PSS Score Research Articles

Medical students' crisis-induced stress and the association with social support.

Medical schools are challenged to guard student wellbeing given the potential negative impact of the COVID-19 outbreak combined with an already high prevalence of mental distress. Although social support is generally associated with less crisis-induced stress, it is unknown whether this applies to medical students during the COVID-19 outbreak. The impact of the COVID-19 outbreak on perceived stress of medical students was assessed by comparing their perceived stress levels during the outbreak to both their own baseline and the previous cohort's pre-COVID-19 stress levels. Then, the association between social support and stress during the COVID-19 outbreak was assessed. Dutch Year-1 medical students of cohort 2019 (n = 99) completed the 14-item Perceived Stress Scale (PSS-14) at two time points: baseline (pre-COVID-19) and final measurement (COVID-19). Social support-emotional-informational support and club membership-was assessed during the final measurement. PSS and social support scores were compared to similar measurements of cohort 2018 (n = 196). Students' baseline stress levels, gender, and study performance were controlled for when comparing final stress levels. In cohort 2018 (pre-COVID-19), students' perceived stress levels did not differ significantly between the baseline and final measurements. Additionally, baseline stress levels of the two cohorts (2018 and 2019) were not found to be significantly different. Cohort 2019's final stress levels (COVID-19) were significantly higher compared to their baseline stress levels (paired t-test: t = 6.07, p < .001) and cohort 2018's final stress levels (linear regression: B = 4.186, p < .001). Only during the COVID-19 outbreak higher social support levels-i.e., emotional-informational support (B = -0.75, p < .001) and club membership (B = -3.68, p < .01)-were associated with lower stress levels. During the COVID-19 outbreak, medical students' perceived stress levels were higher-especially for students with lower social support levels. Our results suggest that medical schools should optimize social support to minimize crisis-induced stress.

A Comparison of Intra-Articular Blood Cell Secretome and Blood Cell Secretome with Triamcinolone Acetonide in Dogs with Osteoarthritis: A Crossover Study.

Osteoarthritis (OA) is a growing welfare problem for dogs and a challenge to manage for the clinician, and most therapeutic options aim to control pain. In a randomized, double-blinded, placebo-controlled, 2-way, 2-period crossover study, we aimed to evaluate the use of Blood Cell Secretome (BCS) administrated intra-articularly, with or without the combination with triamcinolone, in dogs with bilateral hip OA. BCS is an acellular orthobiologic containing anti-inflammatory and anabolic proteins produced from the patient’s own blood through extended coagulation in a defined environment. Fifteen dogs were initially assigned to a BCS group (BCSG, n = 5), a triamcinolone group (TG, n = 5), or a combination group (BCS+TG, n = 5). All had bilateral hip OA. After a 180-day follow-up, the crossover was performed with BCSG (n = 7) and BCS+TG (n = 7). BCSG received a single intra-articular administration of 3 mL of Blood Cell Secretome, and BCS+TG received BCS plus 0.5 mL of triamcinolone acetonide (40 mg/mL). The volume in BCSG was corrected to 3.5 mL with saline. In all patients, both hips were treated. For treatment follow-up, a copy of the Canine Brief Pain Inventory (divided into pain interference score—PIS and Pain Severity Score—PSS), Liverpool Osteoarthritis in Dogs (LOAD), and Canine Orthopedic Index (COI, divided into function, gait, stiffness, and quality of life) was completed on days 0, 8, 15, 30, 60, 90, 120, 150, and 180. Results were analyzed with the Mann−Whitney U test, effect size, and Kaplan−Meier estimators, followed by the log-rank test. p was set at <0.05. Patients of the sample had a mean age of 9.6 ± 2.9 years and a body weight of 29.2 ± 3.9 kg. Seven hips were classified as severe osteoarthritis, and eight were classified as moderate. No differences were found between groups at T0. Significant differences were observed in PSS scores at +8d, with BCS+TG exhibiting better results. PIS, PSS, LOAD, stiffness, and function scores were also lower in BCS+TG from +15 to +60d. The two groups showed similar improvements from +90 to +120d. Kaplan−Meier estimators showed that dogs in BCS+TG showed clinically-important differences for longer, despite a positive result in BCSG. The intra-articular administration of BCS alone was able to improve the overall condition of OA patients. Its combined use with triamcinolone acetonide lead to a faster and longer-lasting improvement in pain scores.

Effects of a small-sided games training program in youth male soccer players: variations of the locomotor profile while interacting with baseline level and with the accumulated load

PurposeThis study aimed to (1) analyze the impact of a small-sided game training program in the locomotor profile of youth male soccer players (while interacting with the baseline level – higher and lower level); and (2) test the relationships between variation in locomotor profile and the accumulated demands in 3v3, 5v5 and match over the period of observation.MethodsThe cohort lasted 3-weeks. Twenty under-17 male amateur soccer players (16.8 ± 0.41 years; experience: 6.35 ± 0.67 years) were assessed twice for their final velocity at 30−15 intermittent fitness test (VIFT), peak speed at 30-m sprint test (PSS) and anaerobic speed reserve (ASR). The PSS was estimated using a Global Positioning System, while the VIFT was estimated using the maximum level attained by the players during the test. Based on the baseline levels, the scores were standardized using the Z-score. The total score of athleticism (TSA) was calculated per player to organize the players into two groups: lower TSA and higher TSA. Over the three weeks of observation, the small-sided games of 3v3 and 5v5 and match demands were monitored using polar team pro. The heart rate responses (mean and peak), distance covered (overall and split by speed thresholds), and peak speed in these games were obtained and summed over the weeks. The repeated measures ANCOVA tested the variations (time) of the locomotor profile of players while considering the baseline as covariable and the group as a factor. The Pearson-product correlation test analyzed the relationships between variations in locomotor profile (Δ, post-baseline) and the accumulated demands in 3v3, 5v5, and match.ResultsBetween-groups analysis (lower TSA vs. higher TSA) revealed no significant differences on VIFT (p = 0.915), PSS (p = 0.269), ASR (p = 0.258) and TSA score (p = 0.138). Within-group (baseline vs. post-observation) analysis revealed significant difference on VIFT (p < 0.001), PSS (p = 0.008), while no significant differences were found on ASR (p = 0.949) and TSA score (p = 0.619). Significant correlations were found between ΔPSS and match total distance (r = 0.444; p = 0.050), match Z2 (r = 0.481; p = 0.032) and match Z3 (r = 0.454; p = 0.044). Significant correlations were found between ΔTSA and match total distance (r = 0.457; p = 0.043), match Z1 (r = 0.451; p = 0.046), match Z2 (r = 0.500; p = 0.025) and match Z3 (r = 0.468; p = 0.037).ConclusionSignificant improvements were observed after the period of observation. However, the fitness baseline level and the accumulated training load in the small-sided games seem to have no significant impact on the observed improvements.

Implementation and impact of a fourth-year student pharmacist wellness series pilot on perceived stress and support

Background and purposeA wellness program was piloted for student pharmacists in their advanced pharmacy practice experience (APPE) year. The purpose is to describe the program implementation and its impact on APPE students' perceived stress and perception of support by school personnel. Educational activity and settingA three-session virtual wellness program was designed for APPE students. Attendance was optional for the pilot year. An online survey assessing demographics, perceived stress (measured by the validated Perceived Stress Scale [PSS]), factors contributing to stress, and perceived support before the first session and after the third session was sent to all APPE students. FindingsTwenty (37%), 13 (24%), and 10 (18.5%) students attended the first, second, and third session, respectively. A total of 49 students completed the post-program survey. Of these, ten (20.4%) attended one session, ten (20.4%) attended two sessions, and two (4.1%) attended three sessions. Students reported moderate stress. Female students endorsed higher PSS scores and career-related stress. PSS scores were lower among students who attended at least one session vs. those who did not attend any sessions and were negatively correlated with total sessions attended. Attendees were likelier to feel supported by staff and preceptors and perceived that concerns were heard by administration and preceptors. SummaryAn APPE wellness program was successfully developed. Students who attended at least one session reported less stress and greater support from school personnel vs. those who did not attend any sessions. These findings are promising as wellness efforts are integrated into pharmacy training.

Effects of perceived stress on lipid profile and BMI (body mass index) in health professional students of Sumandeep Vidyapeeth Deemed to be University, Vadodara

Nelson Mandela, one of the all-time great personalities of the world beautifully described about how education is a powerful tool by commenting that "Education is the most powerful weapon which you can use to change the world". In order to be educated, one has to acquire adequate amount of competency in the program. We often experience that most of the students are under stress, not only striving to be competent but also to achieve a high level in this competitive environment. "stress is an unpleasant state of emotional and physiological arousal that individuals experience in situations that they perceive as dangerous or threatening to their well-being" Cross-sectional study was conducted in the Department of Biochemistry, SBKS MI &amp; RC, SVDU for consecutive two batches 2016-17 &amp; 2017-18. Total 506 first-year MBBS, BDS &amp; BPT students were studied for age, gender, Lipid Profile and Body mass index.Stress was assessed by PSS-10 scale. Two groups were identified as their PSS score, stressed and non-stressed. Various studies have shown to increase in total cholesterol and LDL level during stress stage also TAG in individuals who had experienced high levels of stress in the preceding 6–12 months also seen changes in body mass index.

PMON68 Effect of an Amino-Acid Based Blend on Human Growth Hormone (hGH) and Fibromyalgia (FM) Symptoms

Abstract Fibromyalgia is a chronic pain sensitivity disorder that affects approximately 3-8% of the general population with symptoms that include fatigue and widespread musculoskeletal pain. Psychological and physical stressors are frequent drivers of fibromyalgia, and additional lockdown-associated stressors may worsen symptoms. Reduced production of human growth hormone (hGH) is evident in approximately 30% of individuals with fibromyalgia, which is hypothesized to contribute to common fibromyalgia symptoms. An orally administered amino acid supplement has been previously shown to improve endogenous hGH status in adults. We investigated if daily administration of the supplement would increase levels of endogenous insulin-like growth factor 1 (IGF-1), a surrogate marker of the body's hGH levels, and improve symptoms related to low-normal hGH production in a cohort of 84 individuals being treated for fibromyalgia. This is the full-cohort analysis of an open-label, single-arm study that investigated the effects of 24 weeks of daily oral administration of the supplement in individuals with low-normal hGH production. The primary endpoint was the change from baseline to endpoint (Week 24) in serum IGF-1. Additional endpoints included the change in body weight, clinical symptoms (assessed with the Revised Fibromyalgia Impact Questionnaire [FIQR], range 0-100, and Perceived Stress Scale [PSS], range 0-40), fasting cardiometabolic markers, tolerability, and safety. Participants continued to receive standard care. The study enrolled 84 fibromyalgia patients with low-normal age-adjusted IGF-1 serum levels. High mean±SD baseline FIQR and PSS scores of 76±16 and 32±5, respectively, indicated poor to moderate symptom management with standard care. All individuals completed 24 weeks of treatment. Serum IGF-1 levels increased with a Week 24 mean±SE change of 28.4±3.0 ng/mL (paired t-test p&amp;lt;0.001). Body weight was reduced with a Week 24 mean±SE change of -5.5±0.3 kg (p&amp;lt;0.001). The change from baseline in FIQR and PSS scores were -29.1±1.1 and -20.0±0.8, respectively (both p&amp;lt;0.001), indicating a substantial improvement. Statistically significant improvements from baseline were also observed for systolic and diastolic blood pressure, HbA1c, LDL and HDL cholesterol, and triglycerides (all p&amp;lt;0.001). The supplement was well tolerated; no adverse events were reported. Sustained augmentation of IGF-1 with the supplement may represent a unique method of improving clinical symptoms of fibromyalgia in individuals with low-normal hGH production. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

RF16 | PSUN177 Predictors of Postpartum Depressive Symptoms in Women with Recent GDM

Abstract Background Patients with gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes mellitus (T2DM) after delivery and are encouraged to practice behaviors, such as healthy nutrition, physical activity and weight loss to attenuate future risk of T2DM. GDM has been shown to significantly increase the risk for post-partum depressive symptoms, which can impair a woman's ability to engage in and adhere to diabetes prevention efforts. To further inform the development and adapation of lifestyle interventions to prevent T2DM, we sought to identify factors associated with depressive symptoms in the early postpartum period among women with recent GDM. Methods Participants are from the baseline cohort of the Balance after Baby Intervention study, a two-year randomized clinical trial of a lifestyle intervention for women with recent history GDM conducted in Boston, MA and Denver, CO between 2016-2019. Prior to randomization, a study visit was scheduled at approximately 6 weeks post-partum. At this visit, weight and height were measured for determination of BMI. We administered the Edinburgh Postpartum Depression Scale (EPDS) and Perceived Stress Scale (PSS-10). We used an EPDS score of ≥9 as depressive symptoms and a PSS score of ≥14 as moderate to high perceived stress. We collected self-reported pre-pregnancy weight, and reviewed medical records to obtain medical history, including GDM diagnosis, mode of delivery, gestational weight gain and insulin use during pregnancy. We conducted bivariate analyses to identify predictors of postpartum depressive symptoms, then modeled the odds of post-partum depressive symptoms using multivariate logistic regression. Results Our study included 181 women (mean age, SD 32.6 ± 5.3 years, 51.4% White/14.4% Black/33.7% Latinx, mean pre-pregnancy BMI 29.8 ± 6.0 kg/m2). 19% of women scored ≥9 on EPDS and 53% of women scored ≥14 on PSS at the post-partum visit. Variables included in the bivariate analysis were age, Black/Latinx-identifying, college completion, perceived stress, primiparity, having a partner, pre-pregnancy BMI, gestational weight gain, C-section, insulin use during pregnancy, breastfeeding, 1st GDM pregnancy, exceeding IOM weight gain guidelines and income level. Of those variables, the best fit multivariate model with the lowest Akaike information criterion (AIC) included perceived stress, C-section and 1st GDM pregnancy. Using this model, the regression analysis showed that only perceived stress (4.5 OR, 95% CI [2.6-7.7], p was predictive of post-partum depressive symptoms. Conclusion Perceived stress was predictive of post-partum depressive symptoms in women with recent GDM. Addressing perceived stress in the early post-partum period may be an important target for development or adaptations of future lifestyle interventions to prevent T2DM in women with recent GDM. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Sunday, June 12, 2022 1:18 p.m. - 1:23 p.m.

Testing the validity and reliability of the Depression Anxiety Stress Scale (DASS)-21 instrument for individuals with psychodermatology

Individual psychological health can be seen from the health of the skin. Some skin diseases such as psoriasis and atopic dermatitis can be exacerbated by psychological problems. Based on this, a collaboration between specialist doctors and psychologists is needed to screen for psychological disorders in sufferers. One psychological screening instrument is the Depression Anxiety Stress Scale (DASS)-21; this study aims to test its validity and reliability. Non-probability convenience sampling was employed, and 292 participants aged 18-54 were willing to take part in the study. An internal structure validity test was conducted using confirmatory factor analysis, while concurrent validity was assessed by correlating DASS-21 with PHQ-9, GAD-7 and PSS scores. The reliability test was analyzed using composite reliability. The results of the CFA analysis showed that the data matched Lovibond's theory and that all DASS-21 items were valid (RMSEA =.076, CFI=.961, TLI = .955, SRMR = .065). The results of the concurrent analysis showed that the three scales had a positive correlation with the dimensions of DASS-21, while the reliability results showed a satisfactory value (.850 – .923). The results of the study indicate that DASS-21 is a valid and reliable instrument and can be used to measure depression, anxiety and stress in individuals with psoriasis and atopic dermatitis.

Perceived stress and semen quality.

Psychological stress is prevalent among reproductive-aged men. Assessment of semen quality for epidemiological studies is challenging as data collection is expensive and cumbersome, and studies evaluating the effect of perceived stress on semen quality are inconsistent. To examine the association between perceived stress and semen quality. We analyzed baseline data on 644 men (1,159 semen samples) from two prospective preconception cohort studies during 2015-2021: 592 in Pregnancy Study Online (PRESTO) and 52 in SnartForaeldre.dk (SF). At study entry, men aged≥21 years (PRESTO) and≥18 years (SF) trying to conceive without fertility treatment completed a questionnaire on reproductive and medical history, socio-demographics, lifestyle, and the 10-item version of the Perceived Stress Scale (PSS; interquartile range [IQR] of scores: 0-40). After enrollment (median weeks: 2.1, IQR: 1.3-3.7), men were invited to perform in-home semen testing, twice with 7-10 days between tests, using the Trak Male Fertility Testing System. Semen quality was characterized by semen volume, sperm concentration, and total sperm count. We fit generalized estimating equation linear regression models to estimate the percent difference in mean log-transformed semen parameters by four PSS groups (<10, 10-14, 15-19, ≥20), adjusting for potential confounders. The median PSS score and IQR was 15 (10-19), and 136 men (21.1%) had a PSS score ≥20. Comparing men with PSS scores ≥20 with<10, the adjusted percent difference was -2.7 (95% CI: -9.8; 5.0) for semen volume, 6.8 (95% CI: -10.9; 28.1) for sperm concentration, and 4.3 (95% CI: -13.8; 26.2) for total sperm count. Our findings indicate that perceived stress is not materially associated with semen volume, sperm concentration, or total sperm count.

Perceived stress and coping strategies among junior doctors during the COVID-19 pandemic: A cross-sectional study in a tertiary care hospital, West Bengal

Background: The severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) disease (COVID-19) pandemic has put frontline health-care workers into unprecedented amounts of difficulty and psychological stress. Methods: In this cross-sectional, analytical study 122 junior doctors (interns, house staffs and postgraduate trainee) of a tertiary care hospital in West Bengal were studied during the period November 2021–January 2022. Data were collected using an online structured questionnaire, prepared as Google Forms and shared by WhatsApp. The Perceived Stress Scale (PSS-10) was used for the study. Information regarding various coping strategies adopted in the past 1 month was also collected. Results: High prevalence (83.7%) of moderate-to-high stress was observed among junior doctors (mean PSS score 21±6.9). Multivariable analysis showed female gender, single (unmarried) status and separation from family during COVID duty assignment were significantly at risk of moderate-to-high stress. The coping behaviours commonly used by the study participants were physical exercise, sharing feelings, talk therapy, meditation, hoping for the best, faith in God/religion, watching movies etc., with many struggling to cope. Conclusions: High prevalence of moderate-to-high stress and difficulty in coping were observed among the junior doctors. It's the need of the hour to plan support programmes dedicated to junior doctors emphasizing coping strategies and stress management.

Acute coronary syndrome and stress: Is there a relationship?

IntroductionAcute coronary syndrome (ACS) is the result of a complex pathophysiological process with various dynamic factors. The 10-item Perceived Stress Scale (PSS-10) is a validated instrument for estimating stress levels in clinical practice and may be useful in the assessment of ACS. MethodsWe carried out a single-center prospective study engaging patients hospitalized with ACS between March 20, 2019 and March 3, 2020. The PSS-10 was completed during the hospitalization period. The ACS group was compared to a control group (the general Portuguese population), and a subanalysis in the stress group were then performed. ResultsA total of 171 patients with ACS were included, of whom 36.5% presented ST-elevation myocardial infarction (STEMI), 38.1% were female and the mean PSS score was 19.5±7.1. Females in the control group scored 16.6±6.3 on the PSS-10 and control males scored 13.4±6.5. The female population with ACS scored 22.8±9.8 on the PSS-10 (p<0.001). Similarly, ACS males scored a mean of 17.4±6.4 (p<0.001). Pathological stress levels were not a predictor of major adverse cardiovascular events or severity at admission. ConclusionsACS patients had higher perceived stress levels compared to the control group. Perceived stress level was not associated with worse prognosis in ACS patients.

Mental Stress of Parents Having Thalassemic Children

Background: Thalassaemia is an emerging global public health concern. It is considering as a rapidly growing major health burden for low- and middle income countries. The prevalence of thalassaemia is increasing in Bangladesh, indicates that thalassemia will be an emerging health burden for our country. Objective: To assess the level of mental stress among parents with a thalassemic child. Materials and Methods: A cross-sectional study was conducted among the 141 parents with a thalassemic child in the purposively selected two hospitals’ Dhaka Shishu Hospital and Bangladesh Thalassemia Hospital in Dhaka. ‘Parental stress scale’ (PSS) was used to measure the level of stress. Results: The mean age of the parents was 36.2±8.8 years and nearly two-thirds (63.8%) of them were aged below 40 years. Almost half of the participants (49.6%) and their spouses (59.6%) completed their education upto the higher secondary level. The mean monthly family income was 27,113.5±46,696.9 taka. More than half of the parent’s (53.2%) had low level of mental stress. The education, occupation, monthly family income, presence of &gt;1 thalassaemic child in family, received blood from a voluntary blood donor, normal growth of thalassaemic child and history of thalassaemic child death were significantly associated with the level of mental stress by PSS scores of the parents (p&lt;0.05). The level of stress was low among the parents, whose educational level was up to primary level (68.6%), occupation as a business (68.4%), monthly family income ≥50,001 taka (85.7%), presence of &gt;1 beta thalassaemia major child (47.6%), received blood from a voluntary blood donor (50.0%), had a history of normal growth of thalassaemic child (60.4%) and had no history of thalassaemic child death (50.0%). Conclusion: Existence of the children with thalassemia in a family cause massive stress and anxiety for parents. Psychological supports for them are essential as a part of comprehensive medical care along with clinical management of the thalassemic child. The burden of disease can be reduced through effective preventive approaches, such as carrier screening, prenatal counseling and diagnosis. KYAMC Journal Vol. 13, No. 02, July 2022: 102-107

A Systematic Review with Meta-Analysis of Comparative Efficacy and Safety of Risankizumab and Ustekinumab for Psoriasis Treatment.

Biological targeted therapy serves as a new alternative treatment for psoriasis due to its minimal side effects. This study is aimed at examining the drug effectiveness and safety of risankizumab and ustekinumab for psoriasis treatment, so as to provide a reference for clinical decision-making. Databases from Embase, Web of Science, PubMed, and Cochrane Library were gathered, starting from inception to March 1, 2022, for randomized controlled trials regarding risankizumab and ustekinumab for psoriasis treatment. All retrieved articles were carefully selected in strict accordance with a set of inclusion and exclusion criteria. Stata 15.0 and RevMan 5.4 were applied to perform meta-analysis and risk of bias assessment. A total of two trials with three NCTs were selected, with 384 participants in the risankizumab group and 140 participants in ustekinumab. Meta-analysis showed that in the long-term and short-term PASI100, risankizumab was more effective than ustekinumab (RR = 2.27, 95% CI (1.77, 2.90), p < 0.05; RR = 2.33, 95% CI (1.75, 3.08), p < 0.05). In PASI90, RR = 1.77, 95% CI (1.54, 2.03), and p < 0.05 and RR = 1.72, 95% CI (1.48, 2.00), and p < 0.05. In short-term PASI75, RR = 1.23, 95% CI (1.13, 1.34), and p < 0.05. In sPGA of 0, the results at week-16 and week-52 showed that risankizumab was significantly more effective than ustekinumab (RR = 2.24, 95% CI (1.67, 3.01), p < 0.05; RR = 2.30, 95% CI (1.80, 2.95), p < 0.05). Risankizumab was significantly more effective than ustekinumab in improving the quality of life and PSS scores (RR = 1.48, 95% CI (1.26, 1.75), p < 0.05; RR = 2.01, 95% CI (1.41, 2.85), p < 0.05). Nevertheless, risankizumab and ustekinumab did not show significant difference in the incidence of adverse responses (RR = 1.02, 95% CI (0.75, 1.39), p > 0.05). Risankizumab was more effective than ustekinumab for the treatment of psoriasis. The adverse reactions of both risankizumab and ustekinumab were similar and could be tolerated. Risankizumab might be a better alternative option for their treatment.

Perceived stress and hair cortisol concentration in a study of Mexican and Icelandic women.

Hair cortisol concentration (HCC) represent a potential biomarker of chronic psychological stress. Previous studies exploring the association between perceived stress and HCC have been limited to relatively small and selected populations. We collected hair samples from 881 women from the Mexican Teachers' Cohort (MTC) and 398 women from the Icelandic SAGA pilot-cohort following identical protocols. HCC was quantified using liquid chromatography coupled with tandem mass spectrometry. The self-reported Perceived Stress Scale (PSS, 10 and 4 item, range 0-40 and 0-16) was used to assess psychological stress. We conducted multivariable linear regression analyses to assess the association between perceived stress and log-transformed HCC in the combined sample and in each cohort separately. MTC participants had slightly higher HCC and PSS scores than SAGA participants (median HCC 6.0pg/mg vs. 4.7pg/mg and mean PSS-10 score 12.4 vs. 11.7, respectively). After adjusting for sociodemographic factors and health behaviors, we observed a 1.4% (95% CI 0.6, 2.1) increase in HCC for each unit increase in the PSS-10 score in the combined sample. Furthermore, PSS-10 quintiles were associated with a 24.3% (95% CI 8.4, 42.6, mean logHCC 1.8 vs 1.6) increase in HCC when comparing the highest to the lowest quintile, after multivariable adjustment. Similar results were obtained when we analyzed each cohort separately and when using the PSS-4. Despite relatively small absolute differences, an association between perceived stress and HCC was found in a sample of women from two diverse geographical and cultural backgrounds supporting the hypothesis that HCC is a viable biomarker in studies of chronic psychological stress.

The association between time-to-pregnancy and postpartum depressive symptoms in a North American prospective cohort study

To prospectively examine the association between time-to-pregnancy (TTP) and postpartum depression (PPD) and determine whether perceived stress during early pregnancy mediated this association. In Pregnancy Study Online, an internet-based preconception cohort study of pregnancy planners, participants completed questionnaires every 8 weeks for up to 12 months or conception, during pregnancy, and at postpartum. A total of 2643 women provided information on sociodemographic factors, reproductive history, and stress (i.e., Perceived Stress Scale [PSS]) during preconception and early pregnancy (completed at ∼4-12 weeks' gestation) and on postpartum depressive symptoms (i.e., Edinburgh Postnatal Depression Scale [EPDS]) at ∼6 months postpartum. We used multivariable modified Poisson regression models to estimate risk ratios and 95% confidence intervals (CIs) for the association between TTP (&lt;3, 3-5, 6-11, ≥12 menstrual cycles) and PPD (EPDS score ≥13). Causal mediation analyses assessed the mediating role of early pregnancy PSS scores. 10.6% of women had EPDS scores indicating possible PPD (≥13). Compared with women who took less than 3 cycles to conceive, risk ratios for those who took 3-5, 6-11, and greater than or equal to 12 were 1.06 (95% CI: 0.77, 1.45), 1.24 (95% CI: 0.90, 1.70), and 1.31 (95% CI: 0.87, 1.99), respectively. Approximately 30% of the association between infertility (TTP ≥ 12) and PPD was mediated by early pregnancy PSS. There was a modest positive dose-response association between delayed conception and PPD. Perceived stress in early pregnancy explained a small proportion of this association. However, given the width of the CIs, chance cannot be ruled out as an explanation for the observed association.

The Efficacy of "Foundations," a Digital Mental Health App to Improve Mental Well-being During COVID-19: Proof-of-Principle Randomized Controlled Trial.

BackgroundAgainst a long-term trend of increasing demand, the COVID-19 pandemic has led to a global rise in common mental disorders. Now more than ever, there is an urgent need for scalable, evidence-based interventions to support mental well-being.ObjectiveThe aim of this proof-of-principle study was to evaluate the efficacy of a mobile-based app in adults with self-reported symptoms of anxiety and stress in a randomized control trial that took place during the first wave of the COVID-19 pandemic in the United Kingdom.MethodsAdults with mild to severe anxiety and moderate to high levels of perceived stress were randomized to either the intervention or control arm. Participants in the intervention arm were given access to the Foundations app for the duration of the 4-week study. All participants were required to self-report a range of validated measures of mental well-being (10-item Connor-Davidson Resilience scale [CD-RISC-10], 7-item Generalized Anxiety Disorder scale [GAD-7], Office of National Statistics Four Subjective Well-being Questions [ONS-4], World Health Organization-5 Well-Being Index [WHO-5]) and sleep (Minimal Insomnia Scale [MISS]) at baseline and at weeks 2 and 4. The self-reported measures of perceived stress (10-item Perceived Stress Score [PSS-10]) were obtained weekly.ResultsA total of 136 participants completed the study and were included in the final analysis. The intervention group (n=62) showed significant improvements compared to the control group (n=74) on measures of anxiety, with a mean GAD-7 score change from baseline of –1.35 (SD 4.43) and –0.23 (SD 3.24), respectively (t134=1.71, P=.04); resilience, with a mean change in CD-RISC score of 1.79 (SD 4.08) and –0.31 (SD 3.16), respectively (t134=–3.37, P<.001); sleep, with a mean MISS score change of –1.16 (SD 2.67) and –0.26 (SD 2.29), respectively (t134=2.13, P=.01); and mental well-being, with a mean WHO-5 score change of 1.53 (SD 5.30) and –0.23 (SD 4.20), respectively (t134=–2.16, P=.02), within 2 weeks of using Foundations, with further improvements emerging at week 4. Perceived stress was also reduced within the intervention group, although the difference did not reach statistical significance relative to the control group, with a PSS score change from baseline to week 2 of –2.94 (SD 6.84) and –2.05 (SD 5.34), respectively (t134= 0.84, P=.20).ConclusionsThis study provides a proof of principle that the digital mental health app Foundations can improve measures of mental well-being, anxiety, resilience, and sleep within 2 weeks of use, with greater effects after 4 weeks. Foundations therefore offers potential as a scalable, cost-effective, and accessible solution to enhance mental well-being, even during times of crisis such as the COVID-19 pandemic.Trial RegistrationOSF Registries osf.io/f6djb; https://osf.io/vm3xq

Investigating Doctor of Physical Therapy Student Stress During Pandemic Related Curricular Changes

Introduction: Stress level in physical therapy students has been a focus of research due to multiple documented effects related to physical health, mental health, and ability to learn. Self-reflection has also been a focus of education research, relating it to personal learning, critical thinking, and demonstrable development of professional behaviors and skills. The aim of this study is to investigate student stress in response to programmatic changes wrought by the pandemic and whether stress impacted student self-reflection. Review of literature: Self-reflection is positively associated with growth of professional behavior and academic performance. Student level of self-reflection has been shown to be negatively impacted by stress. Subjects: A convenience sample of 35 students entering the program fall 2019 made up the participants. Methods: Outcome measures were collected six times over two academic years. The Self-Reflection Insight Scale (SRIS) consists of 20 statements rated on a 5-point Likert scale with 3 subscales: need for reflection (N), engaging in reflection (E), and insight (I), scoring from 10 to 100. The Perceived Stress Scale (PSS-10) is a 10-item questionnaire rated on a 4-point Likert scale, scoring from 0 to 40. Results: SRIS scores increased significantly from time 1 to 2, prior to the campus closure; no significant change for times 3 through 6. PSS scores indicated a higher percentage of students reporting a high level of stress at time 3 in the months after campus closure, decreasing significantly from time 3 to 4 during virtual/hybrid learning and increasing from time 5 to 6 as students prepared for clinical internship. No correlation was seen between SRIS and PSS, however a negative correlation was observed between SRIS subscale I and PSS at time 4 and 5. Discussion: Student perceived stress decreased during the study despite a universally stressful time. Student stress increased as students prepared for their first clinical internship experience, consistent with prior research. Initial gains in student self-reflection did not significantly change during the 1.5 years of the pandemic indicating that despite multiple academic and social challenges, students were able to maintain, but not grow, their level of professional self-reflection. Research is needed to further describe the relationship between stress and insight. Conclusion: The Program’s response to pandemic mandates may have positively influenced student stress.

Heart rate variability, perceived stress and willingness to seek counselling in undergraduate students

ObjectiveThe primary aim was to determine the level of stress in Czech pharmacy students using both subjective and physiological markers of stress throughout their study. The secondary aim was to investigate association of stress with sociodemographic and clinical characteristics, and to determine the predictors of the likelihood of enrolling in psychotherapy counselling. MethodsDesign: A prospective observational study. Setting: Faculty of Pharmacy in Hradec Kralove, Czech Republic.Subjects: 175 s-year pharmacy students in 2016, 149 students in 2017, and 51 students in 2018.Outcome measures: Perceived stress scale (PSS-10), heart rate variability (HRV, emWavePro), a self-administered survey (sociodemographic and clinical data, likelihood of enrolling in psychotherapy counselling). ResultsThe average PSS score was 18.3 ± 6.7. There were no significant changes in PSS-10 and HRV parameters between 2016 and 2018. There was a significant negative correlation between PSS-10 and LF power (p = 0.012). Female gender and poor health status were more frequently observed among the respondents with impaired HRV (p = 0.026 for female gender and p = 0.025 and p = 0.042 for poor health status). Fifty-nine percent of students would be likely to enroll in psychotherapy counselling, with men being significantly less inclined to participate compared to women (p = 0.01). ConclusionCzech pharmacy students experience moderate levels of stress throughout their studies, which correlates with physiological markers of stress as well as their overall health. Push and pull factors of using mind-body interventions to manage stress should be further examined, especially in high risk groups.

Perceived stress among physician parents during COVID-19 pandemic

IntroductionStress among physician parents is still poorly studied, especially during the SARS-COV-2 pandemic.ObjectivesTo describe the stress of being both a doctor and a parent during COVID-19 epidemic.Methods It was a cross-sectional, descriptive and analytical study, carried out on google drive in March 2021, and relating to 93 Tunisian medical parents. We used a questionnaire containing the parents’ personal and professional data as well as the perceived stress scale (PSS10).ResultsThe majority of parents (94.7%) were women. The average age was 34.43 years old. The average age of marriage was 29.6 years for men and 25.4 years for women. The majority of parents (89.4%) had one or two children and 70.2% were satisfied with their relationship with their children. On another side, 71.3% of doctors had to provide on duty services in the hospital, with 44.1% providing 3-4 on-calls per month, while 69% were providing on duty services in the COVID units. The average PSS score was 22.6. The distribution of scores indicated medium and high stress level in respectively 84.9% and 14% of parents. Furthermore, the PSS score was negatively correlated with the marriage age (p = 0.046, r = -0.2). On the other hand, no association was observed with the children number nor with the satisfaction of the relationship with his child.ConclusionsIt follows from our study that stress among physician parents is at a fairly high level. Managing this stress during a pandemic is not easy and requires the activation of several defense mechanisms.DisclosureNo significant relationships.

Perceived Stress Among Students of Private and Public Sector Medical Colleges of Pakistan: A Cross Sectional Study

IntroductionMedical-education is associated with high overall stress and it is important to identify relevant factors.ObjectivesThe study was aimed to discern the differences in perceived stress among the students of public and private medical colleges of Pakistan and to identify factors subservient to any hypothesized difference.MethodsThis cross-sectional study was conducted at different private and public medical colleges of Pakistan using validated tools: PSS-14 (Perceived Stress Scale) to find out the levels of stress faced by each sector and MSSQ (Medical Student Stressor Questionnaire) to determine the factors associated with increased stress.ResultsTotal of 424 medical students from various public and private medical colleges of Pakistan (212 each) filled the questionnaires. The mean score +/- SD of PSS-14 was 36.17 ± 6.096 for the public sector and 36.29 ±5.732 for the private sector. Hence, there was no difference between the two comparative means of PSS score, t(422)=-0.213,p=0.831.The results for both sectors were classified as high perceived stress (27-40 score is high perceived stress). Out of 40 individual stress-causing factors in MSSQ, the students from private-sector scored higher as compared to public-sector: Quota System in examination t(422)=-3.951,p=0.000, stress caused by lack of time for friends and family t(422)=-3.225,p=0.001, stress caused by Tests/Examination t(422)=-2.131,p=0.034, stress caused by the parental wish for them to study medicine t(422)=-2.346,p=0.019 and stress caused by fear of getting poor marks t(422)=-2.183,p=0.030.ConclusionsThere exists no overall difference in the perceived-stress among the medical students of public and private medical colleges despite private-sectors having significantly more operational financial resources.DisclosureNo significant relationships.