A DEAL-based intervention for the reduction of depression, denial, self-blame and academic stress: A randomized controlled trial
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| internalnotes | 1. Guthrie EA, Black D, Bagalkote H, Shaw C, Campbell M, Creed F. Psychological stress and burnout in medical students: a five-year prospective longitudinal study. J R Soc Med 1998; 91(5): 237-243. 2. Niemi PM, Vainiomaki PT. Medical students’ distress-quality, continuity and gender differences during a six-year medical programme. Med Teach 2006; 28(2): 136-141. 3. Yusoff MSB, Abdul Rahim AF, Baba AA, Ismail SB, Mat Pa MN, Esa AR. The impact of medical education on psychological health of students: a cohort study. Psychol Health Med 2013; 18(4): 420-430. 4. Yusoff MSB, Abdul Rahim AF, Baba AA, Ismail SB, Mat Pa MN, Esa AR. Prevalence and associated factors of stress, anxiety and depression among prospective medical students. Asian J Psychiatry 2013; 6(2): 128-133. 5. Yusoff MSB, Mat Pa MN, Esa AR, Abdul Rahim AF. Mental health of medical students before and during medical education: a prospective study. J Taibah Univ Med Sci 2013; 8(2): 86-92. 6. Yusoff MSB, Liew YY, Ling HW, Tan CS, Loke HM, Lim XB, et al. A study on stress, stressors and coping strategies among Malaysian medical students. Int J Stud Res 2011; 1(2): 45-50. 7. Yusoff MSB, Rahim AFA, Yaacob MJ. Prevalence and sources of stress among Universiti sains Malaysia medical students. Malays J Med Sci 2010; 17(1): 30-37. 8. Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc 2005; 80(12): 1613-1622. 9. Chandavarkar U, Azzam A, Mathews CA. Anxiety symptoms and perceived performance in medical students. Depress Anxiety 2007; 24(2): 103-111. 10. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Acad Med 2006; 81(4): 354-373. 11. Givens JL, Tjia J. Depressed medical students’ use of mental health services and barriers to use. Acad Med 2002; 77(9): 918. 12. Mohd Sidik S, Kaneson N. The prevalence of depression among medical students. Malays J Psychiatry 2003; 11(1): 12-17. 13. Yusoff MSB, Rahim AFA, Yaacob MJ. The prevalence of final year medical students with depressive symptoms and its contributing factors. Int Med J 2011; 18(4): 305-309. 14. Goebert D, Thompson D, Takeshita J, Beach C, Bryson P, Ephgrave K, et al. Depressive symptoms in medical students and residents: a multischool study. Acad Med 2009; 84(2): 236. 15. Hem E, Gronvold N, Aasland O, Ekeberg O. The prevalence of suicidal ideation and suicidal attempts among Norwegian physicians. Results from a cross-sectional survey of a nationwide sample. Eur Psychiatry 2000; 15(3): 183-189. 16. WHS. Country report for Malaysia: mental health condition, vol. I-V. Institute for Health System Research; 2002. 17. Dyrbye LN, Thomas MR, Massie F, Power DV, Eacker A, Harper W, et al. Burnout and suicidal ideation among US medical students. Ann Intern Med 2008; 149(5): 334-341. 18. Yusoff MSB, Esa AR. Stress management for medical students: a systematic review. In: Lopez-Varela MA, editor. Social sciences and cultural studies e issues of language, public opinion, education and welfare. Croatia: InTech; 2012. M.S.B. Yusoff and A.R. Esa 91 19. Shapiro SL, Shapiro DE, Schwartz GER. Stress management in medical education: a review of the literature. Acad Med 2000; 75(7): 748. 20. Yusoff MSB. Interventions on medical students’ psychological health: a meta-analysis. J Taibah Univ Med Sci 2014; 9(1): 1-13. 21. Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. J Personal Soc Psychol 1989; 56(2): 267. 22. Carver CS. You want to measure coping but your protocol too long: consider the brief cope.Int J Behav Med 1997; 4(1): 92-100. 23. Moffat KJ, McConnachie A, Ross S, Morrison JM. First year medical student stress and coping in a problem-based learning medical curriculum. Med Educ 2004; 38(5): 482-491. 24. Chandrasekhar TS, Pathiyil RS, Binu VS, Chiranjoy M, Biswabina R, Ritesh GM. Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal. BMC Med Educ 2007; 7(1): 26. 25. Johari A, Hashim IN. Stress and coping strategies among medical students in National university of Malaysia, Malaysia university of Sabah and university Kuala Lumpur Royal College of medicine Perak. J Com Health 2009; 15(2): 106-115. 26. Yusoff MSB, Ahmad Hamid AH, Rosli NR, Zakaria NA, Che Rameli NA, Abdul Rahman NS, et al. Prevalence of stress, stressors and coping strategies among secondary school students in Kota Bharu, Kelantan, Malaysia. Int J Stud Res 2011; 1(1): 23-28. 27. Park CL, Adler NE. Coping style as a predictor of health and well-being across the first year of medical school. Health Psychol 2003; 22(6): 627. 28. Yusoff MSB. Effects of a brief stress reduction intervention on medical students’ depression, anxiety and stress level during stressful period. Asean J Psychiatry 2011; 12(1): 1-14. 29. Yusoff MSB, Rahim AFA. The impact of medical students well-being workshop on medical students’ stress level: a preliminary finding. Asean J Psychiatry 2010; 11(1): 1-8. 30. Zeitlin D, Keller SE, Shiflett SC, Schleifer SJ, Bartlett JA. Immunological effects of massage therapy during academic stress. Psychosom Med 2000; 62(1): 83-84. 31. McGrady A, Brennan J, Lynch D, Whearty K. A wellness program for first year medical students. Appl Psychophysiol Biofeedback 2012; 37(6): 1-8. 32. Yusoff MSB, Esa AR. The medical student wellbeing workshop. MedEdPORTAL. USA: AAMC; 2012. 33. Yusoff MSB, Yaacob MJ, Naing NN, Esa AR. An educational strategy to teaching stress management skills in medical education: the DEAL model. Int Med J 2013; 20(2): 1-11. 34. Yusoff MSB, Esa AR. Medical student wellbeing workshop: a stress management programme for medical students. Saarbrucken, Germany: VDM Verlag Dr Muller GmbH & Co. KG; 2011. 35. Yusoff MSB, Yaacob MJ, Naing NN, Esa AR. A conceptual framework of stress management intervention for medical students. Educ Med J 2013; 5(3): e93-e99. 36. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4(6): 561. 37. McDowell I. Measuring health: a guide to rating scales and questionnaires. 3rd ed. New York: Oxford University Press; 2006. 38. Yusoff MSB. A confirmatory factor analysis study on the medical student stressor questionnaire among malaysian medical students. Educ Med J 2011; 3(1): e44-e55. 39. Yusoff MSB, Abdul Rahim AF, Yaacob MJ. The development and validity of the medical student stressor questionnaire (MSSQ). Asean J Psychiatry 2010; 11(1): 231-235. 40. Yusoff MSB. The stability of MSSQ to measure stressors among medical students. Int Med J 2013; 20(2): 1-3. 41. Yusoff MSB. A multicenter study on validity of the 30-items brief COPE in identifying coping strategies among medical students. Int Med J 2010; 17(14): 249-253. 42. Mukhtar F, Oei TP. Exploratory and confirmatory factor validation and psychometric properties of the beck depression inventory for Malays (BDI-Malay) in Malaysia. Malays J Psychiatry 2008; 17(1): 51-64. 43. Barman A. Sample size precision and power calculator. 1.0. Malaysia: Arunodaya Barman; 2009. 44. Kaplowitz MD, Hadlock TD, Levine R. A comparison of web and mail survey response rates. Public Opin Q 2004; 68(1): 94-101. 45. Cobanoglu C, Warde B, Moreo PJ. A comparison of mail, fax and web-based survey methods. Int J Mark Res 2001; 43(4): 441-452. 46. Yusoff MSB, Rahim AFA, Yaacob MJ. Stress and stressors among medical students in school of medical sciences, Universiti Sains Malaysia. Germany: VDM Publishing House; 2011. 47. Arifin WN. Random sampling and allocation using SPSS. Educ Med J 2012; 4(1). 48. Pallant J. SPSS survival manual e a step by step guide to data analysis using SPSS. 4th ed. Australia: Allen & Unwin; 2011. 49. Cohen JW. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988. 50. Roh MS, Jeon HJ, Kim H, Han SK, Hahm BJ. The prevalence and impact of depression among medical students: a nationwide cross-sectional study in South Korea. Acad Med 2010; 85(8): 1384-1390. 51. Mosley Jr TH, Perrin SG, Neral SM, Dubbert PM, Grothues CA, Pinto BM. Stress, coping, and well-being among third-year medical students. Acad Med 1994; 69(9): 765-767. 52. Hau JL, Yusoff MSB. Psychological distress, sources of stress and coping strategy in high school students. Int Med J 2013; 20(6): 1-6. 53. Kaufman DM, Day V, Mensink D. Stressors in 1st-year medical school: comparison of a conventional and problem-based curriculum. Teach Learn Med 1996; 8(4): 188-194. 54. Kaufman DM, Mensink D, Day V. Stressors in medical school: relation to curriculum format and year of study. Teach Learn Med 1998; 10(3): 138-144. 55. Smith CK, Peterson DF, Degenhardt BF, Johnson JC. Depression, anxiety, and perceived hassles among entering medical students. Psychol Health Med 2007; 12(1): 31-39. 56. Van Harrison R. Person-environment fit and job stress. In: Cooper CL, Payne R, editors. Stress at work. Chichester, UK: Wiley; 1978. pp. 175-205. 57. Stewart SM, Betson C, Marshall I, Wong C, Lee P, Lam T. Stress and vulnerability in medical students. Med Educ 1995; 29(2): 119-127. 58. Yusoff MSB. Impact of summative assessment on first year medical students’ mental health. Int Med J 2011; 18(3): 172-175. |
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| spelling | 11651 https://intelek.unisza.edu.my/intelek/pages/view.php?ref=11651 https://intelek.unisza.edu.my/intelek/pages/search.php?search=!collection407072 Restricted Document Article Journal UniSZA Unisza unisza image/jpeg inches 96 96 1425 793 1425x793 2015-04-13 08:24:58 82 82 5918-01-FH02-FPSK-15-02828.jpg UniSZA Private Access A DEAL-based intervention for the reduction of depression, denial, self-blame and academic stress: A randomized controlled trial Journal of Taibah University Medical Sciences Objective: This study aimed to evaluate effectiveness of a DEAL-based based intervention on medical students’ depression symptoms, coping strategies and perceived stressors. Methods: A parallel randomized controlled trial was conducted on a government medical school in Malaysia. A total of 171 medical students consented to participate in the study. A 4-h educational workshop that was designed based on the DEAL model was conducted on the medical students. Depression, coping strategies and perceived stressors were measured by Beck’s Depression Inventory, Brief COPE and Medical Student Stressor Questionnaire respectively. The mixed model ANCOVA was applied to determine the effect of intervention. Partial eta squared (h2partial) was used to estimate effect size. Results: 171 medical students were randomized into study groups by draw lots (control ¼ 83 and intervention ¼ 88). 18 medical students withdrew from the study before 32nd week, leaving 153 medical students (control ¼ 80 and intervention ¼ 73) for analysis. The intervention group significantly experienced lower depression symptoms (p ¼ 0.017, h2partial ¼ 0.037), less frequent of denial (p ¼ 0.002, h2partial ¼ 0.063), less frequent of self-blame (p ¼ 0.002, h2partial ¼ 0.064) and lower perceived academic stress (p ¼ 0.009, h2partial ¼ 0.044) than the control group. Conclusion: The results support the positive impacts of the DEAL-based intervention on the medical students’ mental health. It is a promising intervention to be adopted by medical schools due to it consumes minimal amount of time, money, training and man power as well as simple to be implemented. 10 1 82-92 1. Guthrie EA, Black D, Bagalkote H, Shaw C, Campbell M, Creed F. Psychological stress and burnout in medical students: a five-year prospective longitudinal study. J R Soc Med 1998; 91(5): 237-243. 2. Niemi PM, Vainiomaki PT. Medical students’ distress-quality, continuity and gender differences during a six-year medical programme. Med Teach 2006; 28(2): 136-141. 3. Yusoff MSB, Abdul Rahim AF, Baba AA, Ismail SB, Mat Pa MN, Esa AR. The impact of medical education on psychological health of students: a cohort study. Psychol Health Med 2013; 18(4): 420-430. 4. Yusoff MSB, Abdul Rahim AF, Baba AA, Ismail SB, Mat Pa MN, Esa AR. Prevalence and associated factors of stress, anxiety and depression among prospective medical students. Asian J Psychiatry 2013; 6(2): 128-133. 5. Yusoff MSB, Mat Pa MN, Esa AR, Abdul Rahim AF. Mental health of medical students before and during medical education: a prospective study. J Taibah Univ Med Sci 2013; 8(2): 86-92. 6. Yusoff MSB, Liew YY, Ling HW, Tan CS, Loke HM, Lim XB, et al. A study on stress, stressors and coping strategies among Malaysian medical students. Int J Stud Res 2011; 1(2): 45-50. 7. Yusoff MSB, Rahim AFA, Yaacob MJ. Prevalence and sources of stress among Universiti sains Malaysia medical students. Malays J Med Sci 2010; 17(1): 30-37. 8. Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc 2005; 80(12): 1613-1622. 9. Chandavarkar U, Azzam A, Mathews CA. Anxiety symptoms and perceived performance in medical students. Depress Anxiety 2007; 24(2): 103-111. 10. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Acad Med 2006; 81(4): 354-373. 11. Givens JL, Tjia J. Depressed medical students’ use of mental health services and barriers to use. Acad Med 2002; 77(9): 918. 12. Mohd Sidik S, Kaneson N. The prevalence of depression among medical students. Malays J Psychiatry 2003; 11(1): 12-17. 13. Yusoff MSB, Rahim AFA, Yaacob MJ. The prevalence of final year medical students with depressive symptoms and its contributing factors. Int Med J 2011; 18(4): 305-309. 14. Goebert D, Thompson D, Takeshita J, Beach C, Bryson P, Ephgrave K, et al. Depressive symptoms in medical students and residents: a multischool study. Acad Med 2009; 84(2): 236. 15. Hem E, Gronvold N, Aasland O, Ekeberg O. The prevalence of suicidal ideation and suicidal attempts among Norwegian physicians. Results from a cross-sectional survey of a nationwide sample. Eur Psychiatry 2000; 15(3): 183-189. 16. WHS. Country report for Malaysia: mental health condition, vol. I-V. Institute for Health System Research; 2002. 17. Dyrbye LN, Thomas MR, Massie F, Power DV, Eacker A, Harper W, et al. Burnout and suicidal ideation among US medical students. Ann Intern Med 2008; 149(5): 334-341. 18. Yusoff MSB, Esa AR. Stress management for medical students: a systematic review. In: Lopez-Varela MA, editor. Social sciences and cultural studies e issues of language, public opinion, education and welfare. Croatia: InTech; 2012. M.S.B. Yusoff and A.R. Esa 91 19. Shapiro SL, Shapiro DE, Schwartz GER. Stress management in medical education: a review of the literature. Acad Med 2000; 75(7): 748. 20. Yusoff MSB. Interventions on medical students’ psychological health: a meta-analysis. J Taibah Univ Med Sci 2014; 9(1): 1-13. 21. Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. J Personal Soc Psychol 1989; 56(2): 267. 22. Carver CS. You want to measure coping but your protocol too long: consider the brief cope.Int J Behav Med 1997; 4(1): 92-100. 23. Moffat KJ, McConnachie A, Ross S, Morrison JM. First year medical student stress and coping in a problem-based learning medical curriculum. Med Educ 2004; 38(5): 482-491. 24. Chandrasekhar TS, Pathiyil RS, Binu VS, Chiranjoy M, Biswabina R, Ritesh GM. Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal. BMC Med Educ 2007; 7(1): 26. 25. Johari A, Hashim IN. Stress and coping strategies among medical students in National university of Malaysia, Malaysia university of Sabah and university Kuala Lumpur Royal College of medicine Perak. J Com Health 2009; 15(2): 106-115. 26. Yusoff MSB, Ahmad Hamid AH, Rosli NR, Zakaria NA, Che Rameli NA, Abdul Rahman NS, et al. Prevalence of stress, stressors and coping strategies among secondary school students in Kota Bharu, Kelantan, Malaysia. Int J Stud Res 2011; 1(1): 23-28. 27. Park CL, Adler NE. Coping style as a predictor of health and well-being across the first year of medical school. Health Psychol 2003; 22(6): 627. 28. Yusoff MSB. Effects of a brief stress reduction intervention on medical students’ depression, anxiety and stress level during stressful period. Asean J Psychiatry 2011; 12(1): 1-14. 29. Yusoff MSB, Rahim AFA. The impact of medical students well-being workshop on medical students’ stress level: a preliminary finding. Asean J Psychiatry 2010; 11(1): 1-8. 30. Zeitlin D, Keller SE, Shiflett SC, Schleifer SJ, Bartlett JA. Immunological effects of massage therapy during academic stress. Psychosom Med 2000; 62(1): 83-84. 31. McGrady A, Brennan J, Lynch D, Whearty K. A wellness program for first year medical students. Appl Psychophysiol Biofeedback 2012; 37(6): 1-8. 32. Yusoff MSB, Esa AR. The medical student wellbeing workshop. MedEdPORTAL. USA: AAMC; 2012. 33. Yusoff MSB, Yaacob MJ, Naing NN, Esa AR. An educational strategy to teaching stress management skills in medical education: the DEAL model. Int Med J 2013; 20(2): 1-11. 34. Yusoff MSB, Esa AR. Medical student wellbeing workshop: a stress management programme for medical students. Saarbrucken, Germany: VDM Verlag Dr Muller GmbH & Co. KG; 2011. 35. Yusoff MSB, Yaacob MJ, Naing NN, Esa AR. A conceptual framework of stress management intervention for medical students. Educ Med J 2013; 5(3): e93-e99. 36. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4(6): 561. 37. McDowell I. Measuring health: a guide to rating scales and questionnaires. 3rd ed. New York: Oxford University Press; 2006. 38. Yusoff MSB. A confirmatory factor analysis study on the medical student stressor questionnaire among malaysian medical students. Educ Med J 2011; 3(1): e44-e55. 39. Yusoff MSB, Abdul Rahim AF, Yaacob MJ. The development and validity of the medical student stressor questionnaire (MSSQ). Asean J Psychiatry 2010; 11(1): 231-235. 40. Yusoff MSB. The stability of MSSQ to measure stressors among medical students. Int Med J 2013; 20(2): 1-3. 41. Yusoff MSB. A multicenter study on validity of the 30-items brief COPE in identifying coping strategies among medical students. Int Med J 2010; 17(14): 249-253. 42. Mukhtar F, Oei TP. Exploratory and confirmatory factor validation and psychometric properties of the beck depression inventory for Malays (BDI-Malay) in Malaysia. Malays J Psychiatry 2008; 17(1): 51-64. 43. Barman A. Sample size precision and power calculator. 1.0. Malaysia: Arunodaya Barman; 2009. 44. Kaplowitz MD, Hadlock TD, Levine R. A comparison of web and mail survey response rates. Public Opin Q 2004; 68(1): 94-101. 45. Cobanoglu C, Warde B, Moreo PJ. A comparison of mail, fax and web-based survey methods. Int J Mark Res 2001; 43(4): 441-452. 46. Yusoff MSB, Rahim AFA, Yaacob MJ. Stress and stressors among medical students in school of medical sciences, Universiti Sains Malaysia. Germany: VDM Publishing House; 2011. 47. Arifin WN. Random sampling and allocation using SPSS. Educ Med J 2012; 4(1). 48. Pallant J. SPSS survival manual e a step by step guide to data analysis using SPSS. 4th ed. Australia: Allen & Unwin; 2011. 49. Cohen JW. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988. 50. Roh MS, Jeon HJ, Kim H, Han SK, Hahm BJ. The prevalence and impact of depression among medical students: a nationwide cross-sectional study in South Korea. Acad Med 2010; 85(8): 1384-1390. 51. Mosley Jr TH, Perrin SG, Neral SM, Dubbert PM, Grothues CA, Pinto BM. Stress, coping, and well-being among third-year medical students. Acad Med 1994; 69(9): 765-767. 52. Hau JL, Yusoff MSB. Psychological distress, sources of stress and coping strategy in high school students. Int Med J 2013; 20(6): 1-6. 53. Kaufman DM, Day V, Mensink D. Stressors in 1st-year medical school: comparison of a conventional and problem-based curriculum. Teach Learn Med 1996; 8(4): 188-194. 54. Kaufman DM, Mensink D, Day V. Stressors in medical school: relation to curriculum format and year of study. Teach Learn Med 1998; 10(3): 138-144. 55. Smith CK, Peterson DF, Degenhardt BF, Johnson JC. Depression, anxiety, and perceived hassles among entering medical students. Psychol Health Med 2007; 12(1): 31-39. 56. Van Harrison R. Person-environment fit and job stress. In: Cooper CL, Payne R, editors. Stress at work. Chichester, UK: Wiley; 1978. pp. 175-205. 57. Stewart SM, Betson C, Marshall I, Wong C, Lee P, Lam T. Stress and vulnerability in medical students. Med Educ 1995; 29(2): 119-127. 58. Yusoff MSB. Impact of summative assessment on first year medical students’ mental health. Int Med J 2011; 18(3): 172-175. |
| spellingShingle | A DEAL-based intervention for the reduction of depression, denial, self-blame and academic stress: A randomized controlled trial |
| summary | Objective: This study aimed to evaluate effectiveness of a DEAL-based based intervention on medical students’ depression symptoms, coping strategies and perceived stressors. Methods: A parallel randomized controlled trial was conducted on a government medical school in Malaysia. A total of 171 medical students consented to participate in the study. A 4-h educational workshop that was designed based on the DEAL model was conducted on the medical students. Depression, coping strategies and perceived stressors were measured by Beck’s Depression Inventory, Brief COPE and Medical Student Stressor Questionnaire respectively. The mixed model ANCOVA was applied to determine the effect of intervention. Partial eta squared (h2partial) was used to estimate effect size. Results: 171 medical students were randomized into study groups by draw lots (control ¼ 83 and intervention ¼ 88). 18 medical students withdrew from the study before 32nd week, leaving 153 medical students (control ¼ 80 and intervention ¼ 73) for analysis. The intervention group significantly experienced lower depression symptoms (p ¼ 0.017, h2partial ¼ 0.037), less frequent of denial (p ¼ 0.002, h2partial ¼ 0.063), less frequent of self-blame (p ¼ 0.002, h2partial ¼ 0.064) and lower perceived academic stress (p ¼ 0.009, h2partial ¼ 0.044) than the control group. Conclusion: The results support the positive impacts of the DEAL-based intervention on the medical students’ mental health. It is a promising intervention to be adopted by medical schools due to it consumes minimal amount of time, money, training and man power as well as simple to be implemented. |
| title | A DEAL-based intervention for the reduction of depression, denial, self-blame and academic stress: A randomized controlled trial |
| title_full | A DEAL-based intervention for the reduction of depression, denial, self-blame and academic stress: A randomized controlled trial |
| title_fullStr | A DEAL-based intervention for the reduction of depression, denial, self-blame and academic stress: A randomized controlled trial |
| title_full_unstemmed | A DEAL-based intervention for the reduction of depression, denial, self-blame and academic stress: A randomized controlled trial |
| title_short | A DEAL-based intervention for the reduction of depression, denial, self-blame and academic stress: A randomized controlled trial |
| title_sort | deal-based intervention for the reduction of depression, denial, self-blame and academic stress: a randomized controlled trial |