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.

Closed doors: Predictors of stress, anxiety, depression, and PTSD during the onset of COVID-19 pandemic in Brazil.

BACKGROUND: The rise in mental health problems in the population directly or indirectly because of the coronavirus disease 2019 (COVID-19) pandemic is a major concern. The aim of this study was to investigate and compare independent predictors of symptoms of stress, anxiety, depression, and posttraumatic stress disorder (PTSD) in Brazilians one month after the implementation of measures of social distancing. METHODS: This cross-sectional study was performed using a web-based survey. The Depression, Anxiety, and Stress Scale (DASS-21) and PTSD Checklist for DSM-5 (PCL-5) were the outcomes. Data were gathered regarding demographics, social distancing, economic problems, exposure to the news of the pandemic, psychiatric history, sleep disturbances, traumatic situations, and substance use. The Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) was also administered. The predictors of the symptoms were investigated using hierarchical multiple linear regression. RESULTS: Of a sample of 3587 participants, approximately two-thirds considered that their mental health worsened after the beginning of the social restriction measures. The most important predictors of the symptoms investigated were the intensity of the distress related to the news of the pandemic, younger age, current psychiatric diagnosis, trouble sleeping, emotional abuse or violence, and economic problems. CONCLUSIONS: These results confirmed the hypothesis that the pandemic impacted the mental health of the population and indicated that the level of distress related to the news was the most important predictor of psychological suffering.

Avocado oil (Persea americana) protects SH-SY5Y cells against cytotoxicity triggered by cortisol by the modulation of BDNF, oxidative stress, and apoptosis molecules.

Chronic psycho-environmental stress can induce neurological dysfunction due to an increase in cortisol levels. It is possible that some food supplements could attenuate its negative impact, such as avocado oil (AO), which is rich in fatty acids with beneficial effects on the brain. This hypothesis was tested by an in vitro model using undifferentiated neuroblastoma cells (SH-SY5Y) exposed to hydrocortisone (HC), an active cortisol molecule with and without AO-supplementation. Cortisol can induce oxidative stress, apoptosis events, and a lowering effect on brain-derived neurotrophic factor (BDNF), a neurogenic molecule. As AO protective effects on HC-exposed cells could involve these routes, some markers of these routes were compared among neuroblastoma cultures. In the first assay, the range concentrations of HC exposure that trigger cell mortality and range AO-concentrations that could revert the HC effect. AO at all concentrations tested (2-30 µg/ml) did not present a cytotoxic effect on SH-SY5Y cells, whereas HC at 0.3-10 ng/ml had a dose-dependent cytotoxic effect on these cells. From these results, HC at 10 ng/ml and AO at 5 µg/ml were chosen for mechanistic analysis. AO was able to decrease the oxidative molecules; however, both AO- and HC-induced differential and varied gene expression modulation of these enzymes. AO partially reverted the protein and gene expression of apoptotic markers that were higher in HC-exposed cells. AO also increases the BDNF levels, which are lower HC-exposed cultures. The results indicate that AO could be a beneficial supplement in situations where cortisol levels are elevated, including chronic psycho-environmental stress. PRACTICAL APPLICATIONS: Psychological chronic stress that induces high cortisol exposure has been linked to premature aging and decreased healthy life expectancy. Neurobiological models involving cortisol have suggested a neurotoxic effect of this molecule, increasing the risk of psychiatric and other CNTDs. This effect can have a high impact mainly in infants and elderly people. In child abuse situations, chronic cortisol exposure could induce extensive apoptosis events, causing impairment in synaptogenesis. In both age groups, chronic cortisol exposure increased the risk of psychiatric conditions, especially anxiety and major depression. However, it is possible that the negative effects associated with chronic cortisol exposure could be attenuated by some food supplements. This is the case for molecules acquired through diet, such as polyunsaturated fatty acids (PUFAs), including omega-3. As inadequate omega-3 levels in the brain can increase the risk factor for neuropsychiatric disorders, it is possible to infer that some from food supplements, such as avocado oil, could attenuate the neurotoxic effects of chronic cortisol exposure. This hypothesis was tested using an exploratory in vitro protocol, and the results suggested that avocado oil could be used as a cytoprotective food supplement by decreasing the oxidative stress and apoptotic events induced by cortisol.

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.