Prevalence of Mental Health Problems and Factors Associated with Psychological Distress in Mountain Exercisers: A Cross-Sectional Study in Austria

T. MS, Barakat M, Abdelaziz DH, Mansour NO, Thabit AK, Ramatillah DL, Al-Jumaili AA, Syed NK, Adam MF, Hossain MS, Baraka MA, Jose J, Elkalmi R, Chandran S, Singh Dehele I, Elrggal M, Fathelrahman AI. Assessment of mental wellbeing of undergraduate pharmacy students from 14 countries: The role of gender, lifestyle, health-related, and academic-related factors

Background

Pharmacy students will assume future roles as frontline healthcare providers. Therefore, evaluating their current state of mental wellbeing and its associated factors is essential for better planning students' support initiatives. This study aimed to assess mental wellbeing and its associated factors among undergraduate pharmacy students from 14 countries during the pandemic.

Methods

A cross-sectional study was conducted among undergraduate pharmacy students in 14 countries in Asia and the Middle East. The validated Warwick-Edinburgh Mental Wellbeing Scale (the 14-item WEMWBS) was adopted to assess mental wellbeing. Data collection was performed online between February and April 2022. Descriptive and inferential statistics were used as appropriate.

Results

A total of 2,665 responses were received, mainly from females (68.7%) with a higher presence of private universities (59.1%). About 34.9% had low mental wellbeing levels, while 57 and 8.1% had medium, and high levels, respectively. Binary logistic regression showed that males (AOR: 1.34; CI 95%: 1.11-1.61; p < 0.01) and students with no chronic illnesses (AOR: 2.01; CI 95%: 1.45-2.80; p < 0.001) were more likely to have higher mental wellbeing. Also, participants who did not engage in any exercise (AOR: 0.71; CI 95%: 0.52-0.98; p = 0.04) and those in public universities (AOR: 0.82; CI 95%: 0.69-0.97; p = 0.02) were less likely to have higher mental wellbeing. Additionally, students who had interest/passion for pharmacy (AOR: 1.69; CI 95%: 1.07-2.68; p = 0.02), and those who known pharmacists inspired (AOR: 1.81; CI 95%: 1.06-3.12; p = 0.03), were more likely to have higher mental wellbeing compared with those who had no specific reason for their choice to study pharmacy. The participants with excellent (AOR: 1.87; CI 95%: 1.29-2.70; p = 0.001) or very good self-reported academic performance (AOR: 1.57; CI 95%: 1.12-2.22; p = 0.01) were more likely to have higher mental wellbeing compared to those with fair academic performance.

Conclusion

More than a third of the participants had low mental wellbeing. Various demographic, lifestyle, medical and academic factors appeared to affect students' mental wellbeing. Careful consideration of these factors and their integration into the pharmacy schools' plans for student support services and academic advising would be essential to improve students' mental wellbeing.

Intention to Engage in Mountain Sport During the Summer Season in Climate Change Affected Environments

Natural environments can make it easier to engage in regular physical activity, including mountain sport activities. However, global warming is expected to change natural environments, especially in mountainous regions with potential impacts on physical activity behavior. While there is some evidence of a reduced intention to engage in winter sport in climate change affected environments, little is known on the impact of climate change in mountain sports conducted in the summer season. Therefore, the present study aimed at comparing the effect of being exposed to a climate change affected scenario (CCA) to being exposed to a climate change unaffected scenario (CCU) on the intention to engage in summer mountain sport activities. Furthermore, we aimed to analyze the role of anticipated affective responses in the context of the Theory of Planned Behavior (TPB). Using a web-based experimental cross-sectional study design, participants were randomly allocated to scenarios of either CCA or CCU pictures. Participants were asked to complete questions about TPB variables and about affective responses referring to the displayed scenarios. Statistical analyses included tests on group differences and hierarchical linear regression analyses. TPB variables (intention to engage in summer mountain sport, attitude, and perceived behavioral control) did not show significant group differences between CCA (n = 155) and CCU (n = 156), p > 0.131; r < −0.10. Significantly lower anticipated affective valence was found in CCA compared to CCU, p < 0.001, r = −0.43. Affective valence did not significantly improve the TPB model, change in R² = 0.7%, p = 0.096. However, a higher affective valence was significantly associated with a higher attitude toward summer mountain sport, beta = 0.19, p < 0.001. Intention to engage in summer mountain sport was similar in the groups. Therefore, an immediate reduced engagement in mountain sport activities due to climate change seems unlikely in the summer season, although differentiated findings across various activities of summer mountain sport cannot be excluded. A reduced affective valence during summer mountain sport activities might occur in the presence of signs of climate change in the environment, which may lead to longer-term behavior changes in climate change affected scenarios also in the summer by repeated experiences of reduced valence.

Comparison of Physical Activity Levels in Youths before and during a Pandemic Lockdown

This study aimed to compare physical activity (PA) levels before and during a pandemic lockdown among adolescent Polish youths in relation to meeting the World Health Organization’s (WHO) recommendations of moderate-to-vigorous physical activity (MVPA) and identify potential environmental factors that may affect these levels. An online survey tool that included validated measures of adolescents’ MVPA and socio-environmental, potential confounders was administered to youths (e.g., lack of classmates, motivation, possibility of choosing any physical exercise time, possibility of choosing your own exercises, home environment). The analytic sample comprised 127 adolescents aged 15.4 ± 0.5 years on average (52% girls and 48% boys). The results highlight that among adolescents who did not meet the WHO MVPA recommendations before the lockdown, 13.4% had an increased frequency of PA (from 2.9 to 5.4 day/week) (p = 0.01) during the lockdown. In the group who did meet these recommendations before the lockdown, 50% significantly decreased their level of MVPA below the WHO’s recommendations (p = 0.01). Self-rated health for PA showed a significantly strong correlation with MVPA in the group of students who met the WHO recommendations before the pandemic (r = 0.76; p < 0.05) but failed to maintain that recommendation during the COVID-19 restriction. The results suggest a negative impact of the pandemic on PA undertaken by youths. Based on these results we see the need for increased action by both Physical Education (PE) teachers and parents to motivate and support youngsters in taking up systematic PA consciously.

Intention to Engage in Winter Sport in Climate Change Affected Environments

Exercise, including winter sport activities, shows positive effects on physical and mental health, with additional benefits when participating in natural environments. Winter sport activities are particularly vulnerable to climate change, since global warming will decrease the duration and amount of snow. In the context of climate change in alpine environments, little is known on the determinants of winter sport behavior. Thus, the following study primarily aimed at comparing the effect of being exposed to a climate change affected scenario (CCA) or to a climate change unaffected scenario (CCU) on the intention to engage in recreational winter sport activities. Secondly, we aimed to analyze the role of anticipated affective responses during exercising based on the Theory of Planned Behavior (TPB). An experimental cross-sectional web-based study design was used. Participants were randomly allocated to pictures of either CCA or CCU. TPB variables and affective responses with regard to the displayed scenarios were assessed. Statistical analyses included Mann-Whitney-U Tests, linear regression, and mediation analyses. Significant group differences were seen in all TPB variables, p < 0.038; −0.13 < r < −0.30, as well as in affective responses, p < 0.001; −0.24 < r < −0.85. Lower intention to engage in winter sport activities and lower anticipated affective valence during exercising was found in CCA compared to CCU. Attitude toward winter sport was significantly positively associated with intention to engage in winter sport, beta = 0.66, p < 0.001. The effect of group allocation on attitude was mediated by anticipated affective valence, indirect effect = 0.37, p < 0.001. Intention to engage in recreational winter sport activities was lower in participants exposed to the climate change affected winter sport scenario. Since affective valence seems to influence attitude and consequently intention to exercise, the role of non-cognitive variables with regard to climate change related exposure should be considered in future studies. Therefore, winter sport resorts may consider altered winter sport behaviors due to the consequences of climate change as well as the importance of providing an optimal framework to enhance affective valence of their guests in order to mitigate potential changes in winter sports behavior.

A Scoping Review of How Income Affects Accessing Local Green Space to Engage in Outdoor Physical Activity to Improve Well-Being: Implications for Post-COVID-19

Background: The National Institute for Health and Care Excellence (NICE) has set out guidance for promoting physical activity (PA) in the physical environment to promote health and well-being. The aim of this selective scoping review was to investigate the influence of gross income on accessing local green spaces to engage in PA and the associated health benefits. Methods: A scoping review was conducted of international literature to facilitate the clarification of the research question. Findings: 15 papers were critically appraised under two themes: (1) environments and well-being and (2) PA and income/socioeconomic status and impact on the frequency, duration and opportunity to engage in PA. Interpretation: Income is related to differential use of green and blue spaces for PA, due mainly to access issues. People who live in lower socioeconomic areas tend to be more sedentary and there are also gender differences related to PA in built environments. Conclusion: There is an effect of income in using green spaces for PA, but the relationship is non-linear, and there is still a lack of knowledge about what kind of green spaces are best for health benefits. The COVID-19 pandemic highlighted the importance of accessing green local spaces to engage in physical exercise to improve well-being among the public.

Psychological Variables Related to Developmental Changes during Adolescence-A Comparison between Alpine and Non-Alpine Sport Participants

Alpine sport is a popular form of exercise and provides several skills that are potentially relevant for positive development during adolescence. However, empirical data on differences between alpine and non-alpine sport participants in variables related to developmental changes are lacking. Therefore, the primary aim of the present study was to analyze differences in self-esteem and additional variables between adolescent alpine and non-alpine sport participants. A comparison to non-regular exercisers was conducted for self-esteem. In a cross-sectional design, information on self-esteem, sensation seeking, agency, and emotion regulation was collected in 183 adolescents [(mean age: 15.4 (SD: 2.3) years, 71.0% female)]. Alpine sport participants reported significantly higher self-esteem compared to non-regular exercisers, p = 0.003, d = 0.95, but not compared to non-alpine sport participants, p = 0.774, d = 0.06. When controlling for sex and high-risk sport engagement, alpine sport participants showed a significantly higher experience of agency compared to non-alpine sport participants, p = 0.016, d = 0.46. We conclude that alpine sport participation is less relevant with regard to self-esteem compared to regular exercise. However, the characteristics of alpine sport might provide a trigger for higher experience of agency during sport participation, potentially helping to satisfy the increased need for autonomy and independence in adolescence.

Mortality in Different Mountain Sports Activities Primarily Practiced in the Summer Season-A Narrative Review

Millions of people engage in mountain sports activities worldwide. Although leisure-time physical activity is associated with significant health benefits, mountain sports activities also bear an inherent risk for injury and death. However, death risk may vary across various types of mountain sports activities. Epidemiological data represent an important basis for the development of preventive measures. Therefore, the aim of this review is to compare mortality rates and potential risk factors across different (summer) mountain sports activities. A comprehensive literature search was performed on the death risk (mortality) in mountain sports, primarily practiced during the summer season, i.e., mountain hiking, mountain biking, paragliding, trekking, rock, ice and high-altitude climbing. It was found that the death risk varies considerably between different summer mountain sports. Mortality during hiking, trekking and biking in the mountains was lower compared to that during paragliding, or during rock, ice or high-altitude climbing. Traumatic deaths were more common in activities primarily performed by young adults, whereas the number of deaths resulting from cardiovascular diseases was higher in activities preferred by the elderly such as hiking and trekking. Preventive efforts must consider the diversity of mountain sports activities including differences in risk factors and practitioners and may more particularly focus on high-risk activities and high-risk individuals.

Fall-related accidents among hikers in the Austrian Alps: a 9-year retrospective study

Objective

To analyse the circumstances of fatal and non-fatal mountain hiking accidents caused by falls.

Methods

The study was designed as a retrospective analysis. Mountain hiking accidents caused by falls were documented during a 9-year period (2006–2014). After screening of all data for potential exclusion criteria the final sample size of 5368 accidents and 5665 victims was included into the analyses. Main outcome measures were details about accidents, victims, type of trail and surface.

Results

The annual number of accidents showed a continuous increase from 467 in 2006 to 700 in 2014. In total, 5.8% of all victims died during the 9-year period. 75.3% of the hikers fell during descent and 80.9% of the victims had their accident on a marked hiking trail or small path. The sex ratio for non-fatal accidents was 55% female and 45% male; for fatal accidents the female-to-male ratio was 28%:72%. Mean age of all victims was 52.5±17.5 years and victims of fatalities were about 5 years older compared with victims of non-fatal accidents (57.5±16.5 vs 52.2±17.5 years, P<0.01).

Conclusion

Descent is the most risky part for accidents caused by falls during mountain hiking. Male hikers are at greater risk for fatalities independent of age and this is associated with accidents occurring in pathless terrain. The death rate from falls was 6%. We recommend a critical self-assessment of the individual capabilities and mountain hiking skills and adequate planning of the hiking tours for mountain hikers.