Mental Health of Czech University Psychology Students: Comparison
View Latest Version
Please note this is a comparison between Version 2 by Dean Liu and Version 1 by Yasuhiro Kotera.

High rates of mental health problems are a growing concern in Czech higher education, negatively impacting students’ performance and wellbeing. Despite the serious nature of poor mental health, students often do not seek help because of negative attitudes and shame over mental health problems. 

  • self-compassion
  • Czech university students
  • mental health

1. Introduction

Mental health is high on the national agenda in the Czech Republic. The social and economic transformations that followed the collapse of the socialistic regime took a toll on the mental health of the people of Central and Eastern Europe that persists to this day [1,2,3][1][2][3]. In the Czech Republic, one in five adults are diagnosed with a mental health illness [4]. Alcohol dependence is almost twice as high as in the rest of Europe [5]. The highest prevalence rates of alcohol dependence (16.64%), as well as mood (7.96%) and anxiety disorders (5.42%), have been found in young people aged 18 to 29 years old, predominantly undergraduate university students [4]. The consequences of poor mental health in university students are higher dropout rates and lower academic achievement [6], which is partially mirrored in lower tertiary qualification attainment (i.e., college, university, and vocational courses) in the Czech Republic [7]. Furthermore, Bobak et al. [8] found a high prevalence of depression among a Czech Republic adult sample and were able to establish an inverse relationship between psychological wellbeing and acquired education: well-educated adults in the Czech Republic tended to have poor psychological wellbeing. This trend is present consistently among Eastern European university students [9]. While the government has recently started reforming mental health care, underfinancing and insufficient legislation [10] are still contributing to the substantial treatment gap in the Czech Republic where 83% of people with a mental disorder need care but have not received it [11,12][11][12].
Furthermore, mental health illness and its diagnosis in the historical Soviet discourse has mainly served as an instrument of oppression, and led to inhumane and amoral treatment. These conditions resulted in a stigmatization of psychiatry [1] that continues to foster negative attitudes towards the discipline of mental health at large [13]. As attitudes and beliefs about mental health are formed and maintained through cultural knowledge and perceptions, which are often based largely on historical narratives [14], the higher prevalence of mental health stigma in former socialist societies not only poses an additional barrier to close the treatment gap in the Czech Republic [13[13][15],15], but can potentially worsen overall mental health in the region [16].
The detrimental effects of negative mental health attitudes (i.e., believing that having a mental health problem indicates that the person is weak and inadequate) are well known. Research suggests that such attitudes impact negatively on self-esteem [17[17][18],18], self-efficacy [19], and physical health [20], and that they are a significant obstacle to treating mental health. These socio-cognitive barriers are among the leading obstacles for help-seeking behaviours, followed by mental health knowledge and awareness [21,22,23,24,25,26][21][22][23][24][25][26]. While studies have shown that mental health literacy is associated with more positive attitudes towards mental health [27], only 1% of Czech medical students are genuinely interested in pursuing careers in psychiatry [28]. The extent to which negative mental health attitudes and shame in post-Soviet societies, such as the Czech Republic, affect treatment seeking, has not yet been explored in detail.

2. Negative Mental Health Attitudes and Shame

It is well established that negative attitudes about mental health can lead to internalisation potentially manifesting in a sense of shame [29,30,31,32,33][29][30][31][32][33]. The emotional state of shame is complex and arises when individuals feel that they fall short of internalised socially constructed standards [32,34,35,36][32][34][35][36]. Shame involves negative self-evaluations and concerns about the judgements of others, and feelings of regret about one’s identity [37,38][37][38]. As a marker of psychopathology, shame has been linked to depression [39], anxiety [40], and eating disorders [41]. “Mental health shame” ([42], p. 136)—feeling ashamed for having a mental health problem—is linked in university students to poorer mental health [43] and is especially prominent in students who prepare to enter demanding careers such as business management [44] and health care [45]. Doblytė [13] qualitatively explored feelings of shame regarding mental health problems in an adult Czech sample and observed that shame was a dominant theme for delayed treatment seeking and the adoption of destructive coping strategies to prevent stigmatisation. Though psychopathology is affecting predominately young adults in the Czech Republic [11] and the stigma surrounding mental health in the country remains pervasive [15], the relationship between negative attitudes, mental health shame, and mental health problems has not yet been quantitatively examined in Czech undergraduate students.

3. Self-Compassion

Research that focused on mental health improvement and shame reduction has consistently identified self-compassion as a protective factor [31,46,47,48,49,50][31][46][47][48][49][50]. Rooted in the tradition of Buddhism [51], self-compassion is related to practicing kindness towards oneself when facing adversity, acknowledging that struggling and suffering is a shared human condition, and becoming mindful and aware of one’s painful thoughts [52]. Self-compassion has been linked to lower rates of depression, anxiety, and stress [52[52][53][54][55],53,54,55], as well as reduced social comparison [56] and self-criticism [31,47,57,58][31][47][57][58]. It has also been beneficially linked to life satisfaction, happiness, optimism, and overall wellbeing and better mental health [53,54,57][53][54][57]. Some have investigated the moderating role self-compassion plays in psychopathological symptoms such as rumination and stress [59], and self-criticism and depression [57]. However, the mediating role of self-compassion in the relationship between shame and mental health problems have largely only been explored in the context of eating disorders (e.g., refs. [58,60][58][60]). Self-compassion has begun to attract attention in the Czech Republic [61]. Montero-Marin et al. [62] suggested that this may be because practicing self-compassion is influenced by cultural values. Most notably, self-compassion is suggested to be inversely related to indulgence and restraint, as outlined by Hofstede’s [63] Cultural Dimensions Theory. Like many other Eastern European countries, the Czech culture scores comparably lower in the indulgence domain than other Western societies such as Germany, the United Kingdom, and the United States [64]. Restraint and control of impulses and desires is a governing cultural value in the Czech Republic [63]. Therefore, self-compassion might not be a common trait or known skill in Czech culture and thus is a meaningful area to explore to support the national mental health agenda goals of improving the quality of life of people with mental illnesses and widening access to treatment [10].

4. Mental Health and Emotion Regulation

Disorders of distress such as anxiety and depression have been widely linked to emotional dysregulation [65] and often lead to maladaptive coping behaviours such as substance [66,67][66][67] and alcohol abuse [68]. Neurophysiological research suggests that there are three main emotion regulation systems [69], namely the threat, drive, and soothing systems [70]. The threat system functions as an alarm apparatus that elicits feelings of anxiety and anger, resulting in protection-seeking behaviours [70]. The drive system is goal oriented and triggers behaviours that bring pleasure [69]. The soothing system focuses on safety, and reduces distress through nurturing and affection [70]. According to Gilbert [71], taken together these emotion regulation systems, if balanced, form the foundation of mental wellbeing, but cause distress and psychopathology if unbalanced. The societal values of restraint and impulse control in Czech culture [64] could lead to imbalances in some individuals, with greater activation of the threat system, and diminished activation of the soothing system [62]. This in turn could explain lower engagement in self-compassionate behaviours. High activation of the threat system could further explain the high prevalence in mental health illness in the Czech Republic. Accordingly, wresearchers theorise that Czech individuals might predominantly operate on the threat system, which could be a plausible explanation for the high prevalence of mental health problems in the country. Therefore, if shame and negative attitudes towards mental health are anchored in the threat system then self-compassion as a soothing mechanism should be able to mediate the negative effects of the overstimulated threat system on mental health.

References

  1. Raikhel, E.; Bemme, D. Postsocialism, the Psy-Ences and Mental Health. Transcult. Psychiatry 2016, 53, 151–175.
  2. Skultans, V. From Damaged Nerves to Masked Depression: Inevitability and Hope in Latvian Psychiatric Narratives. Soc. Sci. Med. 2003, 56, 2421–2431.
  3. Skultans, V. The Appropriation of Suffering: Psychiatric Practice in the Post-Soviet Clinic. Theory Cult. Soc. 2007, 24, 27–48.
  4. Formánek, T.; Kagström, A.; Cermakova, P.; Csémy, L.; Mladá, K.; Winkler, P. Prevalence of Mental Disorders and Associated Disability: Results from the Cross-Sectional CZEch Mental Health Study (CZEMS). Eur. Psychiatry 2019, 60, 1–6.
  5. Wittchen, H.U.; Jacobi, F.; Rehm, J.; Gustavsson, A.; Svensson, M.; Jönsson, B.; Olesen, J.; Allgulander, C.; Alonso, J.; Faravelli, C.; et al. The Size and Burden of Mental Disorders and Other Disorders of the Brain in Europe 2010. Eur. Neuropsychopharmacol. 2011, 21, 655–679.
  6. Poh Keong, P.; Chee Sern, L.; Foong, M.; Ibrahim, C. The Relationship between Mental Health and Academic Achievement among University Students—A Literature Review. Second Int. Conf. Glob. Trends Acad. Res. 2015, 2, 755–764.
  7. Organisation for Economic Co-Operation and Development Czech Republic Country Note. Available online: http://www.oecd.org/education/Czech%20Republic-EAG2014-Country-Note.pdf (accessed on 14 March 2022).
  8. Bobak, M.; Pikhart, H.; Pajak, A.; Kubinova, R.; Malyutina, S.; Sebakova, H.; Topor-Madry, R.; Nikitin, Y.; Marmot, M. Depressive Symptoms in Urban Population Samples in Russia, Poland and the Czech Republic. Br. J. Psychiatry J. Ment. Sci. 2006, 188, 359–365.
  9. Mikolajczyk, R.T.; Maxwell, A.E.; El Ansari, W.; Naydenova, V.; Stock, C.; Ilieva, S.; Dudziak, U.; Nagyova, I. Prevalence of Depressive Symptoms in University Students from Germany, Denmark, Poland and Bulgaria. Soc. Psychiatry Psychiatr. Epidemiol. 2008, 43, 105–112.
  10. Pec, O. Mental Health Reforms in the Czech Republic. BJPsych Int. 2019, 16, 4–6.
  11. Kagstrom, A.; Alexova, A.; Tuskova, E.; Csajbók, Z.; Schomerus, G.; Formanek, T.; Mladá, K.; Winkler, P.; Cermakova, P. The Treatment Gap for Mental Disorders and Associated Factors in the Czech Republic. Eur. Psychiatry 2019, 59, 37–43.
  12. Kale, R. The Treatment Gap. Epilepsia 2002, 43, 31–33.
  13. Doblytė, S. Shame in a Post-Socialist Society: A Qualitative Study of Healthcare Seeking and Utilisation in Common Mental Disorders. Sociol. Health Illn. 2020, 42, 1858–1872.
  14. Choudhry, F.R.; Mani, V.; Ming, L.; Khan, T.M. Beliefs and Perception about Mental Health Issues: A Meta-Synthesis. Neuropsychiatr. Dis. Treat. 2016, 12, 2807–2818.
  15. Winkler, P.; Mladá, K.; Janoušková, M.; Weissová, A.; Tušková, E.; Csémy, L.; Evans-Lacko, S. Attitudes towards the People with Mental Illness: Comparison between Czech Medical Doctors and General Population. Soc. Psychiatry Psychiatr. Epidemiol. 2016, 51, 1265–1273.
  16. Weiss, M.G.; Ramakrishna, J.; Somma, D. Health-Related Stigma: Rethinking Concepts and Interventions. Psychol. Health Med. 2006, 11, 277–287.
  17. Link, B.G.; Struening, E.L.; Neese-Todd, S.; Asmussen, S.; Phelan, J.C. Stigma as a Barrier to Recovery: The Consequences of Stigma for the Self-Esteem of People with Mental Illnesses. Psychiatr. Serv. 2001, 52, 1621–1626.
  18. Rodrigues, S.; Serper, M.; Novak, S.; Corrigan, P.; Hobart, M.; Ziedonis, M.; Smelson, D. Self-Stigma, Self-Esteem, and Co-Occurring Disorders. J. Dual Diagn. 2013, 9, 129–133.
  19. Watson, A.C.; Corrigan, P.; Larson, J.E.; Sells, M. Self-Stigma in People With Mental Illness. Schizophr. Bull. 2007, 33, 1312–1318.
  20. Sickel, A.E.; Seacat, J.D.; Nabors, N.A. Mental Health Stigma: Impact on Mental Health Treatment Attitudes and Physical Health. J. Health Psychol. 2019, 24, 586–599.
  21. Corrigan, P.W.; Druss, B.G.; Perlick, D.A. The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychol. Sci. Public Interest J. Am. Psychol. Soc. 2014, 15, 37–70.
  22. Eisenberg, D.; Golberstein, E.; Gollust, S.E. Help-Seeking and Access to Mental Health Care in a University Student Population. Med. Care 2007, 45, 594–601.
  23. Kopinak, J.; Berisha, B.; Mursali, B. An Investigation into the Health of a Representative Sample of Adults in Kosovo. J. Humanit. Assist. 2001, 17, 1–7.
  24. Lannin, D.G.; Vogel, D.L.; Brenner, R.E.; Abraham, W.T.; Heath, P.J. Does Self-Stigma Reduce the Probability of Seeking Mental Health Information? J. Couns. Psychol. 2016, 63, 351–358.
  25. Shannon, P.J.; Wieling, E.; Simmelink-McCleary, J.; Becher, E. Beyond Stigma: Barriers to Discussing Mental Health in Refugee Populations. J. Loss Trauma 2015, 20, 281–296.
  26. Ting, L. Depressive Symptoms in a Sample of Social Work Students and Reasons Preventing Students from Using Mental Health Services: An Exploratory Study. J. Soc. Work Educ. 2011, 47, 253–268.
  27. Milin, R.; Kutcher, S.; Lewis, S.P.; Walker, S.; Wei, Y.; Ferrill, N.; Armstrong, M.A. Impact of a Mental Health Curriculum on Knowledge and Stigma Among High School Students: A Randomized Controlled Trial. J. Am. Acad. Child Adolesc. Psychiatry 2016, 55, 383–391.e1.
  28. Janoušková, M.; Formánek, T.; Bražinová, A.; Mílek, P.; Alexová, A.; Winkler, P.; Motlová, L.B. Attitudes towards People with Mental Illness and Low Interest in Psychiatry among Medical Students in Central and Eastern Europe. Psychiatr. Q. 2021, 92, 407–418.
  29. Corrigan, P.W.; Watson, A.C.; Miller, F.E. Blame, Shame, and Contamination: The Impact of Mental Illness and Drug Dependence Stigma on Family Members. J. Fam. Psychol. 2006, 20, 239–246.
  30. Gilbert, P.; Bhundia, R.; Mitra, R.; McEwan, K.; Irons, C.; Sanghera, J. Cultural Differences in Shame-Focused Attitudes towards Mental Health Problems in Asian and Non-Asian Student Women. Ment. Health Relig. Cult. 2007, 10, 127–141.
  31. Gilbert, P.; Procter, S. Compassionate Mind Training for People with High Shame and Self-Criticism: Overview and Pilot Study of a Group Therapy Approach. Clin. Psychol. Psychother. 2006, 13, 353–379.
  32. Hampton, N.Z.; Sharp, S.E. Shame-Focused Attitudes Toward Mental Health Problems: The Role of Gender and Culture. Rehabil. Couns. Bull. 2014, 57, 170–181.
  33. Kotera, Y.; Green, P.; Sheffield, D. Mental Health Attitudes, Self-Criticism, Compassion and Role Identity among UK Social Work Students. Br. J. Soc. Work 2019, 49, 351–370.
  34. Gilbert, P. Evolution, Social Roles, and the Differences in Shame and Guilt. Soc. Res. Int. Q. 2003, 70, 1205–1230.
  35. Kim, S.; Thibodeau, R.; Jorgensen, R.S. Shame, Guilt, and Depressive Symptoms: A Meta-Analytic Review. Psychol. Bull. 2011, 137, 68–96.
  36. Tangney, J.P. Assessing Individual Differences in Proneness to Shame and Guilt: Development of the Self-Conscious Affect and Attribution Inventory. J. Pers. Soc. Psychol. 1990, 59, 102–111.
  37. Benetti-McQuoid, J.; Bursik, K. Individual Differences in Experiences of and Responses to Guilt and Shame: Examining the Lenses of Gender and Gender Role. Sex Roles 2005, 53, 133–142.
  38. Tangney, J.P.; Stuewig, J.; Mashek, D.J. Moral Emotions and Moral Behavior. Annu. Rev. Psychol. 2007, 58, 345–372.
  39. Matos, M.; Pinto-Gouveia, J. Shame as a Traumatic Memory. Clin. Psychol. Psychother. 2010, 17, 299–312.
  40. Gilbert, P. The Relationship of Shame, Social Anxiety and Depression: The Role of the Evaluation of Social Rank. Clin. Psychol. Psychother. 2000, 7, 174–189.
  41. Caglar-Nazali, H.P.; Corfield, F.; Cardi, V.; Ambwani, S.; Leppanen, J.; Olabintan, O.; Deriziotis, S.; Hadjimichalis, A.; Scognamiglio, P.; Eshkevari, E.; et al. A Systematic Review and Meta-Analysis of ‘Systems for Social Processes’ in Eating Disorders. Neurosci. Biobehav. Rev. 2014, 42, 55–92.
  42. Kotera, Y.; Green, P.; Sheffield, D. Mental Health Shame of UK Construction Workers: Relationship with Masculinity, Work Motivation, and Self-Compassion. Rev. Psicol. Trab. Las Organ. 2019, 35, 135–143.
  43. Arimitsu, K. The Relationship of Guilt and Shame to Mental Health. . Jpn. J. Health Psychol. 2001, 14, 24–31.
  44. Kotera, Y.; Conway, E.; Van Gordon, W. Mental Health of UK University Business Students: Relationship with Shame, Motivation and Self-Compassion. J. Educ. Bus. 2019, 94, 11–20.
  45. Kotera, Y.; Cockerill, V.; Chircop, J.G.E.; Forman, D. Mental Health Shame, Self-compassion and Sleep in UK Nursing Students: Complete Mediation of Self-compassion in Sleep and Mental Health. Nurs. Open 2021, 8, 1325–1335.
  46. Kotera, Y.; Green, P.; Sheffield, D. Mental Health of Therapeutic Students: Relationships with Attitudes, Self-Criticism, Self-Compassion, and Caregiver Identity. Br. J. Guid. Couns. 2019.
  47. Neely, M.E.; Schallert, D.L.; Mohammed, S.S.; Roberts, R.M.; Chen, Y.-J. Self-Kindness When Facing Stress: The Role of Self-Compassion, Goal Regulation, and Support in College Students’ Well-Being. Motiv. Emot. 2009, 33, 88–97.
  48. Neff, K.D.; Kirkpatrick, K.L.; Rude, S.S. Self-Compassion and Adaptive Psychological Functioning. J. Res. Personal. 2007, 41, 139–154.
  49. Sirois, F.M.; Kitner, R.; Hirsch, J.K. Self-Compassion, Affect, and Health-Promoting Behaviors. Health Psychol. 2015, 34, 661–669.
  50. King, R.; Gaerlan, M.J.M. High Self-Control Predicts More Positive Emotions, Better Engagement, and Higher Achievement in School. Eur. J. Psychol. Educ. 2014, 29, 81–100.
  51. Neff, K.D. Self-Compassion, Self-Esteem, and Well-Being: Self-Compassion, Self-Esteem, and Well-Being. Soc. Personal. Psychol. Compass 2011, 5, 1–12.
  52. Neff, K.D. The Development and Validation of a Scale to Measure Self-Compassion. Self Identity 2003, 2, 223–250.
  53. MacBeth, A.; Gumley, A. Exploring Compassion: A Meta-Analysis of the Association between Self-Compassion and Psychopathology. Clin. Psychol. Rev. 2012, 32, 545–552.
  54. Ying, Y.W. Contribution of Self-Compassion to Competence and Mental Health in Social Work Students. J. Soc. Work Educ. 2009, 45, 309–323.
  55. Kotera, Y.; Dosedlova, J.; Andrzejewski, D.; Kaluzeviciute, G.; Sakai, M. From Stress to Psychopathology: Relationship with Self-Reassurance and Self-Criticism in Czech University Students. Int. J. Ment. Health Addict. 2021.
  56. Neff, K.D.; Vonk, R. Self-Compassion Versus Global Self-Esteem: Two Different Ways of Relating to Oneself. J. Pers. 2009, 77, 23–50.
  57. Braehler, C.; Gumley, A.; Harper, J.; Wallace, S.; Norrie, J.; Gilbert, P. Exploring Change Processes in Compassion Focused Therapy in Psychosis: Results of a Feasibility Randomized Controlled Trial. Br. J. Clin. Psychol. 2012, 52, 199–214.
  58. Liss, M.; Erchull, M.J. Not Hating What You See: Self-Compassion May Protect against Negative Mental Health Variables Connected to Self-Objectification in College Women. Body Image 2015, 14, 5–12.
  59. Samaie, G.; Farahani, H.A. Self-Compassion as a Moderator of the Relationship between Rumination, Self-Reflection and Stress. Procedia-Soc. Behav. Sci. 2011, 30, 978–982.
  60. Wollast, R.; Riemer, A.; Sarda, E.; Wiernik, B.; Klein, O. How Self-Compassion Moderates the Relation Between Body Surveillance and Body Shame Among Men and Women. Mindfulness 2020, 11, 2298–2313.
  61. Benda, J.; Reichová, A. Psychometrické Charakteristiky České Verze Self-Compassion Scale (SCS-CZ). . Českoslov. Psychol. Časopis Psychol. Teor. Praxi 2016, 60, 120–136.
  62. Montero-Marin, J.; Kuyken, W.; Crane, C.; Gu, J.; Baer, R.; Al-Awamleh, A.A.; Akutsu, S.; Araya-Véliz, C.; Ghorbani, N.; Chen, Z.J.; et al. Self-Compassion and Cultural Values: A Cross-Cultural Study of Self-Compassion Using a Multitrait-Multimethod (MTMM) Analytical Procedure. Front. Psychol. 2018, 9, 2638.
  63. Hofstede, G.H. Culture’s Consequences: Comparing Values, Behaviors, Institutions, and Organizations across Nations, 2nd ed.; Sage Publications: Thousand Oaks, CA, USA, 2001; ISBN 978-0-8039-7323-7.
  64. Hofstede Insights. Available online: https://www.hofstede-insights.com/country-comparison/czech-republic,germany,the-uk,the-usa/ (accessed on 23 December 2020).
  65. Suveg, C.; Morelen, D.; Brewer, G.A.; Thomassin, K. The Emotion Dysregulation Model of Anxiety: A Preliminary Path Analytic Examination. J. Anxiety Disord. 2010, 24, 924–930.
  66. Carver, C.S.; Scheier, M.F.; Weintraub, J.K. Assessing Coping Strategies: A Theoretically Based Approach. J. Pers. Soc. Psychol. 1989, 56, 267–283.
  67. Lazarus, R.S.; Folkman, S. Stress, Appraisal, and Coping; 11. ; Springer: New York, NY, USA, 1984; ISBN 978-0-8261-4191-0.
  68. Sher, K.J.; Grekin, E.R. Alcohol and Affect Regulation. In Handbook of Emotion Regulation; Gross, J.J., Ed.; Guilford Press: New York, NY, USA, 2007; pp. 560–580.
  69. Depue, R.A.; Morrone-Strupinsky, J.V. A Neurobehavioral Model of Affiliative Bonding: Implications for Conceptualizing a Human Trait of Affiliation. Behav. Brain Sci. 2005, 28.
  70. Gilbert, P. Evolutionary Approaches to Psychopathology: The Role of Natural Defences. Aust. N. Z. J. Psychiatry 2001, 35, 17–27.
  71. Gilbert, P. Compassion: Conceptualisations, Research and Use in Psychotherapy, 1st ed.; Routledge: New York, NY, USA, 2005; ISBN 978-1-58391-982-8.
More
© Text is available under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/)
Video Production Service
Feedback