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

Cyclothymic affective temperament and low positive attitude coping strategies as predictors of comorbid depressive symptomatology in adult ADHD patients

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) in adults could be frequently underdiagnosed due to concomitant psychiatric disorders, including depressive symptomatology, which could determine inappropriate treatments. Our study aims at clinically characterizing adult ADHD with or without depressive symptomatology in order to identify the relationship with specific affective temperamental profiles and coping strategies.

METHODS

A total of 225 outpatients consecutively afferent to our outpatient adult ADHD service since September 2019 were retrospectively screened for eligibility and administered Beck Depression Inventory-II (BDI-II), Coping Orientation to Problems Experienced Inventory (COPE-NV) and Temperament Evaluation of the Memphis, Pisa, Paris and San Diego (TEMPS-M).

RESULTS

64.7 % of patients displayed a significant comorbid depressive symptomatology. According to the multivariate linear regression model, depressive levels were positively predicted by TEMPS-M cyclothymic subscale (B = 0.567, p = 0.004) and negatively predicted by COPE-NVI "positive attitude" subscale (B = -0.438, p = 0.024) (R = 0.496, R2 = 0.246, F(2,66) = 10.747, p < 0.001).

LIMITATION

While considering the results, it should be taken in consideration that: the assessment was carried out only at baseline, our sample is constituted only by adult ADHD patients and mostly without a previous ADHD diagnosis, the presence of a discrepancy between the rates of ADHD subtypes, the absence of a healthy control group and emotional dysregulation was not directly assessed.

CONCLUSION

Affective temperamental profiles and coping strategies could help in clinically characterizing and personalizing treatment in adult comorbid ADHD-depressive symptomatology patients. Further research is warranted to explore the efficacy of targeted psychotherapeutic and pharmacological interventions within this ADHD sub-sample.

Barriers to Seeking Psychological Help among First-Year Medical Students: A Cross- Sectional Study from Turkey

Despite high rates of psychological symptoms, many medical students often avoid psychological help. Determining the mental status of medical students at an early stage is very important for developing necessary interventions. The aim of this study was to evaluate the barriers to seeking psychological help among first-year medical students. This cross-sectional study was conducted between January 2-20, 2023. Data were collected using an anonymous online questionnaire comprising students' self-reported psychological problems and treatment status, help-seeking barriers, and a validated mental health tool (Patient Health Survey 4). The response rate was 58.8% (n = 250). Of them, 34.4% had anxiety symptoms and 25.2% had depressive symptoms. The prevalence of self-reported psychological problems and serious psychological problems were 61.2% and 10.4%, respectively. Only 7.6% of students reported receiving psychological treatment. It was found that 5.6% of the students used psychiatric drugs (2% officially prescribed and 3.6% not officially prescribed). The most common barriers to help-seeking were not were not serious problems, lack of time, difficulty explaining psychological problems, fear of being recorded, and fear of stigmatization. The results indicated that a significant number of students had psychological problems, and some did not seek psychological help.

Prevalence and correlates of depressive symptoms among undergraduate health science students at the University of Parakou, Benin

OBJECTIVES

Research on psychological distress in African students is scarce. This study aimed at exploring the epidemiology (prevalence and correlates) of depressive symptoms among undergraduate health sciences students at the University of Parakou (Benin).

METHODS

We conducted a cross-sectional survey from June to July 2022 at the University of Parakou, the second-largest university in the Republic of Benin. Depressive symptoms were assessed using the Patient Health Questionnaire depression scale (PHQ-9). Information on several independent factors was collected and their associations with depressive symptoms were investigated using logistic regression models.

RESULTS

Data from 560 students were analyzed (mean age: 21.3± 2.3 years, 60 % were male, and 50.4 % were registered in the first year of study). The overall prevalence of depressive symptoms was 39.1 % [95 % CI: 35.2 %-43.1 %]. Moderate and severe depressive symptoms were observed in 15.3 % and 1.8 % of participants, respectively. In the multivariable model, being aged 21-23 (adjusted Odds Ratio=1.8, p-value: 0.007), a female (aOR=1.5, p-value: 0.050), a medical student (aOR=2.9, p-value: <0.001), a public health student (aOR=3.6, p-value: <0.001), belonging to households with higher incomes (aOR= 2.4, p<0.001), and experiencing stress (aOR=1.5, p-value: 0.048) independently increased the probability of having depressive symptoms. However, having support from close relatives (aOR= 0.5, p-value: 0.026) was associated with a lower probability of depressive symptoms.

CONCLUSIONS

Our findings revealed a high prevalence of depressive symptoms among undergraduate health science students. Given the correlates identified, actions to promote coping skills in stress and encourage more parental support may be real avenues likely to help reduce the frequency and consequences of depressive symptoms.

Medical students' perspectives on a longitudinal wellness curriculum: a qualitative investigation

Introduction

There is growing concern about the mental health status of medical students. Medical students are at a higher risk for depression, anxiety, and burnout than non-medical students. The Undergraduate Medical Education (UGME) Office of Medical Learner Affairs at McGill University developed a Longitudinal Wellness Curriculum (LWC) to foster medical students' well-being, self-care, and adaptability.

Methods

We conducted a qualitative descriptive study to explore students' experiences with the LWC. We conducted three semi-structured focus groups involving a total of 11 medical students. We used thematic framework analysis for data analysis.

Results

We found four main themes related to participants' engagement with the curriculum: 1) diverse perceptions on curriculum relevance and helpfulness; 2) the benefits of experiential sessions, role model speakers, and supportive staff; 3) insights on student-friendly curriculum scheduling; and 4) the importance of wellness education and systemic interventions in medical education.

Conclusions

Most participants found the curriculum valuable and supported its integration into the academic curriculum. Experiential and active learning, diverse approaches to wellness, small group sessions, role modeling, and student-centered approaches were preferred methods. Inconvenient curriculum scheduling and skepticism over system-level support were seen as barriers to curriculum engagement and uptake. The findings of our study contribute to the development and implementation of wellness curriculum efforts in medical education.

Prevalence and Associations of Depression among Saudi College Nursing Students: A Cross-Sectional Study

Depression affects approximately 350 million individuals globally and is the leading cause of disability. Depression among nursing students is an ongoing issue, yet little is known about the relationship between depression and its risk factors among nursing students in Saudi Arabia. The purpose of this study was to determine the prevalence of depression among a cohort of Saudi nursing students and to explore the risk factors associated with depression in this group. A cross-sectional design was employed for this study, which was conducted by the nursing faculty at King Saud University in Riyadh, Saudi Arabia. The researcher sampled 330 nursing students, with 252 students (a 76.3% response rate) randomly selected by the academic advising unit in the nursing college between January and February 2023. The participants completed an online survey based on the Arabic version of the Center for Epidemiologic Studies Depression Scale. The data were analyzed using univariate analysis and backward multi-variable logistic regression. The findings revealed that 65.1% of the participants scored 16 or above on the depression scale, indicating high levels of depressive symptoms. Univariate analysis identified several significant risk factors for depression, including sex (OR, 0.29; 95% CI, 0.16-0.51; p < 0.001), academic pressure (OR, 5.87; 95% CI, 2.04-16.84; p < 0.001), interpersonal relationships (evaluated by balance and harmony in thoughts, emotions, behavior, and interactions with others; categorized as good/fair or poor), and the relationship with the father, which were strongly associated with the presence of depression symptoms. Backward multi-variable logistic regression analysis further revealed that being male, experiencing reduced academic pressure, having stronger father-son relationships, and maintaining positive interpersonal relationships were significantly associated with decreased levels of depression (ORs ranged from 0.25 to 3.94). These findings highlight the need for family and school-based prevention interventions to help nursing students in college avoid depression.

Depressive Symptoms Among Higher Education Students in Germany-A Systematic Review and Meta-Analysis

Objectives

Higher education students in Germany are vulnerable to depressive symptoms. Despite ample evidence, no comprehensive review has recently been conducted. Thus, our systematic review and meta-analysis aims at describing the extent to which students are affected by depressive symptoms.

Methods

We searched three databases for articles reporting the prevalence rates of depressiveness among students in Germany published between 2002 and 2023. Pooled prevalence rates were calculated using random effects models, both for the overall sample and for subgroups categorized by gender, study setting, assessment instrument, and whether the study was conducted before or during the COVID-19 pandemic.

Results

The search yielded 992 records. After screening, 60 articles remained for data extraction. About one out of five students (21.1%) exhibits depressive symptoms. Pooled prevalence rates differ between subgroups, with higher rates during the COVID-19 pandemic than before (30.6% versus 18.0%) and with females being more affected than their male counterparts (29.0% versus 23.1%).

Conclusion

This review underlines the urgency with which the mental health of students should be addressed at the (higher educational) policy level.

Clinical Trial Registration: PROPSPERO, Identifier CRD42022384066.

A Scoping Review of Mental Health Needs and Challenges among Medical Students within South African Universities

The mental health of medical students is a growing concern worldwide, with studies indicating high levels of stress, anxiety, and depression among this population. In a South African context, this review aims to review the existing literature on mental health needs and challenges among medical students in South Africa. The rationale for this review is crucial to identify gaps, understand unique contextual factors, and inform the development of targeted interventions and support tailored to the specific needs of South African medical students. This review followed a scoping review framework by Arksey and O'Malley which consists of five stages. The review was initiated in December 2023. The search process was conducted on the following electronic databases: PubMed, Psych-info, Scopus, Google Scholar, and Science Direct. The search terms of this review were "Medical students" OR "Mental health", OR "Challenges", OR "South Africa", OR "Universities" OR "Needs", OR "Support systems", OR "Mental health interventions". This study included articles published in English between 2010 and 2023. After a thorough review of the literature, only eight articles met the inclusion criteria. This study excluded articles that were not published in English, articles published before 2010, full-text articles that could not be retrieved, and studies that did not address the mental health needs and challenges faced by medical students and risk factors contributing to mental issues among South African medical students. The review yielded only three themes utilizing Creswell's Tesch method of data analysis. (1) Prevalence of mental health disorders, (2) risk factors contributing to poor mental health, and (3) available university support systems and interventions. Therefore, the unique aspect of our review lies in shedding light on the underexplored intersections between mental health and the unique context of medical education in South Africa. This includes examining the impact of historical, cultural, and institutional factors on the mental health and well-being of medical students, which has not been comprehensively addressed in previous literature in terms of the South African context. The findings of this review highlight the importance of implementing comprehensive mental health support programs within medical education institutions to address the needs of students and promote their well-being.

The Impact of COVID-19 on Mental Health in Medical Students: A Cross-Sectional Survey Study in Italy

Background: This study aimed to assess the impact of the COVID-19 pandemic in terms of the prevalence of anxiety, depression and stress symptoms in Italian medical students and to identify the associated factors. Design and Methods: A cross-sectional online survey was administered to second-sixth year medical students of the University of Torino, collecting data on the students' sociodemographics, COVID-19 exposure, anxiety, depression and stress symptoms. Three hierarchical regressions adjusted for age, gender and year of study were executed. Results: The sample size was 1359. The prevalence of anxiety, depression symptoms, moderate perceived stress and severe perceived stress was 47.8%, 52.1%, 56.2% and 28.4%, respectively. The factors associated with mental health symptoms were: being a woman, a family history of psychiatric disorders, living off-site, competitive/hostile climates and unsatisfying friendships among classmates, poor relationships with cohabitants, negative judgment of medical school choice, fear of COVID-19 infection, feelings of loneliness, distressing existential reflections, and a worsening psychological condition related to the pandemic. Being in the fourth or sixth year constituted a protective factor for depression symptoms. Conclusions: Mental health in medical students was associated with both COVID-independent and COVID-related factors. Accessibility to effective interventions must be increased to counteract these changes.

Mental health and quality of life across 6 years of medical training: A year-by-year analysis

BACKGROUND

Despite growing evidence on medical students' mental health deterioration, studies have primarily used short follow-up periods and not followed the students throughout their medical training.

OBJECTIVE

To assess mental health (stress, anxiety, and depression) and quality of life changes throughout their medical program, we followed up with the same cohort of students for 6 years.

METHODS

This longitudinal prospective study followed up with the same group of medical students at a Brazilian public medical school from 2014 to 2020. The study analyzed sociodemographic data, mental health (including depression, anxiety, and stress [DASS-21]), quality of life (WHOQOL-BREF), satisfaction from studying to be a physician, and happiness with life. General linear mixed models were used for the analyses.

RESULTS

The cohort included 80 Brazilian medical students (63.7% women; mean age = 19.6 years [SD = 2.21]). A high prevalence of depressive symptoms, anxiety, and stress was found throughout medical training, with more than 50% of students having significant symptoms. Mental health, happiness, and quality of life levels tended to be better in the first and last semesters, being worse in the middle of the program. However, satisfaction from studying to become a doctor decreased in the second semester, remained low throughout the program, and never returned to baseline levels.

CONCLUSION

Mental health and quality of life levels remained high throughout the medical program, with better levels in the first and last semesters and falling in the middle of the program. These data can help managers and educators understand how psychological distress affects medical students.

Sleep quality and subjective well-being in healthcare students: examining the role of anxiety and depression

Objective

Sleep issues, negative emotions, and health conditions are commonly co-occurring, whereas their associations among healthcare students have yet to be elucidated. This study aimed to examine whether anxiety and depression mediate the relationship between sleep quality and subjective well-being in healthcare students.

Methods

A cross-sectional survey was conducted among Chinese healthcare students (N = 348). A battery of paper-and-pencil questionnaires-the Sleep Quality Questionnaire (SQQ), World Health Organization-Five Well-Being Index (WHO-5), and Patient Health Questionnaire-4 (PHQ-4) were applied. Descriptive analysis with means (standard deviations) and counts (proportions), Spearman correlation analysis between the SQQ, WHO-5, and PHQ-4, and mediation analysis via structural equation models were performed.

Results

Correlation analysis revealed statistically significant associations between sleep quality, anxiety and depression, and well-being among healthcare students. Mediation analysis identified that poor sleep quality produced relatively low levels of self-reported well-being, which were entirely attributable to anxiety and depression.

Conclusion

Sleep quality was associated with subjective well-being, and this interrelationship was fully mediated by anxiety and depression. Interventions aimed at promoting sleep quality of healthcare students may contribute to promoting their well-being by reducing anxiety and depression.

Common mental health problems in medical students and junior doctors - an overview of systematic reviews

BACKGROUND

Common mental health problems (CMHP) are prevalent among junior doctors and medical students, and the COVID-19 pandemic has brought challenging situations with education disruptions, early graduations, and front-line work. CMHPs can have detrimental consequences on clinical safety and healthcare colleagues; thus, it is vital to assess the overall prevalence and available interventions to provide institutional-level support.

AIMS

This overview summarises the prevalence of CMHPs from existing published systematic reviews and informs public health prevention and early intervention practice.

METHODS

Four electronic databases were searched from 2012 to identify systematic reviews on the prevalence of CMHPs and/or interventions to tackle them.

RESULTS

Thirty-six reviews were included: 25 assessing prevalence and 11 assessing interventions. Across systematic reviews, the prevalence of anxiety ranged from 7.04 to 88.30%, burnout from 7.0 to 86.0%, depression from 11.0 to 66.5%, stress from 29.6 to 49.9%, suicidal ideation from 3.0 to 53.9% and one obsessive-compulsive disorder review reported a prevalence of 3.8%. Mindfulness-based interventions were included in all reviews, with mixed findings for each CMHP.

CONCLUSIONS

The prevalence of CMHPs is high among junior doctors and medical students, with anxiety remaining relatively stable and depression slightly increasing during the COVID-19 pandemic. Future research on mindfulness-based interventions is required for a resilient and healthy future workforce.

PRISMA/PROSPERO

the researchers have followed PRISMA guidance. This overview was not registered with PROSPERO as it was conducted as part of an MSc research project.

The relationship of psychological health and primary emotional traits in medical students

INTRODUCTION

Several studies have called for attention to medical students' well-being. Building on the neuroevolutionary affective neuroscience perspective that views primary emotional systems as central to well-being and the foundation of personality, this study investigated the facets of medical students' psychological well-being that are challenged and the relationships between emotional traits, psychological well-being, and depression.

METHODS

In a single-center cross-sectional study, medical students' primary emotional traits (SEEKING, FEAR, ANGER, SADNESS, CARE, PLAY and Spirituality), psychological well-being dimensions (autonomy, environmental mastery, positive relations, self-acceptance, purpose in life, and personal growth), and depressive symptoms were assessed using the Affective Neuroscience Personality Scale; the Psychological Well-being Scale, which provides normative data; and the Beck Depression Inventory.

RESULTS

Compared with the normative data, the medical students perceived lower psychological autonomy, positive relations, and self-acceptance but higher purpose in life. The medical students' emotional traits were related to specific psychological well-being facets and depression. SEEKING and, inversely, FEAR were related to well-being across dimensions and depressive symptoms.

CONCLUSION

Our findings are the first to show a link between emotional traits and specific facets of psychological health in medical students. Thus, this study encourages medical teachers to set learning environments that target multiple facets of well-being that harness primary emotional traits.

Is mental health literacy for depression associated with the intention toward preventive actions? A cross-sectional study among university students

Objective: Mental Health Literacy (MHL) might play an important role in preventing depression. This study assessed the MHL level for depression of university students and its association with intentions toward preventive actions against depression. Participants: University students (n = 315) were surveyed online. Methods: MHL level and group differences were analyzed using t-tests and one-way ANOVA. To investigate the relation between MHL and the intention for preventive actions against depression, correlation and regression analyses were performed. Results: The mean MHL level of the participants was reasonably high (42.65 of 75 points). MHL levels differed significantly between different groups. MHL was slightly associated with intention for preventive actions (beta = 0.274, p < 0.001). The explained variance was low (7.5%). Conclusions: MHL levels of university students have potential for improvement, especially among males and non-health related students. Promotion of MHL could be one of the targets points in interventions aimed at depression prevention.

Perceived Stress among Healthcare Students and Its Association with Anxiety and Depression: A Cross-Sectional Study in Saudi Arabia

Introduction. Healthcare students are subjected to high-stress levels due to different academic, social, and financial stressors. Persistent and severe stress might predispose students to depression and anxiety. Therefore, this research aims to investigate the level of perceived stress among healthcare students and its relation to anxiety and depression. Methods. A prospective cross-sectional study using a validated questionnaire was conducted among healthcare students in Saudi Arabia. The 14-item Perceived Stress Scale (PSS) was used to evaluate perceived stress, and depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). All statistical analyses were carried out using PSPP Statistical Analysis Software version 1.2.0. Results. A total of 701 respondents participated in this study. The average age of the students was 20.9 years old, and 59.3% were female. Almost three-quarters of students perceive themselves as stressed. Around two-thirds were categorized as having borderline/cases of depression or anxiety. Perceived stress was four times more likely among students with cases of anxiety [Adjusted Odds Ratio (AOR) = 4.83; 95% CI 2.89, 8.06], depression [AOR = 4.79; 95% CI 2.68, 8.53] as compared with those without these conditions. Conclusions. Stress is highly prevalent among healthcare students, and it is strongly associated with female gender and students' anxiety and depression. Therefore, the mental health of healthcare students is an essential factor affecting perceived stress and at-risk individuals. Therefore, preventative mental health interventions targeting healthcare students are necessary to help improve mental health and cope with stressors in academic education.

Prevalence of depression, anxiety and burnout in medical students at the University of Namibia

Background

There is an increased prevalence of depression, anxiety, and burnout among medical students worldwide with no information from Namibia.

Aim

This study aimed to determine the prevalence and factors associated with depression, anxiety, and burnout among medical students at the University of Namibia (UNAM).

Methods

A quantitative descriptive cross-sectional survey was conducted utilising a specially designed questionnaire for the study and standardised instruments to evaluate depression, anxiety, and burnout.

Results

Of the 229 students in this study, 71.6% were female and 28.4% were male. The prevalence of depression, anxiety, and burnout was 43.6%, 30.6%, and 36.2%, respectively. The prevalence of emotional exhaustion (EX), cynicism (CY), and professional efficacy (EF) was 68.1% (n = 156), 77.3% (n = 177) and 53.3% (n = 122), respectively. In the final regression model, participants with a current psychiatric illness were more likely to screen positive for depression (adjusted odds ratio [aOR] 4.06, confidence interval [CI] 1.28-12.91; p = 0.02) and anxiety (aOR: 3.63, CI: 1.17-11.23; p = 0.03). Emotional exhaustion and cynicism were significantly associated with female gender (EX: aOR, 0.40, CI: 0.20-0.79; p = 0.01) (CY: aOR, 0.42, CI: 0.20-0.91; p = 0.03).

Conclusion

More than one in three medical students at the UNAM were either depressed or burnt out.

Contribution

This is the first study to highlight the mental health needs of medical students at the University of Namibia.

The mediating role of psychological flexibility in the association of autistic-like traits with burnout and depression in medical students during clinical clerkships in Japan: a university-based cross-sectional study

BACKGROUND

Burnout and depression among medical students is linked to serious problems that require appropriate solutions. Subthreshold autism traits or autistic-like traits (ALTs) may be possible factors associated with burnout and depression. The effectiveness of acceptance and commitment therapy (ACT) for burnout and depression has been widely reported. The treatment aims to improve psychological flexibility, a concept indicating engagement in personal value-based behaviors without avoiding uncomfortable private experiences. This study examined whether ALTs were associated with burnout or depression among medical students during clinical clerkships in Japan, and then investigated what psychological flexibility processes might mediate these associations.

METHODS

A cross-sectional survey was administered to 284 medical students at Nagoya City University School of Medical Sciences who had been in clinical clerkships for 10 months or longer. Linear multiple regressions were performed with each burnout factor or depression as the outcome variable using validated tools measuring burnout (Maslach Burnout Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), ALT (Autism-Spectrum Quotient Japanese version-21), and psychological flexibility processes (Cognitive Fusion Questionnaire-7 and Valuing Questionnaire). Additionally, a mediation analysis was conducted using structural equation modeling.

RESULTS

A linear multiple regression analysis that controlled for age and gender found that ALTs were significantly associated with lower personal accomplishment, a factor of burnout, and depression. Lower personal accomplishment was also associated with males and lower progress toward values of the psychological flexibility process. Depression was also associated with males and higher cognitive fusion, lower progress towards values, and higher obstruction to values of the psychological flexibility process. Surprisingly, emotional exhaustion and depersonalization were not significantly associated with ALTs. The mediation analysis revealed that the relationship between ALTs and personal accomplishment was partially mediated by a process of progress toward values, while the relationship between ALTs and depression was partially mediated by both processes of progress toward values and cognitive fusion.

CONCLUSIONS

ALTs were significantly associated with lower personal accomplishment of burnout and depression among medical students in clinical clerkships. Consideration should be given to the psychological flexibility processes that focus on interventions targeting psychological flexibility for medical students with ALTs to reduce burnout and depression.

Pooled prevalence of depressive symptoms among medical students: an individual participant data meta-analysis

BACKGROUND

The methodological choice of aggregated estimates for meta-analysis may be notable for some common drawbacks, including variations in the cut-off values of depression, and lower statistical power for analyzing the associated factors. The study aimed to refine the precision of previous findings on the prevalence of depressive symptoms among medical students, through gathering individual participant data (IPD) as identified from our previous reviews.

MATERIAL AND METHODS

In the present study, we searched MEDLINE, EMBASE, PsycINFO, WanFang, Scielo and LILACS to identify published systematic reviews and meta-analyses up to March 2018, then individual data was requested for further analysis (PROSPERO registration: CRD42018091917). The participants' age, sex, year of study, scores for depressive symptoms, and other predictor variables were requested. To pool the prevalence from the included studies, random-effects model (two-step method) was used. Multiple linear regression was used to examine the associated factors on the depression z-scores (one-step method).

RESULTS

Of the 249 studies, the datasets of 34 studies were included. The crude prevalence was 19.4% (95% CI: 18.8%, 19.9%) by one-step method and the pooled prevalence was 18.1% (95% CI: 14.1%, 22.1%) by two-step method. Multiple linear regression revealed that being a female, older age, and senior year of study were significantly associated with the z-score.

CONCLUSION

The pooled prevalence of depressive symptoms from the Individual Participant Data (IPD) meta-analysis was lower than the previous meta-analyses using aggregated data. Age, sex, and year of study were significantly associated with the depression z-score. IPD meta-analysis may provide a more accurate estimation of disease burden, and allow verification of associated factors.

Influencing factors of depressive symptoms among undergraduates: A systematic review and meta-analysis

OBJECTIVE

This systematic review aims to examine the influencing factors of undergraduates' depressive symptoms by summarizing the categories and intensity of the factors, to lay a foundation for subsequent research.

METHODS

Two authors independently searched in Medline (Ovid), Embase (Ovid), Scopu, PsycINFO, PsycARTICLES, the Chinese Scientific Journal Database (VIP Database), China National Knowledge database (CNKI), and the WanFang database for cohort studies related to the influencing factors affecting depressive symptoms among undergraduates published prior to September 12, 2022. Adjusted Newcastle-Ottawa scale (NOS) was used to assess the risk of bias. Meta-analyses of regression coefficient estimates were performed to calculate pooled estimates with R 4.0.3 software.

RESULTS

A total of 73 cohort studies were included, involving 46362 participants from 11 countries. Factors affecting depressive symptoms were classified into relational, psychological, predictors of response to trauma, occupational, sociodemographic and lifestyle factors. In Meta-analysis, 4 of 7 influencing factors were revealed to be statistically significant: negative coping (B = 0.98, 95%CI: 0.22-1.74), rumination (B = 0.06, 95%CI: 0.01-0.11), stress (OR = 0.22, 95%CI: 0.16-0.28) and childhood abuse (B = 0.42, 95%CI:0.13-0.71). No significant association was found in positive coping, gender and ethnicity.

LIMITATIONS

The current studies have the problems of inconsistent use of scales and large heterogeneity of research design, making it difficult to summarize, which is expected to be further improved in future research.

CONCLUSION

This review evidences the importance of several influencing factors of depressive symptoms among undergraduates. We advocate for more high-quality studies with more coherent and appropriate study designs and outcome measurement approaches in this field.

TRIAL REGISTRATION

Systematic review registration: PROSPERO registration CRD42021267841.

Perspectives on mental health services for medical students at a Ugandan medical school

BACKGROUND

University-based mental health services for medical students remain a challenge, particularly in low-income countries, due to poor service availability. Prior studies have explored the availability of mental health services in high-income countries but little is known about mental health services in countries in sub-Saharan Africa, such as Uganda. Medical students are at a higher risk of developing mental health challenges during their course of study as compared with other students. Thus, there is a need for well-structured mental health services for this group of students. The aim of this study was to explore perspectives on mental health services for medical students at a public University in Uganda.

METHODS

This was a qualitative study where key informant interviews were conducted among purposively selected university administrators (n = 4), student leaders (n = 4), and mental health employees of the university (n = 3), three groups responsible for the mental well-being of medical students at a public university in Uganda. Interviews were audio-recorded, transcribed, and thematically analyzed to identify relevant themes.

RESULTS

The working experience of university administrators and mental health providers was between eight months to 20 years, while student leaders had studied at the university for over four years. We identified five broad themes: (1) Burden of medical school: A curriculum of trauma, (2) Negative coping mechanisms and the problem of blame, (3) The promise of services: Mixed Messages, (4) A broken mental health system for students, and (5) Barriers to mental health services.

CONCLUSION

Distinguishing between psychological distress that is anticipated because of the subject matter in learning medicine and identifying those students that are suffering from untreated psychiatric disorders is an important conceptual task for universities. This can be done through offering education about mental health and well-being for administrators, giving arm's length support for students, and a proactive, not reactive, approach to mental health. There is also a need to redesign the medical curriculum to change the medical education culture through pedagogical considerations of how trauma informs the learning and the mental health of students.

The Consequences of the Pandemic on Medical Students’ Depressive Symptoms and Perceived Stress: A Repeated Cross-Sectional Survey with a Nested Longitudinal Subsample

This study aimed to explore the impact of the pandemic on medical students’ mental health in Italy using a repeated cross-sectional survey with a nested longitudinal subsample (first timepoint: 2018; second: 2020/2021). Three research questions (RQs) were investigated. Study 1 (longitudinal sub-sample) explored whether medical students had higher levels of depressive symptoms and stress during the pandemic compared with a pre-pandemic period (RQ1) and what variables were associated with these conditions during the pandemic adjusting for baseline levels (RQ2). Study 2 (repeated cross-sectional data) aimed to examine whether medical students had higher levels of these conditions during the pandemic compared with their same-year peers during a pre-pandemic period (RQ3). In Study 1, higher levels of depressive symptoms and stress were shown during the pandemic (RQ1). Multivariable models highlighted associations between poor mental health and worsening of the judgment of medical school choice, worsened psychological condition due to the pandemic, economic repercussions due to the pandemic, and baseline levels of symptoms (RQ2). In Study 2, our findings reported higher levels of depressive symptoms and stress during the pandemic, also adjusting for other variables (RQ3). In conclusion, depressive symptoms and stress were greater during the pandemic. The most relevant variables were pandemic-related items and medical school choice judgment.

Cross-Sectional Analysis of Mental Health among University Students: Do Sex and Academic Level Matter?

University students' mental health and well-being is a growing public health concern. There is a lack of studies assessing a broad range of mental health domains by sex and academic level of study. This cross-sectional online survey of BSc, MSc, and PhD students (n = 3353, 67% female) enrolled at one university in Germany assessed a wide scope of mental health domains, covering positive (i.e., self-rated health, self-esteem, student engagement) and negative aspects (i.e., perceived stress, irritation, and screening positive for depression, anxiety, comorbidity, and psychological distress). We evaluated differences in mental health by sex and academic level. Overall, although self-rated health did not differ by sex and academic level, females and lower academic level were associated with less favorable mental health. Males reported higher prevalence of high self-esteem, and higher engagement (all p ≤ 0.04). Conversely, mean perceived stress and cognitive/emotional irritation were higher among females, as were rates for positive screenings for anxiety, anxiety and depression comorbidity, and psychological distress (p < 0.001 for all). Likewise, lower academic level (BSc) was associated with lower rates of high self-esteem (p ≤ 0.001), increased perceived stress (p < 0.001), and higher prevalence of positive screening for depression, anxiety, comorbidity, and psychological distress (p ≤ 0.002 for all), while higher academic level (PhD) was linked to increased student engagement (p < 0.001 for all). Although the effect sizes of sex and academic level on student mental health were modest, these findings support a need for action to establish and expand early detection and prevention programs, on-campus advisory services, and peer counseling that focus on the sex-specific and academic-study-level-specific factors, as well as mental health and career development resources for students. Academics and policy makers need to consider multipronged intervention strategies to boost confidence of students and their academic career.

Prevalence and Correlates of Likely Major Depressive Disorder among Medical Students in Alberta, Canada

BACKGROUND

Medical students are exposed to multiple factors during their academic and clinical studies that contribute to depression.

AIMS

This study aims to examine the prevalence and correlates of likely major depressive disorder (MDD) among medical students.

METHODS

This study utilized a descriptive cross-sectional design. Data were collected through a self-administered online survey, which included questions on sociodemographic characteristics and likely MDD using the PHQ-9. Data were analyzed using a descriptive, Chi-square test and logistic regression model.

RESULTS

There were 246 medical students who participated in the survey. The majority were females, 155 (65.1%); Caucasian, 158 (66.4%); and in a relationship, 168 (70.5%). The prevalence of likely MDD was 29.1%. Respondents who did not feel supported and respondents who were neutral about their social support, friends, and family, were 11 and 4 times more likely to experience MDD than those who felt well supported (OR = 11.14; 95% CI: 1.14-108.80) and (OR = 4.65; 95% CI: 1.10-19.56), respectively.

CONCLUSIONS

This study suggests a high prevalence of likely MDD among medical students who do not feel they have sufficient social support from friends and family. Social adjustments, including talking to friends and family and participating in leisure activities, could reduce the level of depression among medical students.

Screening of substance use and mental health problems among Spanish medical students: A multicenter study

BACKGROUND

This study aimed to determine the prevalence of substance consumption and mental health problems among Spanish medical students, and their association with sociodemographic factors.

METHODS

A multicentre cross-sectional study was conducted. Self-reported data on sociodemographic and clinical characteristics were collected, including BDI-II, PHQ-9, brief STAI, and single-item academic burnout (IUBA).

RESULTS

Overall, 1265 students (74.2% female) completed the survey. Of them, 37.4% scored positive for depressive symptoms, as measured by the BDI-II, and more than half (53%) by the PHQ-9. Suicidal ideation was reported by about 12% whilst high levels of state and trait anxiety were informed by 28.8% and 29.4% of the students. The prevalence of burnout was 40.2%. Female and pre-clinical students reported significantly (p < 0.01) higher rates of depressive, anxiety, and burnout symptoms. Alcohol, energy drinks, and tobacco were the most frequently used substances. Total scores of self-reported mental health problems negatively correlated (p < 0.001) with objective academic results and positively correlated (p < 0.02) with the number of substances consumed in the last 30 days.

LIMITATIONS

Research-based on self-reported data could favour information bias due to the social desirability effect and memory error.

CONCLUSIONS

A high prevalence of substance consumption and several mental health problems was found among medical students, especially females. The relevant influence of academic-related factors on students' well-being may be a call for medical schools to implement initiatives aimed to improve students' ability to detect, address, and seek help for their mental health issues.

Attachment anxiety and depressive symptoms in undergraduate medical students : The mediating role of emotion regulation strategies

INTRODUCTION

Several studies report that medical students are at high risk of depression. Despite the variability in students' vulnerability to depression, the role of individual differences in depression risk among medical students has hardly been investigated. Studies outside of medical student populations have shown that individual differences in attachment style and emotion regulation participate in vulnerability to depression.

OBJECTIVES

This study investigates to what extent medical students' depressive symptoms are related to differences in students' insecure attachment styles and their perception of reduced access to emotion regulation strategies.

METHODS

In a cross-sectional quantitative study, undergraduate medical students at the beginning of their second academic year completed online questionnaires measuring their attachment style, difficulties in emotion regulation, and depressive symptoms.

RESULTS

Out of the 390 medical students invited, 267 participated in the survey. Higher secure attachment was associated with fewer depressive symptoms. Medical students' insecure attachment style and emotion dysregulation were significantly related to depressive symptoms. Difficulties in employing strategies to disengage from one's own negative affect partly mediated the effects of two dimensions of insecure anxious attachment-need for approval and preoccupation with relationships-on depressive symptoms.

DISCUSSION

Anxious attachment style and limited access to emotion regulation strategies participate in medical students' depressive symptoms. These findings highlight the need for acknowledging medical students' attachment style and students' perceived access to emotion regulation strategies for the early identification of and intervention programs for the risk of depression.

Behavioral and psychosocial predictors of depression in Bangladeshi medical students: a cross-sectional study

BACKGROUND

Depression, stress, and anxiety were found in a large number of medical undergraduate students, indicating a neglected aspect of their psychology that required immediate attention. The goal of this study was to find out the prevalence of depression among medical students, as well as potential psychosocial and behavioral predictors for depression.

METHODS

This cross-sectional study was conducted from July to November 2021 among 840 randomly selected medical students from four medical colleges using stratified random sampling. Data were collected using a semi-structured, self-administered questionnaire and were analyzed through the SPSS v.23 software. Multiple regression was performed to assess the effect of several behavioral and psychosocial factors on depression.

RESULTS

Among the 840 study participants, 55.7% (n= 468) were female and 44.3% (n= 372) were male. According to the data, the prevalence of depression, anxiety, perceived stress among medical students was found to be 28.8%, 65% and 85% respectively. A strong link was found between depression and anxiety, stress, poor sleep quality, poor academic performance, and a negative social and romantic relationship status.

CONCLUSIONS

A significant number of medical students are depressed. In order to prevent and treat depression, medical students should be screened for depression and its associated factors.

Impact of Providing Peer Support on Medical Students’ Empathy, Self-Efficacy, and Mental Health Stigma

Background: Peer-support programs in medical school can buffer feelings of inadequacy, anxiety, social isolation, and burnout, drawing upon the benefits of near-peer-support resources. This study examined the effects of providing support to students in a medical school peer-support program. Methods: Using a pre-post, quasi-experimental study design, the investigators surveyed medical students who were peer supporters in their second through fourth years of medical school with four measures assessing (1) empathy, (2) self-efficacy, (3) mental health stigma, and (4) likelihood to assist peers with mental health problems to examine if serving as a volunteer peer supporter had any effect. Participants included 38 medical students that were actively enrolled peer supporters during the 2020–2021 year at a United States allopathic medical school. Results: Medical students who participated as peer supporters were found to have higher ratings of empathy scores (Z = −1.964, p = 0.050, r = 0.34) and self-efficacy scores (Z = −2.060, p = 0.039, r = 0.35) after participation in the program. No significant changes were noted for mental health stigma or likelihood to assist peers with mental health problems. Discussion: Peer-support programs present a low-cost, sustainable modality to promote wellbeing in medical students. There is a growing body of literature documenting the benefits of peer-support services. This brief, novel study examined the effects of providing peer support on the peer supporters and found higher self-reported ratings of empathy and self-efficacy after participation. These findings underscore peer-support programs as a valuable wellness resource not only for medical students who use the services but for those who provide them as well.

Telemedicine in the Management of Patients with Rheumatic Disease during COVID-19 Pandemic: Incidence of Psychiatric Disorders and Fibromyalgia in Patients with Rheumatoid Arthritis and Psoriatic Arthritis

The management of patients with immuno-rheumatological diseases has profoundly changed during the COVID-19 pandemic and telemedicine has played an important role in the disease follow-up. In addition to monitoring disease activity and any adverse events, especially infectious events, assessing the psychological situation of the patient can be fundamental. Furthermore, COVID-19 has a serious impact on mental health and, since the beginning of the pandemic, a significantly higher incidence of anxiety disorders and depressive symptoms especially in younger people was observed. In this study, we evaluated the incidence of depressive disorders, anxiety, and fibromyalgia (FM) in our patients with rheumatoid arthritis and psoriatic arthritis during the lockdown period due to the COVID-19 pandemic and we validate the use of telemedicine in the clinical management of these patients. Mental and physical stress during the COVID-19 pandemic can greatly worsen FM symptoms and intensify patients’ suffering without a clinical flare of the inflammatory disease for patients affected by rheumatoid arthritis. Telemedicine has allowed us to identify patients who needed a face-to-face approach for therapeutic reevaluation even if not related to a flare of the inflammatory disease. Even if our data does not allow us to draw definitive conclusions regarding the effectiveness of telemedicine as greater than or equal to the standard face-to-face approach, we continue to work by modifying our approach to try to ensure the necessary care in compliance with safety and, optimistically, this tool will become an important part of rheumatic disease management.

Correlation between Positive Orientation and Control of Anger, Anxiety and Depression in Nursing Students in Poland, Spain and Slovakia during the COVID-19 Pandemic

(1) This study analysed the relationship between positive orientation and subjective control of anger, anxiety and depression in nursing students in Poland, Spain and Slovakia during the pandemic. (2) The survey was carried out by the diagnostic survey method in a group of 756 nursing students in Poland, Spain and Slovakia. The empirical data were gathered using an original survey questionnaire, the Positive Orientation Scale and the Courtauld Emotional Control Scale. (3) It was shown that the positive orientation level in Polish students was significantly lower than in students in Spain (p < 0.0001) and Slovakia (p < 0.0001). Low results for positive orientation were obtained in nearly half (47.18%) of the respondents in the Polish sample, whereas it was 34.18% and 31.18% in the Spanish and Slovak samples, respectively (p < 0.0001). A positive orientation was the most important predictor of emotional control among the nursing students at all the sites (p < 0.0001). (4) Positive orientation has been shown to have a significant impact on emotional control in nursing students during the pandemic. Therefore, it is important to carefully monitor students' mental health during the pandemic to determine the demand for psychological and emotional support.

Gender Disparities in Symptoms of Depression After Medical School Exams and Student Coping Strategies for Postexam Depression Symptoms

CONTEXT

Little research exists to determine if medical students experience symptoms of depression after examinations and if symptoms vary by gender.

OBJECTIVES

Determine if is there a difference between male and female medical students in the number of symptoms of major depressive disorder (MDD) experienced after exams, as well as which coping strategies are used by students to alleviate depression symptoms.

METHODS

An anonymous and secure survey was sent via university email to first, second, and third-year medical students after exams for 2 consecutive exam periods. Surveys that were not fully completed were excluded from the analysis.

RESULTS

A total of 162 out of 550 students completed the survey for a response rate of 30%. Overall, a greater proportion of female students experienced more symptoms of depression compared to males. This was statistically significant for the Diagnostic and Statistical Manual of Mental Disorders 5th Edition symptoms of MDD: depressed mood, anhedonia, changes in sleep, fatigue, and difficulty with concentration after exams compared to their male counterparts. Male first-year medical students experienced higher rates of depression compared to their third-year counterparts. Most students exhibited coping strategies that helped them feel less depressed. The 3 most common coping strategies reported were: reaching out to social support networks, physical activity/exercise, and engaging in hobbies.

CONCLUSIONS

Both gender and year in a medical school play a role in the number of symptoms of depression experienced after medical school exams. Recognizing that examinations can be a trigger of depressive symptoms in medical students, particularly female and first-year students, has important implications on student mental health. Helping students recognize these symptoms and employ healthy coping strategies may further help alleviate these symptoms. Long-term consequences of experiencing symptoms of depression after recurrent exams in medical school are unknown and require further research.

Depression, anxiety, burnout and empathy among Spanish medical students

Medical Education studies suggest that medical students experience mental distress in a proportion higher than in the rest of the population In the present study, we aimed to conduct a nationwide analysis of the prevalence of mental health problems among medical students. The study was carried out in 2020 in all 43 medical schools in Spain, and analyzes the prevalence of depression, anxiety, empathy and burnout among medical students (n = 5216). To measure these variables we used the Beck Depression Inventory Test for assessing depression, the Maslach Burnout Inventory Survey for Students was used for burnout, the State-Trait Anxiety Inventory (STAI) was used to assess anxiety state and trait and the Jefferson Empathy Scale 12 to obtain empathy scores. In relation to depression, the data indicate an overall prevalence of 41%, with 23.4% of participants having moderate to severe levels, and 10% experiencing suicidal ideation. Burnout prevalence was 37%, significantly higher among 6th year than among 1st year students. Anxiety levels were consistent with those reported previously among medical students (25%), and were higher than in the general population for both trait and state anxiety. The prevalence of trait anxiety was higher among women. Empathy scores were at the top end of the scale, with the highest-scoring group (>130) containing a greater percentage of women. Similarly to those published previously for other countries, these results provide a clear picture of the mental disorders affecting Spanish medical students. Medicine is an extremely demanding degree and it is important that universities and medical schools view this study as an opportunity to ensure conditions that help minimize mental health problems among their students. Some of the factors underlying these problems can be prevented by, among other things, creating an environment in which mental health is openly discussed and guidance is provided. Other factors need to be treated medically, and medical schools and universities should therefore provide support to students in need through the medical services available within their institutions.

Prevalence and Predictors for Depression among Medical Students during Coronavirus Disease-19 Pandemic: A Cross-sectional Study

BACKGROUND: Since the declaration of the World Health Organization of the coronavirus (SARS-COV-2) as a pandemic, several countries have locked down and quarantined their residents with restrictive procedures to control spread of the disease. Due to pandemic related stressors, concerns and worries have developed regarding negative psychological impact on the mental well-being of the general population, particularly those known to have higher levels of psychological impairment with high vulnerability to mental health diseases such as medical students. AIM: The objectives of the study were to assess the prevalence of self-reported depression and to explore its predictors during the period of Coronavirus Disease 2019 first lock down among medical students. METHODS: This was a cross-sectional study design. The study was conducted at Kasr Alainy Medical School, Faculty of Medicine, Cairo University, Egypt, in June 2020. A simple random sample was picked of one subgroup of 4th year medical students (No. = 300) at faculty of medicine during the academic year 2019–2020. Self-administered questionnaires including Beck’s Depression Inventory scoring were distributed using Google form through communication social media such as WhatsApp. RESULTS: Out of the 300 participants, 238 responses were received with response rate 79.3%. Results indicated that 38.2% of the respondents were experiencing depression with different degrees with Beck’s Depression Inventory mean scores was 19.4 ± 11.6. Multiple logistic regression analysis point out that gender (odds ratio [OR] = 2.4 and p = 0.022) and “Good” grade level of academic performance (OR = 7.2 and p = 0.045) are significant predictors for developing depression among the participating medical students. CONCLUSION: A significantly high prevalence of depression is detected among medical students during the first wave of the SARS-COV-2 pandemic. The prevalence of depression is more among females than males and more with medical students achieving “Good” grade level.

How large is the burden of depression in a medical school? A cross-sectional study among medical students in Nigeria

Introduction

mental health of students deteriorate when they begin studies in a medical school. The study aimed to determine the prevalence of depression and associated factors among medical students in a university in Nigeria.

Methods

a cross-sectional study design was used. All matriculated medical students of Ebonyi State University Abakaliki, Nigeria were included in the study. Information was obtained using a self-administered structured questionnaire. Beck´s depression inventory was used to determine the prevalence of depression. Chi square test was used to ascertain association between variables. Level of statistical significance was determined by p value of <0.05.

Results

the mean age of the students was 23.2 ± 3.3 years and majority, 60.2% were males. Prevalence of depression was 17.4%. Third-year class (major examination class) had the highest proportion of students who were depressed, 24.2% while final year class had the least, 8.8%. Coping mechanisms for low moods included sleeping, 50.4% and having interactions with colleagues, 46.9%. Factors associated with depression included being <25 years, (p=0.008), being in the pre-clinical school, (p=0.023) and being afraid some students may not graduate from medical school (p=0.030).

Conclusion

burden of depression was high among the students and most pronounced among third year students. There is need for proper orientation of newly admitted medical students on the medical curriculum by authorities of the university. Efforts should be made to decrease undue anxiety among students especially during examination. Adequate measures should be put in place for early detection and prompt management of cases of depression among the students.

[Depression, stress and anxiety in students of human medicine in Ayacucho (Peru) in the context of the COVID-19 pandemic]

OBJECTIVE

To evaluate rates of anxiety, depression and stress, as well as associated factors and changes in habits, among students of human medicine from the Universidad Nacional San Cristóbal de Huamanga [San Cristóbal of Huamanga University] (UNSCH), located in Ayacucho (Peru), in the context of the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted through a virtual survey. The Depression Anxiety Stress Scale-21 (DASS-21) was used. To evaluate associated factors, prevalence ratios (PR) were estimated using Poisson regression with robust variance.

RESULTS

A total of 284 surveys were analysed (48.2% women; median age 22 years). Rates of (at least moderate) depression, anxiety and stress were 24.3%, 28.5% and 13.0%, respectively. Adjusted analyses found that having completed fewer years of study, being Catholic and having a chronic disease were associated with a higher rate of anxiety, while being of a younger age was associated with a higher rate of stress. The students reported mostly decreased physical activity, as well as increased Internet and social media use, hours of sleep, hours spent in front of a screen, food intake, and weight, during the COVID-19 pandemic.

CONCLUSIONS

In the context of the pandemic, despite the changes in habits described, rates of depression, anxiety and stress were lower than in previous studies in students in the health sciences. The higher rate of anxiety was associated with being in an earlier academic year, Catholicism and chronic diseases, while the higher rate of stress was associated with being of a younger age.

Association between spirituality/religiousness and quality of life among healthy adults: a systematic review

BACKGROUND

Health-related quality of life (HRQoL) is determined by multiple factors that include components such as spirituality and religiousness (S/R). Even though various systematic reviews have investigated the association between S/R and improved health outcomes in the most different groups, healthy young individuals are seldom addressed.

OBJECTIVE

To assess the association between S/R and HRQoL among young, healthy individuals.

METHODS

Systematic review of papers published in the last ten years and indexed in four academic research databases (PubMed, Web of Science, Cochrane Library, and Scopus) and two gray literature databases. Inclusion criteria were studies assessing S/R and HRQoL using validated instruments and assessing healthy adults (i.e., non-clinical patients, not belonging to any specific group of chronic diseases), aged between 18 and 64 years old.

RESULTS

Ten out of 1,952 studies met the inclusion criteria: nine cross-sectional and one longitudinal cohort study, in which 89% of the participants were college students. Nine studies report a positive association between S/R and HRQoL, while one study did not report any significant association. The main HRQoL domains associated with S/R were the psychological, social relationships, and environment domains, while the S/R most influent facets/components were optimism, inner strength, peace, high control, hope, and happiness.

CONCLUSIONS

Higher S/R levels among healthy adult individuals were associated with higher HRQoL levels, suggesting the S/R can be an important strategy to deal with adverse environmental situations even among those without chronic diseases, enhancing the wellbeing of individuals. Registration of systematic review: PROSPERO-CRD42018104047.

Global prevalence of depression and elevated depressive symptoms among adolescents: A systematic review and meta-analysis

OBJECTIVE

Adolescence is a formative and turbulent phase where physiological, psychosocial, and cognitive changes leave adolescents vulnerable to psychological disorders. Given the lack of reviews that consolidate and compare worldwide prevalence of depression among adolescents, this review aims to examine the global prevalence of major depressive disorders, dysthymia, and elevated depressive symptoms among adolescents.

METHODS

A systematic review and meta-analysis was conducted. Six databases were searched for studies published from 2001 to December 2020. Seventy-two studies were included. Subgroup analysis were performed for year of publication, geographical region, gender, and assessment tools used.

RESULTS

The global point prevalence rate of elevated self-reported depressive symptoms from 2001 to 2020 was 34% (95% CI: 0.30-0.38). Point prevalence for major depressive disorder (MDD) and dysthymia was 8% (95% CI: 0.02-0.13) and 4% (95% CI: 0.01-0.07), respectively. The pooled one-year prevalence and lifetime prevalence for MDD were 8% (95% CI: 0.05-0.12) and 19% (95% CI: 0.12-0.26). Point prevalence of elevated depressive symptoms among adolescents increased from 24% (95% CI: 0.19-0.28) between 2001 and 2010 to 37% (95% CI: 0.32-0.42) between 2011 and 2020. The Middle East, Africa, and Asia have the highest prevalence of elevated depressive symptoms, and female adolescents were reported to have a higher prevalence of elevated depressive symptoms than male adolescents.

CONCLUSION

Besides targeting those with existing clinical depression, research and policies should also focus on educational and supportive mitigation efforts to curb depressive symptoms among adolescents before escalation. The findings encourage future research to develop more gender-specific and culturally relevant intervention programmes.

PRACTITIONER POINTS

34% of adolescents globally, aged 10-19 years, are at risk of developing clinical depression, which exceeds the reported estimates of individuals aged 18 to 25 years. Practitioners are highly encouraged to prioritize depression screening and intervention implementation for individuals in this age group. Female adolescents and adolescents from Middle East, Africa, and Asia have the highest risk of developing depression. This urges practitioners and researchers to develop more gender-specific and culturally relevant intervention programmes.

Self-reported mental health symptoms, quality of life and coping strategies in French health sciences students during the early stage of the COVID-19 pandemic: An online survey

Introduction

Health sciences students usually report high rates of mental health problems. The COVID-19 pandemic context may have serious psychological impacts in this at-risk population. We aimed to assess the self-reported mental health status, health-related quality of life and coping strategies of health sciences students during the early stage of the pandemic.

Method

An online 128-item questionnaire sent to 17,673 health sciences students from the Claude Bernard University Lyon 1 in April 2020 assessed: a) sociodemographic characteristics, b) conditions of lockdown, c) depressive (Beck Depression Inventory- Short Form, BDI-SF), anxiety (State-Trait Anxiety Inventory-A, STAI-A) and traumatic symptoms (Impact of Event Scale -Revised, IES-R), d) health-related quality of life (SF12) and e) coping strategies (Brief Coping Orientation to Problems Experienced, Brief COPE).

Results

The participation rate was 9.9% (n = 1,765). A total of 19.5% of participants reported an IES-R > 33, 11.6% depressive symptoms, 58.1% anxiety symptoms, and 4.4% suicidal ideation. Their mental health-related quality of life was significantly poorer than for physical health. Female gender, COVID-like symptoms, social isolation due to the lockdown, pandemic-related financial restraint and exams-related stress were significantly associated with poorer self-reported mental health conditions. Volunteering in the healthcare system was significantly associated with lower mental health scores. Coping strategies were mostly oriented toward avoidance and positive appraisal.

Conclusion

French health sciences students exhibited high levels of self-reported mental health problems and a poor mental health-related quality of life during the early stage of the COVID-19 pandemic. Specific risk factors related to the pandemic partly explain the observed prevalence.

Predictors of academic performance during the covid-19 outbreak: impact of distance education on mental health, social cognition and memory abilities in an Italian university student sample

BACKGROUND

This study aimed to investigate the impact of distance education (DE) on mental health, social cognition, and memory abilities in a sample of university students during the national COVID-19 lockdown in Italy and to identify the predictors of academic performance.

METHODS

Two hundred and three students (76.4% women, mean age 24.3, SD ± 4.9) responded to an anonymous online cross-sectional survey between July 15 and September 30, 2020, on DE experience and cognitive and social-cognitive variables. A short version of the Beck Depression Inventory-II, ten images from the Eyes Task, and five memory vignette stimuli were included in the survey. Descriptive, one-way ANOVA, correlation, and logistic regression analyses were conducted.

RESULTS

Half of the student sample reported significant impairment in concentration and learning abilities during DE. Regarding psychological health, 19.7%, 27.1%, and 23.6% of the sample reported mild, moderate, and severe depressive symptoms, respectively. Correlation analyses showed a statistically significant negative association between depression and the overall subjective evaluation of DE (r =  - 0.359; p < 0.000). Changes in one's study context and habits, i.e., studying alone at one's parents' home instead of studying with colleagues or alone in a university "social place" (e.g., the university library), seemed to increase the likelihood of poor academic performance by almost 3 times (O.R. 3.918; p = 0.032). This predictor was no longer statistically significant in the subsequent step when the individual impairment predictors were entered. Learning concentration impairment during DE (O.R. 8.350; p = 0.014), anxiety about COVID-19 contagion for oneself or others (O.R. 3.363; p = 0.022), female gender (O.R. 3.141; p = 0.045), and depressive symptomatology (O.R. 1.093; p = 0.047) were ultimately determined to be the strongest predictors of poor academic performance, whereas the appreciation of DE represented a protective variable (O.R. 0.610; p < 0.000).

CONCLUSIONS

The study showed a negative impact of DE on the mental health of students presenting depressive symptoms and impairment in concentration and learning, the latter identified as the strongest predictors of poor academic performances. The study confirms the emerging need to monitor the impact of DE, which occurred during the 2019/2020 academic year and will continue in the coming months, to refine educational offerings and meet students' psychological needs by implementing psychological interventions based on the modifiable variables that seem to compromise students' psychological well-being and academic outcomes.

Intégration de la santé mentale dans les services de soins de santé primaires en République démocratique du Congo

OBJECTIVE

The study aims to document the experience of integrating a mental health care package into the general health care system of Lubero district in the Democratic Republic of Congo (DRC) between 2011 and 2015, and more specifically, the effects of this integration on the access to and use of health services offering mental health care.

METHOD

This is a retrospective study using a case study design. Data collected from different project documents and an analytic review of the official reports of the Ministry of Public Health were used for an analysis of the results of the integration.

RESULTS

The results indicate that 3,941&#160;patients with mental health problems used the care offered at the health centers and the district hospital between 2012 and 2015. In 2015, the average utilization rate of curative care in health centers for mental health problems was 7&#160;new cases/1,000&#160;inhabitants/year. The majority of these patients were treated on an outpatient basis, at primary health care level.

DISCUSSION

Our study shows that it is possible to integrate mental health into existing general health services in the DRC. Nevertheless, the major problems in terms of access and use of basic care in the Lubero district indicate that the success of such an integration depends on the quality of the health system in place and the involvement of a wide range of both health and non-health actors, including key people within communities.

Heart and Head: Profiles and Predictors of Self-Assessed Cognitive and Affective Empathy in a Sample of Medical and Health Professional Students

For medical and health professions, students learning to respond to others' distress with well-regulated empathy is an important developmental skill linked to positive health outcomes and professionalism. Our study aimed to investigate the sociodemographic, psychological, and psychosocial differences between medical (MS) and health professional (HPS) students and their empathic abilities, since both populations share common stressors, namely, dealing with suffering people. Additionally, we were interested in assessing the psychological and psychosocial predictors of empathy of MS compared to HPS. One hundred thirty MS and 86 HPS were administered the Patient Health Questionnaire-9, Interpersonal Reactivity Index, Integrative Hope Scale, and UCLA Loneliness Scale. The two groups showed differences in their contextual characteristics, with the HPS group having larger families, lower parents' education levels, and lower family income compared to the MS group. In both groups, ~15% of students reported previous contact for psychological problems. A higher proportion of HPS (23.3%) reported depressive symptoms than MS (10%), and female HPS reported more intense feelings of loneliness than other subgroups of students. No differences were found between the two groups in self-assessed cognitive and affective empathy. In both groups, women showed greater affective scores than men and, at the same time, seemed to be particularly prone to personal distress. The cognitive empathic dimension of “perspective taking” was predicted by young age (OR, 612; 95% CI, 1.395–15.242) and the overall socioeconomic status (OR, 3.175; 95% CI, 1.154–8.734) of the HPS. Self-assessed affective competence was predicted by female gender (OR, 3.112; 95% CI, 1.328–7.288), depressive symptomatology (OR, 2.777; 95% CI, 1.004–7.681), higher mother's level of education (OR, 2.764; 95% CI, 1.147–6.659), and feeling of hope related to social relationships (OR, 1.367; 95% CI, 1.152–1.622). Risk factors for poor self-assessed affective emphatic skills were previous contact for psychological problems (OR, 3.263; 95% CI, 1.238–8.601) and feelings of loneliness (OR, 1.18; 95% CI, 1.09–1.276). Our findings emphasize the need to test psychosocial models to better understand empathic skills.

[Chronic diseases among medical students in Morocco: What are the interactions with psychosocial stress?]

OBJECTIVES

To evaluate the prevalence and factors associated with Chronic psychiatric and somatic illness among medical students in Morocco.

METHODS

A multicentric cross-sectional study during a period of four weeks in February 2019 involving 605 students of 1st, 2nd and 3rd cycle of medical studies of the faculties of medicine in Morocco.

RESULTS

41.5% (251) of students confirmed having a chronic disease, among which 80% were under treatment. Psychiatric conditions represented the most frequent chronic illnesses among medical students (28%), followed by dermatological (16%), allergic and respiratory (12.2%), and gastroenterological (11%) conditions. Chronic illnesses among medical students were significantly associated with female gender (P: 0.0000000037), level of education (P: 0.0000), personal history of suicide attempts (P: 0.0000259), and a consumption of psychoactive substances (P: 0.0000029046).

CONCLUSION

Chronic illnesses are frequent, underestimated and undertreated among medical students in Morocco. The link with stress has been suggested as the value of establishing a program to train medical students in stress management.

The Association Between Social Support, COVID-19 Exposure, and Medical Students' Mental Health

Background: The coronavirus disease-2019 (COVID-19) pandemic has halted in-person medical education worldwide. Limited studies have reported on the mental health status of medical students during this public health emergency. This study aimed to explore the association of personal virus exposure, regional epidemic condition, and social support with medical students' depressive and anxiety symptoms during the COVID-19 outbreak in China. Methods: In February 2020, 5,982 medical students (60.0% females, Meanage = 21.7 years, Medianage = 22 years) completed an online survey consisting of demographics, personal virus exposure, the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, and the Social Support Rating Scale. Results: The prevalence rates of mild to severe depressive symptoms and anxiety symptoms were 35.2 and 22.8%, respectively. Multivariate linear regression showed that students with low- or medium-level social support had a higher risk of experiencing depressive or anxiety symptoms than those with high-level social support. COVID-19 exposure was positively associated with mild to severe depressive or anxiety symptoms. Respondents living in provinces with 500-1,000 confirmed COVID-19 cases had an increased risk of experiencing mild to severe depressive symptoms compared with those living in provinces with <100 cases. Other related factors were gender and years of training. Conclusions: Some medical students suffered from a poor psychological status during the COVID-19 outbreak. Low social support was a stronger factor related to poor mental status compared with COVID-19 exposure or the provincial epidemic condition. Thus, we suggest that colleges or universities provide social support and mental health screening.

A quantitative study of test anxiety and its influencing factors among medical and dental students

Objective

The study was conducted to assess test anxiety and its influencing factors on medical and dental students.

Methods

A cross-sectional study was conducted among students from three private and public medical and dental colleges in the Punjab province of Pakistan. The survey included statements about the demographic profile of the study participants and used the Test Anxiety Inventory (TAI) by Spielberger.

Results

The study included 680 students with a mean age of 20.93 ± 1.76 years. About half the sample (51.8%) scored high on test anxiety (TAI score > 45), and the mean TAI score was slightly higher for the dental (47.75 ± 11.45) than medical students (46.42 ± 12.79). Female students had a significantly higher mean TAI score (48.45 ± 12.79) than male students (41.85 ± 8.91; p < 0.001). The students from private colleges had a significantly greater test anxiety score (50.15 ± 13.23) than students from public colleges (42.88 ± 9.7; p < 0.001). Students whose parents were graduates from a college or university perceived significantly increased test anxiety than those of parents with no/school education (p < 0.001). A female gender (adjusted odds ratio (AOR) 2.10, 95% CI:1.37, 3.22), being a private college student (AOR 2.88, 95% CI:1.90, 4.38), and having a mother with a college or university education (AOR 2.05, 95% CI: 1.25, 3.35) were significantly associated with high on test anxiety.

Conclusion

In our study cohort, test anxiety was common among medical and dental students. A female gender, being a student from a private college, and having a mother with a high education were significantly associated with high test anxiety. The study findings may guide the development of programs that can reduce students’ test anxiety and potentially improve their education.

Global mapping of overviews of systematic reviews in healthcare published between 2000 and 2020: a bibliometric analysis

OBJECTIVE

To conduct a bibliometric analysis using a large sample of overviews of systematic reviews (OoSRs) and reveal research trends and areas of interest about these studies.

STUDY DESIGN AND SETTING

We searched MEDLINE, Scopus and Cochrane Database of Systematic Reviews from 1/1/2000 to 15/10/2020. We used Scopus meta-data and two authors recorded supplementary information independently. We summarized the data using frequencies with percentages.

RESULTS

A total of 1558 studies were considered eligible for analysis. We found that the publications have been increasing yearly and their nomenclature was not uniform (the most frequent label in the title was "overview of systematic reviews"). The largest number of papers and the most cited ones were published by corresponding authors from the UK. The publications were distributed across 737 scholarly journals and many of them were published in the field of complementary/alternative medicine, psychiatry/psychology, nutrition/dietetics, and pediatrics. The co-authorship analysis revealed collaborations among countries. The most common clinical conditions were depression, diabetes, cancer, dementia, pain, cardiovascular disease, stroke, obesity, and schizophrenia.

CONCLUSION

OoSRs have recently become a popular approach of evidence synthesis. International collaborations between overview authors from countries with increased research productivity and countries with less research activity should be encouraged.

Prevalence of Depressive Symptoms Among University Students in Pakistan: A Systematic Review and Meta-Analysis

Background: In Pakistan, almost 30% population is between 15 to 29 years of age, with university enrollment rates of 10-15%. Although there is a growing concern on mental health of university students across the globe, studies from low and middle income countries such as Pakistan are scarce. We conducted a systematic review and meta-analysis of prevalence of depressive symptoms among Pakistani university students. Methods: PubMed, Web of Science, PsycInfo and Google Scholar were searched between 15 to 30th January 2020. Cross-sectional and longitudinal studies, published till 31st December 2019 were included. Data on study characteristics and prevalence of depressive symptoms were extracted. Meta-analysis was conducted using random effects models. To estimate subgroup difference based on study characteristics, meta-regression and sub-group analyses were conducted. Results: In total, 26 studies involving 7,652 participants were included in review. Overall prevalence of depressive symptoms was 42.66% (95% CI: 34.82% to 50.89%), with significant heterogeneity among studies. Subgroup analyses revealed a significant difference in prevalence estimates based on depression screening instrument and study major. Statistically significant differences were observed among studies employing different psychometric scales (test for subgroup differences, Q = 21.92, p < 0.05) and between students from different study majors (test for subgroup differences, Q = 3.76, p = 0.05). Conclusion: Our study found that overall prevalence of depressive symptoms among university students in Pakistan was 42.66%, however, findings should be interpreted with caution. Large scale epidemiological surveys using valid and reliable tools are needed to better estimate prevalence of depression among Pakistani university 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.

Prevalence and factors associated to depression and suicidal behavior among medical students

ABSTRACT Objective: Depression and suicidal behavior have been described as major problems among medical students. The aim of this study was to assess the prevalence of depression and suicidal behavior among medical students of an institution and to investigate possible associated variables. Methods: The authors carried out a cross-sectional study through a self-administered questionnaire, including the Beck Depression Inventory (BDI) and the Beck’s Suicide Intent Scale (BSIS) instruments. The diagnosis of depression was based on an instrument adapted according to the DSM-IV and ICD-10 criteria. Logistic regression was performed to search for depression predictor variables. Results: In a total of 381 students, the prevalence of depression was 27.6%. Suicidal ideation of moderate to severe intensity was observed in 10.5% of the sample. About 6% of students had previously attempted suicide. Consumption of licit and illicit drugs was frequent among the participants, reaching 78% and 24% of the sample, respectively. The demand for specialized treatment was lower than expected among students with depression. Logistic regression revealed that female gender, reduced interpersonal contact with friends, reduced physical activity, difficulty in facing new situations and high perception of personal pressure were risk factors for depression. Conclusion: The prevalence of depression and suicidal behavior among medical students is higher than in the general population. There is a need for further studies to enable a better understanding of the risk factors and variables at play, which is fundamental for the development of early intervention strategies and support for students.

Depression, Suicidal Ideation and Perceived Stress in Italian Humanities Students: A Cross-Sectional Study

Mental health issues are common among university students. Nevertheless, few studies focused on Italian students. This study aimed to assess prevalence and associated factors of perceived stress (PS), depressive symptoms (DS) and suicidal ideation (SI) in an Italian sample. A cross-sectional study was conducted amongst a convenience sample of students in humanities field (2018). Questionnaires were self-administered. Outcomes were assessed through Beck Depression Inventory-II (DS, SI) and Perceived Stress Scale (PS). Multivariable regressions were performed (p-value < 0.05 significant; sample size = 203). DS and SI prevalence was 30.6% and 8.8%. PS median score was 20 (IQR = 11), 87.7% reported moderate/severe PS. DS likelihood was increased by psychiatric disorders family history and not attending first year of course and decreased by not thinking that university hinders personal activities. Chronic disease and higher stress score increased SI probability; good/excellent family cohesion reduced it. Being female, thinking that university hinders resting/relaxing, seeing a psychologist/psychiatrist were positively associated with PS; having no worries about future was negatively associated. A high prevalence of mental health issues was reported, with miscellaneous associated factors that were linked to both private and social aspects. Universities must be aware of this to provide efficient preventive measures.