Impact of mental disorders during education on work participation: a register-based longitudinal study on young adults with 10 years follow-up.

BACKGROUND: Mental disorders are a leading cause of disability and a major threat to work participation in young adults. This register-based longitudinal study aims to investigate the influence of mental disorders on entering and exiting paid employment among young graduates and to explore differences across socioeconomic groups. METHODS: Register information on sociodemographics (age, sex, migration background) and employment status of 2 346 393 young adults who graduated from secondary vocational (n=1 004 395) and higher vocational education or university (n=1 341 998) in the period 2010-2019 was provided by Statistics Netherlands. This information was enriched with register information on the prescription of nervous system medication for mental disorders in the year before graduation as a proxy for having a mental disorder. Cox proportional hazards regression models were used to estimate the influence of mental disorders on (A) entering paid employment among all graduates and (B) exiting from paid employment among graduates who had entered paid employment. RESULTS: Individuals with mental disorders were less likely to enter (HR 0.69-0.70) and more likely to exit paid employment (HR 1.41-1.42). Individuals using antipsychotics were the least likely to enter (HR 0.44) and the most likely to exit paid employment (HR 1.82-1.91), followed by those using hypnotics and sedatives. The association between mental disorders and work participation was found across socioeconomic subgroups (ie, educational level, sex and migration background). DISCUSSION: Young adults with mental disorders are less likely to enter and maintain paid employment. These results ask for prevention of mental disorders and for a more inclusive labour market.

Translation, cultural adaptation, and validation of the Brazilian Portuguese version of the Higher Education Stress Inventory (HESI-Br).

OBJECTIVES: There are no validated instruments to measure education-related stress in Brazilian university students. Thus, we aimed to translate and test the internal reliability, convergent/discriminant validity, and measurement equivalence of the Higher Education Stress Inventory (HESI). METHODS: The translation protocol was carried out by two independent translators. The instrument was culturally adapted after a pilot version was administered to 36 university students. The final version (HESI-Br) was administered to 1,021 university students (mean age = 28.3, standard deviation [SD] = 9.6, 76.7% female) via an online survey that lasted from September 1 to October 15, 2020. The factor structure was estimated using exploratory factor analysis (EFA) on the first half of the dataset. We tested the best EFA-derived model with confirmatory factor analysis (CFA) on the second half. Convergent/discriminant validity was tested using the Depression, Anxiety and Stress Scale (DASS-21). Sex, age groups, period of study, family income and area of study were used to test measurement equivalence. RESULTS: EFA suggested five factors: career dissatisfaction; faculty shortcomings; high workload; financial concerns; and toxic learning environment. CFA supported the five-factor model (15 items), but not a higher order factor, suggesting multidimensionality. All five factors presented acceptable internal reliabilities, with Cronbach's α ≥ 0.72 and McDonald's ω ≥ 0.64. CFA models indicated that the HESI-Br and DASS-21 assess different but correlated underlying latent constructs, supporting discriminant validity. Equivalence was ascertained for all tested groups. CONCLUSION: The 15-item HESI-Br is a reliable and invariant multidimensional instrument for assessing relevant stressors among university students in Brazil.

Translation, cultural adaptation, and validation of the Brazilian Portuguese version of the Higher Education Stress Inventory (HESI-Br)

Abstract Objectives There are no validated instruments to measure education-related stress in Brazilian university students. Thus, we aimed to translate and test the internal reliability, convergent/discriminant validity, and measurement equivalence of the Higher Education Stress Inventory (HESI). Methods The translation protocol was carried out by two independent translators. The instrument was culturally adapted after a pilot version was administered to 36 university students. The final version (HESI-Br) was administered to 1,021 university students (mean age = 28.3, standard deviation [SD] = 9.6, 76.7% female) via an online survey that lasted from September 1 to October 15, 2020. The factor structure was estimated using exploratory factor analysis (EFA) on the first half of the dataset. We tested the best EFA-derived model with confirmatory factor analysis (CFA) on the second half. Convergent/discriminant validity was tested using the Depression, Anxiety and Stress Scale (DASS-21). Sex, age groups, period of study, family income and area of study were used to test measurement equivalence. Results EFA suggested five factors: career dissatisfaction; faculty shortcomings; high workload; financial concerns; and toxic learning environment. CFA supported the five-factor model (15 items), but not a higher order factor, suggesting multidimensionality. All five factors presented acceptable internal reliabilities, with Cronbach's α ≥ 0.72 and McDonald's ω ≥ 0.64. CFA models indicated that the HESI-Br and DASS-21 assess different but correlated underlying latent constructs, supporting discriminant validity. Equivalence was ascertained for all tested groups. Conclusion The 15-item HESI-Br is a reliable and invariant multidimensional instrument for assessing relevant stressors among university students in Brazil.

Associations of university student life challenges with mental health and self-rated health: A longitudinal study with 6 months follow-up.

BACKGROUND: Mental health problems are highly prevalent among university students. Stress due to student life challenges may be a risk factor for poorer health. This study investigates to what extent student life challenges and changes therein are associated with mental health and self-rated health. METHODS: In a longitudinal study with 568 Italian university students mental health was assessed using the Mental Health Inventory-5 (MHI-5) and self-rated health with a single item from the Short Form 36 Health Survey (SF36) (score ranges: 0-100) at baseline and at six months follow-up. Student life challenges were investigated using six subscales (score ranges: 1-4) of the Higher Education Stress Inventory (HESI). A between-within linear regression model was used to investigate whether a higher exposure to life challenges was associated with poorer health (between individuals) and whether changes in student life challenges were associated with changes in health (within individuals). RESULTS: Higher exposure to student life challenges was associated with poorer mental health (b ranging from -5.3 to -10.3) and self-rated health (b ranging from -3.1 to -9.6). An increase in student life challenges within individuals was associated with poorer mental health and self-rated health, in particular for high workload (b up to -5.9), faculty shortcomings (b up to -5.7), and unsupportive climate (b up to -5.6). DISCUSSION: Exposure to student life challenges and changes therein are associated with university students' health. Our findings suggest that student life challenges may be a target for interventions to improve mental health and self-rated health among university students.

Mental health among university students: The associations of effort-reward imbalance and overcommitment with psychological distress.

BACKGROUND: Mental health problems are highly prevalent among university students, but little is known about their underlying determinants. This study explores mental health among university students, the association between "effort-reward imbalance" (ERI), overcommitment and mental health, and to what extent ERI and overcommitment explain gender differences in mental health. METHODS: Cross-sectional data were analyzed from 4760 Italian university students. The Kessler Psychological Distress Scale-10 was used to measure self-reported psychological distress, as an indicator of mental health, and the ERI - Student Questionnaire to measure effort, reward and overcommitment. The associations between ERI and overcommitment with psychological distress were estimated with multinomial logistic regression analyses. RESULTS: 78.5% of the respondents experienced psychological distress, with 21.3%, 21.1%, and 36.1% reporting respectively mild, moderate and severe psychological distress. Female students were more likely to report moderate and severe psychological distress. ERI and overcommitment were strongly associated with severe psychological distress with ORs respectively up to 19.9 (95% CI: 12.2-32.5) and 22.2 (95% CI: 16.1-30.7). ERI and overcommitment explained part of the higher odds of severe psychological distress among female students comparing to males, attenuating the ORs from 2.3 (95% CI: 1.9-2.7) to 1.4 (95% CI: 1.2-1.7). LIMITATIONS: This cross-sectional study was performed on a large, but convenient sample. DISCUSSION: More than one out of three students reported severe psychological distress. Decreasing ERI and overcommitment may be beneficial in the prevention of psychological distress among university students and may reduce gender differences in psychological distress. Longitudinal studies are needed to further investigate these associations.

Stress among medical students: factor structure of the University Stress Scale among Italian students.

OBJECTIVES: The main purpose of the current study was to investigate the psychometric properties of the Italian version of the University Stress Scale (USS) among Italian medical students. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional observational study based on data from an online cross-sectional survey from 11 to 23 December 2018. A total of 1858 Italian medical students participated in the study. OUTCOME MEASURES: We measured perceived stress among medical students using the USS, the Effort-Reward Imbalance Student Questionnaire (ERI-SQ) and the Kessler-10 (K10). RESULTS: Results showed that a bifactor-Exploratory Structural Equation Modeling solution provided excellent levels of fit to the data. Our results suggest that the modified version of 19 items of the Italian version of the USS does not have a simple unidimensional structure. Overall, an inspection of ancillary indices (omega indices, ECV and percentage of uncontaminated correlations) revealed that these were too low to suggest the use of the USS as a composite measure of university stress. We tested an alternative unidimensional short form (eight items; USS-S) that assessed all the five sources of stress. This version provided a good fit to the data. Evidence of convergent validity of the USS-S was observed by analysing the correlations between the USS and ERI-SQ (ranging from -0.34 to 0.37, all p<0.01). Finally, based on the clinical cut-off recommended on the K10, results from receiver operating characteristic showed that considering the clinical cut-off of the USS is 7.5 and that 59.70% of medical students reported stress levels in the clinical range. CONCLUSION: Finally, our results showed a lack of support for using the USS to measure a general university stress factor, as the general USS factor accounted for little variance in our sample. In this sense, stress scores among Italian students can be better assessed by the use of the USS-S.

Stress among university students: factorial structure and measurement invariance of the Italian version of the Effort-Reward Imbalance student questionnaire.

BACKGROUND: In the last decade academic stress and its mental health implications amongst university students has become a global topic. The use of valid and theoretically-grounded measures of academic stress in university settings is crucial. The aim of this study was to examine the factorial structure, reliability and measurement invariance of the short student version of the effort-reward imbalance questionnaire (ERI-SQ). METHODS: A total of 6448 Italian university students participated in an online cross-sectional survey. The factorial structure was investigated using exploratory factor analysis and confirmatory factor analysis. Finally, the measurement invariance of the ERI-SQ was investigated. RESULTS: Results from explorative and confirmatory factor analyses showed acceptable fits for the Italian version of the ERI-SQ. A modified version of 12 items showed the best fit to the data confirming the 3-factor model. Moreover, multigroup analyses showed metric invariance across gender and university course (health vs other courses). CONCLUSIONS: In sum, our results suggest that the ERI-SQ is a valid, reliable and robust instrument for the measurement of stress among Italian university students.

The impact of depressive symptoms on exit from paid employment in Europe: a longitudinal study with 4 years follow-up.

Background: Mental health problems are a risk factor for loss of paid employment. This study investigates (i) the relation between depressive symptoms and different involuntary pathways of labour force exit and (ii) explores gender and geographical differences in this relation. Methods: The study population consisted of 5263 individuals in paid employment aged between 50 years and the country-specific retirement age from 11 European countries participating in the longitudinal Survey of Health, Ageing and Retirement in Europe (SHARE). Self-reported depressive symptoms at baseline were assessed using the EURO-D. Employment status was derived from interviews after 2 and 4 years. Cox proportional hazards regression analyses were used to investigate the association between depressive symptoms and labour force exit via disability benefit and unemployment. Population attributable fractions (PAFs) were calculated to estimate the contribution of depressive symptoms to these pathways of labour force exit. Results: Both men and women with a EURO-D score ≥4 had a >2-fold increased risk of a disability benefit (HR: 2.46, 95%CI 1.68-3.60) after adjustment for demographics and work-related characteristics. Among men depressive symptoms elevated the risk of becoming unemployed at follow-up (HR 1.55; 95%CI: 0.94-2.57). The PAF was 0.18 for disability benefit and 0.04 for unemployment, and varied across European regions. Conclusions: Individuals with depressive symptoms are at increased risk of losing paid employment, which in turn may aggravate their symptoms. Targeting depressive symptoms with public health and occupational policies should be considered to reduce the burden of mental diseases in Europe.

Measuring Burnout Among University Students: Factorial Validity, Invariance, and Latent Profiles of the Italian Version of the Maslach Burnout Inventory Student Survey (MBI-SS).

Burnout has a long tradition of studies in the workplace and recently researchers suggested burnout is also rising among university students. The Maslach Burnout Inventory (MBI) is considered a valid measure of burnout. However, the student version of the MBI (MBI-SS) has received limited empirical support. The aim of this paper is to analyze the factorial validity, invariance, and latent profiles of the Italian version of the MBI-SS in a sample university students. A total of 7757 Italian university students participated in an online cross-sectional survey. Results from explorative and confirmatory factor analyses showed acceptable fits for the Italian version of the MBI-SS. In addition, multigroup analyses supported full-metric invariance of MBI-SS within gender and academic level (bachelor vs. master). Finally, results from latent profile analysis showed that a three latent profile model was the better solution for the data: (a) burned-out (high levels of exhaustion, cynicism (CY), and low professional efficacy (PE); n = 2665, 34.2%); (b) overextended (high levels of exhaustion, moderate other, n = 3953, 51.0%); and (c) engaged (moderate exhaustion, low CY, and high PE, n = 1149, 14.8%). The resulting three-profile solution in the present study partially agrees with a prior study as it replicated three of the five-profile solution identified. In sum, we suggest that the MBI-SS is valid and reliable and represents a robust instrument for the measurement of burnout among Italian speaking university students.