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Full-Text Articles in Psychiatry and Psychology

Implementation Of A Standardized Suicide Screening Process In A University Student Health Clinic: A Quality Improvement Project, Addie Grace Strong, Kathryn Dambrino, R. David Phillippi, Linda Wofford Apr 2024

Implementation Of A Standardized Suicide Screening Process In A University Student Health Clinic: A Quality Improvement Project, Addie Grace Strong, Kathryn Dambrino, R. David Phillippi, Linda Wofford

DNP Scholarly Projects

Background: Suicide is a leading cause of death among college age students, prompting the need for evidence-based screening tools like the Columbia Suicide Severity Rating Scale (C-SSRS) to enable early detection and timely intervention. Inconsistencies in suicide screening may pose a risk of missed intervention opportunities. This Doctor of Nursing Practice project specifically aimed to improve the quality and consistency of suicide screening in a university student health clinic by implementing the C-SSRS tool into the clinic workflow during mental health appointments. Methods: Employing a quality improvement framework, this scholarly project followed the Institute for Healthcare Improvement Model for Improvement …


Music As A Coping Mechanism: Clinical Implications Of How College Students Utilize Music To Cope With Anxiety, Depression, And Daily Stressors, Karly Pikel Apr 2024

Music As A Coping Mechanism: Clinical Implications Of How College Students Utilize Music To Cope With Anxiety, Depression, And Daily Stressors, Karly Pikel

Senior Theses

Many college students face stress, anxiety, and/or depression in their daily lives which they cope with in their own ways. Listening to music or playing an instrument are particularly powerful forms of coping that can have a plethora of positive effects on an individual. The purpose of this study was to conduct a survey amongst the University of South Carolina student body to determine how they utilize music to cope in their daily lives. Of 847 respondents, almost all of them reported experiencing some extent of anxiety and/or stress and listening to music to help them cope. Respondents agreed that …


An Evidence-Based Approach For Decreasing Burnout In Health Care Workers, Leonor T. Salalila Mar 2024

An Evidence-Based Approach For Decreasing Burnout In Health Care Workers, Leonor T. Salalila

Student Scholarly Projects

Practice Problem: Health care worker (HCW) burnout is a pervasive phenomenon within the healthcare industry, affecting professionals across various disciplines. Emotional exhaustion is a prominent feature, leading to feelings of being emotionally drained, overwhelmed, and unable to cope effectively with the demands of the job. Additionally, burnout often results in a significant lack of motivation among HCWs, who may struggle to find meaning and purpose in their work, exacerbating feelings of frustration and disillusionment. Consequences extend beyond individual well-being, impacting healthcare organizations with reduced work efficacy, low productivity, increased absenteeism, and high turnover rates. Addressing burnout requires a multifaceted approach, …


Unveiling The Therapeutic Garden Experience For People With Schizophrenia At A Rehabilitation In North Texas, Jeevita Sai Paspuneti Jan 2024

Unveiling The Therapeutic Garden Experience For People With Schizophrenia At A Rehabilitation In North Texas, Jeevita Sai Paspuneti

Landscape Architecture Masters & Design Theses

Therapeutic gardens have numerous benefits, including pain reduction, improved attention, stress reduction, and medical reduction (Urban et al.,2018). Green spaces have been shown to improve the physical, mental, social, and emotional health and well-being of those staying in healthcare facilities (Urban et al.; Greening,2022). Since the 1980s, research studies have discussed the therapeutic benefits of landscape design at healthcare facilities and the importance of sustainable practices in high-performance landscape design. Many successful and expensive landscape projects have been designed and constructed on hospital sites using healing gardens or sustainable strategies (Kaplan et al. S., 1989). However, researchers suggest additional empirical …


On-Campus Mental Health Service Use Among College Students With Autism: A Case Study Applying The Andersen Behavioral Model Of Health Services Use, Estella C. Lilyquist Jul 2023

On-Campus Mental Health Service Use Among College Students With Autism: A Case Study Applying The Andersen Behavioral Model Of Health Services Use, Estella C. Lilyquist

Electronic Theses and Dissertations

The unique set of impairments and limitations presented by students with autism spectrum disorder (ASD) make the accessing of campus-based nonacademic resources more difficult and complicated than their typically developed peers. Each year, the rate of students entering college with disabilities continues to grow, but their mental well-being is relatively poor. The purpose of this qualitative case study was to apply the conceptual framework of the Andersen behavioral model of health services use (ABMHSU) to the experiences of college students with ASD to understand and predict their utilization of campus-provided mental health resources. The participants were seven college students with …


Uplifting An Invisible Population: How We Can Combine Psychology And Policy To Improve The Educational And Mental Health Outcomes Of Homeless Youth, Melissa Hamilton May 2023

Uplifting An Invisible Population: How We Can Combine Psychology And Policy To Improve The Educational And Mental Health Outcomes Of Homeless Youth, Melissa Hamilton

Washington Semester Program

The goal of this thesis is to a) explain why homeless youth are frequently linked to poor mental health and education outcomes, and b) offer evidence-based suggestions that ought to be considered when developing any intervention aiming to improve the education and mental health of homeless youth. To accomplish this, prominent theories in both the psychology (ex: Maslow’s Hierarchy of Needs) and political science (ex: failed implementation of the McKinney-Vento Act) fields that pertain to student homelessness were reviewed, and a comparative analysis of existing intervention models was conducted. Three key trends were identified across successful homeless youth intervention models …


An Exploration Of The Social And Economic Factors That Influence The Mental Health Of Lgbtq College Students, Alexandria Mh Fossum Apr 2023

An Exploration Of The Social And Economic Factors That Influence The Mental Health Of Lgbtq College Students, Alexandria Mh Fossum

Senior Theses

LGBTQ individuals face a much higher prevalence of psychiatric disorders and mental health issues than their heterosexual, cisgender counterparts. The added academic pressures of college introduce a unique set of challenges that LGBTQ students face. This thesis includes a review of academic literature and data examining the intersections between social isolation, institutional discrimination, and financial insecurity and the effects they have on the mental health outcomes of LGBTQ college students. The paper is accompanied by a documentary consisting of a set of interviews of LGBTQ college students, giving a more personal insight into the multitude of factors that affect their …


Racial Differences In Depression Indicators Before And After 2008 Financial Crisis In A Sample Of Older Adults, Angelina E. Jackson Jan 2023

Racial Differences In Depression Indicators Before And After 2008 Financial Crisis In A Sample Of Older Adults, Angelina E. Jackson

Electronic Theses and Dissertations

The present study was designed to examine patterns of mental health outcomes in older Black and White adults after the national 2008 financial crisis. The data was acquired from the University of Michigan Health and Retirement Study, a publicly available dataset. This longitudinal study has obtained data from a representative sample of approximately 20,000 older adults in America, aged 55 and older. The hypotheses were (1) rates of mental health indicators related to symptoms of depression will increase after the 2008 financial crisis and (2) that increase will be significantly higher in Black respondents compared to White respondents. The analysis …


The Perceptions, Barriers, And Facilitators To Seeking Mental Health Help In College Student-Athletes (Pbas-Mh And Pfas-Mh): A Mixed-Methods Pilot Study, Margaret Hunt Jan 2023

The Perceptions, Barriers, And Facilitators To Seeking Mental Health Help In College Student-Athletes (Pbas-Mh And Pfas-Mh): A Mixed-Methods Pilot Study, Margaret Hunt

West Chester University Master’s Theses

Through the COVID-19 pandemic, 1 in 10 NCAA student-athletes reported feeling so depressed it has been difficult to function (NCAA, 2020). Despite this, student-athletes are significantly less likely to seek mental-health help than their non-athlete peers. The present study sought to develop and validate the Perceptions of Barriers to Seeking Mental Health Help in Student-Athletes (PBaS-MH) and the Perceptions of Facilitators to Seeking Mental Health Help in Student-Athletes (PFaS-MH) surveys in college student-athletes, as well as determine predominant barriers and facilitators they experience with seeking mental health help. A convergence mixed-methods research design was conducted to triangulate results. The surveys …


An Updated Look At Mental Health Services In American Public And Private Prisons, Lieren E. Tyira Dec 2022

An Updated Look At Mental Health Services In American Public And Private Prisons, Lieren E. Tyira

Student Theses

People residing in American prisons have the legal right to mental health care while incarcerated (Justia, 2021). This is important, as the prevalence of mental disorders is high in this population (Prins, 2014), and incarceration is a psychologically damaging experience, which hinders a person’s success at rehabilitation. Numerous of issues related to the mental health services (MHSs) in both public and private prison facilities have been reported in recent years, which warrants systematic exploration. The little existing research comparing the presence of MHSs in these facilities has produced mixed results, it uses out-of-date datasets, and none has explored MHSs in …


Evaluating Patient Health Questionnaire-9 (Phq-9) Use In Burn Survivors, Chelsey Friend Jul 2022

Evaluating Patient Health Questionnaire-9 (Phq-9) Use In Burn Survivors, Chelsey Friend

Dissertations

Problem: A burn injury affects both psychological and physical health, resulting in a greater than 50% major depressive disorder morbidity. The purpose of this quality improvement (QI) project is to evaluate the use of the Patient Health Questionnaire-9 (PHQ-9) in adult burn survivors, with an aim to increase the use of the screening tool.

Methods: A mixed-methods pre/post-survey design with an educational component was utilized to assess nurse knowledge, confidence, willingness, and barriers to completion of the PHQ-9. Aggregate data were collected to determine PHQ-9 completion rates for patients admitted to and discharged from the unit during the two months …


Evaluation Of Middle School Teachers Knowledge, Attitudes, And Barriers Pertaining To Adapted Youth Mental Health First Aid For Middle School Students, Lauren Hurley Jan 2022

Evaluation Of Middle School Teachers Knowledge, Attitudes, And Barriers Pertaining To Adapted Youth Mental Health First Aid For Middle School Students, Lauren Hurley

DNP Projects

Background: An estimated 17.1 million youth have experienced a mental health disorder, more than the number of children with cancer, diabetes, and AIDS combined (National Council for Behavioral Health, 2016). Unfortunately, of those children with a diagnosable condition, only a third receive mental health treatment (National Council for Behavioral Health, 2016). If a child or adolescent’s mental health disorder is left untreated, then unresolved issues may continue to affect them as adults, creating physical and mental health impairments, that could potentially have a negative impact on their futures. Youth Mental Health First Aid (YMHFA) is an evidenced-based training program that …


Auto- Ethnography With A Deep Dive Into Changes Mental Health During The Pandemic And A Look Into The Way The Pandemic Has Shaped Nursing Protocols For Recent Nursing College Graduates, Audrey Shaffer, Sarah Bereznay Jan 2022

Auto- Ethnography With A Deep Dive Into Changes Mental Health During The Pandemic And A Look Into The Way The Pandemic Has Shaped Nursing Protocols For Recent Nursing College Graduates, Audrey Shaffer, Sarah Bereznay

Williams Honors College, Honors Research Projects

In this project we completed a deep dive into how the Covid-19 pandemic reshaped our mental health and has affected our preparation for careers as registered nurses through a series of auto- ethnographic narrative journals using scholarly articles to support this idea. By utilizing personal narratives, we analyzed and reflected upon the cognitive and mental changes we experienced throughout this pandemic. We fulfilled this by comprising two personal narratives with inquiries pertaining to each shared narrative by utilizing the common themes of being nursing students and living through a pandemic. Within these personal narratives, we discussed how the pandemic influenced …


Sleep Self-Efficacy, Loneliness, And Physical Activity: Assessing The Pathways Between Sleep Quality And Mental Health Using Structural Equation Modeling, Amber M. Fox Jan 2022

Sleep Self-Efficacy, Loneliness, And Physical Activity: Assessing The Pathways Between Sleep Quality And Mental Health Using Structural Equation Modeling, Amber M. Fox

Theses and Dissertations

Although there is robust empirical support that poor sleep contributes to declines in mental health, explanations of this relationship remain unclear. The purpose of the present study was to examine the pattern of associations between sleep quality, sleep self-efficacy, loneliness, physical activity, and mental health among U.S. adults across the lifespan, and whether they differed by gender or age group. A structural equation model with invariance analysis was developed and examined data from 2,300 adults (Mage = 44.1, SD = 16.78) participating in the online study Investigating Sleep Longitudinally Across Normal Development (ISLAND). Sleep quality was measured by …


The Ecology Of Mental Health And The Impact Of Barriers On Mental Health Service Utilization, Alisha Aggarwal Dec 2021

The Ecology Of Mental Health And The Impact Of Barriers On Mental Health Service Utilization, Alisha Aggarwal

Theses & Dissertations

Mental health has emerged as a major public health concern in recent times with several disparities and barriers related to adequate health service utilization. Different age groups experience diverse symptoms and face distinct barriers in accessing and utilizing healthcare. Policies like Mental Health Parity and Addiction Equity Act and the Patient Protection and Affordable Care Act were launched to improve insurance coverage and delivery of mental health services. However, a large gap of unmet needs exists for adequate mental health service utilization in the country. This dissertation aims to describe the financial and non-financial barriers to mental health service utilization …


Giving Birth At A Critical Time: Assessing Perinatal Depression Among Syrian Refugees In Low Resource Settings, Nada Alnaji Dec 2021

Giving Birth At A Critical Time: Assessing Perinatal Depression Among Syrian Refugees In Low Resource Settings, Nada Alnaji

Theses & Dissertations

Refugee mothers are at an increased risk of suffering from stress and mental health conditions during the first year after giving birth to a child. The objective of this study is to enhance the early identification of treatable mental health conditions among perinatal women living within humanitarian settings. The central hypothesis is that a culturally specific approach can be helpful for the long-term success of mental health efforts. In this study, we use qualitative interview methods to understand the cultural paradigms and predisposing factors for perinatal depression related to being a Syrian refugee in Lebanon during the COVID-19 pandemic. In …


Designing And Implementing A De-Escalation Toolkit To Improve Staff Education And Competency On De-Escalation Within A Mental Health Outpatient Setting, Balraj Bajwa Dec 2021

Designing And Implementing A De-Escalation Toolkit To Improve Staff Education And Competency On De-Escalation Within A Mental Health Outpatient Setting, Balraj Bajwa

Doctor of Nursing Practice (DNP) Projects

Background: The purpose of this study is to develop and implement a de-escalation toolkit to help improve memory, retention, and utility of de-escalation techniques within an outpatient mental health crisis stabilization unit.

Problem: The aforementioned crisis stabilization unit has elevated rates of patient aggression/violence and staff present with difficulty recalling de-escalation techniques due to the lapse in memory and/or retention.

Methods: The project was introduced to the stakeholders of the crisis stabilization unit and input was obtained on the design and components of the toolkit. Various analyses were conducted to ensure the appropriate implementation of the project.

Intervention: A de-escalation …


Peer-Led Building Resilience And Enhancing Social-Emotional Skills Program, Danielle K. Enrico Dec 2021

Peer-Led Building Resilience And Enhancing Social-Emotional Skills Program, Danielle K. Enrico

Department of Occupational Therapy Entry-Level Capstone Projects

The purpose of the Capstone experience was to develop and implement a five-week peer-led building resilience and social-emotional skills training program at a public high school. This program addressed high school students' knowledge, skills, and attitudes regarding resources, social-emotional skills, and resilience. A questionnaire was administered pre and post-program to measure effectiveness. The results indicated an increase in scores, demonstrating a clearer understanding in all three areas.


Training And Individual Predictors Of Attitudes Toward Serious Mental Illness Amongst Clinical Psychology Doctoral Students, Lauren K. O'Connor Sep 2021

Training And Individual Predictors Of Attitudes Toward Serious Mental Illness Amongst Clinical Psychology Doctoral Students, Lauren K. O'Connor

Dissertations, Theses, and Capstone Projects

Clinical psychologists are grossly underrepresented in treatment provision for individuals with serious mental illness (SMI; Roe, Yanos, Lysaker, 2006). Systemic (e.g., emergence of managed care) and training-based (e.g., limitations to SMI specific training) factors contribute to the establishment of this underrepresentation, while mental health stigma amongst psychologists may play a role in perpetuating it. Many individual and experiential factors have been found to impact clinicians’ attitudes toward those with SMI (Henderson et al., 2014; Schulzes, 2007). Though many of these factors are present and relevant from the beginning of one’s career and may involve elements related to training, little research …


Longitudinal Trauma Treatment Outcomes In An Immigrant And Refugee Sample, Shuen-En Ho Jun 2021

Longitudinal Trauma Treatment Outcomes In An Immigrant And Refugee Sample, Shuen-En Ho

Clinical Psychology Dissertations

Refugee and immigrant populations are at an increased risk of having posttraumatic stress disorder (PTSD) and exhibit a significant amount of variance in trauma treatment outcomes that may be impacted by sociocultural factors. This study examines the impact of demographic variables on treatment outcome and trajectory of PTSD symptoms in a clinic setting with trauma-focused treatments in refugee/immigrant and general populations. Data was collected from the electronic medical record at the Harborview Center for Sexual Assault and Traumatic Stress. A total of 817 participants completed intake, 58 of which self-identified as immigrant/refugee. One-way ANOVAs were conducted to examine group differences …


Storytelling As An Expressive Arts Therapy Intervention With Children Via Telehealth, Sidney Marie Joines May 2021

Storytelling As An Expressive Arts Therapy Intervention With Children Via Telehealth, Sidney Marie Joines

Expressive Therapies Capstone Theses

As an expressive arts therapist in training working in the midst of a global pandemic, I sought to develop a creative, safe, accessible, and effective intervention for children via telehealth during a time of great uncertainty. Coronavirus 2019 has had a massive impact on mental and physical health and disrupted the lives of billions across the globe; the pandemic also forced mental health professionals to online formats. I found a significant lack of literature around expressive arts therapy via telehealth. Through considering theoretical approaches from cinematherapy, narrative therapy, metaphor therapy, play therapy, and expressive arts therapy, I developed an eight-week …


The Power, (Problem), And Potential Of Prayer, Meghan E. Stretar May 2021

The Power, (Problem), And Potential Of Prayer, Meghan E. Stretar

School of Theology and Seminary Graduate Papers/Theses

This paper illuminates the complex and nuanced relationship between mental health and prayer, particularly seeking theologically grounded understandings of prayer and of our relationship with God in times of mental distress that goes beyond intercessory prayer. The paper begins with an evaluation of social structures that cause mental health problems (notably in college students). A discussion on emotional agility, scarcity, and vulnerability serves as a transition to examining this question from a theological perspective, the second main section of this paper. In this section, I claim that a misunderstanding of the divine-human relationship and of prayer is one potential source …


Treatment Access For Dual Diagnosis Substance Use And Mental Health Disorders, Pedro Banuelos May 2021

Treatment Access For Dual Diagnosis Substance Use And Mental Health Disorders, Pedro Banuelos

Electronic Theses, Projects, and Dissertations

In 2018, of 1.3 million Latinx adults in the United States facing concurrent issues with substance use disorders (SUD) and mental health disorders (MHD) 93% remained untreated for either diagnosis. This is concerning since Substance Abuse and Mental Health Services Administration (SAMHSA) data reveals that this population is at greater risk for suicidal thoughts, plans, and attempts. They also face structural barriers such as employment, housing, legal involvement, and insurability that further impede access to treatment.

This study’s purpose was to examine barriers to accessing treatment for Latinx populations confronting co-occurring SUDs and MHDs. This study used a qualitative design …


A Systematic Review Of Culturally Sensitive Interventions For Ethnic Minority Elders With Mental Illness, Sarah Littlefield, Rosalinda Villareal Jan 2021

A Systematic Review Of Culturally Sensitive Interventions For Ethnic Minority Elders With Mental Illness, Sarah Littlefield, Rosalinda Villareal

Williams Honors College, Honors Research Projects

Honors Research Proposal

Goals and Objectives

Our systematic review asks the question: In ethnic minority elders with mental illness, how does culturally sensitive care, compared to current practices, affect patient outcomes? Our project goal is identifying evidence based practice with the goal of improving patient outcomes for ethnic minority elders with mental illnesses.

Methodology:

We will compile evidence from 20 current peer-reviewed studies. These studies will be selected from the CINAHL Plus med database, and key search terms will include: culturally sensitive care, culture, ethnic, mental health, intervention. All selected articles will be current within the last five years.

Outcomes: …


The Role Of Paraprofessionals In The Mental Health Structure Of India, Amy Abraham Oct 2020

The Role Of Paraprofessionals In The Mental Health Structure Of India, Amy Abraham

Senior Theses

The mental health treatment gap in India is part of a growing public health crisis, with over 95% of those in need of services never receiving them. Over 197 million Indians suffer from at least one diagnosable mental health disorder, and this number continues to grow given the treatment gap. The treatment gap is a result of four major factors: lack of government support, stigma, limited treatment facilities, and the dearth of professionals able to provide treatment. The current study aimed to analyze several factors of paraprofessional led mental health interventions including setting, treatments delivered, treatment models, and client outcomes. …


Exploration Of Physician Attitudes About Self-Care And Personal Mental Health: Possible Barriers To Physician Well Being, Candich Farrar Jun 2020

Exploration Of Physician Attitudes About Self-Care And Personal Mental Health: Possible Barriers To Physician Well Being, Candich Farrar

Dissertations

The present study was designed to examine physicians’ mental health, attitudes, and behaviors toward self-care and the utilization of mental health services. As the medical field can be very demanding and exhausting, it is believed that many physicians suffer from mental illnesses such as anxiety and depression. However, it was theorized that many physicians do not engage in adequate self-care regimes or seek support and suppress their symptoms, which may further exacerbate their illnesses. A thorough literature review was performed to explore the following: possible barriers to physicians seeking mental health services to address high rates of mental illnesses, physicians …


Mental Health Service Use In The Kingdom Of Saudi Arabia, Abdulaziz S. Alangari Jan 2020

Mental Health Service Use In The Kingdom Of Saudi Arabia, Abdulaziz S. Alangari

Graduate Theses, Dissertations, and Problem Reports

Objectives: The goal of this project was to increase knowledge concerning the current prevalence, needs and barriers to mental health service use in the Kingdom of Saudi Arabia (KSA). It’s purpose was to gather data that would help to inform future policy decisions aimed at optimizing the use and availability of these services in the KSA. There were three specific aims: 1) Examine the barriers to initiation and continuation of mental health treatment in people with a disorder diagnosed during the previous 12-months. 2) Explore the prevalence and predictors of mental health treatment dropout. 3) Examine the prevalence and patterns …


An Exploratory Study Of How Millennials Approach And Communicate Mental Health In The Workplace, Johanna I. Seitenbach Dec 2019

An Exploratory Study Of How Millennials Approach And Communicate Mental Health In The Workplace, Johanna I. Seitenbach

Student Theses and Dissertations

Depression is the leading cause of disability worldwide, affecting more than 300 million people. As more millennials take on leadership positions, it is important to understand how companies are currently addressing mental health in the workplace and compare this to how millennials approach the subject. The quantitative analysis completed through this study helped to determine what a mentally healthy workplace looks and feels like for millennials. Companies are increasingly investing in mental health initiatives for several reasons: to increase brand recognition, to improve company culture, to mitigate potential lawsuits, and to increase employee engagement and retention. This survey assessed how …


Off-Label, On Brand: How Psychiatric Drugs Reached Unsuspecting Youths, Charles J. May, Danielle Hyams, Larisa Karr Dec 2019

Off-Label, On Brand: How Psychiatric Drugs Reached Unsuspecting Youths, Charles J. May, Danielle Hyams, Larisa Karr

Capstones

This capstone project takes a deep dive into the world of off-label medicine, specifically focusing on psychiatric drugs for children. Off-label medicine is common practice, but not many people understand the potential dangers of this practice if doctors are not forthcoming and honest with their patients about potential side effects. Throughout this report, we detail the experiences of youths who took antipsychotics and antidepressants for off-label purposes, and the life-changing side effects the experienced as a result.

https://medium.com/@charlie.may/off-label-on-brand-how-psychiatric-drugs-reached-unsuspecting-youths-cdcb22315789


Understanding The Help-Seeking Behaviors Of Student-Athletes: Effect Of A Multidisciplinary Healthcare Team And The Perception Of Barriers And Facilitators For Seeking Help, Lauren M. Sander May 2019

Understanding The Help-Seeking Behaviors Of Student-Athletes: Effect Of A Multidisciplinary Healthcare Team And The Perception Of Barriers And Facilitators For Seeking Help, Lauren M. Sander

Masters Theses, 2010-2019

This study was aimed at identifying barriers and facilitators that influence help-seeking as well as the effect of implementing an integrated healthcare approach based on current recommendations. A total of 411 student-athletes from 18 intercollegiate teams at a mid-major Division I institution in the mid-Atlantic region completed a 12–item instrument comprised of ten quantitative items and two open-ended questions. The quantitative data was analyzed using SPSS software, and a constant comparative method was used to code responses from the open-ended questions. Findings suggested a prevalence of mental health challenges among student-athletes, especially overwhelming stress, struggles with time management, and anxiety. …