Group interventions to promote mental health in health professional education: a systematic review and meta-analysis of randomised controlled trials

Effects of interventions for improving mental health of health professional students has not been established. This review analysed interventions to support mental health of health professional students and their effects. The full holdings of Medline, PsycINFO, EBM Reviews, Cinahl Plus, ERIC and EMBASE were searched until 15th April 2016. Inclusion criteria were randomised controlled trials of undergraduate and post graduate health professional students, group interventions to support mental health compared to alternative education, usual curriculum or no intervention; and post-intervention measurements for intervention and control participants of mindfulness, anxiety, depression, stress/distress or burnout. Studies were limited to English and short term effects. Studies were appraised using the PEDro scale. Data were synthesised using meta-analysis. Four comparisons were identified: psychoeducation or cognitive-behavioural interventions compared to alternative education, and mindfulness or relaxation compared to control conditions. Cognitive-behavioural interventions reduced anxiety (?0.26; ?0.5 to ?0.02), depression (?0.29; ?0.52 to ?0.05) and stress (0.37; ?0.61 to ?0.13). Mindfulness strategies reduced stress (?0.60; ?0.97 to ?0.22) but not anxiety (95% CI ?0.21 to 0.18), depression (95% CI ?0.36 to 0.03) or burnout (95% CI ?0.36 to 0.10). Relaxation strategies reduced anxiety (SMD ?0.80; 95% CI ?1.03 to ?0.58), depression (?0.49; ?0.88 to ?0.11) and stress (?0.34; ?0.67 to ?0.01). Method quality was generally poor. Evidence suggests that cognitive-behavioural, relaxation and mindfulness interventions may support health professional student mental health. Further high quality research is warranted.     

Are resilience and perceived stress related to social support and housing stability among homeless adults with mental illness?

Perceived stress has been associated with adverse health outcomes. Although people experiencing homelessness often report multiple acute and chronic stressors, research on resilience and perceived stress on the general homeless population is limited. This longitudinal study examined homeless adults with mental illness who were part of a 24‐month trial of Housing First to explore: (a) changes in levels of resilience and perceived stress during the trial, and (b) the association between levels of resilience and perceived stress with measures of social support, social functioning and percentage of days stably housed over the study period. This longitudinal study (2009–2013) that used trial data included 575 participants in Toronto, Ontario. Of these individuals, 507 were included in this study. Connor‐Davidson Resilience Scale and Perceived Stress Scales (PSS) measured the two outcomes, resilience and perceived stress. Time (baseline, 12 and 24 months), housing stability and three measures of social support and social functioning were the main predictors. A longitudinal analysis was done with repeated measures analysis of resilience and perceived stress using linear mixed models with random intercepts. Mean resilience scores increased (baseline: 5.1 [95% CI: 4.9, 5.2], 12 months: 5.5 [95% CI: 5.3, 5.7], 24 months: 5.6 [95% CI: 5.4, 5.8]), and PSS scores decreased (baseline: 22.3 [95% CI: 21.5, 23.0], 24 months: 18.6 [95% CI: 17.9, 19.4]). In the multivariable analyses, increased resilience was associated with higher scores on the three social support and social functioning measures, (estimates = 0.12, 0.04, 0.02) but not percentage days stably housed. Lower PSS scores were associated with higher scores on all three social support and social functioning measures (?0.20, ?0.33, ?0.21) and higher percentages of days stably housed (?0.015). Strong social support and social functioning may minimise the harmful effects of stressful life events on homeless individuals by increasing resilience and reducing stress. Interventions to help homeless people build appropriate support networks should be delivered in parallel to efforts that increase housing stability.     

The effects of probiotics on mental health and hypothalamic–pituitary–adrenal axis: A randomized,double-blind,placebo-controlled trial in petrochemical workers

Objective: The aim of this study was to determine effects of probiotic yogurt and multispecies probiotic capsule supplementation on mental health and hypothalamic–pituitary–adrenal axis in petrochemical workers.

Methods: The present randomized double-blind, placebo-controlled trial was conducted on 70 petrochemical workers. Subjects were randomly divided into three groups to receive 100?g/day probiotic yogurt?+?one placebo capsule (n?=?25) or one probiotic capsule daily?+?100?g/day conventional yogurt (n?=?25) or 100?g/day conventional yogurt?+?one placebo capsule (n?=?20) for 6 weeks. Mental health parameters including general health questionnaire (GHQ) and depression anxiety and stress scale (DASS) scores were measured. Fasting blood samples were obtained at the beginning and 6 weeks after the intervention to quantify hypothalamic–pituitary–adrenal axis.

Results: After 6 weeks of intervention, a significant improvement of GHQ was observed in the probiotic yogurt (18.0?±?1.5 vs. 13.5?±?1.9, P?=?0.007) and in the probiotic capsule group (16.9?±?1.8 vs. 9.8?±?1.9, P?=?0.001), as well as a significant improvement in DASS scores in the probiotic yogurt (23.3?±?3.7 vs. 13.0?±?3.7, P?=?0.02) and the probiotic capsule group (18.9?±?3.2 vs. 9.4?±?4.0, P?=?0.006). However, there was no significant improvement in the conventional yogurt group (P?=?0.05 for GHQ and P?=?0.08 for DASS).

Discussion: The consumption of probiotic yogurt or a multispecies probiotic capsule had beneficial effects on mental health parameters in petrochemical workers.     

Reducing Stress Among Mothers in Drug Treatment: A Description of a Mindfulness Based Parenting Intervention

Background Parenting women with substance use disorder could potentially benefit from interventions designed to decrease stress and improve overall psychosocial health. In this study we assessed whether a mindfulness based parenting (MBP) intervention could be successful in decreasing general and parenting stress in a population of women who are in treatment for substance use disorder and who have infants or young children. Methods MBP participants (N?=?59) attended a two-hour session once a week for 12 weeks. Within-group differences on stress outcome measures administered prior to the beginning of the MBP intervention and following the intervention period were investigated using mixed-effects linear regression models accounting for correlations arising from the repeated-measures. Scales assessed for pre-post change included the Perceived Stress Scale-10 (PSS) and the Parenting Stress Index-Short Form (PSI). Results General stress, as measured by the PSS, decreased significantly from baseline to post-intervention. Women with the highest baseline general stress level experienced the greatest change in total stress score. A significant change also occurred across the Parental Distress PSI subscale. Conclusions Findings from this innovative interventional study suggest that the addition of MBP within treatment programs for parenting women with substance use disorder is an effective strategy for reducing stress within this at risk population.     

Evaluation of a Wellness-Based Mindfulness Stress Reduction intervention: a controlled trial

PURPOSE: To determine if participation in a Wellness-Based Mindfulness Stress Reduction intervention decreases the effect of daily hassles, psychological distress, and medical symptoms. DESIGN: A randomized controlled trial of a stress reduction intervention with a 3-month follow-up. SETTING: A university setting in West Virginia. SUBJECTS: A total of 103 adults, with 59 in the intervention group and 44 in the control group. Eight-five percent of subjects completed the intervention. Fifty-nine percent and 61% of the intervention and control subjects completed the study, respectively. INTERVENTION: The intervention consisted of an 8-week group stress reduction program in which subjects learned, practiced, and applied "mindfulness meditation" to daily life situations. The control group received educational materials and were encouraged to use community resources for stress management. MEASURES: The Daily Stress Inventory assessed the effect of daily hassles, the Revised Hopkins Symptom Checklist measured psychological distress, the Medical Symptom Checklist measured number of medical symptoms, and a Follow-up Questionnaire measured program adherence. RESULTS: Intervention subjects reported significant decreases from baseline in effect of daily hassles (24%), psychological distress, (44%), and medical symptoms (46%) that were maintained at the 3-month follow-up compared to control subjects (repeated measures analysis of variance [ANOVA]; p < .05). CONCLUSIONS: Self-selected community residents can improve their mental and physical health by participating in a stress reduction intervention offered by a university wellness program.     

Abbreviated Mindfulness Intervention for Job Satisfaction,Quality of Life,and Compassion in Primary Care Clinicians: A Pilot Study

PURPOSE

Burnout, attrition, and low work satisfaction of primary care physicians are growing concerns and can have a negative influence on health care. Interventions for clinicians that improve work-life balance are few and poorly understood. We undertook this study as a first step in investigating whether an abbreviated mindfulness intervention could increase job satisfaction, quality of life, and compassion among primary care clinicians.

METHODS

A total of 30 primary care clinicians participated in an abbreviated mindfulness course. We used a single-sample, pre-post design. At 4 points in time (baseline, and 1 day, 8 weeks, and 9 months postintervention), participants completed a set of online measures assessing burnout, anxiety, stress, resilience, and compassion. We used a linear mixed-effects model analysis to assess changes in outcome measures.

RESULTS

Participants had improvements compared with baseline at all 3 follow-up time points. At 9 months postintervention, they had significantly better scores (1) on all Maslach Burnout Inventory burnout subscales—Emotional Exhaustion (P =.009), Depersonalization (P = .005), and Personal Accomplishment (P <.001); (2) on the Depression (P =.001), Anxiety (P =.006), and Stress (P = .002) subscales of the Depression Anxiety Stress Scales-21; and (3) for perceived stress (P = .002) assessed with the Perceived Stress Scale. There were no significant changes on the 14-item Resilience Scale and the Santa Clara Brief Compassion Scale.

CONCLUSIONS

In this uncontrolled pilot study, participating in an abbreviated mindfulness training course adapted for primary care clinicians was associated with reductions in indicators of job burnout, depression, anxiety, and stress. Modified mindfulness training may be a time-efficient tool to help support clinician health and well-being, which may have implications for patient care.     

Preventing behavior problems among elementary schoolchildren: impact of a universal school-based program in China

BACKGROUND: To evaluate the effect on problem behaviors of a universal school‐based prevention curriculum of third grade students. METHODS: Six regular classes in 1 elementary school were randomly assigned to an intervention (n = 208) or control (n = 209) group. A 13‐session program was offered to students in the intervention group. The Achenbach Child Behavior Checklist (CBCL), parent report, was used to assess problem behaviors at baseline, at the conclusion of the curriculum, and again at 6‐month follow up. RESULTS: The unadjusted mean estimates of behavioral problems were significantly lower in the intervention group posttest (at the conclusion of the curriculum), ?3.53 (95% confidence interval [CI] = ?6.59 to ?0.48; p = .023) and at the 6‐month follow up, ?5.22 (95% CI: ?8.27 to ?2.16; p = .001). After adjusting for potential confounders, gender (female), father's educational status (high school), family relationships (good and average), and child's age in months, intervention groups (intervention posttest and intervention after 6‐month follow up) showed significantly lower total behavioral scores. CONCLUSIONS: A universal school‐based prevention program for Chinese elementary school‐age children resulted in a significant positive change in behavioral problems. This is an important finding in the context of the Chinese 1‐child policy that places great value on the achievement of the child.     

Physical activity and positive youth development: impact of a school-based program

BACKGROUND: Protective factors associated with positive youth development predict health and education outcomes. This study explored trends in these protective factors and in physical activity among low‐income students, and determined the impact of a school‐based youth development program on these trends. METHODS: This study used a quasi‐experimental time series design including data from 158 low‐income schools from 2001 to 2007. Ninety‐four schools had exposure to a school‐based program promoting physical activity and youth development through structured play; 64 schools served as controls. Primary outcomes were 5th‐grade student scores (n = 13,109) on a California statewide survey for physical activity (1–6 scale) and measures of protective factors including problem solving skills, meaningful participation in school, and caring adults (1–4 scales). Predictors were time (year) and school's number of years of exposure to the program. RESULTS: Overall, significant annual declines were seen in protective factors, including students' report of feeling safe (?0.03, 95% CI [?0.03, ?0.01]), caring adults at school (?0.03 [?0.05, ?0.02]), and problem solving skills (?0.03 [?0.04, ?0.02]). Cumulative declines over 6 years were equivalent to a drop of 1 school‐level SD. Each additional year of exposure to the program predicted greater meaningful participation (0.02 [0.001, 0.5]), problem‐solving skills (0.03 [0.0001, 0.06]), and increased physical activity (0.06 [0.01, 0.10]); exposure throughout elementary school (6 years) increased scores by 1 school‐level SD. CONCLUSIONS: Low‐income students reported a significant decline in protective factors since 2001. School partnerships with youth development programs promoting physical activity may ameliorate declines in emotional well‐being and increase physical activity.     

赴利比里亚抗击埃博拉军人心理应激调查

目的 追踪研究中国人民解放军赴利比里亚抗击埃博拉军人心理应激特点和变化规律.方法 将整个赴利比里亚抗击埃博拉医疗任务划分为5个阶段,采用军人心理应激自评问卷(PSET),对医疗队中150名军人进行动态追踪调查,比较不同任务阶段军人心理应激的动态变化以及每个阶段的性别、年龄、人员类别、人员层次、文化程度差异.结果 ①心理应激得分呈显著的阶段差异(P<0.05),集结期最高,海外任务早期最低.②女性应激得分呈显著的阶段差异(P<0.05),集结期最高,医学观察期最低;男性应激得分未发现各阶段统计学差异.除医学观察期外,女性应激得分显著高于男性(P<0.05).③"≥41岁"组应激得分呈显著的阶段差异(P<0.05),集结期最高,海外任务早期最低.除海外任务早期外,"31~40岁"组和"≥41岁"组应激得分显著高于"≤30岁"组(P<0.05).④护士应激得分呈显著的阶段差异(P<0.05),集结期最高,医学观察期最低.护士集结期、国内集训期应激得分显著高于医师和行政后勤人员(P<0.05).⑤军官应激得分呈显著的阶段差异(P<0.05),集结期最高,海外任务早期最低.军官集结期、国内集训期和医学观察期的应激得分显著高于战士(P<0.05).⑥研究生和本科生应激得分呈显著的阶段差异(P<0.05),在集结期最高.本科生应激得分在集结期、国内集训期和海外任务后期显著高于研究生和专科生(P<0.05).结论 赴利比里亚抗击埃博拉军人心理应激呈明显阶段差异和人群差异.     

Nature or nurture: the effect of undergraduate rural clinical rotations on pre-existent rural career choice likelihood as measured by the SOMERS Index

Objective: Do undergraduate rural clinical rotations increase the likelihood of medical students to choose a rural career once pre‐existent likelihood is accounted for? Design: A prospective, controlled quasi‐experiment using self‐paired scores on the SOMERS Index of rural career choice likelihood, before and after 3 years of clinical rotations in either mainly rural or mainly urban locations. Setting: Monash University medical school, Australia. Participants: Fifty‐eight undergraduate‐entry medical students (35% of the 2002 entry class). Main outcome measures: The SOMERS Index of rural career choice likelihood and its component indicators. Results: There was an overall decline in SOMERS Index score (22%) and in each of its components (12–41%). Graduating students who attended rural rotations were more likely to choose a rural career on graduation (difference in SOMERS score: 24.1 (95% CI, 15.0–33.3) P < 0.0001); however, at entry, students choosing rural rotations had an even greater SOMERS score (difference: 27.1 (95% CI, 18.2–36.1) P < 0.0001). Self‐paired pre–post reductions in likelihood were not affected by attending mainly rural or urban rotations, nor were there differences based on rural background alone or sex. Conclusions: While rural rotations are an important component of undergraduate medical training, it is the nature of the students choosing to study in rural locations rather than experiences during the course that is the greater influence on rural career choice. In order to improve the rural medical workforce crisis, medical schools should attract more students with pre‐existent likelihood to choose a rural career. The SOMERS Index was found to be a useful tool for this quantitative analysis.     

Stress im Studium

Background

Many studies investigate students’ stress level caused by the implementation of the bachelor/master system. Empirical evidence about the possibilities of stress prevention based on the resources of students is missing. This study investigates the relationship between self-efficacy, mindfulness and stress perception.

Method

2,435 students took part in an online study in Germany and answered the Perceived Stress Questionnaire (with its facets worries, tension, demands and joy), the Generalized Self-Efficacy Scale and the Freiburg Mindfulness Inventory.

Results

Students perceive a high level of stress. High self-efficacy correlates with a low degree of worries and a high degree of joy. High mindfulness is related to a low level of tension and a high level of joy. There is a correlation of 0.53 (p?<?0.001) between self-efficacy and mindfulness.

Conclusion

Self-efficacy and mindfulness should be considered when developing stress reduction and prevention approaches.     

Supporting student‐doctors from under‐resourced educational backgrounds: an academic development programme

Medical Education 2010: 44 : 917–925 Objectives Increased student diversity in medical schools is considered necessary. However, very few medical school applicants from under‐resourced educational backgrounds achieve competitive academic entrance scores. Pre‐admission development programmes that aim to produce competitive applicants may be inefficient in countries where under‐represented communities are majority populations. This study set out to determine: (i) whether an academic development programme (ADP) integrated into an existing South African medical training programme retained ADP students and enabled them to graduate within a reasonable period of time; (ii) the academic impact of the ADP, and (iii) whether performance in high school matriculation examinations predicted performance in medical school. Methods This retrospective study analysed records of medical students admitted between 1991 and 2001. Non‐ADP and ADP students were compared with respect to: student retention; time to graduation; matriculation scores, and performance in medical school. The association between matriculation scores and third‐year examination results was determined. Results The average student retention rates for the non‐ADP (1992–2001) and ADP (1991–2000) cohorts were 92% and 70%, respectively. Non‐ADP and ADP students who graduated were compared with respect to four parameters: the mean additional time required to graduate by each group was 0.16 years (95% confidence interval [CI] 0.13–0.18) and 0.38 years (0.27–0.48), respectively. Mean matriculation scores were 44.5 (95% CI 44.4–44.7) and 37.4 (95% CI 37.0–37.7) points, respectively (effect size = 3.2). Mean marks for third‐year courses were 65.0% (95% CI 64.6–65.4) and 58.7% (95% CI 57.7–59.6), respectively (effect size = 1.0). Mean marks for final‐year courses were 68.3% (95% CI 68.1–68.5) and 64.2% (95% CI 63.6–64.7), respectively; the effect size remained constant at 1.2. Third‐year marks for non‐ADP and ADP students, respectively, showed moderate (11%) and low (3%) association with matriculation scores. Conclusions Although the retention of ADP students was lower than that of non‐ADP students, the ADP enabled those who graduated to overcome the effects of under‐resourced schooling and to perform well in final‐year examinations.     

Can simulation replace part of clinical time? Two parallel randomised controlled trials

Medical Education 2012 Context Education in simulated learning environments (SLEs) has grown rapidly across health care professions, yet no substantive randomised controlled trial (RCT) has investigated whether SLEs can, in part, substitute for traditional clinical education. Methods Participants were physiotherapy students (RCT 1, n = 192; RCT 2, n = 178) from six Australian universities undertaking clinical education in an ambulatory care setting with patients with musculoskeletal disorders. A simulated learning programme was developed as a replica for clinical education in musculoskeletal practice to replace 1 week of a 4‐week clinical education placement. Two SLE models were designed. Model 1 provided 1 week in the SLE, followed by 3 weeks in clinical immersion; Model 2 offered training in the SLE in parallel with clinical immersion during the first 2 weeks of the 4‐week placement. Two single‐blind, multicentre RCTs (RCT 1, Model 1; RCT 2, Model 2) were conducted using a non‐inferiority design to determine if the clinical competencies of students part‐educated in SLEs would be any worse than those of students educated fully in traditional clinical immersion. The RCTs were conducted simultaneously, but independently. Within each RCT, students were stratified on academic score and randomised to either the SLE group or the control (‘Traditional’) group, which undertook 4 weeks of traditional clinical immersion. The primary outcome measure was a blinded assessment of student competency conducted over two clinical examinations at week 4 using the Assessment of Physiotherapy Practice (APP) tool. Results Students’ achievement of clinical competencies was no worse in the SLE groups than in the Traditional groups in either RCT (Margin [Δ] ≥ 0.4 difference on APP score; RCT 1: 95% CI ? 0.07 to 0.17; RCT 2: 95% CI ? 0.11 to 0.16). Conclusions These RCTs provide evidence that clinical education in an SLE can in part (25%) replace clinical time with real patients without compromising students’ attainment of the professional competencies required to practise.     

Effect of Concept Mapping Education on Critical Thinking Skills of Medical Students: A Quasi-experimental Study

BackgroundFostering critical thinking (CT) is one of the most important missions in medical education. Concept mapping is a method used to plan and create medical care through a diagrammatic representation of patient problems and medical interventions. Concept mapping as a general method can be used to improve CT skills in medical students. The aim of this study was to explore the effect of concept mapping on CT skills of medical students.MethodsThis quasi-experimental study was conducted on 100 second-year medical students which take an anatomy course. Participants were randomly assigned into a control group (lecture-based) and an intervention group (concept mapping). CT levels of medical students were assessed using the California Critical Thinking Skills Test. Data were analyzed using independent sample t-test.ResultsBefore intervention, CT scores of the intervention and control groups were 6.68 ± 2.55 and 6.64 ±2.74, respectively, and after intervention, they were 11.64 ±2.29 and 10.04 ± 3.11, respectively. Comparison of mean score differences for both groups before and after intervention demonstrated that CT scores in the experimental group significantly increased after intervention (P=0.021).ConclusionsMedical students who were taught through concept mapping showed an increase in CT scores, compared with those in the control group. Medical students require effective CT skills in order to make sound knowledge-based assessment and treatment choices during patient care. Therefore, instructors and planners of medical education are expected to apply this educational strategy for developing CT skills in medical students.     

Reducción de los niveles de estrés y ansiedad en médicos de Atención Primaria mediante la aplicación de un programa de entrenamiento en conciencia plena (mindfulness)

PurposeTo check the effectiveness of a mindfulness development meditation technique on stress and anxiety in a group of primary-care physicians.DesignQuasi-experimental with pretest/posttest/follow-up measurements in a control group and an experimental group.SiteUniversity of Almeria.Participants38 primary-care physicians enrolled in a Teaching Aptitude Course (CAP).InterventionAn experimental group and a control group were formed with 19 participants in each. The experimental group took a psycho-educational meditation program for training and practice in mindfulness.MeasurementThe Perceived Stress Scale (PSS), the Strain Questionnaire and the State-Trait Anxiety Questionnaire were used to measure stress and anxiety levels.ResultsA comparative statistical analysis was performed using the Mann-Whitney non-parametric U test, finding a significant reduction in all the primary-care physician stress and anxiety variables in the experimental group compared to the control group in pretest-posttest and follow-up tests.ConclusionsThe results of this study support the effectiveness of mindfulness development meditation techniques in decreasing stress and anxiety in primary-care physicians. Nevertheless, the study shows various limitations that would have to be corrected in successive studies to bring more validity to the results.     

正念训练对大学生睡眠和焦虑抑郁情绪的干预效果

  目的  探究线上、线下正念训练对改善新冠肺炎疫情后大学生焦虑抑郁情绪和睡眠质量的效果评价,为提高大学生心理健康程度提供参考。  方法  于2020年9月,采用随机整群抽样法选取华北理工大学1 203名大学生进行抑郁自评量表(SDS)、焦虑自评量表(SAS)和匹兹堡睡眠质量指数量表(PSQI)筛查,符合入组标准者103名,随机分为线上组(64名)和线下组(39名),干预后评估大学生焦虑抑郁情绪和睡眠质量改善程度。  结果  线上线下正念训练干预后大学生SAS、SDS、PSQI得分均低于干预前,差异均有统计学意义（t值分别为5.57,5.31,3.99;4.88,5.02,5.88,P值均 < 0.01）。线上、线下两种干预训练,对睡眠质量改善程度差异有统计学意义（t=-2.55,P < 0.05）。大学生焦虑、抑郁、睡眠3种症状合并越少,正念干预症状缓解率越高,3种症状并存缓解率≤25%,2种症状并存缓解率 < 40%,仅有1种症状缓解率100%。  结论  线上、线下正念训练皆可作为干预睡眠、焦虑和抑郁情绪的有效手段;线下正念训练对于改善大学生睡眠质量优于线上;正念训练对于单一症状者缓解效果更为明显。     

The Medical Student Stress Profile: a tool for stress audit in medical training

Medical Education 2010: 44 : 1027–1037 Objectives It is well recognised that medical training can be extremely stressful and that high stress is a risk factor for a wide range of psychological and health‐related consequences. The primary aims of this study were to introduce the Medical Student Stress Profile (MSSP) and to demonstrate its psychometric quality as a specific device for auditing medical student stress. Secondary aims were to establish the reliability, construct and criterion validity of this instrument and to explore the relationships between stress, coping, personality, motivation and emotional intelligence in medical students. Methods A battery of self‐report measures including the MSSP was administered to a sample of 239 undergraduate and graduate‐entry medical students. The battery included indices of stress, coping with and proneness to stress, as well as measures of emotional intelligence, motivation style, personality traits, educational environment perception and self‐reported symptomatology. Psychometric evaluation of the MSSP was conducted along with a correlation analysis of stress concomitants. Results The MSSP revealed good psychometric properties and showed a substantial stress load in the participant sample. The pattern of correlations with concomitant measures conformed generally to expectations. Strong cohort effects were observed, which suggest the importance of future investigation into the role of the group in stress amelioration. Stress adversely affects ratings of the educational environment as measured by the Dundee Ready Education Environment Measure. Conclusions The MSSP was specifically developed for the medical training context and may have utility for individual and group stress audits of medical students and as a device to inform remedial programmes in stress management in medical education.     

Amigas Latinas Motivando el Alma (ALMA): an Evaluation of a Mindfulness Intervention to Promote Mental Health among Latina Immigrant Mothers

Latina immigrants are at increased risk for poor mental health. Amigas Latinas Motivando el Alma (ALMA) is a group-based intervention to reduce symptoms of depression, anxiety, and stress among Latina immigrants. Based on participants’ feedback and growing evidence supporting mindfulness as a way to reduce stress and improve mental health, additional sessions of the ALMA intervention were developed and pilot tested to provide more training on mindfulness as a coping strategy. The feasibility and potential efficacy were evaluated in a community sample using a pre- and post-test study design. Findings suggested that women were satisfied with the sessions and used mindfulness strategies they learned in their daily lives. The program also reduced symptoms of depression and anxiety (19% reduction in mean depression scores and 26% reduction in mean anxiety scores). Further evaluation is needed to test the efficacy of the intervention.     

Is advice to stop smoking from a midwife stressful for pregnant women who smoke? Data from a randomized controlled trial

BACKGROUND: There are no randomized trials examining whether intensive advice to pregnant smokers is more stressful than standard care. METHOD: Nine hundred eighteen U.K. women currently smoking on commencing antenatal care were randomized into three arms. Women in Arm A received one episode of brief advice to stop smoking. Women in Arm B were assessed for stage of change and worked through an exercise in self-help manuals on three occasions. Women in Arm C used a 20-min interactive computer program three times in addition to the intervention women in Arm B received. Stress was assessed by the change in score on the Perceived Stress Scale (PSS) from baseline to 30 weeks gestation, the month before delivery, and 10 days postpartum. RESULTS: There were small and not significant differences in the changes in PSS between the arms at all outcome times. There was no evidence that the importance women attached to pleasing their midwife by stopping, having failed to quit, or nulliparity modified the effect of intensive advice on change in stress levels. CONCLUSIONS.: Intensive advice to stop smoking was not associated with increases in stress. Advice and support for pregnant women to stop smoking should be given without fear of causing stress.