Mental health services for German university students: acceptance of intervention targets and preference for delivery modes

Introduction

Most university students with mental disorders remain untreated. Evaluating the acceptance of intervention targets in mental health treatment, promotion, and prevention, as well as mental health service delivery modes is crucial for reducing potential barriers, increasing healthcare utilization, and efficiently allocating resources in healthcare services.

Aim

The study aimed to evaluate the acceptance of various intervention targets and delivery modes of mental health care services in German first-year university students.

Methods

In total, 1,376 first-year students from two German universities from the 2017-2018 multi-center cross-sectional cohort of the StudiCare project, the German arm of the World Mental Health International College Student Survey initiative, completed a web-based survey assessing their mental health. Mental disorder status was based on self-reported data fulfilling the DSM-IV criteria. We report frequencies of accepted delivery modes [categories: group or in-person therapy with on or off campus services, self-help internet- or mobile-based intervention (IMI) with or without coaching, or a combination of a in-person and IMI (blended)]. In a multinomial logistic regression, we estimate correlates of the preference for in-person vs. IMI vs. a combination of both modes (blended) modalities. Additionally, we report frequencies of intervention targets (disorder specific: e.g., social phobia, depressive mood; study-related: test anxiety, procrastination; general well-being: sleep quality, resilience) their association with mental disorders and sex, and optimal combinations of treatment targets for each mental illness.

Results

German university students' acceptance is high for in-person (71%-76%), moderate for internet- and mobile-based (45%-55%), and low for group delivery modes (31%-36%). In-person treatment (72%) was preferred over IMI (19%) and blended modalities (9%). Having a mental disorder [odds ratio (OR): 1.56], believing that digital treatments are effective (OR: 3.2), and showing no intention to use services (OR: 2.8) were associated with a preference for IMI compared to in-person modes. Students with prior treatment experience preferred in-person modes (OR: 0.46). In general, treatment targets acceptance was higher among female students and students with mental disorders. However, this was not true for targets with the highest (i.e., procrastination) and the lowest (i.e., substance-use disorder) acceptance. If only two intervention targets were offered, a combination of study-related targets (i.e., procrastination, stress, time management) would reach 85%-88% of the students.

Conclusion

In-person services are preferred, yet half of the students consider using IMI, preferably aiming for a combination of at least two study-related intervention targets. Student mental health care services should offer a combination of accepted targets in different delivery modes to maximize service utilization.

Promoting Physical Activity among Workers: A Review of Literature and Future Directions on Developing Theory-Based Interventions

Insufficient physical activity (PA) has been identified as a leading risk factor for premature and all-cause death, as well as non-communicable diseases. Employees, especially those with low occupational PA, are more vulnerable to physical inactivity, and studies in this population are scarce. However, employees may receive benefits for both health and work productivity from PA. Therefore, well-designed behavior change studies to promote PA in employees are urgently needed, especially during the COVID-19 pandemic. Literature was searched before 30 July 2022, and updated evidence was summarized. This review elaborates on the evidence related to insufficient PA and further provides an overview of theory-based interventions for promoting PA. Evidence indicates that intervention mapping (IM) was a useful tool to develop, implement, and evaluate behavior change interventions. Based on the IM framework, reviewing the theory- and evidence-based change methods and delivery modes, and further identifying the research gaps and limitations of existing interventions could provide promising suggestions and directions for development of well-founded interventions promoting PA among employees. The updated knowledge base for developing future interventions may boost efficacy and provide firm conclusions for researchers in this area.

Giving birth alone due to COVID-19-related hospital restrictions compared to accompanied birth: psychological distress in women with caesarean section or vaginal birth - a cross-sectional study

OBJECTIVES

We examined the mental health of mothers after unaccompanied birth (unaccompanied group, UG) due to COVID-19-related visiting bans and compared the data with a control group with accompanied birth (AG). Additionally, a distinction was made between caesarean section (CS) and vaginal birth (VB), as existing research indicates a higher risk for mental distress after CS.

METHODS

The cross-sectional study included 27 mothers in the UG and 27 matched controls (AG). Anxiety, depression, postpartum traumatic stress symptoms (PTSS), and psychological well-being were assessed. Additionally, emotions and attitudes related to the restrictions were measured by self-developed items.

RESULTS

Psychological distress was high especially in the UG (anxiety: 23%, PTSS: 34.6%, low well-being: 42.3%, depression: 11.5%). Mothers in the AG had lower psychological distress than those in the UG, but still had enhanced rates of PTSS (11.1%) and diminished well-being (22.2%). In both groups, women with CS reported higher anxiety and trauma scores and lower well-being than women with VB. Unaccompanied mothers with CS perceived visitation restrictions as less appropriate and felt more helpless, angry, worried, and frustrated about the partner's absence than women with VB.

CONCLUSIONS

The partner's absence during, but also after childbirth has a major impact on psychological outcomes. Particularly, higher rates of anxiety and PTSS can lead to negative consequences for mothers and their children. Therefore, it is strongly recommended to relax visitation bans and avoid unaccompanied births. Psychological treatment in obstetric units is more urgently needed than ever, especially for women with a caesarean section.

Delivery Mode Affects Intestinal Microbial Composition and the Development of Intestinal Epithelial Cells

Background

The infant's intestine contains diverse microbiota, which play an important role in an infant's health.

Objective

This study aimed to analyze the different intestinal microbiota and their function in two delivery modes [vaginal delivery and cesarean section (C-section)] and to investigate the proprieties of bacteria associated with vaginal delivery on the development of intestinal epithelial cells in rat pups.

Materials and Methods

We evaluated the intestinal microbial diversity of the stool samples of 51 infants of subjects who underwent vaginal delivery and C-section by sequencing the V4 regions of the 16S rRNA gene and predicted the function of the microbiotas. The infant stool microbiota in the vaginal delivery group was associated with the digestive system and cell growth and death, whereas that of the C-section group was associated with membrane transport. Then, we isolated the strains based on function prediction.

Results

A total of 95 strains were isolated in the vaginal delivery group. Bifidobacterium bifidum FL-228.1 (FL-228.1) was screened and selected owing to its good surface hydrophobicity, bacterial survivability in the simulated gastrointestinal condition and adhesion ability to the IEC-6 cell line as well as owing to the development of intestinal epithelial cells. Furthermore, in vivo experiments revealed that FL-228.1 exhibited favorable effects on the development of intestinal epithelial cells in rat pups.

Conclusion

The results of this study indicate an apparent difference in the bacterial composition of the stool samples collected from infants of the two delivery modes. By analyzing and screening the bacteria in infant stool samples, we found that one strain, i.e., B bifidum FL-228.1, exhibited favorable effects on the development of intestinal epithelial cells.

The effect of continuous midwifery services on the delivery mode, labor progress, and nursing satisfaction of primiparas during natural deliveries

OBJECTIVE

To analyze the effect of continuous midwifery services on the delivery mode, labor progress, and primiparas' nursing satisfaction levels during natural deliveries.

METHODS

340 primiparas admitted to our hospital from January 2017 to June 2020 were recruited as the study cohort and randomized into a continuous midwifery group and a traditional midwifery group, with 170 patients in each group. They underwent traditional midwifery nursing services and continuous midwifery services, respectively. The two groups' delivery modes, labor progress, analgesic methods, perinatal Self-Rating Anxiety Scale (SAS) scores, postpartum hemorrhage amounts, Apgar scores, and nursing satisfaction levels were compared.

RESULTS

The natural delivery rate in the continuous midwifery group was higher than it was in the traditional midwifery group (P<0.05). The maternal non-drug analgesia rate in the continuous midwifery group was higher than it was in the traditional midwifery group (P<0.05). The duration of the first stage in the continuous midwifery group was shorter than it was in the traditional midwifery group (P<0.05). The comparisons made during the second and third stages in the two groups showed no statistical differences (P>0.05). The SAS scores in the continuous midwifery group were significantly better than the SAS scores in the traditional midwifery group at the time of waiting for delivery and at one day after delivery (P<0.01). The postpartum hemorrhage amounts in the continuous midwifery group were lower than they were in the traditional midwifery group (P<0.01). The neonatal Apgar scores and maternal nursing satisfaction levels in the continuous midwifery group were better than they were in the traditional midwifery group (P<0.01).

CONCLUSION

Continuous delivery services for primiparas during natural delivery can significantly increase the natural delivery rate, reduce the use of analgesics, shorten the delivery times, alleviate the delivery-related anxiety levels in the primiparas, reduce postpartum hemorrhages, effectively improve the delivery outcomes, improve the quality of the newborns, and improve the primiparas' nursing satisfaction levels, so it is worthy of clinical promotion and application.

Choice of Nanovaccine Delivery Mode Has Profound Impacts on the Intralymph Node Spatiotemporal Distribution and Immunotherapy Efficacy

Nanovaccines have attracted booming interests in vaccinology studies, but the profound impacts of their delivery mode on immune response remain unrealized. Herein, immunostimulatory CpG-modified tumor-derived nanovesicles (CNVs) are used as a nanovaccine testbed to initially evaluate the impacts of three distinct delivery modes, including mono-pulse CNVs, staggered-pulse CNVs, and gel-confined CNVs. Fundamentally, delivery mode has enormous impacts on the immunomodulatory effects, altering the spatiotemporal distribution of nanovaccine residence and dendritic cell-T cell interaction in lymph nodes, and finally affecting subsequent T cell-mediated immune performance. As a result, the gel-confined delivery mode offers the best therapeutic performance in multiple tumor models. When extending evaluation to examine how the various delivery modes impact the performance of liposome-based nanovaccines, similar trends in intralymph node distribution and antitumor effect are observed. This work provides a strong empirical foundation that nanovaccine researchers should position delivery mode near the top of their considerations for the experimental design, which should speed up nanovaccine development and facilitate efficient selection of appropriate delivery modes in the clinic.