of ACEs in nursing students and to examine the relationship between ACEs and perceived depression, anxiety, and stress among undergraduate nursing students.

METHODS

This is a descriptive correlational study to determine Adverse Childhood Experiences (ACEs) scores and Modified Depression Anxiety and Stress Scale (DASS-21) scores for undergraduate pre-licensure students at a private mid-western college. Students' ACEs scores were correlated with DASS-21 scores and demographic data.

RESULTS

409 students volunteered to participate in the study. Seventeen percent of students had high ACEs scores (≥4). Those students with high ACEs scores also scored statically significantly higher on the DASS-21 items relating to depression, anxiety, and stress.

CONCLUSION/IMPLICATIONS

Results from this study demonstrated that many nursing students have experienced ACEs and nursing students with ACEs scores of 4 or higher had higher rates of depression, anxiety, and stress. These findings should drive faculty in nursing programs to acknowledge the prevalence of ACEs among their nursing students and recognize that impact on the mental health of students.

Adverse Childhood Experiences, Ethnicity, and Substance Use among College Students: Findings from a Two-State Sample

Objectives: Despite college students reporting high rates of substance use and adverse childhood experiences (ACE), few studies have examined ACE-related substance use patterns with diverse student samples. We estimated the prevalence of ACE and substance use and investigated ethnic differences in the relationship between ACE and substance use among college students from two states. Design: Data are responses (N = 7,148) on the National College Health Assessment (in California) and the College Student Health Survey (in Minnesota). Multivariable regression models assessed the associations between individual and accumulated ACE and alcohol, tobacco, marijuana, and illicit substance use and binge drinking (adjusting for age, gender, depression, and state) among non-Hispanic White, Hispanic, African American/Black, Asian Pacific Islanders, multiracial, and other students. Interaction terms were calculated to test for ethnic differences. Results: In the month preceding the survey, 22% of students used marijuana, 28% used tobacco, 75% drank alcohol; 6% used an illicit drug in the past year and 30% acknowledged past 2-week binge drinking. Although ACE were associated with all substance use behaviors (AORs ranged from 1.19 to 1.54, p < .001), there was significant ethnic variation in ACE exposure (40-52%) and the dose-response relationship between ACE and marijuana and tobacco use and binge drinking. Conclusions: The variability in ACE-related substance use patterns across ethnic groups highlights the need for research that advances our understanding of sociocultural influences in trauma response and the role that campus communities could have in the development of culturally sensitive services that address this issue.

Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians

BACKGROUND

Concerns about ethical conflicts, moral distress, and burnout in veterinary practice are steadily increasing. Root causes of these problems have not been rigorously identified. Little research has been done to evaluate the existence of moral distress in North American veterinarians or to explore its impact on career sustainability and poor well-being.

HYPOTHESIS/OBJECTIVES

Ethical conflict and resultant moral distress are common occurrences in contemporary veterinary practice and negatively impact daily practice life, but may not be identified or labeled by veterinarians as such.

ANIMALS

No animals were used in this study.

METHODS

Mixed methods sequential explanatory design; confidential and anonymous on-line sampling of 889 veterinarians in North America.

RESULTS

A majority of respondents reported feeling conflict over what care is appropriate to provide. Over 70% of respondents felt that the obstacles they faced that prevented them from providing appropriate care caused them or their staff moderate to severe distress. Seventy-nine percent of participants report being asked to provide care that they consider futile. More than 70% of participants reported no training in conflict resolution or self-care.

CONCLUSIONS AND CLINICAL IMPORTANCE

Veterinarians report widespread ethical conflict and moral distress across many practice types and demographics. Most veterinarians have little to no training on how to decrease the impact of these problems. Ethical conflict and resulting moral distress may be an important source of stress and poor well-being that is not widely recognized or well defined. Well-researched and effective tools used to decrease moral distress in human healthcare could be adapted to ameliorate this problem.