Abstract

Objective: To explore the current status of depression among nursing senior students under public health emergencies and to analyze its relationship with self-efficacy and hope. Methods: A cross-sectional study of 210 nursing vocational college students from a vocational college in Sichuan Province were selected by convenience sampling method in January 2023, and investigated with General demographic information, Self-rating depression scale, General self-efficacy scale, and hope scale. Results: The scores of depression, general self-efficacy and hope were (41.96 ± 10.05), (23.84 ± 5.92) and (21.18 ± 4.46), respectively; Correlation analysis showed that depression was negatively correlated with self-efficacy (r=-0.617, P<0.01), and depression was negatively correlated with hope (r=-0.612, P<0.01). The results of the multiple linear regression analysis showed that the three variables of self-efficacy, willingness motivation dimension, and path dimension entered the regression equation and together explained 43.70% of the total variance. Conclusion: Nursing vocational college students have mild depression under public emergencies, and their psychological problems should be paid attention to. Therefore, higher vocational colleges should take targeted measures to enhance their self-efficacy and hope, so as to reduce their depression.

1. Introduction

The COVID-19 epidemic in 2020 has brought a huge impact on the physical and mental health of individuals as a public health emergency, and as a special group of college students, a very high proportion of higher education nursing girls, who are in their adolescent years and not yet mature in physical and mental development, are more vulnerable to shock and negative emotions under public emergencies ¹. And some studies have shown that negative emotions may cause expressive states or aggravate the level of depression in individuals ². Self-efficacy can play its role by influencing the cognitive, emotional, and choice processes of individuals, which determine the choice of behavior, the effort and persistence of that behavior, and the attitude to cope with difficulties ³. And the sense of hope it is one of the four elements that constitute the positive psychological capital ⁴, from the emotional perspective, it is the one that allows the individual to maintain a good state and thus have the ability to mobilize psychological energy to overcome the negative emotions generated by the organism ⁵. Therefore, this study investigated the current state of depression among nursing senior students and explored the effects of self-efficacy and hope on depressive symptoms under an unexpected public health event in order to propose a new theoretical basis and a new perspective for psychological counseling of nursing senior students.

2. Methods

A cross-sectional survey was conducted in January 2023, and a convenience sampling method was used to select nursing higher vocational students from a higher vocational college in Sichuan Province as the research object. The study received ethical approval from the Ethics Committee of Dali University (NO.0163/2022), following the principle of voluntariness, the investigated subjects could withdraw or refuse this study at any time, and the investigators promised the investigated subjects that the information obtained would be kept strictly confidential for research use only.

A convenience sampling method was used to select nursing senior students from a higher education institution in Sichuan Province in January 2023 as the study population. Inclusion criteria: nursing students enrolled in school; informed consent and voluntary participation in this study. Exclusion criteria: not enrolled in school during the survey period, such as suspension or leave of absence. The sample was estimated based on 10-20 times the number of independent variables of the research instrument ⁶, and there were 11 independent variables in this study, and considering the possibility of 20% invalid questionnaires, about 132-264 were needed; 210 nursing students were actually included in this study.

3. Measures

Designed by the researcher, the questionnaire contained seven items, including gender, grade, only child, family’s area, class leader, divorced parents, and family status.

The Chinese version of the Depression Self-Rating Inventory has 20 items ⁷. The scale has 20 entries, 10 of which are scored positively and 10 of which are scored negatively. The scale was a Likert 4-point scale, with higher scores indicating a more severe depression index. The Cronbach’s alpha coefficient for this study was 0.870.

The Chinese version of the self-efficacy scale has 10 items ⁸. The scale was a 4-point Likert scale. The higher the total score, the higher the self-efficacy. The Cronbach’s alpha coefficient for this study was 0.903.

The Chinese version of hope Scale has 12-item scale, including 2 dimensions (willingness motivation, path) with 8 questions, and the remaining 4 questions are interfering items not counted in the total score ⁹. The scale was a Likert 4-point scale, with higher scores indicating higher levels of hopefulness. The Cronbach’s alpha coefficient for this study was 0.887.

The online data was collected by two researchers. By contacting with higher vocational colleges and the head teachers of nursing major in this school, the purpose and significance of this study were informed and the two-dimensional code of electronic questionnaire was issued after consent was obtained. A total of 221 questionnaires were returned for this study, and after eliminating invalid questionnaires such as missing and consistent answers, 210 questionnaires were finally returned, with an effective rate of 95.0%.

This study used SPSS 25.0 for statistical analysis of the data, in which the count data were described by n (%) and the normally distributed measures were expressed by Mean±SD, using t-test, and ANOVA. Pearson correlation analysis was used to explore the relationship between depressive symptoms and feelings of self-efficacy and hope. Multiple linear regression was used to analyze the factors influencing depressive symptoms among nursing students. Statistical significance was found at P < 0.05.

4. Results

All above 210 nursing seniors, 39 (18.57%) were male and 171 (81.43%) were female, with an age of (16.24 ± 0.82) years. Depression score was (41.96±10.05) with a mean entry score of (2.58±0.45), self-efficacy score was (23.83±5.92) with a mean entry score of (2.38±0.59), and hope score was (21.18±4.46) with a mean entry score of (2.65±0.56).

There were no statistically significant differences in depression scores by gender, being an only child, family location, being a class officer, and family economic status (P > 0.05); there were statistically significant differences in depression scores by grade level and parental marital status (P < 0.05). As detailed in Table 1.

Pearson correlation analysis showed that depression scores were negatively correlated with self-efficacy and hope scores on all dimensions (P<0.01), As detailed in Table 2.

Multiple linear regression was conducted with depression as the dependent variable and the 2 dimensions of general demographic data of depression with statistically significant items, self-efficacy and hope as independent variables, and the specific assignments are shown in Table 3. multiple linear regression analysis showed that the variables grade and whether the parents were divorced were not statistically significant and were excluded from the equation. The variables statistically significant self-efficacy, willingness motivation, and path were included in the regression equation, explaining 43.7% of the total variance. The regression equation: Y=3.375-0.278×Χ₁-0.210×Χ₂-0.064×Χ₃, see Table 4.

5. Discussion

In this study, the depression symptom score of nursing students was ( 41.96 ± 10.05 ) points, and the depression severity index ( total score / 80 ) showed a mild depression state, which was higher than the norm in China ( 41.88 ± 10.57 ) points. The reasons may be as follows. First, from the perspective of psychological stress-response, the rare long-term COVID-19 epidemic can be regarded as a huge source of stress. Due to its high transmission and serious consequences in many aspects, nursing students have a higher degree of risk perception ¹⁰. High-risk perception often causes individual cognitive and emotional problems, induces non-adaptive behavior, produces uncertainty about their selected profession, academic burnout, and depression ¹¹. Second, during the possible investigation period, due to the implementation of the new policy of epidemic prevention and control in China, public hospitals have ushered in a surge in the number of patients, and the medical system is under tremendous pressure. In the face of this situation, nursing students who are about to become medical workers often have negative emotions such as anxiety and depression. In this study, there was a statistically significant difference in depressive symptoms between the two demographic variables of grade and whether the parents were divorced (P < 0.05). The reasons may be: (1) The higher the grade, the higher the depression, which is consistent with the results of a Chinese study ¹². Grade 1 students just entered the campus, but also not familiar with the nursing profession, just a hot blood, and with the expansion of colleges and universities, nursing higher vocational students are slightly weaker than the students entering the undergraduate stage of learning. The autonomous ability may still be in a state of pleasure and playfulness, while grade 2 students may have a deeper understanding of the nursing profession through theoretical learning. Coupled with the unknown anxiety of clinical practice, it is more likely to produce negative emotions, depression and so on. (2) Nursing students with divorced parents are more prone to depression, which may be due to the misfortune of parents’ marriage in the family, leaving them in an atmosphere of long-term parent-child relationship disharmony.

The correlation analysis of this study showed that depressive symptoms were negatively correlated with self-efficacy, hope and its dimensions. This is similar to the results of a study in China ¹³, indicating that the higher the depression, the lower the self-efficacy. Self-efficacy refers to the individual’s judgment on whether he can succeed in something, which can affect the individual’s emotional thinking ¹⁴. The nursing growth period is in a negative depression, which will reduce self-efficacy in the long run. When facing difficulties, it will produce timid withdrawal behavior. Therefore, educators should correctly guide students to have a good state of mind and emotions, especially in the period of public health emergencies, to cultivate students to form a good sense of self-efficacy, in the future when encountering career risks and difficulties, can face these challenges and pressures with a positive state of mind and emotions. In this study, the stronger the sense of hope, the lower the depression, which is consistent with the results of a Chinese study ¹⁵. The sense of hope is an emotional experience that allows people to maintain a good state, a sense of happiness and meaning in life, and the ability to mobilize psychological energy to overcome difficulties and avoid falling into despair due to excessive mental fatigue ¹⁶.This shows that nursing students with a stronger sense of hope have higher confidence to cope with difficulties and maintain an optimistic and positive attitude to achieve their goals. Therefore, in the face of the long-term public health event of the COVID-19 epidemic, educators should strengthen the spiritual energy of nursing students, enhance their confidence, increase their sense of hope, and help them establish a sense of overcoming difficulties and obstacles. At the same time, strengthen the positive emotions of self-affirmation, and then gradually eliminate the negative emotions such as depression of nursing students.

According to multiple linear regression analysis, the ‘willingness motivation’ dimension of self-efficacy and hope has a large weight in the whole equation, and both are the reducing factors in the equation. The reasons may be as follows: First of all, self-efficacy, as a concept in positive psychology, plays an important role in the self-regulation system and can affect individual thinking, choice and motivation ¹⁷. Nursing students with high self-efficacy will process emotional cognition in time when they encounter negative things or worrying problems, so as to buffer negative emotions, produce positive experiences and adjust their depressed mood, thus reducing the level of depression. Secondly, the “will power” of the sense of hope is the individual’s ability to initiate, act, adhere to and strive to achieve valuable goals, that is, the motivation to pursue goals and achieve goals ^{18, 19}. It is based on a positive motivational state generated by their sense of internal ability. In the process of achieving the goal, it will prompt the individual to continuously evaluate their internal ability. In the process of evaluation, a positive emotion will be generated to help the individual actively find a path to achieve the goal and mobilize the spiritual energy to maintain the path until the ultimate goal is achieved ²⁰. Hope is the strongest force in the face of the future, and it is the motivation component in the cognitive process. Nursing vocational college students are in adolescence. When they are full of hope for the future, they can better face the future when pursuing their studies and careers, and then continuously enhance their self-happiness. Therefore, it is suggested that educators should consider the two important variables of self-efficacy and hope in positive emotions according to the results of multiple linear regression analysis and the weight of influencing factors. In the period of public health emergencies, we should understand more about the practical problems encountered by nursing students in their study and life and pay attention to their psychological feelings in time. As an important environment for the growth of nursing students, higher vocational colleges should adopt various ways to improve their self-efficacy and hope, so as to formulate achievable goals for students and encourage nursing students to overcome them.

6. Limitations

Due to the limitations of the sample size of this study, a large sample survey can be conducted in the future, and qualitative research methods can be added to enrich this study in order to obtain more perfect conclusions.

7. Conclusion

In summary, under the public health emergencies, the depression of nursing vocational students is relatively high, so it is particularly important to maintain the mental health status of nursing students. It is suggested that educators can reduce the negative emotional level of nursing students by creating a harmonious learning atmosphere, enhancing their confidence, enhancing their self-efficacy and enhancing their sense of hope.

Acknowledgements

The author would like to thank all the teachers in higher education institutions for their assistance. Also, we would like to thank all the students who participated in this study.

Funding

This study is supported by the Doctoral Research Start-up Fund of Dali University (No. : DFY20220302).

References