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Dingle GA, Han R, Alhadad SSJ, Beckman E, Bentley SV, Gomersall SR, Hides L, Maccallum F, McKimmie BM, Rossa K, Smith SS, Walter ZC, Williams E, Wright O. Data from four consecutive cohorts of students in Australia (2019-2022) show the impact of the COVID-19 pandemic on domestic and international university students' mental health. Aust N Z J Psychiatry 2024; 58:528-536. [PMID: 38383969 PMCID: PMC11128135 DOI: 10.1177/00048674241233111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
INTRODUCTION COVID-19 and related travel and social restrictions caused significant stress for university students in Australia and globally. Learning quickly moved online and many students (particularly international students) were separated from social and economic support. This study examined the impact of the pandemic from pre-pandemic (2019) to the COVID-19 Omicron wave (2022) on domestic and international students' mental health. METHODS Participants were 1540 students (72% females, 28% international) in four first-year cohorts (2019, 2020, 2021, 2022). We screened for mental health concerns (% positive) and symptom scores for depression, anxiety and somatic distress using the PsyCheck, and general wellbeing using the Warwick-Edinburgh Mental Well-being scale. RESULTS From pre-COVID (2019) to the first wave of COVID-19 (2020), the proportion of students screening positive for mental health problems rose in both domestic students (66-76%) and international students (46-67%). Depression symptoms and wellbeing were worse in 2020 than in 2019, 2021 and 2022. Anxiety symptoms increased from 2019 to 2020 and continued to rise in 2021 and 2022. Somatic symptoms did not show an effect of cohort. Contrary to expectations, domestic students reported higher distress and lower wellbeing than international students across cohorts. CONCLUSION The pandemic was associated with a marked increase in psychological distress in first-year university students, not all of which settled with the easing of restrictions. Post-pandemic recovery in the Australian university sector must include university-wide access to mental health information and support for incoming students.
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Affiliation(s)
- Genevieve A Dingle
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Rong Han
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Sakinah SJ Alhadad
- School of Education and Professional Studies, Griffith University, Nathan, QLD, Australia
| | - Emma Beckman
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Sarah V Bentley
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Sjaan R Gomersall
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Leanne Hides
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
- Lives Lived Well Research Group, The University of Queensland, St Lucia, QLD, Australia
| | - Fiona Maccallum
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Blake M McKimmie
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Kalina Rossa
- Institute for Social Science Research, The University of Queensland, St Lucia, QLD, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course, Indooroopilly, QLD, Australia
| | - Simon S Smith
- Institute for Social Science Research, The University of Queensland, St Lucia, QLD, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course, Indooroopilly, QLD, Australia
| | - Zoe C Walter
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Elyse Williams
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Olivia Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
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Patwary MM, Bardhan M, Disha AS, Dzhambov AM, Parkinson C, Browning MHEM, Labib SM, Larson LR, Haque MZ, Rahman MA, Alam MA, Tareq MF, Shuvo FK. Nature exposure and mental health during the COVID-19 pandemic: A Navigation Guide systematic review with meta-analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 356:124284. [PMID: 38821342 DOI: 10.1016/j.envpol.2024.124284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/02/2024]
Abstract
Prior reviews have highlighted that nature exposure was a valuable coping strategy enhancing mental health during the COVID-19 pandemic. However, no existing reviews have determined the quality of evidence and risk of bias of the empirical studies supporting this claim. To address this gap, we employed a Navigation Guide systematic review and meta-analysis approach to investigate associations between nature exposure and mental health during the pandemic. Searches in PubMed, Web of Science, Scopus, CINAHL, and PsycInfo retrieved relevant articles published between January 1, 2020, and March 4, 2024. We used the Navigation Guide methodology to assess the risk of bias and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessments to evaluate the overall quality of evidence. Our search retrieved 113 studies that met the inclusion criteria and reported diverse types of exposure, including nature availability, nature visit frequency, green space accessibility, and green space type, alongside associations with 12 mental health outcomes. Meta-analyses found access to gardens was associated with lower odds of depression [(Pooled odds ratio [OR] = 0.71, 95%CI = 0.61, 0.82), I2 = 0%, n = 3] and anxiety [(Pooled OR = 0.73, 95%CI = 0.63, 0.84), I2 = 0%, n = 3]. Increased time in green spaces was associated with lower level of stress [(Pooled Corr = -0.11, 95%CI = -0.17, -0.05), I2 = 0%, n = 2]. Higher frequency of visits to nature was associated with improved mental well-being [(Pooled standardized beta = 0.10, 95%CI = 0.07, 0.14), I2 = 0%, n = 2] and general mental health [(Pooled standardized beta = 0.11, 95%CI = 0.03-0.38), I2 = 82%, n = 2]. However, the number of pooled studies was small and the overall quality of evidence was "very low" for all outcomes, and high levels of bias were observed (26% of studies had high, 71% probably high). Nonetheless, given the trends in the results, nature-based solutions emphasizing exposure to gardens and green spaces near the home may have promoted psychological resilience during this public health crisis.
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Affiliation(s)
- Muhammad Mainuddin Patwary
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Environmental Science Discipline, Life Science School, Khulna University, Khulna, Bangladesh.
| | - Mondira Bardhan
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Department of Parks, Recreation, and Tourism Management, Clemson University, Clemson, SC, USA
| | - Asma Safia Disha
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Department of Environmental Science and Management, North South University, Bashundhara, Dhaka, 1229, Bangladesh
| | - Angel M Dzhambov
- Research Group "Health and Quality of Life in a Green and Sustainable Environment", Strategic Research and Innovation Program for the Development of MU - Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Environmental Health Division, Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Institute of Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria
| | - Colby Parkinson
- Department of Recreation, Park, and Tourism Management, Pennsylvania State University, University Park, PA, USA
| | - Matthew H E M Browning
- Department of Parks, Recreation, and Tourism Management, Clemson University, Clemson, SC, USA
| | - S M Labib
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Vening Meineszgebouw A, Princetonlaan 8a, 3584 CB, Utrecht, the Netherlands
| | - Lincoln R Larson
- Department of Parks, Recreation & Tourism Management, North Carolina State University, Raleigh, NC, USA
| | - Md Zahidul Haque
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Environmental Science Discipline, Life Science School, Khulna University, Khulna, Bangladesh
| | - Md Atiqur Rahman
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Environmental Science Discipline, Life Science School, Khulna University, Khulna, Bangladesh
| | - Md Ashraful Alam
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Md Faysal Tareq
- Environment and Sustainability Research Initiative, Khulna, Bangladesh; Institute of Environmental Sciences (CML), Leiden University, Netherlands
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Cockcroft K, Greyling M, Fouché A, Ungar M, Theron L. South African emerging adults' capacity for resilience in the face of COVID-19 stressors. J Health Psychol 2024; 29:522-533. [PMID: 37974374 DOI: 10.1177/13591053231208620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Little is known about resilience responses to COVID-19 stressors from emerging adults in minority world contexts. In this cross-sectional study, we explored the association between self-reported COVID-19 stressors and capacity for resilience in 351 emerging adults (Meanage = 24.45, SD = 2.57; 68% female) who self-identified as Black African. We were interested in whether age, gender and neighbourhood quality influenced this association. The main findings were that higher pandemic stress was associated with a greater capacity for resilience. Older participants showed higher levels of resilience, while there was no gender difference in this regard. Those who perceived their neighbourhoods as being of a good quality also showed greater capacity for resilience, despite all participants residing in disadvantaged communities. The theoretical and practical implications of these results are considered.
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Affiliation(s)
- Kate Cockcroft
- School of Human and Community Development at the University of the Witwatersrand, South Africa
| | - Mike Greyling
- Data Management and Statistical Analysis, South Africa
| | - Ansie Fouché
- United Arab Emirates University, UAE
- North-West University, South Africa
| | | | - Linda Theron
- University of Pretoria, Lynnwood Avenue, Pretoria 0002, South Africa
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Ribeiro H, Santana KVDS, Oliver SL. Natural Environments in University Campuses and Students' Well-Being. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:413. [PMID: 38673325 PMCID: PMC11050544 DOI: 10.3390/ijerph21040413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Most recent university campuses follow the North American model, built on city limits or countryside, with large separate buildings in open green spaces. Studies suggest that the prevalence and severity of mental health issues among university students has been increasing over the past decade in most countries. University services were created to face this growing problem, however individual-based interventions have limited effects on mental health and well-being of a large population. Our aim was to verify if and how the natural environment in campuses is focused on programs to cope with the issue of mental health and well-being among students. A systematic review of literature was undertaken with search in Scopus and LILACS with the keywords "green areas" AND "well-being" AND "Campus", following PRISMA guidelines. As a result, 32 articles were selected. Research on the topic is recent, mostly in the USA, Bulgaria, and China. Most studies used objective information on campuses' greenness and/or university students' perception. Mental health was usually measured by validated scores. Findings of all the studies indicated positive association between campus greenery and well-being of students. We conclude that there is a large potential for use of university campuses in programs and as sites for students' restoration and stress relief.
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Affiliation(s)
- Helena Ribeiro
- Department of Environmental Health, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo 01246-904, Brazil; (K.V.d.S.S.); (S.L.O.)
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Wiciak MT, Shazley O, Santhosh D. Social Media Behaviors and Lifestyle Changes in Young Adults (Ages 18-28 years) During the COVID-19 Pandemic: Analysis From an International Cross-Sectional Study. J Prim Care Community Health 2024; 15:21501319241228117. [PMID: 38291923 PMCID: PMC10832443 DOI: 10.1177/21501319241228117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Screen time (ST), mainly social media (SM), has increased during the coronavirus 2019 (COVID-19) pandemic, impacting mental and physical health. This study aims to analyze SM use in young adults ages 18 to 28 years and lifestyle changes during COVID-19 to provide a baseline on pandemic habits in the younger population. METHODS An international cross-sectional observational study was conducted from September 2020 to January 2021. Participants responded about their SM behavior, and activities they noticed they did less and more during COVID-19. A total of 183 responses were analyzed. RESULTS The top reason respondents increased SM was for entertainment. Many respondents increased ST, physical activity (PA), and sleeping habits during COVID-19, while many decreased socialization, PA, and going outdoors. PA had mixed results among participants, indicating some increased PA and some decreased. Evidence suggests that timing of quarantining during the pandemic significantly influenced variables, like ST (P = .004) and socialization (P = .037). DISCUSSION AND CONCLUSION Respondents generally noticed increased SM use for various reasons, including socialization, potentially explaining why respondents feel they socialize less. ST use increased; some people reported increased PA while others reported a decrease. Altogether, this provides vital context on young adults' SM and lifestyle habits, highlighting potential areas for further research.
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Affiliation(s)
| | - Omar Shazley
- Saint James School of Medicine, St. Vincent and the Grenadines, West Indies
| | - Daphne Santhosh
- Saint James School of Medicine, St. Vincent and the Grenadines, West Indies
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Wang W, Jiang J, Qi L, Zhao F, Wu J, Zhu X, Wang B, Hong X. Relationship between mental health, sleep status and screen time among university students during the COVID-19 pandemic: a cross-sectional study. BMJ Open 2023; 13:e073347. [PMID: 38070905 PMCID: PMC10729102 DOI: 10.1136/bmjopen-2023-073347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE On 20 July 2021, after the outbreak of COVID-19 at Nanjing Lukou International Airport, several universities started closed management and online teaching. This had a large impact on students' daily life and study, which may lead to mental health problems. The purpose of this study is to study the effect of screen time on mental health status of university students and the possible mediating effect of sleep status. METHODS This was a cross-sectional study. A web-based questionnaire survey was employed that included demographic characteristics, sleep status and mental health status (depression, anxiety and loneliness). The Pittsburgh Sleep Quality Index scale was used to assess sleep status, while the Centre for Epidemiologic Studies Depression (CES-D) scale, Generalised Anxiety Disorder-7 (GAD-7) scale and Emotional versus Social Loneliness Scale (ESLS) were used to assess depression, anxiety and loneliness, respectively. Linear and logistic regression models were developed and adjusted for confounding factors, and finally the mediating effects were tested using the Karlson-Holm-Breen method. RESULTS Finally, 1070 valid questionnaires were included. Among these, 604 (56.45%) indicated depressive symptoms (CES-D score ≥16) and 902 (84.30%) indicated anxiety symptoms (GAD-7 score ≥10). The mean ESLS score (for loneliness) was 26.51±6.64. The relationship between screen time and depressive symptoms (OR 1.118, 95% CI 1.072 to 1.166) and anxiety symptoms (OR 1.079, 95% CI 1.023 to 1.138) remained significant after adjusting for confounding factors. Meanwhile, sleep status plays an intermediary role in screen time and mental health status (depression and anxiety) and accounts for 13.73% and 19.68% of the total effects, respectively. We did not find a significant association between screen time and loneliness. CONCLUSION During the outbreak of COVID-19, screen time is inevitably prolonged among university students. There is a relationship between mental health and screen time, and sleep status plays a mediating role.
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Affiliation(s)
- Wei Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Jingfeng Jiang
- Wuxi Center for Disease Control and Prevention, Wuxi, Jiangsu, China
| | - Lerong Qi
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Fanqi Zhao
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Jingying Wu
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Xiaoqi Zhu
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Bei Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Xiang Hong
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
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Black O, Lane TJ, Flatau-Harrison H, Canuto K, Smith JA. Exploring Health Literacy and Psychological Resilience as Moderators of Symptoms of Mental Illness Among Australian Men. Am J Mens Health 2023; 17:15579883231211054. [PMID: 37963873 PMCID: PMC10647959 DOI: 10.1177/15579883231211054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/13/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Although highly related, mental illness may not fully determine perceived well-being, a distinction captured by dual-continuum models. Separating mental illness and well-being into related but separate constructs prompted investigation into potential buffers to reduce the impact of mental illness on perceived well-being. This study explored two such buffers in health literacy and psychological resilience among Australian men. Using the Ten to Men Australian Longitudinal Study on Male Health, this secondary data analysis of n = 8,408 men between 18 and 60 years of age assessed the moderating effect of three components of health literacy (feeling supported by health care providers, ability to find health information, and active engagement with health care providers) and psychological resilience on the relationship between mental illness and well-being. Mental illness symptoms were negatively associated with well-being, whereas psychological resilience, active engagement with health care, and health care provider support (β res = .65, β eng = .28, and β sup = .25) had positive significant relationships with the outcome (all p ≤ .001). Ability to find health information (p = .25) and psychological resilience (p = .43) were not significantly associated with well-being. Of the four interactions tested, health literacy relating to health care worker support was the only significant moderator between mental illness and well-being (β sup = .03). This study identified that meaningful support and understanding from health care providers for Australian men aged between 18 and 60 years may somewhat ameliorate the impact of mental illness on well-being. Further related investigation may reveal specific interventions that improve perceptions of support among men.
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Affiliation(s)
- Oliver Black
- Flinders University, Casuarina, Northern Territory, Australia
| | | | | | - Kootsy Canuto
- Flinders University, Casuarina, Northern Territory, Australia
| | - James A. Smith
- Flinders University, Casuarina, Northern Territory, Australia
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Amiel Castro RT, Schaal NK, Meyerhoff H, Preis H, Mahaffey B, Lobel M, La Marca-Ghaemmaghami P. Investigating Factors Influencing Prenatal Stress, Anxiety, and Fear of Childbirth During the COVID-19 Pandemic in Germany and Switzerland: An Online Survey. Matern Child Health J 2023; 27:1864-1875. [PMID: 37470899 DOI: 10.1007/s10995-023-03758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES Pregnant women are likely to experience high levels of stress during the COVID-19 pandemic. However, the factors that might influence the extent of experienced emotional distress are poorly understood. Therefore, we aimed to investigate potential correlates of prenatal emotional distress during the COVID-19 pandemic. METHODS In total, N = 1437 pregnant women from Germany and Switzerland participated in an online study during the first wave of the COVID-19 pandemic (May-August 2020). The survey assessed prenatal distress, pandemic-related pregnancy stress, general anxiety, fear of childbirth, and several socio-demographic, pregnancy- and COVID-19-related factors. Linear multivariate regression models were the main analytical strategy. RESULTS The results highlight that several factors such as full-time employment, nulliparity, high-risk pregnancy, emotional problems, cancelled prenatal appointments, and stating that COVID-19 affected the choice of birth mode were significantly associated with elevated prenatal distress, anxiety, pandemic-related pregnancy stress, and fear of childbirth. Conversely, access to an outdoor space was a protective factor for pandemic-related pregnancy stress and prenatal distress. CONCLUSIONS FOR PRACTICE Overall, the study highlights significant correlates influencing the levels of emotional distress pregnant women experienced during the COVID-19 pandemic. These findings may contribute to the improvement of maternal prenatal medical and psychological care during a public health crisis of international concern, such as the COVID-19 pandemic.
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Affiliation(s)
- Rita T Amiel Castro
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Nora K Schaal
- Institute of Experimental Psychology, Heinrich-Heine-University, Dusseldorf, Germany
| | - Hannah Meyerhoff
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Heidi Preis
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Brittain Mahaffey
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Pearl La Marca-Ghaemmaghami
- Psychology Counselling and Research Institute for Sexuality, Marriage and the Family, International Academy for Human Sciences and Culture, Staadweg 3, P.O. Box 57, 8880, Walenstadt, Switzerland.
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Essadek A, Shadili G, Bergami Goulart Barbosa P, Assous A, Widart F, Payan S, Rabeyron T, Corruble E, Falissard B, Gressier F. Precarious Young Adults' Mental Health during the Pandemic: The Major Impact of Food Insecurity Independently of COVID-19 Diagnosis. Nutrients 2023; 15:3260. [PMID: 37513678 PMCID: PMC10384015 DOI: 10.3390/nu15143260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic had a major impact on mental health across populations, especially young and precarious people. Furthermore, COVID-19 diagnosis itself has been associated with psychiatric symptoms. However, only a few studies have assessed the mental health of precarious youth, and examined a possible association with food insecurity, while including COVID-19 diagnosis in their analyses. We aimed to determine the prevalence of poor mental health in precarious youth during the COVID-19 pandemic, and to investigate its possible association with food insecurity, independently of COVID-19 diagnosis. In a cross-sectional study conducted in the context of an employment program for precarious youth (18-25 years) living in Paris, France, 823 individuals were assessed for depression, anxiety, subjective distress and food insecurity during the second lockdown of 2020. A directed acyclic graph (DAG)-based approach was used to identify confounders for inclusion in a multivariate regression model. Of the 823 precarious youth, 45.93% reported significant symptoms of depression, 36.69% anxiety, 39% distress and 25.39% suicidal ideation. In the multivariate analysis based on DAG, food insecurity (less than one meal per day) was associated with depression (OR = 2.30; CI%: 1.19-4.51), anxiety (OR = 2.51; CI%: 1.29-4.88), distress (OR = 2.36; CI%: 1.23-4.57) and suicidal ideation (OR = 4.81; CI%: 2.46-9.44), independently of age, gender, education, COVID-19 contact and COVID-19 diagnosis. This study highlights the importance of food insecurity on mental health among young precarious people during the COVID-19 pandemic. Reducing food insecurity is essential to help reduce psychological distress.
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Affiliation(s)
- Aziz Essadek
- INTERPSY Laboratory, Faculty of Psychology, University of Lorraine, 54015 Nancy, France
| | - Gérard Shadili
- PCPP Laboratory, Institute of Psychology, University of Paris Cité, 75006 Paris, France
- Institut Mutualiste Montsouris, 75014 Paris, France
| | | | - Adèle Assous
- CRPMS Laboratory, Faculty of Psychology, University of Paris Cité, 75006 Paris, France
| | - Frédéric Widart
- Faculty of Psychology, University of Liège, 4000 Liège, Belgium
| | - Ségolène Payan
- Essonne Research and Social Work Institute, IRFASE, 91034 Evry, France
| | - Thomas Rabeyron
- INTERPSY Laboratory, Faculty of Psychology, University of Lorraine, 54015 Nancy, France
| | - Emmanuelle Corruble
- Department of Psychiatry, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris APHP, Hôpitaux Universitaires Paris Saclay, 94275 Le Kremlin Bicêtre, France
- CESP, INSERM U1018, Moods Team, Faculté de Médecine Paris Saclay, University Paris-Saclay, 94275 Le Kremlin Bicêtre, France
| | - Bruno Falissard
- Department of Public Health, School of Medecine, University Paris-Saclay, 94270 Le Kremlin Bicêtre, France
- CESP, INSERM 1018, University Paris-Saclay, 94275 Le Kremlin Bicêtre, France
| | - Florence Gressier
- Department of Psychiatry, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris APHP, Hôpitaux Universitaires Paris Saclay, 94275 Le Kremlin Bicêtre, France
- CESP, INSERM U1018, Moods Team, Faculté de Médecine Paris Saclay, University Paris-Saclay, 94275 Le Kremlin Bicêtre, France
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Nigg C, Petersen E, MacIntyre T. Natural environments, psychosocial health, and health behaviors in a crisis - A scoping review of the literature in the COVID-19 context. JOURNAL OF ENVIRONMENTAL PSYCHOLOGY 2023; 88:102009. [PMID: 37065613 PMCID: PMC10082968 DOI: 10.1016/j.jenvp.2023.102009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 05/03/2023]
Abstract
The COVID-19 outbreak led to major restrictions globally, affecting people's psychosocial health and their health behaviors. Thus, the purpose of this scoping review was to summarize the available research regarding nature and health in the COVID-19 context. Keywords relating to natural environments and COVID-19 were combined to conduct a systematic online search in six major databases. Eligibility criteria were a) published since 2020 with data collected in the COVID-19 context b) peer-reviewed, c) original empirical data collected on human participants, d) investigated the association between natural environments and psychosocial health or health behaviors, and e) English, German, or Scandinavian languages. Out of 9126 articles being screened, we identified 188 relevant articles, representing 187 distinct studies. Most research focused on adults in the general population and was predominantly conducted in the USA, Europe, and China. Overall, the findings indicate that nature may mitigate the impact of COVID-19 on psychological health and physical activity. Through a systematic thematic analysis of the extracted data, three primary themes were identified: 1) type of nature assessed, 2) psychosocial health and health behaviors investigated, and 3) heterogeneity in the nature-health relationship. Research gaps in the COVID-19 context were identified regarding I) nature characteristics that promote psychosocial health and health behaviors, II) investigations of digital and virtual nature, III) psychological constructs relating to mental health promotion, IV) health-promoting behaviors other than physical activity, V) underlying mechanisms regarding heterogeneity in the nature-health relationship based on human, nature, and geographic characteristics, and VI) research focusing on vulnerable groups. Overall, natural environments demonstrate considerable potential in buffering the impact of stressful events on a population level on mental health. However, future research is warranted to fill the mentioned research gaps and to examine the long-term effects of nature exposure during COVID-19.
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Affiliation(s)
- Carina Nigg
- Institute of Sport Science, University of Bern, Bremgartenstrasse 145, 3012, Bern, Switzerland
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Evi Petersen
- Department of Sports, Physical Education and Outdoor Life, University of South-Eastern Norway, 3800, Bø i, Telemark, Norway
- Department of Early Childhood Education, Oslo Metropolitan University, Pilestredet 42, 0167, Oslo, Norway
| | - Tadhg MacIntyre
- Department of Psychology, Faculty of Science & Engineering, Maynooth University, North Campus, W23 F2K8, Maynooth, Ireland
- Insight SFI Research Centre for Data Analytics, Maynooth University, North Campus, W23 F2k8, Maynooth, Ireland
- TechPA Research Group, Department of Public Health and Sport Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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11
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Shareck M, Aubé E, Sersli S. Neighborhood Physical and Social Environments and Social Inequalities in Health in Older Adolescents and Young Adults: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085474. [PMID: 37107756 PMCID: PMC10139110 DOI: 10.3390/ijerph20085474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
Poor health and well-being are prevalent among young people. Neighborhoods may play a role in promoting good health. Little is known on if and how neighborhood characteristics affect health, and social inequalities therein, among young people. In this scoping review, we asked: (1) what features of the neighborhood physical and social environments have been studied in association with the physical and mental health and well-being of young people 15 to 30 years old; and (2) to what extent have social differentials in these associations been studied, and how? We identified peer-reviewed articles (2000 to 2023) through database and snowball searches. We summarized study characteristics, exposure(s), outcome(s) and main findings, with an eye on social inequalities in health. Out of the 69 articles reviewed, most were quantitative, cross-sectional, conducted among 18-year-olds and younger, and focused on the residential neighborhood. Neighborhood social capital and mental health were the most common exposure and outcome studied, respectively. Almost half of the studies examined social inequalities in health, mostly across sex/gender, socioeconomic status, and ethnicity. Evidence gaps remain, which include exploring settings other than residential neighborhoods, studying the older age stratum of young adulthood, and assessing a broader range of social inequalities. Addressing these gaps can support research and action on designing healthy and equitable neighborhoods for young people.
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12
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Edwards JR, Gotschall JW, Clougherty JE, Schinasi LH. Associations of greenspace use and proximity with self-reported physical and mental health outcomes during the COVID-19 pandemic. PLoS One 2023; 18:e0280837. [PMID: 36857353 PMCID: PMC9977027 DOI: 10.1371/journal.pone.0280837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/12/2022] [Indexed: 03/02/2023] Open
Abstract
Research has shown that the COVID-19 pandemic affected individual's mental and physical health. The aim of this study was to estimate associations between greenspace use and proximity with perceived mental and physical health during the COVID-19 pandemic. We surveyed metropolitan Philadelphia residents, October 20-December 1, 2020, about walking time to the nearest greenspace from their home, frequency of greenspace use in the past 30 days, change in frequency of greenspace use during the COVID-19 pandemic, and perceived physical and mental health outcomes. We ran unadjusted and adjusted log-binomial regression models to derive Risk Ratio (RR) and 95% Confidence Intervals (CI) estimates of associations of loneliness, physical and mental health outcomes with: (1) self-reported walking time to nearest greenspace; (2) reported greenspace use frequency; and (3) changes in greenspace use frequency. Of 485 survey participants, 244 (51.4%) reported feeling lonelier, 147 (31.37%) reported higher perceived stress, 261 (54.9%) reported worsened mental health, and 137 (28.7%) reported worsened physical health during vs. before the start of pandemic-restrictions in mid-March of 2020. After adjustment for gender, age, and change in financial status, RR estimates suggested modest protective associations between visiting greenspaces more frequently during vs. before the pandemic and worsened mental (RR: 0.84, 95% CI: 0.70-1.00), and physical health (RR 0.77, 95% CI: 0.56-1.10), and loneliness (RR: 0.91, 95% CI: 0.75-1.1) and perceived stress (RR 0.83, 95% CI: 0.61-1.13). Shorter walking distances to the nearest greenspace were associated with reduced risk of reporting worsened physical health and higher perceived stress; however, living shorter walking distances from greenspace were not associated with protection against worsened mental health or loneliness. These results suggest that active greenspace use may provide mental and physical health protection, particularly during a stressful public health crisis.
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Affiliation(s)
- Janelle R. Edwards
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Jeromy W. Gotschall
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jane E. Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Leah H. Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
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13
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Deyo A, Wallace J, Kidwell KM. Screen time and mental health in college students: Time in nature as a protective factor. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 36796079 DOI: 10.1080/07448481.2022.2151843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 10/10/2022] [Accepted: 11/21/2022] [Indexed: 06/18/2023]
Abstract
Objective: To examine how time spent on handheld screens was related to internalizing mental health symptoms in college students and whether time spent in nature was associated with fewer mental health symptoms. Participants: Three hundred seventy-two college students (Mage = 19.47 ± 1.74, 63.8% female; 62.8% college freshman). Methods: College students completed questionnaires for research credit in their psychology courses. Results: Screen time significantly predicted higher anxiety, depression, and stress. Spending time outdoors ("green time") significantly predicted lower stress and depression, but not lower anxiety. Green time moderated the relationship, such that college students who spent less time outside (1SD below mean) had consistent rates of mental health symptoms across hours of screentime, but individuals who spent average/above average (mean, 1SD above mean) time outside had fewer mental health symptoms at lower levels of screentime. Conclusions: Promoting green time in students may be an effective way of improving stress and depression.
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Affiliation(s)
- Alexa Deyo
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Josh Wallace
- Department of Psychology, Syracuse University, Syracuse, New York, USA
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14
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Lanza-León P, Pascual-Sáez M, Cantarero-Prieto D. Alleviating mental health disorders through doses of green spaces: an updated review in times of the COVID-19 pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:98-115. [PMID: 34821172 DOI: 10.1080/09603123.2021.2005780] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/09/2021] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic has highlighted issues due to mental health disorders, in particular the serious consequences derived from lockdown measures. This paper aims to analyse the literature on the potential direct impact of the natural environment on mental health disorders. We have systematically reviewed the studies analysing green spaces and mental health included in this review using PubMed, Web of Science, Scopus and Cochrane Library. A retrospective time-frame is considered, covering the COVID-19 pandemic. We have found that exposure to, use and proximity to green spaces have a beneficial impact on mental health among elderly, students and patients with underlying pathologies. However, it has negative effects on the mental health of women and young adults. Exposure to and interaction with the natural environment can improve certain mental health disorders and should be taken into account for strategies and policies related to future threats to public health.
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Affiliation(s)
- Paloma Lanza-León
- Research Group of Health Economics and Health Service Management, Department of Economics, University of Cantabria - Idival, Santander, Spain
| | - Marta Pascual-Sáez
- Research Group of Health Economics and Health Service Management, Department of Economics, University of Cantabria - Idival, Santander, Spain
| | - David Cantarero-Prieto
- Research Group of Health Economics and Health Service Management, Department of Economics, University of Cantabria - Idival, Santander, Spain
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15
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Trott M, Driscoll R, Irlado E, Pardhan S. Changes and correlates of screen time in adults and children during the COVID-19 pandemic: A systematic review and meta-analysis. EClinicalMedicine 2022; 48:101452. [PMID: 35615691 PMCID: PMC9122783 DOI: 10.1016/j.eclinm.2022.101452] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/13/2022] [Accepted: 04/27/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Screen time has increased as a result of the COVID-19 pandemic, and several correlates have been associated with these increases. These changes, however, have not been aggregated. It was the aim of this review to (a) aggregate changes in screen time in adults and children, and (b) report on variables in relation to screen time during the COVID-19 pandemic. METHODS A systematic review of major databases was undertaken for studies published from inception to 06/12/2021, using a pre-published protocol (PROSPERO ID: CRD42021261422). Studies reporting (a) screen time pre-versus-during the pandemic, (b) screen time percentage change, or (c) correlates of screen time during the pandemic were included. A random effects meta-analysis was undertaken with subgroup analysis by age group and type of screen time. FINDINGS After review, 89 studies (n = 204,734; median age=20·6; median female=53·3%) were included. The majority of studies were cross-sectional. With regards to total screen time, primary aged children (6-10 years) reported largest increases (1·4 hrs/day; 95%CI 1·1-1·7), followed by adults (>18 years; 1·0 hrs/day; 95%CI 0·7-1·2), adolescents (11-17 years; 0·9 hrs/day; 95%CI 0·3-1·5), and young children (0-5 years; 0·6 hrs/day 95%CI 0·3-0·9 hrs/day). For leisure screen time (non-work/non-academic), primary aged children reported largest increases (1·0 hrs/day 95%CI 0·8-1·3), followed by adults (0·7hr/day 95%CI 0·3-1·2), young children (0·6 hrs/day; 95%CI 0·4-0·8), with adolescents reporting the lowest increase (0·5 hrs/day 95%CI 0·3-0·7). Several correlates were associated with reported increases in screen time, including adverse dietary behaviours, sleep, mental health, parental health, and eye health. INTERPRETATION Pooled evidence suggest that primary aged children reported the highest increase in both total and leisure screen time during COVID-19. It is recommended that screen time should be reduced in favour of non-sedentary activities. This study has the potential to inform public health policy and future guidance regarding screen time, and to inform future research in this area. FUNDING No funding was received for this study.
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Affiliation(s)
- Mike Trott
- Vision and Eye Research Institute (VERI), Anglia Ruskin University, Young Street, Cambridge CB1 2LZ, UK
| | - Robin Driscoll
- Vision and Eye Research Institute (VERI), Anglia Ruskin University, Young Street, Cambridge CB1 2LZ, UK
| | - Enrico Irlado
- Vision and Eye Research Institute (VERI), Anglia Ruskin University, Young Street, Cambridge CB1 2LZ, UK
| | - Shahina Pardhan
- Vision and Eye Research Institute (VERI), Anglia Ruskin University, Young Street, Cambridge CB1 2LZ, UK
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16
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O’Keeffe P. Young Peoples’ Construction of DIY Dirt Jumps in Melbourne, Australia, Throughout the Covid-19 Lockdowns. JOURNAL OF APPLIED YOUTH STUDIES 2022. [PMCID: PMC9088726 DOI: 10.1007/s43151-022-00075-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Access to public space is critically important for young people, providing key opportunities for self-expression, independence, identity development and relationship building. The Covid-19 pandemic has profoundly affected how young people can engage with public spaces. In Melbourne, Australia, young people have experienced 262 days in lockdown, contributing to escalating anxiety and depression, social isolation, physical health impacts and increased exposure to family conflict and family violence. Throughout this time, there has been a proliferation of young people constructing DIY dirt jumps across Melbourne. This article analyses this unstructured production of public space, focusing on one case study and drawing from council responses. I suggest that through this practice, young people challenge adult interpretations of public space, intentionally or unintentionally, resisting adult control of public space at a time when young people have been denied opportunities for independence and autonomy.
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Affiliation(s)
- Patrick O’Keeffe
- Social and Global Studies Centre, RMIT University, GPO Box 2476, Melbourne, VIC 3001 Australia
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17
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Darcy PM, Taylor J, Mackay L, Ellis NJ, Gidlow CJ. Understanding the Role of Nature Engagement in Supporting Health and Wellbeing during COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073908. [PMID: 35409590 PMCID: PMC8997429 DOI: 10.3390/ijerph19073908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 12/04/2022]
Abstract
The importance of natural environments in supporting health and wellbeing has been well evidenced in supporting positive mental and physical health outcomes, including during periods of crisis and stress. Given the disproportionate impacts of the COVID-19 pandemic have been greatest for those who are most vulnerable, understanding the role of natural environment and alternative forms of nature engagement in supporting health and wellbeing for vulnerable groups is important. This study explored how nature engagement supported health and wellbeing in those with a pre-existing health condition during the first UK lockdown. Semi-structured interviews were conducted with 17 adults with a pre-existing health condition and analysed using Interpretative Phenomenological Analysis (IPA). Four themes were identified: COVID-19 versus nature; Nature as an extension and replacement; Nature connectedness; and Therapeutic nature. The findings show the importance of nature in supporting health and wellbeing in those with a pre-existing health condition through engagement with private and public natural environments, micro-restorative opportunities, nature connection as an important pathway, and the therapeutic benefits of nature engagement. The present research extends the evidence-base beyond patterns of nature engagement to a deeper understanding of how those with existing health conditions perceived and interacted with nature in relation to their health and wellbeing during the first UK lockdown. Findings are discussed in relation to health supporting environments, micro-restorative opportunities, and policy implications.
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Affiliation(s)
- Patricia M. Darcy
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent ST4 2DF, UK; (N.J.E.); (C.J.G.)
- Correspondence:
| | - Jennifer Taylor
- School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DE, UK; (J.T.); (L.M.)
| | - Lorna Mackay
- School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DE, UK; (J.T.); (L.M.)
| | - Naomi J. Ellis
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent ST4 2DF, UK; (N.J.E.); (C.J.G.)
| | - Christopher J. Gidlow
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent ST4 2DF, UK; (N.J.E.); (C.J.G.)
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18
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Oswald TK, Langmaid GR. Considering ecological determinants of youth mental health in the era of COVID-19 and the Anthropocene: A call to action from young public health professionals. Health Promot J Austr 2021; 33:324-328. [PMID: 34855274 PMCID: PMC9015409 DOI: 10.1002/hpja.560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/08/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022] Open
Abstract
In 2019, young Australians reported that two of their top concerns were ‘climate change and the environment’ and ‘mental health’. The events of 2020/2021, such as the ongoing climate emergency, the Australian bushfires, and the COVID‐19 pandemic, reflect the human‐induced environmental issues young people are most worried about and have also exacerbated the mental health issues which they already reported to be at a crisis point back in 2019. Given experiences of mental illness in adolescence are associated with poorer mental health across the lifespan, it is becoming increasingly important to address ecological determinants of youth mental health in the Anthropocene. However, despite the inclusion of ecological determinants of health in seminal health promotion frameworks, health promotion has been described as ‘ecologically blind’, emphasising social determinants of health at the expense of ecological determinants of health. A socio‐ecological model, which equally considers upstream social and ecological factors, should be applied to youth mental health issues. Using the Ottawa Charter for Health Promotion, we demonstrate how the ecological determinants of health may be incorporated into health promotion approaches targeting youth mental health. We also call for the health promotion sector to consider a number of actions to work towards achieving a transition to ecological determinants of health being at the forefront of health promotion activities. This commentary, written by young public health professionals, hopes to build on the momentum garnered by youth activists around the world and bring attention to the importance of ecological determinants of health for youth mental health promotion in the era of COVID‐19 and the Anthropocene.
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Affiliation(s)
- Tassia K Oswald
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Georgia R Langmaid
- School of Health & Social Development, Deakin University, Burwood, Victoria, Australia
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