The current results underscore the significant role of cognitive, affective, and behavioral factors in perceived physical disability and their mediated detrimental effect on physical and psychological quality of life in patients with rheumatic diseases. Implications for rehabilitation The fear-avoidance model is applicable to the prediction of quality of life in patients with rheumatic diseases. As pain-catastrophizing and fear-avoidance beliefs are important factors linked to physical disability and depression, intervening these cognitive factors is necessary to improve physical function and depression in patients with rheumatic diseases. Considering the strong association between depression and physical and psychological quality of life, the assessment and treatment of the former should be included in the rehabilitation of patients with rheumatic diseases. Interventions targeting physical function and depression are likely to be effective in terms of improving physical and psychological quality of life in patients with rheumatic diseases.

BackgroundMedical students face a variety of stressors associated with their education; if not promptly identified and adequately dealt with, it may bring about several negative consequences in terms of mental health and academic performance. This study examined psychometric properties of the Korean version of the Higher Education Stress Inventory (K-HESI).MethodsThe reliability and validity of the K-HESI were examined in a large scale multi-site survey involving 7110 medical students. The K-HESI, Beck Depression Inventory (BDI) and questions regarding quality of life (QOL) and self-rated physical health (SPH) were administered.ResultsExploratory factor analysis of the K-HESI identified seven factors: Low commitment; financial concerns; teacher-student relationship; worries about future profession; non-supportive climate; workload; and dissatisfaction with education. A subsequent confirmatory factor analysis supported the 7-factor model. Internal consistency of the K-HESI was satisfactory (Cronbach’s α = .78). Convergent validity was demonstrated by its positive association with the BDI. Known group validity was supported by the K-HESI’s ability to detect significant differences on the overall and subscale scores of K-HESI according to different levels of QOL and SPH.ConclusionsThe K-HESI is a psychometrically valid tool that comprehensively assesses various relevant stressors related to medical education. Evidence-based stress management in medical education empirically guided by the regular assessment of stress using reliable and valid measure is warranted.

Depression is related to a higher initial level of DD and its faster rate change which in turn, predicted end-semester fatigue, identifying one of the possible pathways through which depression impacts the functioning and health of affected students.

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Background: Late chronotype is known to be related with decreased overall health of college students. Yet, the factors that mediate the relationship between chronotype and physical quality of life (QOL) are relatively less studied. Methods: College students (N=566, mean age=21.3, 56.4% male) completed Composite Scale for Mornings (CSM), Chalder Fatigue Scale (CFQ), Maslach Burnout Inventory-Student Survey (MBI-SS), and World Health Organization Quality of Life Instrument-Short Version (WHOQOL-BREF). PROCESS macro for SPSS was used to examine the mediating effects. Covariates included sex, living status, financial difficulty, academic stress, anxiety and depression. Results: The direct effect of chronotype on physical QOL was not significant (c'=0.010, p=.341). The indirect effects of chronotype on physical QOL through fatigue (a1b1=0.013, 95%CI 0.004∼0.023) and academic burnout (a2b2=0.005, 95%CI 0.001∼0.012) were significant. The serial mediating effect of fatigue and academic burnout between chronotype and physical QOL was significant (a1d21b2=0.001, 95%CI 0.000∼ 0.003). Conclusions: Late chronotype appears to be vulnerable to decreased physical QOL through its relation with increased fatigue and academic burnout. This warrants its intervention.