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Mental Wellbeing of Caring Profession Students: Relationship with Caregiver Identity, Self-Compassion, and Intrinsic Motivation

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Abstract

Aims To assess mental well-being in a sample of UK caring profession students and explore the relationship between mental well-being, psychological distress, caregiver role identity, self-compassion, and motivation. Background Students of caring profession subjects in UK universities typically follow a demanding educational and clinical training curriculum. Consequently, compared to other UK student groups, levels of psychological distress and mental illness are high. Design A cross-sectional observational study was conducted during the 2016-2017 academic year. Methods UK caring profession students (n=116) completed measures assessing mental well-being, psychological distress, caregiver role identity, self-compassion, and motivation. Significant correlations and independent predictors of mental well-being and psychological distress were identified. Results/Findings The current sample of UK caring profession students had low levels of mental well-being and two-thirds were deemed to have severe levels of psychological distress. Mental well-being and psychological distress were negatively associated with role identity, and positively associated with self-compassion and intrinsic motivation. Role identity, self-compassion and intrinsic motivation were significant independent predictors of mental well-being and psychological distress. Conclusion This study accords with other studies reporting that levels of psychological distress and mental illness are high amongst UK caring profession students. Findings suggest role identity, self-compassion, and intrinsic motivation are key factors that influence the mental well-being of this student group. Further research is warranted to determine whether adjusting the training curriculum to change how students identify with their caregiver role, as well as improve student levels of self-compassion and intrinsic motivation, leads to improvements in mental well-being and academic completion. Keywords: mental well-being, caring profession, nurse, social worker, self-compassion, role identity, intrinsic motivation, psychological distress, students
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ACCEPTED MANUSCRIPT
Mental Well-Being of Caring Profession Students: Relationship with Caregiver Identity, Self-
Compassion, and Intrinsic Motivation
Reference
Kotera, Y., Green, P., & Van Gordon, W. (2018) Mental wellbeing of caring profession students:
Relationship with caregiver identity, self-compassion, and intrinsic motivation. Mindfulness and
Compassion, In Press.
Corresponding author: Yasuhiro Kotera (Y.Kotera@derby.ac.uk), University of Derby, UK.
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Abstract
Aims
To assess mental well-being in a sample of UK caring profession students and explore the
relationship between mental well-being, psychological distress, caregiver role identity, self-
compassion, and motivation.
Background
Students of caring profession subjects in UK universities typically follow a demanding
educational and clinical training curriculum. Consequently, compared to other UK student
groups, levels of psychological distress and mental illness are high.
Design
A cross-sectional observational study was conducted during the 2016-2017 academic year.
Methods
UK caring profession students (n=116) completed measures assessing mental well-being,
psychological distress, caregiver role identity, self-compassion, and motivation. Significant
correlations and independent predictors of mental well-being and psychological distress were
identified.
Results/Findings
The current sample of UK caring profession students had low levels of mental well-being and
two-thirds were deemed to have severe levels of psychological distress. Mental well-being and
psychological distress were negatively associated with role identity, and positively associated
with self-compassion and intrinsic motivation. Role identity, self-compassion and intrinsic
motivation were significant independent predictors of mental well-being and psychological
distress.
3
Conclusion
This study accords with other studies reporting that levels of psychological distress and mental
illness are high amongst UK caring profession students. Findings suggest role identity, self-
compassion, and intrinsic motivation are key factors that influence the mental well-being of this
student group. Further research is warranted to determine whether adjusting the training
curriculum to change how students identify with their caregiver role, as well as improve student
levels of self-compassion and intrinsic motivation, leads to improvements in mental well-being
and academic completion.
Keywords: mental well-being, caring profession, nurse, social worker, self-compassion,
role identity, intrinsic motivation, psychological distress, students
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SUMMARY STATEMENT
Why is this research needed?
Compared to other student groups, UK caring profession students have low levels of
mental well-being which can lead to non-completion and poor academic performance.
Research demonstrates that role identity, self-compassion, and intrinsic motivation are
key factors that influence mental well-being. However, the relationship between these
three factors and mental well-being has not been investigated in a UK caregiver student
population.
What are the key findings?
The current sample of UK caring profession students had low levels of mental well-being
and two-thirds were deemed to have severe levels of psychological distress.
Role identity, self-compassion, and intrinsic motivation were significantly related to
mental well-being and psychological distress.
Role identity, self-compassion, and intrinsic motivation were also significant independent
predictors of mental well-being and psychological distress.
How should the findings be used to influence policy/practice/research/education?
Modifying the training curriculum to change how students identify with their caregiver
role, as well as to improve student levels of self-compassion and intrinsic motivation,
may lead to improvements in mental well-being and academic completion in UK caring
profession students.
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INTRODUCTION
Caring profession subjects are one of the most popular subjects studied in UK universities.
Indeed, out of the 700,000 students that applied to UK undergraduate programmes in 2014, more
than 55% applied to caring profession programmes (McGhee, 2015). Furthermore, out of the 2.3
million students enrolled in the UK at either undergraduate or postgraduate level during the
2015-2016 academic year, more than 20% were studying caring profession subjects (Higher
Education Statistics Agency, 2017). This is different from countries such as the US and Japan
where business (accounting for 20% of all applications in the US; The Institute of Education
Sciences, 2016) and social science (accounting for 33% of all university students enrolled in
Japan; Ministry of Education, Culture, Sports, Science and Technology-Japan, 2015) reflect the
most popular university subjects, respectively.
Caring professions encompass jobs in which humans take care of other humans, whether
physically, mentally, emotionally or spiritually. Examples of such professions include the allied
health professions (e.g. occupational therapy, physiotherapy), counselling, clinical psychology,
nursing, social work, and teaching (Hugman, 2005). One notable advantage of studying a caring
profession subject at a UK university is good graduate prospects. Indeed, about 90% of
healthcare graduates attain professional level employment or move onto further study within six
months of graduation (The Complete University Guide, n.d.; Prospect, 2015). However, despite
the popularity of the subject in UK universities, levels of mental well-being in UK caring
profession students are relatively low. For example, UK nursing students are more stressed than
students studying any other subject (Por, 2005), and more than one third of social work students
have high levels of depression and/or are at risk for clinical depression (Horton, Diaz, & Green,
2009). These figures are clearly a cause for concern for higher education establishments because
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amongst other negative consequences, poor mental well-being is associated with reduced
academic achievement and programme non-completion (e.g. Eisenberg, Golberstein, & Hunt,
2009; Poh Keong, Chee Sern, Ming, & Che, 2015). Understanding the key factors that influence
the mental health of caring profession students in the UK is important and will contribute to the
provision of training programmes that better serve the needs of this student group.
Background
Caring profession students typically follow a demanding educational and clinical training
curriculum that involves being confronted with potentially stressful experiences both at
university and during professional placement schemes (Morrissette, 2004; Tully, 2004).
Therefore, it is unsurprising that 70% of UK professional nursing students have high levels of
psychological distress (Jones & Johnston, 1997), and that nursing students – including in
countries outside the UK – often require psychological support or counselling to cope with their
training-related emotional problems (Omigbodun, Onibokun & Yusuf, 2004). It is well
established that psychological distress fosters sickness absence as well as poor academic
performance (Deary, Watson, & Hogston, 2003; Eisenberg, Golberstein, & Hunt, 2009; Jones,
Smith, & Johnston, 2005; Poh Keong et al., 2015). Indeed, a 2008 survey (n=4,500) by the Royal
College of Nursing (RCN) revealed that 44% of UK nursing students had considered leaving the
course, and that of this 44%, the majority believed their tutors were unaware of their intentions
(RCN, 2008). Concerning reports also exist for social work students’ in which approximately 4%
report having recently had depression-related suicidal thoughts (Horton et al., 2009).
In line with the reported association between caregiver role identity and mental well-
being (Mlotshwa et al., 2015), caring profession students often fail to recognise their mental
7
health problems because of their strong identity as a caregiver (Deutsch, 1985; Kottler & Hazler,
1996; Nace, 1995; Thoreson, Nathan, Skorina, & Kilburg, 1983). Role identity theory (McCall &
Simmons, 1978) claims that behaviour is shaped by perceptions of self in personal and
professional roles, and workers in caring professions have multiple professional and personal
identities (Brody, 2010) that define how they should behave (e.g. helper, manager, assessor and
coordinator of services, mediator, etc.). The lack of synergy between their ideal image of
themselves as a caregiver and their mental health problems could explain why some caring
professionals find it difficult to acknowledge that they have similar problems to their clients or
the people they support (Siebert & Siebert, 2005). Furthermore, being unaware of their mental
health problems is likely to hinder mental well-being (Corrigan, Druss, & Perlick, 2014; Jorm,
2012). However, despite these reported associations in professional caregivers, no study to date
has explored correlations between role identity and mental well-being in a UK student caregiver
population.
Self-compassion, that corresponds to caring and offering comfort to oneself in times of
difficultly (Neff, 2003), is also related to mental well-being (Beaumont et al., 2012; Beaumont &
Hollins Martin, 2013, 2015; Gilbert, 2009; Hutcherson et al., 2008; Kelly et al., 2009; Leary et
al., 2007; Lutz et al., 2008; Neff, 2003; Neff et al., 2005). While a strong caregiver identity may
cause caring profession students to overlook their own mental health problems, self-compassion
helps them to acknowledge, accept and seek to alleviate these problems (Gilbert, 2009).
However, although a recent study (Beaumont et al., 2016) reported a positive relationship
between self-compassion and mental well-being in midwifery students, no studies to date have
explored this relationship in other caring profession students in the UK.
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In addition to role identity and self-compassion, intrinsic motivation is also known to be a
determinant of mental well-being (Amabile, Goldfarb, & Brackfield, 1990; Baard, Deci, & Ryan,
2004; Bailey & Phillips, 2016; Ilardi et al., 1993; Locke & Latham, 2004; Miller & Rollnick,
2002). Intrinsic motivation is a key component of self-determination theory (SDT), a prevalent
theory of motivation. SDT assumes that human beings have a natural inclination to integrate
their psychic elements into a sense of self and larger social structures (Deci & Ryan, 1985). SDT
distinguishes intrinsic from extrinsic forms of motivation and explicates that intrinsic motivation
underlies activities undertaken due to being inherently interesting and satisfying, while extrinsic
motivation underlies activities undertaken for instrumental reasons such as money or status.
Intrinsic motivation is associated with goal achievement (Sheldon & Elliot, 1998), better task
performance (Amabile et al., 1990; Baard et al., 2004; Miller & Rollnick, 2002), well-being
(Bailey & Phillips, 2016; Ilardi et al., 1993), job and life satisfaction (Locke & Latham, 2004),
volunteering, and prosocial behaviour (Gagne, 2003). Conversely, external motivation is
associated with negative consequences (Vallerand & Ratelle, 2002) including emotional
exhaustion (Houkes, Janssen, de Jonge, & Bakker, 2003), depression (Blais, Lachance,
Vallerand, Briere, & Riddle, 1993), and compromised task performance due to low concentration
and memory impairment (see Vallerand, 1997 for a review). Although previous studies have
reported that caring profession students’ intrinsic motivation is related to academic performance
(Khalaila, 2015) and meaningfulness (Utvaer, 2014), no study to date has explored the
relationship between intrinsic motivation and mental well-being in UK caring profession
students.
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THE STUDY
Aims
The current study assessed levels of mental well-being and psychological distress (depression,
anxiety, and stress) in a sample of UK caring profession students. The study then investigated the
relationship between mental well-being, psychological distress, role identity, self-compassion
and intrinsic motivation in the same group of participants. Finally, an analysis was conducted to
establish whether role identity, self-compassion and intrinsic motivation independently predict
levels of mental well-being and psychological distress. This study focused on depression,
anxiety, and stress as indices of psychological distress because these are the most common types
of mental health problems in UK university students (Aronin & Smith, 2016).
Research questions
1. What proportion of the current sample of UK caring profession students have below-
average mental well-being and severe or worse levels of psychological distress?
2. How do mental well-being and psychological distress relate to caregiver role identity,
self-compassion, and intrinsic motivation in the same participant group?
3. Are any of these variables (i.e., role identity, self-compassion, and intrinsic motivation)
significant independent predictors of mental well-being and mental health?
Design
A cross-sectional observational study was conducted during the 2016-2017 academic year (data
collected between April and July 2017).
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Participants
Caring profession students studying at the researchers’ university were recruited. The inclusion
criteria were aged 18 years or older and in full-time education in a caring profession subject. A
total of 120 UK students agreed to participate, and 116 completed the five assessment measures
outlined below (101 female, 15 male; 103 social work students, 13 nursing students). This
satisfied the required sample size of 114 based on statistical power calculations (Faul, Erdfelder,
Buchner, & Lang, 2009).
Data collection and rigor
After consenting to partake to the study, participants were sent links to the following scales:
The Warwick-Edinburgh Mental Well-being Scale (WEMWBS). This scale uses fourteen
positively worded items (e.g. ‘I’ve been feeling optimistic about the future’) with five response
categories. It assesses subjective mental well-being and psychological functioning for the
previous two weeks. It defines mental well-being as psychological functioning (sense of
autonomy, self-acceptance, personal growth, life purpose, and self-esteem), satisfaction in life,
and the ability to nurture reciprocal relationships (Stewart-Brown & Janmohamed, 2008). Each
item is scored from 1 ('None of the time') to 5 ('All of the time') and total scores range from 14 to
70. The average score for a general population sample (n=1749) of Scottish people aged 16 to 74
was 50.7 (Stewart-Brown & Janmohamed, 2008). The Cronbach’s alpha has been reported as
.90, indicating high reliability (Tennant, Joseph, & Stewart-Brown, 2007).
Depression Anxiety and Stress Scale (DASS-21). This 21-item, four-point Likert scale is a
short-form version of the DASS-42 (Lovibond & Lovibond, 1995) and was used to measure
psychological distress. It consists of three seven-item subscales; depression (e.g. ‘I felt that I had
11
nothing to look forward to’), anxiety (e.g. ‘I felt I was close to panic’) and stress (e.g. ‘I found it
difficult to relax’). Cronbach’s alphas for the DASS-21 subscales have been reported as .94 for
depression, .87 for anxiety and .91 for stress (Antony, Bieling, Cox, Enns, & Swinson, 1998).
Role Identity Scale (RIS). This eight-item self-report measure evaluates participants’
caregiver role identity by considering how they view themselves as a caregiver, and how they
perceive others’ view of them as a caregiver (Siebert & Siebert, 2005; 2007). Participants score
how much they agree or disagree with each item (e.g. ‘It is my responsibility to be helpful to
family and friends’) on a five-point Likert scale. A higher summed score indicates a more
prominent caregiving identity. Cronbach’s alpha has been reported as .78 (Siebert & Siebert,
2005).
Self-Compassion Scale-Short Form (SCS-SF). This self-report measure is an abridged
version of the Self-Compassion Scale and comprises 12 five-point Likert items (Neff, 2003). The
scale defines self-compassion as being compassionate to oneself when experiencing suffering
(Neff, 2003). The Cronbach’s alpha has been reported as .86, indicating good reliability (Raes,
Pommier, Neff, & Gucht, 2011).
Academic Motivation Scale (AMS). This 28-item self-report measure evaluates the levels
of seven different types of motivation: amotivation, three types of extrinsic motivation (external,
introjected, and identified regulation), and three types of intrinsic motivation (to know, to
accomplish, and to experience stimulation). Amotivation (AM), the lowest type of motivation,
corresponds to not being motivated at all, and an amotivated student remains disinterested in
terms of the outcome that arises from their academic input (Deci & Ryan, 1985). The next lowest
form of motivation is extrinsic motivation external regulation (EMER), which relates to being
driven by reward or punishment (e.g., studying in order to avoid being reprimanded by one’s
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parents). Extrinsic motivation with introjected regulation (EMIJ) is an internalised form of
EMER (e.g., studying because one believes that is what good students are supposed to do). A
student with extrinsic motivation with identified regulation (EMID) recognises the value of a
behaviour, and choses to implement the behaviour without relying on other external drivers (e.g.,
studying because one believes it is important to do so) (Deci, 1975; Deci & Ryan, 1985;
Vallerand et al., 1992).
The next highest level of motivation following EMER, EMIJ, and EMID (i.e., which are
all extrinsic forms of motivation) is intrinsic motivation to experience stimulation (IMS) that
corresponds to engaging in an activity to experience stimulating sensations. Flow and peak
experience (e.g. Csikszentmihalyi, 1975) might be considered similar to an experience of IMS.
Intrinsic motivation towards accomplishments (IMA) refers to the desire to create something
unique as well as the pleasure that arises from pursuing this goal (e.g., going the extra mile on an
assessment paper to accomplish something unique). IMA is similar to mastery motivation in
educational psychology (Harter, 1981). The final form of intrinsic motivation (i.e., in addition to
IMS and IMA) is intrinsic motivation to know (IMK). It relates to several educational concepts
such as exploration, curiosity and learning goals (e.g. Gottfried, 1985; Harter, 1981), and
embodies the epistemic need to search for meaning (Vallerand, Blais, Briere, & Pelletier, 1989).
A student with IMK may read books for the sheer pleasure of learning something new (Deci,
1975; Deci & Ryan, 1985; Vallerand, 1992). Each type of motivation is assessed using four
items on a seven-point Likert scale (from 1 = 'Does not correspond at all' to 7 = 'Corresponds
exactly'). All of the subscales have adequate Cronbach’s alphas between .62 and .91 (Vallerand
et al., 1992).
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Ethical considerations
Ethics approval was obtained from the University Research Ethics Committee.
Data analysis
Data was screened for the assumptions of parametric tests and descriptive statistics were then
calculated. Pearson’s correlations were calculated prior to conducting a multiple regression
analyses in order to examine the best independent predictors of mental well-being and
psychological distress. All statistical analysis was conducted using IBM SPSS version 24.0.
RESULTS
Study participants (n=116) ranged in age from 18 to 58 years old (mean = 30.5, SD = 8.81 years)
with 26% undertaking postgraduate study and 10% classed as international students (3 students
from Europe and 9 from African countries). A total of 23% of participants did not have any
placement experience (the mean placement experience for the remaining students was 9 months)
and 45% did not have a part-time job. The mean reported weekly self-study time was 13 hours.
Four scores in RIS and two scores in DASS-21 were identified as outliers using the
outlier labelling rule (Hoaglin & Iglewicz, 1987), and were subsequently winsorised (Turkey,
1962). Skewness values ranged from -1.19 to 1.15, and Kurtosis values from -.38 to 3.06. The
Cronbach’s alpha for all of the scales and subscales were .75 or higher, demonstrating high
levels of internal consistency. As shown in Table 1, the mean score of mental well-being in our
participants (45.01) was lower than the comprehensive Scottish sample (Stewart-Brown &
Janmohamed, 2008) and 30% of participants had below average levels of mental-wellbeing; 41%
14
had severe or higher levels of depression, and 63% had severe or higher levels of anxiety and
stress.
Table 1 Descriptive statistics: mental well-being, psychological distress, role identity,
self-compassion, motivation among caring profession students
Scale/subscale (Range)
N
M
SD
α
MW (14-70)
116
45.01
9.56
.93
30% below average
Dpn (0-21)
116
10.33
7.14
.87
41% severe or worse
Anx (0-21)
116
10.41
7.80
.84
63% severe or worse
Strs (0-21)
116
15.71
8.53
.84
63% severe or worse
RI (8-40)
116
31.34
5.79
.85
SC (12-60)
116
32.84
8.37
.85
IMK (4-28)
116
20.54
5.27
.90
IMA (4-28)
116
18.31
5.53
.84
IMS (4-28)
116
15.11
5.55
.86
EMID (4-28)
116
21.84
4.02
.84
EMIJ (4-28)
116
20.15
5.65
.86
EMER (4-28)
116
19.84
5.56
.80
AM (4-28)
116
7.05
3.96
.75
MW = Mental well-being; Dpn = Depression; Anx = Anxiety; Strs = Stress; RI = Role identity;
SC= Self-compassion; IMK = Intrinsic motivation to know; IMA = Intrinsic motivation toward
accomplishment; IMS = Intrinsic motivation to experience stimulation; EMID = Extrinsic
motivation identified; EMIJ = Extrinsic motivation introjected; EMER = Extrinsic motivation
external regulation; AM = Amotivation.
Correlations
All of the scales and subscales, except for mental well-being and self-compassion, were not
normally distributed, as assessed by the Shapiro-Wilk's test (p < .05). Thus, they were square-
root-transformed to satisfy the assumption of normality. As shown in Table 2, mental well-being
15
was positively related to self-compassion and intrinsic motivation, and negatively related to
mental health problems and amotivation. Psychological distress was positively related to role
identity and amotivation, and negatively related to self-compassion and self-study time.
Furthermore, role identity was negatively related to sleeping time, and self-compassion was
positively related to intrinsic motivation, age and self-study time, and negatively related to
amotivation. The level of the academic programme was positively related to extrinsic motivation,
and negatively related to amotivation.
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Table 2. Correlations among the mental well-being, psychological distress, role identity, self-
compassion, motivation measures, and demographics
1
2
3
4
5
6
7
8
9
10
11
12
1.Dpn
-
2.Anx
.61**
-
3.Strs
.69**
.76**
-
4.RI
.14
.27**
.38**
-
5.SC
-.46**
-.32**
-.47**
-.16
-
6.IMK
-.12
-.01
.02
-.02
.34**
-
7.IMA
-.06
.03
.08
.13
.29**
.78**
-
8.IMS
-.04
.10
.002
-.01
.33**
.65**
.61**
-
9.EMID
.14
.04
.13
.004
.06
.63**
.54**
.49**
-
10.EMIJ
-.004
.08
.09
.08
-.01
.53**
.70**
.34**
.43**
-
11.EMER
.17
-.01
.05
-.05
-.04
.29**
.37**
.10
.56**
.54**
-
12.AM
.22*
.19*
.07
-.09
-.20*
-.32**
-.21*
-.02
-.19*
-.12
.09
-
GN
-.004
.09
.09
.06
-.05
.16
.14
.10
.18
.19*
.11
.002
Age
-.11
-.15
-.19*
-.03
.36**
.19*
.15
.13
-.10
-.07
-.20*
.003
PrgLv
-.03
.004
-.07
.11
.02
-.12
-.18
-.03
-.18
-.29**
-.23*
.22*
Plcmt
.08
.11
.07
.09
.10
-.04
-.07
-.04
-.06
-.27**
-.13
-.13
SelfStdy
-.25**
-.16
-.23*
.02
.30**
.01
0.13
0.13
-.18*
.09
-.14
-.12
Sleep
-.07
-.15
-.18*
-.23*
-.13
.15
.07
.02
.15
.17
.18
-.11
PTjob
-.09
-.07
-.09
-.05
.14
.10
.16
.26**
-.02
.08
-.08
.07
WorkHr
.08
.01
-.01
-.02
-.03
-.06
-.11
-.13
.02
-.06
.01
-.11
MW = Mental well-being; Dpn = Depression; Anx = Anxiety; Strs = Stress; RI = Role identity;
SC= Self-compassion; IMK = Intrinsic motivation to know; IMA = Intrinsic motivation toward
accomplishment; IMS = Intrinsic motivation to experience stimulation; EMID = Extrinsic
motivation identified; EMIJ = Extrinsic motivation introjected; EMER = Extrinsic motivation
external regulation; AM = Amotivation; GN = Gender (1=male, 2=female); ProgLv =
Programme level they are entoled to; Plcmt = how many months they have worked in placement;
SelfStdy = weekly self-study hours; Sleep = Sleep hours per day; WorkHr = working hours per
week in their parttime job. *p<.05; **p<.01.
Regression
Multiple regression analyses were conducted to explore the relative contribution of role identity,
self-compassion, and intrinsic motivation to mental well-being and psychological distress. At
17
step one, gender and age were entered to statistically adjust for their effects, and at step two, all
the scores for role identity, self-compassion, and motivation were imputed. Because of the many
predictor variables, adjusted coefficient of determination (Adj. R2) was reported.
Multicollinearity was not a concern as all the VIF values were less than 10.
As shown in Table 3, role identity, self-compassion, and intrinsic motivation predicted
30% of the variance for mental wellbeing after adjusting for demographic information (self-
compassion and intrinsic motivation were identified as independent predictors). Role identity,
self-compassion, and intrinsic motivation predicted 29% of the variance for depression after
adjusting for demographic information (self-compassion was the only independent predictor).
Role identity, self-compassion, and motivation predicted 14% of the variance for anxiety after
adjusting for demographic information (role identity, self-compassion, and intrinsic motivation
toward accomplishment were each independent predictors). Finally, role identity, self-
compassion, and motivation predicted 30% of the variance for stress after adjusting for
demographic information (role identity and self-compassion were independent predictors).
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Table 3 Multiple regression: Mental well-being and psychological distress as predicted by role
identity, self-compassion, and motivation in UK caring profession students
Well-being
Depression
Anxiety
Stress
B
SEB
β
B
SEB
β
B
SEB
β
B
SEB
β
Step 1
Gender
-.20
2.63
-.01
-.03
.36
-.01
.35
.38
.09
.30
.34
.08
Age
.19
.10
.18
-.02
.01
-.11
-.02
.02
-.15
-.03
.01
-.19*
Adj. R2
.02
.01
.01
.01
Step 2
Gender
-.63
2.26
-.02
-.19
.32
-.05
.15
.37
.04
.05
.30
.01
Age
-.07
.10
-.06
.01
.01
.09
-.02
.02
-.10
-.01
.01
-.07
RI
-.19
1.43
-.01
.18
.20
.08
.59
.23
.23*
.65
.19
.29**
SC
.55
.11
.49**
-.07
.02
-.48**
-.05
.02
-.29**
-.07
.01
-.49**
IMK
5.95
2.36
.39*
-.30
.34
-.15
.21
.38
.10
.20
.31
.10
IMA
-.18
2.20
-.01
-.19
.31
.10
-.06
.36
-.03**
.37
.29
.21
IMS
-1.63
1.48
-.13
.15
.21
.09
.31
.24
.17
-.01
.20
-.01
EMID
.04
2.57
.002
.51
.37
.19
-.04
.42
-.01
.22
.34
.08
EMIJ
-.96
1.80
-.07
-.32
.26
-.17
.08
.29
.04
-.24
.24
-.13
EMER
-.38
1.64
-.03
.28
.23
.15
-.19
.27
-.10
-.12
.22
-.07
AM
-.14
1.29
-.01
.19
.18
.10
.39
.21
.19
.15
.17
.08
Δ Adj.R2
.30
.29
.14
.30
MW = Mental well-being; Dpn = Depression; Anx = Anxiety; Strs = Stress; RI = Role identity;
SC= Self-compassion; IMK = Intrinsic motivation to know; IMA = Intrinsic motivation toward
accomplishment; IMS = Intrinsic motivation to experience stimulation; EMID = Extrinsic
motivation identified; EMIJ = Extrinsic motivation introjected; EMER = Extrinsic motivation
external regulation; AM = Amotivation; B = unstandardised regression coefficient; SEB =
standard error of the coefficient; β = standardised coefficient; *p<.05; **p<.01.
19
DISCUSSION
This study assessed levels of mental well-being and psychological distress among a sample of
UK caring profession students. Relationships between mental well-being, psychological distress,
role identity, self-compassion and intrinsic motivation were also investigated. Findings
demonstrated that approximately one third of the current sample of caring profession students
had below average levels of mental well-being, and two-thirds had severe or worse levels of
psychological distress. Mental well-being and psychological distress were related to self-
compassion, intrinsic motivation, and amotivation. Furthermore, multiple regression analyses
revealed that role identity, self-compassion, and intrinsic motivation were significant predictors
of mental well-being and psychological distress.
Poor levels of mental well-being and a high prevalence of psychological distress in the
current sample of UK caring profession students is consistent with findings from other studies
(Horton et al., 2009; Jones & Johnston, 1997; Por, 2005). However, compared to a previous
study that reported 77% of UK students (of all subject disciplines) suffered from depression,
74% from anxiety, and 63% from stress (Aronin & Smith, 2016), only 41% of participants in the
current study suffered from depression (the rate of both anxiety and stress in the present study
was 63%). This relatively lower occurrence of depression may be explained by (i) the peer group
effects derived from studying with peers that aspire to help others, and (ii) the fact that students
prefer disclosing their mental distress to peers rather than to a professional (Kalafat & Elias
1995, Hope et al., 2005) or family member (Ciarrochi et al., 2003). Indeed, a strong negative
correlation has been observed between peer support and depression in nursing and midwifery
students in Ireland (Horgan, Sweeney, Behan, & McCarthy, 2016).
20
The relationship between mental well-being and role identity observed in the current
study may be indicative of caring profession students’ image of themselves as a future care
worker, which could blind them to their own mental health issues (Siebert & Siebert, 2005).
Reduced mental well-being is also likely to be caused by expectations or pre-conceived ideas
concerning the demands of the caregiver role (Lev-Wiesel, 2003). In line with recommendations
and findings by other researchers (Compton & Galaway, 1989; Fook, 1993; McKee, 2017;
O’Connor, Wilson, & Setterlund, 2003), self-awareness training may be an effective means of
addressing this issue by helping students become more aware of their values, mental health,
attitudes, and personal issues, including how these might affect their caring work. Indeed,
although this form of training is yet to be applied to UK caring profession students, self-
awareness training has already been used in some caring profession programmes in other
countries (Australian Association of Social Workers, 1994).
The positive relationship observed between mental well-being and self-compassion is
likewise consistent with previous research findings (Braehler et al., 2013; Gilbert & Procter
2006; Kelly et al. 2009). For example, self-compassion has been shown to be negatively
associated with depression, anxiety and self-criticism in individuals with chronic psychological
distress (Gilbert & Procter 2006). Furthermore, self-compassion has previously been shown to
predict mental wellbeing in non-student samples (Baer, Lykins, & Peters, 2012; Hollis-Walker &
Colosimo, 2011; Van Dam, Sheppard, Forsyth, and Earleywine, 2011) as well as in students
studying subjects other than those related to a caring profession (Bluth & Blanton, 2015).
Consequently, there may be value in explicitly training students to cultivate self-compassion as
part of caring profession training curriculums. In addition to direct training in self-compassion,
another means of doing this could be to offer mindfulness training that was shown to
21
significantly increase levels of self-compassion in 31 caring profession students (Newsome,
Waldo, & Gruszka, 2012) as well as in 21 post-graduate psychotherapy students (Dorian &
Killebrew, 2014). Stickle (2016) appears to advocate the use of compassion and self-compassion
as part of the training of caring professionals and posits that – irrespective of whether taught
directly or elicited via techniques such as mindfulness – compassion and self-compassion
honours caring profession's humanitarian roots.
The positive relationship observed in the current study between mental well-being and
motivation likewise accords with previous research findings (Amabile et al., 1990; Baard et al.,
2004; Bailey & Phillips, 2016; Ilardi et al., 1993; Locke & Latham, 2004; Miller & Rollnick,
2002). Furthermore, intrinsic motivation has previously been shown to be a significant
independent predictor of mental wellbeing in Chinese medical undergraduate students (Huang,
Lv, & Wu, 2016) as well as in non-student populations (Weinstein & Ryan, 2010; Zuroff et al.,
2007). This relationship indicates that helping caring profession students derive personal
meaning from their current training and anticipated professional role is likely to be a useful
means of enhancing both intrinsic motivation and mental well-being. Dawes and Larson (2011)
suggest that cultivating a sense of personal meaning could be achieved via nurturing a goal that
transcends the individual’s self-needs. For example, the Disney strategy, a dynamic Neuro-
Linguistic Programming skill that considers dreams and plans (Dilts, 1998), could help students
identify what they want internally from their studies and career (Kotera & Sheffield, 2017). Such
a dynamic process could be introduced either as an adjunct or alternative to traditional
classroom-based training approaches (Kotera, 2017).
Limitations
22
There are several limitations to this study. A key limitation is the fact that participants were all
either social work or nursing students, meaning that findings may not generalise to students
studying other caring profession disciplines. A further limiting factor is that participants were
recruited from a single academic institution which means that factors unique to the university
(e.g., learning and assessment styles, teaching quality, student satisfaction, etc.) may have
influenced the findings. Furthermore, as with all cross-sectional studies, the study was limited by
the fact that it is not possible to ascertain the causal direction of the relationships identified.
CONCLUSION
While the number of caring profession students in UK universities exceeds that of any other
student group in the UK, the mental well-being of caring profession students is comparatively
poor. Findings from this study suggest that role identity, self-compassion, and intrinsic
motivation are key factors that influence the mental health of this student group. Consequently,
further research is warranted to determine whether adjusting the training curriculum to change
how UK caring profession students identify with their caregiver role, as well as to improve
student levels of self-compassion and intrinsic motivation, leads to improvements in mental
health and academic completion.
23
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... Further, mental health shame was a positive predictor of mental health problems in therapeutic students (Kotera et al. 2019c). This may imply that offering these students 'mental health' support directly would not be effective, as they would not fully engage in such support because of shame (Kotera et al. 2018b). On the other hand, positive psychological approaches may be effective as these approaches could bypass their high mental health shame, focusing on nurturing what assets they have (Joseph and Linley 2006;Kotera and Ting 2019). ...
... Lastly, self-compassion has been increasingly paid attention to, for its relevance to mental wellbeing (Ehret et al. 2015;Kotera et al. 2018bKotera et al. , 2019Muris et al. 2018). Self-compassionbeing understanding and accepting of one's weaknesses and inadequacies (Gilbert 2009)protects mental wellbeing by supporting resilience (Trompetter et al. 2017). ...
... Students who are (a) well-engaged with academic work, (b) passionate about academic work, (c) able to bounce back from challenges and (d) understanding towards themselves tend to have a high level of mental wellbeing. Previously, these relationships between mental wellbeing and positive psychology have been reported in other student populations (Kotera and Ting 2019;Kotera et al. 2018b), and our findings report that the relationships were identified in the UK therapeutic students too. These identified relationships can help substantiate practitioners' experience, noting that positive mental resources are essential in the therapeutic field (Vandenberghe and Silvestre 2014). ...
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This study aimed to examine the relationships between mental wellbeing and positive psychological constructs in therapeutic students (psychotherapy and occupational therapy students). The number of therapeutic students has increased recently, however they suffer from poor mental health, which may be improved by potentiating their positive psychological constructs, bypassing mental health shame. Therapeutic students (n=145) completed measures regarding positive psychological constructs, namely mental wellbeing, engagement, motivation, resilience, and self-compassion. Resilience and self-compassion predicted mental wellbeing, explaining a large effect. Self-compassion partially mediated the relationship between resilience and mental wellbeing. This study highlights the importance of positive psychological constructs, especially resilience and self-compassion, for mental wellbeing of therapeutic students.
... Self-compassion-being understanding and accepting of one's weaknesses and inadequacies [2]-has been receiving increasing attention [3], particularly in the fields of mental health and psychology [4][5][6][7][8][9]. A meta-analysis of 20 studies reported large (as defined [10]) associations between selfcompassion and various types of mental distress including depression and anxiety [11]. ...
... (2-tailed). Scores in the negative subscales (2,4,6) were reversed Relatedly, our findings using SCS-SF did not support Neff's theoretical model of self-compassion (2003), where the three positive subscales contribute to self-compassion, and each positive subscale corresponds to the opposing negative subscale (e.g. self-judgement is an opposing construct to self-kindness). ...
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Objectives The Self-Compassion Scale-Short Form (SCS-SF) was developed as an economical alternative for the Self-Compassion Scale (SCS), one of the few scales to assess self-compassion. Despite the active use of the SCS-SF, a psychometric evaluation of this scale remains limited. This study analysed the factor structure, reliability, and construct validity of the SCS-SF in UK university student populations. Methods Of 365 students approached, 333 completed the SCS-SF, and other measures including negative psychological constructs (mental health problems, self-criticism, and mental health shame) and positive psychological constructs (self-reassurance, resilience, and wellbeing). Data were analysed through confirmatory factor analyses and correlations. Results CFA revealed that the six-factor structure, reported in the validation paper, was not replicated. The positive factor, consisting of the three positive subscales, was not strongly related to any variable, but moderately related to reassured-self, resilience, wellbeing, and inadequate-self. The negative factor, consisting of the three negative subscales, was strongly related to inadequate-self, and moderately related to resilience, reassured-self, stress, wellbeing, depression, and internal shame. Coefficients in the negative factor were in general larger than those in the positive factor. The total SCS-SF score was most strongly related to inadequate-self, followed by resilience. Inter-correlations of the six subscales did not follow Neff (2003b)'s theoretical model of self-compassion nor the full-scale factor solution. Conclusions Findings do not accord with the common use of the global SCS-SF score as an assessment of six factors of self-compassion, and suggest a two factor solution assessing self-criticism and self-compassion.
... For example, Beaumont et al. (2016) reported that student midwives, reporting high levels of self-compassion and wellbeing, were less overwhelmed by compassion fatigue and burnout. Kotera et al. (2018) found that self-compassion and intrinsic motivation among UK caring profession students were associated with mental wellbeing and reduced psychological distress. Moreover, Babenko et al. (2018) found that, among Canadian medical students, selfcompassion and psychological needs were related to burnout-related exhaustion. ...
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Objectives Compassion is the beneficial response of an individual to the sufferings and difficulties of others. Self-compassion refers to feelings of concern an individual feel towards oneself. Both may serve as potential buffers in a hospital setting where caregivers attending to patients in critical condition experience emotional distress, which may lead to burnout. However, the unique contribution of compassion, both to self and others, to the decrease of burnout is unclear. Methods In the present study, we recruited 109 professional caregivers working in a hospital’s intensive care and rehabilitative units. We explored a theoretically driven mediation model in which the relationship between compassion for self and others and burnout is mediated by different basic psychological needs, detailed in the self-determination theory. Results Results indicated that self-compassion and concern for others were associated with reduced levels of burnout. Each of these buffers against burnout was mediated by a unique psychological need, thereby supporting a three-layered model of (a) compassion and self-compassion, (b) basic psychological needs, and (c) burnout. Conclusions Our study highlights compassion and self-compassion as potential resilience factors against the challenge of burnout in healthcare. It points to promising avenues for preemptive clinical interventions.
... [Insert Table 2 about here] Although AMS has demonstrated its high utility in assessing students' motivation, a shorter version has been sought to reduce time and effort to complete for students (Kotera, Conway & Van Gordon, 2019, Kotera, Conway & Van Gordon, 2018bKotera, Green & Van Gordon, 2018c). High response burden can lead to reduced response rates and fewer completions, hindering data quality (Diehr, Chen, Patrick, Feng & Yasui, 2005). ...
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Academic motivation is important to students’ mental health and performance. One established measure is the Academic Motivation Scale (AMS), comprising 28 items. AMS assesses intrinsic motivation, extrinsic motivation, and amotivation, which are further categorised into seven subscales. One weakness of AMS is its length. This study constructed and validated a short version of the 14-item Academic Motivation Scale (SAMS). Data from two UK university student samples were analysed to construct and validate the factorial structure. SAMS yielded adequate internal consistency, and very strong correlations with the original version of AMS in both samples. Confirmatory factor analysis on SAMS replicated the seven-factor model identified in the original AMS. SAMS can be a reliable and valid alternative to the original AMS.
... 6 It found that construction workers are reluctant to reveal their emotional difficulties, which perhaps explains their reluctance to seek help. Mental health shame has been linked with mental health problems in many different populations: university students in healthcare subjects 7,8 (including psychotherapy) 9 and business studies, 10 UK hospitality workers 11 and Japanese workers. 12 An individual who is ashamed of having a mental health problem therefore tends to be mentally distressed, or vice versa. ...
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... Whereas general team meetings can provide opportunities to discuss ideas and make decisions (Kauffeld & Lehman-Willenbrock, 2012), our morning huddles focus on caring for each other's well-being, which is the priority of this meeting (e.g., asking how they and their family are doing). By attending the huddle, we feel more compassionate and connected with 6 Sensitivity: Internal the team (Dolan, 2011), which can counteract loneliness (a debilitating factor for well-being) in isolation to protect our well-being (Kotera, Green & Van Gordon, 2018;Victor et al., 2018). ...
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Isolation can affect our well-being negatively. To prevent the spread of the infection COVID-19, many workers, including university lecturers, are required to work from home. In order to maintain high levels of well-being and team cohesion, academics at the University of Derby Online Learning initiated a virtual huddle to briefly socialise and check on their colleagues’ well-being every morning. This piece of field notes reports the context (COVID-19 in the United Kingdom), the details of this morning socialization, the first-hand experience of attending this huddle, and possible applications. Perceived positive impacts of our huddles include better well-being, cultivating compassion in team culture, and enhanced team cohesion. These advantages can be also useful in student supervision, wider socialization with colleagues to counter the silo mentality, and other occupational sectors. Our field notes will be helpful for lecturers and other types of employees who work collaboratively yet in isolation during this uncertain and challenging time of crisis.
... Particularly social care students are afraid to seek help, as they aspire to help people with mental health problems. Their strong caregiver identify was associated with poor mental health and high mental health shame (Kotera, Green & Sheffield, 2019;Kotera, Green & Van Gordon, 2018;Ting, 2011). Despite these relationships, mental health attitudes and caregiver identity of Irish social care students have not been explored in-depth to date. ...
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Mental health is a concern in the Republic of Ireland, and in particular mental health of higher education students is challenging. Further, their poor mental health may be negatively impacted by their negative mental health attitudes and caregiver identity, which can yield high self-criticism and low self-reassurance. Accordingly, this study aimed to (i) elucidate the relationships among these five constructs, and (ii) assess the impact of self-criticism and self-reassurance in the relationship (a) between mental health attitudes and mental health, and (b) between caregiver identity and mental health. One-hundred twenty-nine Irish undergraduate students completed self-report measures regarding these constructs. Correlation and path analyses were conducted. Overall all variables were related to each other, in particular family-related shame subscales were strongly related to mental health problems. In path analysis, self-criticism completely mediated the relationship between mental health attitudes and mental health, while self-reassurance did not. Likewise, self-criticism also completely mediated the relationship between caregiver identity and mental health, while self-reassurance did not. The findings suggest the importance of self-criticism to their mental health. While current literature highlights the importance of mental health attitudes such as stigma and caregiver identity such as low self-awareness, our results indicated that it was their self-criticism that predicted poor mental health. Their mental health may be more effectively improved by targeting self-criticism. Compassion training, peer-support groups, and reframing were recommended to counter self-criticism. Our findings will help educators and researchers to identify an alternative and effective means to improve mental health in Irish students.
... Self-compassion-being kind and understanding to one's weaknesses and inadequacies (Gilbert 2010)-ameliorates mental distress by cultivating resilience (Trompetter et al. 2017). Self-compassion is strongly associated with better mental health (Ehret et al. 2015;Hayter and Dorstyn 2014;Muris et al. 2016), and also a key predictor of good mental health in UK students (Kotera et al. 2018f). ...
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Malaysia plays a key role in education of the Asia Pacific, expanding its scholarly output rapidly. However, mental health of Malaysian students is challenging, and their help-seeking is low because of stigma. This study explored the relationships between mental health and positive psychological constructs (academic engagement, motivation, self-compassion, and wellbeing), and evaluated the relative contribution of each positive psychological construct to mental health in Malaysian students. An opportunity sample of 153 students completed the measures regarding these constructs. Correlation, regression, and mediation analyses were conducted. Engagement, amotivation, self-compassion, and wellbeing were associated with, and predicted large variance in mental health. Self-compassion was the strongest independent predictor of mental health among all the positive psychological constructs. Findings can imply the strong links between mental health and positive psychology, especially self-compassion. Moreover, intervention studies to examine the effects of self-compassion training on mental health of Malaysian students appear to be warranted.
... SDage=9.11 years; 94 UK nationals; Kotera, Green & Van Gordon, 2018). After screening the data for the assumptions of various parametric tests, correlations between mental health attitudes, mental health symptoms, motivation, and self-compassion were explored. ...
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There is growing awareness of mental health problems among UK business students, which appears to be exacerbated by students’ attitudes of shame toward mental health. This study recruited 138 UK business students and examined the relationship between mental health and shame, and mental health and potential protective factors such as self-compassion and motivation. A significant correlation between each of the constructs was observed and self-compassion was identified as an explanatory variable for mental health. Shame moderated the relationship between self-compassion and mental health. Integrating self-compassion training into business study programs may help to improve the mental health of this student group.
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As mental health awareness increases, more students enrol to therapeutic subjects, aspiring to help others' mental wellbeing. While mental health of other caring students has been explored, therapeutic students' mental health has not been investigated thoroughly. This study aimed to explore relationships between mental health, mental health attitudes, self-criticism/self-reassurance, self-compassion, and caregiver identity of counselling and occupational therapy students. One hundred forty-five students, recruited through opportunity sampling, completed measures about those constructs. Correlation and regression analyses revealed that their mental health was associated with attitudes, self-criticism/self-reassurance and self-compassion. Self-criticism and internal shame were independent predictors of mental health. Findings will inform the mental health status of therapeutic students and help identify better solutions for their challenging mental health.
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The Disney strategy, a neuro-linguistic programming skill, has been reported to be useful for career guidance by qualified career consultants in Japan. This mixed methods pilot study aimed to examine the effects and the experience of using this strategy for career guidance in Japanese students. Six students responded to four job-search-related scales at pre-training and post-training, and were interviewed. Students' self-esteem and job-search self-efficacy increased significantly in the short-term. Thematic analysis of the interviews revealed three key experiential features: body movement; clear vision; and positive emotions. These promising findings suggest the Disney strategy should be examined in larger, longitudinal studies.
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Content and Focus: This narrative review summarises findings of research that has shown use of Compassion-Focused Therapy (CFT) to improve psychological outcomes in clinical populations. This article reviews the research studies that have utilised CFT to treat clients experiencing a variety of mental health issues. The paper begins offering an overview of CFT theory and compassionate mind interventions. A literature search was conducted which included book chapters and articles that discussed compassion focused therapy. Twelve studies were identified which showed significant psychological improvements in clients with diagnosed trauma symptoms, brain injury, eating disorders, personality disorders, schizophrenia-spectrum disorder, chronic mental health problems and psychosis, both within groups and during one-to-one therapy. Within the context of the reviewed studies, CFT has shown itself to be an effective therapeutic intervention when combined with approaches such as Cognitive Behavioural Therapy (CBT). Conclusion: The research design of the majority of the studies examined precluded determining the extent of individual contributions that CFT made towards client recovery. Further research that uses more rigorous approaches are required to evaluate more effectively the role CFT plays in clients’ therapeutic recovery.
Book
I: Background.- 1. An Introduction.- 2. Conceptualizations of Intrinsic Motivation and Self-Determination.- II: Self-Determination Theory.- 3. Cognitive Evaluation Theory: Perceived Causality and Perceived Competence.- 4. Cognitive Evaluation Theory: Interpersonal Communication and Intrapersonal Regulation.- 5. Toward an Organismic Integration Theory: Motivation and Development.- 6. Causality Orientations Theory: Personality Influences on Motivation.- III: Alternative Approaches.- 7. Operant and Attributional Theories.- 8. Information-Processing Theories.- IV: Applications and Implications.- 9. Education.- 10. Psychotherapy.- 11. Work.- 12. Sports.- References.- Author Index.
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This study examined the effect of intrinsic academic motivation and interpersonal conflict on the perceived depression and stress. Participants were 537 Chinese undergraduate students (191 males and 346 females; M age = 20.4 years, SD age = 1.3). They completed four scales measuring intrinsic academic motivation, interpersonal conflict, stress, and depression. Linear regressions were conducted with intrinsic academic motivation, interpersonal conflict, and their interaction as independent variables to predict depression and stress. Results showed that intrinsic academic motivation was negatively, while interpersonal conflict was positively, associated with depression and stress. Moreover, the interaction was significant: negative association of “intrinsic academic motivation and depression” and that of “intrinsic academic motivation and stress” was weaker among participants who reported higher (vs. lower) levels of interpersonal conflict.
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AimThis study aimed to identify levels of depressive symptoms, social and personal college adjustment and peer support among nursing and midwifery students. Background Student mental health is of international concern, particularly among students who are undertaking professional qualifications in health care. DesignCross-sectional design. Methods Data were collected in 2013 using the Centre for Epidemiology Depressive Symptoms Scale, two subscales of the Student Adaptation to College Questionnaire; and a subscale of the Peer Support Evaluation Inventory with 417 students in Ireland. ResultsFindings indicated that 34% of participants experienced depressive symptoms, 20% were poorly personally adjusted and 9% poorly socially adjusted. Most students had good levels of peer support. Statistically significant relationships were found between all key variables. Students in their second year of study had significantly higher rates of depressive symptoms. Participants who reported having poor relationships with their fathers were at higher risk and had more difficulties personally and socially adjusting to university life and study. The alcohol consumption of participants had a statistically significant relationship with depressive symptoms with higher consumption rates having a positive impact on symptoms. Conclusion The mental health of undergraduates undertaking professional healthcare studies needs to be a key research, educational and clinical priority. High rates of adjustment and mental health difficulties, particularly in the second year of the programme need to be examined and more effective interventions developed.
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Compassion is a core value in social work. As an emerging topic in research, we are learning how to distinguish this higher-level mental faculty from empathy and seeing important implications for social work practice. Functional magnetic imagery technology is enabling researchers to study the neural responses of empathy and compassion as they are occurring. Empathy accompanies negative affect, activating a pain network, while compassion activates positive affect and regions associated with affiliation. Research focusing on compassion training demonstrates that compassion prevents empathic distress even with short periods of intervention. This article addresses the differences between empathy and compassion, compassion training and plasticity, and the implications for practitioner health, including spirituality. Compassionate presence is proposed as a way of practicing social work that encompasses both our humanitarian roots and current research.