Student Health Service Research Articles

Stress, Distress, and Burnout among Medical Trainees

In the recent changes in medical education and health-care systems, stressful work condition and concurrent destabilizing psychosocial dynamics can result in adverse consequences of medical trainee's mental health. This can range from the usual stress in a medical school to distress and long-term burnout emerging into psychological disorders often underrecognized and ill managed. Stigma and poorly integrated available mental health services, administration, peers, and families can be roadblocks to implement an effective campus mental health services. This article also provides a template of student mental health service model in our institution and suggested measures for a holistic professional grooming during medical curriculum.

Increasing utilization of student mental health services on a college campus: Eight actionable tips

Undergraduate and graduate students have a higher risk of mental illness than the general population. Multiple barriers may contribute to decreased help-seeking, including mental health stigma, lack of awareness of available resources, lack of prioritization of self-care, busy class schedules, and different preferences in communication styles. Over the past six years, we have increased the utilization of our Student and Resident Mental Health Clinic on the University of Colorado Anschutz Medial Campus by more than 100%. This viewpoint article highlights eight initiatives that address some of the barriers that mental health clinics on undergraduate and graduate campuses may face. These initiatives include involving students to reduce stigma and increase engagement, matching capacity of clinic services to demand, using technology, being as visible as possible, modeling vulnerability and self-care, adapting services to your audience needs, providing food (other than pizza!), and building a team and promoting collegiality.

How perceived Australian sexual norms shape sexual practices of East Asian and sub-Saharan African international students in Sydney

IntroductionSexual norms, real or perceived, shape young people’s sexual behaviour and may constitute one of the greatest challenges in HIV/STIs prevention among this population. This study used sexual script theory to explore how international students in Sydney, Australia – from traditional cultures of East Asian and sub-Saharan African countries – construct home backgrounds and Australian sexual norms and how this may shape their sexual practices during their studies in Australia.MethodsThe study involved face-to-face and telephone semi-structured in-depth interviews. Data were provided by 20 international students who are enrolled in various universities in Sydney. Interviews were audio-recorded, transcribed, coded into NVivo and analysed using reflexive thematic analysis.ResultsIdentified patterns in the data showed three themes through which participants perceive sexual norms in Australia as distinctly different from their home country norms. First, participants stated that unlike their home country norms, sexual norms in Australia are permissive. Second, participants hold the view that compared to their home country norms, sex in Australia is largely casual as it is not always attached to love. Some participants revealed that this could shape their own sexual practices during their studies in Australia. Finally, participants noted that compared to their home countries’ norm of sex talk taboo, Australia has an open sexual communication norm; which they believe, enables young people in western societies to easily acquire sexual health information.ConclusionsFindings provide evidence to support a need for contextualized and effective sexual health services for international students that take account of perceptions around sexual norms and how they can be modified to ensure that sexual practices which these students may engage in, will be managed in a safe and responsible manner.

Indian Medical Students with Depression, Anxiety, and Suicidal Behavior: Why Do They Not Seek Treatment?

Background:Identification of barriers to mental healthcare seeking among medical students will help organize student mental health services in medical colleges across India. This study was conducted to estimate the prevalence of depression, anxiety disorders, and suicidal behavior among medical students and to identify the potential barriers to mental healthcare seeking among them.Methods:In this cross-sectional observational study, the medical students from a medical college in South India were asked to complete a structured pro forma for sociodemographic details, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Questionnaire (GAD-7),and Suicide Behaviors Questionnaire-Revised (SBQ-R). The barriers to mental healthcare seeking were assessed using the mental health subscale of Barriers to Healthcare Seeking Questionnaire for medical students. A cut-off of 15 was used for determining the presence of depression on PHQ-9. A cut-off of 10 on GAD-7 indicated the presence of anxiety disorder, and a cut-off of 7 on SBQ-R indicated suicidal risk.Results:Out of the 425 participants, 59 (13.9%) were found to have depression (moderately severe or severe) and 86 (20.2%) were found to have anxiety disorders (moderate or severe). A total of 126 (29.6%) students were found to have a suicidal risk. Preference for informal consultations, concerns about confidentiality, and preference for self-diagnosis were the most commonly reported barriers to mental healthcare seeking. Students with psychiatric disorders perceived more barriers to mental healthcare seeking than students without psychiatric disorders.Conclusions:One-fourth of the medical students were detected to have depression and/or anxiety disorders. Establishing student mental health services, taking into account the perceived barriers, will go a long way in improving medical students’ mental well-being.

Combatting the Epidemic of E-cigarette Use and Vaping among Students and Transitional-age Youth

Background: Over the past decade, the use of electronic nicotine delivery system (ENDS) devices such as e-cigarettes has increased dramatically, particularly among students and other transitional- age youth. Societal norms and the variety of ENDS devices available have also evolved dramatically in recent years. Objective: This article provides a comprehensive review and synthesis of contemporary literature, as it relates to ENDS use among transitional-age youth. Methods: Over 125 peer-reviewed studies, literature syntheses, legal reports and contemporary media works focused on ENDS use and vaping were reviewed. Results: Marketing strategies for ENDS devices have primarily targeted teens and young adults. Though ENDS devices are advertised as a safer alternative to cigarettes, accumulating data demonstrate significant health risks and consequences associated with use. The long-term health effects remain largely unknown; however, detrimental acute effects are apparent. Furthermore, rather than aiding in tobacco cessation efforts, the use of ENDS by transitional-age youth is correlated with the increased use of conventional tobacco products and other substances of abuse. Students appear to be ill-informed regarding the dangers of using ENDS products. Conclusion: Given the rapid increase in ENDS users each year, and accumulating concerns about health risks associated with use, university student health services must be prepared to address this growing problem. As clinical practice guidelines do not yet exist to encourage ENDS-product cessation, the use of the evidence-based strategies developed for tobacco cessation is advised. More research is needed to determine the most effective methods to prevent the initiation of ENDS use within this population.

A therapist-guided smartphone app for major depression in young adults: A randomized clinical trial

BackgroundMeru Health Program (MHP) is a therapist-guided, 8-week intervention for depression delivered via smartphone. The aim was to test its efficacy in patients with clinical depression in a Finnish university student health service. MethodsPatients (n=124, women 72.6%, mean age 25y) were stratified based on antidepressant status, and randomized into intervention group receiving MHP plus treatment as usual (TAU), and control group receiving TAU only. Depression, measured by the Patient Health Questionnaire-9 (PHQ-9) scale, was the primary outcome. After baseline (T0), follow-ups were at mid-intervention (T4), immediately post-intervention (T8); 3 months (T20), and 6 months (T32) post-intervention. ResultsThe intervention group and control group did not have significant differences in depression outcomes throughout end of treatment and follow-up. Among secondary outcomes, increase in resilience (d=0.32, p=0.03) and mindfulness (d=0.57, p=0.002), and reduction in perceived stress (d=-0.52, p=0.008) were greater in MHP+TAU versus TAU at T32; no differences were found in anxiety, sleep disturbances, and quality of life between groups. Post-hoc comparisons of patients on antidepressants showed significantly greater reduction in depression at T32 for MHP+TAU versus TAU (d=-0.73, p=0.01); patients not on antidepressants showed no between-group differences. LimitationsLimitations include unknown characteristics of TAU, potential bias from patients and providers not being blinded to treatment group, and failure to specify examination of differences by antidepressant status in the protocol. ConclusionsMost outcomes, including depression, did not significantly differ between MHP+TAU and TAU. Exploratory analysis revealed intervention effect at the end of the 6-month follow-up among patients on antidepressant medication.

Effectiveness of providing university students with a mindfulness-based intervention to increase resilience to stress: 1-year follow-up of a pragmatic randomised controlled trial

BackgroundThere is concern that increasing demand for student mental health services reflects deteriorating student well-being. We designed a pragmatic, parallel, single-blinded randomised controlled trial hypothesising that providing mindfulness courses to...

College Student Perspectives of Telemental Health: a Review of the Recent Literature.

Purpose of ReviewWe review the recent literature regarding college student experiences with and attitudes toward telemental health (TMH). We examine their perspectives of the advantages and drawbacks to this form of mental healthcare and their willingness to engage in TMH.Recent FindingsCollege students view TMH as convenient, accessible, easy to use, and helpful. TMH helps to overcome the barrier of stigma associated with seeking mental health treatment. Despite positive reviews, many students find a lack of customization or connection to the provider to be drawbacks to some forms of TMH. Willingness to engage in TMH varies based on prior experience with mental health treatment, ethnicity, and severity of symptoms.SummaryThe recent literature highlights the potential for TMH to play a key role in mental health services for college students. It also highlights some of its shortcomings, which are indicative of the continued need for in-person services. Future studies should continue to track college student perspectives toward and utilization of TMH.

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Improving management of sexually transmitted infections in primary care: feasibility and acceptability of a new patient management tool for clinicians.

INTRODUCTION Routinely following an evidence-based clinical pathway of care for bacterial sexually transmitted infections (STIs) such as chlamydia or gonorrhoea is important to help reduce the spread of infections, prevent reinfections and avoid associated health complications. AIM To develop an easy-to-use tool for routine use by primary care clinicians to ensure best practice management of patients tested for and diagnosed with chlamydia or gonorrhoea. METHODS The tool (a MedTech Advanced Form) was developed in consultation with seven primary care clinicians and included different tabs for use during the STI care pathway (testing, treatment, advice, partner notification and follow up) with clickable links to relevant online resources. The tool was trialled over 3 months by 19 clinicians in three Wellington primary care clinics - two youth health and a student health service. Outcome measures were frequency of use, completeness of fields related to best practice care and clinician acceptance of the tool (from focus group feedback). RESULTS The tool was used for approximately one in four patients who were tested during the trial period, with 'forgetting' reported as the most common reason for non-use. Clinician views about the tool were favourable, with most indicating they would like to continue use and would recommend it to colleagues. Documentation of best practice care was excellent; fields to record reasons for testing, discussion of sexual history, provision of treatment and advice given were used for most patients for whom the form was completed. CONCLUSIONS Inclusion of this STI management tool in the electronic patient records system appeared to improve primary care clinicians' delivery and documentation of best practice sexual health care at a practice level. Wider use of a modified version of this tool could facilitate more comprehensive best practice management of bacterial STIs.

Investigation on Reproductive Health Knowledge Cognition and Service Demand of University Students——Based on Three Universities in Huangjiahu University Town

The paper aims to provide a reference for policy-making on reproductive health services for university students by investigating the recognition degree of reproductive health knowledge and current status of reproductive health service needs of students of three universities in Huangjiahu University Town. The author carries out the questionnaire surveys in the three universities using “wjx”, a platform for questionnaire-making, then adopts descriptive analysis and spss analysis to process the data obtained from the questionnaire survey. Sexual behavior among university students is a common phenomenon. However, due to the low cognition degree of reproductive health, they have a strong demand for reproductive health services.

The Wuhan model of visual health management for students : a referential framework for the public-school health system

According to the Healthy China Action Plan, gives full play to the role of preventing and controlling student myopia by promoting student health. The primary focus is placed on education in schools, and has integrated educational resources to develop a multi-level myopia prevention and control system and service network for school students. The network contains educational adminstrative, schools, families, and professional technical service organizations. By integrating multiple disciplines, has built a comprehensive vision health management service system for all students. The Internet and cloud intelligent monitoring facilitated the establishment of a smart vision health management platform for students, which thoroughly and efficiently implemented myopia prevention and control to safeguard students’ visual health by engaging in education, monitoring, and supervision. The prevention and control of student myopia is a breakthrough for comprehensive healthy development of students. A comparison of the standard myopia rate in in 2019 and 2018 revealed that the standard myopia rate at different learning stages of primary school, junior high school, and high school dropped by 3.31, 2.50, and 2.26 percentage points, respectively, and the rate of myopia in primary school was significantly lower than the national level. Post-epidemic surveys showed that the compliance rate and the awareness rate of the visual environment and visual behaviors of primary and secondary school students in reached more than 80%, and prevalence of newly onset myopia or decreased vision was 30%, which was lower than the national average. The Wuhan Model” provides an important referential framework for public health services for school students. 【摘 要】武汉市落实健康中国行动精神,充分发挥学生近视防控工作在学生健康促进中的作用,以教育为主线、以学校为 阵地,通过整合教育资源,建立由教育行政管理部门、学校、家庭和公益性专业技术服务机构组成的多层次学校学生近视综 合防控体系与服务网络,融合多学科,针对全体学生构建全过程的视力健康管理服务体系,并运用互联网+云智能监测,建 立智慧化学校学生视力健康管理平台,全面高效实施学校学生视力健康教育、监测、监控、监管工作的近视防控新路径,以 学生近视防控工作作为突破口,全面促进学生体质健康。武汉市 2019 与 2018 年标准近视率对比,不同学习阶段标准化近 视率小学、初中、高中分别下降了 3.31, 2.50, 2.26百分点,小学阶段近视率明显低于全国水平。疫情后调查显示,武汉市中 小学生家庭视觉环境及视觉行为的达标率和知晓率达到 80%以上,新生近视或视力下降人群为 30%,低于国家平均水平。 “武汉模式” 对于完善当前的学校学生、公共卫生工作不足具有重要借鉴意义。

Barriers and Facilitators of Mental Health Services for African-American College Students: A Pilot Study

African-American/Black college students are less likely to utilize mental health services, when compared to other races or ethnicities in the United States. It must be noted that in general, Black college students have unique experiences that affect their mental health. However, there is paucity of published research and information in the literature on the utilization of mental health services by this population of college students. This pilot study was conducted to understand and appreciate the shared barriers and facilitators that affect Black students in seeking and utilizing mental health services on campus. Primary data collection involved two qualitative focus group discussions with 20 self-identified Black/African-American undergraduate students at a university in southern California. Semi-structured interviews were administered to two focus groups. The participants were asked questions that assessed their mental health knowledge, attitudes and beliefs, and personal experiences in accessing and utilizing mental health services on campus. Results from the study identified four common themes regarding barriers and facilitators to accessing and utilizing mental health services: racism/discrimination, lack of Black mental health counselors, cultural perceptions of mental health, and stigmatization. There were no facilitators identified in utilizing mental health services on campus. The results of the study suggest a greater need to employ more Black/African-American mental healthcare providers who are counselors/psychologists. Additionally, there is need to explore the necessity for alternative mental health treatments for Black students (e.g., group discussions, or group therapy, etc.), train faculty members and campus staff on cultural competencies to minimize potential biases and discrimination, and promote diversity, equity, and inclusiveness through mental health outreach for Black students. It is hoped that these findings may play a significant role in increasing the accessibility and utilization of mental health services by Black students.

You Have Options: Implementing and evaluating a contraceptive choice social marketing campaign.

Background:Up to two-thirds of pregnancies among young, unmarried women in the United States are unintended, despite increased access to highly effective contraceptive options.Aim:This study implemented and evaluated a social marketing campaign designed to increase access to a full range of contraceptive methods among women aged 18–24 years on a southeastern university campus.Methods:Researchers partnered with Choose Well and Student Health Services to design, implement, and evaluate You Have Options, a 10-week multi-media social marketing campaign. The campaign aimed to raise awareness, increase knowledge, and improve access to contraceptive options, including long-acting reversible contraception (LARC) methods among college women. A pretest-posttest web-based survey design measured campaign awareness and recognition, as well as attitudes, subjective norms, and behavior.Results:Participants demonstrated a significant increase in knowledge about intrauterine devices (IUDs) between pretest (M = 2.66, SD = 1.30) and posttest (M = 3.06; SD = 1.96); t(671) = −2.60, p < .01). Analysis revealed that frequent exposure to the campaign prompted participants to engage in discussions about LARC with friends (p < .05). In addition, 20- to 24-year-olds who reported seeing the campaign messages were more likely to seek out information (p < .01) and adopt a LARC method (p = .001) than 18- or 19-year-olds who saw the campaign messages.Conclusion:Findings from the study offer practical recommendations for implementing social marketing campaigns aimed at increasing access to LARC and reducing unintended pregnancy.

Financial difficulties and student health: Results from a National Cross-Sectional Survey of Norwegian college and university students

To examine financial circumstances among Norwegian higher education students and investigate associations between financial difficulties and health, academic outcomes and self-destructive behaviours, we used data from a recent national health survey from 2018 for higher education in Norway (the SHoT study). 50,054 full-time students (69.1% women; 30.9% men) aged 18–35 years participated and reported work status, income and experience of financial difficulties, self-reported mental health problems, deliberate self-harm and suicide attempts, somatic health complaints and exam failures in higher education. Students often experiencing financial difficulties (n = 3933, 7.9%) reported more mental health problems (HSCL-25; M = 2.1 vs 1.6), depression (24% vs 7.2%), anxiety (20.8% vs 6.7%), deliberate self-harm (12.2% vs 4.9%), attempted suicide (3.1% vs 0.5%), somatic health complaints (SSS8; M = 13.1 vs 7.4), having ever failed exams (45.5% vs 28.4%) and higher average number of failed exams (M = 1.1 vs 0.6) compared to peers not experiencing financial difficulties. These associations were robust to adjustments for age, gender, relationship status, immigrant background and study program. Strategies to alleviate problems associated with financial difficulties may be to improve the existing financial support to students, strengthen student mental health services, and expand services for financial counselling and guidance.

MOOCs as open online learning tools for developing competences related to digital health and social care services for multidisciplinary students

Digital health and social care services are increasing worldwide, and the rapidly changing nature of the world is creating a need for new competences among health and social care students and professionals. The purpose of this paper is to describe the pedagogical solutions of the SotePeda 24/7 national educational development project and to explore especially the massive open online courses (MOOCs) related to digital health and social care services as open (CC BY-SA 4.0) and flexible opportunities for developing the competence of multidisciplinary students and professionals. The data were collected via an online questionnaire from 266 Finnish University of Applied Science (UAS) students participating in the 20 MOOCs piloted during the spring 2020 semester. The majority of the participants (87.6%) came from the health and social care fields. From the 913 registrees, 562 (62%) completed the MOOCs. While piloting the MOOCS, the COVID-19 pandemic influenced heavily, and this may have increased the number of participants in the MOOCs, but also affecting the MOOCs in decreased retention and increased number of dropouts. To motivate students to actively complete the MOOCs, most were offered as 1-ECTS credit courses. Shorter study units were used as they were considered more flexible than longer ones, allowing students to find time to complete them more easily. The data were analysed using nonparametric quantitative methods. According to the results, the MOOCs were very successful in offering students flexible and open online learning opportunities and tools for developing their competences. MOOCs can potentially be efficient tools also in developing professionals’ competences and pursuing lifelong learning. There is a fruitful ground in Finland to utilize open online learning opportunities as tools for developing competences because the already wide usage of digital tools and solutions in the country.

Sexual Harassment Among Medical Students: Prevalence, Prediction, and Correlated Outcomes.

Few studies are dedicated to understanding the extent and impact of sexual harassment among medical students. The aim of this study was to use behaviorally specific measures to examine prevalence of sexual harassment toward medical students. Associated mental health and academic impacts were also studied. A multisite survey was conducted at four medical schools. Sexual harassment was measured using the Sexual Experiences Questionnaire (SEQ), a valid and reliable instrument. Students were also surveyed about depressive and post-traumatic stress disorder (PTSD) symptoms and their level of academic engagement. We also assessed their perceptions of institutional response and whether they felt safe at their institution. The final sample included 524 medical students (response rate = 13%). Findings revealed that 36.6% reported sexual harassment by a faculty/staff member and 38.5% reported harassment by a fellow student. The odds of harassment by faculty/staff, as well as peers, were significantly higher for women with an adjusted odds ratio (AOR) = 9.83, 95% confidence interval (CI) = [3.74, 25.80] and multiracial students with an AOR: 2.93, 95% CI: [1.16, 7.39]. Those who experienced sexual harassment were more likely to report academic disengagement and symptoms of depression and PTSD. Sexual harassment in medical schools can potentially limit a student's academic success and negatively impact their mental health. Supportive services and efforts to address peer and professional cultures that promote harassment are needed. Experiences of harassment require swift and competent responses by medical school leadership in collaboration with occupational and/or student health services to mitigate detrimental impacts and support medical students throughout their training.

Understanding barriers to prescription retrieval and attitudes toward mental health medications at a university student health services pharmacy

ObjectivesTo describe barriers affecting college students’ ability to retrieve prescription medications for mental health conditions from a community pharmacy embedded within a student health center on a university campus and then describe beliefs and attitudes toward the use of those medications. MethodsWe conducted a cross-sectional study of college students who were prescribed a medication(s) for a mental health condition(s) and left the medication(s) unclaimed at the pharmacy for at least 5 days. Eligible participants were identified through routine reminder telephone calls and then provided a link to an online survey via e-mail. The survey collected information on demographics, prescription retrieval barriers, and medication beliefs and attitudes using 2 validated questionnaires. Data were summarized using descriptive statistics and scoring methods specific to the validated questionnaires. ResultsA total of 83 e-mails were distributed with 46 usable responses received (55.4% response rate). Participants were undergraduate students (n = 38, 82.6%) and most frequently prescribed a medication(s) for depression (n = 21, 45.7%) or anxiety (n = 16, 34.8%). Forgetting to pick up their medication was the most commonly cited reason for prescription nonretrieval (n = 32, 69.6%) followed by limited pharmacy hours (n = 21, 45.7%). Participants generally viewed the necessity of their medication(s) as outweighing their concerns about their medication(s), and they generally viewed themselves as medication adherent. ConclusionsUniversity students taking medications for mental health conditions identified forgetfulness and limited pharmacy hours as the most common reasons for not retrieving prescriptions. Students generally viewed their medication(s) as necessary and themselves as medication adherent, suggesting that attitudes and beliefs may play a smaller role in medication use behaviors in this population. Future research is needed to develop and evaluate interventions that improve medication adherence in college students, potentially focused on reminder-based interventions.

Analysis of a School-Based Behavioral Health Program: Exploring the Value of Mental Health Services for Vulnerable Students

This paper explores the effectiveness of public school-based mental health treatment for K-12 students. Extant clinical data from 2017- 2018 for behavioral health service recipients (n = 874) was used in this analysis. Relationships among clinical diagnosis at discharge, duration in treatment, student participation, and status of mental health improvement were examined. Logistic regression explored associations among variables of interest. Results indicate 74.3% (n = 649) of students were identified by clinicians with improvement in mental health status at discharge. The most prominent mental health diagnoses being treated in the schools were depression, anxiety, and trauma. Students involved in treatment were over 15 times more likely to be categorized as having an improved mental health status; students who lacked participation were 63% less likely to improve. Our results highlight the necessity for school administrators to prioritize and support school-based mental health services. The findings provide school administrators guidance, evidence, and impetus for implementing effective school-based mental health programs.

Associations between e-health questionnaire responses, health checks and graduation: Finnish register-based study of 2011–2012 university entrants

ObjectiveTo evaluate the association between health and study-related factors measured by an Electronic Health Questionnaire (eHQ), participation in a health examination process and graduation in a university student population.DesignNationwide, retrospective,...