Tracking Stress, Mental Health, and Resilience Factors in Medical Students Before, During, and After a Stress-Inducing Exam Period: Protocol and Proof-of-Principle Analyses for the RESIST Cohort Study (Preprint)

BACKGROUND Knowledge of mental distress and resilience factors over the time span from before to after a stressor is important to be able to leverage the most promising resilience factors and promote mental health at the right time. To shed light on this topic, we designed the RESIST (Resilience Study) study, in which we assessed medical students before, during, and after their yearly exam period. Exam time is generally a period of notable stress among medical students, and it has been suggested that exam time triggers mental distress. OBJECTIVE In this paper, we aim to describe the study protocol and to examine whether the exam period indeed induces higher perceived stress and mental distress. We also aim to explore whether perceived stress and mental distress coevolve in response to exams. METHODS RESIST is a cohort study in which exam stress functions as a within-subject natural stress manipulation. In this paper, we outline the sample (N=451), procedure, assessed measures (including demographics, perceived stress, mental distress, 13 resilience factors, and adversity), and ethical considerations. Moreover, we conducted a series of latent growth models and bivariate latent change score models to analyze perceived stress and mental distress changes over the 3 time points. RESULTS We found that perceived stress and mental distress increased from the time before the exams to the exam period and decreased after the exams to a lower level than before the exams. Our findings further suggest that higher mental distress before exams increased the risk of developing more perceived stress during exams. Higher perceived stress during exams, in turn, increased the risk of experiencing a less successful (or quick) recovery of mental distress after exams. CONCLUSIONS As expected, the exam period caused a temporary increase in perceived stress and mental distress. Therefore, the RESIST study lends itself well to exploring resilience factors in response to naturally occurring exam stress. Such knowledge will eventually help researchers to find out which resilience factors lend themselves best as prevention targets and which lend themselves best as treatment targets for the mitigation of mental health problems that are triggered or accelerated by natural exam stress. The findings from the RESIST study may therefore inform student support services, mental health services, and resilience theory.

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Tracking Stress, Mental Health, and Resilience Factors in Medical Students Before, During, and After a Stress-Inducing Exam Period: Protocol and Proof-of-Principle Analyses for the RESIST Cohort Study

JMIR Formative Research ◽

10.2196/20128 ◽

2021 ◽

Vol 5 (6) ◽

pp. e20128

Author(s):

Jessica Fritz ◽

Jan Stochl ◽

Rogier A Kievit ◽

Anne-Laura van Harmelen ◽

Paul O Wilkinson

Keyword(s):

Mental Health ◽

Cohort Study ◽

Medical Students ◽

Perceived Stress ◽

Mental Distress ◽

Mental Health Problems ◽

Growth Models ◽

Temporary Increase ◽

Exam Stress ◽

Resilience Factors

Background Knowledge of mental distress and resilience factors over the time span from before to after a stressor is important to be able to leverage the most promising resilience factors and promote mental health at the right time. To shed light on this topic, we designed the RESIST (Resilience Study) study, in which we assessed medical students before, during, and after their yearly exam period. Exam time is generally a period of notable stress among medical students, and it has been suggested that exam time triggers mental distress. Objective In this paper, we aim to describe the study protocol and to examine whether the exam period indeed induces higher perceived stress and mental distress. We also aim to explore whether perceived stress and mental distress coevolve in response to exams. Methods RESIST is a cohort study in which exam stress functions as a within-subject natural stress manipulation. In this paper, we outline the sample (N=451), procedure, assessed measures (including demographics, perceived stress, mental distress, 13 resilience factors, and adversity), and ethical considerations. Moreover, we conducted a series of latent growth models and bivariate latent change score models to analyze perceived stress and mental distress changes over the 3 time points. Results We found that perceived stress and mental distress increased from the time before the exams to the exam period and decreased after the exams to a lower level than before the exams. Our findings further suggest that higher mental distress before exams increased the risk of developing more perceived stress during exams. Higher perceived stress during exams, in turn, increased the risk of experiencing a less successful (or quick) recovery of mental distress after exams. Conclusions As expected, the exam period caused a temporary increase in perceived stress and mental distress. Therefore, the RESIST study lends itself well to exploring resilience factors in response to naturally occurring exam stress. Such knowledge will eventually help researchers to find out which resilience factors lend themselves best as prevention targets and which lend themselves best as treatment targets for the mitigation of mental health problems that are triggered or accelerated by natural exam stress. The findings from the RESIST study may therefore inform student support services, mental health services, and resilience theory.

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Tracking Stress, Mental Health and Resilience Factors in Medical Students, Before, During and After a Stress-Inducing Exam Period: Protocol and Proof of Principle Analyses for the RESIST Cohort-Study

10.31219/osf.io/mt346 ◽

2020 ◽

Author(s):

Jessica Fritz ◽

Jan Stochl ◽

Rogier Kievit ◽

Anne-Laura Van Harmelen ◽

Paul Wilkinson

Keyword(s):

Mental Health ◽

Cohort Study ◽

Medical Students ◽

Perceived Stress ◽

Mental Distress ◽

Mental Health Problems ◽

Change Score ◽

Temporary Increase ◽

Stress Exposure ◽

Resilience Factors

Background: Resilience factors, such as self-esteem or social support, are known to reduce mental distress in the face of stress or adversity exposure. So far, knowledge on the promotive value of resilience factors over the time span from before to during and after the stress or adversity exposure is concerningly scarce. Such knowledge seems however important to eventually be able to leverage the most promising resilience factors at the right time. To shed light on this topic we designed the RESIST study, in which we assessed medical students (N=457) before, during and after their yearly exam period. Exam time is a period of notable stress in medical students and has been suggested to trigger mental health problems.Objectives: Here we describe the study protocol and examine whether the exam period did indeed induced higher (di)stress.Methods: RESIST is a cohort-study in which exam stress functions as within-subject natural stress manipulation. In this manuscript we outline the sample, procedure, assessed measures (including demographics, perceived stress, mental distress, 13 resilience factors and adversity) and ethical considerations. Moreover, we conducted a series of latent growth and bivariate latent change score models to analyse perceived stress and mental distress changes over the three time points.Results: We found that perceived stress and mental distress increased during exams compared to before exams, but decreased below pre-exam levels afterwards. Our findings further suggest that higher perceived stress before the exams may result in less recovery in mental distress after exams. Moreover, higher mental distress before the exams increased the chance of higher perceived stress during exams, which in turn increased the risk for a less successful (or quick) recovery of mental distress after exams.Conclusion: As expected, the exam period caused a temporary increase in (di)stress. Therefore, the RESIST study lends itself well to explore whether the promotive value of resilience factors changes from before to during and/or after stress exposure. Such knowledge will eventually help to find out which resilience factors lend themselves best as prevention and which as intervention targets for the mitigation of mental health problems that are triggered or accelerated by the stress exposure. Findings from the RESIST study may therefore inform student support services, mental health services and resilience theory.

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The Reliability and Compatibility of the Paper and Electronic Versions of the POLLEK Cohort Study Questionnaire

Healthcare ◽

10.3390/healthcare8040438 ◽

2020 ◽

Vol 8 (4) ◽

pp. 438

Author(s):

Maksymilian Gajda ◽

Szymon Szemik ◽

Katarzyna Sedlaczek ◽

Małgorzata Kowalska

Keyword(s):

Mental Health ◽

Cohort Study ◽

Medical Students ◽

Mental Health Problems ◽

Correlation Coefficients ◽

Chronic Fatigue ◽

Cross Sectional Study ◽

Burnout Syndrome ◽

Cross Sectional ◽

Paper Version

Background: Chronic fatigue, depression, burnout syndrome, and alcohol addiction have been identified as significant mental health problems in young medical doctors. Given the lack of prospective studies in this area in Poland, the POLski LEKarz (POLLEK) cohort study was created. The goal of the POLLEK study is to assess the quality of life and health status (including mental health) of medical students and young physicians. The aim of the presented paper was to assess the reliability and compatibility of paper and electronic versions of the POLLEK questionnaire. Methods: Between 1 October 2019 and 28 February 2020, all medical students (N = 638) of the first year in the Medical University of Silesia were invited to participate in a cross-sectional study. Three hundred and fifty-three students (55.3%) who accomplished both versions were included in the current analysis. Results: Values of Cronbach’s alpha >0.7 proved both modes of delivery to have good internal consistency, except for the individual Alcohol Use Disorder Identification Test (AUDIT) domains and the Environmental domain of the WHOQOL-BREF (paper version). Similarly, interclass correlation coefficients equal to or greater than 0.9 denoted an excellent reproducibility. Conclusions: We documented very good accordance and reproducibility of POLLEK questionnaire (both paper and electronic versions). These findings legitimize the use of the questionnaire interchangeably.

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An Empirical Examination of How Resilience Factors Mitigate the Effect of Childhood Adversity on Adolescent Mental Health

10.31219/osf.io/6z5h9 ◽

2020 ◽

Author(s):

Jessica Fritz ◽

Jan Stochl ◽

Ian Goodyer ◽

Anne-Laura Van Harmelen ◽

Paul O. Wilkinson

Keyword(s):

Mental Health ◽

Direct Effect ◽

Mental Distress ◽

Mental Health Problems ◽

Childhood Adversity ◽

Adolescent Mental Health ◽

Self Esteem ◽

Health Problems ◽

Resilience Factors ◽

The Relationship

Objective: More than one in three people worldwide are exposed to some form of childhood adversity (CA). CA is strongly associated with an increased risk for the development of mental health problems. Resilience factors (RFs), such as self-esteem, are known to reduce such vulnerability to mental health problems. Here we examine besides direct RF effects, whether RFs predominantly alter the relationship (i.e. moderation) or disrupt the developmental chain (i.e. mediation) between CA and mental health problems.Methods: We studied 1130 adolescents. CA exposure and 10 RFs (3 inter-individual e.g. friendships; 7 intra-individual e.g. self-esteem) were assessed at age 14. Mental health problems were assessed at age 14 and 17, and were combined into a mental distress index. We estimated direct-effect, moderation and mediation models.Results: When taking the effects of all 10 RFs into account, five of the 10 RFs had a significantly negative direct effect in the overall sample. However, of those five, only brooding revealed a significant effect in both the group of adolescents with and without CA. Of the 10 RFs, friendship support, family cohesion and distress tolerance had a significantly negative relationship with age-17 distress in the group of adolescents with CA, and no effect in the group of adolescents without CA. Yet, none of the three RFs revealed a significant moderation effect (p = 0.07-0.09). Positive self-esteem, negative self-esteem and aggression functioned as significant mediators for the relationship between CA and mental distress.Conclusions: In situations in which CA is not known, brooding seems to be the most beneficial RF, as it reduced subsequent mental distress in both adolescents with and without CA. Regarding RFs in the aftermath of CA, our findings provide predominant support for mediation rather than for moderation effects. More specifically, targeting negative self-esteem, positive self-esteem, and aggression seems most fruitful, when the aim is to disrupt the chain between CA and adolescent mental health problems.

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A Network Model of Resilience Factors for Adolescents with and without Exposure to Childhood Adversity

10.31219/osf.io/hvtng ◽

2018 ◽

Cited By ~ 1

Author(s):

Jessica Fritz ◽

Eiko I Fried ◽

Ian Goodyer ◽

Paul O. Wilkinson ◽

Anne-Laura Van Harmelen

Keyword(s):

Mental Health ◽

Network Analysis ◽

Lower Risk ◽

Mental Distress ◽

Mental Health Problems ◽

Childhood Adversity ◽

Health Problems ◽

General Distress ◽

Resilience Factors ◽

Almost All

THIS IS A PRE-PRINT OF AN ARTICLE PUBLISHED IN “SCIENTIFIC REPORTS (8: 15774)”. THE FINAL AUTHENTICATED VERSION IS AVAILABLE ONLINE AT: https://doi.org/10.1038/s41598-018-34130-2Resilience factors (RFs) help prevent mental health problems after childhood adversity (CA). RFs are known to be related, but it is currently unknown how their interrelations facilitate mental health. Here, we used network analysis to examine the interrelations between ten RFs in 14-year-old adolescents exposed (‘CA’; n=638) and not exposed to CA (‘no-CA’; n=501). We found that the degree to which RFs are assumed to enhance each other is higher in the no-CA compared to the CA group. Upon correction for general distress levels, the global RF connectivity also differed between the two groups. More specifically, in the no-CA network almost all RFs were positively interrelated and thus may enhance each other, whereas in the CA network some RFs were negatively interrelated and thus may hamper each other. Moreover, the CA group showed more direct connections between the RFs and current distress. Therefore, CA seems to influence how RFs relate to each other and to current distress, potentially leading to a dysfunctional RF system. Translational research could explore whether intervening on negative RF interrelations so that they turn positive and RFs can enhance each other, may alter ‘RF-mental distress’ relations, resulting in a lower risk for subsequent mental health problems.

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Demographics Associated With Stress, Severe Mental Distress, and Anxiety Symptoms During the COVID-19 Pandemic in Japan: Nationwide Cross-sectional Web-Based Survey (Preprint)

10.2196/preprints.29970 ◽

2021 ◽

Author(s):

Haruhiko Midorikawa ◽

Hirokazu Tachikawa ◽

Takaya Taguchi ◽

Yuki Shiratori ◽

Asumi Takahashi ◽

...

Keyword(s):

Mental Health ◽

Logistic Regression ◽

Regression Analysis ◽

Perceived Stress ◽

Logistic Regression Analysis ◽

Mental Distress ◽

Mental Health Problems ◽

Health Problems ◽

Anxiety Symptoms ◽

Web Based

BACKGROUND With the spread of COVID-19, the deterioration of public mental health has become a major global and social problem. OBJECTIVE The purpose of this study was to elucidate the relationship between the 3 mental health problems associated with COVID-19, that is, perceived stress, severe mental distress, and anxiety symptoms, and the various demographic factors, including occupation. METHODS A nationwide web-based questionnaire survey was conducted in Japan from August 4 to 31, 2020. In addition to sociodemographic data, the degrees of perceived stress, severe mental distress, and anxiety symptoms associated with COVID-19 were measured. After performing a descriptive statistical analysis, factors related to stress, severe mental distress, and anxiety symptoms were analyzed using logistic regression analysis. RESULTS A total of 8203 respondents submitted survey responses, among whom 34.9% (2861/8203) felt intense stress associated with COVID-19, 17.1% (1403/8203) were depressed, and 13.5% (1110/8203) had severe anxiety symptoms. The logistic regression analysis showed that each of the 3 mental health problems were prevalent in females, nonbinary gender, people in their 50s, 60s and older, respondents who visited psychiatrists, and those currently in psychiatric care. Severe mental distress and anxiety symptoms were associated with the number of effective lifestyle coping strategies during the lockdown period. Severe mental distress was only prevalent in teenagers and respondents in their 20s, as students tended to develop stress and severe mental distress. With regard to occupation, working in nursing care and welfare, education and research, and medical and health sectors was associated with stress; however, working in these occupations was not associated with severe mental distress and anxiety symptoms. Unemployment was associated with severe mental distress and anxiety symptoms. All 3 mental health problems were prevalent in part-time workers and those working in entertainment and arts sectors. CONCLUSIONS Gender, age, occupation, history of psychiatric visits, and stress coping mechanisms were associated with mental health during the COVID-19 pandemic, but their associations with stress, severe mental distress, and anxiety symptoms differed. In addition, the actual state of mental health varied according to the respondents’ occupation. It is necessary to consider the impact of the COVID-19 pandemic on mental health not only at the individual level but also at the occupational level.

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Relationships with caregivers and mental health outcomes among adolescents living with HIV: a prospective cohort study in South Africa

BMC Public Health ◽

10.1186/s12889-020-10147-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yulia Shenderovich ◽

Mark Boyes ◽

Michelle Degli Esposti ◽

Marisa Casale ◽

Elona Toska ◽

...

Keyword(s):

Mental Health ◽

South Africa ◽

Cohort Study ◽

Mental Health Problems ◽

Health Problems ◽

Sub Saharan Africa ◽

Depression Symptoms ◽

Sub Saharan ◽

Positive Caregiving ◽

Living With Hiv

Abstract Background Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question. Methods The study traced adolescents aged 10–19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive caregiving, and adolescent-caregiver communication) and adolescent mental health (depression symptoms and anxiety symptoms), controlling for potential confounders (age, sex, rural/urban residence, mode of infection, household resources), n=926 adolescents. Results Improvements in caregiver supervision were associated with reductions in anxiety (0.98, 95% CI 0.97–0.99, p=0.0002) but not depression symptoms (0.99, 95% CI 0.98–1.00, p=.151), while changes in positive caregiving were not associated with changes in mental health symptoms reported by adolescents. Improvements in adolescent-caregiver communication over time were associated with reductions in both depression (IRR=0.94, 95% CI 0.92–0.97, p<.0001) and anxiety (0.91, 95% CI 0.89–0.94, p<.0001) symptoms reported by adolescents. Conclusions Findings highlight open and supportive adolescent-caregiver communication and good caregiver supervision as potential factors for guarding against mental health problems among adolescents living with HIV in South Africa. Several evidence-informed parenting programmes aim to improve adolescent-caregiver communication and caregiver supervision, and their effect on depression and anxiety among adolescents living with HIV should be rigorously tested in sub-Saharan Africa. How to improve communication in other settings, such as schools and clinics, and provide communication support for caregivers, adolescents, and service providers through these existing services should also be considered.

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Does a comprehensive service user-led education programme effect more positive attitudes towards recovery and less stigmatising attitudes towards people with lived experience of mental distress in medical students? A comparative cohort study

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867420987886 ◽

2021 ◽

pp. 000486742098788

Author(s):

Giles Newton-Howes ◽

Jessica Senior ◽

Ben Beaglehole ◽

Gordon L Purdie ◽

Sarah E Gordon

Keyword(s):

Cohort Study ◽

Medical Students ◽

Lived Experience ◽

Service User ◽

Mental Distress ◽

Healthcare Providers ◽

Education Programme ◽

Positive Attitudes ◽

Comprehensive Service ◽

The Impact

Objective: This study sought to investigate the impact of a service user-led anti-stigma and discrimination education programme, encompassing numerous interventions focused on facilitating multiple forms of social contact, the promotion of recovery, and respect for human rights, on medical student attitudes. Method: A comparison cohort study was used to compare the attitudes of two cohorts of medical students who received this programme as part of their fifth (the fifth-year cohort) or sixth (the sixth-year cohort) year psychological medical education attachment (programme cohorts) with two cohorts of equivalent students who received a standard psychological medical attachment (control cohorts). Attitudes to recovery (using the Recovery Attitudes Questionnaire) and stigma (using the Opening Minds Scale for Healthcare Providers) were measured at the beginning and end of the attachments for each year and compared both within and between the cohorts using Wilcoxon signed-rank or Wilcoxon rank-sum tests. Results: With sample sizes ranging from 46 to 70 across all cohorts, after their psychological medicine attachment both the programme and control cohorts showed more positive attitudes towards recovery and less stigmatising attitudes towards people with lived experience of mental distress. Significant differences between the programme cohorts and the control cohorts were found for recovery attitudes (median difference of 2, p < 0.05 in both fifth and sixth year), with particularly large differences being found for the ‘recovery is possible and needs faith’ subdomain of the Recovery Attitudes Questionnaire. There were no significant between cohort differences in terms of stigmatising attitudes as measured by the Opening Minds Scale for Healthcare Providers. Conclusion: The introduction of a comprehensive service user-led anti-stigma and education programme resulted in significant improvements in recovery attitudes compared to a control cohort. However, it was not found to be similarly superior in facilitating less stigmatising attitudes. Various possible reasons for this are discussed.

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The effect of childhood deprivation on weight status and mental health in childhood and adolescence: longitudinal findings from the Millennium Cohort Study

Journal of Public Health ◽

10.1093/pubmed/fdy139 ◽

2018 ◽

Vol 41 (3) ◽

pp. 456-461 ◽

Cited By ~ 1

Author(s):

Robert J Noonan

Keyword(s):

Mental Health ◽

Cohort Study ◽

Health Outcomes ◽

Weight Status ◽

Mental Health Problems ◽

Health Problems ◽

Childhood And Adolescence ◽

Millennium Cohort Study ◽

Strengths And Difficulties ◽

Childhood Deprivation

Abstract Background The study aims were to: (i) examine associations between deprivation at age 7 and health outcomes at age 7 and 14, (ii) determine whether a deprivation gradient to health outcomes exists at age 7 and 14, and (iii) assess the extent to which health outcomes at age 7 are associated with health outcomes at age 14. Methods Data were from wave four and six of the Millennium Cohort Study. Health outcome measures were weight status, and Strengths and Difficulties Questionnaire measured mental health problems. Deprivation was determined using the 2004 English Indices of Multiple Deprivation. Adjusted logistic and multinomial logistic regressions were conducted. Results A total of 6109 children (1890 girls) had complete data. Overweight, obesity and mental health problems were greatest among children in the highest deprivation decile at age 7 and 14 (P < 0.001). Health outcomes at age 7 were significantly associated with health outcomes at age 14 (P < 0.001). Conclusions A marked social gradient to weight status and mental health was evident at age 7 and 14, and no evidence of equalization was found. Weight status and mental health in childhood is strongly associated with weight status and mental health in adolescence.

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Preconception prediction of expectant fathers' mental health: 20-year cohort study from adolescence

BJPsych Open ◽

10.1192/bjo.2017.10 ◽

2018 ◽

Vol 4 (2) ◽

pp. 58-60 ◽

Cited By ~ 8

Author(s):

Elizabeth Spry ◽

Rebecca Giallo ◽

Margarita Moreno-Betancur ◽

Jacqui Macdonald ◽

Denise Becker ◽

...

Keyword(s):

Mental Health ◽

Cohort Study ◽

Mental Disorders ◽

Mental Health Problems ◽

Common Mental Disorders ◽

Common Mental Disorder ◽

Health Problems ◽

Adolescent And Young Adult ◽

Future Research ◽

Expectant Fathers

We examined prospective associations between men's common mental disorders in the decades prior to offspring conception and subsequent paternal antenatal mental health problems. Data came from a prospective intergenerational cohort study which assessed common mental disorder nine times from age 14 to 29 years, and in the third trimester of subsequent pregnancies to age 35 years (N = 295 pregnancies to 214 men). Men with histories of adolescent and young adult common mental disorders were over four times more likely to experience antenatal mental health problems. Future research identifying modifiable perinatal factors that counteract preconception risk would provide further targets for intervention.Declaration of interestNone.

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