Preventive Mental Health Services Research Articles

Prevalence of Low Self-esteem and Mental Distress among Undergraduate Medical Students in Jimma University: A Cross-Sectional Study.

Medical students often experience chronic stress. Self-esteem is one of the most important factors in the process of psychosocial growth and has remarkable effect on thoughts, feelings, values, and goals. The aim of this study was to assess the prevalence and associated factors of low self-esteem (LSE) and mental distress among Medical Students of Jimma University. This cross-sectional study was conducted in Jimma University from June to July, 2018. Self-esteem was measured with Rosenberg self-esteem scale. Self-administered Short form with General Health Questionnaire was used to assess presence of mental distress. Out of 422 students enrolled to the study, 279 (66.1%) were male, and 413 (97.9 %) were 18 to 25 years of age. The prevalence of LSE and mental distress were 19.0%, and 19.7 %, respectively. Students who had LSE had 5 times higher risk of having mental distress, AOR= 5.1 (95% CI, 2.9-8.9). Moreover, female students had higher risk of developing mental distress (AOR=1.9, 95% CI, 1.1-3.3). Students who had poor social support were 4.3 times at higher risk of developing LSE, AOR=4.3 (95% CI, 1.9-9.8). Those who reported to have poor academic performance were also more likely to have LSE AOR= 3.7 (95% CI, 1.3-10.0). One in five medical students had LSE and it is strongly associated with metal distress. Female students were at higher risk of mental distress. Preventive, curative and rehabilitative mental health services should be available for medical students with particular attention to those with poor social support.

“There Was No Plan in Place to Get Us Help”: Strategies for Improving Mental Health Service Utilization Among Law Enforcement

Police experience a documented, elevated need for mental health (MH) care due to the significant chronic stressors and acute traumatic experiences that characterize police work. Yet, many barriers prevent officers from accessing and engaging fully in MH treatment. The purpose of this study is to understand the idiosyncratic officer-perceived barriers and facilitators to MH service utilization to generate strategies for increasing the accessibility of MH resources. Heeding the call for more qualitative work in this line of inquiry, we used thematic analysis of in-depth, semi-structured interviews with a sample of 48 U.S. police officers to examine how officers came to initiate MH services, why they chose to engage or not engage such resources, and what organizational and supervisory factors promoted service utilization. Officers’ narratives show that police leadership should strive to (1) alleviate fear of negative professional consequences by addressing structural stigma, (2) improve agency culture and social norms around mental health care by focusing on prevention and resilience, and (3) emphasize the development of relevant and trustworthy MH care. To address structural barriers, officers described the urgent need for police leadership to clarify and make transparent organizational MH policies and processes, systematize departmental MH responses, and leverage mandated counseling. Additionally, officers perceived the need for a cultural shift emphasizing comprehensive, incentivized, preventative MH services. Finally, officers’ concerns regarding the quality of MH care encompassed the need for confidential, trustworthy services grounded in the realities of police work. Implications for research and practice are discussed.

Prevalence and factors associated with depression, anxiety and stress among healthcare workers of Trinidad and Tobago during COVID-19 pandemic: a cross-sectional study

ObjectivesTo determine the prevalence and factors associated with depression, anxiety and stress among healthcare workers (HCWs) during COVID-19 pandemic.DesignCross-sectional online survey.SettingHCWs from four major hospitals within the Regional Health Authorities...

Evaluating the Cost of Prevention Programming and Universal Screening with Discrete Event Simulation.

Discrete Event Simulation (DES) is a novel system modeling technique that allows for the evaluation of the potential costs and personnel needed for mental health services in school. A case study is presented to illustrate how DES could be used by a school's decision makers to help plan for implementation of an integrated mental health service model. Discrete Event Simulation was used to model the personnel, time, and costs of an integrated mental health service model within a school setting. In addition, costs are calculated and then compared to a business as usual model. Data from the present investigation indicate substantial cost savings of implementing a prevention oriented mental health intervention model within a school setting. In a school of 1000 students, the prevention model could result in an annual cost savings of approximately $30,000 as well as a 50% reduction in disciplinary referrals and 22% reduction in suspensions. Results from the present investigation indicate substantial savings in financial resources and overall numbers of disciplinary infractions when implementing a prevention model. The DES allows for customization of personnel and time to modify the model and resulting output to local conditions. These data may allow school administrators to modify resources to meet student needs. In addition, cost data can help address some of the common implementation barriers associated with adoption of universal screening and preventative mental health services.

Health Anxiety and Emotion Regulation during the Period of COVID-19 Outbreak in Turkey.

The process of COVID-19 outbreak has affected Turkey as it has affected the whole world. The purpose of the current study is to investigate individuals' health anxiety and emotion regulation during the period of COVID-19 outbreak in Turkey in relation to some variables. The study also aims to explore the relationship between emotion regulation and health anxiety. The study was conducted on 874 individuals reached online through the google e-forms. The participants were administered the "Health Anxiety Scale and Emotion Regulation Scale" to collect data. In the analysis of the collected data, Mann- Whitney U Test, Kruskal Wallis-H Test, Spearman Correlation Coefficient were used. In the current study, healthy anxiety scores of the participants were analyzed depending on some variables. Health anxiety was found to be higher in women, 18-30 age group, singles, students, and groups with physical and mental health problems. The research also found that there is a low and negative relationship between health anxiety and cognitive reappraisal. It is understood that men's suppression scores are higher than women. There is no significant difference between suppressing emotions and health anxiety. It was found that educators received the highest scores in terms of cognitive reappraisal. The cognitive reappraisal level of the group without mental disorder was found to be higher than the other group. According to the results of the research, more supportive services should be provided for the groups with the higher health anxiety. Considering that especially students and young people are affected more, it can be said that mental health preventive services should be included more in these groups. At the same time, the fact that men have higher emotion suppression scores than women shows that this situation should also be taken into consideration in mental health services.

Mindfulness and Self-Regulation in a Summer Camp Setting: An EBP Project

BackgroundGuidelines for pediatric mental/behavioral health promotion call for preventative mental health services. Previous studies have found mindfulness an effective approach to addressing self-regulation/behavior concerns. Behavioral and self-regulation concerns had been identified in a summer camp program held in a large urban setting. Camp directors sought methods to address concerns, nurture the whole child and improve the overall program. PurposeThe purposes of this evidence-based practice (EBP) project in a summer day-camp setting were to (1) implement an evidence-based mindfulness program for children and (2) evaluate the impact on child self-regulation skills and behavior. MethodologyTwo questions consistent with the purpose guided this project: 1) How can a mindfulness program be implemented in a summer camp setting 2) What impact does a mindfulness program have on self-regulation of school age participants in a camp setting? To achieve the purpose of this EBP project, an eight-week program guided by the Mindful Schools© curricula was implemented in a summer day camp program in a large urban setting. Descriptive statistics and qualitative methods were used for evaluation of the program. ResultsWe were able to show a decrease in emotional distress and assess the mindful strategies which most connected with a school age population. In addition, camp counselor responses illuminated the value of dyad instruction approach in which child and counselors engaged in the Mindful Schools© guided program. ConclusionsUse of an evidenced-based programs allows for sustainability of programs in community settings outside of schools setting to broaden the reach of mental health promotion in a pediatric population.

Factors that Influenced Adoption of a School-Based Trauma-Informed Universal Mental Health Intervention.

We know little about why school administrators choose to adopt preventive mental health interventions within the context of school-based prevention trials. This study used a qualitative multiple-case study design to identify factors that influenced the adoption of a trauma-informed universal intervention by urban public school administrators during an efficacy trial. Semi-structured interviews were conducted with 15 school administrators who adopted a trauma-informed mindfulness intervention called RAP (Relax, be Aware, and do a Personal Rating) Club as part of their participation in a school-based trial with eighth graders. Findings indicated that administrators adopted RAP Club to provide support for students affected by trauma and prevent students from engaging in unhealthy coping behaviors. Examples of contextual factors that contributed to adoption included a lack of trauma-informed mental health programs within schools, inadequate district funding for preventive school mental health services, and the perceived benefits of engaging in a university-community partnership. The study's findings suggest strategies to increase school program adoption in the context of research and, more broadly, for implementation science.

Longitudinal association between school climate and depressive symptoms: The mediating role of psychological suzhi.

The protective role of students' perceptions of school climate against mental health problems has been supported in previous research, yet relatively little is known about the mechanism underlying school climate's influence on Chinese youths' depressive symptoms. Guided by the process-person-context-time model, this study examined the mediating effect of psychological suzhi (a Chinese cultural construct comprising a hierarchical, integrated set of positive psychological qualities) on the longitudinal association between perceived school climate and depressive symptoms among Chinese adolescents. Students (N = 1,151; 52.2% boys; mean [M]age = 16.24, standard deviation [SD] = 0.70) from one Chinese high school participated in a 3-wave (each wave was 6 months apart) longitudinal study. Multilevel mediation models were used to analyze between- and within-person effects on the longitudinal association between perceived school climate and depressive symptoms. The results indicated that students who perceived a more positive school climate reported lower depressive symptoms than students who perceived a more negative school climate (between-person effect); however, students who perceived their school climate positively did not always directly report lower depressive symptoms across time (within-person effect). Psychological suzhi mediated the association between perceived school climate and depressive symptoms at both the between- and within-person levels. Students who perceived a more positive school climate had increased psychological suzhi, which, in turn, decreased their depressive symptoms. The findings provided implications for school-based mental health prevention services by highlighting the need for promoting both positive school climate and students' psychological suzhi. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Undetermined and accidental mortality rates as possible sources of underreported suicides: population-based study comparing Islamic countries and traditionally religious Western countries

Four Western countries (Greece, Ireland, Italy and Portugal) with strong Orthodox and Catholic traditions have been associated with the underreporting of death by suicide, and underreported suicides are sometimes found among deaths recorded as 'undetermined' or 'accidental'. This population-based study tests whether there are any significant difference in patterns of suicides, undetermined deaths and accidental deaths between these four Western countries and 21 predominately Islamic countries. World Health Organization age-standardised death rates per million population were used to compare suicide rates with combined undetermined death and accidental death (UnD+AccD) rates, from which odds ratios were calculated. Substantial odds ratios (OR > 2.0) were taken as indicative of likely underreporting of suicides. The Islamic countries come from four different historico-cultural regions, described as: less-traditional Islamic countries; former USSR countries; Gulf Arab states; and Middle Eastern and North African countries. χ2-tests were used to determine any significant differences between the Western comparator countries and the Islamic regions. For the Western comparator countries, the average suicide rate was 66 per million population, the average undetermined death rate 56 per million and the average accidental death rate 58 per million, yielding a suicide:UnD+AccD odds ratio (OR) of 1.73. The average values for the other three groups were as follows. Less-traditional Islamic countries: suicide rate, 31 per million; UnD+AccD rate, 101 per million; suicide:UnD+AccD OR = 3.3. Former USSR countries: suicide rate, 61 per million; UnD+AccD rate, 221 per million; suicide:UnD+AccD OR = 3.6. Gulf Arab states: suicide rate, 10 per million; UnD+AccD rate, 76 per million; suicide:UnD+AccD OR = 8.6. Middle Eastern and North African countries: suicide rate, 6 per million; UnD+AccD rate, 151 per million; suicide:UnD+AccD OR = 25.2. The patterns of these mortalities in the Islamic countries was significantly different from Western comparator countries. The results indicate underreporting of suicides in Islamic countries. This might inadvertently lead to reduced access to mental health preventive services in both Western and Islamic countries.

The Monetary Value of Human Lives Lost to Suicide in the African Continent: Beating the African War Drums.

Background: Suicide is an important public health problem in the African continent whose economic burden remains largely unknown. This study estimated the monetary value of human lives lost due to suicide in the African continent in 2017. Methods: The human capital approach was applied to monetarily value the years of life lost due to premature mortality from suicide deaths (SD) among 54 African countries. A 3% discount rate was used to convert future losses into their present values. The sensitivity of monetary value of human lives lost to changes in discount rate and average life expectancy was tested. Results: The 75,505 human lives lost from suicide had a grand total monetary value of International Dollars (Int$) 6,989,963,325; and an average present value of Int$ 92,576 per SD. About 31.1% of the total monetary value of SD was borne by high-income and upper-middle-income countries (Group 1); 54.4% by lower-middle-income countries (Group 2); and 14.5% by low-income countries (Group 3). The average monetary value per human life lost from SD was Int$ 234,244 for Group 1, Int$ 109,545 for Group 2 and Int$ 32,223 for Group 3. Conclusions: Evidence shows that suicide imposes a substantive economic burden on African economies. The evidence reinforces the case for increased investments to ensure universal coverage of promotive, preventive, curative and rehabilitative mental health services.

Mental Well-being, and Coping Strategies during Stress for Preclinical Medical Students in Vietnam

Inappropriate coping strategies may be key factors that have contributed to a consistently high prevalence of stress and mental disorders that have been reported worldwide, particularly in resource-limited countries. Thus, one aim of this paper is to estimate the prevalence of these inconstructive strategies, and explore more positive coping strategies through observation of undergraduate medical students in Vietnam. The methodology that has been employed for this project has been a cross-sectional analysis that was conducted on 411 first year medical students at the University of Medicine and Pharmacy in the cities of Ho Chi Minh and Can Tho who have shown signs of stress indicative of low mental well-being—that being a WHO-5 score of 13 or under or an answer of 0 to 1 to any of the five items of a WHO-5 mental disagnstic test. Participants completed a self-report questionnaire including a depression anxiety stress scale and a coping strategies inventory scale. The results show a prevalence of depression, anxiety, and stress that were identified in 51.6%, 70.3% and 49.9% of students respectively. Problem solving was impacted mostly by the failure of coping strategies, and subsequent failures in cognitive restructuring. Students who had mental disorders were more likely to engage in negative coping strategies such as self-criticism, and were less likely to choose positive coping strategies such as expressions of emotion and problem solving. Medical students face a wide range of stressful situations, and the findings of these particular students suggest that there is a failure of coping strategies to overcome these stressful occurences. The findings indicate an urgent need to develop stress management programs and training workshops to build up early preventive mental health services at medical schools and to improve student support systems.

Long-term posttraumatic stress disorder in mine workers after a coalmining disaster

Background: A coalmine disaster has occurred in Turkey on 13 May 2014, which caused the death of 301 miners. Objective: This study aimed to determine the prevalence of posttraumatic stress disorder (PTSD) symptoms and the risk factors for PTSD among mine workers, 2 years after the coalmining disaster. Methods: This was a cross-sectional survey conducted between June 2016 and July 2016 among mine workers who were the employees of either the mine where the accident occurred or three other mines in the same area. Sociodemographic data form and PTSD Symptom-Scale Self-Report (PSS-SR) were used to collect data. Results: 672 mine workers participated in the study. At the time of the accident, 23.7% (n = 159) of them were in the mine where the accident occurred. The mean score on total PSS-SR was 4.27 (SD: ±4.49). Eighteen (2.7%) participants screened positive for PTSD. Logistic regression analysis revealed the significant risk factors for PTSD are: being single/divorced/widowed, having a chronic disease, having a family history of psychiatric illness and previously experiencing traumatic events more than one. Discussion: Coalmining workers have considerably high prevalence rate of PTSD symptoms after a coalmining disaster. Assessing PTSD and associated risks is important for preventive mental health services.

Why Do Approved Mental Health Professionals Think Detentions under the Mental Health Act Are Rising and What Do They Think Should Be Done about It?

Abstract The number of people detained under the 1983 Mental Health Act has risen significantly in recent years and has recently been the subject of an independent review. Most existing research into the rise in detentions has tended to prioritise the perspectives of psychiatrists and failed to consider the views of Approved Mental Health Professionals (AMHPs), usually social workers, who ultimately determine whether detention is appropriate. This mixed-methods study focused on AMHPs’ views on the reasons behind the rise in detentions and potential solutions. It included a national online survey of AMHPs (n = 160) and semi-structured interviews with six AMHPs within a Community Mental Health Team in England. AMHPs reported that demand for mental health services vastly exceeded supply and, due to inadequate resources, more people were being detained in hospital. AMHPs argued that greater investment in preventative mental health services and ‘low intensity’ support would help to mitigate the impact of social risk factors on mental health; and greater investment in crisis services, including non-medical alternatives to hospital, was required. Such investment at either end of the spectrum was expected to be more effective than changes to the law and lead to better outcomes for mental health service users.

Examining the Psychological Resilience of Adolescents with Leukemia: A Comparative Study

ÖZAmaçAraştırma, lösemi tanısıyla izlenen 15–18 yaş dönemindeki adölesanların psikolojik sağlamlık düzeylerini belirlemek amacıyla karşılaştırmalı tanımlayıcı tasarımda gerçekleştirilmiştir.YöntemAraştırma grubunun örneklemini iki üniversite hastanesi ve Sağlık Bakanlığı’na bağlı bir eğitim araştırma hastanesinin çocuk hematoloji polikliniklerinde lösemi tanısı ile izlenen 15–18 yaş arası 80 adölesan oluşturmuştur. Karşılaştırma grubunun örneklemini ise seçilen bir lisenin 9, 10, 11 ve 12. sınıflarında okuyan 15–18 yas arası 80 sağlıklı öğrenci oluşturmuştur. Veriler, anket formu ve California Psikolojik Sağlamlık ve Ergen Gelişim Ölçeği/Yılmazlık Değerlendirme Ölçeği uygulanarak toplanmıştır. Verilerin değerlendirilmesinde, varyansların homojenlik testi (Levene), Mann-Whitney U testi, Kruskal Wallis varyans analizi ve Ki-Kare testi kullanılmıştır.BulgularAraştırma sonuçlarına göre, lösemili adölesanlar ile sağlıklı adölesanların psikolojik sağlamlık düzeylerinde anlamlı bir fark belirlenmemiştir (p>0.05). Araştırma grubunda cinsiyeti kız olanlarda erkeklere göre daha yüksek psikolojik sağlamlık düzeyi belirlenirken, psikolojik destek almayan adölesanlarda psikolojik destek alan adölesanlara göre daha düşük psikolojik sağlamlık düzeyi belirlenmiştir (p<0.05). Ölçeğin alt faktörlerine göre ise okuldaki koruyucu ilişkiler ve yüksek beklentiler alt faktör puan ortalaması araştırma grubundaki adölesanlarda, amaçlar ve özlemler alt faktör puan ortalaması ise karşılaştırma grubundaki adölesanlarda daha yüksek bulunmuştur (p<0.05).SonuçAraştırmadan elde edilen bulgular doğrultusunda, adölesanların psikolojik sağlamlık düzeylerini geliştirmeye yönelik koruyucu ruh sağlığı hizmetlerinin planlanıp uygulanması, okul-arkadaş-aile-toplum tarafından sağlanacak koruyucu ilişkilerin desteklenmesi önerilmektedir.

English

The study aims to assess the prevalence and associated factors of stress among Ambo University students. Institute based cross-sectional study was conducted on a sample of 343 undergraduate students at Ambo University. Data were collected using the Student-life Stress Inventory. Descriptive statistics, independent t-test, analysis of variance (ANOVA) and Pearson correlation coefficient were utilized to analyze the collected data using statistical package for social sciences (SPSS) version 20. The general life time prevalence of stress was 24.5%. More specifically, fear of academic failure, fear of family disappointment, lack of motivation and interpersonal relationship problem were highly reported symptom of stress students. Likewise, academic overload, projects or assignments timings, political situation of country, financial strain, high family expectations, study skill problem, being alone, procrastination, living away from home, difficulty reading materials, language barrier, acculturation, relationship with opposite sex, lack of entertainment in the University, lack of family support, inability to socialize with peers, adjustment with roommate, family problems, time management problem, and lack of personal interest in their department were frequently reported causes of stress in the University respectively. In this study, the independent t-test result shows that there was a statistically significant mean difference in experiencing stress across students’ sex and residential area. Besides, ANOVA result revealed that year of study, students’ perceived social support and perceived parenting style of the respondents had a significant effect on stress. However, statistical significant mean differences were not observed in experiencing stress across respondents’ monthly family income. Also, a statistically significant negative and moderate relationship was reported between stress and academic achievement. Nearly one fourth of students were suffering from measureable stress. Therefore, Ambo University management shall strengthen the academic counseling and preventive mental health services for the students so as to provide a conducive learning environment. Key words: Stress, undergraduate, students, Ambo University.

Oral Health Needs and Experiences of Medicaid Enrollees With Serious Mental Illness

Chronic dental diseases are among the most prevalent chronic conditions in the U.S., despite being largely preventable. Individuals with mental illness experience multiple risk factors for poor oral health and need targeted intervention. This study investigated experiences of Kansas Medicaid enrollees with serious mental illness in accessing dental services, examined their oral health risk factors, and identified oral health needs and outcomes. Survey data were collected from October 2016 through February 2017 from 186 individuals in Kansas with serious mental illness enrolled in Medicaid. Data were analyzed quantitatively (descriptive and bivariate statistics) and qualitatively (for major themes). Despite Medicaid coverage of dental cleanings, 60.2% of respondents had not seen a dentist in the last 12 months. Reasons included out-of-pocket costs, lack of perceived need, uncertainty about coverage, difficulty accessing providers, fear of the dentist, and transportation issues. High rates of comorbid physical health conditions, including diabetes and cardiovascular disease, and current or former tobacco use were also observed. Medicaid dental benefits that cover only dental cleanings and low levels of oral health knowledge create barriers to utilizing needed preventive dental care. Lack of perceived need for preventive dental services and lack of contact with dentists necessitates the development of targeted oral health promotion efforts that speak to the specific needs of this group and are disseminated in locations of frequent contact. The Medicaid population with serious mental illness would be an ideal group to target for the integration of chronic oral, physical, and mental health prevention services and control.

Stress, Depression and Anxiety among Medical Students of Imam Mohammed Ibn Saud Islamic University, KSA

Background: Exposure of Physicians to some stress factors during the occupational environmental work could induce some psychological problems. The first postgraduate years are particularly susceptible to these problems. In Arab countries, epidemiological data about psychological morbidity among medical undergraduate students are scarce. The Objective of the present study was to assess anxiety and depression levels among the third-year imam medical college students. Methods: A cross sectional study was done on the medical students of the 3rd year at Imam University; College of Medicine in Riyadh city on 2013. The sample consisted of 50 male medical students. The Higher Education Stress Inventory (HESI) was used in data collection. Results: Our results showed that 24% of the students were with minimal depression, 18% of students was with mild depression, 8% of student was with moderate depression, 2% of student was with moderately severe depression and none (0%) of student was reported with severe depression. Conclusion: The study indicated that medical students are extra sensitive to deal with the environmental occupational atmosphere which stress factors could prevail, so, depression and anxiety are common among medical students. Large, prospective, multicenter, multi-method studies are needed to identify personal and curricula features that influence stress, depression, anxiety and coping strategies among medical students. The study findings highlighted the need of psychiatric counseling and preventive mental health services to be an integral part of the routine clinical facilities caring for medical students.

EARLY CHILDHOOD PREDICTORS OF LOW-INCOME BOYS' PATHWAYS TO ANTISOCIAL BEHAVIOR IN CHILDHOOD, ADOLESCENCE, AND EARLY ADULTHOOD.

Guided by a bridging model of pathways leading to low-income boys' early starting and persistent trajectories of antisocial behavior, the current article reviews evidence supporting the model from early childhood through early adulthood. Using primarily a cohort of 310 low-income boys of families recruited from Women, Infants, and Children Nutrition Supplement centers in a large metropolitan area followed from infancy to early adulthood and a smaller cohort of boys and girls followed through early childhood, we provide evidence supporting the critical role of parenting, maternal depression, and other proximal family risk factors in early childhood that are prospectively linked to trajectories of parent-reported conduct problems in early and middle childhood, youth-reported antisocial behavior during adolescence and early adulthood, and court-reported violent offending in adolescence. The findings are discussed in terms of the need to identify at-risk boys in early childhood and methods and platforms for engaging families in healthcare settings not previously used to implement preventive mental health services.

The evaluation of children referred for health measure ruling according to the Child Protection Law

Objective. To assess the children referred to our clinic with a health measure ruling which was given in accordance with Turkey’s no. 5395 Child Protection Law, in terms of socio-demographic characteristics, psychiatric diagnosis, and follow-up. Methods. Thirty children referred to our clinic with a health measure ruling given according to Turkey’s no. 5395 Child Protection Law were assessed. Results. The mean age was 13.20±3.86 (min-max: 2-17). Referral reasons of the children with a health measure ruling included driven to crime in 7 (23.3%), family therapy in 8 (26.7%), sexual abuse in 8 (26.7%), substance abuse in 3 (10%), physical abuse in 1 (3.3%), and medical care and rehabilitation in 3 (10%) children. Of the children referred for a health measure, 19 (63.3%) did not continue following the initial assessment. Conclusions. To enhance the effectiveness of the protective and preventive mental health services, children and adolescents who have a health measure ruling should be treated, followed-up, and rehabilitated at every stage of the process. It is necessary to increase in-house and inter-agency communication in order to implement the system effectively for the benefit of these children.

Measuring Stress in Hostelites and Day Scholars

The Constitution of the World Health Organisation (WHO) defines health as state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Medical education is perceived as being stressful as it is characterised by many psychological changes in students. Medical students often experience different stresses which may affect their emotional, psychosocial and as well as physical health. A study of stress score was carried out on 50 dental students, who were divided into two groups; day scholars (25) and hostelites (25). From this baseline study we come to a conclusion that timely counselling and preventive mental health services integrated with other creative and extracurricular activities should be considered even in day scholars.