Procrastination, depression and anxiety symptoms in university students: a three-wave longitudinal study on the mediating role of perceived stress.

BACKGROUND: It is generally assumed that procrastination leads to negative consequences. However, evidence for negative consequences of procrastination is still limited and it is also unclear by which mechanisms they are mediated. Therefore, the aim of our study was to examine the harmful consequences of procrastination on students' stress and mental health. We selected the procrastination-health model as our theoretical foundation and tried to evaluate the model's assumption that trait procrastination leads to (chronic) disease via (chronic) stress in a temporal perspective. We chose depression and anxiety symptoms as indicators for (chronic) disease and hypothesized that procrastination leads to perceived stress over time, that perceived stress leads to depression and anxiety symptoms over time, and that procrastination leads to depression and anxiety symptoms over time, mediated by perceived stress. METHODS: To examine these relationships properly, we collected longitudinal data from 392 university students at three occasions over a one-year period and analyzed the data using autoregressive time-lagged panel models. RESULTS: Procrastination did lead to depression and anxiety symptoms over time. However, perceived stress was not a mediator of this effect. Procrastination did not lead to perceived stress over time, nor did perceived stress lead to depression and anxiety symptoms over time. CONCLUSIONS: We could not confirm that trait procrastination leads to (chronic) disease via (chronic) stress, as assumed in the procrastination-health model. Nonetheless, our study demonstrated that procrastination can have a detrimental effect on mental health. Further health outcomes and possible mediators should be explored in future studies.

Physical and psychosocial factors are crucial for maintaining physical and mental health in endometriosis: a longitudinal analysis.

OBJECTIVE: To test the associations of physical and psychosocial factors with physical and mental health in individuals living with endometriosis (EM) by means of cross-sectional and longitudinal analyses. METHODS AND MEASURES: Data were gathered via an online survey between February and August 2021. At survey date t1, sociodemographic, EM-related and psychosocial factors as well as physical and mental health of people with EM were assessed. At survey date t2 three months later, physical and mental health was reassessed. The sample consisted of n_t1 = 723 (30.60 ± 6.31 years) and n_t2 = 216 (30.56 ± 6.47 years) cis women with EM. Statistical analyses included bivariate and partial correlation analyses and hierarchical regression analyses. RESULTS: The participants' physical health was within the average range and their mental health was below-average at t1 and t2. Cross-sectional analyses revealed that worse health was associated with longer diagnostic delay, more surgeries, greater pelvic pain and lower sense of coherence, self-efficacy, sexual satisfaction and satisfaction with the gynecological treatment. In longitudinal analyses, pelvic pain and participants' satisfaction with the gynecological treatment remained significantly associated with health. CONCLUSION: Treatment should address both pelvic pain and psychosocial factors to improve long-term physical and mental health in EM.

[The Role of Specific Study-Related Demands and Resources to Student Health and Life Satisfaction]. / Die Bedeutung spezifischer studienbedingter Anforderungen und Ressourcen für die Gesundheit und Lebenszufriedenheit von Studierenden.

BACKGROUND: Studies report an association between study conditions and student health outcomes. The aim was to investigate the influence of specific study-related demands and resources on self-assessed health. METHOD: Students of the Technical University of Dresden were surveyed online about their health and their studies. Referring to the Study Demands-Resources Model descriptive and regression analytic methods were applied. RESULTS: 1,312 students were included in the analyses. About one-fifth of participants reported low life satisfaction and high exhaustion. Time and cognitive demands were associated with poorer health, social support and time margin in studies were linked to better health. This relationship was particularly evident with a combination of high demands and low resources. CONCLUSION: The results provide approaches for preventive measures to strengthen the health of students.

["Shifting the Curve": New Developments and Challenges in the Field of Public Mental Health]. / "Shifting the Curve": Neue Entwicklungen und Herausforderungen im Bereich der Public Mental Health.

In recent years, the field of public mental health has received increasing attention in national and international research. However, a key challenge remains to map this field in its interdisciplinarity across the entire spectrum of mental health and lead the discourse between public health, psychiatric epidemiology, mental health promotion, prevention, and health services research in order to realize more fully its innovative potential for improving mental health at the population level. In this interdisciplinary discourse, a number of fundamental conceptual and methodological issues arise, which will be discussed in this essay in relation to Geoffrey Rose's population strategy. In a national initiative across relevant learned societies that has recently been formed, these issues are currently starting to be addressed, also in relation to fundamental causes of social and health inequalities, which ultimately is geared towards more tangible strategies for improving mental health at the population.

Chronic Pelvic Pain in Endometriosis: Cross-Sectional Associations with Mental Disorders, Sexual Dysfunctions and Childhood Maltreatment.

The aim of this cross-sectional study was to compare the rates of mental disorders, sexual dysfunctions and childhood maltreatment (CM) in women with endometriosis with either chronic pelvic pain (CPP) or minimal to no pelvic pain. Additionally, two models to predict a current mental disorder were tested, including pelvic-pain-related or psychosocial predictor variables. We examined 100 women with confirmed endometriosis (group CPP, n = 50; group NOPAIN, n = 50). Participants responded to a comprehensive questionnaire and the Childhood Trauma Questionnaire. The Diagnostic Interview for Mental Disorders was used to assess mental disorders according to DSM-5 and to screen for sexual dysfunctions. The mean age was 28.8 ± 5.6 (CPP)/2.7 ± 6.3 (NOPAIN). Participants with CPP had higher rates of current mental disorders (p = 0.019), lifetime mental disorders (p = 0.006) and sexual dysfunctions (p < 0.001), but not CM (p = 0.074). In two binary-logistic regression analyses, a greater need for pain relief (aOR = 4.08, p = 0.026) and a sexual dysfunction (aOR = 2.69, p = 0.031) were significant predictors for a current mental disorder. Our findings confirmed the crucial role of pelvic pain for mental and sexual well-being in endometriosis. They highlight the need for pain relief and interdisciplinary care in the treatment of endometriosis.

Comorbidities and psychosocial factors as correlates of self-reported falls in a nationwide sample of community-dwelling people aging with HIV in Germany.

BACKGROUND: Falls are a frequent health problem with potentially severe consequences among the elderly. Due to the aging HIV population, there is a growing interest in falls as a geriatric syndrome in HIV research and clinical practice. Previous studies found rather high prevalences of falls in this population and focused on biomedical and demographic risk factors for falls. Psychosocial risk factors like stigma, social support or loneliness were not previously assessed as correlates of fall events in this population. METHODS: We assessed self-reported fall frequency in the past 12 months in a nationwide sample of 897 community-dwelling people aged 50 years or older living with HIV in Germany using a cross-sectional study design. We calculated odds of any fall for sociodemographic and HIV-related variables in bivariate analyses and for comorbidities, and psychosocial variables in bivariate and adjusted analyses. RESULTS: Eighteen percent of our participants reported at least one fall in the preceding 12 months, 12 % reported recurring falls. A lower socioeconomic status, being single and living alone were significantly associated with a higher risk for falling. An AIDS diagnosis was related to fall risk, but time since diagnosis and a detectable viral load were not. Reporting at least one comorbidity increased fall risk in our sample 2.5 times (95% CI: 1.59; 3.97). The strongest association with fall risk was found for diseases of the central nervous system, heart disease, rheumatism, osteoporosis, and chronic pain. Experienced HIV stigma (AOR: 2.11; 95% CI: 1.58; 2.83) and internalized HIV stigma (AOR: 1.43; 95% CI: 1.12; 1.85), as well as social support (AOR: .92; 95% CI: .86; .99) and loneliness (AOR: 1.51; 95% CI: 1.22; 1.87) were significantly related to fall risk in bivariate and adjusted analyses. CONCLUSIONS: We found a low prevalence of falls in our sample of community-dwelling people aging with HIV. Our results show evidence for a strong association between comorbidity and falling, and between psychosocial factors and falling. Especially the strong association between experienced HIV stigma and fall risk is noteworthy and adds falls to the list of health outcomes affected by HIV stigma.

Sociodemographic, HIV-Related Characteristics, and Health Care Factors as Predictors of Self-Reported Vaccination Coverage in a Nationwide Sample of People Aging with HIV in Germany.

Preventing infectious diseases through vaccination becomes more significant among the growing population of people aging with HIV. Coverage rates for vaccinations and factors associated with vaccination utilization among this population in Germany are unknown. We assessed the coverage of eight recommended vaccinations in a certain time frame in our convenience sample of 903 people living with HIV aged 50 years and older. We analysed coverage rates and used bivariate and multiple linear regression analyses to identify factors associated with number of reported vaccinations. Coverage rates in our sample ranged between 51.0% for meningococcus disease and 84.6% for the triple vaccination against tetanus, diphtheria, and pertussis. All rates were higher compared to the German general population. Seven factors were related to the number of vaccinations in multiple regression analysis: sexual orientation, education, relationship status, CD4 count, time since last visit to HIV specialist, type of HIV specialist, and distance to HIV specialist. Vaccination coverage among people aging with HIV in Germany is high, but not optimal. To improve vaccination uptake, strengthened efforts need to be focused on female and heterosexual male patients, socioeconomically disadvantaged patients, and patients with barriers to access regular HIV care.

Finding the Right Balance: A Social Norms Intervention to Reduce Heavy Drinking in University Students.

Introduction: Heavy alcohol consumption constitutes a major health risk among University students. Social relationships with peers strongly affect University students' perception of the drinking behavior of others, which in turn plays a crucial role in determining their own alcohol intake. University students tend to overestimate their peers' alcohol consumption - a belief that is associated with an increase in an individual's own consumption. Therefore, we implemented a social norms intervention with personalized normative feedback at a major University in Germany to reduce and prevent excessive drinking among University students. Methods: Our intervention was part of a regular health monitoring survey. We invited all enrolled University students to take part in this survey on two occasions. A total of 862 University students completed the questionnaire, 563 (65.3%) of which received e-mail-based feedback upon request concerning their peers' and their own alcohol consumption. For the intervention group (n = 190) as well as the control group (no feedback requested; n = 101), we included only University students in the evaluation who overestimated their peers' alcohol use and indicated above average consumption of the peers. We applied analyses of variance to assess intervention effects with regard to the correction of overestimated group norms as well as University students' drinking behavior. Results: Within the intervention group, we observed a significantly larger reduction of the previously overestimated behavioral norms compared to the control group (p < 0.001; ηp2 = 0.06). With regard to behavioral outcomes the intervention group showed a significantly larger reduction in the AUDIT-C score (p = 0.020; ηp2 = 0.03). Discussion: Our study confirms previous research whereupon personalized, gender-specific and selective normative feedback is effective for alcohol prevention among University students. However, University students still overestimated their peers' alcohol intake after the intervention. Furthermore, we did not reach high-risk groups (University students with the highest alcohol intake) since no feedback was requested. Future studies should address factors influencing the impact of the intervention and reachability of selective groups.

Time Pressure and Health-Related Loss of Productivity in University Students: The Mediating Role of Exhaustion.

Introduction: Being present at work when sick is not just prevalent in employees. Since university is also a demanding context, there is a growing interest in this phenomenon in university students. Especially students with mental health issues show a higher degree of productivity loss. However, little research has examined the causes of these productivity losses-especially in university students. Therefore, we examined health-related (burnout) and non-health-related (time pressure) aspects that lead to productivity losses in the long run. Methods: We decided to examine the effect from time pressure on health-related loss of productivity, mediated by exhaustion. This assumption is in line with the health impairment process proposed by the Study Demands-Resources (SD-R) framework. To examine this assumption properly, we conducted a longitudinal study with three occasions. We surveyed 392 students in three waves over 1 year and performed structural equation modeling (SEM) to confirm the assumptions longitudinally. Results: In line with our assumptions, time pressure predicted burnout which, in turn, predicted health-related loss of productivity in the long run. Hence-as assumed by the SD-R framework-burnout serves as a mediator between study demands and negative outcomes such as loss of productivity. Discussion: Our study is the first that uncovers health-related and non-health-related causes of health-related productivity loss in university students. Thus, we were able to confirm SD-R's health impairment process longitudinally. Since we know that time pressure serves as a major antecedent for burnout and health-related loss of productivity, we are well-advised to establish appropriate interventions to reduce students' time pressure.

Associations Between Experienced and Internalized HIV Stigma, Adversarial Growth, and Health Outcomes in a Nationwide Sample of People Aging with HIV in Germany.

HIV-related stigmatization and adversarial growth are known to influence health outcomes in people living with HIV. But not much is known how these psychosocial factors are related to each other and how they interact to influence health outcomes. We tested whether the effect of experienced and internalized stigma on mental health and self-rated health is mediated by adversarial growth, and whether each of these factors is uniquely associated with health outcomes. In our sample of 839 people aging with HIV in Germany based on a cross-sectional study design we did not find an indirect effect of experienced HIV stigma on health outcomes and a very small indirect effect of internalized HIV stigma. All variables were significant predictors of health outcomes in multiple regression analyses.

RESUMEN: Se sabe que el estigma y el crecimiento postraumático asociados al VIH influyen en los indicadores del estado de salud de las personas que viven con el virus. Sin embargo, se desconoce cómo estos factores psicosociales se relacionan entre sí, y cómo interactúan sobre los indicadores del estado de salud. En este estudio comprobamos si los efectos de la experiencia e internalización del estigma sobre la salud mental y la evaluación subjetiva del estado salud están mediados por el crecimiento postraumático, así como el impacto único de cada uno de estos factores sobre los indicadores de salud. Usando un diseño de estudio transversal en una muestra de 839 personas que viven con VIH en Alemania, no encontramos un efecto indirecto del estigma experimentado en los indicadores de salud, pero sí, un efecto indirecto muy pequeño del estigma internalizado. Todas las variables se mostraron predictores significativos de los resultados de salud en un análisis de regresión múltiple.

The Study Demands-Resources Framework: An Empirical Introduction.

Based on the well-established job demands-resources (JD-R) framework, in our study we introduce the novel study demands-resources (SD-R) framework. The SD-R framework allows the study of salutogenic and pathogenic effects of university settings on students' health and well-being. Using a large sample of university students (n = 5660), our aim was to translate and validate the JD-R's essential assumptions within the university context, and thus establish the SD-R framework. We performed structural equation modelling to examine these essential assumptions. As assumed, we found that study demands-the "bad things" at university-predict student burnout (ß = 0.50), whereas study resources-the "good things" at university-predict student engagement (ß = 0.70) as well as burnout (ß = -0.35). Also, in line with the SD-R's assumptions, student burnout predicts life satisfaction negatively (ß = -0.34), whereas student engagement predicts life satisfaction positively (ß = 0.29). Hence, we were able to introduce the novel SD-R framework and validate its core assumptions. The SD-R framework serves as an excellent theoretical basis to examine both the salutogenic and pathogenic effects of the study context on students' health and well-being. However, the framework needs further longitudinal and meta-analytical verification in accordance with the research on the JD-R framework.

Social inequalities in health-related quality of life among people aging with HIV/AIDS: the role of comorbidities and disease severity.

PURPOSE: While socioeconomic inequalities in health-related quality of life are well documented in the scientific literature, research has neglected to look into the reasons for these inequalities. The purpose of this study is to determine in what way social inequalities in health-related quality of life among patients with the same chronic disease could be explained by variations in disease severity. METHODS: We used the data of 748 people aging with HIV in Germany who took part in the nationwide study 50plushiv and provided self-report data on socioeconomic status, health-related quality of life (SF-12) and various markers of disease severity (comorbidity, falls, late presentation and AIDS diagnosis). Regression analyses were applied to determine the impact of SES on HRQOL after adjusting for disease severity variables. RESULTS: The mental and physical subscales of the SF-12, comorbidity burden and falls were significantly related to SES. SES explained 7% of the variance in PCS scores and 3% of the variance in MCS scores after adjusting for age and time since diagnosis. Markers of disease severity explained 33% of the variance in PCS scores and 14% of the variance in MCS scores. After adjusting for disease severity SES was still significantly related to PCS and MCS scores. CONCLUSIONS: The diverse sample of people aging with HIV showed social inequalities regarding HRQOL and most of the disease severity markers. SES was significantly related to mental and physical HRQOL after adjusting for disease severity. Possible explanations for this phenomenon are discussed.

More than 20 years of research into the quality of life of people with HIV and AIDS--a descriptive review of study characteristics and methodological approaches of published empirical studies.

BACKGROUND: The quality of life of people living with HIV and AIDS (PLWHA) is becoming increasingly important--a fact that is also reflected in extensive research efforts. Owing to the almost complete lack of systematic integration of research findings, it is hardly possible to provide an overview of the current status of research, or to derive valid statements about research results. METHODS: A literature search regarding the quality of life of PLWHA was performed in two international research databases. After checking their relevance, 852 publications appearing in scientific journals and explicitly measuring the quality of life of PLWHA were categorized on the basis of various study characteristics. RESULTS: The number of publications per year in our study pool has been rising steadily since 1989. Well over 40 established instruments were used to determine the quality of life, most frequently the MOS-HIV, followed by the SF-36. The great majority of the studies are correlation studies. CD4 cells, gender, and age are the most common variables for which correlations with quality of life are reported. CONCLUSIONS: Our descriptive review stresses both the increasing significance and the challenges of research into quality of life of PLWHA such as the great variety of instruments used. The limits of this review are discussed and we conclude with the formulation of research desiderata concerning comparative review studies on instruments and systematic reviews of frequent research questions.

The effects of a clinical care pathway for schizophrenia: a before and after study in 114 patients.

BACKGROUND: The implementation of clinical guidelines in care pathways is being promoted for quality assurance in psychiatry and psychotherapy, as in other medical fields. The achievable benefits are disputed and are generally thought to be small. There have been hardly any studies of the effect of clinical care pathways on the costly inpatient treatment of schizophrenic psychoses. METHODS: We conducted a prospective, controlled, before and after study in 114 patients with schizophrenia to determine whether the implementation of a pathway would improve diagnosis and treatment in conformity with published guidelines, and whether there would be any associated improvement in outcome. The patients' course was extensively documented with a number of structural, process-related, and outcome-related variables in the years before and after pathway implementation. Moreover, two different intensive methods of pathway implementation were tested. Data were collected from 2003 to 2005. The primary indicators of outcome quality included pharmacotherapy-related variables and assessments of treatment efficacy by the physicians, the nurses, and the patients themselves. RESULTS: After pathway implementation, some diagnostic tests that had been performed only rarely beforehand were performed much more often. The percentage of over- or undermedicated patients, as defined by the treatment pathway, declined markedly. Surprisingly, however, the patients' multidimensionally documented psychopathological course and their subjective judgments of their condition were worse after pathway implementation than before on all four scales that were used to assess these variables. CONCLUSION: The implementation of a treatment pathway brought about a robust change in process-related variables. The findings of this study furnish no explanation for the observed decline in treatment efficacy.