BACKGROUND: Self-guided web-based interventions have the potential of addressing help-seeking barriers and symptoms common among university students, such as depression and anxiety. Unfortunately, self-guided interventions are also associated with less adherence, implicating motivation as a potential moderator for adherence and improvement for such interventions. Previous studies examining motivation as a moderator or predictor of improvement on web-based interventions have defined and measured motivation variably, producing conflicting results.
OBJECTIVE: This secondary analysis of data from a randomized controlled trial aimed to examine constructs of motivation as moderators of improvement for a self-guided 8-week web-based intervention in university students (N=1607).
METHODS: Tested moderators included internal motivation, external motivation, and confidence in treatment derived from the Treatment Motivation Questionnaire. The primary outcome was an improvement in depression and anxiety measured by the Depression Anxiety Stress Scale-21.
RESULTS: Piecewise linear mixed effects models showed that internal motivation significantly moderated symptom change for the intervention group (t1504=-2.94; P=.003) at average and high (+1 SD) motivation levels (t1507=-2.28; P=.02 and t1507=-4.05; P<.001, respectively). Significant results remained even after controlling for baseline severity. The results showed that confidence in treatment did not significantly moderate symptom change for the intervention group (t1504=1.44; P=.15). In this sample, only internal motivation was positively correlated with service initiation, intervention adherence, and intervention satisfaction.
CONCLUSIONS: The combination of a web-based intervention and high or moderate internal motivation resulted in greater improvement in the total Depression Anxiety Stress Scale-21 score. These findings highlight the importance of conceptually differentiating motivation-related constructs when examining moderators of improvement. The results suggest that the combination of a web-based intervention and high or moderate internal motivation results in greater improvement. These findings highlight the importance of conceptually differentiating motivation-related constructs when examining moderators of improvement. To better understand the moderating role of internal motivation, future research is encouraged to replicate these findings in diverse samples as well as to examine related constructs such as baseline severity and adherence. Understanding these characteristics informs treatment strategies to maximize adherence and improvement when developing web-based interventions as well as allows services to be targeted to individuals likely to benefit from such interventions.
BACKGROUND: ClinicalTrials.gov NCT04361045; https://clinicaltrials.gov/study/NCT04361045.

This study aims to analyze the association between bullying behaviors, adverse childhood experiences and social capital in late adolescence. Secondary school students aged 15-19 of a metropolitan region of Brazil were recruited for a sectional epidemiological survey, with a sample of 2,281 students, stratified by municipality of school location. Descriptive and inferential statistics were performed from three instruments: Olweus Bully/Victim Questionnaire, Childhood Adversity History Questionnaire and Integrated Questionnaire to Measure Social Capital, in adapted versions. The results showed that the factors associated with bullying victims were gender and adversity in childhood. The factors associated to bullying aggressors were gender, childhood adversities, and cognitive social capital. And the factors associated with bullying aggressor-victims were gender, childhood adversities, and cognitive social capital. It is concluded that bullying is associated with adversity in childhood and also with cognitive social capital and they point out the need to address the causes of violence in order to provide a healthy and safe development for children and adolescents, preventing negative outcomes for physical and mental health.

BACKGROUND: The rapid proliferation of technology and its impact on adolescents\' lives have raised concerns about addictive behaviors and its potential consequences, including behavioral and mental health problems. This study investigates the prevalence and risk factors associated with the co-occurrence of Problematic Facebook Use and Problematic Video game Use among Tunisian adolescents.
METHODS: We conducted a cross-sectional study in the urban area of Sousse governorate in Tunisia during the 2018/2019 school year. We selected a representative sample of high school students enrolled in public educational institutions in Sousse. Data collection was performed through a self-administered structured questionnaire, which gathered information on sociodemographic characteristics, lifestyle behaviors, and mental health disorders. Problematic Facebook Use was assessed using the validated Arabic version of the Bergen Scale, while Problematic Video Game Use was measured using the 21-point Lemmens Scale, which was translated into Arabic. Statistical analysis was carried out using the SPSS program (version 20).
RESULTS: We enrolled a total of 1342 high school students in our study, of whom, 63.2% were female with a mean age of 17.5 ± 1.44 years. The prevalence of Problematic Facebook Use and Problematic Video Game Use was  28.3% and  13% respectively. Regarding the co-occurrence of the two problematic behaviors, 31.3% of participants faced a singular addictive behavior, either related to problematic Facebook or video game use, while 5% had both addictive behaviors simultaneously. In a multivariate analysis, risk factors for the co-occurrence of Problematic Facebook and Video Game Use, in decreasing order of significance, included severe depression (AOR = 4.527; p = 0.003), anxiety (AOR = 4.216; p = 0.001), male gender (AOR = 4.130; p < 0.001), problematic internet use (AOR = 3.477; p = 0.006), as well as moderate depression (AOR = 3.048; p = 0.007).
CONCLUSIONS: Our study found that Problematic Facebook and Video Game Use were prevalent among Tunisian adolescents. The co-occurrence of these disorders is strongly linked to male gender, problematic internet use, depression, and anxiety disorders. These findings underscore the urgency of implementing tailored and effective awareness and prevention programs to address these emerging challenges.

With the rapid advancement of educational technology, the flipped classroom approach has garnered considerable attention owing to its potential for enhancing students\' learning capabilities. This research delves into the flipped classroom teaching methodology, employing the Unified Theory of Acceptance and Use of Technology (UTAUT), learning engagement theory, and the 4C skills (comprising communication, collaboration, creativity, and critical thinking) to investigate its effects on learning capabilities. The research surveyed 413 students from three universities in Jiangxi Province, employing stratified random sampling. SPSS 24.0 and Amos were used for structural equation modeling and hypothesis testing analysis. The findings indicate that: (1) Performance expectancy, effort expectancy, and peer influence significantly enhance students\' learning engagement in the flipped classroom. (2) Students\' learning engagement in the flipped classroom notably promotes their learning capabilities. (3) Performance expectancy, effort expectancy, and peer influence can significantly boost learning capabilities by increasing learning engagement. (4) Personality traits significantly moderate the effect of peer influence on learning engagement, highlighting the crucial role of individual differences in learning. (5) The level of students\' learning engagement is differentially influenced by performance expectancy and peer influence across various academic disciplines. Ultimately, this research provides valuable insights for educational policymakers and guides improvements in teaching practices, collectively advancing educational quality and equity.

Dry eye syndrome (DES) is a tear film disorder caused by increased tear evaporation or decreased production. The heavy workload on the eye and the increased usage of digital screens may decrease blink frequency, leading to an increased evaporation rate and an upsurge in the incidence and severity of DES. This study aims to assess the severity of DES symptoms and the risk factors among university students. A cross-sectional study was conducted at Umm AlQura University to evaluate the severity of DES among students and explore its potential association with digital screen use. Validated questionnaires were used to assess the severity of DES and digital screen usage. The study included 457 participants, of which 13% had symptoms suggestive of severe DES. Furthermore, multiple risk factors had a significant association with the severity of DES, including gender, use of monitor filters, monitor and room brightness, and smoking habits. DES symptoms were prevalent among university students, particularly female students. Although there was no significant association with the duration of screen usage and collage distribution. Other factors however, such as the usage of screen monitors and the brightness of both the monitor and the room, were significantly associated with the severity of DES symptoms.

BACKGROUND: Suicidal behaviour can be influenced by attitudes towards suicide and psychological distress. This study aimed to investigate the associations between psychological distress, attitudes towards suicide, and suicidal behaviour and to determine the prevalence of suicidal behaviour among students of a public university in East Malaysia.
METHODS: A total of 521 students from a public university in East Malaysia were asked to complete the Malay versions of the Suicidal Behaviour Questionnaire-Revised (SBQ-R), the Attitudes Towards Suicide Scale, and the Depression Anxiety Stress Scale.
RESULTS: 197 women and 290 men (mean age, 19.13 years) completed the questionnaires, giving a response rate of 93.4%. The prevalence of high-risk suicidal behaviour (SBQ-R score ≥7) was 23.8%. Suicidal behaviour was positively associated with psychological distress and favourable attitudes towards suicide, and negatively associated with unfavourable attitudes towards suicide. Predictors for suicidal behaviour were psychological distress and favourable attitudes towards suicide (\'the ability to understand and accept suicide\').
CONCLUSIONS: The prevalence of suicidal behaviour is high among students in a public university in East Malaysia. Services and education for mental health awareness and screening for early detection and intervention of psychological distress should be provided to university students. Implementation of suicide awareness policies and suicide prevention training is crucial.

In the realm of language education, the influence of learners\' personality traits on their educational outcomes within novel instructional frameworks has gained prominence, prompting an exploration into the effects of ambiguity tolerance on grammar acquisition among English as a Foreign Language (EFL) students. This study investigates the impact of learners\' personality traits on their learning outcomes in innovative instructional models, such as flipped and blended classes. A sample of 120 EFL students was divided into four comparative groups and two control groups based on their proficiency and ambiguity tolerance (AT) scores. The study utilized a Learning Management System (LMS) to deliver instruction to the different groups. The blended group received a combination of online and face-to-face instruction, while the flipped group received online instruction using the flipped approach. The control group received only face-to-face instruction. After a semester of instruction, a posttest on grammar learning was administered. The findings showed that the blended group performed better than the flipped and face-to-face groups in terms of grammar learning. The study also found no significant differences in grammar learning between high AT and low AT participants in the flipped and blended classes. However, high AT students in the face-to-face class demonstrated higher levels of success in grammar learning compared to low AT students.

BACKGROUND: Adolescents are exposed to various psycho-physiological stressors due to rapid changes in their bodies along with increased academic pressure, peer pressure, and pressures from other sources of society. Group health education sessions in schools could have a positive outcome in not only the way they perceive stress but also tackle it efficiently.
OBJECTIVE: The objective of the study was to assess the effectiveness of group health education intervention on \"perceived stress\" among the high school children of Kolar.
METHODS: An open-label cluster randomized controlled trial was conducted among high school students (8th, 9th, and 10th standard) in selected English Medium Schools of Kolar Taluk. The study was conducted in three phases spanning 5 months of duration. Phase I included baseline data collection wherein \"perceived stress\" level was captured using the Perceived Stress Scale (PSS) 10 questionnaire. Phase II was the interventional phase in the form of group health education sessions. Phase III was end-line assessment.
RESULTS: Before the intervention, 6.2%, 92.4%, and 1.5% of the students had mild, moderate, and severe stress, respectively, in the intervention group. After the intervention in the intervention group, about 57.9% had mild stress, 42.1% had moderate stress, and none had severe stress. The difference in difference analysis (DID) showed that the mean PSS scores in the intervention group changed by -8.84 while in the control group by 0.40.
CONCLUSIONS: Group health education delivered was effective in reducing the perceived stress levels among high school children and it is a feasible and acceptable intervention for stress in school-going adolescent children.

Dehydroepiandrosterone (DHEA) and cortisol release appear to have contrasting effects on stress perception during stressful tasks. This study aimed to investigate anticipatory examination stress in college students by considering DHEA, cortisol, psycho-emotional aspects and examination performance. Seventy-six students (66 females, 10 males; age range 18-25 years) provided saliva samples and completed questionnaires in two sessions 48 hours apart. During the second session, the students performed the examination. The questionnaires used were the State-Trait Anxiety Inventory, the Positive and Negative Affect Scale, and the Brief-Coping Orientation to Problems Experienced Inventory. DHEA, cortisol, anxiety and negative affect showed an anticipatory rise before the examination (all ps < 0.001). This rise of DHEA and cortisol was associated with lower positive affect (p = 0.001 and p = 0.043, respectively). However, only the DHEA anticipatory levels were linked to poorer examination marks (p = 0.020). Higher levels of the DHEA/cortisol ratio in anticipation of the examination were related to lower scores on the support-seeking strategy (p = 0.022). There was no association between DHEA and cortisol levels and anxiety, negative affect, active and avoidant coping strategies, or academic record. These results suggest that how DHEA and cortisol respond in anticipation of examination stress significantly impacts students\' emotional well-being during examination periods and how they cope with stress. They also suggest that levels of DHEA in anticipation of an academic stressor have detrimental effects on stress management.

This article aims to assist practitioners in understanding dyslexia and other reading difficulties and assessing students\' learning needs. We describe the essential components of language and literacy, universal screening, diagnostic assessments, curriculum-based measurement and eligibility determination. We then introduce four diagnostic assessments as examples, including norm-referenced assessments (i.e. the Comprehensive Test of Phonological Processing second edition and the Woodcock-Johnson IV Tests of Achievement) and criterion-referenced assessments (i.e. the Gallistel-Ellis Test of Coding Skills and the Dynamic Indicators of Basic Early Literacy Skills). Finally, We use a makeup case as a concrete example to illustrate how multiple diagnostic assessments are recorded and how the results can be used to inform intervention and eligibility for special education services.