Annina E. Zysset

Background: Anxiety symptoms are highly prevalent among young adults and remain a major public mental health concern, with national data showing a marked increase during the COVID-19 pandemic. Contrary to expectations, anxiety rates did not decline after the pandemic ended. Persistent high anxiety levels may be contextually linked to an accumulation of concurrent global challenges, including climate change and geopolitical conflicts, that have been described as a “polycrisis” and are characterized by pervasive uncertainty. However, this framework was not directly examined in the present study. This study investigated the association between uncertainty, anxiety symptoms, resilience, and self-efficacy among university students. Methods: We used two datasets collected in Switzerland: a repeated cross-sectional pandemic study conducted during the COVID-19 pandemic (April 2020 to April 2023), and a post-pandemic cross-sectional study conducted in Fall 2023. First, general linear models were used to examine the trend of anxiety from Spring 2020–Fall 2023, combining data from both studies (N _wave = 1,158). Second, using data from the post-pandemic study ( N = 1,001), a hierarchical regression was conducted to examine the relationship between uncertainty, self-efficacy and resilience with anxiety symptoms, and to test for moderation effects of self-efficacy and resilience on the uncertainty–anxiety relationship. Results: A general linear model exhibited significantly better for a quadratic function compared to a linear function, suggesting an increase in anxiety followed by a saturation-plateau post-COVID-19 [β = −0.02, 95% CI (−0.03, −0.01)]. Regression results supported independent relationships [ R ( anxiety ) 2 = 39%], such that uncertainty positively was associated with anxiety [β = 0.50, CI (0.44, 0.56)], whereas self-efficacy [β = −0.22, 95% CI (−0.29, −0.15)], and resilience [β = −0.08, 95% CI (−0.29, −0.03)] were negatively associated. Moderation results were non-significant. Conclusion: Our findings highlight that uncertainty may play a role in sustaining high levels of anxiety among university students. Although high self-efficacy and resilience did not modify the relationship between uncertainty and anxiety symptoms, they were independently associated with lower anxiety levels. Addressing both global and specific facets of uncertainty appears to be highly relevant when designing targeted interventions to support mental health in young adults, particularly university students.

Background: Injuries to children and adolescents are common and are associated with individual suffering and costs. Switzerland lacks data of injuries in children and adolescents. This study investigates the feasibility of utilizing machine learning (ML) methodology to automatically extract relevant data from electronic pediatric patient records needed for monitoring and prevention purposes. Methods: The feasibility study follows three steps. 1. Utility evaluation of text data from electronic pediatric patient records regarding ML, injury monitoring and prevention requirements in a test-sample. 2. The development of an ML-based approach to extract relevant information based on electronic pediatric patient records (N = 30’884) of children treated for injuries at the University Children’s Hospital Zurich emergency department between 2018-2022. 3. The performance of the ML methodology is evaluated. Results: Qualitative and ML expert assessment of the sample showed that the desired data on injuries is contained in the test-sample and necessary requirements are met. Data records differ in detail with severe injuries providing especially rich information records. The international IDB code-tree was proved to be too elaborate and adult-orientated and was adapted. Preliminary data analyses indicate that the number of accidents is highest in the age group from 0 to 4 years (36%). More male (58%) children were treated. Majority of accidents were classified as less severe (73%), few (<1%) as very severe. Further lessons learned, along with more detailed prevalence data on injuries in children and adolescents, will be available by August 2024. Conclusions: Extraction of injury information from electronic patient record by means of ML may provide valuable information for injury monitoring and prevention, so far missing in Switzerland. Prerequisites for the successful application of ML are digital record access, usable coding-tree, and detailed text input by the emergency departments. Key messages: • An ML-based approach has the potential to improve the data basis by extracting valuable accidents information from existing texts of patient records. • To successfully apply this method, digital record access and detailed text data are needed.

Background: The need to maintain physical and social distance between people and the stay-at-home recommendation/order to contain the spread of COVID-19 have raised concerns about the possible increase in loneliness. However, few studies have analyzed trends or changes in loneliness in samples of young adults. The present study aimed to explore the prevalence of loneliness and its change during the COVID-19 pandemic.Participants and procedure: This is a repeated cross-sectional study analyzing data collected through six online surveys between April 2020 and March 2021 from 5,669 university students in Switzerland. Logistic regression models were used to examine trends in loneliness and associations between loneliness, well-being, life at home, COVID-19 symptoms and tests.Results: Loneliness decreased between April 2020 and May-June 2020. In contrast, loneliness was higher in December 2020, January and March 2021 compared to April 2020. Loneliness was associated with younger age, studying architecture, design and civil engineering or engineering, enjoying time spent with family/partner, experiencing tensions and conflicts at home, boredom, feeling locked up and subjective well-being and current health.Conclusions: Our findings highlight an increase in loneliness during the second wave of the COVID-19 pandemic, although a seasonality effect cannot be excluded. Public health systems and educational institutions need to monitor the effects of social distancing measures and reduced social contact on students’ loneliness and well-being.

During pregnancy and early parenthood, parents’ strong interest in pediatric health information presents a valuable opportunity to positively impact long-term health-seeking behavior and overall child health. In line with the increasing prevalence of digital transformation, a scoping review was conducted to explore two key aspects: (1) information seeking and use of digital health information among immigrant parents, and (2) associated reasons and factors. The literature search covered the period until July 2022, using Web of Science, MEDLINE, and CINAHL Complete databases. Out of 625 articles, 12 were included, comprising six qualitative, five quantitative studies, and one review. The majority of studies focused on immigrants in North America, primarily from Latin America and Asia. The studies varied in topics and methodologies, making it challenging to draw general conclusions. Nevertheless, while most immigrant parents rely on digital information on child health, they often prefer human sources such as family, friends, or healthcare providers. Trustworthiness and accessibility emerged as critical criteria for health resources. Two focus group discussions, derived from the results of the review, confirmed these findings for migrant mothers in Switzerland.

Background: Eating behavior represents individual appetitive traits which are related to the individual’s regulation of food intake. Eating behavior develops at an early age. There is some evidence that parenting styles might impact on the child’s eating behavior. The aim of this study was to investigate the relationship of different dimensions of positive and negative parenting styles with the child’s eating behavior at a critical age period of the child’s early development. Methods: Parents of 511 preschool children (aged 2–6 years) completed the Children Eating Behavior Questionnaire and the Alabama Parenting Questionnaire. Results: Analyses revealed that different dimensions of negative parenting styles were associated with eating behavior of the child. In details, inconsistent parenting showed a consistent association with eating behavior of a child (i.e. higher emotional eating, higher food responsiveness, higher food fussiness, higher satiety responsiveness and more enjoyment of food), whereas corporal punishment was associated with more emotional overeating and more food responsiveness but less satiety responsiveness. Further, powerful implementation was related to higher food responsiveness and less enjoyment of food and low monitoring was associated with higher emotional overeating and more slowness in eating. There was no such consistent association of positive parenting and eating behavior. Conclusions: More negative parenting styles were associated with eating behavior which is more often related to potential weight problems in a long term, whereas positive parenting did not show such a consistent relationship with eating behavior. Negative parenting should be in the focus of prevention and treatment of eating behavior problems in young children. Trial registration: ISRCTN41045021 (06/05/2014).

Background: Attention deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders in childhood. In Switzerland, the complex diagnosis and treatment are being carried out by adolescent-/child psychiatrists, and pediatricians. Guidelines recommend a multimodal therapy for patients with ADHD. However, it has been questioned whether health professionals follow this approach or favor drug therapy. This study aims to provide insights into the practice of pediatricians in Switzerland regarding diagnosis and treatment of ADHD and their perceptions of these processes. Method: An online survey (self-report) about current practices of diagnosis and management as well as challenges regarding ADHD was distributed to office-based pediatricians in Switzerland. 151 pediatricians participated. Results show that therapy options were almost always discussed with parents and older children. Exchange with parents (81%) and level of child’s suffering (97%) were central when selecting therapy options. Results: Therapies about which pediatricians informed most often were: pharmacological therapy, psychotherapy, and multimodal therapy. Challenges voiced were the subjectivity of diagnostic criteria and dependence on third parties, low availability of psychotherapy, and a rather negative public attitude towards ADHD. Needs that were expressed were further education for all professionals, support for coordination with specialists and schools as well as improvement of information on ADHD. Conclusions: Pediatricians do consider a multimodal approach when treating ADHD and take the families` and children`s opinions into account. Improvements of the availability of child and youth psychotherapy, the strengthening of the interprofessional cooperation with therapists and schools, and efforts to increase public knowledge about ADHD are proposed.

Objectives: Young adults have been overly affected by the containment measures against COVID-19 and, consequently, worsening in mental health and change in health behavior have been reported. Because the life phase of emerging adulthood is crucial for developing health behaviors, this study aims to examine increase in alcohol consumption, single and multiple binge drinking, and associated factors in students during lockdown and post-lockdown periods.Methods: A prospective open cohort study design with nine survey time points between April 2020 and June 2021 was conducted. The present study uses pooled data from the first survey T0 (3 April to 14 April) and follow-ups at T1 (30 April to 11 May 2020) and T2 (28 May to 8 June 2020). Students from all faculties of the Zurich University of Applied Sciences (ZHAW) (N = 12'431) were invited. Of the 1,300 students who participated at baseline and in at least one follow-up, 1,278 (98.3%) completed the questionnaires, final net sample size was 947. Generalized Estimating Equations (GEE) models were used to investigate the factors associated with increases in alcohol consumption based on number of occasions/last 30 days; drinks/week, and binge drinking at T0, and respective changes at T1 and T2 (increases, decreases, no change).Results: Overall, 20% of Swiss university students reported an increased alcohol consumption and 26% engaged in binge drinking. Number of drinks at baseline was associated with a higher probability of increased alcohol consumption, as well as engaging in single and multiple binge drinking events. Higher anxiety scores were associated with a higher probability to increase the alcohol consumption and engaging at least once in binge drinking. Additional factors associated with any binge drinking were male gender, younger age and not living with parents. Higher perceived social support was only associated with engaging in heavy binge drinking.Conclusions: A substantial number of students developed a more risky health behavior regarding alcohol consumption. It is important to identify at risk students and design target prevention including factors such as age, gender and social norms. Further, health behavior and determinants of health behaviors of students should be carefully monitored during the further course of the pandemic.

Background: University students were confronted with abrupt changes by the COVID-19 lock-down in their personal and academic lives. The “Health in Students during the Corona pandemic” study investigated the impact on mental health and health behaviors of Swiss university students. Methods: April 2020 all students of the Zurich University of Applied Sciences (N = 12,431) were invited to a repeated cross-sectional open cohort survey, participation ranged from T0 20% - T5 13%. Generalized anxiety (GAD-7), stress (PSS) and depression (PHQ-9) were investigated with descriptive and multivariate analyses. Latent class analyses (LCA) was applied to identify groups who differed in perception of impact on daily and student life. PHQ-9 results were compared with pre-pandemic data matched for age, sex and education. Results: At T0 mean age was 26.5 (sd 5.6), 69% were female. Participants were similar across all surveys. LCA yielded three classes of perceived impact: 1 (low, n = 675), 2 (moderate, n = 1098), and 3 (strong, n = 656). At T0 adjusted proportion of moderate to severe anxiety was significantly higher in class 3 (45% (95% CI: 28.0-62.0), compared to 2 (15.5%, 95% CI: 13.1-17.9) and 1 (5.1%, 95% CI: 4.7-5.6). Class 3 showed significantly higher odds of high stress levels (class 3: OR = 28.4; 95% CI: 15.5 - 52.0; p = 0.000; class 2: OR = 2.8; 95% CI: 1.5 - 5.3; p = 0.002) compared to other students. Anxiety and stress levels declined with time. The adjusted prevalence of depressive symptoms in females (30.8% (95% CI: 28.6-33.0)) and males (24.8% (95% CI: 21.7-28.1) was substantially higher than in a matching pre-pandemic national sample of young women (10.9% (95% CI: 8.9-13.2)) and men (8.5% (6.6-11.0)). Depressive symptoms between T0 and T3 did not decline. Conclusions: Students reported high anxiety, stress and depressive symptoms during the pandemic. Depressive symptoms did not decline with time, indicating a continuing impact on mental health throughout the pandemic.

Background: Young adults are not considered a risk group for contracting COVID-19, but they are disproportionately affected by pandemic containment measures compared to other age groups. University students were confronted with abrupt changes both in their personal and academic lives. The “Health in Students during the Corona pandemic” study (HES-C) investigated the health and health behavior, concerns and views in students of the Zurich University of Applied Sciences. In the current analyses, we focused on COVID-19 related preventive behaviors, alcohol and marijuana consumption during the pandemic. Methods: All students of the Zurich University of Applied Sciences (N = 12,429) were invited to a voluntary repeated cross-sectional open cohort survey which took place from the April 3 2020 (T0) to January 25 (T5), covering two university semesters with overall 6 surveys. Participation rates varied from T0 20% to T5 13%. Results: While overall adherence to containment measures was high, men yielded lower adjusted odds (OR; 95%-CI) of adherence regarding the following measures: social distancing (0.68; 0.53-0.87), non-utilization of public transport (0.74; 0.56-0.97), 5-person limit for social gatherings (0.47; 0.35-0.64) and the stay at home rule (0.64; 0.51-0.82). In addition to gender, factors associated with adherence were information source and perceived susceptibility to the virus. Out of 80% who reported having drunk alcohol during the last 30 days at T0, 31% engaged at least once in binge drinking (>5 beverages) and 18% consumed more than usual. Marijuana was consumed by 11%, of which 27% reported higher use during the lock-down than before. Longitudinal data on risk behavior and factors associated with risk behavior and changes in behavior are currently being analyzed and will be presented. Conclusions: Public health communication targeting university students should not only address pandemic related preventive behavior but also risk behavior during the pandemic. Key messages: The pandemic has led to increased risky health behavior among certain students. Public health communication targeting university students should not only address pandemic related preventive behavior but also risk behavior during the pandemic.

To date, little is known about the long-term trajectory of generalized anxiety disorder (GAD) symptoms in health professions (HP) students over the course of the pandemic. Like health professionals in general, HP students may have a significantly greater susceptibility to GAD symptoms due to their involvement in the health care system and the associated specific stressors and risks during the COVID-19 pandemic. The HEalth in Students during the Corona pandemic study (HES-C) provided the opportunity to investigate the long-term course of GAD symptoms with eight measurement points over 14 months in 9380 HP and non-HP students in Switzerland between March 2020 and June 2021. We employed logistic regression models with clustered sandwich standard errors to estimate unadjusted and adjusted prevalence of GAD symptoms. In the full model, we adjusted for age, gender, nationality, social status, social support, self-efficacy, and COVID-19 symptoms in the past 4 weeks. At baseline, the estimated adjusted GAD symptom prevalence was 17.6% (95% CI = 14.4–20.7) in HP students and 24.4% (95% CI = 22.3–26.5) in their peers. With the peak of the second SARS-CoV-2 infection wave in October/November 2020, GAD symptom prevalence substantially increased and then remained stable over time, despite changes in the epidemiological situation and its associated containment measures. At the last follow-up in June 2021, GAD symptom prevalence in HP and non-HP students was 22.9% (95% CI = 16.3–29.5) and 36.9% (95% CI = 32.9–40.9), respectively. Absolute differences in GAD symptom prevalence between student groups over all eight measurement points ranged from 6.2% to 14.9% (all p < 0.05). Non-HP students are identified as a specifically vulnerable group. Accordingly, target group-specific public health campaigns and interventions should be developed with the aim to strengthen their resources, reducing GAD symptoms, and preventing chronification.