Factors Associated with Depression and Anxiety Symptoms Among Medical Students in Bahrain

Uncovering heterogeneity in mental health changes among first-year medical students

INTRODUCTION

The initial year of medical school is linked to a decline in mental health. To assess mental health comprehensively, the dual-factor model posits the consideration of both psychopathology (e.g., depression) and positive mental health (e.g., well-being). Previous mental health research among medical students has primarily examined these two factors independently. This study uses the dual-factor approach for a deeper understanding of mental health changes during the first year of medical school.

METHODS

Students from eight German medical schools (N = 450) were surveyed three times (T0 = entering medical school, T1 = end of the first semester, T2 = end of the second semester) regarding depression (PHQ-9), well-being (subscale of FAHW-12), and general life satisfaction (German Single-Item Scale L1). Latent profile analysis was used to identify distinct mental health groups based on their combinations of psychopathology and positive mental health. We then analysed trajectories descriptively by examining the longitudinal stability and dynamics of mental health group membership during the first year of medical school.

RESULTS

We identified five mental health groups: (1) complete mental health, (2) moderately mentally healthy, (3) symptomatic but content, (4) vulnerable, and (5) troubled. The examination of change trajectories unveiled diverse paths pointing towards both recovery and deterioration. In comparison to the other groups, students belonging to the complete mental health group exhibited greater stability and a higher potential to recover after initial deteriorations in the first semester.

CONCLUSIONS

Our study uncovers distinct mental health trajectories in the first year of medical school, emphasizing the crucial role of initial mental health status. Our findings stress the diverse nature of mental health changes in medical students, underscoring the need for tailored prevention strategies. The implications for research and practice are discussed.

Smoking and Depression among Medical School Students: A Cross-Sectional Study from Turkey's Largest Province

BACKGROUND

To examine the prevalence of smoking among medical faculty students in Turkey, and to explore the associations between smoking, depression, and other factors.

METHODS

This cross-sectional study was carried out among medical students in Konya, Turkey, from November 2018 to February 2019. The first section included eight questions pertaining to sociodemographic details. The second comprised nine questions addressing smoking and other harmful habits. The third section involved the Fagerstrom Test for Nicotine Dependence while the fourth was the Beck Depression Inventory (BDI).

RESULTS

The study was completed with a total of 1117 participants (90.2% of all students). In regard to smoking, 813 (72.78%) were non-smokers, 98 (8.77%) were ex-smokers, and 222 (19.87%) were active smokers. Notably, 16.29% of students (n = 182) had a high BDI score (≥17). Male sex, good economic status, depression diagnosis at any time in life, and alcohol use were independently associated with active smoking. Being a senior student and regular exercise were independently associated with a low (<17) BDI score, whereas depression diagnosis at any time in life and drug use were independently associated with high (≥17) BDI.

CONCLUSIONS

Almost 20% of medical school students were active smokers, with about a 2.5-fold higher prevalence among males compared to females. There is a significant association between smoking frequency and symptoms of depression. Policies targeting modifiable risk factors can reduce smoking and depression among future physicians, which can have a strong impact on population-wide smoking.

Influencing factors of life satisfaction among medical staff of rehabilitation departments based on a structural equation model

Life satisfaction (LS) exhibited gender differences and was associated with age, income, and negative emotions. There is no research on the relationship between professional values and LS, although professional values are essential for medical staff and correlate with negative emotions. This study aimed to explore the relationship between professional values and LS, the action mechanism of influencing factors of LS, and gender differences among medical staff of rehabilitation departments in China. A total of 284 participants (108 men and 176 women) completed the questionnaires. Data were analyzed using SPSS19.0 and Amos21.0. Age, length of service, and anxiety differed significantly between genders. Professional values had a direct effect on LS and an indirect effect on LS via anxiety and depression. Therefore, enhancing professional values and reducing anxiety and depression could increase the medical staff's LS. Moreover, the LS of female medical staff improved with age.

Depression and Anxiety among Undergraduate Health Science Students: A Scoping Review of the Literature

Background: Health science students in post-secondary institutions experience high levels of depression and anxiety due to increased stress levels, workload, low socioeconomic status, and history of family mental illness, among other factors. Given the significant negative impact that depression and anxiety can have on undergraduate health science students, it is essential to understand the prevalence and correlation of these conditions in this population. In light of this, this scoping review aims to identify, document, and analyze the literature on the prevalence and determinants of anxiety and depression among undergraduate health sciences students and identify gaps in knowledge for future research. Methods: This scoping review was planned and executed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for the Scoping Reviews statement. A comprehensive and systematic search was carried out for five databases, namely MEDLINE, Scopus, EMBASE, CINAHL, and PubMed. Results: From the literature identified by our search strategy, the lowest prevalence for anxiety was 5.8%, and the highest was 82.6%, with a median of 44.25%. The prevalence of depression ranged from a high of 88.8% to a low of 2.1%, with a median value of 34.8%. Our analysis revealed that correlates of anxiety and depression among health science students include sociodemographic factors such as age, sex, gender, relationships, ethnicity, and family history, personal health conditions, and academic and socioeconomic issues. Conclusions: With the high incidence of anxiety and depression among health science students, there is an increasing need to find practical remedies to support these students. It is also essential for policymakers and university authorities to implement interventions such as supportive text messages and other strategies geared toward providing support and improving the psychological well-being of health science students.

Depression among medical students in Tunisia: Prevalence and associated factors

BACKGROUND

Medical school is known for its lengthy process, which is both physically and emotionally draining. Students' mental balance would shrink as they progress in their medical training. A systematic review and meta-analysis reported that the prevalence of depressive symptoms among medical students remained relatively constant at 27.2%.

AIM

To assess the prevalence of depressive symptoms among Tunisian medical students and evaluate its associated factors.

METHODS

This is a descriptive cross-sectional study that was carried out in the second semester of the academic year 2017/2018, between April 2018 and July 2018 among 1138 medical students. Data were collected using a socio-demographic questionnaire and the Beck Depression Inventory-II (BDI-II).

RESULTS

Sixty-four percent (n = 728) of the participants had depressive symptoms, of which 266 (23.4%) met the criteria for mild, 271 (23.8%) for moderate, and 191 (16.8%) for severe depressive symptoms. Female gender, low socio-economic level, smoking habits and history of mental disorder, performing leisure and physical activities, satisfaction toward a career choice, and happiness perception were the main prognostic factors for depression among medical students. Although academic grades may not be considered a prognostic factor, final-year students appeared to be less depressive than their colleagues.

CONCLUSION

These findings give insight into mental health issues and comorbidities among Tunisian medical students. It is a hopeful request for decision-makers and academic authorities to set serious measures and draw effective interventions to minimize the currency of psychological distress among this subpopulation.

Prevalence and Risk Factors for Anxiety Symptoms among Student Nurses in Gauteng Province of South Africa

Background: Globally, mental disorders are common among nursing students; therefore, effective prevention and early detection are urgently needed. However, the prevalence rate of anxiety symptoms has not been investigated in South African nursing colleges. Aim: The study aimed to assess the prevalence of anxiety symptoms and their sociodemographic risk factors among nursing students in Gauteng province, South Africa. Methods: This cross-sectional descriptive study was conducted at Chris Hani Baragwanath and SG Lourens nursing colleges in the first week of June 2022. A purposeful sampling technique selected the third- and fourth-year nursing students aged ≥ 18 years registered at the two nursing colleges. The seven-item Generalised Anxiety Disorder scale was used to assess anxiety symptoms. Results: The prevalence of anxiety symptoms was 74.7% (95% confidence interval: 69.9-78.9). Being a student at nursing college B, being in the fourth academic year of study and use of substances were identified as predictors of anxiety symptoms in these nursing students. Conclusions: The prevalence of anxiety symptoms in this study is relatively high, with predictors of developing anxiety being a student at nursing college B, in the fourth academic year and current use of psychoactive substances were predictors of anxiety symptoms. These findings highlight the need to develop interventions and strategies to promote mental health assessments and management to prevent and reduce the problem of mental disorders among nursing students.

The mediating role of psychological capital in the association between life satisfaction and depressive and anxiety symptoms among Chinese medical students during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Although life satisfaction is a predictor of depressive and anxiety symptoms, the mechanisms underlying this association are poorly understood. This study examined how psychological capital (PsyCap), a positive psychological state, mediated the association between life satisfaction and depressive and anxiety symptoms among Chinese medical students during the COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted at three medical universities in China. A self-administered questionnaire was distributed to 583 students. Depressive symptoms, anxiety symptoms, life satisfaction, and PsyCap were measured anonymously. A hierarchical linear regression analysis was performed to explore the effects of life satisfaction on depressive and anxiety symptoms. Asymptotic and resampling strategies were used to examine how PsyCap mediates the association between life satisfaction and depressive and anxiety symptoms.

RESULTS

Life satisfaction was positively associated with PsyCap and its four components. There were significant negative associations between life satisfaction, psychological capital, resilience, optimism, and depressive and anxiety symptoms among medical students. Self-efficacy was negatively associated with depressive and anxiety symptoms. Psychological capital (a×b = -0.3201, BCa 95% CI: -0.3899, -0.2446; a×b = -0.2749, BCa 95% CI: -0.3817, -0.1996), resilience (a×b = -0.2103, BCa 95% CI: -0.2727, -0.1580; a×b = -0.1871, BCa 95% CI: -0.2520, -0.1414), optimism (a×b = -0.2100, BCa 95% CI: -0.3388, -0.1150; a×b = -0.1998, BCa 95% CI: -0.3307, -0.0980), and self-efficacy (a×b = -0.0916, BCa 95% CI: 0.0048, 0.11629; a×b = 0.1352, BCa 95% CI: 0.0336, 0.2117) significantly mediated the association between life satisfaction and depressive and anxiety symptoms.

LIMITATIONS

This was a cross-sectional study, and causal relationships between the variables could not be ascertained. Self-reported questionnaire instruments were used for data collection, which may have recall bias.

CONCLUSIONS

Life satisfaction and PsyCap can be used as positive resources to reduce depressive and anxiety symptoms among third-year Chinese medical students during the COVID-19 pandemic. Psychological capital and its components (self-efficacy, resilience, and optimism) partially mediated the relationship between life satisfaction and depressive symptoms, and completely mediated the relationship between life satisfaction and anxiety symptoms. Therefore, improving life satisfaction and investing in psychological capital (especially self-efficacy, resilience, and optimism) should be included in the prevention and treatment of depressive and anxiety symptoms among third-year Chinese medical students. Additional attention is needed to pay for self-efficacy in such disadvantageous contexts.

A systematic review and meta-analysis of studies exploring prevalence of non-specific anxiety in undergraduate university students

BACKGROUND

Anxiety is a common mental health problem in the general population, and is associated with functional impairment and negative impacts upon quality of life. There has been increased concern about university students' mental health in recent years, with a wide range of non-specific anxiety rates reported worldwide in undergraduate university students. We aimed to explore prevalence of non-specific anxiety in undergraduate university student populations.

METHODS

Four databases were searched to identify studies published between 1980 and 2020 which investigated prevalence of non-specific anxiety in undergraduate university students. Each study's quality was appraised using a checklist. Sub-analyses were undertaken reflecting outcome measure utilized, course of study, location of study, and whether study was before or during the COVID-19 pandemic.

RESULTS

A total of 89 studies - representing approx. 130,090 students-met inclusion criteria. Eighty-three were included in meta-analysis, calculating a weighted mean prevalence of 39.65% (95% CI: 35.72%-43.58%) for non-specific anxiety. Prevalence from diagnostic interview studies ranged from 0.3%-20.8% 12-month prevalence. Prevalence varied by outcome measure used to assess non-specific anxiety, the type of course studied by sample, and by study location. In half the studies, being female was associated with being more likely to have higher non-specific anxiety scores and/or screening above thresholds. Few of the included studies met all quality appraisal criteria.

CONCLUSION

The results suggest that approximately a third of undergraduate students are experiencing elevated levels of non-specific anxiety. Results from sub-analyses have identified some methodological issues that need consideration in appraising prevalence in this population.

Prevalence and Factors Associated with Anxiety and Depression in Peruvian Medical Students

During medical training, students are exposed to stressors that deteriorate mental health. This study determined depression and anxiety prevalence and their associated factors in students from four medical schools in northern Peru. A cross-sectional study was conducted among medical students from Lambayeque, Peru. The Goldberg Anxiety and Zung Depression tests were applied. The dependent variables were depression and anxiety, and their association with covariates (age, sex, type of university, socioeconomic level, experience, family problem, and physical activity) was evaluated. Prevalence ratios were calculated using generalized linear models. Of 482 students, the prevalence of anxiety was 61.8% and depression was 22.0%. A severe level of anxiety was observed in 6.2% in the group between 16 and 20 years old. It was observed that private university students had higher frequencies of having depression (PR = 2.01) and anxiety (PR = 1.35); males had a lower risk of anxiety (PR = 0.82), but higher risk of depression compared to females (PR = 1.45). Performing physical activity decreased the prevalence of depression (PR = 0.53); however, it increased the frequency of anxiety (PR = 1.26). Having family problems increased the prevalence of anxiety (PR = 1.26). Medical students from private universities experienced higher rates of depression and anxiety. Depression and anxiety were associated with gender and physical activity. These findings highlight the importance of mental health promotion due to its link with quality of life and academic performance.

The prevalence and factors associated with anxiety symptoms among resident physicians in Oman: a cross-sectional study

Background

Anxiety disorders are a significant factor associated with physician burnout and poor patient care, reported to have a significant frequency among the youth in the Middle East. However, to date, no study has explored the prevalence of anxiety among resident physicians in the Arabian Gulf country of Oman. This cross-sectional study, conducted among a random sample of residents affiliated with the Oman Medical Specialty Board, aimed to examine the frequency and factors associated with anxiety symptoms among them. Participants were asked to complete the General Anxiety Disorder Assessment (GAD-7) to assess anxiety, as well as a socio-demographic questionnaire.

Results

In a total of 251 residents, the prevalence of anxiety was 14.7% (GAD-7 cut-off score ≥ 10). More than 60% of the respondents were female (68.9%). The age breakdown ranged from 25 to 30 years old (66.5%) and the majority were married (64.9%). More than 70% of respondents attended at least 5 shifts in their weekly schedule and received at least 5 on-call shifts from the hospital per week. Logistic regression showed that residents with chronic disease were 2.5 times (95% CI 1.36–4.72, p = 0.003) more likely to have anxiety than those without them. Those residents who did not exercise were 2.1 times (95% CI 1.04–4.46, p = 0.038) more likely to have anxiety than those who exercise often or regularly. Residents who received 6 or more on-calls from the hospital were 2.6 times (95% CI 1.35–5.25, p = 0.005) more likely to have anxiety than those who received 5 or fewer on-calls in a month.

Conclusions

The factors seemingly responsible for anxiety symptoms in this sample of resident physicians are those that are typically associated with poor work-life balance and unhealthy lifestyles. Pending further scrutiny, these results could be used to lay the groundwork for the identification of those who will require more protracted help during their training in Oman and in other culturally similar Middle Eastern countries.

Online academic satisfaction during the COVID-19 pandemic in medical students: role of sleep, psychological issues, college adjustment, and digital skills

Background: The measures taken to contain the COVID-19 pandemic, led to significant changes in university education, resulting in the new normal standard of virtual teaching in many undergraduate medical schools worldwide. Therefore, the aim of this paper was to determine the factors related to academic satisfaction with virtual teaching in medical students during the COVID-19 pandemic. Methods: A cross-sectional-analytical study was conducted on medical students at a private university in Peru, through self-reported questionnaires divided into sociodemographic data and variables of interest that could influence academic satisfaction during the pandemic. To evaluate possible factors related to academic satisfaction, stepwise regression models were performed for both sexes. Results: In total, data from 310 medical students, 117 males and 193 females, were analyzed. Academic satisfaction reached a score of 11.2 ± 2.9, which was similar in both sexes. The best regression model for males (AIC: 544.32; RMSE: 2.42; R2: 0.30) showed that adaptation to university life (favorable change) and depression (unfavorable change) explained 30% of changes in students' academic satisfaction. While in females (AIC: 907.59; RMSE: 2.49; R 2: 0.22) the model integrated favorable factors such as adjustment to college life and anxiety; while depression and poor sleep quality were unfavorable factors. Conclusion: Factors that contributed to academic satisfaction in medical students were determined in this study, which differed by gender. Thus, it is important to take into account the particularities of male and female medical students in order to improve their academic satisfaction during their university careers.

Advances and challenges in the detection of academic stress and anxiety in the classroom: A literature review and recommendations

In recent years, stress and anxiety have been identified as two of the leading causes of academic underachievement and dropout. However, there is little work on the detection of stress and anxiety in academic settings and/or its impact on the performance of undergraduate students. Moreover, there is a gap in the literature in terms of identifying any computing, information technologies, or technological platforms that help educational institutions to identify students with mental health problems. This paper aims to systematically review the literature to identify the advances, limitations, challenges, and possible lines of research for detecting academic stress and anxiety in the classroom. Forty-four recent articles on the topic of detecting stress and anxiety in academic settings were analyzed. The results show that the main tools used for detecting anxiety and stress are psychological instruments such as self-questionnaires. The second most used method is acquiring and analyzing biological signals and biomarkers using commercial measurement instruments. Data analysis is mainly performed using descriptive statistical tools and pattern recognition techniques. Specifically, physiological signals are combined with classification algorithms. The results of this method for detecting anxiety and academic stress in students are encouraging. Using physiological signals reduces some of the limitations of psychological instruments, such as response time and self-report bias. Finally, the main challenge in the detection of academic anxiety and stress is to bring detection systems into the classroom. Doing so, requires the use of non-invasive sensors and wearable systems to reduce the intrinsic stress caused by instrumentation.

Depressive symptoms and its correlates among medical students in Upper Egypt

Background

Medical students are at high risk of developing depressive symptoms rather than their age-matched group as medical education is stressful and medical students have psychological and academic stressors. The study aimed to estimate the prevalence of depressive symptoms and the most important correlates associated with it among Assiut University Medical Students in the academic year 2019–2020. It is a cross sectional study conducted among 766 medical students at Assiut University in the academic year 2019–2020, screening for depressive symptoms was by patient health questionnaire-9 (PHQ-9).

Results

The mean age of students was 21.27 ± 1.9, 55.5% of them have depressive symptoms. Female students had statistically significantly higher percent of depressive symptoms compared with males (58.9% vs 51.2%), there was statistically significant lower mean socio-economic score among students having depressive symptoms compared to students with no depressive symptoms (5.73 ± 2.46 and 6.22 ± 2.5 respectively). Students having depressive symptoms had higher mean scores of stresses. The multivariable regression revealed that younger age of the students (OR = 0.797; p < 0.001), having a chronic disease (OR = 3.174; P = 0.024), lower life satisfaction score (OR = 0.908; p < 0.001), students with higher medical stress score (OR = 3.596, P < 0.001), and high sense of control score (OR = 2.323; p < 0.001) were the significant correlates of depressive symptoms among medical students.

Conclusions

Female gender, low socio-economic status, having chronic disease, presence of family history of either mental illness or depressive symptoms, low satisfaction with life, higher total medical stressors, and low sense of control were the most important correlates of depressive symptoms among medical students.

Online academic satisfaction during the COVID-19 pandemic in medical students: role of sleep, emotions, college adjustment, and digital skills

Background: The measures taken to contain the COVID-19 pandemic, led to significant changes in university education, resulting in the new normal standard of virtual teaching in many undergraduate medical schools worldwide. Therefore, the aim of this paper was to determine the factors related to academic satisfaction with virtual teaching in medical students during the COVID-19 pandemic. Methods: A cross-sectional-analytical study was conducted on medical students at a private university in Peru, through self-reported questionnaires divided into sociodemographic data and variables of interest that could influence academic satisfaction during the pandemic. To evaluate possible factors related to academic satisfaction, stepwise regression models were performed for both sexes. Results: In total, data from 310 medical students, 117 males and 193 females, were analyzed. Academic satisfaction reached a score of 11.2 ± 2.9, which was similar in both sexes. The best regression model for males (AIC: 544.32; RMSE: 2.42; R 2: 0.30) showed that adaptation to university life (favorable change) and depression (unfavorable change) explained 30% of changes in students' academic satisfaction. While in females (AIC: 907.59; RMSE: 2.49; R 2: 0.22) the model integrated favorable factors such as adjustment to college life and anxiety; while depression and poor sleep quality were unfavorable factors. Conclusion: Factors that contributed to academic satisfaction in medical students were determined in this study, which differed by gender. Thus, it is important to take into account the particularities of male and female medical students in order to improve their academic satisfaction during their university careers.

Online academic satisfaction during the COVID-19 pandemic in medical students: role of sleep, emotions, college adjustment, and digital skills

Background: The measures taken to contain the COVID-19 pandemic, led to significant changes in university education, resulting in the new normal standard of virtual teaching in many undergraduate medical schools worldwide. Therefore, the aim of this paper was to determine the factors related to academic satisfaction with virtual teaching in medical students during the COVID-19 pandemic. Methods: A cross-sectional-analytical study was conducted on medical students at a private university in Peru, through self-reported questionnaires divided into sociodemographic data and variables of interest that could influence academic satisfaction during the pandemic. To evaluate possible factors related to academic satisfaction, stepwise regression models were performed for both sexes. Results: In total, data from 310 medical students, 117 males and 193 females, were analyzed. Academic satisfaction reached a score of 11.2 ± 2.9, which was similar in both sexes. The best regression model for males (AIC: 544.32; RMSE: 2.42; R 2: 0.30) showed that adaptation to university life (favorable change) and depression (unfavorable change) explained 30% of changes in students' academic satisfaction. While in females (AIC: 907.59; RMSE: 2.49; R 2: 0.22) the model integrated favorable factors such as adjustment to college life and anxiety; while depression and poor sleep quality were unfavorable factors. Conclusion: Factors that contributed to academic satisfaction in medical students were determined in this study, which differed by gender. Thus, it is important to take into account the particularities of male and female medical students in order to improve their academic satisfaction during their university careers.

One-year changes in the prevalence and positive psychological correlates of depressive symptoms during the COVID-19 pandemic among medical science students in northeast of Iran

Objectives

The COVID‐19 pandemic has imposed a significant psychological burden on many across society especially students studying medical sciences. This study intended to investigate the one‐year changes in the prevalence and correlates of depressive symptoms during the COVID‐19 pandemic among medical science students.

Methods

A cross‐sectional study in Shahroud, Iran administering a convenience sampling method (January to February 2021). Online self‐reported questionnaires included Rosenberg Self‐Esteem Scale, Paloutzian‐Ellison Spiritual Well‐Being Questionnaire, Diener's Satisfaction with Life Scale and the University Student Depression Inventory. Data analyzed using descriptive and inferential statistics (Independent t‐test and Multiple Regression Analysis).

Results

A total of 306 medical science students were investigated in this study. The mean scores 1 year after the outbreak of COVID‐19 were for depression (81.25 ± 26.04), spiritual well‐being (80.98 ± 18.06), self‐esteem (26.89 ± 2.20), and life satisfaction (19.68 ± 6.81). The results indicated that depression mean score was significantly higher in post outbreak assessment (71.92 ± 22.94 vs 81.25 ± 26.04) (P < .001). Fifty percentage of changes in depression can be predicted by studied variables. A high score of depression was directly associated with a higher level of self‐esteem. Moreover, increased interest in the field, scores of spiritual well‐being, and life satisfaction were inversely and significantly associated with depression.

Conclusions

Iran's education system has been significantly affected, with the addition to the COVID‐19 pandemic imposing a psychological burden such as depression, exacerbating this within medical science students compared to a year ago. Spiritual well‐being and life satisfaction as positive psychology constructs were recognized as protective factors against depression during the pandemic. Spiritual and social support should be integrated in psychological interventions within university settings for medical science students.

Latent class analysis of depression and anxiety among medical students during COVID-19 epidemic

OBJECTIVE

The novel coronavirus disease 2019 (COVID-19) is a global public health emergency that has caused worldwide concern. The mental health of medical students under the COVID-19 epidemic has attracted much attention. This study aims to identify subgroups of medical students based on depression and anxiety and explore the influencing factors during the COVID-19 epidemic in China.

METHODS

A total of 29,663 medical students were recruited during the epidemic of COVID-19 in China. Depression and anxiety symptoms were assessed using Patient Health Questionnaire 9 (PHQ9) and Generalized Anxiety Disorder 7 (GAD7) respectively. Latent class analysis was performed based on depression and anxiety symptoms in medical students. The latent class subtypes were compared using the chi-square test. Multinomial logistic regression was used to examine associations between identified classes and related factors.

RESULTS

In this study, three distinct subgroups were identified, namely, the poor mental health group, the mild mental health group and the low symptoms group. The number of medical students in each class is 4325, 9321 and 16,017 respectively. The multinomial logistic regression results showed that compared with the low symptoms group, the factors influencing depression and anxiety in the poor mental health group and mild mental health group were sex, educational level, drinking, individual psychiatric disorders, family psychiatric disorders, knowledge of COVID-19, fear of being infected, and participate in mental health education on COVID-19.

CONCLUSIONS

Our findings suggested that latent class analysis can be used to categorize different medical students according to their depression and anxiety symptoms during the outbreak of COVID-19. The main factors influencing the poor mental health group and the mild mental health group are basic demographic characteristics, disease history, COVID-19 related factors and behavioural lifestyle. School administrative departments can carry out targeted psychological counseling according to different subgroups to promote the physical and mental health of medical students.

The association between anxiety and academic performance in children with reading disorder: A longitudinal cohort study

The purpose of this study was to examine the association between anxiety and overall academic performance (AP) in children with reading disorder (RD). This two-year longitudinal cohort study included 128 participants (aged 7-14 years) with RD. Anxiety symptoms were evaluated using the School Anxiety Scale - Teacher Report for the first year and the eight-item Spence Children's Anxiety Scale for the second year. AP was assessed by teacher ratings of progress in academic content areas, including reading, writing and math. Teachers completed evaluations every 3 months. We standardized all scores (to z scores). Multivariate linear regression models (adjusting for age, sex and Attention-Deficit/Hyperactivity Disorder symptoms) assessed the association cross-sectionally at each timepoint of survey completion. Repeated measures analysis using mixed models assessed the relationship longitudinally. Results from both univariate and multivariate analyses showed anxiety being significantly negatively associated with AP in children with RD, both cross-sectionally and longitudinally. Importantly, increased anxiety was significantly associated with reduced AP over time within an individual (adjusted β = -0.22, p = .002). This lends support to screening for anxiety disorders in children with RD. Future research should examine the directionality of this relationship, potential mediators in the pathway and whether interventions to reduce anxiety increase AP.

Frequent Sports Dance May Serve as a Protective Factor for Depression Among College Students: A Real-World Data Analysis in China

Purpose

This study aims to investigate the role of frequent sports dance in preventing mental disorders, including anxiety and depression, among college students using real-world data, and to further analyze potential risk factors associated with anxiety and depression.

Methods

We investigated 921 college students from eight universities in China. A survey was completed by 901 students and they were included in the analysis. The anxiety score was evaluated by the Generalized Anxiety Disorder 7-item (GAD-7) scale and the depression score was evaluated by the Patient Health Questionnaire-9 (PHQ-9). Subgroup comparisons were performed among frequent sports dance students and non-frequent sports dance students.

Results

Of all the students, 9.98% had moderate-to-severe anxiety and 14.65% students suffered from moderate-to-severe depression. Compared with non-frequent sports dance students, frequent sports dance students had significantly lower depression scores (P=0.04). According to the multiple logistic regression models, when potential confounding factors were all adjusted, frequent sports dance was also significantly associated with less depression (OR=0.55, 95% CI: 0.36–0.84, P<0.01). We also found that higher college grade levels (P<0.01), non-physical education students (P=0.02), higher body mass index (P=0.02), lower exercise frequency per week (P<0.01), addiction to drinking (P=0.02), and previous diagnosis of anxiety or depression in hospital (P<0.01) were significantly associated with more anxiety; higher college grade levels (P<0.01), addiction to drinking (P<0.01), preference for eating fried food (P=0.02), soda as the main source of drinking water (P=0.01), and previous diagnosis of anxiety or depression (P=0.03) were significantly associated with more depression, while higher exercise frequency per week (P<0.01), only-child status (P<0.01), and preference for eating vegetables (P=0.02) were significantly associated with less depression.

Conclusion

Anxiety and depression are common among college students. Frequent sports dance may serve as a protective factor for preventing depression and it can be recommended for college students.

Association of Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder Traits with Depression and Empathy Among Medical Students

PURPOSE

This study aimed to investigate the associations of the traits of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) with depression and empathy among medical students.

PATIENTS AND METHODS

A cross-sectional survey was conducted with 202 fifth-year students at a Japanese medical school for 10 months during their clinical clerkship. The survey included sociodemographic questions and validated tools to measure depressive symptoms (Hospital Anxiety and Depression Scale [HADS]), medical students' empathy for patients (Jefferson Scale of Empathy-Student version [JSE]), ADHD traits (ADHD Self-Report Scale Screener [ASRS Screener]), and ASD traits (Autism-Spectrum Quotient Japanese version-21 [AQ-J-21]).

RESULTS

A total of 151 students (response rate: 74.7%) participated in the survey. Of these, 41 (27.2%) reported a total score of ≥ 20 on the HADS and were categorized as depressed. Depressed students reported significantly lower and higher rates of having a part-time job and a history of enrolment in other faculties, respectively, than non-depressed students. According to the cutoff criteria of the ASRS Screener and AQ-J-21, 31 (20.5%) and 42 (27.8%) students reported ADHD and ASD traits, respectively. Multivariate regression analysis, controlling for age and sex, reported that higher age, ASRS Screener scores, and AQ-J-21 scores were significant predictors of higher HADS total scores. Additionally, higher AQ-J-21 scores significantly predicted lower JSE scores.

CONCLUSION

The degree of ADHD and ASD traits was significantly associated with depression. Moreover, the degree of ASD traits was significantly associated with lower empathy for their patients. It is important to consider that about 20-30% of medical students have these neurodevelopmental traits and to develop intervention strategies for improving depression and empathy.

Algorithms to Predict Anxiety and Depression Among University Students in China After Analyzing Lifestyles and Sport Habits

PURPOSE

This study aims to identify potential risk factors associated with anxiety or depression and propose algorithms to predict anxiety and depression especially among university students.

METHODS

We included and analyzed 881 university students from eight colleges in China in November 2020. Student's basic information, lifestyles, sport habits, comorbidities, and mental health conditions were collected. Anxiety and depression were measured using the generalized anxiety disorder 7 (GAD-7) and the patient health questionnaire 9 (PHQ-9), respectively. A multiple linear regression analysis was used to assess the ability of 25 potential risk factors for predicting anxiety and depression, and significant risk factors were included in the algorithms.

RESULTS

Of all the included students, 44.27% lived with mild or above anxious symptoms and 50.62% had mild or above depressive symptoms. According to the multiple linear regression model, grade levels (P<0.01), member of college sports dance team (P=0.05), sedentary time (P=0.02), exercise frequency (P<0.01), only child status (P=0.05), addiction of drinking (P<0.01), and prefer eating vegetable (P<0.01) were significantly associated with anxiety; grade levels (P<0.01), member of college sports dance team (P<0.01), sedentary time (P<0.01), exercise frequency (P<0.01), academic study period during free time (P=0.03), only child status (P<0.01), addiction of drinking (P<0.01), prefer eating vegetables (P<0.01), and main types of drinking water (P<0.01) were significantly associated with depression. Based on these significant factors, two algorithms were successfully developed, and two risk groups were created according to the algorithms.

CONCLUSION

The study proposed two algorithms to calculate anxiety and depression, respectively, which can be useful tools to identify students with different risk of anxiety or depression. Effective measures are warranted to improve student's sport habits and healthy lifestyles in order to mitigate anxiety and depression, especially among students in the high risk group.

Depressive disorders in Thai medical students: an exploratory study of institutional, cultural, and individual factors

OBJECTIVES

This exploratory qualitative study conducted among Thai medical students aimed to investigate factors related to the development of medical students' depression and how these factors interact in contributing to depressive disorders.

METHODS

Forty-three undergraduate medical students of the six-year Doctor of Medicine program were identified as having moderate to severe depression on an annual depression screening. From these, eighteen students agreed to participate in individual in-depth interviews. Transcriptions of the interviews were analyzed by independent reviewers using a thematic analysis approach.

RESULTS

Among 43 participants screened as having moderate-to-severe depression, major depressive disorder and adjustment disorder were 9.3% and 14.0%, respectively. Reported factors related to medical students' disorders were personal vulnerabilities, medical educational administration, academic achievement, learning environment, intrinsic motivation, self-care and self-management, relationship, and community. In particular, lack of social support and relationship problems were mentioned among those with more severe and persistent symptoms. Protective factors were social support, positive relationships, a growth mindset, spiritual and mindfulness practices, and an adequate mentoring program.

CONCLUSIONS

Medical students' depression and suicidal ideations are significant concerns in Thai medical education. Besides personal vulnerabilities, high expectations, the value placed on academic achievement, and relationship problems can precipitate the onset of depressive disorders, if not being properly addressed. The 4P framework of predisposing, precipitating, perpetuating, and protective factors are suggested to understand the onset and development of students' depressive disorders and to identify targets for institutional and educational intervention.

Empathy, well-being, and mental health: do gender differences diminish by the end of medical school?

This study aims to investigate if medical students demonstrate differences related to gender in terms of empathy, burnout, tolerance, openness to spirituality, well-being, and mental health, and to examine whether these differences vary across levels of medical training. A cross-sectional study was conducted in the first semester of 2015 in a Brazilian medical school. The following were evaluated: quality of life (WHOQOL-Bref), burnout (Oldenburg), mental health (DASS-21), empathy (Empathy Inventory and ESWIM), and tolerance, well-being, and openness to spirituality (ESWIM). We investigated how these outcomes varied in terms of gender, stage of medical training, and its interaction using a two-way MANOVA. A total of 776 students were included and important differences were observed. As medical training advanced, the differences between genders that were present during students' initial years (greater empathy, worse quality of life, and worse mental health among women) tended to become nonsignificant during the clerkship years. In addition, a significant interaction between stage and gender was found for ESWIM Wellness; WHOQOL; DASS Anxiety and DASS Stress. These results may denote a shortcoming in the way medical schools approach gender differences. Educators should consider these findings when restructuring curricula to respect gender differences, thus fostering their respective potentials.

The Prevalence of Depression, Anxiety and Stress and Their Associated Factors in College Students

AIM

To estimate the prevalence of symptoms of depression, anxiety, stress and associated factors in a population of college students.

METHOD

Cross-sectional study of psychological distress measured through the Depression, Anxiety and Stress Scale (DASS-21) in a sample of 1074 college students.

RESULTS

We found a moderate prevalence of depression (18.4%), anxiety (23.6%) and stress (34.5%) symptoms in our study population. Being <21, having problematic Internet use behavior, smoking, presenting insomnia and having a low self-esteem were independently associated with symptoms of depression, anxiety and stress. Being a woman, living with their family, having a stable partner, consuming alcohol frequently and having poor nutritional habits were significantly associated with symptoms of stress; lacking a stable partner was significantly associated with depressive symptoms; and frequent consumption of alcohol was significantly associated with symptoms of anxiety.

CONCLUSION

We found a moderate prevalence of depression, anxiety and stress symptoms in our population. Interventions aimed at promoting mental health among college students should be implemented.

Anxiety and Its Association with Preparation for Future Specialty: A Cross-Sectional Study Among Medical Students, Saudi Arabia

Background

Anxiety disorders are a significant global health concern with destructive morbidity and mortality. Medical school is a stressful environment worldwide. This study measures the prevalence of anxiety symptoms among clinical-year medical students in Saudi Arabia. As well as to explore its association with students’ sociodemographic factors, academic performance, issues experienced by them during the study of medicine, and their perceived readiness for their future specialties.

Methods

The generalized anxiety disorder (GAD-7) tool along with a sociodemographic questionnaire was distributed to 523 clinical-year medical students (fourth, fifth and sixth years) from the Imam Abdulrahman Bin Faisal University, Saudi Arabia, in this cross-sectional study. Data analysis was performed with SPSS version 23 and it included the Chi-Square or Fisher’s exact tests for bivariate analysis, and the multivariable logistic regression to account for confounders.

Results

The prevalence of anxiety symptoms as measured by the GAD-7 was found to be 31.7%. Of these, 14.3% had severe symptoms. Only 4.4% students went to a healthcare professional and were diagnosed with psychiatric problems. Logistic regression analysis revealed that the odds of anxiety was higher among females and students who had perceived psychological problems. However, students’ grade point average (GPA) and perceived readiness for their future specialty were not statistically significant with anxiety symptoms.

Conclusion

Anxiety was highly prevalent among clinical-year medical students included in this study. This urges periodic mental health screening, proper diagnosis of high-risk individuals in medical schools, and early interventions through confidential access to mental health services.

Facing the truth - A report on the mental health situation of German law students

Depression is a serious and widespread mental illness that can occur among all ages and genders. This cross-sectional study investigates the previously disregarded state of mental health of German law students based on the Beck Depression Inventory-II. A sample consisting of N = 306 students was surveyed, showing an increased frequency of depressive symptoms. One-third of the participants reported having depression according to BDI-II scoring criteria. More specifically, in the whole sample there are 16.7% with mild, 11.1% with moderate, and 5.6% with severe depression. About 17.7% reported having suicidal thoughts in the last two weeks before the survey. Moreover, the study reports about the correlation between the BDI-II total score and certain risk factors, stress factors and resilience factors, which were assessed using self-report questionnaires and the NEO-FFI. The self-reported depressive symptoms were higher with every accumulation of risk or stress factors and lower with each accumulation of resilience factors. Finally, based on the test results, recommendations are offered to facilitate the burdened student's life.

Prevalence and factors associated with depressive and anxiety symptoms among Palestinian medical students

BACKGROUND

Co-existence of depression and anxiety can be associated with severe detrimental consequences to the physical, mental and social wellbeing of the affected populations. This study was conducted to determine prevalence of depressive and anxiety symptoms among Palestinian medical students and to investigate associations between sociodemographic factors of the students with depressive and anxiety symptoms.

METHODS

This study was conducted in a cross-sectional observational design using a questionnaire in the period between September 2018 and April 2019 in a major university in the West Bank of Palestine. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II) and anxiety symptoms were assessed using the Beck Anxiety Inventory (BAI). The questionnaire also collected the sociodemographic characteristics of the students. Reliability of the questionnaire was tested using the test re-test method. A total of 425 medical students were invited to participate in the study.

RESULTS

Of those invited, 286 students completed the questionnaire, giving a response rate of 67.3%. More than half (56.6%) of the students had minimal depression, 20.3% had mild depression, 14.0% had moderate depression, 9.1% had severe depression, 23.4% had no anxiety, 29.7% had mild to moderate anxiety, 25.5% had moderate to severe anxiety, and 21.3% had severe anxiety. Multiple linear regression analysis showed that academic stage (p-value < 0.01), Grade Point Average (p-value < 0.01), mental health status (p-value < 0.001), ever attempted suicide (p-value < 0.05), and religious commitment (p-value < 0.01) were predictors of BDI-II scores. Multiple linear regression analysis showed that academic stage (p-value < 0.05) and mental health status (p-value < 0.001) were predictors of BAI scores.

CONCLUSIONS

Depressive and anxiety symptoms were prevalent among Palestinian medical students in a major university in the West Bank of Palestine. Interventions might be designed to improve self-rated mental health of medical students in their academic years, ameliorate study conditions, and provision of counseling services to improve spirituality might be effective in reducing symptoms of depression and anxiety among medical students in Palestine. Future studies are still needed to investigate if these interventions could be useful in reducing depressive and anxiety symptoms among Palestinian medical students.

The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis

Anxiety, although as common and arguably as debilitating as depression, has garnered less attention, and is often undetected and undertreated in the general population. Similarly, anxiety among medical students warrants greater attention due to its significant implications. We aimed to study the global prevalence of anxiety among medical students and the associated factors predisposing medical students to anxiety. In February 2019, we carried out a systematic search for cross-sectional studies that examined the prevalence of anxiety among medical students. We computed the aggregate prevalence and pooled odds ratio (OR) using the random-effects model and used meta-regression analyses to explore the sources of heterogeneity. We pooled and analyzed data from sixty-nine studies comprising 40,348 medical students. The global prevalence rate of anxiety among medical students was 33.8% (95% Confidence Interval: 29.2–38.7%). Anxiety was most prevalent among medical students from the Middle East and Asia. Subgroup analyses by gender and year of study found no statistically significant differences in the prevalence of anxiety. About one in three medical students globally have anxiety—a prevalence rate which is substantially higher than the general population. Administrators and leaders of medical schools should take the lead in destigmatizing mental illnesses and promoting help-seeking behaviors when students are stressed and anxious. Further research is needed to identify risk factors of anxiety unique to medical students.

Prevalence and predictors of depression and anxiety among medical students in Addis Ababa, Ethiopia

Background

Depression and anxiety are among the common mental health problems among medical students and are associated with poor academic performance, disability and poor quality of life. A better understanding of the magnitude and correlates of depression and anxiety is essential for planning appropriate intervention for those population groups. However, research into depression and anxiety and the potential contributing factors is limited in low and middle-income countries including Ethiopia. Therefore, this study aimed to determine the prevalence and associated factors of depression and anxiety among medical students.

Methods

A cross-sectional study was conducted among 273 medical students selected by systematic sampling technique. Hospital anxiety and depression scale (HADS) was used to assess anxiety and depression. Binary and multivariable logistic regression models were fitted, adjusting for the potential confounding factors. Odds ratios (OR) with the corresponding 95% confidence interval (95% CI) was computed to assess the strength of association.

Result

The prevalence of co-morbid depression and anxiety was found to be 21.20% (16.35% to 26.05%) and prevalence of depression and anxiety was 51.30% (45.37% to 57.23%) and (30.1% 24.66% to 35.54%), respectively. Multivariate analysis showed that being female [AOR 2.56, 95% CI (1.32, 4.95)], first-year educational level [AOR 12.06, 95% CI (2.18, 66.72)], second-year educational level [AOR 8.99, 95% CI (1.67, 48.45)] and those who had poor/low social support [AOR 5.36, 95% CI (2.08, 13.76)] were significantly association with anxiety. Students who were in the age interval of 18–21 years [AOR 2.42, 95% CI (1.64, 9.22)], first-year educational level [AOR 1.63, 95% CI (1.43, 6.26)], second-year educational level [AOR 1.39, 95% CI (1.17, 5.18)] and who had stressful life events [AOR 1.61, 95% CI (1.14, 2.76)] were significantly associated with depression among medical students.

Conclusion

The current study demonstrated that a remarkable proportion of medical students are suffering from depression (51.30%), anxiety (30.10%) as well as comorbid depression and anxiety (21.20%). There was strong evidence of association between anxiety and female sex, first-year educational level, second-year educational level and having poor/low social support. Whereas a significant association was observed between depression and younger age (18–21 years old), first-year educational level, second-year educational level and having one or more stressful life events in the last 6 months. Screening of depression and anxiety among medical students was recommended. Future studies focusing on better ways of preventing and treating depression and anxiety among medical students are warranted.

Prevalence of depressive symptoms among medical students: overview of systematic reviews

CONTEXT

The prevalence of depressive symptoms among medical students has been found to be higher than among other students because of their longer studying time, higher workload and larger financial burden. Despite the availability of reviews examining this, some have focused solely on one country, whereas others used databases containing papers of solely one language; therefore, the results from reviews might not be comprehensive. Against this background, this overview aims to synthesise the results from all the published systematic reviews of depression among medical students, in order to provide a more accurate result.

METHODS

A systematic search was conducted of online databases for published systematic reviews or meta-analyses examining the prevalence of depressive symptoms among medical students. The findings of individual studies included in these reviews were extracted and then combined with a random-effects model. Subgroup analysis was conducted by regions.

RESULTS

A total of 10 studies were selected in this overview, involving 249 primary studies and 162 450 medical students. MEDLINE was the most popular database used in these studies. The overlapping of primary studies in these reviews was appreciably high, except for three studies that focused on specific countries. The overall pooled prevalence was 27.0% (95% CI, 24.7-29.5%). Significant subgroup differences were detected (p < 0.001). The pooled prevalence among studies in the Western Pacific Region was the lowest, 18.9% (95% CI, 11.7-29.0%), whereas that in Africa (40.9%) was the highest (95% CI, 28.8-54.4%). The top five significant factors associated with depressive symptoms were: (i) year of study; (ii) gender; (iii) personal issues; (iv) family relations or issues, and (v) health status.

CONCLUSIONS

Depression affected around a quarter of medical students in general and 40.9% of students in Africa. It is suggested that medical schools and health authorities should introduce preventive measures to curb the high prevalence of depressive symptoms.