Psychological Morbidity among University Students in Hong Kong (2014-2018): Psychometric Properties of the Depression Anxiety Stress Scales (DASS) and Related Correlates

Mental health profiles and the related socio-demographic predictors in Hong Kong university students under the COVID-19 pandemic: A latent class analysis

While the COVID-19 pandemic has brought about significant challenges to mental health of university students, there is limited research in this area. Particularly, few studies examined the person-centered mental health symptom profiles such as depression and anxiety and the related socio-demographic predictors. Using Latent Class Analysis (LCA), this study investigated the symptom profiles of depression and anxiety in university students in Hong Kong under the COVID-19 pandemic and the socio-demographic predictors. A total of 978 undergraduate students completed an online questionnaire including socio-demographic factors and measures of depression and anxiety during the summer of 2022. The LCA identified three latent classes: "normal" group, "moderate comorbid depression and anxiety" group and "severe comorbid depression and anxiety" group. Multinominal logistic regression showed that comparing with the "normal" group and the "moderate symptom" group, the "severe symptom" group had higher personal financial difficulties and individual/family member unemployment during the pandemic. In contrast, other socio-demographic factors (age, gender, year of study, living status, and COVID-19 infection status) had no significant association with group status. The study contributes to understanding of person-centered depression and anxiety symptom profiles and the risk role of personal financial difficulty in mental health of university students under the pandemic.

Find Joy in Sorrows: The Role of Hope in Buffering the Psychological Impact of COVID-19 on Chinese University Students in Hong Kong

The global coronavirus disease 2019 (COVID-19) crisis has exerted significant psychological impacts on university students who have faced drastic changes in the learning mode and suspension of classes. Despite these challenges, many students maintained subjective well-being. In this study, we examined the role of "hope" as a potential protector to maintain their subjective well-being when facing adversity during this global crisis. Specifically, we explored the mediating role of two hope components (agency thinking and pathways thinking) on the association of positive emotions and life satisfaction among Chinese university students. We conducted an online survey at a local university and recruited a total of 315 undergraduates from the humanities, creative arts, and social sciences programs through convenience sampling. Participants confirmed their informed consent and completed a set of self-administered questionnaires measuring positive emotions, hope, life satisfaction, and demographic variables. The results of mediation testing indicated that, during a global crisis such as COVID-19, positive emotions indirectly influenced life satisfaction through agency thinking rather than pathways thinking. The findings highlight the importance of agency thinking among Chinese university students in adverse situations and provide valuable insights for psychological interventions during a crisis. The article concludes by discussing possible explanations and implications of the findings in a post-pandemic world.

The mechanism and effectiveness of mindfulness-based intervention for reducing the psychological distress of parents of children with autism spectrum disorder: A protocol of randomized control trial of ecological momentary intervention and assessment

BACKGROUND

Existing studies have unequivocally demonstrated that parents of children with autism spectrum disorder (ASD) experience various stressful daily life events and suffer from psychological distress. Mindfulness level is found to be an effective buffer between parents' appraisal of stress life events and psychological distress. However, the mechanism behind the function of mindfulness is unclear, and traditional mindfulness-based intervention (MBI) in experimental settings is not tailored to personal real-life needs. This study proposes to conduct a randomized controlled trial (RCT) to examine the effectiveness of MBI delivered by ecological momentary intervention (EMI) and assessed by ecological momentary assessment (EMA) in changing participants' cognitive appraisal of stressful life events and thus reducing the psychological distress of parents of children with ASD.

METHOD

The proposed study will recruit 670 parents of children with ASD and randomly assign them to the intervention and control groups (335 in each group). Participants in the intervention group will install the EMI/A app on their smartphones. In the app, participants can receive practice prompts daily, browse and practice different mindfulness exercises in the intervention library at any time, talk to a virtual counselor (chatbot) when feeling stressed, complete EMA on the cognitive appraisal of life events, and receive the log of change of psychological status daily. Participants in the control group will only receive audio-based standardized mindfulness practice instructions three times per week. The effects of MBI will be assessed based on the EMA data, right after the intervention and at the 2-month follow-up. The primary outcome will be participants' psychological distress measured by the depression anxiety stress scale. The secondary outcomes will include participants' subjective well-being, measured by the satisfaction with life scale, and level of resilience, measured by the psychological empowerment scale. Multilevel structural equational modelling will be applied to examine the pathways of the relationship between daily life events, cognitive appraisal, and psychological distress.

DISCUSSION

The potential benefit of the proposed study is to increase the psychological well-being of parents of children with ASD, and the method may extend to participants suffering from other psychological issues in the future. Trial registration: This trial has been registered on clinicaltrials.gov with the ID of NCT05746468.

Profiles and predictors of mental health of university students in Hong Kong under the COVID-19 pandemic

This study investigated the mental health problems of university students in Hong Kong and related sociodemographic and psychosocial predictors under the pandemic. A total of 978 undergraduate students (mean age = 20.69 ± 1.61) completed an online questionnaire measuring sociodemographic factors, psychological morbidity, positive well-being, COVID-19 related stress and self-efficacy, and positive psychosocial attributes. Psychosocial risk factors included psychological morbidity, COVID-19 related stress, and difficulties encountered under the pandemic, whereas protective factors comprised pandemic related self-efficacy, positive psychological attributes, positive environmental factors, need satisfaction and positive perception toward service. Results showed that psychological morbidity in the participants was widespread, and it was related to sociodemographic factors, particularly family financial difficulties. While pandemic related stress positively predicted psychological morbidity and negatively predicted well-being indicators, COVID-19 self-efficacy showed an opposite effect. Besides, positive psychological attributes (resilience, emotional competence, and positive beliefs related to adversity) and environmental factors (healthy family functioning, peer support, and supportive community atmosphere) negatively predicted psychological morbidity and positively predicted well-being. Furthermore, need satisfaction and positive perception toward service were negatively associated with psychological morbidity and positively associated with well-being, while perceived difficulties showed an opposite effect.

Risk Factors and Protective Factors of Internet Addiction in University Students during the Pandemic: Implications for Prevention and Treatment

While the prevalence rates of Internet addiction (IA) amongst young people during the pandemic are disturbing, few studies have investigated the risk and protective factors of IA in Hong Kong university students under COVID-19. In this study, we examined the relationship between COVID-19-related stress and IA and the role of psychological morbidity and positive psychological attributes in the relationship. In summer 2022, 978 university students completed a survey assessing pandemic-related stress, psychological morbidity, and positive psychological attributes. While psychological morbidity was indexed by depression, post-traumatic stress disorder, and suicidal behavior, positive psychological attributes included life satisfaction, flourishing, adversity beliefs, emotional competence, resilience, and family functioning measures. Results showed that stress and psychological morbidity positively predicted IA, and psychological morbidity mediated the association between stress and IA. Positive psychological attributes negatively predicted stress and IA, and mediated the connection between stress and IA. Positive psychological attributes moderated the mediating effect of psychological morbidity on the relationship between stress and IA. In addition to theoretical contributions, this study contributes to IA prevention and treatment: reducing psychological morbidity and promoting positive psychological attributes are promising strategies to address IA issues in young people.

Self-leadership as an attribute of service leadership: Its relationship to well-being among university students in Hong Kong

Introduction

In the scientific literature, although conceptual models and empirical evidence have shown that leadership attributes are intimately linked to the well-being of followers, there is a lack of studies focusing on leadership in the service economy. According to the Service Leadership Theory, service leadership is a process that satisfies the needs of self, others, and systems (teams, organizations, communities, and societies) in ethical ways that is characterized by leadership competence, character, and care. With specific reference to self-leadership emphasized in service leadership, higher levels of service leadership attributes should promote personal well-being. However, the relationships between "service leadership attributes" and "well-being" in leaders at the intrapersonal level in leadership education among Chinese university students are rarely examined.

Methods

In this study, we collected data from 198 students to understand the linkages between "service leadership attributes" and "well-being" in university students taking a course on service leadership. For tracking changes in students, we collected both pretest and posttest data on validated measures of "service leadership attributes" (i.e., "knowledge," "attitude," and "behavior") and "well-being" (i.e., "positive youth development attributes" and "life satisfaction").

Results

Results showed that the posttest scores on all three domains of "service leadership attributes" as well as two dimensions of "well-being" encompassing life satisfaction and positive youth development attributes were higher than the respective pretest scores, suggesting that students experienced a shift in a positive direction after taking the course. Cross-lagged analyses showed that pretest service leadership attitude and behavior predicted posttest positive youth development attributes; pretest service leadership behavior predicted posttest life satisfaction. Pretest life satisfaction also predicted posttest service leadership behavior.

Discussion

Findings suggest that there is an intimate relationship between "service leadership attributes" and "well-being" in the "pre-work" context among university students.

A therapist-guided internet-based cognitive behavioral therapy program for Hong Kong university students with psychological distress: A study protocol for a randomized controlled trial

BACKGROUND

University students are at high risk of various mental health problems due to high levels of psychological distress. However, university counseling services are often inadequate to meet their mental health needs due to shortage of mental health professionals, especially in Hong Kong. Internet-based cognitive behavioral therapy (iCBT) has shown similar effects as those of face-to-face CBT in addressing these mental health concerns, but few iCBT programs have been developed for Hong Kong university students.

OBJECTIVE

This study protocol aims to develop and evaluate a culturally and linguistically appropriate iCBT program called "REST Online" to reduce the psychological distress and improve the mental health of Chinese university students in Hong Kong in a randomized controlled trial (RCT).

METHOD

The contents and functionality of the "REST Online" program which includes both web- and app-based versions, are described. A blended mode of service delivery is adopted, with 8 online modules and 2 counseling sessions. Therapist support will be provided by a CBT therapist. A total of 338 Chinese university students with mild to moderate levels of psychological distress will be openly recruited and randomized to three groups: the (1) web-based and (2) app-based "REST Online" groups, and (3) waitlist control group. The program effectiveness is evaluated in psychological distress, depression and anxiety symptoms, and positive and negative emotions and positive and negative thoughts at pre-, post- and 3-month follow-up tests. Linear mixed effect models will be conducted for data analysis.

DISCUSSION

The "REST Online" program is among the first of its kind to address the mental health needs of Hong Kong university students by an internet intervention. Theoretically, this study will provide some empirical evidence for the effectiveness of this iCBT program in the Hong Kong context for Chinese clients. Practically, if proven effective, this program can be provided to local university counselors as an option for service delivery. Strengths and limitations are also discussed.

Subjective Outcome Evaluation of Instructional Videos in Leadership Education

The aims of this study were to examine the psychometric properties of two subjective outcome evaluation tools measuring students' perceptions of 24 instructional videos and to understand the profiles of students' perceptions of the videos. Online teaching and learning played an important role when school lockdown measures were imposed during the COVID-19 pandemic. To facilitate online teaching in a college-level leadership education subject, we developed and piloted 24 instructional videos, including 15 animated videos and 9 case-based videos, in the 2021/22 academic year. To understand students' perceptions of the videos, we developed two subjective outcome evaluation scales (one for the animated videos and another for the case-based videos) to assess the subjective perceptions of 1308 students. Results showed that the developed tools possessed good psychometric properties, including factorial, convergent and discriminant validity. The findings of this study also revealed the students had positive attitudes towards the developed videos, including positive perceptions of the videos' design and the benefits gained from watching them. The present study suggests teachers can meaningfully use the 24 instructional videos in the context of leadership education in higher education.

Law abidance leadership education for university students in Hong Kong: Post-lecture evaluation

Law abidance is very important for effective leaders. Without law abidance, abuse of power and corruption would easily happen, which would eventually erode organizational health. To promote law abidance leadership in university students in Hong Kong, we developed a law abidance leadership program with 3 h of face-to-face lecture and 7 h of self-study of materials disturbed to students. To understand students' perception of the 3-h lecture, we conducted a post-lecture evaluation study using a 26-item measure (N = 914). Results showed that the scale possessed good reliability and validity. Confirmatory factor analyses showed that the assessment tool has three internally consistent and factorial invariant dimensions: program attributes, appreciation of law abidance, and teacher attributes. Regarding students' perception of the program, students were generally satisfied with the lecture attributes, including design, content, lecture atmosphere, teaching quality, and benefits to students. In particular, students agreed that the lecture helped them understand the importance and value of law abidance and national security; over 95% of the students indicated that they would try their best to serve as law-abiding citizens and socially responsible leaders. Multiple regression analyses showed that program attributes, appreciation of law abidance, and teacher attributes predicted overall satisfaction with the lecture. Qualitative comments of the student echoed the quantitative findings, with most of the comments being positive in nature. The present study replicated the findings reported previously. Local and international contextual factors relevant to the interpretations of the findings are highlighted.

Burnout, negative emotions, and wellbeing among social workers in China after community lockdowns during the COVID-19 pandemic: Mediating roles of trait mindfulness

Objective

This study aimed to investigate burnout situation of social workers (SWs) who experienced the COVID-19 pandemic-related community lockdown 1 year before, and to assess the protective value of trait mindfulness (TM) in states of burnout.

Method

We surveyed the burnout, trait mindfulness, negative emotions (NEs) and wellbeing (WB) of 182 social workers provided services to Wuhan lockdowns community by COVID-19 one year before. Burnout were measured using the Maslach Burnout Inventory-Human Services Survey; TM using the Mindful Attention Awareness Scale; NEs using the Depression Anxiety and Stress Scale-21; and WB using the General Wellbeing Schedule. We also performed correlation regression analysis and mediation test for burnout, TM, NEs, and WB.

Results

Among the 182 respondents, 75 (41.2%) still suffered from severe burnout. TM was negatively correlated with burnout (r = -0.623), negatively correlated with NEs (r = -0.560), and positively correlated with WB (r = 0.617). Burnout had a significantly positive correlation with NEs (r = 0.544) and a significantly negative correlation with WB (r = -0.666). Further, WB had significantly negative correlation with NEs (r = -0.758). After controlling for age, gender, marital status, educational level, and years of employment, burnout had a significantly positive predictive effect on NEs (β = 0.509), whereas TM had a significantly negative predictive effect on NEs (β = -0.334). TM played a partial mediating role in the effect of burnout on NEs, with a mediating effect and effect ratio of 0.088 and 39.7%, respectively. Burnout had a significantly negative predictive effect on WB (β = -0.598), whereas TM had a significantly positive predictive effect on WB (β = 0.299). TM played a partial mediating role in the effect of burnout on NEs, with a mediating effect and effect ratio of -0.164 and 30.3%, respectively. WB had a significantly negative predictive effect on NEs (β = -0.711), and it played a partial mediating role in the effect of burnout on NEs, with a mediating effect and effect ratio of 0.185 and 83.3%, respectively.

Conclusion

The current levels of burnout among local SWs remained high 1 year after the community lockdowns. TM played a mediating role in the relationship between burnout, NEs, and WB. Concomitantly, WB played a mediating role in the relationship between burnout and NEs. Therefore, in the context of burnout, TM is a protective factor for reducing emotional stress and risks of developing psychiatric disorders through the enhancement of WB.

The Effectiveness of a Leadership Subject Using a Hybrid Teaching Mode during the Pandemic: Objective Outcome and Subjective Outcome Evaluation

Positive youth development (PYD) is an innovative approach to protect students from mental health problems and promote their positive and holistic development. Although there are many studies on the beneficial effects of PYD programs on youth in high school and community contexts, it is not clear whether subjects adopting PYD principles can promote positive development for university students. Moreover, it is unclear whether such subjects are effective under COVID-19, where subjects are commonly taught via the "hybrid" mode (i.e., face-to-face plus online teaching). The present study examined students' changes in the PYD, wellbeing, and desired graduate attributes after they had taken a leadership subject utilizing PYD principles taught by the "hybrid" mode (N = 630). Adopting the one-group pre-test and post-test design (i.e., objective outcome evaluation), we found that students showed significant positive improvement in PYD indicators, wellbeing, as well as desired graduate attributes. Additionally, students had high satisfaction with the course design and teaching staff, and perceived many benefits from this subject based on the subjective outcome evaluation conducted at the end of the subject. Results also showed that students' satisfaction with the curriculum significantly and positively predicted their positive change in PYD indicators, indicating the convergence of subjective outcome evaluation and objective outcome evaluation. The results highlight the positive impacts of the hybrid mode leadership subject with PYD principles in higher education.

Severe Stress among Medical Students of Two Medical Colleges: A Descriptive Cross-sectional Study

Introduction

Mental health problems are common in medical students and there is a high prevalence of psychological morbidity among them. The inability to use effective coping strategies affects the health and academic performance of students. The aim of this study was to find out the prevalence of severe stress among medical students of two medical colleges.

Methods

A descriptive cross-sectional study was conducted among medical undergraduates of two medical colleges from 14 September to 14 October 2021. Ethical approval was taken from the Institutional Review Committee (Reference number: 0609202109). Three hundred fifteen students were selected for the study using the proportionate stratified random sampling technique. Perceived Stress Scale was used to assess the level of stress and the Brief Cope Inventory scale was used to assess the coping strategies employed by students during stress. Point estimate and 95% confidence interval was calculated.

Results

Among 315 medical students, severe stress was found in 39 (12.38%) (8.76-16.04, 95% Confidence Interval).

Conclusions

The prevalence of severe stress among medical students was higher when compared to similar studies done in similar settings.

Keywords

coping strategies; medical students; psychological stress.

Need Satisfaction and Depressive Symptoms Among University Students in Hong Kong During the COVID-19 Pandemic: Moderating Effects of Positive Youth Development Attributes

As studies on the mental health status of university students during the COVID-19 pandemic are almost non-existent in Hong Kong, we examined four research questions in this paper: What is the prevalence of depressive symptoms in university students in Hong Kong? What are the socio-demographic correlates of depressive symptoms? Do need satisfaction and positive youth development (PYD) attributes, including beliefs about adversity, psychosocial competence (resilience and emotional competence) and family functioning predict depression? Do PYD attributes moderate the predictive effect of need satisfaction on depression? We examined the above research questions using the Centre for Epidemiologic Studies Depression Scale Revised (CESD-R) in 1,648 university students in Hong Kong. For PYD attributes, we utilized validated measures of Chinese beliefs about adversity, psychosocial competence (resilience and emotional competence), and family functioning. For need satisfaction, we used a measure derived from two focus group interviews involving university students. Results showed that 48.4% of the respondents (95% confidence interval = [45.9%, 51.1%]) scored 16 or above (i.e., "at-risk" for clinical depression). As predicted, age, gender, student status (local vs. international), and family financial hardship were significant socio-demographic correlates of depressive symptoms. Besides, need satisfaction and PYD attributes negatively predicted depression scores. Finally, multiple regression analyses controlling for gender, age, and student status as covariates showed that all PYD attributes moderated the impact of need satisfaction on depression. The findings reinforce the theoretical proposition that PYD attributes serve as important factors in protecting the mental health of university students during the pandemic.

Prevalence and Correlates of Mental Health of University Students in Hong Kong: What Happened One Year After the Occurrence of COVID-19?

Purpose

In this study, we studied the prevalence and correlates of mental health problems (depression, anxiety, and stress) in Hong Kong university students after one year of the occurrence of COVID-19. We examined the relationships between mental health problems and socio-demographic factors (including age, gender, local/international students, living status, and economic strain), need satisfaction, and difficulties encountered.

Methods

A cross-sectional online survey involving 1,648 university students (Mean age = 20.09 years ± 1.37) was conducted. They responded to a questionnaire assessing their mental health (including the Depression, Anxiety, and Stress Scales-DASS), psychosocial resources, social support, need satisfaction, difficulties and challenges, and evaluation of services they received.

Results

Based on DASS cutoff scores, prevalence rates of moderate or above levels of depression, anxiety, and stress were 40.0, 50.7, and 22.2%, respectively. While age and gender were not related to the DASS measures, economic strain and living alone were positively related to negative emotional states based on the results of MANOVAs. Multiple regression and PROCESS analyses showed that need satisfaction and difficulties contributed to depression and anxiety, with stress as a mediating factor.

Conclusions

The proportions of students who experienced moderate and above levels of depression (40.0%), anxiety (50.7%), and stress (22.2%) indexed by DASS deserve attention. Living alone and experienced economic disadvantage are risk factors for negative emotional states. Need satisfaction and life challenges are related to negative emotional states. Need satisfaction and difficulties contributed to stress, which further influenced anxiety and depression.