Nursing students have high levels of stress, anxiety, and depression which could develop into mental health problems. These challenges can be dealt with before they spin out of control with potentially serious consequences. The theme of World Mental Health Day on October 10 this year is “Young people and mental health in a changing world.” The aim is to make teenagers and young adults aware of how to look after their mental health as well as to help friends, family, and others learn how they can be supported.
Nursing students and mental health
Nursing students, like young people all over, are in a stage of life where they experience many transitions. This includes hormonal, physical and brain changes that go with growing into adulthood, peer pressures, high expectations, and leaving their familiar physical and social surroundings when going to into college or university.
On top of this, online technologies, including social media, can bring pressures that were unknown to previous generations. Posts by their friends can make young people feel that others are having so much more fun than they are, and then there are also cyberbullying and cybercrime.
While these changes are exciting, they can also cause stress and anxiety. When you become unable to cope with the challenges life throws at you it can lead to mental distress that could eventually develop into a mental health problem, followed by a serious mental disorder or illness, and even suicide.
The World Health Organization reports that half of the mental health problems begin at around 14 years of age and that this mostly goes unrecognized and untreated. The signs are often written off as part of growing up. Suicide is the second leading cause of death in 15-29-year-olds.
Nursing courses are particularly stressful. Besides the though coursework, the clinical placements add extra hours as well as recognized psychological demands.
A systematic review of and meta-analysis of 27 research studies from across the world reported that around 34% of nursing students showed signs of depression. Younger and Asian students were particularly affected.
34% of nursing students showed signs of depression
Another study on undergraduate nursing students found significant relationships between depression and anxiety, depression and stress and anxiety and stress. The authors pointed out that “this finding is alarming in terms of increased risk for psychiatric morbidity” and emphasized the need for teaching nursing students how to manage stress.
Mental resilience is widely recognized as the reason why some people cope better with challenges than others. Mental resilience can be developed from an early age to help prevent mental illness in adolescents and young adults.
Mental resilience means to have the personal ability to overcome the challenges that life brings – to bounce back when things go wrong. Developing resilience is a natural part of human growth, and it continues throughout life. When one actively engages with the circumstances that life presents, you build new skills that you can then apply to future situations.
Keys to mental health and resilience
- Engage with and take action in distressing circumstances. Few crises can’t be overcome. Allow yourself to feel the strong emotions at first, but then actively and creatively look for solutions to problems, as opposed to ignoring and detaching from difficult situations.
- Build and maintain strong connections with other people. Be willing to approach those who care about you when you need help or just a listening ear.
- Don’t let daunting tasks to get you down. Break them down into smaller steps that you can take every day and will move you towards your goal – the sense of achievement will keep your spirits up and reduce stress and anxiety.
- Nourish a positive attitude towards yourself and life. Focus on your strong points and trust in your abilities. Maintain optimism by visualizing and believing in what you want rather than worrying about what might happen. There are tools and tips on how to do this in any of a number of self-help books and websites.
- Get enough sleep. Most of us have experienced that we tend to feel more stressed out and emotional when we are tired.
- Adopt those lifestyle activities that keep you physically, mentally, emotionally and spiritually healthy.
- A healthy diet to provide all the nutrients our body and brain need for optimal well-being
- Physical activity which strengthens the mind as much as the body
- Relaxation which should include socializing, hobbies, and spiritual practices such as keeping a journal, meditation or prayer.
Depression and how to deal with it
At times life’s challenges may overwhelm a person’s usual coping mechanisms and this can evolve into a mental health problem, usually depression.
Mild depression may not need professional medical and psychological intervention. Guidance, support, and care provided by family, friends, teachers, and counselors at educational institutions or churches may be all that is needed. When depression becomes severe, there could pose a serious risk of suicide, and the person should be encouraged to seek professional help.
Signs of depression
- Losing interest in normal activities. Withdrawing from friends, sports, and social activities that the person used to enjoy.
- Sadness, irritability, anxiety and/or easily angered
- Expressing feelings of worthlessness and hopelessness. This can be accompanied by extreme sensitivity to criticism, especially in overachievers.
- Unable to sleep or wanting to sleep all the time
- No longer paying attention to personal hygiene and appearance
- Changes in school performance, complaining that unable to concentrate. The person may even stop attending classes.
- Changes in eating patterns – either not eating or wanting to eat all the time
- Often complaining of headaches, stomach aches, and tiredness.
- Increased use of alcohol and drugs
Signs that someone is contemplating suicide
The following signs could be red flags that should be taken seriously.
- Talking about wanting to die or killing themselves
- Talking about being worthless, being a burden to others
- Expressing feelings of hopelessness and having no reason to live
- Talking about feeling trapped and there being no solutions to their problems
- Obsession with death – in pictures, music, or talking about it all the time
- Searching online about ways to commit suicide
- Giving away possessions that were important to them
What you can do
As a student nurse and peer, you could be the right person to recognize and intervene when a fellow student is depressed.
- Connect with the person and help them to talk about their feelings. Let them know that they are not alone.
- The person might become isolated from the student group because they are withdrawing from usual activities and social interaction, as well as becoming negative. Keep encouraging her/him to join in group activities or even to just go for a walk.
- Bullying is often an underlying cause of depression. You can intervene if you find that the person is being bullied by other fellow-students.
- If the person is severely depressed and the signs and symptoms have persisted for more than two or three weeks or are getting worse, encourage him/her to seek professional help.
- You can ask the person straight out if she/he is contemplating suicide. If so, ensure professional help – even offer to go along. You could also discuss the problem with a course leader, school counselor or educator.
If you have recognized that you are depressed, use the above points as guidelines – find someone you trust to discuss your problems and feelings with, join in activities you used to enjoy even if you don’t feel like it, eat regular healthy meals and get enough sleep, exercise to boost your mood, avoid masking your feelings with alcohol and drugs. Get professional help – you do not have to deal with your problems alone.
Support one another
Studying to become a nurse can be a very stressful period, and this is one of the reasons why there is a high drop-out rate among student nurses. There are ways in which to build resilience and maintain mental health. There is also help available when things become too much. We should all extend the same support and care to each other than what we give to our patients.
You get more in-depth information on young people and mental health in the booklet published by the World Federation of Mental Health for the 2018 World Mental Health Day.