The Role of the COVID-19 Pandemic and Marginalized Identities in US Medical Students' Burnout, Career Regret, and Medical School Experiences.

Little is known about the impact of the COVID-19 pandemic on medical students. We examined medical students' burnout, career regret, and medical school experiences from before to during the pandemic, and differences between students from marginalized and nonmarginalized groups. We analyzed data from 2019 to 2022 Association of American Medical Colleges Year Two Questionnaires (N = 52,152) and Graduation Questionnaires (N = 66,795). Given large samples, we focused on effect sizes versus statistical significance. All effects of study year were less than small (η2 < .01) indicating minimal differences in medical students' burnout, career regret, and school experiences from before (2019) to during (2020-2022) the pandemic. Interactions between study year and demographic characteristics (gender, race-ethnicity, sexual orientation) were less than small; thus, students from marginalized groups were not affected more by the pandemic than others. Across study years, women reported more exhaustion and discrimination than men. Black students reported more discrimination than students from other racial-ethnic groups; bisexual students reported more discrimination than heterosexual students (all ds > 0.20). Differences between students from marginalized and nonmarginalized groups were bigger than the effects of the pandemic, suggesting a need for system-level interventions to foster inclusion in medical education.

A preliminary examination of sexual and physical victimization 6 months after recent rape.

One in four US women will experience a completed or attempted rape in their lifetime, and more than 50% of survivors will experience two or more rapes. Rape and physical violence also co-occur. Multiple experiences of sexual and physical violence are associated with elevated mental and physical health problems. This secondary analysis examined the prevalence and correlates of experiencing sexual or physical violence within 6 months of a sexual assault medical forensic exam (SAMFE). Between May 2009 and December 2013, 233 female rape survivors aged 15 and older were enrolled in a randomized controlled trial during a SAMFE in the emergency department (ED). Demographics, rape characteristics, distress at the ED, and pre-rape history of sexual or physical victimization were assessed. New sexual and physical victimization was assessed 6 months after the SAMFE via telephone interview. Six months after the exam, 21.7% reported a new sexual or physical victimization. Predictors of revictimization during follow-up included sexual or physical victimization prior to the index rape, making less than $10,000 annually, remembering the rape well, life threat during the rape, and higher distress at the ED. In adjusted models, only pre-rape victimization and making less than $10,000 annually were associated with revictimization. Factors assessed at the ED can inform subsequent victimization risk. More research is needed to prevent revictimization among recent rape victims. Policies to provide financial support to recent rape victims and/or targeted prevention for those with pre-rape victimization at the SAMFE could reduce revictimization risk. TRIAL REGISTRATION: NCT01430624.

Randomized controlled trials assessing efficacy of brief web-based stress management interventions for college students during the COVID pandemic.

The purpose of this study was to evaluate the efficacy of brief, self-guided web-based interventions for decreasing distress among U.S. college students during the pandemic. Three randomized controlled trials were conducted during the spring (Study 1), summer (Study 2), and fall (Study 3) 2020 terms, and were combined into one sample to increase power (N = 775). We evaluated a web-based intervention that focused on increasing present control that had been shown to be effective in several studies prior to the pandemic (e.g., Nguyen-Feng et al., 2017). This intervention was compared to an active comparison condition (psychoeducation about and reminders to engage in Centers for Disease Control and Prevention (CDC)-recommended stress management techniques) in Study 1, to a waitlist comparison in Study 2, and to both comparison conditions in Study 3. Participants were undergraduate psychology students at two campuses of a midwestern state university system. Outcomes-perceived stress (primary); depression, anxiety, and stress symptoms (secondary); and boredom (tertiary)-were assessed at pretest and posttest (and 3-week follow-up in Study 3). Differences across conditions were significant for perceived stress, stress symptoms, and boredom (but not depression or anxiety). Contrary to hypotheses, the Present Control and CDC stress management interventions were equally effective. Both were more effective than no intervention (between-group ds = -0.27 and -0.42). Both interventions were more effective for students with higher baseline stress levels. Completion and adherence rates were high for both conditions. Results suggest that very brief, self-guided stress management interventions can be effective in reducing stress among college students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Trajectories of posttraumatic stress symptoms following the September 11, 2001, terrorist attacks: A comparison of two modeling approaches.

Several studies have analyzed longitudinal data on posttraumatic stress symptoms (PTSS) from individuals who were proximal to the September 11, 2001, terrorist attacks (9/11) in an attempt to identify different trajectories of mental health in the years following mass trauma. The results of these studies have been heterogeneous, with researchers who used latent growth mixture modeling (LGMM) tending to identify four trajectories and those who used group-based trajectory modeling (GBTM) identifying five to seven trajectories. Given that no study has applied both GBTM and LGMM to their data, it remains unknown which modeling approach and what number of trajectories best fit post-9/11 PTSS data. The present study aimed to address that question by applying both LGMM and GBTM to data from the largest sample of survivors to date, comprising 37,545 New York City community members. When analyzing four waves of PTSS, reflecting participants' mental health up to 15 years post-9/11, LGMM fit the data better than GBTM. Our optimal solution consisted of four trajectories: low-stable (72.2% of the sample), decreasing (12.8%), increasing (9.5%), and high-stable (5.5%) symptoms. Covariate analyses indicated that economic factors (i.e., having a household income less than $25,000 and experiencing job loss due to 9/11) increased the odds of belonging to the high-stable symptom trajectory group to the greatest degree, ORs = 4.93-6.08. The results suggest that providing financial support, including affordable mental health care, could be an important intervention in the wake of future mass traumatic events.

Classes of lifetime adversity in emerging adult women and men and their associations with weight status.

The aim of this paper was to better understand how child and adult adversities cluster together into classes, and how these classes relate to body weight and obesity. Analyses included 2015 and 2018 data from emerging adults (18-25 years old) who participated in a state surveillance system of 2- and 4-year college students in Minnesota (N = 7475 in 2015 and N = 6683 in 2018). Latent Class Analyses (LCA) of 12 child and adult adversities were run stratified by gender and replicated between 2015 and 2018. The distal outcome procedure and three-step Bolck-Croon-Hagenaars approach were used to estimate predicted BMI means and predicted probabilities of obesity for each class, adjusted for covariates. The LCA identified seven classes in women and 5 in men. In women, BMI ranged from 23.9 kg/m2 in the lowest-BMI class ("Adult Adversities and Childhood Household Dysfunction"; 95% CI: 22.6-25.1) to 27.3 kg/m2 in the highest-BMI class ("High Lifetime Adversities"; 95% CI: 25.9-28.7), a statistically significant difference of 3.4 kg/m2. In men, the adjusted BMIs ranged from 24.6 kg/m2 ("Low Adversities"; 95% CI: 24.3-25.0) to 26.0 kg/m2 ("Childhood Household Mental Illness"; 95% CI: 25.1-26.9), a statistically significant difference of 1.4 kg/m2. The pattern was similar for obesity. These results indicate that specific classes of child and adult adversities are strongly associated with BMI and obesity, particularly in women. A key contribution of LCA appeared to be identification of small classes at high risk for excess weight.

Post-traumatic growth as positive personality change: Challenges, opportunities, and recommendations.

OBJECTIVE: Post-traumatic growth typically refers to enduring positive psychological change experienced as a result of adversity, trauma, or highly challenging life circumstances. Critics have challenged insights from much of the prior research on this topic, pinpointing its significant methodological limitations. In response to these critiques, we propose that post-traumatic growth can be more accurately captured in terms of personality change-an approach that affords a more rigorous examination of the phenomenon. METHOD: We outline a set of conceptual and methodological questions and considerations for future work on the topic of post-traumatic growth. RESULTS: We provide a series of recommendations for researchers from across the disciplines of clinical/counseling, developmental, health, personality, and social psychology and beyond, who are interested in improving the quality of research examining resilience and growth in the context of adversity. CONCLUSION: We are hopeful that these recommendations will pave the way for a more accurate understanding of the ubiquity, durability, and causal processes underlying post-traumatic growth.

Relations among daily stressors, childhood maltreatment, and sleep in college students.

This study aimed to assess (a) the within- and between-person associations between daily stress and sleep; (b) the relation between childhood maltreatment and sleep; and (c) whether the relation between stress and sleep was moderated by the extent of childhood maltreatment among college students. Participants (N = 181) comprised the active control group in a previous intervention study. Participants completed a self-report measure of childhood maltreatment and 14 daily self-report measures of stressor exposure and severity (evenings) and 6 sleep measures (e.g., quality, duration; mornings). Experiencing more daily stressors than usual (within-person relation) was significantly associated with delayed sleep latency (i.e., time falling asleep). Greater daily stressor severity was also significantly associated with lower sleep efficiency within persons. Participants who reported more stressors in general had shorter sleep duration, poorer sleep quality, and less restful sleep (between-person relations). Students who reported more childhood maltreatment also reported significantly lower quality sleep and feeling less rested upon awakening. Childhood maltreatment did not moderate the within-person association between daily stress and sleep. Unexpectedly, at the between-person level, maltreatment moderated the association between stressors and stressor severity and several sleep parameters (e.g., efficiency and latency) such that there was a weaker relation between stress and sleep among those with more maltreatment. Interventions on campus could aim to reduce stress and improve sleep. Additional awareness of the prevalence of maltreatment and how it may be related to sleep also appears warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Trajectories of changes in distress in counseling center clients: a replication study.

Objective: Latent growth mixture modeling (LGMM) and latent class growth analysis (LCGA) are methods of identifying subgroups of individuals with similar trajectories during the course of psychotherapy. Due to inconsistent methodology, previous LGMM/LCGA psychotherapy research has led to inconsistent findings. The purpose of this study was to contribute to our understanding of individual differences in change trajectories during psychotherapy using LGMM/LCGA by attempting to replicate a previous study by Owen et al. (2015. Trajectories of change in psychotherapy. Journal of Clinical Psychology, 71(9), 817-827). Method: This study used LGMM/LCGA to model trajectories of change in a sample of 2538 psychotherapy clients at a university student counseling center. This was a secondary analysis of naturalistically-collected outcome data using The Behavioral Health Measure. Results: LGMM models did not converge. A 2-class LCGA model was selected based on fit statistics and parsimony. One class was labeled as Slow and Steady Change Before Plateau, whereas the other was labeled as Early Rapid Change Before Plateau. We also extended these findings by considering variables associated with class membership. Conclusions: These classes followed similar trajectories to two of the classes identified by Owen et al. These results indicate that latent trajectory modeling may lead to replicable findings. Furthermore, these results have implications for managing expectations about change in psychotherapy.

Childhood maltreatment predicts daily stressor exposure in college students but not perceived stress or stress reactivity.

The purpose of this observational longitudinal study was to investigate the role of childhood maltreatment in explaining individual differences in daily stress processes. College students (N = 253) completed the Childhood Trauma Questionnaire and a measure of neuroticism at baseline before completing 14 nightly surveys assessing exposure to daily stressors (particularly interpersonal stressors), perceived stressor severity, and negative affect. Given mixed findings in past research, no specific hypotheses were proffered. Generalized linear mixed modeling showed that students with a history of maltreatment experienced roughly one more stressor every 1-to-2 days compared with those without a history of maltreatment, and experienced an interpersonal stressor on approximately half of the 14 study days compared to about one quarter of the study days for those without a history of maltreatment. In contrast, childhood maltreatment (except for physical abuse) was unrelated to perceived stressor severity and stress reactivity, controlling for gender and neuroticism. This suggests that college students reporting childhood maltreatment have more daily stressors, but they neither perceive them as more stressful nor react to them more strongly. In exploratory analyses assessing exposure to specific stressors, childhood maltreatment was associated with reporting more financial, work-related, career, and grade-related stressors in addition to interpersonal stressors. These findings underscore the importance of assessing stressor exposure separately from stress reactions. They also suggest that both individualized skill-based interventions to reduce stressor exposure and campus-wide programs to reduce financial and other burdens on students may be warranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Comparing life satisfaction and functioning 15 years after September 11, 2001 among survivors with and without injuries: a mixed-method study.

PURPOSE: This study compares life satisfaction and limited activity days among 9/11 survivors with and without physical injuries using quantitative and qualitative approaches. METHODS: The study population included World Trade Center Health Registry enrollees who reported being injured on 9/11 in 2003-2004 and a sample of non-injured enrollees who participated in a cross-sectional substudy. We used multivariable logistic regression to examine differences in life satisfaction and number of limited activity days in the last 30 days between those with and without injuries. The free-response section of the survey was analyzed qualitatively to compare themes of those with and without injuries. RESULTS: The final sample consisted of 2821 adult enrollees. Compared to those who were not injured, those who were injured on 9/11 were more likely to report being unsatisfied with their life (adjusted odds ratio (AOR): 1.5, 95% confidence intervals (CI) 1.1-2.0) and have 14 or more limited activity days in the last 30 days (AOR: 1.4, 95% CI 1.0-1.9). Among those who were injured, being partially or completely prevented from working increased the odds of being unsatisfied with life and having 14 or more limited activity days. In qualitative analysis, the emotional trauma experienced from 9/11 was a major and common theme, regardless of injury status. Those with injuries were more likely to express anger/lack of recognition/appreciation, describe substance use/abuse, and have financial/health care access issues. CONCLUSIONS: More than 15 years after 9/11, those who were injured continue to be impacted, reporting lower life satisfaction and more functional impairment.

Prescription Opioid Misuse After a Recent Sexual Assault: A Randomized Clinical Trial of a Video Intervention.

BACKGROUND AND OBJECTIVES: Prescription opioid (PO) misuse is increasing and is associated with overdose. Individuals who experienced a recent sexual assault are at risk for increased substance use, yet limited interventions target PO misuse after sexual assault. The current study examined the efficacy of video interventions on PO misuse after sexual assault. METHODS: Adolescent girls and women (n = 154) were recruited in the context of a sexual assault medical forensic exam in the emergency department. Effects of a prevention of post-rape stress (PPRS) video and a pleasant imagery and relaxation instruction (PIRI) video were compared with treatment as usual (TAU) during a sexual assault medical forensic exam on PO misuse. Participants reported if they had used POs for non-medical purposes since the sexual assault at 1.5 month follow-up. RESULTS: Results from a logistic regression analysis indicated that participants with a prior sexual assault were less likely to misuse prescription opioids 1.5 months after the assault in the PIRI condition compared with TAU. There were no main effects for video condition and no interactions for the PPRS condition on PO misuse. DISCUSSION AND CONCLUSIONS: Providing the PIRI video, or teaching other types of mindfulness or relaxation exercises, may be warranted as a secondary prevention for individuals during the sexual assault medical forensic exam for those with a prior sexual assault history. SCIENTIFIC SIGNIFICANCE: This research provides an initial examination of the impact of mindfulness skills recently after traumatic event exposure on PO misuse. (Am J Addict 2019;28:376-381).

Moderators of the efficacy of a web-based stress management intervention for college students.

High levels of stress are common among college students. Web-based interventions may be one way to teach students stress management skills. Although previous research has demonstrated the overall efficacy of web-based stress management interventions, little attention has been paid to who might benefit most from these interventions. In this study, we analyzed data from 3 prior studies (N = 782) to examine moderators of the efficacy of a web-based stress management intervention that focused on increasing perceived present control (i.e., aspects of stressors that are controllable in the present). Specific moderators assessed in regression analyses were baseline scores on outcome measures (perceived stress, stress symptoms, anxiety, depression) and the putative mechanism (perceived present control) of the intervention. Baseline symptom levels moderated the effects of the intervention on all outcomes, such that the intervention was more effective for students with more baseline symptoms. Baseline levels of present control had less consistent moderating effects, but significant interactions indicated that the intervention was more effective for those with lower levels of present control. The novel Johnson-Neyman technique was used to identify specific cutoff scores on these measures, below which the effect of the intervention was not significant, and scores on the measures associated with varying effect sizes. Findings from the Johnson-Neyman analyses can inform the development of screening criteria for future research and clinical application. Because the intervention was more effective for students with higher levels of baseline distress, it may be better suited for an indicated rather than universal prevention approach. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Emotional abuse moderates efficacy of an ecological momentary stress management intervention for college students.

Web-based stress management interventions are effective for college students, particularly those with interpersonal trauma histories. However, these interventions have not been assessed among those reporting childhood emotional abuse, a group with the most distress. Ecological momentary interventions (EMIs), which use mobile phones to deliver near-real-time psychosocial interventions in daily life, offer the possibility of increasing intervention efficacy. This randomized controlled trial examined the feasibility and efficacy of an EMI for reducing psychological distress among students with and without an emotional abuse history. Undergraduate students (N = 382) were randomly assigned to receive (a) an EMI that taught stress management skills, or (b) an ecological momentary assessment (EMA) with self-monitoring of stressors and mood. Both the EMI and EMA lasted for 14 days. Participants completed outcome measures (e.g., depression, anxiety, stress symptoms) at pretest, posttest, and 3-week follow-up. Overall, the EMI appeared feasible, acceptable, and usable, with 80% to 91% completion rates. Linear mixed models indicated that there were no significant Condition × Time interaction effects in the total sample, with decreases in perceived stress and increases in positive affect over time regardless of condition (EMI vs. EMA). Moderation analyses indicated that the EMI was generally more effective for those with a history of emotional abuse and that the EMA was more effective for those without such a history. Post hoc analyses demonstrated that participants wrote less in the EMI than in a web-based version of the intervention. Future interventions could target at-risk groups based on trauma history or baseline distress. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Randomized Clinical Trial Examining the Effect of Video-Based Prevention of Alcohol and Marijuana Use Among Recent Sexual Assault Victims.

BACKGROUND: This study examined whether a brief video intervention (Prevention of Post-Rape Stress [PPRS]) delivered in the emergency department to recent sexual assault (SA) victims reduced alcohol and marijuana use at 3 points over the course of a 6-month follow-up compared to treatment as usual (TAU) and an active control condition (Pleasant Imagery and Relaxation Instruction [PIRI]). Prior assault history, minority status, and pre-SA substance use also were examined as moderators of intervention efficacy. METHODS: Women aged 15 and older (N = 154) who participated in a post-SA medical forensic examination were randomly assigned to watch the PPRS video (n = 54) or the PIRI video (n = 48) or receive TAU (n = 52) and completed at least 1 follow-up assessment targeted at 1.5 (T1), 3 (T2), or 6 (T3) months following the examination. RESULTS: Regression analyses revealed that, relative to TAU, PPRS was associated with less frequent alcohol use at 6 months post-SA among women reporting pre-SA binge drinking and minority women. Relative to TAU, PPRS also was associated with fewer days of marijuana use at T1 among those who did not report pre-SA marijuana use and prior SA. Findings for pre-SA marijuana use were maintained at T3; however, findings for prior SA shifted such that PPRS was associated with fewer days of marijuana use at T3 for women with a prior SA. CONCLUSIONS: PPRS may be effective at reducing substance use for some recent SA victims, including those with a prior SA history, a prior substance use history, and minority women.

Posttraumatic Stress Disorder Symptoms and Problematic Overeating Behaviors in Young Men and Women.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a risk factor for obesity, but the range of behaviors that contribute to this association are not known. PURPOSE: The purpose of this study was to examine associations between self-reported PTSD symptoms in 2007, with and without comorbid depression symptoms, and three problematic overeating behaviors in 2010, and to estimate the associations of PTSD-related overeating behaviors with obesity. METHODS: Cross-sectional and longitudinal analyses included 7438 male (n = 2478) and female (n = 4960) participants from the Growing Up Today Study (mean age 22-29 years in 2010). Three eating behavior outcomes were assessed: binge eating (eating a large amount of food in a short period of time with loss of control), top quartile of coping-motivated eating (from the Motivations to Eat scale), and top quartile of disinhibited eating (from the Three-Factor Eating Questionnaire). RESULTS: PTSD symptoms were associated with two- to threefold increases in binge eating and top-quartile coping-motivated eating; having ≥4 PTSD symptoms, relative to no PTSD symptoms, was associated with covariate-adjusted RRs of 2.7 (95% CI 2.1, 3.4) for binge eating, 2.1 (95% CI 1.9, 2.4) for the top quartile of coping-motivated eating, and 1.5 (95% CI 1.3, 1.7) for the top quartile of disinhibited eating. There was a trend toward PTSD symptoms in 2007 predicting new onset binge eating in 2010. Having depression symptoms comorbid with PTSD symptoms further increased risk of binge eating and coping-motivated eating. All eating behaviors were associated with obesity. CONCLUSION: Clinicians treating patients with PTSD should know of potential comorbid problematic eating behaviors that may contribute to obesity.

Sexual victimization, childhood emotional abuse, and distress: Daily coping and perceived control as mediators.

The primary aim of the present study was to assess 2 potential mediators (daily avoidant coping and perceived control) of the relations between past sexual victimization and childhood emotional abuse and current distress. Participants (N = 268) were undergraduate students in psychology courses at a large Midwestern university who completed measures of sexual victimization, childhood emotional abuse, neuroticism, and distress at baseline; daily measures of avoidant coping and perceived control over stressors for 14 days (Time 2); and measures of avoidant coping, perceived control, and distress at Time 3. Structural equation modeling (SEM) was used to test the mediation model. The indirect path between childhood emotional abuse and T3 distress through daily avoidant coping was significant and remained significant in an alternate model that controlled for baseline neuroticism. The indirect effect of childhood emotional abuse on T3 distress through perceived control was not significant. Sexual victimization was not associated with greater use of avoidant coping or perceived control in the SEM models. The present study added to the literature by assessing multiple traumas and multiple mediators using longitudinal, daily diary methods. (PsycINFO Database Record

Sexual victimization history predicts academic performance in college women.

College women frequently report having experienced sexual victimization (SV) in their lifetime, including child sexual abuse and adolescent/adult sexual assault. Although the harmful mental health sequelae of SV have been extensively studied, recent research suggests that SV is also a risk factor for poorer college academic performance. The current studies examined whether exposure to SV uniquely predicted poorer college academic performance, even beyond contributions from three well-established predictors of academic performance: high school rank, composite standardized test scores (i.e., American College Testing [ACT]), and conscientiousness. Study 1 analyzed longitudinal data from a sample of female college students (N = 192) who were assessed at the beginning and end of one semester. SV predicted poorer cumulative end-of-semester grade point average (GPA) while controlling for well-established predictors of academic performance. Study 2 replicated these findings in a second longitudinal study of female college students (N = 390) and extended the analyses to include follow-up data on the freshmen and sophomore students (n = 206) 4 years later. SV predicted students' GPA in their final term at the university above the contributions of well-established academic predictors, and it was the only factor related to leaving college. These findings highlight the importance of expanding the scope of outcomes of SV to include academic performance, and they underscore the need to assess SV and other adverse experiences on college campuses to target students who may be at risk of poor performance or leaving college. (PsycINFO Database Record

Randomized Controlled Trial of Online Expressive Writing to Address Readjustment Difficulties Among U.S. Afghanistan and Iraq War Veterans.

We examined the efficacy of a brief, accessible, nonstigmatizing online intervention-writing expressively about transitioning to civilian life. U.S. Afghanistan and Iraq war veterans with self-reported reintegration difficulty (N = 1,292, 39.3% female, M = 36.87, SD = 9.78 years) were randomly assigned to expressive writing (n = 508), factual control writing (n = 507), or no writing (n = 277). Using intention to treat, generalized linear mixed models demonstrated that 6-months postintervention, veterans who wrote expressively experienced greater reductions in physical complaints, anger, and distress compared with veterans who wrote factually (ds = 0.13 to 0.20; ps < .05) and greater reductions in PTSD symptoms, distress, anger, physical complaints, and reintegration difficulty compared with veterans who did not write at all (ds = 0.22 to 0.35; ps ≤ .001). Veterans who wrote expressively also experienced greater improvement in social support compared to those who did not write (d = 0.17). Relative to both control conditions, expressive writing did not lead to improved life satisfaction. Secondary analyses also found beneficial effects of expressive writing on clinically significant distress, PTSD screening, and employment status. Online expressive writing holds promise for improving health and functioning among veterans experiencing reintegration difficulty, albeit with small effect sizes.

Psychological and sociocultural adjustment of first-year international students: Trajectories and predictors.

Despite the increasing number of international students in U.S. universities, the temporal course of international students' adjustment has not been adequately tested, and only 1 study to date has examined multiple trajectories of adjustment. Therefore, the first goal of the current study was to explore multiple trajectories of adjustment among first-year international students using a broader range of adjustment measures (i.e., psychological distress, positive psychological adjustment, sociocultural adjustment). The second goal was to identify important predictors of trajectories. A wide range of individual and interpersonal predictor variables was examined, including academic stress and perceived control over academic stress, personality, social relationships, and language-related factors. Undergraduate and graduate international students in their first semester at a large midwestern university participated in this 5-wave longitudinal study (N = 248) that spanned 1 academic year. Multiple trajectories emerged, and the trajectories varied across the 3 adjustment measures. Average trajectories masked the trajectories of small groups of students who maintained or increased in terms of adjustment difficulties across outcomes. Contrary to popular theories, the U-shape adjustment trajectory (characterized by initial euphoria, distress, and then recovery) did not emerge. The most consistent predictors of adjustment trajectories were perceived present control over academic stress and Neuroticism.

Evaluating an online stress management intervention for college students.

The goal of this study was to assess the feasibility and effectiveness of a theory-based online intervention designed to improve stress management in undergraduate students. The intervention focused on present control because it has been found to be associated with a range of positive outcomes, including lower levels of depression, anxiety, and stress, controlling for a range of other variables (e.g., Frazier et al., 2011, 2012). Two pilot studies were first conducted to confirm that our intervention could increase present control. We then randomly assigned psychology students (n = 292) who were prescreened to have lower scores on the present control subscale of the Perceived Control Over Stressful Events Scale (Frazier et al., 2011) to 1 of 3 conditions: the present control intervention, the present control intervention plus feedback, and stress-information only. Seventy-six percent (n = 223) began the intervention, and 87% (n = 195) of those completed the posttest and 3-week follow-up. The 2 present control intervention groups had lower levels of stress, depression, and anxiety symptoms (on the Depression Anxiety Stress Scales; Lovibond & Lovibond, 1995) and perceived stress (on the Perceived Stress Scale; Cohen, Kamarck, & Mermelstein, 1983) relative to the stress-information-only group at posttest and 3-week follow-up (mean between group d at follow-up = .35, mean within group d for intervention groups at follow-up = -.46). Further, mediation analyses revealed that these effects were mediated by changes in present control. Our intervention represents a potentially valuable tool for college mental health services.