Fiona Moir

Quality of life: international and domestic students studying medicine in New Zealand

International students form a significant proportion of students studying within universities in Western countries. The quality of life perceptions of international medical students in comparison with domestic medical students has not been well documented. There is some evidence to suggest that international medical students may have different educational and social experiences in relation to their domestic peers. This study investigates the levels of quality of life experienced by international and domestic students studying medicine. A total of 548 medical students completed the abbreviated version of the World Health Organization Quality of Life questionnaire. The focus of the analysis was to evaluate differences between international and domestic students in their early clinical years. The responses were analysed using multivariate analysis of variance methods. International medical students are experiencing lower social and environmental quality of life compared with domestic peers. International medical students in New Zealand have expressed quality of life concerns, which likely have an impact on their academic achievement, feelings of wellness, acculturation, and social adaptation. The findings reinforce the need for creating stronger social networks and accessible accommodation, as well as developing systems to ensure safety, peer mentorship and student support.

Time for a rethink of treatment for patients with depression in primary care

The publication of a paper showing that mindfulness-based cognitive therapy prevented relapse of depression in a group of primary care patients at high risk of relapsing, is another reminder of the importance about these non-pharmacological therapies and should make us rethink what we are doing with treatment of depression in primary care.1 Cognitive therapy encourages patients to concentrate on their thinking patterns and become aware of their thoughts, so that they eventually introduce more helpful thoughts into their minds, while mindfulness refers to looking at our thoughts with increasing interest and acceptance. The current approach for many is to suggest a follow-up appointment within 2 weeks,2 and practitioners may have no system to check if this happens or not. Kay McKall in her wonderful article on ‘An Insiders Guide to Depression’ reminds us that patients with depression may not be thinking clearly and thus may not make a return visit, having neither the energy nor the inclination.3 A strategy for the alert practitioner is to book the next appointment while the patient is present, so that if they do not show up there is a reminder for the practitioner or team to contact them. ‘Active monitoring’ is an important part of current …

A Peer-Support and Mindfulness Program to Improve the Mental Health of Medical Students

ABSTRACT Problem: There is evidence that peer-support programs can improve mental health indices and help-seeking behavior among students in some secondary school and university settings and that mindfulness can improve mental health in medical students. Peer-led programs have not been formally assessed in a medical student population, where psychological issues exist and where it has been shown that students approach peers for help in preference to staff members or professional services. Intervention: Medical students elected peer leaders who underwent training and then provided the intervention. The peer leaders provided support to students in the intervention group, as well as offering teaching in mindfulness meditation. Context: An exploratory study was conducted with 2nd- and 3rd-year medical students at 1 medical school in New Zealand randomized into 2 groups. In addition to existing mental health resources, intervention participants received a program including peer support and peer-taught mindfulness practice. Study participants not offered the intervention participants could use existing mental health resources. Primary measures included depression (PHQ-9) and anxiety (GAD-7) scores. Secondary measures were quality of life, resilience (15-item resilience scale), academic self-concept, and motivation to learn, assessed at baseline and 6 months. Outcome: Of the 402 students eligible, 275 (68%) participated and 232 (58%) completed the study. At baseline, 53% were female and mean age was 21 years (SD = 3)—PHQ-9 score (M = 5.2, SD = 3.7) and GAD-7 score (M = 4.5, SD = 3.4). Twelve peer leaders were elected. There was good participation in the intervention. One fourth of intervention students used the face-to-face peer support and more than 50% attended a peer social event and/or participated in the mindfulness program. Although improvements in mental health were seen in the intervention group, the difference between the intervention and nonintervention groups did not reach statistical significance. Lessons Learned: Although evidence exists for effectiveness of peer support and mindfulness in other contexts, this exploratory study was not able to show a statistically significant effect. Future studies could consider using a longer training period for the peer leaders, as well as targeting the study population to those most likely to benefit such as those with poorer mental health, or using a more intensive intervention or larger sample size. A cluster randomized study design would also reduce the risk of contamination.

A systematic review of the health benefits of Tai Chi for students in higher education

Background The poor health consequences of stress are well recognized, and students in higher education may be at particular risk. Tai Chi integrates physical exercise with mindfulness techniques and seems well suited to relieve stress and related conditions. Methods We conducted a systematic review of the health benefits of Tai Chi for students in higher education reported in the English and Chinese literature, using an evidence hierarchy approach, allowing the inclusion of studies additional to randomized controlled trials. Results Sixty eight reports in Chinese and 8 in English were included — a combined study sample of 9263 participants. Eighty one health outcomes were extracted from reports, and assigned evidence scores according to the evidence hierarchy. Four primary and eight secondary outcomes were found. Tai Chi is likely to benefit participants by increasing flexibility, reducing symptoms of depression, decreasing anxiety, and improving interpersonal sensitivity (primary outcomes). Secondary outcomes include improved lung capacity, balance, 800/1000m run time, quality of sleep, symptoms of compulsion, somatization and phobia, and decreased hostility. Conclusions Our results show Tai Chi yields psychological and physical benefits, and should be considered by higher education institutions as a possible means to promote the physical and psychological well-being of their students.

An evidence-based first consultation for depression: nine key messages

Depression is commonly understood as a psychological condition characterised by ≥2 weeks of low mood often accompanied by low self-esteem, loss of interest in normally enjoyable activities, low energy, and pain without a clear cause. The prevalence of major depression in primary care is estimated to be about 13% (range 4–23%). Because doctors are usually trained to focus on physical aspects first, some may perceive that it is less problematic to miss a mental health diagnosis1 or may even evade enquiring about psychosocial issues to avoid opening Pandora’s Box (ironically in which lies hope).1 Some perceive that low mood related to loss may be better understood within a model of grief, choosing not to diagnose depression. Others have concerns about stigma or the impact on insurance claims if ‘depression’ is documented.2 Empathic listening is key to gaining a shared understanding of the patient’s problems, including relevant cultural aspects. Actively listening shows respect, enhances rapport, builds trust, and enables a healing partnership. In addition to mental health concerns, there may be loneliness, comorbid physical conditions, family violence, sexual and physical abuse, crime, war, migration, or homelessness. Although there are reasons to avoid official labelling in primary care, it is important to identify psychological distress with or without the label. Making a mental health diagnosis for clinicians in primary care is challenging, and a depression diagnosis may be more accurate if made over more than …