An experimental study exploring the impact of vignette gender on the quality of university students’ mental health first aid for peers with symptoms of depression

Background University students have high rates of depression, and friends are often the most commonly-used source of support for emotional distress in this population. This study aimed to explore students’ ability to provide effective support for their peers with depressive symptoms and the factors influencing the quality of their mental health first aid (MHFA) skills, including students’ gender, course of study, and gender of student experiencing depression. Methods Via an online survey, students at two British universities (N = 483) were quasi-randomly allocated to view a video vignette of either a male or female student depicting symptoms of depression. An open-ended question probed MHFA actions they would take to help the vignette character, which were rated using a standardised scoring scheme based on MHFA guidelines. Results Students reported low MHFA scores (mean 2.89, out of possible 12). The most commonly reported action was provision of support and information, but only eight (1.6 %) students stated an intention to assess risk of harm. Those studying clinically non-relevant degrees with limited mental health content reported poorer MHFA (p = <0.001) and were less confident about their ability to support a friend with depression (p = 0.04). There was no main effect of vignette gender, but within the group of students on non-relevant courses the male vignette received significantly poorer MHFA than the female vignette (p = 0.02). A significant three-way interaction found that male participants studying non-relevant degrees who viewed a male vignette had poorer MHFA compared to females studying non-relevant degrees who viewed the female vignette (p = 0.005). Conclusions Most students lack the necessary MHFA skills to support friends suffering from symptoms of depression, or to help them get appropriate support and prevent risk of harm. Students on courses which do not include mental health related content are particularly ill-equipped to support male students, with male students receiving the poorest quality MHFA from fellow male students on these courses. MHFA training has the potential to improve outcomes for students with depression, and could have a valuable role in reducing the excess risk of harm seen in male students

Serious complications of urinary tract infection in diabetes: emphysematous pyelonephritis and endogenous endophthalmitis

Introduction Severe infectious complications may occur in poorly regulated diabetic patients. In most cases treatment will lead to full recovery. Here we describe a patient with urosepsis complicated by emphysematous pyelonephritis (EPN) and endogenous endophthalmitis. Case description A 42-year-old woman with uncontrolled diabetes presented with a ketoacidosis and right flank pain due to an urosepsis with Escherichia coli (E. coli). Ultrasonography and CT scan of the abdomen showed features of emphysematous pyelonephritis of the right kidney with gas in the renal parenchyma. Subsequently the patient complained of pain and photophobia of the left eye, diagnosed as an endogenous endophthalmitis with a cloudy cornea, hypopyon en loss of details of the iris. Confirmation of the diagnosis and treatment consisted of vitrectomy of the left eye, silicone oil injection and intravitreal antibiotics. E. coli was isolated from the vitreous fluid. Pyelonephritis was treated with systemic antibiotics and percutaneous drainage. Patient follow up learned that she had no light perception of the left eye and a non- functional right kidney. Conclusion Both endogenous endophthalmitis and emphysematous pyelonephritis are rare complications of infection, which are sight- and lifethreatening. Treatment of endogenous endophthalmitis comprises both intravitreal and systemic therapy and has a poor visual prognosis despite aggressive therapy. Treatment of EPN consists of antibiotic therapy, early percutaneous drainage and nephrectomy when indicated. With the increasing number of diabetics we should be aware of the occurrence of rare infectious complications