How do stressful life events affect medical students' academic adjustment? Parallel mediating mechanisms of anxiety and depression.

BACKGROUND: Medical students frequently face challenges in academic adjustment, necessitating effective support and intervention. This study aimed to investigate the impact of stressful life events on medical students' academic adjustment, focusing on the mediating roles of depression and anxiety. It also differentiated the impacts between at-risk students (those with academic failures) and their peers respectively. METHODS: This case-control study involved 320 at-risk medical students and 800 other students from a university in western China. Participants anonymously completed the scales of stressful life events, depression, anxiety, and academic adjustment. T-tests, ANOVA, Pearson correlation, and structural equation modeling were employed for statistical analysis. RESULTS: Depression and anxiety were significantly more prevalent in at-risk students (46.8% and 46.1%, respectively) than in controls (34.0% and 40.3%, respectively). Notably, at-risk students had poorer academic adjustment (t = 5.43, p < 0.001). The structural equation modeling had good fit indices and the results indicated that depression and anxiety fully mediated the effects of stressful life events on academic adjustment. For at-risk students, stressful life events significantly decreased academic adjustment through increased depression and anxiety (p < 0.001). Conversely, anxiety had a positive effect on academic adjustment in other students. CONCLUSION: Targeted interventions focusing on depression and anxiety could reduce the negative impact of stressful life events on medical students' academic adjustment. However, educators have to distinguish the differences between at-risk students and others.

Discrimination Experiences of Orphans and Left-Behind Children in China as Predictors of Suicidal Thoughts and Behaviors.

Background: Suicide has been recognized as a serious problem in orphans and left-behind children. It is important to examine the differences in the factors affecting suicidal thoughts and behaviors between the two groups. Aims: To compare the lifetime rates of suicidal thoughts and behaviors between orphans, left-behind children, and other children, and to assess the impact of discrimination experiences and the mediating role of self-esteem. Methods: A total of 2,413 children from middle schools in China completed standardized anonymous questionnaires that assessed child type, suicidal thoughts and behaviors, discrimination experiences, and self-esteem. Data analysis employed χ2 test, Pearson correlation test, and structural equation modeling (SEM). Results: Left-behind children had a significantly higher lifetime rates of suicidal ideation than orphans and other children (χ2 = 9.35, p < .05). Discrimination experiences significantly and positively predicted suicidal thoughts and behaviors through the mediating effect of self-esteem in orphaned children, and there was no self-esteem mediating effect found for left-behind children. Discrimination experiences had a greater impact on suicidal thoughts and behaviors for orphans than for left-behind children. Limitations: Cross-sectional studies based on self-report might lead to biased results and mean that causality cannot be inferred. Conclusions: Attention should be paid to suicidal thoughts and behaviors among vulnerable groups, especially left-behind children. Reducing discrimination and improving orphans' self-esteem can be considered as targets of prevention and intervention for suicidal thoughts and behaviors.

Analysis of the screening and predicting characteristics of the house-tree-person drawing test for mental disorders: A systematic review and meta-analysis.

Background: The house-tree-person (HTP) drawing test has received growing attention from researchers as a common projective test. However, the methods used to select and interpret drawing indicators still lack uniformity. Objective: This study aims to integrate drawing indicators into the process of screening for or classifying mental disorders by conducting a systematic review and meta-analysis of the application of the HTP test. Methods: A search of the following electronic databases was performed in May 2022: PubMed, Web of Science, Embase, EBSCO, CNKI, VIP, and Wanfang. Screening and checking of the literature were performed independently by two researchers. The empirical studies published on the use of the HTP test in mental disorders and studies providing specific data on the occurrence frequency of drawing characteristics were analyzed. A total of 30 studies were included in the meta-analysis, including 665 independent effect sizes and 6,295 participants. The strength of the association between drawing characteristics of the HTP test and the prevalence of mental disorders was measured by the ratio (OR) with a 95% CI. Publication bias was assessed using a funnel plot, Rosenthal's fail-safe number (N fs), and the trim and fill method. Results: The results revealed 50 drawing characteristics that appeared at least three times in previous studies, of which 39 were able to significantly predict mental disorders. The HTP test can be divided into the following four dimensions: house, tree, person, and the whole. These dimensions reflect the structure, size, and other characteristics of the picture. The results showed that the greatest predictor of mental disorders was the whole (OR = 4.20, p < 0.001), followed by the house (OR = 3.95, p < 0.001), the tree (OR = 2.70, p < 0.001), and the person (OR = 2.16, p < 0.001). The valid predictors can be categorized into the following four types: item absence, bizarre or twisted, excessive details, and small or simplified. The subgroup analysis showed that the affective-specific indicators included no motion, leaning house, and decorated roof; thought-specific indicators included excessive separation among items, no window, loss of facial features, and inappropriate body proportions; and common indicators of mental disorders included no additional decoration, simplified drawing, very small house, two-dimensional house, and very small tree. Conclusion: These findings can promote the standardization of the HTP test and provide a theoretical reference for the screening and clinical diagnosis of mental disorders.