Effectiveness of a Brief Nursing Advice in Promoting the Psychological Well-Being for University Students With Mild to Moderate Depressive Symptoms: A Randomized Controlled Trial

University Students with Mild to Moderate Depressive symptoms University students experience a range of unique psychosocial stressors that increase their risk of major depression that are substantially higher than those found in the general population (Nahla, et.al., 2013). The prevalence rates of moderate to extremely severe depression symptom was 69.5% in Bangladesh (Islam, et.al., 2020), and 57.6% of the students suffered from moderate to extremely severe depression symptom among final-year medical students in India (Kumar, et.al.,2019), and a study showed that the prevalence of depression is particularly high among Australian university students (Farrer, et. al.,2016).

A report from the CHP in Hong Kong showed that the prevalence of mild to moderate, and severe depressive symptoms in adolescents and children were 51.1%, and 4.2% respectively in 2012 (CHP, 2020). However, a cross-sectional study of Hong Kong showed that a high proportion of the university students displayed depressive symptoms with 68.5% of them presented mild and moderate depressive symptoms, and 9% presented moderately severe to severe depressive symptoms (Lun, et. al., 2018). The result was higher than a similar survey (20.9%) conducted by the University of Hong Kong 10 years ago (Wong, et. al., 2006). Although almost 3 in every 5 undergraduate students (59.5%) in Hong Kong are likely to experience mild to moderate depressive symptoms, inadequate attention has been given in primary health care.

Health impact with Mild to Moderate Depressive symptoms Mild depression usually affects our daily activities and causes detectable symptoms in university students, and it is common but often remain unrecognized and treated inadequately (Klein, et. al., 2016). If the investigator can accurately diagnose depression when it is mild, and treating it effectively at this stage that can prevent the condition from worsening to become moderate or severe. The majority of suicide cases are linked with mental disorders, and most of them are triggered by severe depression. Suicide was the second leading cause of death among 15-29 year olds globally in 2015 (WHO, 2017). In Hong Kong, the number of suicides in the age-group 15 to 24 years increased in subsequent years from 54 in 2014, to 68 in 2015 and 75 in 2016 (DH, 2018).

Insufficient student mental health services within the University Campus In Hong Kong, only 3 out of 8 universities providing health services on campus. At the beginning of school term, students will be arranged to fill the mental wellness questionnaire from Office of Student Affairs, and they will be referred to see counselors or consult the doctor in school clinic if necessary. Only one university provides in-house psychiatric service, the student will be referred to In-house psychiatric service by OPD doctors. Other universities may refer to outside psychiatric service, with a long waiting queue for more than 6 months in Hospital Authority, or to receive private psychiatrist subsidized by university itself. For the current psychiatric service in one of the universities in Hong Kong, there is a total of 803 attendances (148 students) in 2018/19, with 5.4 visits per student, 79 of students have depression (53%), 55 students who had suicidal idea, plan or act (37%). A considerable increase in the demand for psychiatric services followed by an increase number of university students reported depressive symptoms (64 students in 2017-18 vs 79 students in 2018-19), consequently increased the waiting time for the consultation. Apart from the existing psychiatric consultation for those who presented severe depressive symptoms, there is an imperative need to develop and evaluate effective prevention strategies to help those university students with mild to moderate depressive symptoms.

Brief nursing advice for University Students with Mild to Moderate Depressive symptoms Evidence shows that a brief nursing advice is more feasible and cost-effective (Vijay, G.C.,et. al., 2015), and all very brief interventions for physical activity were acceptable and low cost. (Pears et. Al., 2015). It can increase physical activity in the short term when compared with usual care or more intensive interventions. Comparing to other interventions, such as cognitive behaviour therapy, which probably takes many weeks to implement but with only short-term effect in reducing depression (Stallman, et al.,2016). All nursing staff are well trained to provide a brief advice on mental health and thus no extra training is required. The intervention is suggested to deliver in a single session of no more than 5 min, that could be delivered in health checks or similar consultations (Vijay, G.C.,et. al., 2015). Students can receive brief nursing advice at the clinic.