1. Introduction

Going to the university Lead to major changes in any person’s life, this period of life is very important . Be in such circumstances is often coupled with the pressures and concerns and can effect on people's functioning and mental health. With regard to the importance of mental health in different strata of society and key role of nursing and midwifery students , their mental health promotion can effect on promotion of community ‘s mental health[1]. Because of the nature of this period , workload and financial problems for some students, study in nursing and midwifery field, has an inverse relationship with mental health. The feeling of depression and mental stress and other adaptive and anxious disorders are major problems in the field of the mental health of the medical students[2,3]. Lack of attention to these problems will lead to the reduction of motivation for studying in the Universities. Therefore, it is necessary for their work to have a strong spirit and good mental health. It seems that the existing problems in mental health creates difficulty in interpersonal relationships. this problem will be increasingly critical in a close mutual relationship[4] in addition to, creating problems for nurses and midwives and Lack of proper communication with patients, problems in mental health will affect on performance of other colleagues. In the meantime patients suffered from the extreme harm[5] .

From the consequences of reduction of mental health and communication skills can be noted to the reduction of concentration and attention, learning disorders, academic and functional failure, and Wasting human resources and economic capital of the country's active youth . Ultimately it will have a bad and irreversible effects on the quality of patient care and community health promotion[6].

In this regard, a study was done on 67 high school students in Izmir, Turkey In 2005 by Akai. The results of this study showed the relationship between communication skills and mental health , demographic variables in this study was not significant. But about 10 percent of students, suffered from anxiety and depression[7].

Also, another study that was done in America“ by Muris & et al on 530 students from different disciplines of humanities in 2005 with the title of “A study on the mental health and communication skills . the results showed that 12 percent of students had problems such as depression and anxiety, and there was a Significant relationship between the low number of friends and reduction of communication skills, relationships and the problems of anxiety and depression[8]. a research was done by Stevens & et al in 2006 in Boston, America on 450 cases of students under title of the assessment of mental health . result showed about 13.5% of students suffered from difficulties such as depression and anxiety[9] .

The study result of Noorbala & et al showed the Prevalence of mental disorders in different parts of Iran ranged from 9 percent to 36 percent, In this study, 3 percent of psychiatric patients and 1.6 percent of the population over 15 years suffered from severe mental disorder and needed to serious psychiatric treat , and 15.3 percent of this age group had a mild mental illness, and 36.6 percent had different emotional problems[10].

Also, another study conducted by Noorbala & et al in 1999. the sample size of this study were more than 35 thousand people and was used from GHQ questionnaires in this study. result showed 21.5 percent of people over 15 years suffered from some degree of mental disorder symptoms[11]. The result of second national survey that conducted by Mohammadi & et al on 25 thousand people over 18 years old showed 17.1 percent of subjects had some degree of mental disorder[12]. In the study conducted by Taleghani &et al on 485 students of Razi University according to mental status , 46.4% of students were health , 35.5 were relatively healthy and 18.1% were unhealthy[13]. Also, Asgharipour and Masoudi with the Examination of the mental health in students of Mashhad’s Ferdusi university with the using of GHQ questionnaire, Showed that 20.03 percent of students suffered from mental problems[14].

Therefore, according to the conflicting results from different research in the field of the prevalence and incidence of mental disorders , this study was conducted to evaluate the mental health and communication skills of nursing and midwifery students at the Universities of the North of the country .

In addition to the drawing of the University students ‘s mental health board , we hope the results of this research can help to the health and students fields planners for better planning .

2. Methods

This applied Research with the using of descriptive – analytical manner reviewed and compared the mental health and communication skills of 139 people of nursing and midwifery student who were studied in the universities of Gilan and Mazandaran province in north of the countries in years 2011 and 2012.

The statistical population consisted of all nursing and midwifery students in public and private universities that were studying in the universities of Sari, Babol, Amol, Ramsar, Chalus, Tonekabon, Rasht , Astara, Lahijan and Rudbar cities. According to the sample size formula, the number of samples Was estimated 139 people. With the Using of cluster sampling , three Nursing and Midwifery Schools of, Sari, Rasht and Tonekabon , were selected Randomly as clusters . After selecting clusters , the applicant samples were selected by random stratified sampling method. for carry out the plan, samples selected from the Students of various semesters and in Proportional to the number of students of that semester . In this study, three questionnaires used as follows:1-Demographic Information Questionnaire consisted of 18 questions, such as sex, age, marital status, educational field, economic status, the family’s place of residency, city name, employment and also education, father’s job, mother's occupation, education level of father , educational level of mother, housing status, quota of acceptance in the entrance, high school GPA, how to select field, interest in and satisfaction with course, needs to a psychiatrist, psychologist or counseling center, examined personal, familial, social and economic Profiles.

2- GHQ-28 Questionnaire :that is a standard questionnaire and is best known screening tool in Psychiatry and for the first time were drawn up by Goldberg in 1972, And widely used to evaluated mental health of the people[15]. For grading samples use from the four scoring Likert method as 0-1-2-3. Therefore, each individual score is between 0 and 84 and Its cut score is 23, This form has four scales of physical symptoms, anxiety symptoms, social functioning and depression Symptoms .

3 - communication skills questionnaire ,that in a study was conducted by Nabizadeh, the reliability of this questionnaire were reported 81 percent and contains 20 questions that are graded from zero to 5. If the total score obtained is between zero to 40, the Communicative skills of person is at low levels. If it is between forty one and sixty the person’s communication skills is at intermediate level and If it is between sixty one an one hundred, the person’s communication skills is at high-level.

Data entered in the software spss18 and for data analysis has been used from descriptive statistics[frequencies and percentages] and Inferential statistics (Pearson, chi-square [χ2] and independent t) at a significant level of p ≤ 0.05.

3. Findings

From 139 total samples, 98/6% were female, 71/9% were single, 71/9% were Nursing student, 27/3% were Midwifery student, 90/6% of participants in the study were native and 38.8% lived in Center of Mazandaran province.

In terms of interest to the field of study, 2.2% of people had very low interest, 12.2% had low interest, 54.7% had high interest and 27.3% of samples had very high interest to their field (Table 1) .

Table 1. Table of individuals frequency based on demographic variables

Table 2. Determining the mental health based on GHQ subscale test in Nursing and midwives student

Table 3. determining and comparing the communication skills of nursing and midwifery groups with the using of independent t-test

According to the cut line score of somatic symptoms Subscale of the general health exam, Two study groups have shown no signs of pathology In this subscale[mean scores of nurses was 6/03, mean scores of midwives was 5/03]. In the anxiety subscale, the nursing students group with an average score of 13/7 Showed Mild signs of the some problems associated with anxiety and tension, But there was not this problem in the Midwives group with the average score of 75/6.

In the social function Impairment subscale, Midwives group with a mean score of 9/14 had mild symptoms in coping with professional demands and problems of everyday life. Also, there were his problem For nurses group with a mean score of 8/88.With regard to the mean scores of the depression subscale (mean score of nurses 4/53, mean scores for Midwives 2/86) this two groups have shown no sign of morbid (Table 2)

The findings of this study showed that according to the cutting line of the GHQ test All subjects had some health problems , So in this study the overall prevalence of mental disorders calculated 25.71 percent. According to the mean scores, the results of this study showed the communication skills of nurses was in average level [the mean scores 59.93] But with respect to the mean scores (63.47) the communication skills of midwives Group was in high level and also with regard to the overall mean of the two groups, communication skills in all of the subjects was in average level.

Our findings also showed that the Communication skills of midwifery group was higher than the communication skills of nursing but independent T-test Showed no statistical significant difference between Nurses group and midwives group in terms of communication skills (Table 3) (P<0.22, df= 136, t= 1.23) .

Findings revealed that In two groups of nursing and midwifery students, there was a significant difference Between the underlying variables of need to Consultation and general health test subscales, In other words, There was a significant difference between the need for psychologist and consultant with the physical symptoms (p<0.00, df=1, f=13.735), Impairment in social functioning (P< 0.018, df=1, f = 5.76), anxiety (P<0.00, df=1, f=33.59), and depression subscales (P<0.001,df=1,f=11.54). Also there was no significant relationship between other underlying variables and communication skills such as field and communication skills(p<0.023,df=1,f=2.44)and between marital status and Communication skill. However, findings showed there were Significant relationship between communication skills and anxiety variables (p<0.007, r=-0.237) between Communication skills and level of depression variables (-0.196) and between Communication skills and Impairment in social functioning variables (0.345) in all subjects.

4. Discussion

Based on this study results, the prevalence of Physical disorder, anxiety, depression and social functioning disorder was 5.77% , 4.6% , 8.95% , 4.06% respectively ,and the rate of overall disorder was reported 25.71 percent . The results showed the communication skills of nurses was in the average level and the communication skills of midwives was in high level and also the communication skills of all subjects was in average level .

But the differences between independent groups test showed there was no significant difference between nurses group and midwives group in terms of communication skills. also, our findings showed there was significant relationship between communication skills and anxiety variables, between communication skills and depression level variables, and between communication skills and Impairment in social functioning variables in all subjects . Accordingly, the overall prevalence rate of mental disorders was 25.71 percent . In this field , the studies conducted by Shariaaty & et al , and Benitez showed the prevalence of psychiatric disorders among college students was 42.6 and 41 percent respectively that their findings was inconsistent with this study[16,8 ]. Perhaps the cause of these differences be related to the characteristics of research samples, the change in research environment and the use of GHQ28 questionnaire instead of GHQ12 questionnaire in this study.

Araujo conducted a study and used the SRQ-20 questionnaire. He evaluate the relationship between occupation and psychological needs of nurses in a public hospital in Brazil . his study’s result showed the prevalence of psychological problems was 33.3 percent , which this rate ranged from 20 percent among nurses women to 36.6% among nursing students which these amounts is slightly more than findings of this study .

This difference could be related to different tools and research environment , and it could be due to this fact that stressful events in life can affect on job performance as well as the cultural specificity[7].

On the other hand, Rafati & et al with the using of the GHQ-28 questionnaire reported the mental health disorder in Nursing Students of Shiraz’s Nursing school was 24.8 percent , that the findings of this study was almost consistent with the present study . Perhaps the reason for this case is the use of a same tool, the cultural property and the role of dormitory and family separation in growth of psychological stress. In some studies that conducted in several Medical Science universities of our country were obtained the same result. in some universities, the prevalence of mental disorders reported below 30 percent and in others above 30 percent. of course in this study, due to the lack of clinical interviews with subjects, accurate detect of mental disorder diagnosis was not possible, so the results only showed signs of mental disorder[6, 16, 17] .

The results showed the communication skills of nurses was in the average level and the communication skills of midwives was in high level and also the communication skills of the all subjects was in average level. But the differences between independent groups test showed no significant difference between nurses group and midwives group in terms of communication skills . In this regard, the research results of Chan& et al (2003) with the title of "Communication skills of health workers and its progress " revealed the Communication skills of studied sample was in average level[9].

A study with the title of "Your knowledge about the basic skills of students» that was conducted by Ingham (2003 ) showed “Less than 50 percent of students in school are familiar with basic skills”. the result of that study was not consistent with the present study[18].

In a study done by Hemmaty & et al in the Faculty of nursing and midwifery of Uromiyeh University, the communication skills in both groups was in moderate level , but the differences between independent groups test showed no significant difference between nurses group and midwives group in terms of communication skills . the result of described study was coordinated with the present study. Study Results of Mo'laee & et al On communication skills of the students of Medical Sciences in Ardabil University revealed the communication skills of most male and female students from different fields, was in average level. this study’s findings were consistent with the present study[19]. Perhaps higher communication skills in midwifery students be due to their higher skills in education and their better Professional independence in the future.

Another study was conducted by Maurice et al on 530 students from different disciplines of humanities in 2005 with the title of “A study on the mental health and communication skills in the United States”. The results of this study showed 12% of students had some difficulties such as depression and anxiety, and there was a significant relationship between small number of friends with reduction of relations and communication skills and the problems of anxiety and depression[18,20]. Also the study’s findings showed that in all subjects there was a significant relationship between Communication skills and anxiety, and between the level of depression and social function variables . In this regard , The results of Akai’s study that was done on 67 high school students in Izmir, Turkey showed the relationship between communication skills and mental health and demographic variables was not significant (p=0.86). But about 10% of school children suffer from anxiety and depression , that the results of this study were not consistent with the present study. It seems that the existing problems in mental health creates difficulty in interpersonal relationships , this problem will be increasingly critical in a close mutual relationship . depression mood causes to reduce of energy, lack of pleasure feeling from life activities and the loss of the person's personal and social performance . the consequences of these cases can be seen in everyday life. The ability for correct communicate In different groups of medical students due to It’s impact on their performance has major importance .

5. Conclusions

Due to the relatively high prevalence of mental disorder among the nursing and midwifery students , and having the average level of communication skills It is necessary until some Strategy be adopted in Educational planning for mentioned students should be noted to Communication skills training, mental health And improving the quality level of Professional and caring in the Nursing and Midwifery.

ACKNOWLEDGEMENTS

Special thanks to the all students participating in this study, Assistance of respected Officials of the unit of the Universities in the approval of this plan with the number of 52081860502002.