Psychological impact of the COVID-19 pandemic on anaesthetists in an academic institution in South Africa

Background: Anaesthesiology is considered to be a medical speciality that can result in high levels of stress. The COVID-19 pandemic required anaesthetists to rapidly adopt additional challenging roles. This study describes the psychological impact of the pandemic on anaesthetists and identified and compared factors associated with depression, anxiety, stress, and post-traumatic stress disorder (PTSD). Methods: A cross-sectional study design was used. An anonymous questionnaire was used to collect data utilising convenience sampling and results were reported using descriptive statistics and logistic regression analysis. The order of importance for the sources of stress and organisational support was determined by calculating the median rank. Results: The majority of the participants were between ages 31­40 (62.6%), male (59.8%), registrars (47.6%), had no comorbidities (73.8%), and had no known mental illness (79.9%). Having a previous diagnosis of a mental health illness was linked with greater levels of depression (OR [95% CI] = 4.50 [2.02­10.24], p < 0.001), anxiety(OR [95% CI] = 3.9 [1.7­9.0], p = 0.001), stress (OR [95% CI] = 3.8 [1.6­9.2], p = 0.002), and PTSD (OR [95% CI] = 5.4 [2.2­13.5], p < 0.001). Sources of stress identified included: insecure access to appropriate personal protective equipment, being exposed to COVID-19 at work, and taking the infection home to family. Conclusion: Participants with a history of mental illness were predisposed to developing negative psychological symptoms as a result of the pandemic. The main source of stress identified was insecure access to appropriate personal protective equipment.

Associations between Sociodemographic, Body Mass Index, Body Image Perception, Physical Activity and Sleep Quality with Mental Health among University Students in Universiti Putra Malaysia during the COVID-19 Pandemic

@#Introduction: Mental health problem among university students during COVID-19 pandemic became one of the global main issues. There is limited study on mental health among university student during COVID-19 pandemic. Therefore, this study aimed to determine the associations between socio-demographic, body mass index, body image perception, physical activity and sleep quality with mental health among university students in Universiti Putra Malaysia. Methods: This is a cross-sectional study with a total sample of 130 students aged 18 to 25 years old which were recruited through a multistage sampling. An English online self-administered questionnaire was used to collect the data on socio-demographic characteristics, weight and height, body image perception (BSQ-8C), physical activity (GPAQ), sleep quality (PSQI), and mental health (DASS-21). Results: Majority of the respondents were female (76.2%), Malay (78.5%), in second year of study (28.5%), from low income family (59.2%) and stayed with parents during COVID-19 pandemic (57.7%). Results showed 44.6% of respondents had depressive symptoms, 56.9% had anxiety symptoms and 29.2% had stress symptoms with severity mild to extremely severe. Body mass index (r=0.205, p<0.005), body image perception (r=0.538, p<0.001), and sleep quality (r=0.460, p<0.001) were associated with depression subscale. Meanwhile, body image perception (r=0.449, p<0.001), and sleep quality (r=0.450, p<0.001) were correlated with anxiety subscale. Stress subscale was correlated with body image perception (r=0.473, p<0.001) and sleep quality (r=0.492, p<0.001). Conclusion: Affected students should be helped and referred to healthcare practitioner to ensure they able to overcome with these problems and remains healthy during this pandemic.

Prevalence of Mental Health Problems Among University Students and Association With Body Mass Index (BMI) and Diet Quality

@#Introduction: Numerous factors contributed to the susceptibility of university students to develop mental health issues. Objective: This study aimed to assess the prevalence of mental health problems among International Islamic University Malaysia (IIUM) students and their relationships with diet quality and body mass index (BMI). Methods: A cross-sectional study was conducted among 104 students. The Depression, Anxiety, and Stress Scale (DASS-21) was used to assess students’ depression, anxiety, and stress levels. The Malaysian Healthy Eating Index (M-HEI) was used to assess diet quality. Spearman Rho was used to determine the relationships between variables. Results: Approximately 69.4% (n = 34), 71.4% (n = 35), and 48.9% (n = 34) of male students experienced moderate to extremely severe symptoms of depression, anxiety, and stress, respectively. In contrast, 85.4% (n = 47), 89.1% (n = 49), and 54.6% (n = 30) of female students had moderate to extremely severe symptoms of depression, anxiety, and stress, respectively. No correlations were found between diet quality and BMI with students’ mental health problems. For male students, there were negative significant associations reported between fat-rich foods (r = -0.447, p-value = 0.001) and sugar-rich foods (r = -0.332, p-value = 0.020) intake with depression; a positive significant relationship between fruit intake and anxiety (r = 0.284, p-value = 0.048); a positive relationship between fruit intake and stress (r = 0.300, p-value = 0.036); and a negative relationship between fat-rich foods and stress (r = -0.293, p-value = 0.041). Female students only had a significant negative correlation between fish intake and anxiety (r = -0.376, p-value = 0.005). Conclusion: No associations were found between diet quality, BMI, and mental health problems. A more profound comprehension of the connections between risk factors and mental health could lead to new intervention strategies.

A multivariate generalizability analysis of the short version of depression-anxiety-stress scale / 中华行为医学与脑科学杂志

Objective:To test the reliability of the short version of the depression-anxiety-stress scale (DASS-21) in adolescents through generalizability theory.Methods:Total of 458 adolescents from three middle schools in Guizhou and Sichuan province were surveyed with the DASS-21 from November to December 2021.Based on multivariate generalization theory(MGT), the generalization coefficients, reliability indexes and variance contribution ratios were calculated.mGENOVA 2.1 was used for data analysis.Results:The generalizability coefficient and reliability index for the total scale of DASS-21 were 0.927 and 0.922, respectively.The generalizability coefficients of depression, anxiety and stress subscales were 0.808-0.840, and the dependability indexes were 0.789-0.832.The contribution ratios of depression, anxiety and stress subscales to the general score were 33.20%, 33.94% and 32.86%, respectively.The stress subscale (34.95%) contributed the most to the relative error variance, and the anxiety subscale (36.98%) contributed the most to the absolute error variance.Conclusion:The DASS-21 has excellent test reliability in adolescents, and it can be used both as the norm-referenced test and the criterion-referenced test in the actual assessment of negative emotions in adolescents.

Anxiety, Depression and Stress Among Medical Students in Malaysia During COVID-19: A Cross-Sectional Study

@#Introduction: This study aimed to determine the prevalence and factors associated with psychological distress following the COVID-19 pandemic among medical students at one of the public universities in Malaysia. Method: From August to October 2020, a web-based cross-sectional study was conducted among undergraduate medical students at a public university. DASS-21, Brief Resilience Scale and WHOQOL-Bref questionnaires were used in this study. Results: The prevalence of depression was 40.5%, anxiety 46.0% and stress 30.9%. Based on multivariate logistic regression, a higher quality of life score is associated with a lower likelihood of depression (AOR=0.583, p<0.001), anxiety (AOR=0.726, p<0.001), and stress, (AOR=0.702, p<0.001) respectively. Likewise, a higher resilience score is less likely to be associated with depression (AOR=0.880, p=0.002), anxiety (AOR=0.880, p=0.002), and stress (AOR=0.850, p<0.001). Older age (OR=0.700, p=0.020) was associated with less stress and being on campus (OR=3.436, p=0.021) was at risk of stress during the COVID-19 pandemic. Conclusion: Our results suggest that medical students with higher quality of life and resilience scores had less depression, anxiety and stress. Older age was associated with less stress, and during the COVID-19 pandemic, being on campus was at risk of stress. Various stakeholders need to keep these findings in mind and identify those who are at risk for developing depression, anxiety, and stress in order to take further action to improve their quality of life and resilience

Multiple linear regression approach to deduce Internet addiction impact on the psychosocial wellness of young medical students

Background: The Internet is an inevitable part of life especially in the education sector, but at the same time irrational use of the Internet causes behavioral disorders. A high number of personality disorders such as impulsive behavior, depression, anxiety, and stress were also observed among medical students. Aim and Objectives: Hence, the present study hypothesized to find out the association of depression, anxiety, and stress with Internet addiction (IA) among young medical students. Materials and Methods: A cross-sectional survey was conducted among 250 1st-year medical students after taking ethics approval and written informed consent. Personal information and socio-demographic profile of participants were obtained. Young IA Test and Depression Anxiety Stress Scale (DASS-21) survey questionnaire was self-administered by participants. To identify the risk and protective factors for IA with DASS-21 step-wise multiple linear regression analyses were performed. Results: The prevalence of IA was 24.0 % with mean scores (±Standard Deviation [SD]) of 39.01 (±16.99) among the medical students. Depression, anxiety, and stress mean scores (±SD) were 5.44 (±4.21), 4.94 (±3.84), 6.77 (±3.83), respectively. Students with IA had a statistically significant difference (P = 0.001) in all domains of DASS-21 over the non-internet addicted. A statistically significant positive relationship of IA with depression (coefficient of determination (R2), (R2 = 0.22)), anxiety (R2 = 0.26), and stress (R2 = 0.33) were observed. Conclusions: 1/4th of the medical students were internet-addicted and 3.0% having severe anxiety. 22.0% of depression, 26.0% of anxiety, and 33.0% of stress among young medical students are attributable to IA. The rational use of the internet should be learned for psychological health and well-being.

Salud mental de médicos y enfermeras en situaciones de crisis sanitaria / Mental health of doctors and nurses in health crisis situations

RESUMEN Introducción: La pandemia de la COVID-19 ha generado muchas repercusiones en la salud mental de la población, sobre todo en aquellos que se encuentran trabajando en la primera línea de atención. Objetivo: Caracterizar al personal de la salud de primera línea, según el nivel de depresión, ansiedad y estrés, en el contexto de la pandemia por la COVID-19. Métodos: Estudio observacional, descriptivo y transversal. Se encuestó a profesionales de la salud involucrados en la atención de primera línea a pacientes COVID-19 en áreas críticas, entre octubre y diciembre de 2020. Se utilizó la Escala de depresión, ansiedad y estrés para medir las variables dependientes; además, se recolectaron las variables epidemiológicas: sexo, edad y tipo de profesión. Se realizó un análisis descriptivo de los datos mediante tablas de frecuencias/porcentajes y tablas cruzadas. Resultados: De los 86 médicos y enfermeros encuestados, el 36,05 % presentaba depresión, a predominio del nivel moderado, 55,81 % presentaba ansiedad a predominio del nivel leve y 53,49 % presentaba estrés, a predominio del nivel leve. Se encontraron mayores niveles de depresión (71 %), ansiedad (75 %) y estrés en el personal del sexo femenino (73,91 %), en el grupo etario de 41-60 años se encontraron mayores niveles de estrés (64,52 %), ansiedad (64,58 %) y estrés (30,43 %); en el grupo profesional de enfermeros se encontraron mayores niveles de depresión (67,71 %), ansiedad (72,92 %) y estrés (67,39 %). Conclusión: De los 3 trastornos psicopatológicos estudiados en los profesionales de la salud, se presenta en mayor porcentaje la ansiedad, seguido del estrés y la depresión. Los participantes de sexo femenino, el grupo etario de 41-60 años y los enfermeros, presentan mayores niveles de depresión, ansiedad y estrés.

ABSTRACT Introduction: The COVID-19 pandemic has generated many repercussions in the mental health of the population, especially in those working in the front line of care. Objective: To characterize front-line health care personnel according to the level of depression, anxiety, and stress in the context of the COVID-19 pandemic. Methods: Observational, descriptive, cross-sectional study. Health professionals involved in the first-line care of COVID-19 patients in critical areas were surveyed between October and December 2020. The Depression Anxiety and Stress Scale was used to measure the dependent variables; in addition, epidemiological variables were collected: sex, age and type of profession. A descriptive analysis of the data was performed using frequency/percentage tables and cross tables. Results: Of the 86 physicians and nurses surveyed, 36.05 % presented depression, predominantly at the moderate level, 55.81 % presented anxiety, predominantly at the mild level, and 53.49 % presented stress, predominantly at the mild level. Higher levels of depression (71 %), anxiety (75 %) and stress were found in female personnel (73.91 %), in the 41-60 age group higher levels of stress (64.52 %), anxiety (64.58 %) and stress (30.43 %) were found, and in the professional group of nurses higher levels of depression (67.71 %), anxiety (72.92 %) and stress (67.39 %) were found. Conclusion: Of the 3 psychopathological disorders studied in the health professionals, the one with the highest percentage is anxiety, followed by stress and depression. Female participants, the 41-60 years age group, and nurses have higher levels of depression, anxiety and stress.

Auriculoterapia em profissionais de enfermagem na pandemia do coronavírus: estudo de casos múltiplos / Auriculotherapy in nursing professionals during the coronavirus pandemic: a multiple case study

Objetivou avaliar o efeito antes e depois de uma sessão de auriculoterapia nos níveis de ansiedade, depressão e estresse nos profissionais de enfermagem escalados para atuar na assistência durante a pandemia do coronavírus. Estudo de caso, com casos múltiplos e uma unidade de análise. Estabeleceu-se uma amostra por conveniência de 41 profissionais. Aplicou-se o instrumento de caracterização sociodemográfica e a escala de Depression, Anxiety, and Stress Scale, antes e após uma sessão de auriculoterapia com protocolo de 10 acupontos. Teste de Wilcoxon e T emparelhado foram empregados para análise. Níveis de ansiedade, depressão e estresse apresentaram resultados significativos, cujas medianas reduziram de seis para quatro (p<0,001), nas variáveis depressão e ansiedade, e a média de estresse reduziu de 19,37 para 11,95 (p<0,001). A auriculoterapia foi efetiva na redução de distúrbios emocionais nos profissionais de enfermagem.

This study aimed to evaluate the levels of anxiety, depression and stress before and after an auriculotherapy session, in nursing professionals working during the coronavirus pandemic. Case study, with multiple cases and one unit of analysis. A convenience sample of 41 professionals was established. The sociodemographic characterization instrument and the Depression, Anxiety, and Stress Scale were applied before and after an auriculotherapy session with a 10-acupoint protocol. The Wilcoxon and t tests were paired for analysis. Anxiety, depression and stress levels showed significant results, the medians decreased from six to four (p<0.001), in the variables depression and anxiety, and the average stress decreased from 19.37 to 11.95 (p<0.001). Auriculotherapy was effective in reducing emotional disorders in nursing professionals.

Depression, Anxiety, and Stress among Students in Newly Established Remote University Campus in Indonesia

@#Introduction: Studies show that many university students experience common mental health problems, such as depression, anxiety, and stress. In severe cases, these problems can cause disability that may hinder youths from achieving their potential academic or career development. This study aims to measure the occurrence and levels of depression, anxiety, and stress and their determinants among undergraduate students of a recently established remote campus in Indonesia. Methods: This cross-sectional study was conducted in Banyuwangi, East Java from September- December 2017. Exactly 229 students were randomly selected using cluster sampling. Mental health status was measured using Depression, Anxiety, and Stress Scale. We used multivariable logistic regression to determine factors related to depression, anxiety, and stress. Results: The prevalence of depression, anxiety, and stress were 25.0%, 51.1%, and 38.9% respectively among these students. Level of education was associated with depression and stress, but not with anxiety. The fifth semester students had significantly greater odds of depression (AOR = 2.27; 95% CI: 1.04-4.93; p value = 0.04) and stress (AOR =2.18; 95% CI: 1.10-4.37; p value = 0.03) compared to the seventh semester students. No variables were significantly associated with the occurrence of anxiety. Conclusion: Fifth semester students had a greater risk for depression, anxiety, and stress compared to students at a higher level of education. The present study highlights the need for policies in new universities to provide a routine psychological support and counseling for students undergoing semesters that place greater mental burden.

Risk Factors of Depression, Anxiety and Stress Among Adults Attending Primary Health Clinics in an Urban Area in Klang Valley, Malaysia

@#Introduction: Mental health problem is an important public health issue which causes deterioration in quality of life, function and financial capabilities. According to the National Health and Morbidity Survey (NHMS) 1996, the prevalence of mental problem among adults in Malaysia was 10.7% and this has increased to 29.2% in NHMS 2015. The aim of this study was to evaluate the burden of depression, anxiety and stress among adults in a city in Klang Valley, Malaysia including its associated factors. Methods: A cross-sectional study was conducted by analysing secondary data obtained from screening program performed in six primary health clinics in the city throughout 2016. There were 576 adults participated in the screening program which consisted of mental health screening using Depression, Anxiety, Stress 21 (DASS-21) questionnaire and health status screening using Health Status Screening Form. Results: The prevalence of depression was 20.5%, anxiety was 44.5%, while stress was 10.1%. By using logistic regression, history of being abused was the only significant protective factor associated with depression, anxiety and stress with OR of 0.062 (95% CI 0.007; 0.563, p=0.004), OR of 0.001 (95% CI 0.000; -, p=0.001) and OR of 0.026 (95% CI 0.003; 0.238, p<0.001) respectively. Other independent variables were not statistically significant. Conclusions: As conclusions, surprisingly the risk of depression, anxiety and stress were not increased among participants who reported history of being abused. This was probably due to good coping mechanism among them. Nevertheless, early intervention needs to be emphasized to prevent mental disorders among this group of people in community.

Empowering Single Mothers through Creative Group Counselling: An Effective Intervention to Improve Mental Wellbeing

@#Introduction: Single parent families, especially, those headed by single mothers are becoming increasingly common around the world especially in Malaysia. Single mothers generally suffer from poorer mental health, job discrimination, abuse and neglect. Hence, they often experience high anxiety, depression, and stress. This calls for research to empower their mental wellbeing. The present study examined the effectiveness of creative group counselling in increasing self-compassion, and decreasing depression, anxiety and stress among single mothers. Methods: A quasi experimental pre-test post-test design was employed in the study. Research participants consisted of 36 single mothers placed in two experimental and two control groups. The instruments used were Self-Compassion Scale and Depression Anxiety and Stress Scale. A self-compassion module was developed that comprised creative therapeutic activities which was administered to the participants in the experimental groups via a 7-session group counselling programme. Participants in the control groups, on the other hand, took part in guidance activities. Semi structured interviews were also performed to gather feedback on the impact of the creative intervention from three single mothers. Results: Findings revealed that creative group counselling successfully increased the level of self-compassion among single mothers. Additionally, the depression, stress and anxiety scores of single mothers were lower after joining the group counselling programme. Furthermore, three themes emerged from the present study which are i) be kind to oneself; ii) mistakes are part of life; and iii) self-transformation. Conclusion: It is evident that the implementation of creative group counselling improves the mental wellbeing of single mothers.

Effectiveness of Progressive Muscle Relaxation in Reducing Depression, Anxiety and Stress among Haemodialysis Patients attending a Public Hospital at Central Java Indonesia

@#The increasing trend of Chronic Kidney Disease (CKD) prevalence in Indonesia is a public health concern as it increases mortality, morbidity and burden of disease that has great implication on the health economic. In addition, CKD patients who are more likely to undergo hemodialysis is commonly associated with psychological problems such as depression, anxiety and stress and these have added more to the disease burden. Immediate measures such as progressive muscle relaxation (PMR) to reduce the psychological symptoms is of great importance before the symptoms progress into psychiatric disorders. The study was aimed to evaluate the effectiveness of PMR in reducing symptoms of depression, anxiety and stress among patients undergoing hemodialysis. It was a quasi-experimental, pretest-posttest control study that recruited 60 eligible respondents who underwent hemodialysis and was randomly allocated into intervention and waitlist control groups. Respondents in the intervention group performed PMR twice a day for two weeks. Mean scores of depression, anxiety and stress of respondents were examined before and after intervention using Depression, Anxiety and Stress Scale–21 questionnaire (DASS-21). Results showed that mean scores of depression, anxiety and stress differed significantly before and after intervention between groups and within the intervention group (p<0.05). PMR was effective to reduce the psychological symptoms among patients underwent hemodialysis. This highlight the importance to screen psychological symptoms among those patients and PMR should be taught to them as one of the stress-reducing measures.

Application of the short version of depression-anxiety-stress scale to stress assessment on students after earthquake / 中华行为医学与脑科学杂志

Objective To test the reliability and validity of the short version of depression-anxiety-stress scale (DASS-21) for students in the disaster region.Methods DASS-21 and the Chinese version of UCLA PTSD Reaction Index for DSM-IV,Revision I were used to evaluate psychological health among 876 students from grades 5 to 9 after Ya' an earthquake.Results (1) Each of the items had a good distinction degree,with CR value ranging from 9.268 to 22.438 (P＜ 0.01),and the correlation coefficients ranged from 0.306 to 0.742.(2)The Cronbach' s alpha coefficients ranged from 0.781 to 0.911.(3) The correlation coefficients between total score and each dimension ranged from 0.714 to 0.914,and the correlation coefficient between PTSD and total DASS score,depression anxiety and stress score was 0.626-0.774.(4)Through the item analysis and explore factor analysis,the revised scale contained 21 items and 3 subscales which could explain 47.813％ of the total variance(KMO =0.937,x2 =3126.85,df=210,P＜0.01),and the results of confirmatory factor analysis supported the three-factor model (x2/df=4.180,P＜0.01,PCFI =0.728,CFI =0.904,IFI =0.905,TLI =0.881,and RMSEA =0.060),and the load of each item was between 0.339 to 0.715.Conclusion The short version of DASS-21 is reliable and valid,and can be used as a tool for post-disaster stress assessment on local students.

Psychological distress and fertility quality of life (FertiQoL) in infertile Korean women: The first validation study of Korean FertiQoL / 대한생식의학회지

OBJECTIVE: To investigate psychological distress and fertility quality of life (FertiQoL) in infertile Korean women, and to investigate whether a correlation exists between psychological distress and FertiQoL. METHODS: Participants in this study were made up of 141 infertile women and 65 fertile women. We conducted a survey on psychological distress (using the Depression Anxiety Stress Scales [DASS]-42 questionnaire) and administered a FertiQoL questionnaire. The levels of stress hormones (adrenocorticotropic hormone [ACTH] and cortisol) in serum were assessed. RESULTS: The scores for depression (13.7±8.4), anxiety (10.7±6.4), and stress (18.0±8.3) among the infertile women were significantly higher than the scores for depression (9.4±7.5), anxiety (6.6±6.0), and stress (12.2±8.3, p<0.001) among the fertile women. There was no difference in the scores for depression (13.5±8.2, 13.8±8.6), anxiety (10.0±6.2, 11.5±6.6) and stress (17.7±8.4, 18.4±8.1) between younger (≤34) and older (≥35) participants. The mind-body (r =–0.495) and emotional (r =–0.590) subscales showed a higher negative correlation with stress compared with other scales of psychological distress. At the same time, the social (r =–0.537) and relational (r =–0.385) subscales showed a higher negative correlation with depression. Levels of cortisol and ACTH in infertile women were 9.1 µg/mL and 11.9 pg/mL, respectively, which are within normal ranges. CONCLUSION: The levels of psychological distress and quality of life in infertile Korean women seem to require psychological intervention. This study provides a baseline measurement of psychological distress and FertiQoL in infertile women in Korea, which will be available for developing psychological interventions for infertile Korean women.

Concurrent Validity Of The Depression And Anxiety Components In The Bahasa Malaysia Version of The Depression Anxiety and Stress Scales (DASS)

Scales 21-item (DASS-21) has been widely used ever since the establishment of its validity. To consolidate the evidence of the BM DASS-21 validity by examining its concurrent validity. Methods: The BM DASS was administered together with the Hospital Anxiety and Depressive Scale (HADS) to a total of 246 patients at International Islamic University Malaysia (IIUM) Infertility Centre. Results: The anxiety domain of BM DASS-21 had good correlation with anxiety domain in HADS (0.61) but for DASS depressive domain, it had modest correlation with its respective domain in HADS (0.49). Conclusions: The results of this study further ensconced the evidence that the BM DASS-21 had relatively satisfactory psychometric properties for clinical subjects in Malaysia.

Translation, validation and psychometric properties of Bahasa Malaysia version of the depressive anxiety and stress scales (DASS)

Background: Up to date, there are handful questionnaires that have been validated in Bahasa Malaysia (BM). This study aimed to translate the Depression Anxiety Stress Scales 21-item (DASS-21) and measure its psychometric properties. Objectives: To determine the construct validity and acceptability of the DASS, BM. Methods: Two forward and backward translations were done in BM in accordance to guideline, and its validation was determined by using confirmatory factor analysis. A total of 263 subjects were selected by systematic random sampling to represent Malaysian population for reliability and validity purposes. Results: The BM DASS-21 had very good Cronbach’s alpha values of .84, .74 and .79, respectively, for depression, anxiety and stress. In addition, it had good factor loading values for most items (.39 to .73). Correlations among scales were between .54 and .68. Conclusions: BM DASS-21 is correctly and adequately translated to Bahasa Malaysia with high psychometric properties. Further studies are required to support these findings.