Abstract: Background: While stress management is crucial for student well-being, little is known about the factors influencing students’ intention to use university-based Stress Management Programs (SMP). Aims: This study aims to investigate factors influencing intentions to use on-campus SMP based on the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2), which comprises Performance Expectancy, Effort Expectancy, Social Influence, Facilitating Conditions, Hedonic Motivation, Price Value, and Habit. Methods: The analysis was based on data from n = 24 students from one university who took part in three focus groups (N = 4, 5, 5) and two workshops (N = 10). We applied qualitative content analysis according to Mayring (2014) to develop a category system around core UTAUT2 constructs. The model was then expanded with theory-based inductively derived categories to capture additional drivers and barriers. Results: Of the UTAUT2 constructs, Facilitating Conditions represented the most cited key factor influencing the intention to use SMP. Moreover, context-sensitive categorizations were derived for Performance Expectancy and Effort Expectancy, as well as for the additional UTAUT2 determinants Price Value (tradeoff between usefulness and time investment) and Hedonic Motivation, while no statements could be assigned to both Social Influence and Habit. Trust, Promotion (communication), and Psychological Safety further expanded the conceptual model for the on-campus setting. Limitations: Although this study provides an empirical foundation for understanding the utilization of on-campus SMP, it is based on a small qualitative sample. Conclusion: The findings offer novel qualitative insights for improving program design and implementation, for example, through streamlined registration supported by a digital health recommender system. They thereby expand the established UTAUT2 model to a broader context of on-campus SMP at universities.
Abstract: Background: Medical students often face high study demands during the clinical stage of their study, which is associated with higher levels of academic burnout. This adverse association might be mitigated by study resources, aligning with the buffering effect proposed by Study Demands-Resources (SD-R) theories. However, this potential buffering effect has not been examined among medical students in the clinical stage, referred to as clinical clerks. Aims: This study investigated whether study resources mitigate the association between study demands and academic burnout among clinical clerks. Methods: In this cross-sectional survey study, 120 clinical clerks from all eight Dutch medical schools (70% female, M age = 24 years) completed questionnaires assessing study demands, study resources, and academic burnout. The data were analyzed using correlation and moderation analyses. Results: Higher study demands and lower study resources were significantly associated with higher academic burnout. Additionally, study resources mitigated the association between study demands and academic burnout; however, this adverse association remained significant even when study resources were high. Limitations: The cross-sectional design precludes causal interpretation, and potential selection bias may limit generalizability. Conclusion: Higher study demands were associated with increased academic burnout among clinical clerks, whereas higher study resources buffered this association, aligning with SD-R theories. Strengthening study resources may reduce academic burnout among clinical clerks exposed to high study demands during clinical clerkships.
Abstract: Background: University students’ mental health has declined in recent years. Possible explanations are rising academic demands and missing resources. According to the Study Demands-Resources (SD-R) model, these factors affect outcomes through the mediating roles of burnout and engagement. Another potential influencing factor is the study mode, as on-campus and distance-learning students differ in various demographic aspects. Aims: The present study seeks to extend research on mental health in distance-learning students by comparing mental health indicators and study demands and resources with those of on-campus students and test the SD-R model in a distance-education setting. Methods: Data from 233 on-campus and 362 distance-learning students were collected through an online survey measuring study demands and resources, burnout, engagement, and mental health problems. Additionally, two open-ended questions assessed participants’ most significant study demand and major resource. Group differences were examined using t-tests, responses to the open-ended questions were analyzed descriptively and model testing was conducted via path analysis. Results: Statistically significant group differences were observed for mental health problems, burnout, and peer support with on-campus students demonstrating higher levels. Distance-learning students were more engaged than on-campus students. The analysis of the open questions indicated that the rank order and frequency of perceived demands and resources varied between groups. Path analyses supported the applicability of the SD-R model in a distance-education setting. Limitations: The cross-sectional design does not allow causal interpretation. Conclusion: The observed group differences emphasize distinct needs and highlight opportunities for targeted research and interventions for distance-learning students.
: Background: Cardiovascular emotional dampening (CED) refers to reduced emotion recognition associated with persistently elevated resting blood pressure (BP). Whether this phenomenon manifests differently in essential hypertension (EH) and secondary hypertension (SH) remains unclear. Aim: This study examined differences in CED among individuals with EH, SH, and normotension, and whether such differences vary by sensory modality (visual vs. auditory), level of processing (implicit vs. explicit), and performance indices (accuracy and response time). Method: Ninety participants (30/group) completed computerized implicit (emotion-matching) and explicit (emotion-labelling) tasks assessing visual and auditory emotion recognition. Mixed-design ANCOVAs controlling for age, sex, and education were conducted. Results: A significant BP group & times; level of recognition interaction emerged for accuracy, with both EH and SH groups showing poorer implicit and explicit emotion recognition compared to normotensive participants. For response time, a significant three-way interaction was observed. Visual emotion recognition speed did not differ between the hypertensive groups. In contrast, during auditory emotion recognition, SH participants were slower than EH participants at the implicit level, whereas EH participants were slowest at the explicit level. Limitations: The cross-sectional design and the possibility of cross-race effects should be considered when interpreting the findings. Conclusion: The findings demonstrate the presence of CED in individuals with SH, similar to those with EH, primarily reflected in reduced emotion recognition accuracy relative to normotensive individuals. Additionally, differences in emotion recognition speed appeared more pronounced in the auditory than the visual modality; however, this finding should be interpreted with caution given differences in task structure across modalities.
: Background: Sexual minority students experience poorer mental health than their heterosexual peers. Based on the minority stress theory, sexual stigma is considered a key risk factor, while the buffering hypothesis suggests that social support may mitigate the negative effects of stigma. Aims: This study examined whether the relationship between perceived public stigma toward non-heterosexuality at university and mental health is mediated by internalized sexual stigma, and whether perceived social support from peer students moderates this relationship. Method: In a cross-sectional study, 248 sexual minority students enrolled in Dutch higher education completed an online survey. Data were analyzed using correlation and (moderated) mediation analyses. Results: Perceived public stigma and internalized stigma were negatively associated with mental health, while perceived peer support was positively associated with mental health and negatively associated with both forms of stigma. The mediation analysis revealed a significant negative indirect effect of perceived public stigma on mental health through higher internalized stigma. Perceived peer support did not moderate these associations. Limitations: Given the cross-sectional design and convenience sampling, causal inference and generalizability are limited. Conclusion: Among sexual minority students, higher perceived public stigma toward non-heterosexuality at university is associated with poorer mental health, both directly and indirectly through higher internalized sexual stigma. Perceived peer support does not buffer this association, yet it contributes to better mental health. Therefore, universities should address public stigma and foster a supportive learning environment to enhance students' mental health.
: Background: Physical activity interventions can promote a more active lifestyle. Previous findings on the effects of such interventions for working adults are mixed. Aims: The main goal of this study was to examine an online physical activity intervention for working adults, building on the theoretical approach of mental contrasting with implementation intentions (MCII). Method: Participants (N = 336) were randomly assigned to an MCII intervention and a control group. Intervention group participants completed an initial online MCII intervention and daily morning refreshers over 10 workdays. Participants reported their moderate-to-vigorous physical activity (MVPA) in daily diaries and at a 6-month follow-up. Results: The intervention resulted in mixed findings. Multi-level path analysis showed that daily refreshers were effective in predicting same-day MVPA. However, control group participants reported more after-work MVPA during the daily-diary period, although intervention group participants successfully completed the initial intervention. In the overall sample, MVPA during the daily-diary phase predicted MVPA at follow-up, even when controlling for baseline physical activity and baseline self-efficacy. Limitations: The overall complex intervention might have imposed too much of a burden on working adults in the intervention group. The generalizability of our findings might be limited. Conclusion: Morning refreshers help to be physically active, but control group participants can also benefit from study participation when survey questions serve as reminders for being physically active.
: Background: Respiratory syncytial virus (RSV) can cause severe illness, especially in older adults. Since the European Medicines Agency approved two RSV vaccines in 2024, it is important to assess the public's knowledge of this virus. Aims: Exploring knowledge about RSV and identifying associations with vaccination antecedents and vaccination intention. Method: We collected data from 565 individuals over 60 years of age in Germany, assessing their awareness and knowledge about RSV using a novel, pre-tested RSV knowledge scale and RSV-specific 5C vaccination antecedents (confidence, constraints, collective responsibility, complacency, and calculation), as well as their RSV vaccination intentions. Results: Around 50% of the sampled individuals stated that they had never heard of RSV. The RSV-aware sample (n = 289) showed an intermediate level of knowledge concerning RSV, M (SD) = 0.58 (0.19). The 5C vaccination antecedents collective responsibility and complacency mediated the relationship between knowledge and intentions. Limitations: As the results are from a survey study, mediation analysis can only be interpreted as correlational evidence. Conclusion: Educational interventions on RSV and respective vaccines are needed, as awareness, particularly about its infectiousness in children and vaccine availability, is low in the target group.
Abstract: Background: The COVID-19 pandemic has been associated with elevated stress levels, yet little is known about how perceived stress evolved over time and which factors influenced individual stress trajectories. Aims: This study aimed to examine time trends in perceived stress among German adults during the COVID-19 pandemic and to identify demographic and COVID-19–related moderators of these trajectories. Method: An Ecological Momentary Assessment study was conducted using the mHealth application Corona Health. A total of 288 participants were assessed weekly with the Perceived Stress Scale between December 2020 and February 2022. Linear multilevel models were estimated in R to analyze linear and quadratic time trends in perceived stress and to test moderating effects of age, education, relationship status, and personal experiences with COVID-19 infection. Results: Younger age was associated with higher baseline stress levels. Education and personal experiences with COVID-19 infection significantly moderated stress trajectories over time. Limitations: Some subgroup sample sizes were small. Perceived stress was assessed via self-report, and while the EMA design enhanced ecological validity, it may have reduced internal validity. Conclusion: Although perceived stress declined over time overall, younger individuals experienced higher stress levels during the COVID-19 pandemic, and several demographic and pandemic-related factors influenced stress trajectories. These findings provide real-time insights into stress dynamics, highlight potentially vulnerable populations, and demonstrate the usefulness of mHealth applications for mental health monitoring during public health crises.
Abstract: Background: University students are increasingly exposed to a variety of demands; yet, little is known about how student demands interact with available resources and how these interactions affect students’ well-being in higher education. Aims: Drawing on the Study Demands–Resources (SD–R) theory ( Bakker & Mostert, 2024 ), this study adopts a person-centered approach to identify distinct student demand–resource profiles and investigate their implications for student well-being and outcomes. Method: A cross-sectional survey was administered to 2,434 South African university students across three campuses. Latent profile analysis (LPA) was performed to identify distinct student subgroups. Results: Five profiles emerged: 1) Collapsing (13.34%): High demands, low resources, associated with high burnout, low engagement, low study satisfaction, high dropout risk; 2) Stable and Supported (25.58%): Low demands, moderate to high resources, associated with low burnout, average engagement, high study satisfaction, low dropout risk; 3) Strained (33.35%): High demands, moderate resources, associated with moderate burnout and engagement, average study satisfaction, average dropout risk; 4) Flourishing (13.76%): Low demands, high resources, associated with low burnout, high engagement, high study satisfaction, low dropout risk; and 5) Enduring (13.97%): Moderate demands and resources, associated with average outcomes across burnout, engagement, study satisfaction, and dropout risk. Limitations: The cross-sectional design limits the ability to assess causality, stability, and change of profiles over time. Conclusion: These findings advance the SD–R theory by contributing to a more nuanced understanding of how demand–resource configurations shape students’ well-being and important outcomes in resource-constrained academic environments and offer evidence to inform targeted profile-specific interventions.
: Background: Several studies reported high rates of acculturative stress and mental health issues among international students. Aims: The aim of the study was to investigate the feasibility and efficacy of a cognitive stress management intervention for international students. Method: Thirty-four international students (intervention group: n = 17, control group: n = 17) participated in a 4-week group-based face-to-face intervention. Cognitive strategies, mental health, acculturative stress, self-efficacy, and well-being were assessed at pre- and postintervention. Intervention effects were analyzed using repeated measures (MANOVA, ANOVA). Results: The intervention group was very satisfied with the training content and the training condition. At postintervention, the intervention group yielded significant improvements in cognitive strategies (acceptance, reappraisal), mental health (anxiety, depression), self-efficacy, and well-being compared to the control group. Moderate to large effect sizes were observed for these outcomes. However, there was no improvement in acculturative stress. Limitations: Most of the sample were female international students, the sample size was small, and no follow-up data were collected. Conclusion: Cognitive strategies in stress management trainings appear effective in enhancing coping skills and improving health outcomes among international students. Universities should therefore recognize the high prevalence of stress and mental health challenges in this population and offer accessible, low-threshold stress management interventions.
: Background: Unhealthy diet and a lack of daily exercise are associated with adverse outcomes in children. Aims: This study investigates the effectiveness of self-regulation interventions for establishing healthy eating and exercising behavior in children with overweight. Method: Thirty-four children (14 girls) with overweight (Mage = 12.03 years, SD = 2.47) were after a 1-week baseline randomly assigned to either a goal or a goal intention + if-then plan intervention condition. Children learned to apply either goal intentions or if-then plans to their everyday eating and exercising behavior, and the effects of these interventions were assessed at a 3-week follow-up. Results: Interventions' effects did not reach statistical significance. However, critical eating situations in the if-part of an if-then plan mainly occurred in social contexts and around high-calorie foods, whereas critical exercising situations reflected various barriers perceived by children. Limitations: The small sample size, self-reported data, and sparse measurements over a month warrant replication of the study in a randomized controlled trial. Conclusion: Training children who are overweight to use self-regulatory tools might be only one component to better manage daily challenges in their eating and exercise habits.
: Background: Women who experience fertility problems often report high levels of distress. Trait mindfulness, or the tendency to be present-minded and accepting of one's thoughts and feelings, could offset this distress. Aims: In two cross-sectional studies, we tested if fertility patients who were higher in trait mindfulness were lower in psychological distress as measured by anxiety and depressive symptoms, fertility-specific distress, and anticipated negative emotions. Method: Study 1 (N = 324; Age M = 34.3; 90% White) included women who had recently sought treatment for fertility problems, and Study 2 (N = 102; Age M = 32.9; 94% White) included fertility patients who were having a consult for their first in-vitro fertilization (IVF) treatment. Both studies tested associations between trait mindfulness, anxiety, and depressive symptoms. Study 1 also measured fertility-specific distress and Study 2 measured anticipated negative emotions for IVF outcomes. Results: Trait mindfulness was moderately associated with every indicator of distress (rs ranged = .34 - .57). Those higher in mindfulness were less anxious, less depressed, had lower distress about fertility problems (Study 1), and anticipated fewer negative emotions if treatment should fail (Study 2). Higher mindfulness was particularly important when imagining IVF treatment failed. Limitations: Both samples were predominantly White and highly educated, and a more general sample of women with fertility problems should be tested. Conclusion: This research contributes to a small literature exploring personality traits in fertility patients. When experiencing fertility problems or navigating IVF treatment, women lower in trait mindfulness may need more mental health support.
Background: The World Mental Health International College Student Project reported a significant need and demand for mental health care. Mental health literacy (MHL) as well as context-specific knowledge about treatment options (CSK) play an important role in help-seeking. Aims: In this cross-sectional, observational study, we aim to explore if CSK of help-seeking options influences the impact that MHL has on students' intentions to seek help and what role the study subject plays. Methods: Aiming to analyse the influences of CSK on the relationship between MHL and students' help-seeking intention from general practitioners (GPs) and mental health professionals (MHPs), moderator models are performed. Aiming to analyze the expression of MHL and CSK, depending on academic subject, separate ANCOVAs are conducted. Ethical approval was obtained, and participants provided informed consent. Results: Via an online survey, data from N = 385 students were acquired. In the moderator analyses, explained variance for help-seeking intention was R-2 = .14 (GPs) and R-2 = .25 (MHPs). While the main effects were significant, the interaction effects in both models were not significant. Students in health-related subjects, that is, medicine and psychology, reported more MHL and CSK. Limitations: Challenges of assessing help-seeking intention in a non-clinical sample via a hypothetical scenario are discussed. Furthermore, the translated scale used to assess MHL is in need of validation in a German sample. Conclusion: The results are discussed and aligned with previous research on MHL and help-seeking among college students, emphasizing the potential benefits of enhancing CSK. Improving MHL and CSK should be prioritized by colleges in mental health campaigns addressing student groups differentially.
: Background and Aims: The Trier Social Stress Test (TSST) is widely used to induce stress reactions using a standardized experimental procedure. This study investigated the relationship between stress reactivity in the TSST (measured by cortisol secretion and subjective stress levels) and stress reports via standardized questionnaire scales and Ecological Momentary Assessment (EMA) in adolescents. Method: Data of 163 adolescents (Mage = 14.26 years, SDage = 1.85; 53% female) were analyzed to examine associations between TSST measures and standardized questionnaire scales on stress level and stress symptomatology. A subsample (N = 58; Mage = 14.55 years, SDage = 1.93; 53% female) completed the TSST and provided EMA data on their current stress experience and stress symptomatology. Results: Elevated baseline cortisol in the TSST was significantly associated with more self-reported somatic complaints in the stress questionnaire. Moreover, increased subjective baseline stress and subjective stress changes in the TSST were linked to more psychological symptoms. At the same time, greater subjective stress changes during the TSST also indicated higher stress vulnerability in the questionnaire. EMA data revealed significantly higher reports of everyday stress for individuals with heightened baseline cortisol and increased subjective stress in the TSST. A more pronounced cortisol increase during the TSST was additionally linked to more somatic complaints in the EMA data. Limitations and Conclusion: Although the statistical power for the EMA part of the study was lower due to the smaller subsample, the findings highlight possible links between experimentally induced stress reactions and stress reports in everyday life as well as in standardized stress questionnaires.
Background: The COVID-19 pandemic was associated with high fear of infection and consequences of the pandemic, decline in physical activity and increase in depressive symptoms. Aims: This study assessed whether fear of COVID-19 is cross-sectionally associated with symptoms of depression in a clinical outpatient sample and if physical activity moderates this effect. Methods: Data was collected between March 2021 and May 2022 at 10 study sites in a cross-sectional assessment of 401 participants, aged 18-65 (M = 42.08, SD = 13.26, 71.0% female). All participants fulfilled diagnostic criteria for major depressive disorders, insomnia, panic disorder, agoraphobia, or posttraumatic stress disorder. Data was analyzed using linear regression models including fear of COVID-19 (disease anxiety; consequence anxiety), self-reported physical activity, physical activity measured by accelerometers (min/week), as well as the interaction of these variables as predictors, depressive symptoms as the outcome. Results: The primary model's fit was significant, F(15, 377.13) = 1.89, p = .022. Consequence anxiety was significantly and positively associated with depressive symptoms (beta = 0.12, t = 2.33, p = .020). We further observed a negative association between self-reported physical activity and depressive symptoms (beta = -0.15, t = -2.73, p = .007). There was no significant interaction effect. Limitations: These results should be interpreted as an observational association. Conclusion: Results show that fear of the consequences of COVID-19 was positively associated with depressive symptoms, but physical activity did not moderate this association. We report an independent, negative association between self-reported physical activity and depressive symptoms.
Background: Social distancing is often used as something of a catch-all category without clear definitions of its subtypes. Aims: We propose that social distancing has three subtypes: physical distancing, social contact limitations, and emotional distancing. Method: To test this hypothesis, we employed a longitudinal design to analyze the trajectories of social distancing subtypes over a period of 8 months during the COVID-19 pandemic (N = 6,026). Three years after the main survey, we recontacted the same participants, asking whether they would be willing to re-adopt social distancing measures in the context of a new pandemic (N = 841). Results: First, using a confirmatory factor analysis, we demonstrated that these subtypes are related but distinct constructs. Second, using group-based trajectory modeling, we identified trajectories of individuals following persistently low, moderate-low, moderate-high, and high levels of social distancing subtypes over time. Trajectories of physical distancing and social contact limitations were highly similar and decreased over time, whereas trajectories of emotional distancing were significantly different from the other two subtypes and showed stability. Importantly, we found sociodemographic and mental health indicators distinguishing these trajectories. Finally, we found that emotional distancing exhibited a stronger and more consistent association with social contact limitations than with physical distancing across studies. Conclusion: This study proposes a refined taxonomy of social distancing, highlighting the distinct subtypes of physical distancing, social contact limitations, and emotional distancing (see items in the Appendix). This new taxonomy has been both conceptually and statistically validated in the present paper and can assist other experts in assessing the construct of social distancing more accurately in future studies.
Background: Caregivers of people with dementia experience grief not only after, but also before the death of the care recipient. This is called dementia grief and can be defined as caregivers' emotional responses to non-death losses during the care for persons with dementia. It has a strong clinical relevance because it is associated with various physical and mental health problems. Aims: A psychoeducation sheet about dementia grief was co-designed with dementia experts, informal caregivers, and healthcare professionals. There were three aims: First, we wanted to identify whether providers would find the psychoeducation sheet appropriate, acceptable, and feasible (implementation outcomes). Secondly, the providers' need for the psychoeducation tool, as well as their capability, motivation, opportunity, and need to use it in everyday work were assessed (potential implementation determinants). Lastly, we wanted to determine significant associations between the outcomes and the determinants. Method: The psychoeducation sheet's acceptability, appropriateness, and feasibility were rated by 381 German mental health care providers. The sheet was presented to them in an online survey. Results: Levels of acceptability, appropriateness, feasibility, opportunity and capability were high. Motivation had the clearest association with each of the three-implementation outcomes. Limitation: Regular contact with persons with dementia (PwD) and their carers was not a requirement to be eligible for the study. Conclusion: The developed psychoeducation tool about dementia grief can be used to educate caregivers. Improving provider motivation should be taken into consideration when trying to implement newly developed interventions in health care.
