A Mental Health Pandemic? Assessing the Impact of COVID-19 on Young People's Mental Health.

BACKGROUND: Research indicates that young people have been a particularly vulnerable group when it comes to negative mental health outcomes following COVID-19, with some authors warning of a 'mental health pandemic'. MATERIALS AND METHOD: Using a survey approach, this study explored the effects of lockdowns on the mental health of 1995 16-year-olds in Northern Ireland. Respondents completed the 12-item version of the General Health Questionnaire (GHQ-12) along with closed- and open-ended questions about COVID-19. RESULTS: Results from regression analysis showed that being female, identifying as non-heterosexual and perceiving that mental health had worsened during lockdown were the best predictors of poor mental health. In the open responses, young people reported significant concerns about their mental health and their educational outcomes. They also felt that their needs were not given the same priority as those of adults during lockdown. CONCLUSIONS: The results suggest that the COVID-19 lockdowns adversely affected the mental health of many young people in Northern Ireland with the effects most acute for females and those identifying as non-heterosexual. Future research should explore the longer-term impact of the pandemic on the mental health of these vulnerable young people and identify what support mechanisms need to be put in place to mitigate the negative effects of any future crises.

Sex differences in hardiness, coping, and health in new West Point cadets.

The U.S. Military Academy at West Point places young men and women in a highly demanding world of extreme mental and physical challenges. As such, it provides an excellent natural laboratory in which to study how people respond and adapt to highly stressful conditions. The present study explores the role of personality hardiness and coping as stress resilience resources in new (freshmen) cadets at West Point, while also considering sex differences. Using survey methods, N = 234 cadets were assessed during their first year at West Point. Measures included personality hardiness, coping strategies, health symptoms, and number of hospitalizations for all causes. Results show that female cadets are higher in hardiness and emotion-focused coping, as well as somewhat higher in symptoms reports. For the total group, hardiness is linked to better health, both in terms of symptoms reports and hospitalizations. Multiple regression results indicate symptoms are predicted by lower hardiness, higher avoidance coping, and female sex. Conditional process path analysis reveals that the effect of hardiness on symptoms is mediated by emotion-focused coping, and that emotion-focused coping can have both positive and negative effects. This study confirms hardiness is an important stress resilience resource for both men and women in the highly stressful first year at West Point. These findings lend further support to a growing body of evidence that hardiness influences health in part via the coping strategies that people choose to apply in dealing with stressful situations.

A Mixed Methods Investigation on the Relationship Between Perceived Self-Regard, Self-Efficacy, and Commitment to Serve Among Military Medical Students.

INTRODUCTION: Routinely faced with potentially traumatizing situations, resilience is critical for military physicians. However, related studies are limited in scope. The current study distinctively combines hyper-realistic immersion training for military medical students with emotional intelligence and hardiness measures. With self-reflection shown to improve performance, qualitative inquiry was concurrently conducted in a mixed methodology approach to provide a uniquely comprehensive perspective on the resilience training needs of this population. MATERIALS AND METHODS: Thirty-four osteopathic military medical students participated in a week-long training simulating real-life combat and mass casualty events. The Emotional Quotient-Inventory 2.0 (EQ-i 2.0) and Hardiness Resilience Gauge were administered as pre- and post-test measures. Paired t-tests were used to determine statistically significant gains, and a multiple case study analysis of a six-student focus group allowed for the synchronization of quantitative and qualitative data. Institutional Review Board approval for the study was obtained through Rocky Vista University with a reciprocal agreement with Touro University California's Institutional Review Board. All students participating in the study received written informed consent. RESULTS: Qualitative findings for this study aligned with this current year's findings of statistically significant results in the improvement of the Overall EQ-i and Overall Hardiness. Qualitative responses thematically analyzed demonstrated environmental realism, adaptation, increased awareness, and positive interpersonal and clinical outlook. Notable increases occurred in all EQ-i domains except Decision-Making and Stress Tolerance. The Self-Perception domain saw significant increases in Self-Regard and Emotional Self-Awareness while Well-Being and Optimism simultaneously improved. CONCLUSION: This unique pilot study showed that quantitative and qualitative results aligned, supporting the finding that a safe trauma-related training environment can improve the confidence and resilience in military medical students. The goal of this training was to promote resilience and mitigate trauma. Results demonstrate improved self-efficacy and enhanced commitment. Increases in self-awareness and confidence made participants more inclined to see their worth and strengthened their sense of duty as described in their qualitative responses. Pervasive gains suggest that the training aligned well with its purpose, and the methods employed enhanced participant experience. Long-term follow-up studies are needed to assess outcome sustainability.

Identifying health care access barriers in southern rural Ecuador.

BACKGROUND: Access to professional health care providers in Loja Province, Ecuador can be difficult for many citizens. The Health Care Access Barrier Model (HCAB) was established to provide a framework for classification, analysis, and reporting of modifiable health care access barriers. This study uses the HCAB Model to identify barriers and themes impacting access to health care access in southern rural Ecuador. METHODS: The research team interviewed 22 participants and completed 15 participant observation studies in the study area. Interviews and a single focus group session of artisans were recorded and transcribed from Spanish to English, and thematic analysis was performed. RESULTS: The thematic analysis found financial, structural, and cognitive health care access barriers. Cost of medications, transportation, missed responsibilities at work and home, difficulty scheduling appointments, and misconceptions in health literacy were the predominant themes contributing to health care access. These pressure points provide insight on where actions may be taken to alleviate access barriers. CONCLUSION: Modifiable health care access barriers outlined in the HCAB are evident in the study area. Further research and implementation of programs to resolve these barriers, such as the creation of health care subcenters and/or mobile clinic, insurance coverage of specialized care, increasing availability and accessibility to affordable transportation, improving roadways, introduction of a 24/7 call center to schedule medical visits, monetary incentive for primary care physicians to practice in rural and underserved areas, provision of affordable work equipment, and emphasizing the improvement of health care literacy through education, may diminish current barriers, identify additional barriers, and improve overall health in the rural area of Loja, Ecuador and similar rural regions around the world.

A Patient-Centered Study Examining Self-Identification of Mental Health Challenges Among Female Military Officers.

Due to the expansion of leadership roles in the military for women, female military personnel now face stressors equal to, and yet unique from, their male counterparts. This pilot study surveyed 73 female U.S. Army officers regarding their experiences of leadership and mental wellness within the military. A mixed-methods survey was distributed via 2 private Facebook groups for female Army officers following an anonymized convenience sampling. This anonymous, patient-centered protocol was used to protect against known stigma surrounding disclosing mental health concerns in the military. Respondents were asked a series of questions including perceived mental health status and access to behavioral health services. Most respondents reported feelings of stress related to their roles as officers (86.6%). Self-reported feelings of anxiety (83.6%) and depression (65.7%) were high. In contrast, only 30.1% had ever received a formal diagnosis of anxiety or depression by a mental health professional. Our survey confirmed a large percentage, 65.7% of respondents, reported avoiding mental/behavioral health services. Female military officers are able to recognize their feelings as symptoms of anxiety and depression; however, many take active steps to hide these symptoms from their family members and senior officers and avoid seeking professional care.

The Benefits of Being a "Buddy": Exploring the Medical Student Experience As Mentor to Minority High-School Students.

Purpose: The Aspiring Doctors Precollege Program at Ohio University Heritage College of Osteopathic Medicine serves to introduce underrepresented minority (URM) high-school students to careers in health care as well as introducing URM high-school students to medical student mentors. Each month, medical students and their student mentees connect through a variety of activities on the medical college campus. While the program has significant benefit for the mentees, it also provides professional development opportunities for the medical students as mentors. Many researchers have written on the value of mentored relationships between medical students and established physicians; however, exploring the benefits of medical student mentorship has yet to be discussed in the literature. Objectives: The primary objectives of this study are to understand medical student perceptions of being a mentor and describe the contributions to their medical education. Methods: Semistructured interviews were conducted with student mentors regarding their experiences serving in this program. These interviews were inductively coded for significant ideas, themes, and patterns. Results: A series of 12 research interviews were conducted with medical students who have participated in The Aspiring Doctors program for at least three semesters. Major themes that emerged from the analysis include the following: the importance of guidance in medicine through person-to-person mentoring, and identification of future career aspirations. Summary/Conclusions: Medical student mentors found this program to be a valuable addition to their educational experience. Mentoring URM high-school students offers pre-clinical medical students the opportunity to connect with their community and envision themselves serving as physicians in underresourced communities. Simultaneously, it provides a meaningful way of paying-it-forward during their education. Further studies can be done to track the outcomes of the medical students with respect to their designations stated while participating in this program, the role of mentorship on professional identity development, and possible effects on preventing/mitigating burnout.

Under-represented minority students and identification of obstacles to a career in medicine.

BACKGROUND AND OBJECTIVES: The Aspiring Doctors Precollege Program is an innovative pipeline program designed to introduce under-represented minority (URM) high school students to career in medicine. A total of 52 students have completed this year-long program. This study sought to provide insight into student perceptions of barriers to entry and success in the medical field. METHODS: Each year, students were selected based on a competitive application process. At the end of the program, students were asked to complete a survey evaluating their experiences in this program and their level of interest in medicine. Students were specifically asked to provide rational for their college/career choices and to identify obstacles they perceived as barriers to a career in medicine. RESULTS: Students repeatedly identified competitiveness, duration, and cost of training as major obstacles to a medical career. Although the majority of students intended to pursue medical education, in the post-survey, a small minority (15%) revealed they were no longer interested in medical education. CONCLUSIONS: All participants highlighted competitiveness, duration, and cost of training as obstacles to their future career. While this resulted in a change in career plans for some, other remained committed to careers in medicine. This work illustrates the importance of acknowledging the impact these factors can have on URM students at early stages of the education. In order to increase the diversity of the health care workforce, systemic solutions must be sought to ensure equitable financial access and pre-medical opportunities be afforded to all qualified students.

Self-Efficacy as an Indicator for Success in a Premedical Curriculum for Underrepresented Minority High School Students.

CONTEXT: The Aspiring DOctors PreCollege Program at the Ohio University Heritage College of Osteopathic Medicine Cleveland Campus is unique among other precollege pipeline and mini-medical school programs in that it engages learners from urban underserved communities for an entire academic year as a cocurricular adjunct to their high school course load. One day per month, students are brought to the medical college campus and introduced to the field of osteopathic medicine. Students also participate in activities related to preparing for college admissions, diversity in higher education, mental health and wellness, and financial stewardship. All these activities are done with the goal of increasing the number of underrepresented minority (URM) students in the health care professions. OBJECTIVE: Self-efficacy has been identified as a measure of internal motivation and belief in one's ability to succeed in the face of challenges. The purpose of this study is to determine what effect, if any, participation in this program has on URM student self-efficacy. METHODS: Students were asked to complete a validated self-efficacy questionnaire at the start and end of this program to determine their levels of self-efficacy and if there were changes after participating in this program. RESULTS: Ten of the 12 seniors completed pre- and post-self-efficacy surveys. Two main discoveries were made through this pilot. First, when tested at the beginning of the program, all students had high levels of self-efficacy (mean score, 4.45 of 5). Second, 2 items were specifically increased by a statistically significant amount. The students increased in self-efficacy concerning the responses "I can learn what is being taught in class this year" (P = .024) and "My ability grows with effort" (P = .015). CONCLUSIONS: With the competitive standards of acceptance into the Aspiring DOctors PreCollege Program, students enrolled in this program had high levels of self-efficacy from the onset. While there was modest increase across the board, many of these indicators remained consistently high after the program. Using self-efficacy as a screening tool for premedical students may be helpful in identifying candidates likely to succeed in a future medical career.