Final Master Thesis
Evaluation of the frequency and reasons of new
diagnosed trauma cases in association to seasons
among LSMU students
LSMU, Department of Environmental and Occupational
Medicine
Faculty of Medicine Author: Tariq Dafalla. Supervisor Prof. Ricardas Radisauskas. Lithuania, Kaunas, 2021
Contents
Abstract ... 3
Santrauka ... 4
Acknowledgments ... 5
Permission issued by the ethics committee ... 7
Abbreviations ... 8
Introduction ... 9
Aim and Objectives ... 11
Literature Review ... 12
Research methodology and methods ... 18
Results ... 20 Discussion of results ... 28 Conclusion ... 30 Practical recommendations ... 31 References ... 33 Annexes ... 36
Abstract
Author’sname:Tariq Dafalla
Title:
Evaluation of the frequency and reasons of new diagnosed trauma cases in association to seasons among LMS students
Aim:
To evaluate the frequency and reasons of new diagnosed trauma cases in association to seasons among LSMU students.
Objectives:
To investigate the frequency of newly diagnosed trauma cases by gender and faculties. To investigate the frequency of newly diagnosed trauma cases by seasons (in the winter and summer). To evaluate and compare the differences in the frequency of newly diagnosed trauma cases with associations to seasons
Methodology:
A cross-sectional study was conducted to evaluate the prevalence of mental and physical trauma among students of Lithuanian University of Health Science during in association to seasons. An online questionnaire was sent to 853 students, with a 10.7% response rate. Statistical analysis was determined by using SPSS version 27. Statistical significance level was set at P <0.05.
Results:
A number of 83.6% of the females answered they didn’t have any hospitalizations in winter compared to 48.4% of the males. The p-value of 0.001 shows that there is a significant correlation between gender and physical trauma cases. 39.3% of females answered fair and 19.7% answered poor, in contrast to the males where only 19.4% answered fair and 12.9% answered poor. The most popular category with both genders was the category of good. A majority of the respondents of both genders answered good and excellent in the summer. P- value was significant for subjective mental health 0.0016. A significant p-value of 0.004 was established in winter and a 0.0011 value was found in summer for substance abuse.
Conclusion:
Medical students were the most affected faculty and females demonstrated the most mental illness symptoms. A significance was found in in the relationship between trauma and seasons. Specific mechanisms of injuries such as Broken bones or dislocated joint, motor vehicle accidents and sports injuries were all higher in the summer. Slips/falls/trips were significantly higher in the winter.
Santrauka
Tyrimas atliekamas siekiant įvertinti naujai diagnozuotų traumų dažnumą ir sezonų priežastis tarp LSMU studentų.
Tikslai:
Ištirti naujai diagnozuotų traumų dažnį pagal lytį ir
dėstytojus. Ištirti naujai diagnozuotų traumų dažnį pagal sezonus
žiemą ir vasarą). Įvertinti ir palyginti naujai diagnozuotų traumų dažnumo skirtumus, susijusius su metų laikais.
fakultetus. Ištirti naujai diagnozuotų traumų atvejų dažnumą pagal sezonus
žiemą ir vasarą). Įvertinti ir palyginti naujai atsirandančių žmonių dažnio skirtumus diagnozuoti traumų atvejai, susiję su metų laikais
Išvados:
Medicinos studentai labiausiai nukentėjo nuo fakulteto, o moterims dažniausiai pasireiškė psichikos ligų simptomai. Vertinimas lemia traumų ir
metų laikais. Konkretūs traumų mechanizmai, pavyzdžiui, kaulų lūžiai ar sąnario išnirimas, motoriniai transporto priemonių avarijos ir sporto traumos buvo dažnesnės vasarą. Buvo paslydimų / kritimų / suklupimų
Acknowledgments
Thanks to the support of my supervisor Prof. Ricardas Radisauskas Thanks to the support of my dear colleague Ahmad A.D
Thanks to the support of my loving family
Conflict of interest
Permission issued by the ethics committee
For this research, approval was required to obtain research data from the student participants by the Bioethics Committee of Lithuanian University of Health Sciences. Approval was granted with reference number BEC-MF-312 which was issued on the 23rd of March. This was necessary as the study would involve some confidential data, and it would ensure that there is no chance that the data of the participants who are students battling with past or present disturbances in their life would leak. This was necessary since some of this data is medical and would cause traumatic anguish if it were to be revealed. Therefore, following the guidelines, the researchers opted to ensure the confidentiality and anonymity of their participants by omitting the names, email addresses and telephone numbers of the participants.
Abbreviations
1. LUHS- Lithuanian University of health and Sciences 2. PTSD- Post traumatic stress disorder
3. GHQ- General health questionnaire 4. ISS- Injury severity score
5. GDS- General depression scale 6. SAD- Seasonal affective disorder 7. NHS- National health service 8. SD- Standard deviation
Introduction
In this article Trauma will be split into two types, Mental trauma referring to mental disorders and its accompanying symptoms. Physical trauma describing the injury caused by an object or an individual. According to the world health organization, there are many people living with trauma, and these numbers have been rising over the years. This disorder is not discriminative, and it can therefore affect people of any age, gender, or race in the world [1]. Many events in a person's life can lead to a psychological disorder, including; abuse of power, helplessness in life, war, natural disaster, loss and personal assault which may alter a person's experiences. This refers to a disorder called PTSD. People who experience trauma, display symptoms that vary from person to person. [2] Some of the symptoms exhibited by victims include; sadness, anger, fear, denial, and shame. The traumatizing experiences they have may lead to; nightmares, emotional outbursts, difficulty socializing, and insomnia. Since this is a national institution with students from all over the world, they meet varying life experiences and perspectives. Therefore, some might have had some traumatic events as they were growing up while others might get it from the challenges that they are facing today even in the University, for example, the stress that occurs from extensive reading, since medical courses in this University are very demanding. [21] There has been an increase in the number of people being diagnosed with trauma cases. This research has used this institution as the subject of study since it is one of the country's largest health sciences institutions, offering an abundance of information on such diagnosed illnesses. The students in this faculty have most recently been diagnosed with trauma cases. This is mainly attributed to the traumatic psychological stress that they have been subjected to by their studies. It has also been associated with a psychiatric disorder called a post-traumatic stress disorder, which has also been a growing issue among these students. This research, therefore, aims to identify the increasing trauma cases among these students and devise ways of handling and managing them. According to the World Health organization, unmanaged Trauma has been one of the recently studied causes of death among young adults, who often die due to suicide. Surprisingly, physical trauma has seemed to also have a variation due to weather whereby according to scientists, trauma cases are higher in the summer than in any other season. [40] The primary objective of this study is to investigate the increasing number of trauma cases and how they relate to other aspects within the University. These aspects include the gender of the students, their faculties, the seasons in which the highest number of cases are and why this was so.
For this study, different methods will be used to determine the objectives of the research and the reasons for the occurrence of trauma cases in this medical institution. The study opted to collect data using online surveys. The data collected from this survey was analyzed efficiently to provide insights into the study objectives. This would facilitate recommendations and solutions on reducing the cases arising within the University, provide
plans to effectively offer solutions to students already suffering from this psychological issue, and inform requisite treatment options to the victims. The medical model of dealing with mental problems indicates that Trauma is treatable depending on the extremism of the cases. Several types of cognitive therapies are used in its treatment, including; medication and forms of self-care like cognitive behavior therapies and somatic therapies. It is factual that many people, including some students at the University of Health Sciences, have experienced a traumatic event in their lives, resulting in shock and distress. While many of them may recover within a short period, others tend to suffer from long-term traumatic grief. However, if these traumatic cases are well handled and managed, the quality of life of these people may be improved. For these students, this would be great since they can now focus on their studies appropriately.
Aim and Objectives
The primary purpose of this study is to evaluate the increased frequency of trauma cases among the students of Lithuania in association to seasons.
The objectives of this study are as outlined below:
1. To investigate the frequency of newly diagnosed trauma cases by gender and faculties.
2. To investigate the frequency of newly diagnosed trauma cases by seasons (in the winter and summer)
3. To evaluate and compare the differences in the frequency of newly diagnosed trauma cases with associations to seasons.
Literature Review
Previous studies have shown that trauma among people is usually affected by factors like seasonal changes characterized by different temperature levels. Research done by Hess et al. in 2018 has shown the prevalence of orthopedic trauma cases in the summer. [12] Little evidence is shown on the relationship between mental disorders and seasonal variation. Although a study by Ron de Graff 2005 showed an increased prevalence in the winter for these mental disorders in students in the Netherlands. [41] Data suggests that there has been an increased frequency in the number of trauma cases among the students of health sciences in the Lithuanian University.
Prevalence of Trauma among medical students
Pedrelli et al., 2015 indicate that attending college is very stressful for students. [26] This is due to several factors, including academic pressure, coping with an increased level of responsibility, separation from familiar settings and immediate families, and the challenge of juggling work-study life balance. Students from high dependent families have an added strain of concentrating on studies while worrying about family situations; this can be very draining and psychologically traumatic. The research indicates that students experience heightened traumatic symptoms when they get into college. Taking on increased adult responsibilities without having the requisite skills and cognitive maturity of adulthood is another cause of trauma among students. This is further complicated by the presence of a new rush of freedom, peer pressure, social identity and the desire to impress new colleagues and persons of attraction. [42] It is during college years that most students experiment with drugs, alcohol and other vices. Often substance use, familial pressure, academic pressure, and emotional heartbreaks from intimate relationships usually experienced by young adults while in college further escalate the student’s prevalence of Trauma.
King et al., 2017 indicate that even when anonymity is guaranteed, medical students exhibit a certain reluctance to disclose any abusive experiences compared to other groups of people. [16] This is informed by the perception that such disclosures will impede their career progression. Studies indicate that medical students who receive mental health support and care do better than those who don't receive such support.
According to Tian-Ci Quek T et al., 2019 while medical schools globally are geared towards producing highly efficient and trained medical professionals who are motivated to help patients, the time and emotional commitment required to excel in medical education are very high thus increasing the chances of medical students suffering psychological pressure, anxiety, and depression. [36] There is a high prevalence of impaired goal-directed attention and concentration and reduced working memory among medical students, thereby hampering their ability to excel in their studies. Anxiety causes various physiological symptoms, including; dizziness, headaches, nausea, abdominal pain, and fatigue. Substance abuse, low academic performance, deservedness, difficulty in socializing, sleep disturbance, poor academic performance, and a negative effect on cognitive functioning and learning have been noted in medical students globally, most likely occasioned by the emotional and intellectual pressure faced by medical students. Environmental and conditioning factors are the most significant contributors to Trauma among students leading to mental and physical health
Behavior
Feelings
Thoughts
challenges. Globally, medical students report the highest levels of stress compared to students in other professions and Tian-Ci Quek study showed a 33.8% prevalence of anxiety among medical students. It is informative that the learning environment, childhood factors, and the demanding nature of medical science cause medical students to exhibit the highest Trauma and related outcomes. Studies on the correlation of physical trauma and medical students have not been carried out.
Subgroup analyses of the prevalence of anxiety in medical students, Tian-Ci Quek T et al., 2019 [38]
Causes of Trauma among Youths
According to Kinker et al., most mental health disorders peak during the onset of young adulthood. Medical health studies are very demanding, and the stress exerted on the students is likely to be traumatic. [17] Studies indicate that childhood trauma causes victims to experience higher rates of depression, suicide, difficulty in socializing, self-harm, anxiety, depression, suicide, and drug and alcohol abuse. People who have experienced any form of abuse and Trauma during their formative years have a higher likelihood of developing heightened stress responses, thus negatively impacting the ability to control emotions objectively. This may lead to insomnia, sleep deprivation and mental distress during adulthood. This post traumatic disorder can be channeled through an individual early on in life through their thoughts and later developing into a feeling, which later builds up to a behavior. At this stage, the behavior creeps in as Trauma, as illustrated in the figure below;
Anxiety attacks are the most prevalent mental disorders among students. If not well managed, it can lead to a secondary type of Trauma. Kinker et al.'s research indicates a strong relationship between high prevalence rates of psychological Trauma and medical students. The emotional change on the students' social life has been well discussed in Lithuania by Kvedaraite et al., which has established the social anxiety among many young students of Lithuania. [18] Depression, anxiety, and low self-esteem are some of the underlying conditions that a person with trauma may develop and are likely to interfere with an individual's social well-being.
According to King et al., 2017 medical students report higher mental health difficulties than other groups of students and the general population. This is characterized by depression and anxiety among medical students. The study indicates that the prevalence rates of anxiety and depression among medical students are higher than in other groups of students and the general population. This necessitates a need to offer increased attention to the mental health of medical students while offering them more improved support services than is what
is currently available in most learning institutions. A significant causal factor of mental health issues among medical students is childhood trauma. Childhood trauma is attributed to a higher chance of subsequently developing mental health difficulties in adult life, including the late teenage years. Thus students who have experienced any form of childhood trauma have a higher chance of experiencing Trauma and mental health issues during their course of study. Yehuda et al., 2001 indicate that childhood life events, childhood trauma are highly attributed to the prevalence of anxiety, depression, and depressive disorders in adulthood. [37] Childhood trauma is usually defined as emotionally painful or distressful experiences to children, generally resulting in long-term mental and physical impacts. Childhood trauma is occasioned by disruptive and emotionally scarring early life events like parents' divorce, being placed in foster care, emotional neglect, psychological, physical or sexual abuse and early parental loss before 16. When these children who have experienced Trauma become Adults, they will most likely exhibit high levels of anger, unresponsiveness, anxiety, panic attacks, depression, and emotional outbursts. [34]
It has been demonstrated that poor sleep quality, low energy levels, stress, and concentration constraints are more prevalent among youthful people at an active age in the summer. According to Tian-Ci Quek T et al., 2019 anxiety, although common and debilitating as depression, gets less attention, often goes undetected, and undertreated in the general population. Anxiety is a highly prevalent condition among medical students. This is the most prevelant condition or symptom of the traumatized student most suffer from. According to Ali et al., most of the students who do not get their trauma treatment and care are more susceptible to emotional change and depression. [3]
Presbitero 2016 recommends help-seeking behavior to be incorporated by the medical students since it was found lacking as the students often perceived this as a weakness. It is also indicated that there is a need for programs that help students manage and battle mental disorder. Malinauskine and Malinauskas also share various experiences that the Lithuanian University of health sciences students experience in life. While students carry the burden of experiencing trauma symptoms, they are still demanded to carry out their core tasks of learning their very demanding studies. [21]
Gender on Trauma Cases
Shimonov 2018 has also shown the significant causes of Trauma among university students. According to Shimonov 2018, the students may have already undergone some traumatizing experiences even before they came to the University. [31]
The author further adds that females is likely to develop Trauma since they are more exposed to traumatic experiences like assault and sexual harassment. Shimonov 2018 exposes the prevalent mental health conditions among students in the Lithuanian University of Health Sciences in his/her research to investigate the various traumatic symptoms like severe headache, depression, anxiety among these students.
Prevalence rates of childhood trauma in medical students
Hess et al. 2018 show that students who have experienced orthopedic Trauma are significantly influenced by seasons and weather. Orthopedic Trauma is obtained by patients who mainly have had fractures or broken bones due to various injuries or accidents. Sar et al., 2019 say that the extent of traumatization among these students depends on the fractures'
severity and if this happens in the winter months. [29] Trauma is expected to increase, then when these happened in summer, according to their research. Some may have been hospitalized due to injuries, accidents, assault, and later developed Trauma, which often affected them. He refers to this condition as hospitalization anxiety and tends to prove its prevalence among the medical students at the University. Duncker et al. 2019 also demonstrate that childhood traumatic experiences among the students have affected them later in life. They could be blamed for the increased frequencies in the number of trauma cases. [8]
Females tend to be subjected to more traumatic experiences at a very tender age compared to males. Instances of rape, assault, and experiences of domestic violence are the leading causes of childhood trauma, as stipulated in their work. Paquette et al., 2019 show the distinctive differences in the prevalence of trauma cases among males and females. [25] By what they have, it is observed that the female gender is more obsessed or is frequently involved in traumatic experiences at different points of life than their male counterparts. He also shows that the people who had traumatic life experiences at a very tender age are often depressed later in life and could quickly develop chronic Trauma if their condition is not well monitored.
Connection of Trauma to Different Seasons
Pape-Köhler et al. 2014 establish the connection between Trauma and seasons. Their research shows the relationship that Trauma has to other external factors, like; time, date, season, and moon, but since our primary focus is the seasons, we, therefore, ignore the insignificant factors; their research shows that it is true that the summer is involved with many traumatic experiences, not only for students but also among other people. [24] This is also determined in Jeffry Nahmias article 2017 where the incidence of trauma was much higher in the summer peaking in July. The below graph illustrates a seasonal representation of trauma admission by victims within a calendar year. [40]
Fig.2.
Trauma symptoms occur, resurface or get worse during particular times of the year. The summer season has been attributed to the increased number of traumatic cases within the University. This is probably due to the brain remembering or being triggered by various causal factors appearing similar during those particular periods of the year. Hjordt et al., 2017 indicate that the summer season is usually spent at home or in familiar surroundings. [14] Thus, they may be acting the trigger or remembering past traumatic experiences hence may heighten traumatic symptoms. This may be remembering the loss of family members, past abuses by caregivers, parents, or teachers. While summer is associated with the high occurrence of trauma symptoms, it may pose a potential gateway towards long-term healing for recurring trauma symptoms. Therapy, groups, and counseling can be beneficial for the victim to face the prevailing triggers of trauma symptoms. While it indicates a period of relapsing in the healing journey, this period might inform the therapist on the real issues that may have slipped the victim's mind in previous therapy sessions. Hess et al., 2018 say that among PTSD patients, every single day poses significant challenges in the path towards recovery. An entire season can be highly challenging to the patients if the season contains many triggers of trauma symptoms. Patients, however, are thought healthy coping mechanisms to sustain their recovery journeys. The symptoms of PTSD that include; avoidant behaviors, hyper-arousal, and re-experiencing of the symptoms have a high correlation with certain seasons of the year. Since the weather impacts people's moods, chilly weather might cause mood dampening and induce trauma symptoms. Among veterans, summer and spring are correlated with higher reports of sleeplessness, irritability, and reduced concentration levels since most deployments occurred during this time.
During the summer, there has been a high prevalence of Trauma symptoms among students, as is shown in the study of Hess et al., 2018, who tries to establish the impact of summer in close relation to the increased volume of trauma cases. They also expose some of the ways that university students try to escape these trauma symptoms, mainly through drug abuse; this research has shown that alcohol is the most abused drug among these university students. Hjordt et al. 2017 further support the research that Trauma can be influenced by cognitive depressive disorders like Alzheimer's disease, behavioral variant frontotemporal dementia, and Lewy body dementia, therefore, affecting them to occur by the season in which one has obtained the Trauma. [14] This study is still trying to establish if there is a relationship
Seasonality In Trauma Admission
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
between the cognitive behavior deficits affected by Trauma and the season. He refers to the kinds of psychological traumas affected by seasons as Seasonal Affective disorder.
Studies indicate that most people are likely to change the mildness of their psychological conditions differently in summer and winter. Emotional change among these students, feeling of tiredness, lack of concentration, and willingness to do tasks are some of the behaviors that have been influenced by the seasons. Finally, Li Y et al. 2019 show the recommended teaching of Trauma in universities, which aims to show the importance of trauma treatment, the dangers of this psychological problem that has increased among university students in the past years. [19]
Most of the students get their kinds of Trauma worsening since it is usually not diagnosed and managed by medical practitioners. It ends up complicating the lives of the students. According to their research, they have established that many students lack knowledge on Trauma and do not often know how to handle it; therefore, they live with its symptoms, which tend to affect them in life and in their education, which is very demanding. Consequently, they recommend that students who study health sciences should be equipped with enough knowledge to help them if such cases are present among them. They then stress that this can only be achieved if such studies are incorporated in the education system and all the courses in health sciences schools.
Research methodology and methods
Surveying is one of the most suitable data collection methods used to collect data needed to fulfill the study's objectives. Surveying is the process that involves questioning a selected sample of individuals within a population so that some data is obtained. Surveys are of many types, including face-to-face interviews, telephone interviews, questionnaires, and electronic surveys that involve emails and websites. In this case, the most suitable form is the use of online surveys. This is because students are known for the extensive use of the internet, making it ideal for collecting data among the students. They can easily use the internet to fill out the questions administered to them online. This study has followed all the ethical guidelines set for research, such as ensuring that the anonymity of the data and the participants' privacy in the study is maintained. A batch link email was sent out to a total of 853 LUHS students on the 25th of March 2021. A total of 92 students filled out the questionnaire.
The Survey: Cross-sectional Google survey
The design of the questions to be used in this research incorporated the distinct characteristics of an excellent online survey. The study population is well-identified; this could be by using various sampling methods, such as random sampling, whereby students from multiple faculties within the Lithuanian University of health sciences are selected. The survey was compiled into three sections:
1: Questions related to the socio-demographic situation of the student. - Gender, age, faculty, locality
2: Mental health questions which were sampled from GHQ-12 (General health questionnaire), GDS (General Depression Scale), NHS mental health survey.
- Question related to their subjective mental health with options “excellent” “good” “fair” and “poor”
- 3 questions about Depression having options of “not at all” “several days” “more than half the days” and “nearly every day”
- 3 questions about Anxiety having options of “not at all” “several days” “more than half the days” and “nearly every day”
- Question related to substance/alcohol/smoking abuse
GHQ-12 is a quick and easy psychological distress measurement tool although widely speculated against on the use and efficacy, we determined that a modified version of this survey would be a reliable source of getting maximum responses and to avoid a long-winded monotonous survey. Certain questions were taken from the GDS and NHS mental survey which we believed to have the most impact and correlation to our study.
3: Questions related to the number previous hospitalizations and the causes of these traumas are investigated in another section so that the most dominant cause is established in the study.
Description of the survey instruments
Questions on the season in which they acquired these traumatic events and their extent are established to further research the most dominant one. A modified General Health Questionnaire and ISS (Injury Severity Score) was sampled. However, the name of these students is not included in the survey since privacy should be guaranteed to them. But other aspects like age and gender are included so that the gender with most frequent trauma cases is established. The Cross-sectional survey used appeared as shown in the attached file. The questions in the questionnaire included;
I. Whether they accepted the information that they would provide to be used for research
II. The participants, gender, age, and the faculty in the University were studying. III. Their country of residence and also if they lived alone or not,
IV. Their mental health assessment in the winter and also in the summer
V. Evaluation of their hygiene in the different seasons that is, summer and winter
VI. The variation of the interests in various activities that they carried out in both seasons VII. The seasons that they felt depressed and hopeless
VIII. The seasons when they felt drained and also had little energy for tasks or even restlessness
IX. Seasons when they lacked concentration in the studies they did X. The months and seasons when they were attacked by anxiety
XI. Their drug usage, like alcohol and smoking according to different seasons XII. Whether they were physically active
XIII. Whether they have suffered from traumatizing events that led them to be hospitalized and the number of times, this has happened in both seasons.
Statistical analysis
Data was collected from the survey and formed on to spreadsheet in Excel. This data was then converted into SPSS (Statistical Package for Social Sciences) for the usage of statistical graphs and tables including frequencies (%) and counts (N). Standard Pearson chi- square coefficient of 0.05 were used to determine statistical significance in the cohort. Question's responses were assigned points to find the sum of frequencies and to determine the mean values of the participants. For example, in the 3 questions for depressive symptoms the responses were categorized as 0= not at all, 1= several days, 2= more than half of the days and 3= nearly every day.
Results
1. Socio-demographic peculiarities of respondents
After the questionnaires were administered, the information from the participants was established. With this information, we were then able to analyze the data and examine the prevalence of occurrences. The information that we got from the online survey that the students conducted also helped answer or satisfy our research objectives. In this way, mainly the primary purpose of the research was achieved. The results of the socio-demographic study were as followed:
Table 1. Baseline characteristics of respondents
Category Frequency Percentage
Gender Male 31 33.7%
Female 61 66.3%
Age 18-24 53 57.6%
25-34 years 38 41.3%
35 years and above 1 1.1%
Faculty Faculty of medicine 69 64.1%
Odontology department 21 22.8% Veterinary department 8 8.7%
Other department 4 4.4%
Nationality International 89 97.8%
Local 2 2.2%
A total of 92 students were analyzed and the information they would provide could be used for the research. A total of 66.3% of the participants were female, whereas only 33.7% of the participants were male. The most common age group among this cohort were the students aged 18-24 and those aged 25-34 were the second largest group in the university deeming the majority of the students were young adults. Only two of the participants were above the stipulated age. After they included their faculties, it was noted that the faculty of medicine had the most significant number of participants for this research, standing at 69 students and the odontology department had the second largest number of students who participated in the study. They were 21 students from this department.
Other departments had fewer students, such as the veterinary department with eight students, the pharmacy department, with fewer participants. However, it was noted that most of the participants were international students who had come to Lithuania to study. They comprised a total of 88 international students.
2. Frequencies of psychological trauma among these LUHS students
2.1. Analysis of frequency of symptoms of mental illness
According to table 1. the mean number of the total sum of students that showed symptoms of Depression, Anxiety and Suicide were all higher in winter compared to summer. The standard deviation was marginally low for both winter and summer for all mental symptoms although the symptoms of depression and suicide in summer had a slightly lower SD.
Table 1. Frequency of Mental Disorder symptoms
Winter Depression Sum 7.39 3.908 92 Summer Depression Sum 4.87 3.892 92 Winter Anxiety Sum 7.47 3.912 92 Summer Anxiety Sum 6.88 4.076 92 Winter Suicide 2.38 2.449 92 Summer Suicide 1.91 1.850 92 Mean Std. Deviation N
2.2. Alcohol consumption in relation to seasons
A total of 30 responded that they don’t drink so a total of 62 people had options to say that alcohol consumption in either the summer or winter increased, decreased or didn’t change. The results in table 2 shows that 44% of students in winter and 26% of students in summer answered there was no change in their drinking habits. A significant 34.8% of students in summer responded that there was an increase in their alcohol consumption whereas only 9.8% answered an increase in winter. There was a quite low response for any decrease in drinking habits n both seasons.
Table 2. Frequency of Alcohol consumption
Alcohol consumption in Winter Alcohol consumption in Summer
Frequenc y Percent Valid Percent Frequenc y Percent Valid Percent Change Decrease s 12 13.0 13.0 Decrease s 6 6.5 6.5 I don't drink 30 32.6 32.6 I don't drink 30 32.6 32.6 Increases 9 9.8 9.8 Increases 32 34.8 34.8 No change 41 44.6 44.6 No change 24 26.1 26.1 Total 92 100.0 100.0 Total 92 100.0 100.0
3. Physical and Mental trauma case analysis and assessment by
sociodemographic factors and faculties.
3.1 Physical trauma in winter and summer in association with gender
The males and females in the university were asked questions on the number of hospitalizations. Unfortunately, 5 males refused to respond to the question. The study comprised of 61 females and 31 males. A number of 83.6% of the females answered they didn’t have any hospitalizations in winter compared to 48.4% of the males. Both genders had the same number of respondent's for having 1 trauma case. Although there was only one more response for the males having 2-5 trauma cases the percentages in their respective gender were overall higher in males. The p-value of 0.001 shows that there is a significant correlation between gender and physical trauma cases in the students shown in table 3 below. Table 4 also shows the frequency in summer. The response for the category no traumas was higher in the summer but answers for 2-5 category was higher in both genders. A significance was also found between genders and summer with a p-value of 0.002.
Table 3. Frequency of trauma in association with gender in the Winter
Frequency of physical trauma in winter Total
1 2 - 5 none Gender Female Count 0 8 2 51 61 % within Gender 0.0% 13.1% 3.3% 83.6% 100.0% Male Count 5 8 3 15 31 % within Gender 16.1% 25.8% 9.7% 48.4% 100.0% Total Count 5 16 5 66 92 % within Gender 5.4% 17.4% 5.4% 71.7% 100.0% P value 0.001
Table 4. Frequency of trauma in association with gender in the Summer
Frequency of physical trauma in summer Total
1 2 - 5 none Gender Female Count 0 5 4 52 61 % within Gender 0.0% 8.2% 6.6% 85.2% 100.0% Male Count 5 2 6 18 31 % within Gender 16.1% 6.5% 19.4% 58.1% 100.0% Total Count 5 7 10 70 92 % within Gender 5.4% 7.6% 10.9% 76.1% 100.0% P value 0.002
3.2. Subjective mental trauma in summer and winter in association with gender
The following results are based on the mental health of the students from a subjective point of view. Students were asked to assess their mental health in winter and summer from the four responses listed below. From the tables 5 and 6 we can see that their was a significance p value of 0.0016, on the other hand in table 3.4 there was no significance deeming winter to have a correlation with gender. 39.3% of females answered fair and 19.7% answered poor, in contrast to the males where only 19.4% answered fair and 12.9% answered poor. The most popular category with both genders was the category of good. A majority of the respondents of both genders answered good and excellent in the summer.
Table 5. Frequency of Subjective Mental Health in association with gender in the Winter
Subjective Mental health Winter
Total
Excellent Fair Good Poor
Gender Female Count 1 24 24 12 61 % within Gender 1.6% 39.3% 39.3% 19.7% 100.0% Male Count 5 6 16 4 31 % within Gender 16.1% 19.4% 51.6% 12.9% 100.0% Total Count 6 30 40 16 92 % within Gender 6.5% 32.6% 43.5% 17.4% 100.0% P-value 0.0016
Table 6. Frequency of Subjective Mental Health in association with gender in the Summer
Subjective Mental health Summer Total
Excellent Fair Good Poor
Gender Female Count 25 4 31 1 61
% within Gender 41.0% 6.6% 50.8% 1.6% 100.0% Male Count 18 3 9 1 31 % within Gender 58.1% 9.7% 29.0% 3.2% 100.0% Total Count 43 7 40 2 92 % within Gender 46.7% 7.6% 43.5% 2.2% 100.0% P-value 0.258
3.3. Mental trauma symptoms in association with gender
The frequency of symptoms of all mental disorders investigated in summer and winter are demonstrated below in table 7. There was no significance found in correlation between mental disorder symptoms and gender. As you can see the mean values of mental disorders in females in the winter were all higher than in males, although in summer they were all higher in males.
Table 7. Frequency of Mental Disorder symptoms in association with gender
Gender N Mean Std. Deviation Std. Error Mean p-value Winter Depressi on Male 31 6.58 3.731 0.670 0.157 Female 61 7.80 3.962 0.507 0.151 Summer Depressi on Male 31 4.97 4.498 0.808 0.864 Female 61 4.82 3.585 0.459 0.874 Winter Anxiety Male 31 7.39 4.112 0.739 0.889 Female 61 7.51 3.841 0.492 0.892 Summer Anxiety Male 31 7.55 4.456 0.800 0.265 Female 61 6.54 3.863 0.495 0.289 Winter Suicide Male 31 2.35 2.430 0.436 0.943 Female 61 2.39 2.478 0.317 0.943 Summer Suicide Male 31 2.42 2.500 0.449 0.061 Female 61 1.66 1.365 0.175 0.121
3.4. Seasonal variation of substance abuse in relation to gender
A grand total of 90.2% of females responded they don’t use any substances/drugs in winter, in contrast to males where only 58.1% responded likewise. Similar results were found in summer for question regarding usage. A significant p-value of 0.004 was established in winter and a 0.0011 value was found in summer. From the table below it was clear that males had a higher response rate in the three other categories which were an increase of usage, a decrease or no change at all in both seasons, except for a decrease in winter where both genders answered with two responses.
Table 8. Substance abuse in relation to gender in the winter
Substance/Drug use increased or decreased in Winter? Total Decre ases No usage Increases No change
Gender Female Count 0 55 2 4 61
% within Gender 0.0% 90.2% 3.3% 6.6% 100.0% Male Count 1 18 5 7 31 % within Gender 3.2% 58.1% 16.1% 22.6% 100.0% Total Count 1 73 7 11 92 % within Gender 1.1% 79.3% 7.6% 12.0% 100.0% P-value 0.004
Table 10. Substance abuse in relation to gender in the summer
Substance/Drug use increased or decreased in Summer? Total Refuse d to answe r Decreas es No usage Increas es No change
Gender Female Count 1 2 54 1 3 61
% within Gender 1.6% 3.3% 88.5% 1.6% 4.9% 100.0% Male Count 0 2 19 6 4 31 % within Gender 0.0% 6.5% 61.3% 19.4% 12.9% 100.0% Total Count 1 4 73 7 7 92 % within Gender 1.1% 4.3% 79.3% 7.6% 7.6% 100.0% P-value 0.0011
3.5. Seasonal variation of mental illness symptoms in relation to faculty among students
Table 11 below shows the relationship between the faculties and mental illness symptoms in the winter and summer. A significant p-value of 0.0012 in winter depressive symptoms and a respective 0.008 value was formulated in winter anxiety symptoms. There was no significance found in the summer symptoms. Medicine and Odontology faculty were the majority of respondents. The odonatological faculty had a higher mean in all respective mental illnesses in comparison to the medical faculty. Although veterinary department had the highest mean value in all responses, they also showed the highest standard deviation, making these conclusions being somewhat unreliable.
Table 11. Frequency of mental illness symptoms in relation to faculty
N Mean Std. Deviati on Std. Error 95% Confidence Interval for Mean
Minimu m Maxim um P-value Lower Bound Upper Bound Winter Depres sion Sum Medicin e 59 6.98 3.989 0.519 5.94 8.02 0 18 0.0012 Odontol ogy 21 7.24 2.719 0.593 6.00 8.48 4 16 Vet 8 11.50 4.243 1.500 7.95 15.05 8 18 Pharma cy 2 9.00 1.414 1.000 -3.71 21.71 8 10 Other 2 3.00 1.414 1.000 -9.71 15.71 2 4 Total 92 7.39 3.908 0.407 6.58 8.20 0 18 Summe r Depres sion Sum Medicin e 59 4.34 3.790 0.493 3.35 5.33 0 18 0.106 Odontol ogy 21 4.86 3.071 0.670 3.46 6.25 0 10 Vet 8 8.00 5.855 2.070 3.10 12.90 0 18 Pharma cy 2 5.00 1.414 1.000 -7.71 17.71 4 6 Other 2 8.00 0.000 0.000 8.00 8.00 8 8 Total 92 4.87 3.892 0.406 4.06 5.68 0 18 Winter Anxiety Sum Medicin e 59 6.51 3.535 0.460 5.59 7.43 1 16 0.008 Odontol ogy 21 8.43 3.682 0.803 6.75 10.10 3 17 Vet 8 11.38 5.097 1.802 7.11 15.64 7 22 Pharma cy 2 8.50 3.536 2.500 -23.27 40.27 6 11 Other 2 9.00 0.000 0.000 9.00 9.00 9 9 Total 92 7.47 3.912 0.408 6.66 8.28 1 22 Summe r Anxiety Sum Medicin e 59 6.29 3.815 0.497 5.29 7.28 1 15 0.112 Odontol ogy 21 7.24 3.404 0.743 5.69 8.79 1 14 Vet 8 10.25 6.628 2.343 4.71 15.79 3 22 Pharma cy 2 5.50 2.121 1.500 -13.56 24.56 4 7 Other 2 8.50 0.707 0.500 2.15 14.85 8 9 Total 92 6.88 4.076 0.425 6.04 7.72 1 22
4. Frequencies of physical trauma cases among LUHS students
4.1. Seasonal variation of physical trauma among students
From table 12 you can see the amount of trauma cases that occurred in winter and summer. Both seasons had high response rates for no hospitalizations with a total of 70 in summer and 66 in winter. The category for 1 trauma case was higher in winter than in summer with 17.4% of participants in winter and a mere 7.6% in summer. Summer had a larger number of responses in the 2-5 trauma cases with a total of 10.9% compared to only 5.4% in winter.
Table 12. Trauma cases in percentage form
FREQUENCY OF TRAUMA IN WINTER
Frequency Percent Valid % Cumulative % No respon 5 5.4 5.4 5.4 Trauma 1 16 17.4 17.4 22.8 2 - 5 5 5.4 5.4 28.3 none 66 71.7 71.7 100.0 Total 92 100.0 100.0
FREQUENCY OF TRAUMA IN SUMMER
Frequency Percent Valid % Cumilitive % Trauma No respon 5 5.4 5.4 5.4 1 7 7.6 7.6 13.0 2 - 5 10 10.9 10.9 23.9 none 70 76.1 76.1 100.0 Total 92 100.0 100.0
A cross-tabulation was formed to analyze the correlation between the summer and winter in regards to trauma cases. A significant p-value of 0.001 was determined showing a clear relationship between the seasons and the trauma cases.
Table 13. Trauma cases in cross-tabulation form
In Winter how many times have you suffered from any kind of injury which required hospitalization? In Summer how many times have you suffered from any kind of injury which required
hospitalization? Crosstabulation
Trauma cases in the summer Total no response 1 2 - 5 none Trauma cases in winter No respon 5 0 0 0 5 1 0 4 1 11 16 2 - 5 0 1 2 2 5 none 0 2 7 57 66 Total 5 7 10 70 92 P-value 0.001
1.. Seasonal variation of most common causes of trauma among students. 2..
A bar chart was constructed to demonstrate the frequency of most common mechanisms of trauma in both winter and summer. A staggering 39.5% claimed they had a slip/trip or fall in the winter compared to 16.2% of people in the summer. Broken bones or dislocated joint, motor vehicle accidents and sports were all higher in the summer rather than the winter. Surprisingly Burns and Sexual Abuse was higher in the summer. No other significant results were found for the most common causes of trauma.
Fig.1 Most common causes of trauma in the Winter
Discussion of results
A significant percentage of the students who participated in the research were females. According to various studies, it is well documented that female have a higher likelihood of experienced Trauma, for example through domestic violence and sexual assault, which has been on the rise in recent years. [9] Furthermore, research has shown that young females are affected mainly by Trauma due to their past experiences, such as encounters in school-life and adolescence. This may manifest itself in the form of PTSD, anxiety, depression, substance and drug abuse, and suicidal thoughts to name a few.
Among the participants, sexual assault was not as prevalent as other types of injuries, which shows that LUHS is morally upright since sexual assault is one of the leading causes of Trauma worldwide. Though the cases of sexual assault in the male students are significantly less, it still may have occurred at some point in their lives. This means that male students might be affected by similar matters to their female counterparts, though it is not well documented. These highlighted issues may influence their psychosocial and biological development. Consequently, the results demonstrate a three-fold likelihood of females developing trauma in comparison to males.
Since the majority of students who responded to the questionnaire were within the international sector (97.8%), it was statically measurable to account for Lithuanian students in this study. Therefore, it is difficult to attest for the Lithuanian student population in comparison to their international colleagues. This study did not discriminate based on country of origin, as this factor was deemed irrelevant. However, it is suggested that international students could be more prone to suffering from mental health disorders due to various reasons such as; homesickness, culture shock, feeling of ‘lack of belonging. [23]
According to the study, the mental health of students was generally observed to be poorer in the winter months; hence, the number of those who felt that this season was closely associated with increased mental trauma cases among these students. Previous studies have shown that summer month had a higher incidence of physical trauma, particular more dangerous activities. Accidents on the road and in various other activities are likely to happen in the summer due to an increase outdoor activity. Consequently, trauma cases are more prevalent in the summer than in the winter. [40]
A significant p-value of 0.001 was determined showing a clear relationship between the seasons and the trauma cases. Suicidal thoughts among the males were also found to be at a higher rate in the summer than in the winter. This could be as a consequence of indulging in drug abuse. Although a significant proportion of students did not engage in smoking and other substance abuse, alcohol-use among these students was definitely higher in the summer. A change of alcohol use with a 34% of respondents opting for an increase in alcohol use in the summer. Academic stress was noted as another significant cause of Trauma experienced by students, which have contributed to the increased number of mental traumas among these students.
It is known fact that medical studies are very intense and can be demanding at times. Proportionally, there was a higher incidence of overall trauma among medical students in comparisons to other faculties. There is a suggestion that medical studies at LUHS are more demanding on their students in comparison to other faculties, however, this is difficult to
quantify as we are limited by the number of participants from respective courses. Mental fatigue experienced by the students from their studies could also have some impact on the increased number of usage of drugs as a coping mechanism. Furthermore, the correlation between alcohol abuse in summer months can be attributed to the increase in academic pursuits e.g., Exams/assignment deadlines/practical's etc.
On another note, motor vehicle accidents, broken bones or dislocated joints, slips, and sports injuries are the major injuries that have led to the hospitalization of the study cohorts. Since university students are of a more physical able state this could show an association between the highlighted injuries and their level of activity. Furthermore, they are likely to engage in sporting activities and road trips that could have been the cause of such injuries. However, this does not mean that the males are not subjected to traumatic experiences. Psychological Trauma can severely impact cognitive functions, and for students, it was likely that their demanding studies would also be affected.
In other cases where students that indulged in drug abuse, such as drinking could have served as possible coping mechanisms to the named stressors. A lack of interest and decrease in pleasure in daily activities and other depressive symptoms; which were highlighted in the questionnaire; were found to be prevalent in the winter than in the summer. Controversially, a lack of sleep or difficulty sleeping was slightly higher in summer. Most students often experience these symptoms of Trauma, and when it reaches advanced stages, they start having suicidal thoughts. Seasonal affective disorder is a well-studied condition which may be attributable to the findings in this study. Due to the shear cold weather conditions of winter months, this could be suggestive of an increase in depressive symptoms reported by the student cohort. On the other hand, the summer brings increased activity levels, which could be why sleep disorders are more prevalent in those months.
Anxiety induced symptoms such as fidgetiness and restlessness were more associated with the winter period, this may be due to a lack of social exposure. Especially in the current climate of COVID restrictions, which were heavily implemented during the winter months when the questionnaire took place, subsequently this may have impacted the feelings/opinions of students.
Students with Trauma should be monitored in order to be better supported treated. There are many forms of therapies that students with trauma may pursue. These include; behavioral therapy, pharmacotherapy, and group therapy. [26] Hospitalization may be a form of treatment for more complex traumatic students who are dealing with suicidal thoughts. All these are aimed at controlling the effects and the symptoms of trauma among the students. Exposure therapy is very popular among anxiety-induced disorders such as GAD (general anxiety disorder), PTSD and other phobias. This means that the form of treatment forces the individual to engage in order to intervene/suppress their traumatic experiences. Trauma treatment among these students could be very effective and helpful for them as they can then focus on their education and lead better lifestyles, both socially and physically. Moreover, since the study showed that most of the students in the University often engaged in some forms of physical activities, they are better positioned to battle Trauma and its’ associated complications.
Conclusion
It was clear that the medical students were more affected by trauma compared to the students of the other faculties.
In between the gender's females were the most likely gender to be affected by mental trauma and their symptoms. There was no significance found in correlation between mental disorder symptoms and gender. Males were more likely to be hospitalized due to physical trauma. The majority of females did not use any substances/drugs in comparison to males.
A significance was found in in the relationship between trauma and seasons. Specific mechanisms of injuries such as Broken bones or dislocated joint, motor vehicle accidents and sports injuries were all higher in the summer. Slips/falls/trips were significantly higher in the winter.
The total sum of students that showed symptoms of Depression, Anxiety and Suicide were all higher in winter compared to summer. Drinking habits in the students was increased significantly in the summer in comparison to the winter.
Practical recommendations
Following the findings of this research, various recommendations were made to decrease the number of trauma cases that had been recently increasing among the Lithuanian students in the health studies with an increased number of trauma cases, there is a threat to both the students, especially in their studies and their lives. If this continues, the dropout rates in the University and suicides will likely increase, which needs to be corrected as early as now. [38] Therefore, the Lithuanian education system and the stakeholders, including the parents of these students, need to be alive to this issue and be proactive in their attempts to solve this monster of a matter of the increased traumatic cases in the University. [22] All of them have a part to play in the well-being of their students. The following are the recommendations that were made:
I. The school increased the number of psychologists to handle the increased number of trauma cases among the students. Students would then be urged to communicate any issue with the psychologists who would join the institution. Trauma often caught the students who failed to speak out about their problems, which often affected them. With the psychologists in place, they would offer help in assisting such students in the institution.
II. The schools would introduce programs to the students that would equip them with Trauma knowledge, how it occurs, its symptoms, and its effects. With this, the students would be better positioned to handle traumatic cases that they may have. [2] III. The school could also introduce an anti-drug campaign, which would help the
students quit the drug abuse that mainly occurred from the symptoms of Trauma that they faced. This was because the results from the research showed that most students often indulged in drug abuse, for example, drinking and smoking, so that they could relieve themselves from the intense symptoms and underlying conditions of Trauma, like anxiety and depression.
IV. The health care institution within the Lithuanian University of health sciences was to increase space for monitoring the students who had Trauma. An increase in the number of therapists who help in the treatment of Trauma was also a recommendation that could counter the growing numbers of trauma cases.
V. Students should report any cases of Trauma that they had for it to be well managed. VI. The University could adjust its learning calendar to ensure that the studies did not
enact stress on the students so that trauma cases due to this stress caused could minimize. For instance, the learning period for the Medicine faculty, which was most affected by trauma cases, would be increased so that there would be breaks in
between the learning sessions of these students so that the educational pressure they experienced would be minimized.
VII. The parents were also required to protect and offer support to their students and share their experiences with them in life. Some students did not speak to anyone about their experiences, and it ended up torturing them mentally. But with the help of the parents, enhanced communication would aid in countering some of these issues that the students of the Lithuanian University of health sciences had.
VIII. The government also was recommended to set up teams investigating the various challenges that the international students were facing since it was discovered that many of them were faced with trauma cases. The government could then come up with ways to counter these problems.
If some of these recommendations are adhered to, the increasing occurrences of Trauma among the students would significantly reduce. Proactive measures will assist in timely diagnosis, effective treatment, and psychological trauma management whenever a case is reported.
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Annexes
ANNEXES A
ONLINE SURVEY OF TRAUMA CASES AMONG LITHUANIAN UNIVERSITY OF HEALTH SCIENCES STUDENTS
Questions
1. Do you consent to the
use of the data
submitted here for research purposes?
YES NO 2. What is your gender Male
Female
3. What is your age 18 to 24
25 to 34 35 to 44 45 to 54 55 to 64 Above 64 4. What faculty are you
studying in? Medicine
Odontology Veterinary Pharmacy Public health Other
5. Are you living alone? YES NO
6. Country of residence Lithuanian International 7. Overall, how would you
assess your mental health in the winter?
Excellent Good Fair
