BACKGROUND: Nursing students are often subjected to bullying during their clinical practices, but few study has examined associations of bullying with psychological status among these groups, and how they cope with the bullying.
OBJECTIVE: This study aimed to evaluate the experience and psychological status of clinical placement setting bullying among nursing students attending clinical practices, and explore students\' coping strategies when bullied.
METHODS: A mixed methods.
METHODS: Six tertiary hospitals in Northwest China.
METHODS: A total of 687 nursing students completed the questionnaire survey, of which 18 nursing students participated in the qualitative interview.
METHODS: A two-phase hybrid study was produced. During first phase, data were collected by using the Bullying Behavior Scale in Nursing Education (BNEQ) and the Depression, Anxiety and Stress Scale (DASS-21). Subsequently, those who have experienced bullying in the workplace were invited to participate in a face-to-face interview (second phase) which focused on exploring students\' deeper insights.
RESULTS: Of the 687 students involved, 72.19 % had experienced various types of bullying. Of them, 92.11 % experienced implicit violence. Those with higher education levels and from rural were more likely to experience bullying. Students were prone to greater psychological stress when exposed to bullying. \"Pretending not to see\" (33.16 %), \"reporting to superiors\" (30.10 %), and \"doing nothing\" were the most common ways students responded. Four themes were obtained from the qualitative interviews: (a) impaired self-esteem; (b) career rejection; (c) psychological stress; and (d) the decline of humanistic care.
CONCLUSIONS: Our findings suggest that senior nursing students experience multiple types of bullying during the clinical practices, leading to a high level of psychological stress, which further effect students\' professional approval and self-esteem. To prevent such incidents, we need to call on university and hospitals\' support to help students successfully cope with bullying.

Research indicates that social media use can lead to addiction, fear of missing out, higher stress levels, anxiety, and experiencing symptoms typical of depression. The purpose of the present study was to conduct a Polish adaptation of the Social Media Escapism Scale and to assess its associations with fear of missing out, Facebook addiction, thought suppression, and the experience of stress, anxiety, and symptoms typical of depression. Two studies were conducted, the first adaptive and the second testing associations. The first study included 383 participants aged 18 to 63 (M = 23.51; SD = 5.7). To adapt the scale, the following were used: the Bergen Facebook Addiction Scale, the fear of missing out Scale, and the demographic questionnaire. The second study included 417 participants aged 18 to 60 (M = 26.33; SD = 9.7). The study tested relationships using the same three scales used in the first study, and also Depression, Anxiety, Stress Scale, and the White Bear Suppression Scale. The Polish version of the Social Media Escapism Scale revealed a univariate structure with strong internal consistency (α = .91). The adapted scale was associated with fear of missing out and Facebook addiction. In study 2, the structural equation modeling analyses revealed that fear of missing out, Facebook addiction and escapism were positively related to thought suppression and the experience of anxiety, stress, and depression symptoms. In addition, thought suppression partially mediated the relationship between harmful media use and anxiety, stress, and depression. Furthermore, the findings reveal a positive correlation between escapism and several psychological constructs, including fear of missing out, Facebook addiction, as well as aspects of depression and suppression, thereby lending support to the convergent validity of the adapted measure under investigation. The results can be used in psychological intervention and developing support and treatment programs for social network addiction.

BACKGROUND: Infertility is a global issue and carries significant mental health implications. Data on mental health among infertile women in Saudi Arabia are limited.
OBJECTIVE: This study aimed to assess the prevalence and severity of depression, anxiety, and stress among infertile women in Saudi Arabia.
METHODS: This analytical cross-sectional study included women of reproductive age visiting governmental hospitals in Jeddah, Saudi Arabia. The participants were asked to fill out a pre-structured questionnaire, which included the Depression, Anxiety, and Stress Scale (DASS-21) to assess their mental health status. Data analysis was conducted using IBM SPSS Statistics, Version 29.0 (released 2023, IBM Corp., Armonk, NY). The three outcome variables derived from the DASS-21 were categorized into five distinct groups for descriptive purposes.
RESULTS: In this study, infertile women had significantly higher median scores for depression (18), anxiety (15), and stress (20) compared to fertile women who had median scores of 8, 8, and 10 for depression, anxiety, and stress, respectively. The differences between these two groups were statistically significant (p-value < 0.001). Furthermore, employed infertile women reported higher median scores for depression (87), anxiety (84.5), and stress (84.5) compared to unemployed women. In addition, infertile women with a monthly income of 10,001-20,000 SAR had notably higher median scores for depression (89.56), anxiety (90.22), and stress (89.94) compared to other income groups. These differences were statistically significant (p-values < 0.05).
CONCLUSIONS: Infertility significantly contributes to mental health issues among women in Saudi Arabia. The findings highlight the need for targeted psychological interventions alongside infertility treatment to enhance the quality of life of these women.

OBJECTIVE: The aim of this study was to investigate the status of health-related quality of life in Chinese patients with ankylosing spondylitis (AS) and to analyze factors associated with the Assessment of SpondyloArthritis international Society Health Index (ASAS-HI) in AS and its relationship with disease activity and psychological status.
METHODS: A cross-sectional study of 484 patients with AS attending 10 hospitals in China from March 2021 to September 2023 was recruited. The ASAS-HI assessed general health and functional status; the Depression Anxiety Stress Scales (DASS-21) assessed psychological disorders such as anxiety, depression, and stress; and the Functional Assessment of Chronic illness Therapy-Fatigue Scale (FACIT-F) assessed patients\' fatigue symptoms; the Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Measurement Index (BASMI) were used to assess patients\' disease activity and functional impairment. The correlation between ASAS-HI and the ASDAS, poor psychological status, and fatigue symptoms was observed. Univariate and multivariate logistic regression analyses were used to explore the relevant influencing factors of ASAS-HI.
RESULTS: A total of 484 patients were included in this study of whom 162 were in poor health, 139 in moderate health, and 183 in good health. On univariate analysis, disease activity is an important factor affecting ASAS-HI. People with extremely high disease activity (ASDAS ≥ 3.5) had a 12 times elevated risk of having poor health status (OR = 12.53; P < 0.001). Other significant covariates included age ≥ 36 (OR = 1.58; P = 0.015), BMI ≥ 24 kg/m2 (OR = 2.93; P = 0.013), smoke (OR = 1.96; P = 0.002), BASFI (OR = 1.49; P < 0.001), BASMI (OR = 1.22; P < 0.001), fatigue (OR = 6.28; P < 0.001), and bad psychological conditions such as depression (OR = 10.86; P < 0.001), anxiety (OR = 3.88; P < 0.001), and stress (OR = 4.65; P < 0.001). The use of bMARDs is inversely associated with the appearance of adverse health status (OR = 0.54; P = 0.012). There was no significant relationship between HLA-B27 and sex. Multivariable logistic regression showed that higher disease activity (ASDAS ≥ 3.5) (OR = 5.14; P = 0.005), higher scores of BASMI (OR = 1.10; P = 0.009), self-reported depression (OR = 3.68; P = 0.007), and fatigue (OR = 2.76; P < 0.001) were factors associated with adverse health status.
CONCLUSIONS: The health status of AS patients is related to age, BMI, smoking, disease activity, poor psychological status, and fatigue and is influenced by a combination of multiple factors such as emotional state, economic level, pain, and dysfunction. Therefore, clinicians should pay attention to the early assessment of ASAS-HI in order to improve the prognosis of the disease. Key Points •Ankylosing spondylitis (AS) is a chronic inflammatory autoimmune disease with a long course and heavy disease burden, which greatly affects patients\' quality of life. Therefore, this study aims to evaluate the health status of ankylosing spondylitis in the Chinese population and its influencing factors. •This is a multi-center cross-sectional study in China, which can better reflect the overall situation of the Chinese population.

UNASSIGNED: The aim of this study was to classify distinct subgroups of adolescents based on the severity levels of their mobile phone addiction and to investigate how these groups differed in terms of their psychosocial characteristics. We surveyed a total of 2,230 adolescents using three different questionnaires to assess the severity of their mobile phone addiction, stress, anxiety, depression, psychological resilience, and personality. Latent class analysis was employed to identify the subgroups, and we utilized Receiver Operating Characteristic (ROC) curves and multinomial logistic regression for statistical analysis. All data analyses were conducted using SPSS 26.0 and Mplus 8.5.
UNASSIGNED: We classified the subjects into subgroups based on their mobile phone addiction severity, and the results revealed a clear pattern with a three-class model based on the likelihood level of mobile phone addiction (p < 0.05). We examined common trends in psychosocial traits such as age, grade at school, parental education level, anxiety levels, and resilience. ROC analysis of sensitivity versus 1-specificity for various mobile phone addiction index (MPAI) scores yielded an area under the curve (AUC) of 0.893 (95% CI, 0.879 to 0.905, p < 0.001). We also determined diagnostic value indices for potential cutoff points ranging from 8 to 40. The optimal cutoff value for MPAI was found to be >14, which corresponded to the maximum Youden index (Youden index = 0.751).
UNASSIGNED: The latent classification process in this research confirmed the existence of three distinct mobile phone user groups. We also examined the psychosocial characteristics that varied in relation to the severity levels of addiction.
UNASSIGNED: This study provides valuable insights into the categorization of adolescents based on the severity of mobile phone addiction and sheds light on the psychosocial characteristics associated with different addiction levels. These findings are expected to enhance our understanding of mobile phone addiction traits and stimulate further research in this area.

UNASSIGNED: To study the effects of playing mother\'s recorded voice to preterm infants in the NICU on their mothers\' mental health as measured by the Depression, Anxiety and Stress Scale -21 (DASS-21) questionnaire.
UNASSIGNED: This was a pilot single center prospective randomized controlled trial done at a level IV NICU. The trial was registered at clinicaltrials.gov (NCT04559620). Inclusion criteria were mothers of preterm infants with gestational ages between 26wks and 30 weeks. DASS-21 questionnaire was administered to all the enrolled mothers in the first week after birth followed by recording of their voice by the music therapists. In the interventional group, recorded maternal voice was played into the infant incubator between 15 and 21 days of life. A second DASS-21 was administered between 21 and 23 days of life. The Wilcoxon rank-sum test was used to compare DASS-21 scores between the two groups and Wilcoxon signed-rank test was used to compare the pre- and post-intervention DASS-21 scores.
UNASSIGNED: Forty eligible mothers were randomized: 20 to the intervention group and 20 to the control group. The baseline maternal and neonatal characteristics were similar between the two groups. There was no significant difference in the DASS-21 scores between the two groups at baseline or after the study intervention. There was no difference in the pre- and post-interventional DASS-21 scores or its individual components in the experimental group. There was a significant decrease in the total DASS-21 score and the anxiety component of DASS-21 between weeks 1 and 4 in the control group.
UNASSIGNED: In this pilot randomized control study, recorded maternal voice played into preterm infant\'s incubator did not have any effect on maternal mental health as measured by the DASS-21 questionnaire. Data obtained in this pilot study are useful in future RCTs (Randomized Controlled Trial) to address this important issue.

BACKGROUND: Comprehensive data has shown that adolescents often suffer from depression, anxiety, and low self-esteem, and are in a particularly fragile stage of psychological, physiological, and social development. Left-behind children in particular tend to have significantly higher, state anxiety and depression compared to non-left-behind children. The Depression, Anxiety, and Stress Scale (DASS-21) is an effective tool for evaluating depression, anxiety, and stress, and is used to measure levels of depression, anxiety, and stress in groups from a variety of backgrounds. The purpose of this study was to determine the effectiveness, reliability, and measurement invariance of the DASS-21 in Chinese left-behind children.
METHODS: The test and re-test method was used (N = 676), and the exploratory structural equation model (Mplus v.8.3) used to verify basic measurement models. For measurement invariance, the configural, weak, strong, and strict models were tested. The reliability of the DASS-21 was also tested using the collected data.
RESULTS: Analysis results showed that the DASS-21 had a stable three-factor structure in the sample of left-behind children in China. The measurement invariance test showed that gender and time not only had strong invariance, but also strict invariance. The results of cross left and non-left invariance indicated a lack of strict invariance. Finally, the McDonald\'s omega coefficient of the DASS-21 total scale was 0.864, and the internal consistency of each subscale was also good.
CONCLUSIONS: The DASS-21 is shown to be an effective and reliable tool for measuring depression, anxiety and stress in Chinese left-behind children.

UNASSIGNED: COVID-19 pandemic resulted in widespread and devastating physical, emotional, societal, and economic repercussions among workers in India.
UNASSIGNED: To evaluate the impact of COVID-19 and to understand the challenges faced and coping mechanism adopted among fishermen community from the coastal area of Karnataka.
UNASSIGNED: This community-based mixed-methods study included participants from a coastal Karnataka fishermen\'s community. Questionnaire based personal interviews collected information on sociodemographics, COVID-19 diagnosis, treatment, and related costs, COVID-19-appropriate behavior and were screened using DASS-21. Focus group discussions and key informant interviews were conducted to acquire qualitative data.
UNASSIGNED: Quantitative data collection involved 107 participants, predominantly males [70.1%], aged between 46-60 years [37.4%] and low socioeconomic status [79.4%]. Among 107, 51 participants reported to have probable COVID-19 symptoms. Around 11% had tested for COVID-19 and two were admitted in hospital with mean hospital stay of seven days. According to DASS-21, 20.6%, 15.9% and 9.3% of participants screened positive for depression, anxiety and stress respectively. Nearly one third of the participants were found to have significant socioeconomic impact.Major challenges faced included loss of livelihood, inaccessibility to health care, repayment of loans, stigma related to COVID-19 and meeting educational expenses of children with one dropping out of college. Activities of local self-help groups in the community and grass root level marketing strategies to sell fish were highly successful in mitigating the impact as a community.
UNASSIGNED: COVID-19 had a significant impact on fishermen community and implies a need for better pandemic and disaster preparedness strategies in the community.

BACKGROUND: Stress, depression and anxiety are prevalent mental health concerns that are getting worse every day in the context of rapidly expanding megacities, where a rising number of people live in slums. The purpose of this study is to evaluate the state of mental health and related variables underlying mental health issues among the impoverished population.
METHODS: A total of 384 slum residents from the Khulna division responded to our questionnaire, which included the DASS-21 and other pertinent questions. Using ordinal logistic regression, the significant factors were extracted.
RESULTS: The Cronbach\'s reliability coefficient for the DASS-21 scale lies between 0.79 and 0.89 which indicates the high reliability of the DASS-21 scales. According to the findings, roughly 72.7%, 84.1%, and 69% of participants slum dwellers experienced anxiety, depression, and anxiety problems respectively. The result of ordinal logistic regression shows, slum dwellers of female gender (B = 0.669*, 95% CI 0.141, 1.197), married (B = 1.506*, 95% CI 0.119, 2.893), having only one earning member in the family (B = 1.224*, 95% CI 0.526, 1.922), day laborers (B = 2.294*, 95% CI 1.115, 3.473), not being able to educate children due to financial problem (B = 0.558*, 95% CI 0.183, 0.932) were more likely to report high levels of anxiety, depression, and stress.
CONCLUSIONS: The study finds that a significant portion of people who live in slums struggle with mental health issues. It also points to the need for further support, intervention, and study on Khulna\'s slum inhabitants who are experiencing mental health issues. The authors anticipate that the results will spur policymakers and government representatives to enhance financing for slum dwellers and employ psychological intervention strategies, both of which will aid in achieving the Sustainable Development Goal.

BACKGROUND: Smartphones have become an indispensable part of almost everyone\'s life. India has now become the leading and second-largest Smartphone market in the world. It has been noted that the purpose of Smartphone usage has exceptionally changed over the past few years, especially among students, professionals, and the common man. Smartphones have now become essential and the need of the hour, and medical students are no exception. Smartphones can make \"smart students smarter\"! There are now 10,275 unique applications labeled under the \"Medical\" and \"Healthcare and Fitness\" categories. The common medical applications used are MedCalc, Drug Infusion, Flashcards, Encyclopedia, Merck Manual, Medscape, PubMed, Epocrates, MedlinePlus, Lab test applications, Medical Dictionary, Eponyms etc. Despite the advantages and needs of smartphones, they have proven to be a source of potential hazard to human health, not only physical but also mental, social, and emotional well-being. There is consistent evidence for co-morbidity (such as obesity, heart diseases, neck and back pain, etc.) between excessive smartphone use and other psychiatric disorders, such as depression, anxiety, obsessive and compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD) similar to internet addiction. The significant association of this addiction with poorer sleep quality and higher perceived stress has been a cause for concern. Hence, further investigation to explore the association between smartphone addiction and mental health, this study was undertaken.
METHODS: Our study was undertaken in Dr VMGMC, Solapur, from June to August 2022, after obtaining approval from the ethical committee, approval number 172/22. Total voluntary participation for the study was 600 (from first to final year), and accordingly convenient sample size was taken.
RESULTS: We found that out of the total participants, 42% of the participants had an average screen time of 4-6 h daily. A very small percentage of participants (4%) spent less than two hours in front of a screen. Alarmingly, 65% of the participants had an average screen time of more than 4 hours, which puts them at risk for the negative health impacts of prolonged screen time. Around 12% of them had symptoms of mild stress, 10.3% for mild anxiety, and 15.6% for mild depression. 10.6% had symptoms of moderate stress, 23.3% for moderate anxiety, and 16% for moderate depression. A small proportion of undergraduates, that is, 5%, 16%, and 11.6%, had symptoms of severe and extremely severe stress, anxiety, and depression, respectively.
CONCLUSIONS: The study participants did not feel a lot of stress, anxiety, or depression symptoms when smartphones were used judiciously and mostly for non-social purposes (such as studying, listening to music, or watching videos). This investigation led us to the conclusion that there are some positive effects of smartphones on mental health. However, those who spent an excessive amount of time on their smartphones for social contact, with an average screen time of 5 h, showed signs of mild to moderate sadness, moderate anxiety, and tension, demonstrating that social media had a negative impact on the mental health of medical undergraduates. Therefore, efforts should be made to inform medical students about how using a smartphone is harming their mental health.