Psychological Health Conditions and COVID-19-Related Stressors Among University Students: A Repeated Cross-Sectional Survey

The Coronavirus Disease 2019 (COVID-19) pandemic has broadly impacted university students’ customary life, resulting in remarkable levels of stress and psychological suffering. Although the acute phase of the crisis has been overcome, it does not imply that perceived stress related to the risk of contagion and to the changes in the relational life experienced over more than 1 year of the pandemic will promptly and abruptly decrease. This study aims at comparing university students’ psychological health conditions before and during the COVID-19 pandemic, but also at providing information on how psychological health conditions evolved over the 1 year of the pandemic. We analyzed data from a repeated cross-sectional survey on different samples of university students before the pandemic in 2017 (n = 545) and during the pandemic (n = 671). During the pandemic, data were collected at three stages (Stage 1, April 2020 n = 197; Stage 2, November 2020 n = 274; and Stage 3, April 2021 n = 200). The COVID-19 Student Stress Questionnaire (CSSQ) and the Symptom-Checklist-90-Revised (SCL-90-R) were used to assess, respectively, COVID-19-related stressors (Relationships and Academic Life, Isolation, and Fear of Contagion) and the presence of psychological symptoms. Psychological health conditions were compared at baseline and during the pandemic, whereas both psychological health conditions and perceived levels of COVID-19-related stressors were compared over the three pandemic stages. In addition, Logistic Regression was used to explore the associations between COVID-19-related stressors and psychological symptoms. Findings revealed a significant increase in symptoms of Depression (DEP), Phobic-Anxiety (PHOB), Obsessive-Compulsive (O-C), and Psychoticism (PSY) from pre to during the pandemic. Perceived levels of COVID-19-related stress and specific psychological symptoms significantly increased as the pandemic was progressing. COVID-19-related stressors emerged as significantly associated with several psychopathological symptoms. Findings are discussed with the aim of providing tailored interventions to prevent mental disease and promote psychological adjustment in this specific stage of transition within this exceptional global emergency

Re-examining the Role of Coping Strategies in the Associations Between Infertility-Related Stress Dimensions and State-Anxiety: Implications for Clinical Interventions With Infertile Couples

Research has shown a direct relationship between infertility-related stress and anxiety in infertile patients. The present study goes into this relationship in depth, testing the moderating role of coping strategies (Seeking Social Support, Avoidant, Positive Attitude, Problem-Solving, Turning to Religion) in the associations between specific infertility-related stress dimensions (Social Concern, Need for Parenthood, Rejection of Childfree Lifestyle, Couple’s Relationship Concern) and State-Anxiety among male and female partners of infertile couples. Gender differences were also explored. Both members of 254 infertile couples completed a questionnaire consisting of Socio-demographics, Fertility Problem Inventory–Short Form (FPI-SF), Coping Orientation to Problem Experienced–New Italian Version (COPE-NIV), and State-Trait Anxiety Inventory-Y (STAI-Y). The results revealed that Social Concern and Couple’s Relationship Concern, in both partners, and Need for Parenthood, in female partners, had positive correlations with State-Anxiety. Seeking Social Support and Avoidant coping were related to increasing levels of State-Anxiety in both partners, whereas Positive Attitude coping strategies were related to lower levels of State-Anxiety in female partners. Problem-Solving and Avoidant coping played moderating roles between specific infertility-related stress dimensions and State-Anxiety in unexpected directions. Problem-Solving exacerbated the negative effects of Social Concern, whereas Avoidant coping buffered the negative effects of several infertility-related stress dimensions in both partners. Interventions to improve stress management and psychological health in infertile couples should consider that the adequacy of coping strategies is inherently situation specific. It therefore follows that patient-centered clinical interventions should consider the potential inadequacy of promoting Problem-Solving strategies, and that even Avoidance can be an efficient strategy for dealing with specific infertility-related stress dimensions

COVID-19 Student Stress Questionnaire: Development and Validation of a Questionnaire to Evaluate Students’ Stressors Related to the Coronavirus Pandemic Lockdown

Clinical observations suggest that during times of COVID-19 pandemic lockdown university students exhibit stress-related responses to fear of contagion and to limitations of personal and relational life. The study aims to describe the development and validation of the 7-item COVID-19 Student Stress Questionnaire (CSSQ), a measurement tool to assess COVID-19-related sources of stress among university students. The CSSQ was developed and validated with 514 Italian university students. Exploratory Factor Analysis (EFA) was conducted with one split-half sub-sample to investigate the underlining dimensional structure, suggesting a three-component solution, which was confirmed by the Confirmatory Factor Analysis (CFA) with the second one split-half sub-sample (CFI = 0.95; TLI = 0.95; RMSEA = 0.06). The CSSQ three subscales measure COVID-19 students’ stressors related to (1) Relationships and Academic Life (i.e., relationships with relatives, colleagues, professors, and academic studying); (2) Isolation (i.e., social isolation and couple’s relationship, intimacy and sexual life); (3) Fear of Contagion. A Global Stress score was also provided. The questionnaire revealed a satisfactory internal consistency (Cronbach’s alpha = 0.71; McDonald’s omega = 0.71). Evidence was also provided for convergent and discriminant validity. The study provided a brief, valid and reliable measure to assess perceived stress to be used for understanding the impact of the COVID-19 pandemic lockdown among university students and for developing tailored interventions fostering their wellbeing

The COVID-19 Student Stress Questionnaire: Validation in Spanish university students from health sciences

This study aimed to validate the Spanish version of the COVID-19 Student Stress Questionnaire (CSSQ), a 7-item tool assessing COVID-19-related stressors among university students, namely, Relationships and Academic Life, Isolation, and Fear of Contagion. Participants were 331 Spanish university students. Factor analyses sustained the three factor solution of the original tool. Data also revealed satisfactory convergent and discriminant validity, suitable internal consistency, and significant associations with psychological symptoms, as measured by the Symptom Checklist-90-Revised. The Spanish version of the CSSQ represents a valid tool to be used in clinical settings to timely identify students at high psychological risk and to develop evidence-based interventions during/after the pandemic

Fluid challenges in intensive care: the FENICE study A global inception cohort study

Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC.This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC.2213 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during an FC was 500 ml (500-1000). The median time was 24 min (40-60 min), and the median rate of FC was 1000 [500-1333] ml/h. The main indication for FC was hypotension in 1211 (59 %, CI 57-61 %). In 43 % (CI 41-45 %) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36 %, CI 34-37 %). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22 %, CI 20-24 %). No safety variable for the FC was used in 72 % (CI 70-74 %) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response.The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

COVID-19 STRESSORS AND PSYCHOLOGICAL HEALTH CONDITIONS AMONG UNIVERSITY STUDENTS OVER TWO YEARS OF THE COVID-19 PANDEMIC: A REPEATED CROSS-SECTIONAL STUDY

The study aims at comparing university students’ perceived COVID-19-related stressors (Relationships and Academic Life, Isolation, Fear of Contagion) and psychological health over three times during the pandemic: April 2020-T1, April 2021-T2, April 2022-T3. COVID-19-related stressors predictivity of psychological disease was also evaluated three times. 567 students completed COVID-19 Student Stress -questionnaire and SCL-90-R (T1 n=197; T2 n=200; T3 n=170). Data revealed significantly higher levels of all COVID-19-related stressors from T1 to T2 and signi$cantly lower levels from T2 to T3. Psychological disease increased from T1 to T2 but remained unchanged from T2 to T3. All COVID-19-related stressors predicted psychological disease at T1 and T2. At T3 Relationships and Academic Life retained its full predictivity, while Isolation lost predictive power with respect to Anxiety and Hostility, and Fear of Contagion lost predictive power with respect to all psychological disorders except Somatization and Phobic-Anxiety. Despite a significant reduction, the impact of COVID-19-stressor related to changes in relationships has enduring effects on students’ psychological health and should be carefully considered to develop evidence-based interventions in the current post-pandemic period