Influences of Australian Nursing Students’ Anxiety, Depression, Personality and Family Interaction on their Psychological Well-Being and Suicidal Ideation

Objective: To examine the relationships between Australian nursing students’ anxiety, depression, personality and family interaction with psychological well-being and suicidal ideation. Participants: A sample of 201 nursing students completed a series of structured questionnaires in an Australian University. Methods: A cross-sectional descriptive research design was used. After explanation of this study, 201 nursing students voluntarily participated. Six reliable and structured questionnaires were used to do data collection. SPSS was used for data analysis including descriptive data, Pearson Correlation, and Stepwise Multiple Regression. Results: Anxiety and depression were positively associated with suicidal ideation and had negative relationships with psychological well-being. Positive personality and family interaction were positively associated with psychological well-being and negatively with suicidal ideation. Parents’ harsh discipline had a negative relationship with the nursing students’ psychological well-being. Conclusions: Depression, personality, and positive family interaction were significant predictors of Australian nursing students’ psychological well-being. Anxiety, depression, and harsh discipline were significant predictors of suicidal ideation DOI : 10.14302/issn.2474-9273.jbtm-16-1175 Corresponding Author: Pi-Ming Yeh, School of Nursing and Health Professionals, Missouri Western State University, Address: 4525 Downs Drive, St Joseph, MO 64507, USA, Telephone: (816)271-4250, Fax number: (816) 271-5849, E-mail: pimingyeh@yahoo.com.


Introduction
It is globally recognized that nursing is a stressful occupation [1]. Nurses often account for the largest percentage of the clinical workforce [2] and their psychological well-being can impact upon the patients [3,4]. There are significant correlations between psychological distress, depression, anxiety and psychological well-being [5][6][7]. Therefore, it is an Research indicates that some students experience feelings of anxiety, hopelessness and depression [10]. Especially nursing students might have high levels of stress [11][12][13][14][15][16]. In Melissa-Halikiopoulou's study, 142 Greek nursing students found that 10% of participants reported suicidal thoughts and 1.4% stated that they might attempt suicide if they had the opportunity [17].
Mental illness is a central topic in Australia [18].
There are 1.2 million students with higher education in Australia; three out of five (61%) are aged 15-24 years [7,19, 20]. Females aged 16-24 years report the highest prevalence of suicidality and anxiety compared to any other age group [7]. There are some barriers to health seeking behaviours among this age group, so their seeking assistance is an issues [21].
Some studies indicate that Australian University students experience higher levels of psychological distress than the general population of the same age [22,23].
Is there any relationship between personality and psychological well-being? Personality is developed by biological temper, family interaction and cognitive learning [24]. When people experience stress, anxiety or depression, according to personality, they use different coping strategies that in turn result in different outcomes such as psychological well-being or suicidal ideation [14,24,25]. During this process, spiritual wellbeing appears to be a mediating factor which influences the outcome variables [24,[26][27][28].
How an individual deals with the stress caused by exposure to harsh parenting or with the significant stressors that are intrinsic to the role of nursing is mediated by personality. Personality and emotional stability were associated with nursing students' psychological well-being [29].
Positive family interaction also provides a stable framework within which the individual is safe to make important decisions, debrief and feel supported.
Individuals who had positive family interactions (eg., communication and involvement) reported lower rates of suicidal behaviours [24,30]. Conversely, a negative family interaction, such as harsh parenting, has a negative impact on people's psychological well-being and increases the risk of suicidal ideation [24,31].
Power assertive parenting and high levels of physical punishment also decrease psychological well-being [32,33]. Therefore, the purpose of this study was to examine the relationships between Australian nursing student's anxiety, depression, personality and family interaction on their psychological well-being and suicidal ideation.

Instruments
Data were collected using six instruments, all of which were selected for their reliability and validity. All of the instruments had good internal consistency. Their Cronbach's Alpha values were greater than 0.7 (Table   1).

Psychological Well-Being Scale (PWBS):
Participants' psychological well-being was measured using the 18-item PWBS [35]. Six concepts (autonomy, environmental mastery, purpose in life, personal growth, positive relations with others, and selfacceptance) were assessed. Items were scored on a six -point Likert-type scale ranging from (1) strongly disagree to (6)  The higher the score, the higher the level of anxiety.
The Cronbach's Alpha for the HAS was 0.95 in this study (Table 1).

Depression was measured using the Zung Depression
Scale (ZDS) [39]: 20 questions were scored on a fourpoint scale ranging from (1) None or Little to (4) Most or All. Higher scores indicate higher levels of depression.
The Cronbach's Alpha for the ZDS was 0.80 in this study (Table 1).
Personality characteristics were measured using the Big Five Personality Test developed by Goldberg [40].

Descriptions of major variables
Overall  (Table 3).
According to Pearson's correlation, Australian    Results indicated that students exposed to harsh discipline had a decreased level of psychological wellbeing.

Suicidal Ideation
Stepwise multiple regression analysis was used to examine the degree to which psychological well-being was predicted by the five independent variables. As shown in Table 4 Stepwise multiple regression analysis also examined the degree to which suicidal ideation was predicted by the five independent variables. Table 4 indicates how the model variables accounted for 49.1% of the suicidal ideation variance. Higher scores of depression (Beta = 0.532, p < 0.001) and higher scores of anxiety (Beta = 0.215, p < 0.001) were found to predict significantly higher scores of suicidal ideation.

Discussion
Overall, participants expressed low levels of anxiety, medium levels of depression, and medium-high  Other unique findings are the predictors of psychological well-being and suicidal ideation. They will be discussed as follows.

Predictors of psychological well-being
There was a significantly negative relationship between participants' depression and psychological wellbeing. Personality and family interaction were positively associated with participants' psychological well-being.

Bhullar et al. concluded that a persons' psychological
well-being profile can be used as a predictor of depression, since since the absence of psychological well -being represents a risk factor in developing depression, and vice versa [44,46].

Personality
In this study, participants had medium-high levels of positive personality, which were positively associated with psychological well-being. Family interaction influences the development of personality [24]. Participants perceived medium-high levels of positive family interaction and medium-low levels of harsh discipline. These results could explain why this group of nursing students had medium -high levels of positive personality. People with positive personality use problem focused coping strategies that are related to increasing psychological well-being and decreasing suicidal ideation [14,24,25]. Therefore, the results of this study are consistent with previous studies in which personality was associated with nursing students' psychological well-being [29].

Positive family interaction
Participants perceived medium-high levels of positive family interaction and medium-low levels of harsh discipline. The family interaction was positively associated with participants' psychological well-being.
This result is consistent with previous studies in which positive family interaction helped people feel safe and supported, so they have higher psychological well-being than people who perceived negative family interaction such as harsh parenting [24,30,31]. A negative relationship between psychological well-being and power assertive parenting and high levels of physical punishment was also documented [32,33]. and Chiao in the USA college students [24].

Limitations
This study has three main limitations. First, the cross-sectional design does not provide insights on the nursing students' psychological distress over time.
Second, the sample was recruited from an Australian University, so the generalizability of this study is limited.
Third, the participants in this study were voluntary and thus the results only refer to those who are willing to share their experiences.

Conclusions
Nursing students require positive psychological well-being to cope with their work. Psychological wellbeing enhances sound clinical decision making and the development of mature, sensitive and therapeutic nursepatient relationships. It also enhances the nurse's ability to successfully communicate with patients, their families, and members of the multidisciplinary team. Given that nursing students are expected to be able to work within rapidly changing and stressful environments, caring for their psychological well-being is important. Identifying factors that influence psychological well-being and suicidal ideation means that strategies can be developed to enhance positive mental health.