Stress in Medical Students: PRIMES, an Italian, Multicenter Cross-Sectional Study

Association between perceived stress, emotional eating, and adherence to healthy eating patterns among Saudi college students: a cross-sectional study

BACKGROUND

College students are vulnerable to high perceived stress (PS) and emotional eating (EE) levels, which are associated with their food consumption. In this study, we aimed to examine the links between perceived stress, emotional eating, and adherence to a healthy eating index. Furthermore, we aimed to test whether sociodemographic data and health measures, including body mass index and physical activity, are associated with perceived stress, emotional eating, or healthy eating index.

METHODS

This study included students from King Abdulaziz University. The participants completed validated perceived stress, emotional eating, and short healthy eating index surveys via an online questionnaire from September to December 2022. Univariate linear regression analysis was performed to examine the association between perceived stress, emotional eating, and adherence to healthy eating index using the short healthy eating index.

RESULTS

Of 434 students (49.8% male, mean age 21.7 ± 3.0 years), 11.3% had low, 72.0% moderate, and 16.7% high perceived stress. Students with moderate perceived stress had the highest short healthy eating index score (P = 0.001), outperforming those with low and high perceived stress for fruit juice (P = 0.002), fruits (P[Formula: see text]0.001), vegetables (P=0.03), greens and beans (P<0.001), whole grains (P=0.009), and seafood/plant proteins (P = 0.001) consumption. Also, emotional eating was significantly associated with short healthy eating index score (P = 0.04), fruit juice (P = 0.01) fruit consumption (P<0.001), added sugar (P=0.02) and saturated fatty acids (P = 0.03). Academic major was associated with perceived stress (P = 0.006) and emotional eating (p=0.04). Higher physical activity levels were associated with low perceived stress levels (P<0.001) and high short healthy eating index score (P=0.001), while high body mass index was associated with high emotional eating score (P<0.001).

CONCLUSIONS

The findings confirmed that students are highly vulnerable to moderate and high perceived stress levels. Furthermore, high perceived stress is inversely associated with adherence to a healthy eating index, especially for fruits, vegetables, greens and beans, whole grains, and seafood and plant proteins consumption. Emotional eating, also, associated with students dietary pattern. Physical activity will be beneficial for reducing the level of perceived stress and improving overall dietary patterns.

The Impact of COVID-19 on Mental Health in Medical Students: A Cross-Sectional Survey Study in Italy

Background: This study aimed to assess the impact of the COVID-19 pandemic in terms of the prevalence of anxiety, depression and stress symptoms in Italian medical students and to identify the associated factors. Design and Methods: A cross-sectional online survey was administered to second-sixth year medical students of the University of Torino, collecting data on the students' sociodemographics, COVID-19 exposure, anxiety, depression and stress symptoms. Three hierarchical regressions adjusted for age, gender and year of study were executed. Results: The sample size was 1359. The prevalence of anxiety, depression symptoms, moderate perceived stress and severe perceived stress was 47.8%, 52.1%, 56.2% and 28.4%, respectively. The factors associated with mental health symptoms were: being a woman, a family history of psychiatric disorders, living off-site, competitive/hostile climates and unsatisfying friendships among classmates, poor relationships with cohabitants, negative judgment of medical school choice, fear of COVID-19 infection, feelings of loneliness, distressing existential reflections, and a worsening psychological condition related to the pandemic. Being in the fourth or sixth year constituted a protective factor for depression symptoms. Conclusions: Mental health in medical students was associated with both COVID-independent and COVID-related factors. Accessibility to effective interventions must be increased to counteract these changes.

Well-Being, Mental Health, and Study Characteristics of Medical Students before and during the Pandemic

Medical students report high demands, stressors, pressure to perform, and a lack of resources, and are therefore at a higher risk for mental strain and burnout. Due to the COVID-19 pandemic, study conditions have changed, and new challenges have emerged. Thus, this study aimed to examine medical students' well-being, mental health, and study characteristics before and during the pandemic. Data from 988 Austrian medical students were included into the cross-sectional comparisons, and 63 students were included into the longitudinal analyses (variance analyses/t-tests or appropriate non-parametric tests). Well-being before and during the pandemic did not differ significantly but the peri-pandemic cohort reported higher study satisfaction, more social support from lecturers, and less emotional exhaustion, cognitive demands, and stressors (information problems, organizational stressors, work overload). Longitudinally, work overload was also perceived to be higher before the pandemic; however, study satisfaction was lower. During the pandemic, approximately every seventh student exceeded the cut-off value for generalized anxiety disorder, and approximately every tenth student exceeded the cut-off value for major depression. These unexpected peri-pandemic results concerning constant high well-being, study satisfaction, and the perception of conditions may be based on response shift effects that require further exploration. The scores exceeding the reasonable cut-point for identifying probable cases of generalized anxiety disorder and depression may reflect medical students' needs, calling for an in-depth analysis if further health promotion is necessary.

Impact of the USMLE Step 1 and COMLEX Level 1 transition to Pass/Fail on osteopathic medical student stress levels and board preparation

CONTEXT

The United States Medical Licensing Examination (USMLE) Step 1 and Comprehensive Osteopathic Medical Licensing Exam (COMLEX) Level 1 transitioned from a numeric scoring system to a Pass/Fail designation in 2022. This transition intended to decrease stress, improve medical student well-being, and encourage residency program directors to emphasize other aspects of residency applications. Pass/Fail score transitions in the undergraduate medical education curriculum have improved medical student psychological well-being and satisfaction; whether these same benefits translate to the board examination period is unknown.

OBJECTIVES

The objectives of this study are to assess the impact of USMLE Step 1 and COMLEX Level 1 grade scale transition on medical student stress, wellness, board preparation decisions, and future residency selection processes. Investigators hypothesized that students under the Pass/Fail designation would experience less stress during the intensive study period leading up to USMLE Step 1 and COMLEX Level 1 and devote more time to other aspects of their residency applications.

METHODS

To examine the impact on osteopathic medical student (OMS) stress and approach to board preparation, two surveys were administered to Rocky Vista University College of Osteopathic Medicine (RVU-COM) students before (Class of 2023) and after (Class of 2024) the transition to a Pass/Fail designation. All students within the RVU-COM Classes of 2023 and 2024 were invited to participate. The Cohen Perceived Stress Scale (PSS-10) was administered at the beginning of the focused board study period in May 2021 and 2022 to the Class of 2023 and 2024, respectively. The investigator-designed Licensing Exam Questionnaire (LEQ), meant to capture board preparation patterns, residency application perspectives, and wellness during examination preparation, was administered immediately after the board examination deadline in July 2021 and 2022 to the Class of 2023 and 2024, respectively. Statistical analysis included the use of independent t tests (numeric variables) and chi-square tests (categorical data). This project was considered exempt from full Institutional Review Board review.

RESULTS

Approximately one-third of the Class of 2023 (PSS-10: n=86; LEQ: n=93) and 2024 (PSS-10=89; LEQ: n=92) responded. No difference was detected in mean PSS-10 score, 20.14 (SD=7.3) compared to 19.92 (SD=6.56) for the Class of 2023 and 2024 (p=0.84), respectively. The Class of 2023 reported more weeks studying (mean 6.27 weeks, SD=0.79) vs. the Class of 2024 (mean 5.44 weeks, SD=0.007), p<0.001, more practice examinations taken X 2 (1, n=182)=13.75, p<0.001, and a greater proportion scheduled examinations after June 20 X 2 (1, n=182)=29.01, p<0.001. No difference existed in hours studying per day, sequence of Step 1/Level 1, time between examinations, money spent, or type of study resources utilized.

CONCLUSIONS

The transition of USMLE Step 1 and COMLEX Level 1 to a Pass/Fail designation did not reduce stress for OMSs at a single, multicampus COM. Respondents, however, altered board preparation practices in meaningful ways. As student behaviors and board-study patterns emerge, these insights must be connected to outcomes in the future.

The Consequences of the Pandemic on Medical Students’ Depressive Symptoms and Perceived Stress: A Repeated Cross-Sectional Survey with a Nested Longitudinal Subsample

This study aimed to explore the impact of the pandemic on medical students’ mental health in Italy using a repeated cross-sectional survey with a nested longitudinal subsample (first timepoint: 2018; second: 2020/2021). Three research questions (RQs) were investigated. Study 1 (longitudinal sub-sample) explored whether medical students had higher levels of depressive symptoms and stress during the pandemic compared with a pre-pandemic period (RQ1) and what variables were associated with these conditions during the pandemic adjusting for baseline levels (RQ2). Study 2 (repeated cross-sectional data) aimed to examine whether medical students had higher levels of these conditions during the pandemic compared with their same-year peers during a pre-pandemic period (RQ3). In Study 1, higher levels of depressive symptoms and stress were shown during the pandemic (RQ1). Multivariable models highlighted associations between poor mental health and worsening of the judgment of medical school choice, worsened psychological condition due to the pandemic, economic repercussions due to the pandemic, and baseline levels of symptoms (RQ2). In Study 2, our findings reported higher levels of depressive symptoms and stress during the pandemic, also adjusting for other variables (RQ3). In conclusion, depressive symptoms and stress were greater during the pandemic. The most relevant variables were pandemic-related items and medical school choice judgment.

Stress Perception and Coping Strategies of Students on Both Sides of the EU's Eastern Border during the COVID-19 Pandemic

The aim of the study was to compare the perception of stress and the characteristic coping-strategies among students in the context of the different anti-pandemic measures taken in Belarus, Poland, and the Russian exclave of Kaliningrad. A cross-sectional online survey using standardized questionnaires (Perceived Stress Scale-PSS-10 and Brief-COPE-Mini-COPE inventory) was conducted among 3113 students of seven universities in three neighboring regions on both sides of the eastern border of the EU. The groups that are the most prone to stress are the Polish and Russians students. Among the students from Belarus, 122 (13.7%) have high levels of stress symptoms. Among the respondents from Poland-238 (19.4%), and 191 (19.2%) from Kaliningrad have high levels of stress, respectively. The different approaches of the authorities to the COVID-19 pandemic diversified the choice of students' stress coping strategies. The behavior of the students from Kaliningrad and Poland was similar. The Belarusian students used active coping strategies less often, while an avoidance-focused style, and denial were more frequent. The neglect of restrictive anti-pandemic measures by the Belarusian students was manifested by a higher incidence of disease and minimal use of vaccinations.

Mental health indicators and their lifestyle associations in German students: a gender-specific multivariable analysis

BACKGROUND

Statistics show that the number of received psychosocial counselling sessions remains at a constantly high level or has even increased since the COVID-19 pandemic situation in 2020. The objective of this work is to identify factors associated with students' mental health to improve prevention and promotion in mental health at universities.

METHODS

The analyses were based on a cross-sectional data set collected by an online survey among 1,842 students from a German University of Applied Sciences in 2014. Descriptive statistics as well as nine different multiple linear regression models were calculated with IBM® SPSS® Statistics software. Mental health indicators used were mental health-related quality of life (mental HRQOL), depression, and anxiety, which were analysed in a gender-specific manner.

RESULTS

The analyses showed that the mean of the mental HRQOL score of the SF-36 for the student sample (46.68) was lower than the values for German (48.76) or American (51.34) norm samples. A key finding was the differences in mental health indicators between male and female students. Women reported worse mental health status in comparison to men. Female gender (ß of -.09; p < 0.01), age (ß of -1.05; p < 0.01), underweight (ß of -.09; p < 0.05), smoking (ß of -.10; p < 0.05) and drug consumption (ß of -.15; p < 0.001) were negatively associated with mental health indicators. In our sample, a moderate consumption of alcohol within the female population (ß of .12; p < 0.01) and physical activity within the male sample (ß of .09; p < 0.05) were positively associated with mental health indicators.

CONCLUSION

The gender-specific differences of students' mental health and its associations could be an important result for counselling services at universities to adjust methods according to gender. Contrary to the general societal perception, students have lower mental health than a norm sample even before the pandemic. Due to the additional mental stress caused by the pandemic, it can be assumed that mental health problems have increased even more. Universities should therefore pay more attention to the mental health of their students.

E-Learning Satisfaction, Stress, Quality of Life, and Coping: A Cross-Sectional Study in Italian University Students a Year after the COVID-19 Pandemic Began

(1) Background: The objective was to investigate e-learning satisfaction in a sample of university students by evaluating quality of life, stress sociality, and coping. (2) Methods: This was an online survey involved 471 students attending the University of L′Aquila from June to July 2021. The primary goal was estimating the e-learning satisfaction as measured by the E-learning Satisfaction Scale, while the secondary outcomes were studying its relationship with demographic factors, the perception of quality of life, sociality, stress, and coping strategies using a hierarchical regression model. (3) Results: A total of 136 participants were males (29%); the mean age was 25 years. The results revealed that the satisfaction score was 30.6, and the mean stress level was 19.4. Students suffered psychologically and physically for 14 days a month. The sociality score was 36. With respect to coping strategies, students reported higher scores for “Acceptance” (6.0), “Active coping” (6.2), and “Planning” (6.4). E-learning satisfaction was significantly related to age and course attendance. It was positively associated with the social presence score and coping strategies such as self-blame and religion, while it was inversely related to stress and unhealthy days. (4) Conclusions: The students revealed a positive propensity to use e-learning despite the end of quarantine. Sociality, stress, quality of life, and coping seemed to play an important role in student′s e-learning satisfaction.