It is well established that the COVID-19 pandemic increased psychological distress in many populations, particularly for people with chronic health conditions (CHCs). Web-based mental health interventions provide a scalable and cost-effective approach to providing psychological support for people disproportionately affected by the COVID-19 pandemic. The current study aimed to explore the feasibility and acceptability of a one-week web-based psychological intervention (ACT2COPE) and explore preliminary effects of the intervention on reducing depression, anxiety, and stress symptoms, and improving wellbeing and psychological flexibility in adults living with CHCs during the COVID-19 pandemic in Aotearoa (New Zealand). A pilot randomised waitlist-controlled trial explored the acceptability and preliminary efficacy of ACT2COPE among 40 participants (n = 20 in the ACT2COPE group and n = 20 in the waitlist control group). Focus groups and open-ended questions explored usability and acceptability of the intervention as well as levels of engagement and adherence to the intervention. Mixed model ANOVAs explored within and between-group differences in psychological outcomes. Qualitative findings suggested that participants found ACT2COPE acceptable and engaging. Depressive symptoms significantly decreased over time compared to the waitlist group at 4-weeks follow-up (p = .012). No other between-group differences were found. The online ACT2COPE intervention presents a promising, scalable intervention that may improve psychological outcomes in adults living with CHCs during the COVID-19 pandemic. Future research is needed to confirm these findings in a larger and more diverse population and over a longer timeframe.

As a highly interconnected set of bodily components generating be-haviors that observers often interpret as defensive or protective, the immune sys-tem can also be viewed as interoceptive -sensing internal shapes within the living body of which it is a part. The activity of the immune system is also extensively af-fected by components of the nervous sys-tem, and this has implications for what we consider to be the boundaries of the immune system and how we understand its domain of operation.

Introduction: This study investigates psychological distress and quality of life (QoL) amongst first year premedical and health science students. The primary aim of this study was to investigate potential differences in QoL and psychological distress between students who sought entry into a medicine programme when compared to those opting for a non-medicine career. Methods: We examined participant responses to measures of QoL, psychological distress, and course preference (medicine or other). A structural equation model was conducted to consider the interrelationships among future course preference, gender, QoL, depression, anxiety and stress. Results: Three hundred and sixty-five students completed the online survey. An a priori conceptual model was developed and then evaluated using a structural equation model. The values obtained for RMSEA (0.027), CFI (0.999), and SRMR (0.016) indicated an excellent model fit. The overall model fit statistic, chi-square (χ2 = 7.626, df=6, p= .267), confirmed a good model fit. Students aiming to enrol in medicine generated higher psychological health and environmental QoL scores compared to their non-medicine oriented peers. In addition, physical QoL and psychological health QoL scores significantly predicted psychological distress measures. Conclusion: The study raises a potential debate regarding placing students with mixed career intentions into the same course and the potential implications this may have on teaching in interprofessional and large student groups in relation to wellbeing, pedagogy, equity, and expenditure. The findings clearly indicated that medical students are not as adversely impacted upon in terms of QoL and psychological distress compared with their non-medical peers.

Background: Nurses are a critical component of any healthcare system. The novel coronavirus pandemic has resulted in an increased workload for nurses and heightened stress. Aims: To assess the psychological health over time of nurses working during the COVID-19 pandemic and to examine the factors associated with stress, anxiety, and psychological wellbeing. Methods: Nurses enrolled in the study between 2 July and 26 August 2020 andcompleted questionnaires about stress, anxiety, and psychological wellbeing at baseline and at a second time point T2 12 weeks later. A paired sample t-test was used to examine whether changes in stress, anxiety, and psychological wellbeing were significantly different between baseline and T2. Linear regression models examined factors associated with psychological health outcomes. Results: Of the 600 nurses initially enrolled, 484 (80.7%) completed psychological health measures at T2. Stress, anxiety, and poor psychological wellbeing scores were high at baseline. Unexpectedly, stress and psychological wellbeing significantly improved between baseline and T2, while anxiety levels increased. Younger nurses had higher baseline stress and anxiety scores. Conclusions: This study demonstrates the potential beneficial effect of effective public health management of the COVID-19 pandemic on nurses' stress and psychological wellbeing and highlights the importance of longitudinal research to understand psychological health in nurses.

Although the current randomized controlled trial has previously reported an effect of mindfulness-based stress reduction (MBSR) on improving disease activity in rheumatoid arthritis (RA), the possible mechanisms underlying this relationship remain unknown. This report presents secondary analyses examining anxiety and depression as potential mediators of the effect of MBSR on changes in RA disease activity. Fifty-one RA patients were randomized to either MBSR or to a wait-list control group. Depression and anxiety (Hospital and Anxiety Depression Scale) and RA disease activity (DAS28-CRP) were assessed at baseline (T1), post-treatment (T2), and at two (T3) and four (T4) months' follow-up. Intention to treat (ITT) and per protocol (PP) analyses using multivariate analyses of variance showed that depression was lower in the MBSR than in the control group, post-treatment and at both follow-up time points. PP analyses suggested that anxiety was lower in the MBSR than in the control group post-treatment. In partial support of expectation, mediation analyses showed that a reduction in depression across the intervention (T2-T1) mediated the effect of MBSR on improvements in RA disease activity at both follow-up time points (T3-T1; T4-T1). This effect held across ITT and PP analyses. PP analyses also suggested an indirect effect of MBSR on RA disease activity via increased anxiety at T3, but not at T4. Together, findings suggest that improvements in depression (rather than anxiety) may mediate the effect of MBSR on RA disease activity. Screening for, and treating depression in RA with MBSR, may have downstream benefits for RA disease activity.

ObjectiveThis study compares data from two medical student cohorts early in their training from New Zealand and Hong Kong and then makes further comparisons with a non-medical group.MethodsQuestionnaires obtained information regarding educational site (universities situated in New Zealand, Hong Kong, and USA), gender, age, motivational beliefs, quality of life, and competitiveness. The study was split into two phases. The first phase focused on measuring and comparing the learning and wellbeing variables of two medical student cohorts. The second phase focussed on making further comparisons with non-medical student groups.ResultsResponses were elicited from 353 students in medically oriented courses and 688 students with a non-medical orientation. For phase 1, the results indicated differences between the two medical student groups on measures of self-efficacy, intrinsic value, enjoyment of competition, and physical quality of life. For phase 2, differences between the medical and non-medical student groups were noted for self-efficacy, intrinsic value, enjoyment of competition, contentiousness, and physical and social quality of life.ConclusionsThe results provide insights into medical and non-medical students' learning and wellbeing experiences from multi-national, multi-discipline perspectives. The results suggest that wellbeing issues of students are likely context-specific and moderated by region, curriculum, gender, and culture.

This study highlights the use of multi-factor analytical approaches in the investigation of students' academic performance and their well-being.The aim of the study was to explore the relationships among physical health, competitiveness, perceived stress, motivation, and academic achievement in pre-medical and health science students.Responses were elicited from 339 students preparing for medical and other health science programmes.Questionnaires obtained information regarding gender, age, grade achievement, perceived stress, motivation, physical health, and competitiveness.Due to the subtle gender differences evident in the literature and substantiated by the findings in this study, two structural equation models were generated, one representing male students and the other female students.In general, the illustrated models showed a positive relationship between physical health and enjoyment of competition.Next, physical health was negatively associated with perceived stress, which showed a negative association with self-efficacy and a positive association with test anxiety.Enjoyment of competition was positively associated with self-efficacy.Grade achievement was positively associated with self-efficacy.The models suggest that students, as a whole, experiencing good physical health report less perceived stress and less test anxiety, and more self-efficacy which are associated with positive grade outcomes.These models give insights into how physical health and learning variables may influence grade outcome providing scope for further research into how these relationships impact learning environments, team behaviours, and professional training.

Measuring competitiveness is necessary to fully understand variables affecting student learning. The 14-item Revised Competitiveness Index has become a widely used measure to assess trait competitiveness. The current study reports on a Rasch analysis to investigate the psychometric properties of the Revised Competitiveness Index and to improve its precision for international comparisons. Students were recruited from medical studies at a university in New Zealand, undergraduate health sciences courses at another New Zealand university, and a psychology undergraduate class at a university in the United States. Rasch model estimate parameters were affected by local dependency and item misfit. Best fit to the Rasch model (χ2(20) = 15.86, p = .73, person separation index = .95) was obtained for the Enjoyment of Competition subscale after combining locally dependent items into a subtest and discarding the highly misfitting Item 9. The only modifications required to obtain a suitable fit (χ2(25) = 25.81, p = .42, person separation index = .77) for the Contentiousness subscale were a subtest to combine two locally dependent items and splitting this subtest by country to deal with differential item functioning. The results support reliability and internal construct validity of the modified Revised Competitiveness Index. Precision of the measure may be enhanced using the ordinal-to-interval conversion algorithms presented here, allowing the use of parametric statistics without breaking fundamental statistical assumptions.

At this university, a Biomedical Common Year 1 occurs prior to admission to the medical programme. Students achieving a minimum GPA of 6.0 are eligible for consideration for an admissions interview. The aim of this research was to assess the psycho-educational factors that underpin students’ intention to study medicine. The research question driving the research was, ‘If students have an interest in becoming a future doctor in their premedical course, does this relate to their levels of motivation, competitiveness, perceived stress, health-related quality of life (HRQOL), and grade attainment?’ A total of 339 students (response rate = 25%) who completed a biosciences assessment filled in a survey that asked them to disclose their grade and to respond to a series of questionnaires, namely the Motivated Strategies for Learning Questionnaire, World Health Organisation Quality Of Life questionnaire New Zealand Version, Perceived Stress Scale, and Revised Competitiveness Index. The findings from the binary logistic regression indicated that several variables predicted students’ career intentions: grade achievement, Perceived Stress, Physical HRQOL, and Environmental HRQOL. Perceived Stress and Physical HRQOL were found to be influential variables that interacted with other variables reducing variability in the model and increasing its predictability. Students with an intention to become a doctor tend to attain higher grades and have better environmental HRQOL scores. Nonetheless, variable interactions suggested that those students with high levels of physical HRQOL and low levels of perceived stress have higher levels of enjoyment regarding competition, self-efficacy, and intrinsic value.

Decisions about progress through an academic programme are made by Boards of Examiners, on the basis of students' course assessments. For most students such pass/fail grading decisions are straightforward. However, for those students whose results are borderline (either at a pass/fail boundary or boundaries between grades) the exercise of some discretion by university staff is required. In the interests of the transparency of the exercise of this discretion and to increase the chances that the 'right' decision is made, we tested the validity of the second version of the Objective Borderline Method (OBM2) decision-making tool in a medical programme. Our results suggest that application of OBM2 provides valid data to help university staff make robust decisions about a student's progression through a programme, and with which to defend these decisions if that should be required.

Rasch analysis was conducted to enhance the precision of the widely used 10-item Perceived Stress Scale using two datasets (n = 450 each) randomly selected from samples of the New Zealand general population (n = 1102), New Zealand university students (n = 479) and US university students (n = 396). The best Rasch model fit (χ2(27) = 29.92, p = .36), good person separation reliability (.80) and coverage (98%) of the sample by the scale items were achieved when locally dependent items were combined into subtests. These findings support reliability and internal structural validity of the 10-item Perceived Stress Scale. The instrument precision can be further improved using the ordinal-to-linear conversion tables published here.

Strong theoretical arguments, such as the expectancy-value theory, support the idea that high-stakes examinations can cultivate competitive behavior and have an impact on wellbeing and motivation, especially in courses that demand high grades for admission. Academic achievement in a high-stakes examination can be explained by cost factors (measured in reference to quality of life variables), persistence factors (measured in terms of competiveness and motivational beliefs), and a utility and choice variable (related to choice of course). All students (N = 1036) studying in a population health course within the biomedical first year course were invited to participate in an online survey in 2014. A questionnaire elicited information regarding gender, age, ethnicity, grade achievement, importance of selection into medicine, motivation, competitiveness, and quality of life (QOL). The main analysis incorporated a structural equation modeling procedure to consider how the aforementioned variables could explain grade achievement. The response rate was 33%. The emergent model was consistent with the theoretical model. Physical QOL generated a negatively oriented regression weight with respect to test anxiety, whereas psychological QOL was positively associated with respect to self-efficacy, intrinsic value, and enjoyment of competition and negatively associated with test anxiety. Social relationship QOL was positively associated with test anxiety, but environmental QOL produced no significant regression weights. Self-efficacy and intrinsic value yielded a positive regression weight in reference to importance of medicine, which in turn generated a positive regression weight when explaining grade attainment. The findings suggest that students who have minimal cost factors in terms of QOL experiences will likely harness efficient persistence strategies resulting in more focused study strategies, which will inevitably lead to a better academic outcome. The findings also suggest that a model based on the expectancy value theory predicted the data well. This study additionally promotes the argument for the need for a comprehensive and integrated strategy for further promoting QOL, learning support, and career advice and to further understand the impact of competitive learning environments on students’ study and social behaviors.

Objective: Writing emotionally about upsetting life events (expressive writing) has been shown to speed healing of punch-biopsy wounds compared to writing objectively about daily activities. We aimed to investigate whether a presurgical expressive writing intervention could improve surgical wound healing. Method: Seventy-six patients undergoing elective laparoscopic bariatric surgery were randomized either to write emotionally about traumatic life events (expressive writing) or to write objectively about how they spent their time (daily activities writing) for 20 min a day for 3 consecutive days beginning 2 weeks prior to surgery. A wound drain was inserted into a laparoscopic port site and wound fluid analyzed for proinflammatory cytokines collected over 24 hr postoperatively. Expanded polytetrafluoroethylene tubes were inserted into separate laparoscopic port sites during surgery and removed after 14 days. Tubes were analyzed for hydroxyproline deposition (the primary outcome), a major component of collagen and marker of healing. Fifty-four patients completed the study. Results: Patients who wrote about daily activities had significantly more hydroxyproline than did expressive writing patients, t(34) = −2.43, p = .020, 95% confidence interval [−4.61, −0.41], and higher tumor necrosis factor–alpha, t(29) = −2.42, p = .022, 95% confidence interval [−0.42, −0.04]. Perceived stress significantly reduced in both groups after surgery. Conclusions: Expressive writing prior to bariatric surgery was not effective at increasing hydroxyproline at the wound site 14 days after surgery. However, writing about daily activities did predict such an increase. Future research needs to replicate these findings and investigate generalizability to other surgical groups.

Objective: In order to harness the placebo effect for clinical benefit, more research is needed to determine who might be responsive to a placebo treatment. Recently, a two-faceted Transactional Model of Placebo Responding (TMPR) was offered, which suggests different personality types might respond to different contextual cues. The current study directly tested this model by manipulating treatment descriptors to match the two purported facets of responsiveness.Methods: Physically healthy volunteers (N = 77) experiencing life stress were randomised to either the: (1) wait list control, (2) 'serotonin treatment' group; or (3) 'oxytocin treatment' group. Both treatment groups received an 'antistress' intranasal spray (placebo). The 'serotonin' and 'oxytocin' treatments were described to appeal to the two purported facets responsiveness set out in the TMPR, inward and outward orientation. The BIS/BAS scale was used as proxies for inward (BIS) and outward (BAS) orientation. It was hypothesised that high BAS types would be more responsive to the 'oxytocin' and high BIS types would be more responsive to the `serotonin'.Results: Findings provide partial support for hypotheses, with high but not low BAS types having a greater response to the 'oxytocin' placebo; but the pattern of responses from high BIS types were contrary to predictions.Conclusions: Findings indicate interactions between personality type and environmental cues may contribute to placebo responding, but more research is needed to investigate possible operationalisations of responsiveness and the contextual cues to which different types may respond. (C) 2016 Elsevier Inc. All rights reserved.