A study on the efficacy of Group PM+ on depressed mood in medical students

A study on the efficacy of Group PM+ on depressed mood in medical students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A study on the efficacy of Group PM+ on depressed mood in medical students Bing Zhang, Sifan Ji, Yuqiu Cui, Yang Guo, Cheng Jiang, Tingting Yang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4858811/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective： The prevalence of mental health problems among medical students is higher than that of students in other disciplines and continues to increase, which may pose a risk to medical students in their subsequent studies and careers. This study adopts a Group Problem Manager Plus (PM+) intervention with medical students and investigates its effectiveness. The study demonstrates the effectiveness of Group PM+ at treating depressed mood and mental health illnesses, providing an important theoretical and experimental basis for new therapies to improve the physical and mental health of medical students. Methods: (1) Participants: Fifty-two participants were recruited through online distribution of the scale and randomly divided into an experimental group (received 5 weekly sessions of the Group PM+ intervention) and a control group (sharing psychology knowledge online only) after interviewing each participant individually. (2) Scales: The participants in both groups completed pre- and post-tests that included the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), UCLA Loneliness Scale, Toronto Alexithymia Scale (TAS), and Chinese version of the Interpersonal Reactivity Index (IRI-C). Results: (1) The results of the repeated measures ANOVA showed a significant improvement in depressed mood in Group PM+ (F 1,43 = 10.460, P = 0.002) and significantly improved anxiety (F 1,43 = 19.007, P < 0.001). (2) The Group PM+ intervention also diminished feelings of loneliness due to depressed mood and partially improved alexithymia. Conclusions: (1) Group PM+ interventions can effectively treat depression and anxiety in medical students, alleviate feelings of loneliness, and reduce alexithymia in this population. Group Problem Management Plus Depressed mood Loneliness Alexithymia Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Emotional disorders are a significant contributor to the global burden of disease 1 , and individuals aged 18 – 24 years are particularly vulnerable to mental health disorders such as major depression, anxiety, and psychiatric comorbidity 2, 3 . Depression is one of the most common mood disorders 4 . It is estimated that approximately 13% – 20% of people will experience depression in their lifetime, with a lifetime prevalence of 6.1%–9.5%, of which 75% of those with depression will relapse and the prognosis tends to worsen with each relapse. Treatment for depression is also complex and expensive. Currently, Cognitive Behavior Therapy (CBT) and Discriminative Behavior Therapy (DBT) are considered the most reliable treatment methods, but their intervention protocols are both complex and expensive 5 . The high cost of psychological treatment and concerns about the side effects of medication have made timely and effective psychological and pharmacological interventions simply unavailable to the university student population. Some studies have suggested that low-intensity psychological interventions delivered by trained paraprofessionals are a potential solution to this problem 6 . The Problem Manager (PM+) is a low-intensity, highly structured, and easy-to-use psychological intervention, and emphasis is placed on the fact that the therapy can be delivered by trained non-specialist assistants 7 . The PM+ intervention has been extensively researched around the world as a World Health Organization (WHO)-approved psychological treatment. 1.1 Current situation of medical students College students face unprecedented levels of stress that seriously affect their physical and mental health, and this population is at high risk of mood disorders 8 . The American College Health Association-National College Health Assessment (ACHA-NCHA) survey assessed mental health diagnoses and suicide rates in the United States in the previous year. It found that the incidence of depression in the US college student population increased by 4.6% between 1998 and 2008 9 . The association's 2015 survey found a significant increase in depression and anxiety as well as suicide rates among college students 10 . In China, the mental health status of college students is also not optimistic. A survey conducted by the Chinese Centre for Disease Control and Prevention revealed that approximately 20% of university students nationwide have varying degrees of psychological disorders, with depressive disorders being the most prominent 11 . Of these, the most prominent mental health problems are among medical students. Depression and suicidal ideation are major public health problems in medical schools. A US study showed that around a quarter of first- and second-year medical students showed signs of depression 12 . Another survey conducted among UK students showed that around 30% of medical students suffer from or have been treated for mental illness. A study carried out in Germany provided evidence that newly enrolled medical students have a higher prevalence of psychosomatic disorders and panic disorder compared to the general population 13 . A meta-analysis of the national prevalence of depression among Chinese medical students, which reported an overall prevalence of 29%, found that the prevalence of depression, anxiety, and suicidal ideation among Chinese medical students was higher than the rates observed among students in other specialties in China, as well as among medical students from other countries 14 . 1.2 The concept of depression Depressed mood and some of the accompanying emotional and physical symptoms can greatly reduce an individual's quality of life. In this study, depressed mood does not meet the clinical diagnosis of depression, but rather reflects mild levels, and only represents a negative subjective experience for healthy people. It is characterized by an abnormally low and persistent mood that can affect an individual’s living and learning conditions in the long term. The main symptoms of depression in university students are as follows: (1) a lower than usual mood; (2) loss of interest in activities; (3) sleep disturbances; (4) laziness, aversion to exercise, and loss of appetite; and (5) suicidal thoughts and behaviors 15 . If these mental health problems are not properly addressed, they can persist into adulthood and future work 16 . For medical students with emotional disturbances, these problems can lead to many negative personal effects and professional consequences (e.g., impairment of their quality of life, increased risk of suicidal ideation, and reduced academic performance, professionalism and empathy for patients) 17 . 1.3 Other emotional problems associated with depressed mood Alexithymia was originally coined by Nemiah and Sifneos to describe a range of cognitive and emotional deficits in the perception, differentiation, processing and expression of emotions 18 . These patients often exhibit symptoms of emotional dysregulation and an inability to self-soothe or manage their emotions appropriately 19 . Based on the results of an extensive literature review, there are two views on alexithymia and depression. One is that alexithymia is a personality trait independent of depressed mood and a predisposing factor for depression. Francisco et al. conducted a study on a population of university students and found that when university students' psychological pain scores improved significantly, the severity of their alexithymia did not change significantly. This finding could demonstrate that alexithymia is independent of depression 20 . Alexithymia is an independent personality trait that is not stable, but rather a temporary and transient trait that individuals may experience when faced with stress and threat (secondary acute illness) 21 . Individuals with alexithymia are more likely to suffer from depressed mood than others 22 . In addition, the findings of Porcelli et al. demonstrated that individuals with alexithymia are more likely to suffer from depressed mood than the general population 23 . Second, it is believed that alexithymia is one of the responses to depressive symptoms and that the two overlap with each other 24 . It was found that levels of depressed mood and alexithymia were significantly correlated and one of the main factors influencing alexithymia 25 . An analysis of the mediation of personality traits, depression, and alexithymia showed that depressed mood mediates between personality traits and alexithymia, and that personality traits can affect alexithymia either directly or through depression 26 . Loneliness is defined as a perceived deficit in social relationships. As a negative emotion, it has been identified as a trigger for depression 27 . Loneliness is the most common negative emotion in the university student population 28 . Erikson's eight-stage theory of life development states that the main task of the university stage is to gain a sense of intimacy and the need to establish good and stable interpersonal relationships; otherwise, one is prone to loneliness. Moreover, the ability to learn intimacy plays an important role in whether university students can enter society satisfactorily 29 . Prolonged loneliness can threaten an individual's future mental health and some indicators of psychosocial functioning 30 . Some studies have shown that male university students have significantly higher levels of loneliness than female university students, and that higher levels of loneliness are associated with higher depressed mood scores, which can be used as a predictor of depressed mood 31, 32 . 1.4 Interventions for depressed mood Numerous studies on depressed mood in college students have been conducted, and numerous successful interventions have been suggested, including Group Therapy 33, 34 , Music Therapy 35 , Exercise Therapy 36-38 , Acceptance and Commitment Therapy (ACT) 39 , Self-help Mindfulness Course 40, 41 , Expressive Arts Therapy 42 , Meridian-following Meditation 43 , and Integration Therapy of Five Wefts 44 . Studies have shown that these therapies can successfully reduce anxiety and depressed mood in university students while also improving their psychological well-being. This can help them to explore who they are and how they feel in the future, giving them the confidence to face life's challenges. The university student population simply cannot access timely and efficient psychological and pharmaceutical interventions due to high levels of academic stress, the high cost of psychological care, and concerns about the adverse effects of medicines. According to several studies, this issue might be resolved by low-intensity psychological therapies given by qualified laypeople 6 . 1.5 Problem Management Plus (PM+） Having been widely applied in post-disaster psychological interventions worldwide, Problem Management Plus (PM+), developed by the WHO in conjunction with cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT), is a well-established intervention technique with scientific and practical validity tested in randomized controlled trials 45 . It is a common intervention strategy that has undergone both scientific and applied testing in randomized controlled studies 46 . A study that validated PM+ with emotional processing (PM+EP) found that it can be widely duplicated in the Netherlands and that PM+ delivers a more palatable intervention for Dutch migrants. A culturally relevant PM+ intervention was used in Pakistan, and the outcomes revealed that PM+ significantly decreased levels of anxiety and sadness, increasing their quality of life 47, 48 . The outcomes of a randomized controlled trial of a PM+ intervention and Enhanced Everyday Care (EUC) demonstrated that a group PM+ intervention program was feasible in Nepal and that PM+ interventions delivered by laypeople were more effective in reducing individuals' psychological distress compared to a conventional treatment group 49 . These results are also consistent with the findings of a previous study that showed that effective PM+ interventions can also be delivered by non-professionals 50 . The PM+, which is a low-intensity, structured and simple-to-use psychological intervention, emphasizes that trained non-specialist assistants can deliver the therapy 7 . The PM+ has been introduced as an innovative psychological intervention in China for a long time, but no research has been conducted on depression among college students. In this study, we employed Group PM+ as an intervention in the treatment of depressed mood among college students in order to study whether the Group PM+ intervention has an impact on certain cognitive disorders (e.g., alexithymia, loneliness, and interpersonal communication) caused by anxiety and depressed mood in this population. The study also provides a theoretical basis for PM+ to improve depressed mood in university students, and encourages laypeople to understand it and learn how to apply it. 1.6 Research hypothesis The following hypotheses are put forth in this study based on a synthesis of the literature on depressive mood in medical students: The PM+ intervention can successfully alleviate anxiety and depressive symptoms in medical students. Alexithymia, loneliness, and pain empathy in medical students who are depressed can be treated by the PM+ intervention. 2. Methods 2.1 Participants The participants were recruited from March 2022 to April 2022, and the PHQ-9 scale was administered at Anhui Medical University, China. The inclusion criteria were as follows: students (18–30 years old) enrolled at Anhui Medical University and who have a PHQ-9 score of at least 4; willing to provide written informed consent; willing to undergo appropriate exams after being made aware of the study; and have no history of serious somatic illnesses. The exclusion criteria were as follows: ( 1 ) students who were unable to provide certain basic information; ( 2 ) those currently being treated for depressed mood and taking psychotropic medication; ( 3 ) those who refused to undergo the examination and withdrew from the study early; and ( 4 ) those with a history of traumatic brain injuries or who were also suffering from serious physical conditions like cardiac or hepatic insufficiency. Fifty-two participants were finally recruited, of whom 24 were male and 28 were female. All participants provided voluntary written informed consent to participate in the research without being informed of the purpose of the study. The study was reviewed by the Ethics Committee of Anhui Medical University (ethics approval number 83220384). 2.2 Research tools 2.2.1 Assessment tools ( 1 ) Background information: gender, age, years of education, place of residence, whether the child is an only child, father's/mother's education level, family economic situation, family members with any suicidal or violent tendencies, and self-assessed academic stress. ( 2 ) The Patient Health Questionnaire-9 (PHQ-9) is one of the internationally used screening scales for depression. The scale is helpful for determining the intensity of depressed mood and may be diagnostically valid because it has nine categories that address the DSM-5 diagnostic criteria for depression 51–53 . A total score of 0–27 is assigned to the scale, which is assessed according to a four-point (0–3) scale. Cronbach's alpha was 0.90. ( 3 ) The Generalized Anxiety Scale (GAD-7) is a simple self-assessment scale for anxiety developed by Spitzer et al. 54 , which covers the diagnostic criteria for anxiety disorders in the DSM-4. Moreover, it can sensitively detect subjects' anxiety with high specificity 55, 56 . The scale is rated on a four-point (0–3) scale with a total score of 0–21. Cronbach's alpha was 0.90. ( 4 ) The Toronto Alexithymia Scale (TAS-20) 57, 58 , the Chinese version of which was used in this study. The scale is divided into three dimensions consisting of seven items for Difficulty Identifying Feelings (DIF), five items for Difficulty Describing Feelings (DDF), and eight items for Externally-oriented Thinking (EOT), producing a total of 20 items, each of which is scored according to a five-point ( 1 – 5 ) scale, with a total score of 20–100. Higher total scores and higher corresponding scores of each factor indicate greater severity of the disorder. Cronbach's alpha was 0.86. ( 5 ) The first version of the UCLA Loneliness Scale was developed in 1978 by Russell et al. and has been revised twice, in 1980 and 1988 59 . This third version of the scale was adopted to measure loneliness caused by a gap between an individual's desire to socialize and their actual level of loneliness. The full scale consists of 20 items, each rated on a four-point ( 1 – 4 ) scale with a total score of 20–80, with higher scores being associated with higher levels of loneliness. Cronbach's alpha was 0.91. 2.3 Intervention implementation 2.3.1 Intervention settings The participants were randomly assigned to the experimental and control groups. Due to restrictions in the number of participants in group therapy, the experimental group included 24 participants. The experimental group was then randomly divided into three sub-groups, each of which comprised eight participants. A primary therapist and five assistants, all of whom had completed comprehensive training in PM + treatments, carried out the intervention with the participants. The study coordinator randomly allocated three assistants to each group. The assistants entered the group with the lead therapist and scrupulously adhered to the PM + intervention protocol. All therapists were required to read the manual carefully before each group PM + intervention in order to familiarize themselves with its contents and to prepare the appropriate PSYCHOLOPS assessment materials (i.e., the PSYCHOLOPS assessment accompanies the PM + manual) in order to more effectively assess the participants. To further support the participants in problem solving and self-improvement, the therapists were also required to give the subjects homework after the intervention. The team of therapists held oversight meetings every 2 weeks to monitor the quality of their intervention and to ensure it was consistent and successful. 2.3.2 Control group intervention program For the participants in the control group, standard pre- and post-tests of the scales were administered, and once a week, without any extra psychological interventions, psychological trivia was shared and made public online. 2.3.3 Experimental group intervention program The primary objective of the Group PM + was to help depressed college students to realize that the difficulties and stress that they were experiencing are common, as well as to provide independent stress-relieving and problem-solving techniques that can be applied to future challenges. For 5 weeks, each cohort of Group PM + participants attended 1.5 hours of weekly sessions. Each lesson focused on teaching the participants stress management techniques and problem-solving abilities. The PM + was based on four main strategies: ( 1 ) stress management, which taught the participants stress reduction techniques (e.g., mindfulness, meditation, or relaxation breathing); ( 2 ) problem management, which focused on managing real-world problems; ( 3 ) “sit, talk, and act”, which emphasized behavioral activation, primarily in the context of depression; and ( 4 ) consolidation of interpersonal bonds, which encouraged the participants to demonstrate initiative in building interpersonal relationships. This program also addressed behavioral activation, which concentrates on the behavioral withdrawal that occurs in depressed individuals as a result of their low mood. 2.3.4 Statistical analyses SPSS version 21.0 (IBM Corp, Armonk, NY, USA) was used for statistical analysis. All data analyses were performed using two-tailed tests with a P -value of < 0.05 as the criterion for statistical significance. Continuous variables were statistically described using the mean ± standard deviation, and main effects and interactions were tested by performing repeated measures analysis of variance (ANOVA), with simple effects analyses used when the interactions were significant. When the interactions were not significant, within-group comparisons were conducted using paired-samples t-tests (i.e., pre- and post-tests for the experimental group, and pre- and post-tests for the control group); categorical variables were statistically described in the form of instances and analyzed using the chi-squared test. 3. Results 3.1 Demographic data 3.1.1 Lost to follow-up of research subjects. This study recruited 52 medical students with depressed mood from Anhui Medical University, China, as the research participants. The control group consisted of 26 cases, and 21 cases were considered effective. The experimental group also comprised 26 cases, and 23 were deemed effective, resulting in an overall effective rate of 84.62%. The cases lost to follow-up were due to voluntary withdrawal from treatment. A detailed flowchart is shown in Fig. 1. Figure 1. Experimental procedures 3.1.2 Comparison of demographic information of subjects in the two groups A total of 44 medical students with depressed mood were included in this study and randomly divided into control and intervention groups. There were 21 cases in the control group: nine males and 12 females, aged 20.14 ± 1.82 years, with 14.48 ± 1.60 years of education. The experimental group comprised 23 cases: 10 males and 13 females, aged 20.22 ± 3.09 years, with 14.39 ± 1.75 years of education. The differences between the two groups in terms of gender, age, years of education, father's literacy, residence, annual family income, the presence of suicidal or violent behaviors by family members (or relatives), and academic pressure were not statistically significant ( P > 0.05), and the two groups were comparable, as shown in Table 1 . Table 1 Comparison of demographic information between the two groups of participants PM+(n = 21) Control(n = 23) χ 2 / t p Sex Male 9 10 0.002 0.967 Female 12 13 Age 20.14 ± 1.82 20.22 ± 3.09 0.096 0.924 Educational attainment 14.48 ± 1.60 14.39 ± 1.75 -0.167 0.868 Residence City 11 17 2.199 0.138 Village 10 6 The only child Yes 4 7 0.759 0.384 No 17 16 Father's education level Primary school 8 5 2.273 0.518 Middle school 5 5 High school 5 10 Bachelor and above 3 3 Mother's education level Primary school 11 3 9.214 0.027 Middle school 6 10 High school 1 6 Bachelor and above 3 4 Annual household income Hard 1 1 0.009 0.995 Normal 19 21 Wealth 1 1 Any suicidal or violent behavior by family members (or relatives) Yes 0 4 4.495 0.106 No 20 17 Unclear 1 2 Academic pressure High 8 12 1.474 0.479 Normal 12 9 Low 1 2 3.2 Scale results 3.2.1 Comparison of depressed mood between the two groups Before the intervention, the PHQ-9 scores of the experimental group were 13.30 ± 6.219, while the scores of the control group were 10.32 ± 4.864 (Table 2 , Fig. 2 ). The time × group repeated measures ANOVA interaction was significant (F 1, 43 = 10.460, P = 0.002). For the experimental group, PHQ-9 scores were reduced by an average of 6.636 ± 5.377 points from the beginning to the end of the intervention, whereas an average reduction of 2.476 ± 3.737 points was observed in the control group. The t-test results showed that the experimental group reduced its scores significantly more than the control group (t 41 = -2.933, P = 0.005). After 5 weeks of intervention, 17 participants (74%) in the experimental group showed remission from depressed mood (downgraded according to the severity of the scale) compared to five participants (23%) in the control group. The difference in the number of remissions between the two groups was significant (χ 2 = 11.790, P = 0.003). 3.2.2 Comparison of anxiety between the two groups For anxiety symptoms, the GAD-7 score before the intervention was 9.04 ± 4.753 for the experimental group and 5.77 ± 2.844 for the control group (Table 2 , Fig. 2 ). The results of the interaction of time × group repeated measures ANOVA was significant (F 1, 43 = 19.007, P < 0.001). For the experimental group, GAD-7 scores were reduced by a mean of 3.435 ± 3.987 points from the beginning to the end of the intervention; however, the control group leveled off while anxiety increased by 1.045 ± 2.768 points. T-test results showed that the experimental group's reduction in scores was significantly greater than that of the control group (t 43 = 4.360, P < 0.001). After 5 weeks of intervention, 12 cases (52%) in the experimental group showed remission from depressed mood (downgraded according to the severity of the scale) and two cases (9%) in the control group. The difference in the number of remissions between the two groups was significant (χ 2 = 9.738, P = 0.002). Table 2 Comparison of symptoms pre- and post- between the two groups PM+ Control F p Pre Post Pre Post PHQ-9 13.30 ± 6.22 5.97 ± 3.16 10.32 ± 4.86 7.95 ± 4.08 10.46 0.002** GAD-7 9.04 ± 4.75 5.61 ± 4.19 5.77 ± 2.84 6.82 ± 3.17 4.603 < 0.001*** 3.2.3 Comparison of loneliness between the two groups The results of the repeated measures ANOVA showed a significant main effect of the pre- and post-tests (F (1, 44) = 24.044, P < 0.001) and a significant interaction between the pre- and post-test and group (F (1, 44) = 41.317, P < 0.001). The simple effects results showed a non-significant difference between the pre- and post-tests for the experimental group and control group (F (1, 44) = 0.978, P = 0.328), and a significant difference in the post-test for the control group of the experimental group (F (1, 44) = 18.409, P < 0.001). The difference between the pre- and post-tests of the experimental group was significant (F (1, 44) = 65.659, P < 0.001), and the difference between the pre- and post-tests of the control group was not significant (F (1, 44) = 1.317, P = 0.292). The results showed that the level of loneliness in the PM + experimental group was significantly lower in the post-test than that in the pre-test. Furthermore, in the post-test, a statistically significant difference in loneliness was observed between the PM + group and the control group. The results are shown in Table 3 and Fig. 3 . Table 3 Comparison of loneliness between the two groups Pre Post F P PM+ 51.96 ± 8.233 44.70 ± 9.65 65.659 < 0.001 Control 50.07 ± 7.40 45.77 ± 7.48 1.317 0.292 F 0.978 18.409 P 0.328 < 0.001 3.2.3 Comparison of alexithymia between the two groups The effect of group PM + on alexithymia was analyzed using a 2 × 2 × 3 repeated measures ANOVA. The results of the repeated measures ANOVA test for time (pre-, post-) × group (PM+, control) × factors (DIF, DDF, EOT) showed a significant main effect of time (F (1,44) = 26.573, P < 0.001), a significant interaction of time × group (F (1,44) = 26.573, P < 0.001), and showed a non-significant difference between groups in the pre-test (F (1,44) = 1.297, P = 0.261), a significant difference between groups in the post-test (F (1,44) = 4.178; P = 0.047), a significant difference between the pre- and post-tests for the experimental group (F (1,44) = 54.355; P < 0.001), and a non-significant difference between the pre- and post-tests for the control group. The results also revealed a significant main effect of factors (F (3,132) = 62.771; P < 0.001). In addition, the factors × group interaction was not significant (F (1,44) = 0.453; P = 0.590), and the time × group × factors interaction was not significant (F (3,132) = 1.355, P = 0.263). The data are presented in Table 4 and Fig. 4 . Table 4 Comparison of alexithymia between the two groups PM+ t P Control t P Pre Post pre post TAS 60.44 ± 11.72 55.48 ± 11.45 2.748 0.012 58.22 ± 10.41 56.14 ± 10.35 0.001 0.99 DIF 22.48 ± 5.51 20.22 ± 5.75 3.081 0.005 21.73 ± 5.43 20.95 ± 5.36 0.871 0.394 DDF 17.09 ± 3.52 14.52 ± 3.29 4.596 < 0.001 15.23 ± 4.08 15.32 ± 3.29 -0.119 0.907 EOT 20.39 ± 4.80 20.74 ± 3.81 -0.479 0.637 19.18 ± 4.21 19.86 ± 3.44 -0.854 0.403 4. Discussion This study is the first to apply the Group PM + among medical students to compare changes in depressed mood, anxiety, loneliness, and alexithymia before and after the PM + intervention. The experiment yielded the following results: the Group PM + had significant efficacy in improving depressed mood and anxiety in the medical students, and also improved alexithymia and loneliness in this population. Furthermore, the difference between the experimental group and the control group in each of the aspects of the intervention was statistically significant. The results of the study showed that the Group PM + intervention program was effective in improving depressed mood and anxiety in medical students, which is consistent with the hypothesis and previous research findings. The PM + intervention is more often used for crisis intervention and the provision of psychological support for people in war-torn or natural disaster-stricken areas who are in a state of chronic fear, despair, and hopelessness. The PM + can help to improve mental health problems and enable such individuals to find trustworthy social supports to help them to cope with the same difficulties in the future 48–50, 60–65 . China has also conducted a brief study of the PM+, in which Liu et al. 66 intervened with residents in a state of stress during the COVID-19 epidemic through the provision of online PM+. The results showed that PM + interventions were effective in improving residents' depressed mood and anxiety, and showed efficacy in relieving their stress and accompanying somatic symptoms. When people encounter adversity, most experience symptoms of depression; however, the symptoms manifest in different ways for different people. For medical students, the symptoms usually take the form of fatigue, despair, persistent low mood, and lack of motivation, which causes them to lose interest in activities that are otherwise enjoyable. Moreover, somatic complaints such as pain are usually present. Without a timely intervention, medical students can become trapped in a vicious cycle characterized by an unwillingness to engage in activities, low mood, and avoidance of daily activities. PM + interventions can improve depressed mood by as it involves developing and implementing programs that encourage clients to break this vicious cycle and to actively engage in activities, thus promoting their sense of achievement and confidence. However, in this study, after the Group PM + intervention, the participants' anxiety and depressed mood showed a significant improvement, but the difference was not significant compared with the control group, which may be related to the participants' education level and a higher capacity for self-regulation. In summary, our findings provide a theoretical basis for the efficacy of the Group PM + intervention and can be used to improve depressed mood in medical students. The results of the study showed that the Group PM + intervention program effectively improved loneliness and alexithymia in medical students, which was consistent with the research hypothesis and the results of previous studies. Liu et al. 67 conducted psychological training for freshly recruited recruits during the intensive training period through the PM + intervention. The study showed that the PM + could effectively reinforce positive emotions, strengthen levels of social support, and effectively reduce stress levels, thereby allowing the recruits to apply positive coping styles to deal with the difficulties they faced. Many studies have analyzed the development of alexithymia by drawing on social learning and psychodynamic theories 68 . High levels of alexithymia among medical students can be largely explained by the current stage of depression, academic pressures, domestic epidemic prevention and control policies, and the social value of blindly pursuing real needs. As part of daily education, greater attention should be paid to addressing the mental health needs of medical students, in an effort to relieve some of the pressure and stress that they encounter, and to alleviate feelings of loneliness, while encouraging them to form the correct values. Meanwhile, relevant studies have shown that cognitive-behavioral therapies, such as relaxation training, role-playing, self-practice, and other therapeutic programs, can improve alexithymia and loneliness 69 . However, the efficacy of psychotherapeutic programs that rely only on verbal forms of communication, such as psychoanalysis and psychodynamic programs, is not significant and may even worsen symptoms of alexithymia 70, 71 . Therefore, it is important to choose the right program when treating individuals with alexithymia. The therapeutic process of the PM + intervention focuses more on encouraging visitors to speak for themselves about the current distress they are facing, find solutions that work for them on their own, and seeks out social supports that they can trust. When people have access to good social supports (i.e., trustworthy friends, family members, community workers, mental health support groups), they tend to be able to cope with the emotional distress caused by situations of adversity. However, medical students are affected by emotional distress such as depressed mood and anxiety; they tend to isolate themselves and are reluctant to actively seek social support. As such, self-isolation in the long run can have a devastating impact on their emotional health. The results of a study exploring the mediating role of social support in alleviating loneliness and depressed mood in college students showed that loneliness directly predicted depressed mood and also indirectly predicted depressed mood through social support, which confirms that social support can effectively alleviate the negative effects of loneliness in college students 72 . The PM + intervention can help medical students to gradually build up their confidence in interacting with others and consolidate their social support, thus alleviating symptoms of alexithymia and loneliness caused by depression. 5. Conclusion The Group PM + intervention program can effectively improve anxiety and depression in medical students, reduce their sense of isolation, and decrease alexithymia symptoms. Currently, medical students are reluctant and afraid to seek professional psychological counseling when faced with emotional distress or mental health problems, which contributes to a higher incidence of depressed mood and other psychological disorders. Indeed, it is widely believed that only those who are “mentally ill” or “mentally retarded” attend psychotherapy. Emotional difficulties and mental health issues cause medical students to feel discouraged and fearful, which increases the prevalence of depressed mood and other mental health problems. Sangraula et al. conducted a PM + feasibility trial with a sample involving various settings and participants, and discovered that mental health stigma is one of the factors that contributed to patients' reluctance to accept PM + interventions 49 . In order to boost the acceptability, demand, and effectiveness of PM + marketing in the future, reasonable PM + programs must be created based on the requirements of the community. Declarations Acknowledgements Many thanks to Dr Graeme J Taylor and R. Michael Bagby for developing the TAS-20 scale and for their support of this study. I have had the privilege of working with colleagues and friends who care deeply about the psychiatry profession. I want to thank them for their ideas, advice and unwavering support. We thank International Science Editing (http://www. internationalscienceediting.com) for editing this manuscript. Authors’ contributions Bing Zhang collected the relevant data, designed the study, analyzed the data, and wrote the manuscript. Many thanks to the authors for their contributions to this article. In particular, Sifan Ji, Yuqiu Cui, Yang Guo, and Cheng Jiang gave a great deal of support in the collection of data for the study, and Dr Kongliang He, Dr Fengqiong Yu gave very important help in the analysis of the data. Funding This work was supported by the Hefei City financial support (Hwk2021zd013). Data availability The data that support the findings of this study are available from Anhui Medical University but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki. Participants and their guardians completed informed consent forms at the beginning of the study. All materials, measures, methods and procedures were approved by the ethics committee of the Anhui Medical University (IRB: 83220384). Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Ferrari AJ, Charlson FJ, Norman RE, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS medicine . Nov 2013;10(11):e1001547. doi:10.1371/journal.pmed.1001547 Wittchen HU, Nelson CB, Lachner G. Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychological medicine . Jan 1998;28(1):109-26. doi:10.1017/s0033291797005928 Patten SB. Major depression prevalence in Calgary. Canadian journal of psychiatry Revue canadienne de psychiatrie . Dec 2000;45(10):923-6. doi:10.1177/070674370004501008 McCarron RM, Shapiro B, Rawles J, Luo J. Depression. Annals of internal medicine . May 2021;174(5):Itc65-itc80. doi:10.7326/aitc202105180 Richards DA, Ekers D, McMillan D, et al. Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet (London, England) . Aug 27 2016;388(10047):871-80. doi:10.1016/s0140-6736(16)31140-0 Doukani A, Free C, Michelson D, et al. Towards a conceptual framework of the working alliance in a blended low-intensity cognitive behavioural therapy intervention for depression in primary mental health care: a qualitative study. BMJ Open . Sep 23 2020;10(9):e036299. doi:10.1136/bmjopen-2019-036299 Sijbrandij M, Farooq S, Bryant RA, et al. Correction to: Problem management plus (PM+) for common mental disorders in a humanitarian setting in Pakistan; study protocol for a randomised controlled trial (RCT). BMC Psychiatry . Oct 15 2018;18(1):331. doi:10.1186/s12888-018-1922-5 Mortier P, Auerbach RP, Alonso J, et al. Suicidal Thoughts and Behaviors Among First-Year College Students: Results From the WMH-ICS Project. Journal of the American Academy of Child and Adolescent Psychiatry . Apr 2018;57(4):263-273.e1. doi:10.1016/j.jaac.2018.01.018 American College Health Association-National College Health Assessment Spring 2008 Reference Group Data Report (abridged): the American College Health Association. Journal of American college health : J of ACH . Mar-Apr 2009;57(5):477-88. doi:10.3200/jach.57.5.477-488 Liu CH, Stevens C, Wong SHM, Yasui M, Chen JA. The prevalence and predictors of mental health diagnoses and suicide among U.S. college students: Implications for addressing disparities in service use. Depression and anxiety . Jan 2019;36(1):8-17. doi:10.1002/da.22830 Zhou H, Li H, Zhou K, Xu R, Fu Y. Social Adjustment and Emotion Regulation in College Students with Depression-trait. Chinese Journal of Clinical Psychology . 2015;23(05):799-803. doi:10.16128/j.cnki.1005-3611.2015.05.009 Givens JL, Tjia J. Depressed medical students' use of mental health services and barriers to use. Academic medicine : journal of the Association of American Medical Colleges . Sep 2002;77(9):918-21. doi:10.1097/00001888-200209000-00024 Wege N, Muth T, Li J, Angerer P. Mental health among currently enrolled medical students in Germany. Public health . Mar 2016;132:92-100. doi:10.1016/j.puhe.2015.12.014 Zeng W, Chen R, Wang X, Zhang Q, Deng W. Prevalence of mental health problems among medical students in China: A meta-analysis. Medicine . May 2019;98(18):e15337. doi:10.1097/md.0000000000015337 Ye J. An introduction to depression in university students. Science and Technology Innovation Herald . 2009;(22):226. doi:10.16660/j.cnki.1674-098x.2009.22.193 Pine DS, Cohen P, Gurley D, Brook J, Ma Y. The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry . Jan 1998;55(1):56-64. doi:10.1001/archpsyc.55.1.56 Lins L, Carvalho FM, Menezes MS, Porto-Silva L, Damasceno H. Health-related quality of life of students from a private medical school in Brazil. Int J Med Educ . Nov 8 2015;6:149-54. doi:10.5116/ijme.563a.5dec Nemiah JC, Sifneos PE. Psychosomatic illness: a problem in communication. Psychother Psychosom . 1970;18(1):154-60. doi:10.1159/000286074 Alpaslan AH, Soylu N, Avci K, Coşkun K, Kocak U, Taş HU. Disordered eating attitudes, alexithymia and suicide probability among Turkish high school girls. Psychiatry Res . Mar 30 2015;226(1):224-9. doi:10.1016/j.psychres.2014.12.052 Francisco M-S, Manuel A-G, Elisabeth Córcoles A, Tania B, Jordi J. Stability in alexithymia levels: A longitudinal analysis on various emotional answers. Personality and Individual Differences . 1998;24(6):767-772. doi:https://doi.org/10.1016/S0191-8869(97)00239-0 Krystal H. Alexithymia and psychotherapy. Am J Psychother . Jan 1979;33(1):17-31. doi:10.1176/appi.psychotherapy.1979.33.1.17 Fisch RZ. Alexithymia, masked depression and loss in a Holocaust survivor. Br J Psychiatry . May 1989;154:708-10. doi:10.1192/bjp.154.5.708 Porcelli P, Leoci C, Guerra V, Taylor GJ, Bagby RM. A longitudinal study of alexithymia and psychological distress in inflammatory bowel disease. J Psychosom Res . Dec 1996;41(6):569-73. doi:10.1016/s0022-3999(96)00221-8 Haviland MG, Shaw DG, Cummings MA, MacMurray JP. Alexithymia: subscales and relationship to depression. Psychother Psychosom . 1988;50(3):164-70. doi:10.1159/000288115 Honkalampi K, Hintikka J, Tanskanen A, Lehtonen J, Viinamäki H. Depression is strongly associated with alexithymia in the general population. J Psychosom Res . Jan 2000;48(1):99-104. doi:10.1016/s0022-3999(99)00083-5 Zhang W. The relationship between affective disorders and personality traits in prison inmates and the development of a normative model . 硕士. China University of Political Science and Law; 2009. Erzen E, Çikrikci Ö. The effect of loneliness on depression: A meta-analysis. Int J Soc Psychiatry . Aug 2018;64(5):427-435. doi:10.1177/0020764018776349 Fu X, Li L. A study on suicide attitude and depression of university students. China Journal of Health Psychology . 2007;(01):42-45. doi:10.13342/j.cnki.cjhp.2007.01.017 Xue G, Zhao X. On the loneliness of Chinese university students and how to cope with it. Heilongjiang Researches on Higher Education . 2009;(02):140-143. Qualter P, Quinton SJ, Wagner H, Brown S. Loneliness, Interpersonal Distrust, and Alexithymia in University Students1. Journal of Applied Social Psychology . 2009;39(6):1461-1479. doi:https://doi.org/10.1111/j.1559-1816.2009.00491.x Ma P, Huang M, He B, Pan W, Zhao S. The influence of undergraduates' loneliness on depression:based on latent moderated structural equation. Journal of Psychological Science . 2021;44(05):1186-1192. doi:10.16719/j.cnki.1671-6981.20210522 Dai G, Guo W, Wang Z, Zeng F, Zhan X, Tan Z. The effect of college students' sense of loneliness on depression. China Journal of Health Psychology . 2017;25(02):297-299. doi:10.13342/j.cnki.cjhp.2017.02.036 Hu R, Chen J, Wang Y, Chen Z. Effectiveness of group training on depressive mood among college students: a Meta-analysis. Chinese Journal of School Health . 2017;38(05):676-679+682. doi:10.16835/j.cnki.1000-9817.2017.05.011 Li T, Ge L, Wang J, Xu Y. Intervention effects of self-confidence training on depressive mood and automatic thoughts of college students. Chinese Journal of Behavioral Medicine and Brain Science . 2016;25(02):171-174. Wang X, Hou J, Luo H, Yu X, Liu W, Li L. A study of the role of music therapy in improving depression in medical students. China Higher Medical Education . 2020;(06):89-90. Guo X, Yang Y. Intervention effects of physical activity on depressed mood in college students. Contemporary Sports Technology . 2017;7(22):237-238. doi:10.16655/j.cnki.2095-2813.2017.22.237 Yu Q, Li L, LI E. A meta-analysis of tai chi training to improve depression in school college students. Journal of International Psychiatry . 2019;46(03):409-412. doi:10.13479/j.cnki.jip.2019.03.008 Zhou W, Sun P, Liu K, Zhao Y, Xue J, zhao J. A Study on the Effect of Bodybuilding Training on Depression and Quality of Life of College Students. Sport Science and Technology . 2021;42(03):38-40+43. doi:10.14038/j.cnki.tykj.2021.03.014 Zhao W, Zou A. Group Counselling Design for Acceptance and Commitment Therapy Interventions for Depression in College Students. Education and Teaching Forum . 2013;(05):271-272. Li J, Luo X, Wang J. Intervention research of mindfulness-based cognitive therapy on depression of college students. Psychology Monthly . 2022;17(15):18-20+24. doi:10.19738/j.cnki.psy.2022.15.005 Zhang S, Ye K, Luo K. A study on the effectiveness of self-help mindfulness course in improving college students' depression. China Journal of Multimedia & Network Teaching . 2022;(07):86-89. Chen J, Song W, Li H, Xue Y. Exploring the Intervention of Expressive Arts Therapy on College Students' Depression and Anxiety--Taking Beijing Normal University as an Example. Art Education . 2021;(12):38-41. Wu Y, Sun J, Gu R, Li J. Effect of Meridian-following Meditation on Depression in College Students. Chinese General Practice . 2020;23(14):1796-1799. Xu C, Jiao Y, Zhang F, Zhang J, Li P, Zhao X. Intervention Study of Integration Therapy of Five Wefts on College Students' Depression Disorder. Value Engineering . 2017;36(04):143-146. doi:10.14018/j.cnki.cn13-1085/n.2017.04.058 Dawson KS, Bryant RA, Harper M, et al. Problem Management Plus (PM+): a WHO transdiagnostic psychological intervention for common mental health problems. World Psychiatry . Oct 2015;14(3):354-7. doi:10.1002/wps.20255 Alozkan Sever C, Cuijpers P, Mittendorfer-Rutz E, et al. Feasibility and acceptability of Problem Management Plus with Emotional Processing (PM+EP) for refugee youth living in the Netherlands: study protocol. Eur J Psychotraumatol . 2021;12(1):1947003. doi:10.1080/20008198.2021.1947003 Rahman A, Riaz N, Dawson KS, et al. Problem Management Plus (PM+): pilot trial of a WHO transdiagnostic psychological intervention in conflict-affected Pakistan. World Psychiatry . Jun 2016;15(2):182-3. doi:10.1002/wps.20312 Rahman A, Hamdani SU, Awan NR, et al. Effect of a Multicomponent Behavioral Intervention in Adults Impaired by Psychological Distress in a Conflict-Affected Area of Pakistan: A Randomized Clinical Trial. Jama . Dec 27 2016;316(24):2609-2617. doi:10.1001/jama.2016.17165 Sangraula M, Turner EL, Luitel NP, et al. Feasibility of Group Problem Management Plus (PM+) to improve mental health and functioning of adults in earthquake-affected communities in Nepal. Epidemiol Psychiatr Sci . May 26 2020;29:e130. doi:10.1017/s2045796020000414 Singla DR, Kohrt BA, Murray LK, Anand A, Chorpita BF, Patel V. Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries. Annu Rev Clin Psychol . May 8 2017;13:149-181. doi:10.1146/annurev-clinpsy-032816-045217 Kroenke K, Spitzer RL. The PHQ-9: A New Depression Diagnostic and Severity Measure. Psychiatric Annals . 2002;32(9) Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med . Sep 2001;16(9):606-13. doi:10.1046/j.1525-1497.2001.016009606.x Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Jama . Nov 10 1999;282(18):1737-44. doi:10.1001/jama.282.18.1737 Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med . May 22 2006;166(10):1092-7. doi:10.1001/archinte.166.10.1092 Plummer F, Manea L, Trepel D, McMillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. Gen Hosp Psychiatry . Mar-Apr 2016;39:24-31. doi:10.1016/j.genhosppsych.2015.11.005 Sousa TV, Viveiros V, Chai MV, et al. Reliability and validity of the Portuguese version of the Generalized Anxiety Disorder (GAD-7) scale. Health Qual Life Outcomes . Apr 25 2015;13:50. doi:10.1186/s12955-015-0244-2 Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale--I. Item selection and cross-validation of the factor structure. J Psychosom Res . Jan 1994;38(1):23-32. doi:10.1016/0022-3999(94)90005-1 Yuan Y, Sheng X, Zhang X, et al. The reliability and validity of Toronto alexithymia scale（TAS－20）. Sichuan Mental Health . 2003;(01):25-27. Russell D, Peplau LA, Cutrona CE. The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. J Pers Soc Psychol . Sep 1980;39(3):472-80. doi:10.1037//0022-3514.39.3.472 Spaaij J, Kiselev N, Berger C, et al. Feasibility and acceptability of Problem Management Plus (PM+) among Syrian refugees and asylum seekers in Switzerland: a mixed-method pilot randomized controlled trial. Eur J Psychotraumatol . 2022;13(1):2002027. doi:10.1080/20008198.2021.2002027 Jordans MJD, Kohrt BA, Sangraula M, et al. Effectiveness of Group Problem Management Plus, a brief psychological intervention for adults affected by humanitarian disasters in Nepal: A cluster randomized controlled trial. PLoS Med . Jun 2021;18(6):e1003621. doi:10.1371/journal.pmed.1003621 Zhang H, Zhang D, Lin H, Huang L. Problem Management Plus in the treatment of mental disorders in patients with multiple myeloma. Support Care Cancer . Oct 2020;28(10):4721-4727. doi:10.1007/s00520-019-05289-9 Uygun E, Ilkkursun Z, Sijbrandij M, et al. Protocol for a randomized controlled trial: peer-to-peer Group Problem Management Plus (PM+) for adult Syrian refugees in Turkey. Trials . Mar 20 2020;21(1):283. doi:10.1186/s13063-020-4166-x Sangraula M, Van't Hof E, Luitel NP, et al. Protocol for a feasibility study of group-based focused psychosocial support to improve the psychosocial well-being and functioning of adults affected by humanitarian crises in Nepal: Group Problem Management Plus (PM+). Pilot Feasibility Stud . 2018;4:126. doi:10.1186/s40814-018-0315-3 Sijbrandij M, Bryant RA, Schafer A, et al. Problem Management Plus (PM+) in the treatment of common mental disorders in women affected by gender-based violence and urban adversity in Kenya; study protocol for a randomized controlled trial. Int J Ment Health Syst . 2016;10:44. doi:10.1186/s13033-016-0075-5 Liu B, Chen J, Xiong W. The Intervention Effect of Online PM+ on Residents’ Stress Response in the COVID-19. Chinese Journal of Clinical Psychology . 2021;29(06):1353-1357+1322. doi:10.16128/j.cnki.1005-3611.2021.06.047 Liu Y, Liu X, Yang Y, Xu C, Li M. Intervention of psychological training of problem management plus ( PM + ) on improvement of psychological adaptability of recruits during training period. Journal of Army Medical University . 2022;44(20):2120-2129. doi:10.16016/j.2097-0927.202207076 Xiao J. The Relationship of College Students' Alexithymia,Life Event and Family Function . 硕士. Sichuan Normal University; 2012. Li Y, Li T, Zen P. Mechanism and intervention strategies of alexithymia. Sichuan Mental Health . 2022;35(01):92-96. Benson H, Frankel FH, Apfel R, et al. Treatment of anxiety: a comparison of the usefulness of self-hypnosis and a meditational relaxation technique. An overview. Psychother Psychosom . 1978;30(3-4):229-42. doi:10.1159/000287304 Yao C. Alexithymia. Journal of International Psychiatry . 1991;(03):141-144. Zhu C, Su R, Huang F, Liu Y. Impact of existential isolation on depression of left behind college students: A moderated mediation model. China Journal of Health Psychology . 2022;30(04):498-503. doi:10.13342/j.cnki.cjhp.2022.04.004 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4858811","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":338308235,"identity":"3a265282-edfd-4eb9-bb0f-5bba91c6e247","order_by":0,"name":"Bing Zhang","email":"","orcid":"","institution":"Wuxi Xincheng Middle School","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bing","middleName":"","lastName":"Zhang","suffix":""},{"id":338308236,"identity":"2a0d816a-987c-40d6-a2ff-fe44ffd2196c","order_by":1,"name":"Sifan Ji","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sifan","middleName":"","lastName":"Ji","suffix":""},{"id":338308237,"identity":"2e04fc88-e0ed-44ef-afaa-a144fe364ca4","order_by":2,"name":"Yuqiu Cui","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yuqiu","middleName":"","lastName":"Cui","suffix":""},{"id":338308238,"identity":"539ec24c-1bc9-4296-92a2-5b93804b23c8","order_by":3,"name":"Yang Guo","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Guo","suffix":""},{"id":338308239,"identity":"cdca41c8-35f2-4e33-82c5-cad533ebbc12","order_by":4,"name":"Cheng Jiang","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Cheng","middleName":"","lastName":"Jiang","suffix":""},{"id":338308240,"identity":"df61395b-796e-4359-8ebc-352b58f6b291","order_by":5,"name":"Tingting Yang","email":"","orcid":"","institution":"Affiliated Psychological Hospital of Anhui Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tingting","middleName":"","lastName":"Yang","suffix":""},{"id":338308241,"identity":"fda06cb5-2704-46e2-ba8b-e68c38605004","order_by":6,"name":"Fengqiong Yu","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fengqiong","middleName":"","lastName":"Yu","suffix":""},{"id":338308242,"identity":"129c1be9-9d19-4c24-a804-8fbfc39b6dba","order_by":7,"name":"Kongliang He","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxUlEQVRIiWNgGAWjYBACAwbGBwwJPBJ2/MzMBx8QqYXZgCFBxiJZsp0t2YB4LQw2FYwbzvOYCRClxZy9mfHBgxwJZuPDDGYMDDU20QS1WPYcZjZIOCPBZ3aYIe0Bw7G03AaCDruRf0wisUeCGajluAFjw2EitNx/zP4j8Z8E4+ZmxjYJ4rTcYGYDBTLjBmZmNiK1nElmlgBqSZY4zAb0FFF+OX6Y8eMPnjo7/v7zHx98qLEhrAUVJJCmfBSMglEwCkYBLgAAfbY66GqbMGoAAAAASUVORK5CYII=","orcid":"","institution":"Anhui Medical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Kongliang","middleName":"","lastName":"He","suffix":""}],"badges":[],"createdAt":"2024-08-05 02:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4858811/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4858811/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":64003612,"identity":"330695b0-8d6c-4fa7-ac5b-3de9b61be7fe","added_by":"auto","created_at":"2024-09-04 21:13:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":89713,"visible":true,"origin":"","legend":"\u003cp\u003eExperimental procedures\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4858811/v1/7cb3b8835a17a708ee243388.png"},{"id":64003611,"identity":"d11742a9-8c16-448d-aaf8-f375d8ba44a3","added_by":"auto","created_at":"2024-09-04 21:13:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":28535,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of symptoms pre- and post- between the two groups\u003c/p\u003e\n\u003cp\u003eNotes：***p \u0026lt; 0.001, **p \u0026lt; 0.01, *p \u0026lt; 0.05\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4858811/v1/19ad7b180e4fa14b01906732.png"},{"id":64003614,"identity":"6804c890-1bf8-49b6-95e4-2604e5d87bde","added_by":"auto","created_at":"2024-09-04 21:13:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":15178,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of loneliness between the two groups\u003c/p\u003e\n\u003cp\u003eNotes：***p \u0026lt; 0.001, **p \u0026lt; 0.01, *p \u0026lt; 0.05\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4858811/v1/5b1a58000530111b326f69d5.png"},{"id":64004319,"identity":"d0cd1dd2-b967-455f-9d8a-6a203eaec82a","added_by":"auto","created_at":"2024-09-04 21:21:10","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":13762,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of pre- and post- tests of the three subscales of alexithymia in the experimental group: DIF, DDF, and EOT\u003c/p\u003e\n\u003cp\u003e注：***p \u0026lt; 0.001, **p \u0026lt; 0.01, *p \u0026lt; 0.05\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4858811/v1/4db10c358e7361a241f730d9.png"},{"id":66430715,"identity":"f81d1f98-e73d-4caa-a8d1-9cbcf2d9efe0","added_by":"auto","created_at":"2024-10-11 20:01:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":914313,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4858811/v1/535c18f5-df8d-4a2c-a3e1-1e42de242eb8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A study on the efficacy of Group PM+ on depressed mood in medical students","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eEmotional disorders are a significant contributor to the global burden of disease\u0026nbsp;\u003csup\u003e1\u003c/sup\u003e, and individuals aged 18\u003cem\u003e\u003cstrong\u003e\u0026ndash;\u003c/strong\u003e\u003c/em\u003e24 years are particularly vulnerable to mental health disorders such as major depression, anxiety, and psychiatric comorbidity\u0026nbsp;\u003csup\u003e2, 3\u003c/sup\u003e. Depression is one of the most common mood disorders\u0026nbsp;\u003csup\u003e4\u003c/sup\u003e. It is estimated that approximately 13%\u003cem\u003e\u003cstrong\u003e\u0026ndash;\u003c/strong\u003e\u003c/em\u003e20% of people will experience depression in their lifetime, with a lifetime prevalence of 6.1%\u0026ndash;9.5%, of which 75% of those with depression will relapse and the prognosis tends to worsen with each relapse. Treatment for depression is also complex and expensive. Currently, Cognitive Behavior Therapy (CBT) and Discriminative Behavior Therapy (DBT) are considered the most reliable treatment methods, but their intervention protocols are both complex and expensive\u0026nbsp;\u003csup\u003e5\u003c/sup\u003e. The high cost of psychological treatment and concerns about the side effects of medication have made timely and effective psychological and pharmacological interventions simply unavailable to the university student population. Some studies have suggested that low-intensity psychological interventions delivered by trained paraprofessionals are a potential solution to this problem\u0026nbsp;\u003csup\u003e6\u003c/sup\u003e. The Problem Manager (PM+) is a low-intensity, highly structured, and easy-to-use psychological intervention, and emphasis is placed on the fact that the therapy can be delivered by trained non-specialist assistants\u0026nbsp;\u003csup\u003e7\u003c/sup\u003e. The PM+ intervention has been extensively researched around the world as a World Health Organization (WHO)-approved psychological treatment.\u003c/p\u003e\n\u003cp\u003e1.1 Current situation of medical students\u003c/p\u003e\n\u003cp\u003eCollege students face unprecedented levels of stress that seriously affect their physical and mental health, and this population is at high risk of mood disorders\u0026nbsp;\u003csup\u003e8\u003c/sup\u003e. The American College Health Association-National College Health Assessment (ACHA-NCHA) survey assessed mental health diagnoses and suicide rates in the United States in the previous year. It found that the incidence of depression in the US college student population increased by 4.6% between 1998 and 2008\u0026nbsp;\u003csup\u003e9\u003c/sup\u003e. The association\u0026apos;s 2015 survey found a significant increase in depression and anxiety as well as suicide rates among college students\u0026nbsp;\u003csup\u003e10\u003c/sup\u003e. In China, the mental health status of college students is also not optimistic. A survey conducted by the Chinese Centre for Disease Control and Prevention revealed that approximately 20% of university students nationwide have varying degrees of psychological disorders, with depressive disorders being the most prominent\u0026nbsp;\u003csup\u003e11\u003c/sup\u003e. Of these, the most prominent mental health problems are among medical students. Depression and suicidal ideation are major public health problems in medical schools. A US study showed that around a quarter of first- and second-year medical students showed signs of depression\u0026nbsp;\u003csup\u003e12\u003c/sup\u003e. Another survey conducted among UK students showed that around 30% of medical students suffer from or have been treated for mental illness. A study carried out in Germany provided evidence that newly enrolled medical students have a higher prevalence of psychosomatic disorders and panic disorder compared to the general population\u0026nbsp;\u003csup\u003e13\u003c/sup\u003e. A meta-analysis of the national prevalence of depression among Chinese medical students, which reported an overall prevalence of 29%, found that the prevalence of depression, anxiety, and suicidal ideation among Chinese medical students was higher than the rates observed among students in other specialties in China, as well as among medical students from other countries\u0026nbsp;\u003csup\u003e14\u003c/sup\u003e.\u003c/p\u003e\n\u003ch2\u003e1.2 The concept of depression\u003c/h2\u003e\n\u003cp\u003eDepressed mood and some of the accompanying emotional and physical symptoms can greatly reduce an individual\u0026apos;s quality of life.\u003c/p\u003e\n\u003cp\u003eIn this study, depressed mood does not meet the clinical diagnosis of depression, but rather reflects mild levels, and only represents a negative subjective experience for healthy people. It is characterized by an abnormally low and persistent mood that can affect an individual\u0026rsquo;s living and learning conditions in the long term. The main symptoms of depression in university students are as follows: (1) a lower than usual mood; (2) loss of interest in activities; (3) sleep disturbances; (4) laziness, aversion to exercise, and loss of appetite; and (5) suicidal thoughts and behaviors\u0026nbsp;\u003csup\u003e15\u003c/sup\u003e. If these mental health problems are not properly addressed, they can persist into adulthood and future work\u0026nbsp;\u003csup\u003e16\u003c/sup\u003e. For medical students with emotional disturbances, these problems can lead to many negative personal effects and professional consequences (e.g., impairment of their quality of life, increased risk of suicidal ideation, and reduced academic performance, professionalism and empathy for patients)\u003csup\u003e17\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e1.3 Other emotional problems associated with depressed mood\u003c/p\u003e\n\u003cp\u003eAlexithymia was originally coined by Nemiah and Sifneos to describe a range of cognitive and emotional deficits in the perception, differentiation, processing and expression of emotions\u0026nbsp;\u003csup\u003e18\u003c/sup\u003e. These patients often exhibit symptoms of emotional dysregulation and an inability to self-soothe or manage their emotions appropriately\u0026nbsp;\u003csup\u003e19\u003c/sup\u003e. Based on the results of an extensive literature review, there are two views on alexithymia and depression. One is that alexithymia is a personality trait independent of depressed mood and a predisposing factor for depression. Francisco et al. conducted a study on a population of university students and found that when university students\u0026apos; psychological pain scores improved significantly, the severity of their alexithymia did not change significantly. This finding could demonstrate that alexithymia is independent of depression\u0026nbsp;\u003csup\u003e20\u003c/sup\u003e. Alexithymia is an independent personality trait that is not stable, but rather a temporary and transient trait that individuals may experience when faced with stress and threat (secondary acute illness)\u003csup\u003e21\u003c/sup\u003e. Individuals with alexithymia are more likely to suffer from depressed mood than others\u0026nbsp;\u003csup\u003e22\u003c/sup\u003e. In addition, the findings of Porcelli et al. demonstrated that individuals with alexithymia are more likely to suffer from depressed mood than the general population\u0026nbsp;\u003csup\u003e23\u003c/sup\u003e. Second, it is believed that alexithymia is one of the responses to depressive symptoms and that the two overlap with each other\u0026nbsp;\u003csup\u003e24\u003c/sup\u003e. It was found that levels of depressed mood and alexithymia were significantly correlated and one of the main factors influencing alexithymia\u0026nbsp;\u003csup\u003e25\u003c/sup\u003e. An analysis of the mediation of personality traits, depression, and alexithymia showed that depressed mood mediates between personality traits and alexithymia, and that personality traits can affect alexithymia either directly or through depression\u0026nbsp;\u003csup\u003e26\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eLoneliness is defined as a perceived deficit in social relationships. As a negative emotion, it has been identified as a trigger for depression\u0026nbsp;\u003csup\u003e27\u003c/sup\u003e. Loneliness is the most common negative emotion in the university student population\u0026nbsp;\u003csup\u003e28\u003c/sup\u003e. Erikson\u0026apos;s eight-stage theory of life development states that the main task of the university stage is to gain a sense of intimacy and the need to establish good and stable interpersonal relationships; otherwise, one is prone to loneliness. Moreover, the ability to learn intimacy plays an important role in whether university students can enter society satisfactorily\u0026nbsp;\u003csup\u003e29\u003c/sup\u003e. Prolonged loneliness can threaten an individual\u0026apos;s future mental health and some indicators of psychosocial functioning\u0026nbsp;\u003csup\u003e30\u003c/sup\u003e. Some studies have shown that male university students have significantly higher levels of loneliness than female university students, and that higher levels of loneliness are associated with higher depressed mood scores, which can be used as a predictor of depressed mood\u0026nbsp;\u003csup\u003e31, 32\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e1.4 Interventions for depressed mood\u003c/p\u003e\n\u003cp\u003eNumerous studies on depressed mood in college students have been conducted, and numerous successful interventions have been suggested, including Group Therapy \u003csup\u003e33, 34\u003c/sup\u003e, Music Therapy \u003csup\u003e35\u003c/sup\u003e, Exercise Therapy \u003csup\u003e36-38\u003c/sup\u003e, Acceptance and Commitment Therapy (ACT) \u003csup\u003e39\u003c/sup\u003e, Self-help Mindfulness Course \u003csup\u003e40, 41\u003c/sup\u003e, Expressive Arts Therapy \u003csup\u003e42\u003c/sup\u003e, Meridian-following Meditation \u003csup\u003e43\u003c/sup\u003e, and Integration Therapy of Five Wefts \u003csup\u003e44\u003c/sup\u003e. Studies have shown that these therapies can successfully reduce anxiety and depressed mood in university students while also improving their psychological well-being. This can help them to explore who they are and how they feel in the future, giving them the confidence to face life\u0026apos;s challenges. The university student population simply cannot access timely and efficient psychological and pharmaceutical interventions due to high levels of academic stress, the high cost of psychological care, and concerns about the adverse effects of medicines. According to several studies, this issue might be resolved by low-intensity psychological therapies given by qualified laypeople \u003csup\u003e6\u003c/sup\u003e.\u003cbr\u003e1.5\u0026nbsp;Problem Management Plus\u0026nbsp;(PM+）\u003c/p\u003e\n\u003cp\u003eHaving been widely applied in post-disaster psychological interventions worldwide, Problem Management Plus (PM+), developed by the WHO in conjunction with cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT), is a well-established intervention technique with scientific and practical validity tested in randomized controlled trials \u003csup\u003e45\u003c/sup\u003e. It is a common intervention strategy that has undergone both scientific and applied testing in randomized controlled studies \u003csup\u003e46\u003c/sup\u003e. A study that validated PM+ with emotional processing (PM+EP) found that it can be widely duplicated in the Netherlands and that PM+ delivers a more palatable intervention for Dutch migrants. A culturally relevant PM+ intervention was used in Pakistan, and the outcomes revealed that PM+ significantly decreased levels of anxiety and sadness, increasing their quality of life \u003csup\u003e47, 48\u003c/sup\u003e. The outcomes of a randomized controlled trial of a PM+ intervention and Enhanced Everyday Care (EUC) demonstrated that a group PM+ intervention program was feasible in Nepal and that PM+ interventions delivered by laypeople were more effective in reducing individuals\u0026apos; psychological distress compared to a conventional treatment group \u003csup\u003e49\u003c/sup\u003e. These results are also consistent with the findings of a previous study that showed that effective PM+ interventions can also be delivered by non-professionals \u003csup\u003e50\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe PM+, which is a low-intensity, structured and simple-to-use psychological intervention, emphasizes that trained non-specialist assistants can deliver the therapy \u003csup\u003e7\u003c/sup\u003e.\u0026nbsp;The\u0026nbsp;PM+ has been introduced as an innovative psychological intervention in China for a long time, but no research has been conducted on depression among college students. In this study, we employed Group PM+ as an intervention in the treatment of depressed mood among college students in order to study whether the Group PM+ intervention has an impact on certain cognitive disorders (e.g., alexithymia, loneliness, and interpersonal communication) caused by anxiety and depressed mood in this population. The study also provides a theoretical basis for PM+ to improve depressed mood in university students, and encourages laypeople to understand it and learn how to apply it.\u003c/p\u003e\n\u003cp\u003e1.6 Research hypothesis\u003c/p\u003e\n\u003cp\u003eThe following hypotheses are put forth in this study based on a synthesis of the literature on depressive mood in medical students:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eThe PM+ intervention can successfully alleviate anxiety and depressive symptoms in medical students.\u003c/li\u003e\n \u003cli\u003eAlexithymia, loneliness, and pain empathy in medical students who are depressed can be treated by the PM+ intervention.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Participants\u003c/h2\u003e \u003cp\u003e The participants were recruited from March 2022 to April 2022, and the PHQ-9 scale was administered at Anhui Medical University, China. The inclusion criteria were as follows: students (18\u0026ndash;30 years old) enrolled at Anhui Medical University and who have a PHQ-9 score of at least 4; willing to provide written informed consent; willing to undergo appropriate exams after being made aware of the study; and have no history of serious somatic illnesses. The exclusion criteria were as follows: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) students who were unable to provide certain basic information; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) those currently being treated for depressed mood and taking psychotropic medication; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) those who refused to undergo the examination and withdrew from the study early; and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) those with a history of traumatic brain injuries or who were also suffering from serious physical conditions like cardiac or hepatic insufficiency. Fifty-two participants were finally recruited, of whom 24 were male and 28 were female. All participants provided voluntary written informed consent to participate in the research without being informed of the purpose of the study. The study was reviewed by the Ethics Committee of Anhui Medical University (ethics approval number 83220384).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Research tools\u003c/h2\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Assessment tools\u003c/h2\u003e \u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Background information: gender, age, years of education, place of residence, whether the child is an only child, father's/mother's education level, family economic situation, family members with any suicidal or violent tendencies, and self-assessed academic stress.\u003c/p\u003e \u003cp\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) The Patient Health Questionnaire-9 (PHQ-9) is one of the internationally used screening scales for depression. The scale is helpful for determining the intensity of depressed mood and may be diagnostically valid because it has nine categories that address the DSM-5 diagnostic criteria for depression \u003csup\u003e51\u0026ndash;53\u003c/sup\u003e. A total score of 0\u0026ndash;27 is assigned to the scale, which is assessed according to a four-point (0\u0026ndash;3) scale. Cronbach's alpha was 0.90.\u003c/p\u003e \u003cp\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) The Generalized Anxiety Scale (GAD-7) is a simple self-assessment scale for anxiety developed by Spitzer et al. \u003csup\u003e54\u003c/sup\u003e, which covers the diagnostic criteria for anxiety disorders in the DSM-4. Moreover, it can sensitively detect subjects' anxiety with high specificity \u003csup\u003e55, 56\u003c/sup\u003e. The scale is rated on a four-point (0\u0026ndash;3) scale with a total score of 0\u0026ndash;21. Cronbach's alpha was 0.90.\u003c/p\u003e \u003cp\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) The Toronto Alexithymia Scale (TAS-20) \u003csup\u003e57, 58\u003c/sup\u003e, the Chinese version of which was used in this study. The scale is divided into three dimensions consisting of seven items for Difficulty Identifying Feelings (DIF), five items for Difficulty Describing Feelings (DDF), and eight items for Externally-oriented Thinking (EOT), producing a total of 20 items, each of which is scored according to a five-point (\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) scale, with a total score of 20\u0026ndash;100. Higher total scores and higher corresponding scores of each factor indicate greater severity of the disorder. Cronbach's alpha was 0.86.\u003c/p\u003e \u003cp\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) The first version of the UCLA Loneliness Scale was developed in 1978 by Russell et al. and has been revised twice, in 1980 and 1988 \u003csup\u003e59\u003c/sup\u003e. This third version of the scale was adopted to measure loneliness caused by a gap between an individual's desire to socialize and their actual level of loneliness. The full scale consists of 20 items, each rated on a four-point (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) scale with a total score of 20\u0026ndash;80, with higher scores being associated with higher levels of loneliness. Cronbach's alpha was 0.91.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Intervention implementation\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Intervention settings\u003c/h2\u003e \u003cp\u003eThe participants were randomly assigned to the experimental and control groups. Due to restrictions in the number of participants in group therapy, the experimental group included 24 participants. The experimental group was then randomly divided into three sub-groups, each of which comprised eight participants. A primary therapist and five assistants, all of whom had completed comprehensive training in PM\u0026thinsp;+\u0026thinsp;treatments, carried out the intervention with the participants. The study coordinator randomly allocated three assistants to each group. The assistants entered the group with the lead therapist and scrupulously adhered to the PM\u0026thinsp;+\u0026thinsp;intervention protocol. All therapists were required to read the manual carefully before each group PM\u0026thinsp;+\u0026thinsp;intervention in order to familiarize themselves with its contents and to prepare the appropriate PSYCHOLOPS assessment materials (i.e., the PSYCHOLOPS assessment accompanies the PM\u0026thinsp;+\u0026thinsp;manual) in order to more effectively assess the participants. To further support the participants in problem solving and self-improvement, the therapists were also required to give the subjects homework after the intervention. The team of therapists held oversight meetings every 2 weeks to monitor the quality of their intervention and to ensure it was consistent and successful.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Control group intervention program\u003c/h2\u003e \u003cp\u003eFor the participants in the control group, standard pre- and post-tests of the scales were administered, and once a week, without any extra psychological interventions, psychological trivia was shared and made public online.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e2.3.3 Experimental group intervention program\u003c/h2\u003e \u003cp\u003eThe primary objective of the Group PM\u0026thinsp;+\u0026thinsp;was to help depressed college students to realize that the difficulties and stress that they were experiencing are common, as well as to provide independent stress-relieving and problem-solving techniques that can be applied to future challenges. For 5 weeks, each cohort of Group PM\u0026thinsp;+\u0026thinsp;participants attended 1.5 hours of weekly sessions. Each lesson focused on teaching the participants stress management techniques and problem-solving abilities. The PM\u0026thinsp;+\u0026thinsp;was based on four main strategies: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) stress management, which taught the participants stress reduction techniques (e.g., mindfulness, meditation, or relaxation breathing); (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) problem management, which focused on managing real-world problems; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) \u0026ldquo;sit, talk, and act\u0026rdquo;, which emphasized behavioral activation, primarily in the context of depression; and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) consolidation of interpersonal bonds, which encouraged the participants to demonstrate initiative in building interpersonal relationships. This program also addressed behavioral activation, which concentrates on the behavioral withdrawal that occurs in depressed individuals as a result of their low mood.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e2.3.4 Statistical analyses\u003c/h2\u003e \u003cp\u003eSPSS version 21.0 (IBM Corp, Armonk, NY, USA) was used for statistical analysis. All data analyses were performed using two-tailed tests with a \u003cem\u003eP\u003c/em\u003e-value of \u0026lt;\u0026thinsp;0.05 as the criterion for statistical significance. Continuous variables were statistically described using the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and main effects and interactions were tested by performing repeated measures analysis of variance (ANOVA), with simple effects analyses used when the interactions were significant. When the interactions were not significant, within-group comparisons were conducted using paired-samples t-tests (i.e., pre- and post-tests for the experimental group, and pre- and post-tests for the control group); categorical variables were statistically described in the form of instances and analyzed using the chi-squared test.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Demographic data\u003c/h2\u003e\n \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\n \u003ch2\u003e3.1.1 Lost to follow-up of research subjects.\u003c/h2\u003e\n \u003cp\u003eThis study recruited 52 medical students with depressed mood from Anhui Medical University, China, as the research participants. The control group consisted of 26 cases, and 21 cases were considered effective. The experimental group also comprised 26 cases, and 23 were deemed effective, resulting in an overall effective rate of 84.62%. The cases lost to follow-up were due to voluntary withdrawal from treatment. A detailed flowchart is shown in Fig.\u0026nbsp;1.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFigure\u0026nbsp;1.\u003c/strong\u003e Experimental procedures\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\n \u003ch2\u003e3.1.2 Comparison of demographic information of subjects in the two groups\u003c/h2\u003e\n \u003cp\u003eA total of 44 medical students with depressed mood were included in this study and randomly divided into control and intervention groups. There were 21 cases in the control group: nine males and 12 females, aged 20.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82 years, with 14.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60 years of education. The experimental group comprised 23 cases: 10 males and 13 females, aged 20.22\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09 years, with 14.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75 years of education. The differences between the two groups in terms of gender, age, years of education, father\u0026apos;s literacy, residence, annual family income, the presence of suicidal or violent behaviors by family members (or relatives), and academic pressure were not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), and the two groups were comparable, as shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of demographic information between the two groups of participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePM+(n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl(n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e /\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.967\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.22\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducational attainment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.868\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e2.199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVillage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eThe only child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eFather\u0026apos;s education level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e2.273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e0.518\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eMother\u0026apos;s education level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e9.214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eAnnual household income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.995\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWealth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eAny suicidal or violent behavior by family members (or relatives)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e4.495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eAcademic pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e1.474\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Scale results\u003c/h2\u003e\n \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\n \u003ch2\u003e3.2.1 Comparison of depressed mood between the two groups\u003c/h2\u003e\n \u003cp\u003eBefore the intervention, the PHQ-9 scores of the experimental group were 13.30\u0026thinsp;\u0026plusmn;\u0026thinsp;6.219, while the scores of the control group were 10.32\u0026thinsp;\u0026plusmn;\u0026thinsp;4.864 (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The time \u0026times; group repeated measures ANOVA interaction was significant (F\u003csub\u003e1, 43\u003c/sub\u003e = 10.460, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002). For the experimental group, PHQ-9 scores were reduced by an average of 6.636\u0026thinsp;\u0026plusmn;\u0026thinsp;5.377 points from the beginning to the end of the intervention, whereas an average reduction of 2.476\u0026thinsp;\u0026plusmn;\u0026thinsp;3.737 points was observed in the control group. The t-test results showed that the experimental group reduced its scores significantly more than the control group (t\u003csub\u003e41\u003c/sub\u003e = -2.933, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005). After 5 weeks of intervention, 17 participants (74%) in the experimental group showed remission from depressed mood (downgraded according to the severity of the scale) compared to five participants (23%) in the control group. The difference in the number of remissions between the two groups was significant (\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;11.790, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\n \u003ch2\u003e3.2.2 Comparison of anxiety between the two groups\u003c/h2\u003e\n \u003cp\u003eFor anxiety symptoms, the GAD-7 score before the intervention was 9.04\u0026thinsp;\u0026plusmn;\u0026thinsp;4.753 for the experimental group and 5.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.844 for the control group (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The results of the interaction of time \u0026times; group repeated measures ANOVA was significant (F\u003csub\u003e1, 43\u003c/sub\u003e = 19.007, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). For the experimental group, GAD-7 scores were reduced by a mean of 3.435\u0026thinsp;\u0026plusmn;\u0026thinsp;3.987 points from the beginning to the end of the intervention; however, the control group leveled off while anxiety increased by 1.045\u0026thinsp;\u0026plusmn;\u0026thinsp;2.768 points. T-test results showed that the experimental group\u0026apos;s reduction in scores was significantly greater than that of the control group (t\u003csub\u003e43\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;4.360, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). After 5 weeks of intervention, 12 cases (52%) in the experimental group showed remission from depressed mood (downgraded according to the severity of the scale) and two cases (9%) in the control group. The difference in the number of remissions between the two groups was significant (\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;9.738, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002).\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of symptoms pre- and post- between the two groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePM+\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePHQ-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.30\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.97\u0026thinsp;\u0026plusmn;\u0026thinsp;3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.32\u0026thinsp;\u0026plusmn;\u0026thinsp;4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.95\u0026thinsp;\u0026plusmn;\u0026thinsp;4.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGAD-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.04\u0026thinsp;\u0026plusmn;\u0026thinsp;4.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.61\u0026thinsp;\u0026plusmn;\u0026thinsp;4.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.82\u0026thinsp;\u0026plusmn;\u0026thinsp;3.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.603\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec24\" class=\"Section3\"\u003e\n \u003ch2\u003e3.2.3 Comparison of loneliness between the two groups\u003c/h2\u003e\n \u003cp\u003eThe results of the repeated measures ANOVA showed a significant main effect of the pre- and post-tests (F \u003csub\u003e(1, 44)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;24.044, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and a significant interaction between the pre- and post-test and group (F \u003csub\u003e(1, 44)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;41.317, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The simple effects results showed a non-significant difference between the pre- and post-tests for the experimental group and control group (F \u003csub\u003e(1, 44)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.978, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.328), and a significant difference in the post-test for the control group of the experimental group (F \u003csub\u003e(1, 44)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;18.409, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The difference between the pre- and post-tests of the experimental group was significant (F \u003csub\u003e(1, 44)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;65.659, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the difference between the pre- and post-tests of the control group was not significant (F \u003csub\u003e(1, 44)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;1.317, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.292). The results showed that the level of loneliness in the PM\u0026thinsp;+\u0026thinsp;experimental group was significantly lower in the post-test than that in the pre-test. Furthermore, in the post-test, a statistically significant difference in loneliness was observed between the PM\u0026thinsp;+\u0026thinsp;group and the control group. The results are shown in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of loneliness between the two groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePM+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.96\u0026thinsp;\u0026plusmn;\u0026thinsp;8.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.70\u0026thinsp;\u0026plusmn;\u0026thinsp;9.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.07\u0026thinsp;\u0026plusmn;\u0026thinsp;7.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.77\u0026thinsp;\u0026plusmn;\u0026thinsp;7.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\n \u003ch2\u003e3.2.3 Comparison of alexithymia between the two groups\u003c/h2\u003e\n \u003cp\u003eThe effect of group PM\u0026thinsp;+\u0026thinsp;on alexithymia was analyzed using a 2 \u0026times; 2 \u0026times; 3 repeated measures ANOVA. The results of the repeated measures ANOVA test for time (pre-, post-) \u0026times; group (PM+, control) \u0026times; factors (DIF, DDF, EOT) showed a significant main effect of time (F \u003csub\u003e(1,44)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;26.573, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), a significant interaction of time \u0026times; group (F \u003csub\u003e(1,44)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;26.573, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and showed a non-significant difference between groups in the pre-test (F \u003csub\u003e(1,44)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;1.297, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.261), a significant difference between groups in the post-test (F \u003csub\u003e(1,44)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;4.178; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.047), a significant difference between the pre- and post-tests for the experimental group (F \u003csub\u003e(1,44)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;54.355; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and a non-significant difference between the pre- and post-tests for the control group. The results also revealed a significant main effect of factors (F \u003csub\u003e(3,132)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;62.771; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In addition, the factors \u0026times; group interaction was not significant (F \u003csub\u003e(1,44)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.453; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.590), and the time \u0026times; group \u0026times; factors interaction was not significant (F \u003csub\u003e(3,132)\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;1.355, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.263). The data are presented in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of alexithymia between the two groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePM+\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePre\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003epre\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003epost\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.44\u0026thinsp;\u0026plusmn;\u0026thinsp;11.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55.48\u0026thinsp;\u0026plusmn;\u0026thinsp;11.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.748\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e58.22\u0026thinsp;\u0026plusmn;\u0026thinsp;10.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56.14\u0026thinsp;\u0026plusmn;\u0026thinsp;10.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDIF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.48\u0026thinsp;\u0026plusmn;\u0026thinsp;5.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.22\u0026thinsp;\u0026plusmn;\u0026thinsp;5.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.73\u0026thinsp;\u0026plusmn;\u0026thinsp;5.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.95\u0026thinsp;\u0026plusmn;\u0026thinsp;5.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.871\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDDF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.09\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.52\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.32\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.907\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.39\u0026thinsp;\u0026plusmn;\u0026thinsp;4.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.74\u0026thinsp;\u0026plusmn;\u0026thinsp;3.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.18\u0026thinsp;\u0026plusmn;\u0026thinsp;4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.86\u0026thinsp;\u0026plusmn;\u0026thinsp;3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.854\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study is the first to apply the Group PM\u0026thinsp;+\u0026thinsp;among medical students to compare changes in depressed mood, anxiety, loneliness, and alexithymia before and after the PM\u0026thinsp;+\u0026thinsp;intervention. The experiment yielded the following results: the Group PM\u0026thinsp;+\u0026thinsp;had significant efficacy in improving depressed mood and anxiety in the medical students, and also improved alexithymia and loneliness in this population. Furthermore, the difference between the experimental group and the control group in each of the aspects of the intervention was statistically significant.\u003c/p\u003e \u003cp\u003eThe results of the study showed that the Group PM\u0026thinsp;+\u0026thinsp;intervention program was effective in improving depressed mood and anxiety in medical students, which is consistent with the hypothesis and previous research findings. The PM\u0026thinsp;+\u0026thinsp;intervention is more often used for crisis intervention and the provision of psychological support for people in war-torn or natural disaster-stricken areas who are in a state of chronic fear, despair, and hopelessness. The PM\u0026thinsp;+\u0026thinsp;can help to improve mental health problems and enable such individuals to find trustworthy social supports to help them to cope with the same difficulties in the future \u003csup\u003e48\u0026ndash;50, 60\u0026ndash;65\u003c/sup\u003e. China has also conducted a brief study of the PM+, in which Liu et al. \u003csup\u003e66\u003c/sup\u003e intervened with residents in a state of stress during the COVID-19 epidemic through the provision of online PM+. The results showed that PM\u0026thinsp;+\u0026thinsp;interventions were effective in improving residents' depressed mood and anxiety, and showed efficacy in relieving their stress and accompanying somatic symptoms. When people encounter adversity, most experience symptoms of depression; however, the symptoms manifest in different ways for different people. For medical students, the symptoms usually take the form of fatigue, despair, persistent low mood, and lack of motivation, which causes them to lose interest in activities that are otherwise enjoyable. Moreover, somatic complaints such as pain are usually present. Without a timely intervention, medical students can become trapped in a vicious cycle characterized by an unwillingness to engage in activities, low mood, and avoidance of daily activities. PM\u0026thinsp;+\u0026thinsp;interventions can improve depressed mood by as it involves developing and implementing programs that encourage clients to break this vicious cycle and to actively engage in activities, thus promoting their sense of achievement and confidence. However, in this study, after the Group PM\u0026thinsp;+\u0026thinsp;intervention, the participants' anxiety and depressed mood showed a significant improvement, but the difference was not significant compared with the control group, which may be related to the participants' education level and a higher capacity for self-regulation. In summary, our findings provide a theoretical basis for the efficacy of the Group PM\u0026thinsp;+\u0026thinsp;intervention and can be used to improve depressed mood in medical students.\u003c/p\u003e \u003cp\u003eThe results of the study showed that the Group PM\u0026thinsp;+\u0026thinsp;intervention program effectively improved loneliness and alexithymia in medical students, which was consistent with the research hypothesis and the results of previous studies. Liu et al. \u003csup\u003e67\u003c/sup\u003e conducted psychological training for freshly recruited recruits during the intensive training period through the PM\u0026thinsp;+\u0026thinsp;intervention. The study showed that the PM\u0026thinsp;+\u0026thinsp;could effectively reinforce positive emotions, strengthen levels of social support, and effectively reduce stress levels, thereby allowing the recruits to apply positive coping styles to deal with the difficulties they faced. Many studies have analyzed the development of alexithymia by drawing on social learning and psychodynamic theories \u003csup\u003e68\u003c/sup\u003e. High levels of alexithymia among medical students can be largely explained by the current stage of depression, academic pressures, domestic epidemic prevention and control policies, and the social value of blindly pursuing real needs. As part of daily education, greater attention should be paid to addressing the mental health needs of medical students, in an effort to relieve some of the pressure and stress that they encounter, and to alleviate feelings of loneliness, while encouraging them to form the correct values. Meanwhile, relevant studies have shown that cognitive-behavioral therapies, such as relaxation training, role-playing, self-practice, and other therapeutic programs, can improve alexithymia and loneliness \u003csup\u003e69\u003c/sup\u003e. However, the efficacy of psychotherapeutic programs that rely only on verbal forms of communication, such as psychoanalysis and psychodynamic programs, is not significant and may even worsen symptoms of alexithymia\u003csup\u003e70, 71\u003c/sup\u003e. Therefore, it is important to choose the right program when treating individuals with alexithymia.\u003c/p\u003e \u003cp\u003eThe therapeutic process of the PM\u0026thinsp;+\u0026thinsp;intervention focuses more on encouraging visitors to speak for themselves about the current distress they are facing, find solutions that work for them on their own, and seeks out social supports that they can trust. When people have access to good social supports (i.e., trustworthy friends, family members, community workers, mental health support groups), they tend to be able to cope with the emotional distress caused by situations of adversity. However, medical students are affected by emotional distress such as depressed mood and anxiety; they tend to isolate themselves and are reluctant to actively seek social support. As such, self-isolation in the long run can have a devastating impact on their emotional health. The results of a study exploring the mediating role of social support in alleviating loneliness and depressed mood in college students showed that loneliness directly predicted depressed mood and also indirectly predicted depressed mood through social support, which confirms that social support can effectively alleviate the negative effects of loneliness in college students \u003csup\u003e72\u003c/sup\u003e. The PM\u0026thinsp;+\u0026thinsp;intervention can help medical students to gradually build up their confidence in interacting with others and consolidate their social support, thus alleviating symptoms of alexithymia and loneliness caused by depression.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe Group PM\u0026thinsp;+\u0026thinsp;intervention program can effectively improve anxiety and depression in medical students, reduce their sense of isolation, and decrease alexithymia symptoms. Currently, medical students are reluctant and afraid to seek professional psychological counseling when faced with emotional distress or mental health problems, which contributes to a higher incidence of depressed mood and other psychological disorders. Indeed, it is widely believed that only those who are \u0026ldquo;mentally ill\u0026rdquo; or \u0026ldquo;mentally retarded\u0026rdquo; attend psychotherapy. Emotional difficulties and mental health issues cause medical students to feel discouraged and fearful, which increases the prevalence of depressed mood and other mental health problems. Sangraula et al. conducted a PM\u0026thinsp;+\u0026thinsp;feasibility trial with a sample involving various settings and participants, and discovered that mental health stigma is one of the factors that contributed to patients' reluctance to accept PM\u0026thinsp;+\u0026thinsp;interventions \u003csup\u003e49\u003c/sup\u003e. In order to boost the acceptability, demand, and effectiveness of PM\u0026thinsp;+\u0026thinsp;marketing in the future, reasonable PM\u0026thinsp;+\u0026thinsp;programs must be created based on the requirements of the community.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany thanks to Dr Graeme J Taylor and R. Michael Bagby for developing the TAS-20 scale and for their support of this study. I have had the privilege of working with colleagues and friends who care deeply about the psychiatry profession. I want to thank them for their ideas, advice and unwavering support. We thank International Science Editing (http://www. internationalscienceediting.com) for editing this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBing Zhang collected the relevant data, designed the study, analyzed the data, and wrote the manuscript. Many thanks to the authors for their contributions to this article. In particular, Sifan Ji, Yuqiu Cui, Yang Guo, and Cheng Jiang gave a great deal of support in the collection of data for the study, and Dr Kongliang He, Dr Fengqiong Yu gave very important help in the analysis of the data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Hefei City financial support (Hwk2021zd013).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from Anhui Medical University but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki. Participants and their guardians completed informed consent forms at the beginning of the study. All materials, measures, methods and procedures were approved by the ethics committee of the Anhui Medical University (IRB: 83220384).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eFerrari AJ, Charlson FJ, Norman RE, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. \u003cem\u003ePLoS medicine\u003c/em\u003e. Nov 2013;10(11):e1001547. doi:10.1371/journal.pmed.1001547\u003c/li\u003e\n \u003cli\u003eWittchen HU, Nelson CB, Lachner G. Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. \u003cem\u003ePsychological medicine\u003c/em\u003e. Jan 1998;28(1):109-26. doi:10.1017/s0033291797005928\u003c/li\u003e\n \u003cli\u003ePatten SB. Major depression prevalence in Calgary. \u003cem\u003eCanadian journal of psychiatry Revue canadienne de psychiatrie\u003c/em\u003e. Dec 2000;45(10):923-6. doi:10.1177/070674370004501008\u003c/li\u003e\n \u003cli\u003eMcCarron RM, Shapiro B, Rawles J, Luo J. Depression. \u003cem\u003eAnnals of internal medicine\u003c/em\u003e. May 2021;174(5):Itc65-itc80. doi:10.7326/aitc202105180\u003c/li\u003e\n \u003cli\u003eRichards DA, Ekers D, McMillan D, et al. Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial. \u003cem\u003eLancet (London, England)\u003c/em\u003e. Aug 27 2016;388(10047):871-80. doi:10.1016/s0140-6736(16)31140-0\u003c/li\u003e\n \u003cli\u003eDoukani A, Free C, Michelson D, et al. Towards a conceptual framework of the working alliance in a blended low-intensity cognitive behavioural therapy intervention for depression in primary mental health care: a qualitative study. \u003cem\u003eBMJ Open\u003c/em\u003e. Sep 23 2020;10(9):e036299. doi:10.1136/bmjopen-2019-036299\u003c/li\u003e\n \u003cli\u003eSijbrandij M, Farooq S, Bryant RA, et al. Correction to: Problem management plus (PM+) for common mental disorders in a humanitarian setting in Pakistan; study protocol for a randomised controlled trial (RCT). \u003cem\u003eBMC Psychiatry\u003c/em\u003e. Oct 15 2018;18(1):331. doi:10.1186/s12888-018-1922-5\u003c/li\u003e\n \u003cli\u003eMortier P, Auerbach RP, Alonso J, et al. Suicidal Thoughts and Behaviors Among First-Year College Students: Results From the WMH-ICS Project. \u003cem\u003eJournal of the American Academy of Child and Adolescent Psychiatry\u003c/em\u003e. Apr 2018;57(4):263-273.e1. doi:10.1016/j.jaac.2018.01.018\u003c/li\u003e\n \u003cli\u003eAmerican College Health Association-National College Health Assessment Spring 2008 Reference Group Data Report (abridged): the American College Health Association. \u003cem\u003eJournal of American college health : J of ACH\u003c/em\u003e. Mar-Apr 2009;57(5):477-88. doi:10.3200/jach.57.5.477-488\u003c/li\u003e\n \u003cli\u003eLiu CH, Stevens C, Wong SHM, Yasui M, Chen JA. The prevalence and predictors of mental health diagnoses and suicide among U.S. college students: Implications for addressing disparities in service use. \u003cem\u003eDepression and anxiety\u003c/em\u003e. Jan 2019;36(1):8-17. doi:10.1002/da.22830\u003c/li\u003e\n \u003cli\u003eZhou H, Li H, Zhou K, Xu R, Fu Y. Social Adjustment and Emotion Regulation in College Students with Depression-trait. \u003cem\u003eChinese Journal of Clinical Psychology\u003c/em\u003e. 2015;23(05):799-803. doi:10.16128/j.cnki.1005-3611.2015.05.009\u003c/li\u003e\n \u003cli\u003eGivens JL, Tjia J. Depressed medical students\u0026apos; use of mental health services and barriers to use. \u003cem\u003eAcademic medicine : journal of the Association of American Medical Colleges\u003c/em\u003e. Sep 2002;77(9):918-21. doi:10.1097/00001888-200209000-00024\u003c/li\u003e\n \u003cli\u003eWege N, Muth T, Li J, Angerer P. Mental health among currently enrolled medical students in Germany. \u003cem\u003ePublic health\u003c/em\u003e. Mar 2016;132:92-100. doi:10.1016/j.puhe.2015.12.014\u003c/li\u003e\n \u003cli\u003eZeng W, Chen R, Wang X, Zhang Q, Deng W. Prevalence of mental health problems among medical students in China: A meta-analysis. \u003cem\u003eMedicine\u003c/em\u003e. May 2019;98(18):e15337. doi:10.1097/md.0000000000015337\u003c/li\u003e\n \u003cli\u003eYe J. An introduction to depression in university students. \u003cem\u003eScience and Technology Innovation Herald\u003c/em\u003e. 2009;(22):226. doi:10.16660/j.cnki.1674-098x.2009.22.193\u003c/li\u003e\n \u003cli\u003ePine DS, Cohen P, Gurley D, Brook J, Ma Y. The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. \u003cem\u003eArch Gen Psychiatry\u003c/em\u003e. Jan 1998;55(1):56-64. doi:10.1001/archpsyc.55.1.56\u003c/li\u003e\n \u003cli\u003eLins L, Carvalho FM, Menezes MS, Porto-Silva L, Damasceno H. Health-related quality of life of students from a private medical school in Brazil. \u003cem\u003eInt J Med Educ\u003c/em\u003e. Nov 8 2015;6:149-54. doi:10.5116/ijme.563a.5dec\u003c/li\u003e\n \u003cli\u003eNemiah JC, Sifneos PE. Psychosomatic illness: a problem in communication. \u003cem\u003ePsychother Psychosom\u003c/em\u003e. 1970;18(1):154-60. doi:10.1159/000286074\u003c/li\u003e\n \u003cli\u003eAlpaslan AH, Soylu N, Avci K, Coşkun K, Kocak U, Taş HU. Disordered eating attitudes, alexithymia and suicide probability among Turkish high school girls. \u003cem\u003ePsychiatry Res\u003c/em\u003e. Mar 30 2015;226(1):224-9. doi:10.1016/j.psychres.2014.12.052\u003c/li\u003e\n \u003cli\u003eFrancisco M-S, Manuel A-G, Elisabeth C\u0026oacute;rcoles A, Tania B, Jordi J. Stability in alexithymia levels: A longitudinal analysis on various emotional answers. \u003cem\u003ePersonality and Individual Differences\u003c/em\u003e. 1998;24(6):767-772. doi:https://doi.org/10.1016/S0191-8869(97)00239-0\u003c/li\u003e\n \u003cli\u003eKrystal H. Alexithymia and psychotherapy. \u003cem\u003eAm J Psychother\u003c/em\u003e. Jan 1979;33(1):17-31. doi:10.1176/appi.psychotherapy.1979.33.1.17\u003c/li\u003e\n \u003cli\u003eFisch RZ. Alexithymia, masked depression and loss in a Holocaust survivor. \u003cem\u003eBr J Psychiatry\u003c/em\u003e. May 1989;154:708-10. doi:10.1192/bjp.154.5.708\u003c/li\u003e\n \u003cli\u003ePorcelli P, Leoci C, Guerra V, Taylor GJ, Bagby RM. A longitudinal study of alexithymia and psychological distress in inflammatory bowel disease. \u003cem\u003eJ Psychosom Res\u003c/em\u003e. Dec 1996;41(6):569-73. doi:10.1016/s0022-3999(96)00221-8\u003c/li\u003e\n \u003cli\u003eHaviland MG, Shaw DG, Cummings MA, MacMurray JP. Alexithymia: subscales and relationship to depression. \u003cem\u003ePsychother Psychosom\u003c/em\u003e. 1988;50(3):164-70. doi:10.1159/000288115\u003c/li\u003e\n \u003cli\u003eHonkalampi K, Hintikka J, Tanskanen A, Lehtonen J, Viinam\u0026auml;ki H. Depression is strongly associated with alexithymia in the general population. \u003cem\u003eJ Psychosom Res\u003c/em\u003e. Jan 2000;48(1):99-104. doi:10.1016/s0022-3999(99)00083-5\u003c/li\u003e\n \u003cli\u003eZhang W. \u003cem\u003eThe relationship between affective disorders and personality traits in prison inmates and the development of a normative model\u003c/em\u003e. 硕士. China University of Political Science and Law; 2009.\u003c/li\u003e\n \u003cli\u003eErzen E, \u0026Ccedil;ikrikci \u0026Ouml;. The effect of loneliness on depression: A meta-analysis. \u003cem\u003eInt J Soc Psychiatry\u003c/em\u003e. Aug 2018;64(5):427-435. doi:10.1177/0020764018776349\u003c/li\u003e\n \u003cli\u003eFu X, Li L. A study on suicide attitude and depression of university students. \u003cem\u003eChina Journal of Health Psychology\u003c/em\u003e. 2007;(01):42-45. doi:10.13342/j.cnki.cjhp.2007.01.017\u003c/li\u003e\n \u003cli\u003eXue G, Zhao X. On the loneliness of Chinese university students and how to cope with it. \u003cem\u003eHeilongjiang Researches on Higher Education\u003c/em\u003e. 2009;(02):140-143.\u003c/li\u003e\n \u003cli\u003eQualter P, Quinton SJ, Wagner H, Brown S. Loneliness, Interpersonal Distrust, and Alexithymia in University Students1. \u003cem\u003eJournal of Applied Social Psychology\u003c/em\u003e. 2009;39(6):1461-1479. doi:https://doi.org/10.1111/j.1559-1816.2009.00491.x\u003c/li\u003e\n \u003cli\u003eMa P, Huang M, He B, Pan W, Zhao S. The influence of undergraduates\u0026apos; loneliness on depression:based on latent moderated structural equation. \u003cem\u003eJournal of Psychological Science\u003c/em\u003e. 2021;44(05):1186-1192. doi:10.16719/j.cnki.1671-6981.20210522\u003c/li\u003e\n \u003cli\u003eDai G, Guo W, Wang Z, Zeng F, Zhan X, Tan Z. The effect of college students\u0026apos; sense of loneliness on depression. \u003cem\u003eChina Journal of Health Psychology\u003c/em\u003e. 2017;25(02):297-299. doi:10.13342/j.cnki.cjhp.2017.02.036\u003c/li\u003e\n \u003cli\u003eHu R, Chen J, Wang Y, Chen Z. Effectiveness of group training on depressive mood among college students: a Meta-analysis. \u003cem\u003eChinese Journal of School Health\u003c/em\u003e. 2017;38(05):676-679+682. doi:10.16835/j.cnki.1000-9817.2017.05.011\u003c/li\u003e\n \u003cli\u003eLi T, Ge L, Wang J, Xu Y. Intervention effects of self-confidence training on depressive mood and automatic thoughts of college students. \u003cem\u003eChinese Journal of Behavioral Medicine and Brain Science\u003c/em\u003e. 2016;25(02):171-174.\u003c/li\u003e\n \u003cli\u003eWang X, Hou J, Luo H, Yu X, Liu W, Li L. A study of the role of music therapy in improving depression in medical students. \u003cem\u003eChina Higher Medical Education\u003c/em\u003e. 2020;(06):89-90.\u003c/li\u003e\n \u003cli\u003eGuo X, Yang Y. Intervention effects of physical activity on depressed mood in college students. \u003cem\u003eContemporary Sports Technology\u003c/em\u003e. 2017;7(22):237-238. doi:10.16655/j.cnki.2095-2813.2017.22.237\u003c/li\u003e\n \u003cli\u003eYu Q, Li L, LI E. A meta-analysis of tai chi training to improve depression in school college students. \u003cem\u003eJournal of International Psychiatry\u003c/em\u003e. 2019;46(03):409-412. doi:10.13479/j.cnki.jip.2019.03.008\u003c/li\u003e\n \u003cli\u003eZhou W, Sun P, Liu K, Zhao Y, Xue J, zhao J. A Study on the Effect of Bodybuilding Training on Depression and Quality of Life of College Students. \u003cem\u003eSport Science and Technology\u003c/em\u003e. 2021;42(03):38-40+43. doi:10.14038/j.cnki.tykj.2021.03.014\u003c/li\u003e\n \u003cli\u003eZhao W, Zou A. Group Counselling Design for Acceptance and Commitment Therapy Interventions for Depression in College Students. \u003cem\u003eEducation and Teaching Forum\u003c/em\u003e. 2013;(05):271-272.\u003c/li\u003e\n \u003cli\u003eLi J, Luo X, Wang J. Intervention research of mindfulness-based cognitive therapy on depression of college students. \u003cem\u003ePsychology Monthly\u003c/em\u003e. 2022;17(15):18-20+24. doi:10.19738/j.cnki.psy.2022.15.005\u003c/li\u003e\n \u003cli\u003eZhang S, Ye K, Luo K. A study on the effectiveness of self-help mindfulness course in improving college students\u0026apos; depression. \u003cem\u003eChina Journal of Multimedia \u0026amp; Network Teaching\u003c/em\u003e. 2022;(07):86-89.\u003c/li\u003e\n \u003cli\u003eChen J, Song W, Li H, Xue Y. Exploring the Intervention of Expressive Arts Therapy on College Students\u0026apos; Depression and Anxiety--Taking Beijing Normal University as an Example. \u003cem\u003eArt Education\u003c/em\u003e. 2021;(12):38-41.\u003c/li\u003e\n \u003cli\u003eWu Y, Sun J, Gu R, Li J. Effect of Meridian-following Meditation on Depression in College Students. \u003cem\u003eChinese General Practice\u003c/em\u003e. 2020;23(14):1796-1799.\u003c/li\u003e\n \u003cli\u003eXu C, Jiao Y, Zhang F, Zhang J, Li P, Zhao X. Intervention Study of Integration Therapy of Five Wefts on College Students\u0026apos; Depression Disorder. \u003cem\u003eValue Engineering\u003c/em\u003e. 2017;36(04):143-146. doi:10.14018/j.cnki.cn13-1085/n.2017.04.058\u003c/li\u003e\n \u003cli\u003eDawson KS, Bryant RA, Harper M, et al. Problem Management Plus (PM+): a WHO transdiagnostic psychological intervention for common mental health problems. \u003cem\u003eWorld Psychiatry\u003c/em\u003e. Oct 2015;14(3):354-7. doi:10.1002/wps.20255\u003c/li\u003e\n \u003cli\u003eAlozkan Sever C, Cuijpers P, Mittendorfer-Rutz E, et al. Feasibility and acceptability of Problem Management Plus with Emotional Processing (PM+EP) for refugee youth living in the Netherlands: study protocol. \u003cem\u003eEur J Psychotraumatol\u003c/em\u003e. 2021;12(1):1947003. doi:10.1080/20008198.2021.1947003\u003c/li\u003e\n \u003cli\u003eRahman A, Riaz N, Dawson KS, et al. Problem Management Plus (PM+): pilot trial of a WHO transdiagnostic psychological intervention in conflict-affected Pakistan. \u003cem\u003eWorld Psychiatry\u003c/em\u003e. Jun 2016;15(2):182-3. doi:10.1002/wps.20312\u003c/li\u003e\n \u003cli\u003eRahman A, Hamdani SU, Awan NR, et al. Effect of a Multicomponent Behavioral Intervention in Adults Impaired by Psychological Distress in a Conflict-Affected Area of Pakistan: A Randomized Clinical Trial. \u003cem\u003eJama\u003c/em\u003e. Dec 27 2016;316(24):2609-2617. doi:10.1001/jama.2016.17165\u003c/li\u003e\n \u003cli\u003eSangraula M, Turner EL, Luitel NP, et al. Feasibility of Group Problem Management Plus (PM+) to improve mental health and functioning of adults in earthquake-affected communities in Nepal. \u003cem\u003eEpidemiol Psychiatr Sci\u003c/em\u003e. May 26 2020;29:e130. doi:10.1017/s2045796020000414\u003c/li\u003e\n \u003cli\u003eSingla DR, Kohrt BA, Murray LK, Anand A, Chorpita BF, Patel V. Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries. \u003cem\u003eAnnu Rev Clin Psychol\u003c/em\u003e. May 8 2017;13:149-181. doi:10.1146/annurev-clinpsy-032816-045217\u003c/li\u003e\n \u003cli\u003eKroenke K, Spitzer RL. The PHQ-9: A New Depression Diagnostic and Severity Measure. \u003cem\u003ePsychiatric Annals\u003c/em\u003e. 2002;32(9)\u003c/li\u003e\n \u003cli\u003eKroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. \u003cem\u003eJ Gen Intern Med\u003c/em\u003e. Sep 2001;16(9):606-13. doi:10.1046/j.1525-1497.2001.016009606.x\u003c/li\u003e\n \u003cli\u003eSpitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. \u003cem\u003eJama\u003c/em\u003e. Nov 10 1999;282(18):1737-44. doi:10.1001/jama.282.18.1737\u003c/li\u003e\n \u003cli\u003eSpitzer RL, Kroenke K, Williams JB, L\u0026ouml;we B. A brief measure for assessing generalized anxiety disorder: the GAD-7. \u003cem\u003eArch Intern Med\u003c/em\u003e. May 22 2006;166(10):1092-7. doi:10.1001/archinte.166.10.1092\u003c/li\u003e\n \u003cli\u003ePlummer F, Manea L, Trepel D, McMillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. \u003cem\u003eGen Hosp Psychiatry\u003c/em\u003e. Mar-Apr 2016;39:24-31. doi:10.1016/j.genhosppsych.2015.11.005\u003c/li\u003e\n \u003cli\u003eSousa TV, Viveiros V, Chai MV, et al. Reliability and validity of the Portuguese version of the Generalized Anxiety Disorder (GAD-7) scale. \u003cem\u003eHealth Qual Life Outcomes\u003c/em\u003e. Apr 25 2015;13:50. doi:10.1186/s12955-015-0244-2\u003c/li\u003e\n \u003cli\u003eBagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale--I. Item selection and cross-validation of the factor structure. \u003cem\u003eJ Psychosom Res\u003c/em\u003e. Jan 1994;38(1):23-32. doi:10.1016/0022-3999(94)90005-1\u003c/li\u003e\n \u003cli\u003eYuan Y, Sheng X, Zhang X, et al. The reliability and validity of Toronto alexithymia scale（TAS－20）. \u003cem\u003eSichuan Mental Health\u003c/em\u003e. 2003;(01):25-27.\u003c/li\u003e\n \u003cli\u003eRussell D, Peplau LA, Cutrona CE. The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. \u003cem\u003eJ Pers Soc Psychol\u003c/em\u003e. Sep 1980;39(3):472-80. doi:10.1037//0022-3514.39.3.472\u003c/li\u003e\n \u003cli\u003eSpaaij J, Kiselev N, Berger C, et al. Feasibility and acceptability of Problem Management Plus (PM+) among Syrian refugees and asylum seekers in Switzerland: a mixed-method pilot randomized controlled trial. \u003cem\u003eEur J Psychotraumatol\u003c/em\u003e. 2022;13(1):2002027. doi:10.1080/20008198.2021.2002027\u003c/li\u003e\n \u003cli\u003eJordans MJD, Kohrt BA, Sangraula M, et al. Effectiveness of Group Problem Management Plus, a brief psychological intervention for adults affected by humanitarian disasters in Nepal: A cluster randomized controlled trial. \u003cem\u003ePLoS Med\u003c/em\u003e. Jun 2021;18(6):e1003621. doi:10.1371/journal.pmed.1003621\u003c/li\u003e\n \u003cli\u003eZhang H, Zhang D, Lin H, Huang L. Problem Management Plus in the treatment of mental disorders in patients with multiple myeloma. \u003cem\u003eSupport Care Cancer\u003c/em\u003e. Oct 2020;28(10):4721-4727. doi:10.1007/s00520-019-05289-9\u003c/li\u003e\n \u003cli\u003eUygun E, Ilkkursun Z, Sijbrandij M, et al. Protocol for a randomized controlled trial: peer-to-peer Group Problem Management Plus (PM+) for adult Syrian refugees in Turkey. \u003cem\u003eTrials\u003c/em\u003e. Mar 20 2020;21(1):283. doi:10.1186/s13063-020-4166-x\u003c/li\u003e\n \u003cli\u003eSangraula M, Van\u0026apos;t Hof E, Luitel NP, et al. Protocol for a feasibility study of group-based focused psychosocial support to improve the psychosocial well-being and functioning of adults affected by humanitarian crises in Nepal: Group Problem Management Plus (PM+). \u003cem\u003ePilot Feasibility Stud\u003c/em\u003e. 2018;4:126. doi:10.1186/s40814-018-0315-3\u003c/li\u003e\n \u003cli\u003eSijbrandij M, Bryant RA, Schafer A, et al. Problem Management Plus (PM+) in the treatment of common mental disorders in women affected by gender-based violence and urban adversity in Kenya; study protocol for a randomized controlled trial. \u003cem\u003eInt J Ment Health Syst\u003c/em\u003e. 2016;10:44. doi:10.1186/s13033-016-0075-5\u003c/li\u003e\n \u003cli\u003eLiu B, Chen J, Xiong W. The Intervention Effect of Online PM+ on Residents\u0026rsquo; Stress Response in the COVID-19. \u003cem\u003eChinese Journal of Clinical Psychology\u003c/em\u003e. 2021;29(06):1353-1357+1322. doi:10.16128/j.cnki.1005-3611.2021.06.047\u003c/li\u003e\n \u003cli\u003eLiu Y, Liu X, Yang Y, Xu C, Li M. Intervention of psychological training of problem management plus ( PM + ) on improvement of psychological adaptability of recruits during training period. \u003cem\u003eJournal of Army Medical University\u003c/em\u003e. 2022;44(20):2120-2129. doi:10.16016/j.2097-0927.202207076\u003c/li\u003e\n \u003cli\u003eXiao J. \u003cem\u003eThe Relationship of College Students\u0026apos; Alexithymia,Life Event and Family Function\u003c/em\u003e. 硕士. Sichuan Normal University; 2012.\u003c/li\u003e\n \u003cli\u003eLi Y, Li T, Zen P. Mechanism and intervention strategies of alexithymia. \u003cem\u003eSichuan Mental Health\u003c/em\u003e. 2022;35(01):92-96.\u003c/li\u003e\n \u003cli\u003eBenson H, Frankel FH, Apfel R, et al. Treatment of anxiety: a comparison of the usefulness of self-hypnosis and a meditational relaxation technique. An overview. \u003cem\u003ePsychother Psychosom\u003c/em\u003e. 1978;30(3-4):229-42. doi:10.1159/000287304\u003c/li\u003e\n \u003cli\u003eYao C. Alexithymia. \u003cem\u003eJournal of International Psychiatry\u003c/em\u003e. 1991;(03):141-144.\u003c/li\u003e\n \u003cli\u003eZhu C, Su R, Huang F, Liu Y. Impact of existential isolation on depression of left behind college students: A moderated mediation model. \u003cem\u003eChina Journal of Health Psychology\u003c/em\u003e. 2022;30(04):498-503. doi:10.13342/j.cnki.cjhp.2022.04.004\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Group Problem Management Plus, Depressed mood, Loneliness, Alexithymia ","lastPublishedDoi":"10.21203/rs.3.rs-4858811/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4858811/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective：\u003c/strong\u003eThe prevalence of mental health problems among medical students is higher than that of students in other disciplines and continues to increase, which may pose a risk to medical students in their subsequent studies and careers. This study adopts a Group Problem Manager Plus (PM+) intervention with medical students and investigates its effectiveness. The study demonstrates the effectiveness of Group PM+ at treating depressed mood and mental health illnesses, providing an important theoretical and experimental basis for new therapies to improve the physical and mental health of medical students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003e(1) Participants: Fifty-two participants were recruited through online distribution of the scale and randomly divided into an experimental group (received 5 weekly sessions of the Group PM+ intervention) and a control group (sharing psychology knowledge online only) after interviewing each participant individually. (2) Scales: The participants in both groups completed pre- and post-tests that included the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), UCLA Loneliness Scale, Toronto Alexithymia Scale (TAS), and Chinese version of the Interpersonal Reactivity Index (IRI-C).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003e(1) The results of the repeated measures ANOVA showed a significant improvement in depressed mood in Group PM+ (F\u003csub\u003e1,43\u003c/sub\u003e = 10.460, \u003cem\u003eP\u003c/em\u003e = 0.002) and significantly improved anxiety (F\u003csub\u003e1,43\u003c/sub\u003e = 19.007, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). (2) The Group PM+ intervention also diminished feelings of loneliness due to depressed mood and partially improved alexithymia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e (1) Group PM+ interventions can effectively treat depression and anxiety in medical students, alleviate feelings of loneliness, and reduce alexithymia in this population.\u003c/p\u003e","manuscriptTitle":"A study on the efficacy of Group PM+ on depressed mood in medical students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-04 21:13:05","doi":"10.21203/rs.3.rs-4858811/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d5314ae6-e222-45b2-9524-59aa4460aea3","owner":[],"postedDate":"September 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-11T19:53:12+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-04 21:13:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4858811","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4858811","identity":"rs-4858811","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}