Stress among Portuguese Medical Students: A National Cross-Sectional Study

Global self-esteem and coping with stress by Polish students during the COVID-19 pandemic

Objectives

Students experience considerable stress and anxiety during the course of their studies, which has a significant impact on their health and hinders the learning process. There are many stressors that can intensify stress, which is why choosing the right strategies for coping with stress and self-esteem is so important.

Methods

The study was conducted on 798 students of the School of Public Health at the University of Warmia and Mazury in majors: nursing, midwifery, emergency medicine and dietetics (subgroup 1; n = 428; 53.77%) and at the Faculty of Veterinary Medicine, major: veterinary medicine (subgroup 2; n = 368; 46.23%). The study employed the diagnostic survey method using a questionnaire technique including Rosenberg's Self-Esteem Scale, MINI-COPE, PSS-10, and a self-questionnaire.

Results

The scores obtained by over half of the students were indicative of low global self-esteem, whereas over 80% of the students felt stress at a high intensity. Moreover, it was shown that the veterinary medicine students demonstrated a higher intensity of coping strategies, i.e., active coping (p < 0.04) and planning (p < 0.02), than medicine students.

Conclusion

The study revealed that students, irrespective of the major, experienced high levels of stress. Self-esteem had a significant impact on the stress level and methods of coping with difficult situations in students of medicine. A majority of the students applied positive styles of coping with stress.

Association between Quality of Life, Confinement, and Sex in Adults: A Multigroup Structural Equation Analysis

The state of confinement during the COVID-19 pandemic affected the quality of life of the general population. This study aims to define and contrast an explanatory model of the quality of life in adults and to analyze the relationships between these variables based on the state of confinement and sex. A total of 872 people from Chile aged between 17 and 50 (M = 21.70 years; SD= 3.272), of both sexes (60.90% male and 39.1% female) participated in this research, of whom 46.6% were not confined when tested and 53.4% were confined, analyzing the quality of life. A model of multi-group structural equations was performed, which adjusted very well (χ2 = 559.577; DF = 38; p < 0.001; IFC = 0.934; NFI = 0.916; IFI = 0.934; RMSEA = 0.061). The results show a positive and direct relationship among all the variables studied and the structural equation model proposed according to confinement and sex reveals a good fit in all the evaluation indexes. Stress and sleep, personality, and introspection were the indicators with the greatest influence in the four models, followed by the family and friends indicator with a medium correlation strength, such as the health monitoring dimension, although this was not as influential in confined individuals. The main conclusions are that the best adjustments are obtained in confined adults and females, and the data show that the psychological indicators obtained (stress and sleep, personality, and introspection) have the greatest influence on adults in the four models proposed with regard to their quality of life.

Prevalence of anxiety depression and stress among first year medical students in Tamilnadu

The present study was to evaluate the examination stress of the first year MBBS students, prior to their university exam by assessing the mood parameters and cortisol level. A cross sectional study was conducted in 150 students of Indira Medical College, Thiruvallur from January to February 2022. The assessment methods implemented were Self-administered, pre-designed questionnaire of DASS 10 scale scoring 0-40, and salivary cortisol by using quantitative ELISA on relaxed (before exam) and stressed (on day of exam) students with prior consent. Respondent data were analysed using the independent t-test and Odds ratio logistic regression analysis was done for strength of association by using (SPSS) version 26.0 and the level of significance *p≤0.05. The prevalence of stress (43%), anxiety (35%), depression (22%) and level of cortisol (2.61±0.41 and 5.14±0.35) between relaxed and stressed respectively were significantly increased due to examination stress despite any significant change in academic performance. Odds ratio of stress (95% CI 2.153), anxiety (3.038), depression (2.513) and salivary cortisol (2.872) were significantly high in stressed. Female students were found to be more susceptible to stress than male students due to examination (p≤0.001**). This study suggests that the medical education and examination are unavoidable stressor in first year students. This could be prevented by providing stress reduction interventions and orientation programmes which could improve student mental well-being and reduce the psychological distress.

Sleep and Lifestyle Habits of Medical and Non-Medical Students during the COVID-19 Lockdown

It has been shown that the measures of social distancing and lockdown might have had negative effects on the physical and mental health of the population. We aim to investigate the sleep and lifestyle habits as well as the mood of Croatian medical (MS) and non-medical students (NMS) during the COVID-19 lockdown. The cross-sectional study included 1163 students (21.6% male), whose lifestyle and sleep habits and mood before and during the lockdown were assessed with an online questionnaire. The shift towards later bedtimes was more pronounced among NMS (~65 min) compared to MS (~38 min), while the shift toward later wake-up times was similar in both MS (~111 min) and NMS (~112 min). All students reported more frequent difficulty in falling asleep, night-time awakenings and insomnia (p < 0.001) during lockdown. A higher proportion of MS reported being less tired and less anxious during lockdown compared to pre-lockdown (p < 0.001). Both student groups experienced unpleasant moods and were less content during lockdown compared to the pre-lockdown period (p < 0.001). Our results emphasize the need for the promotion of healthy habits in the youth population. However, the co-appearance of prolonged and delayed sleep times along with decreased tiredness and anxiety among MS during lockdown reveals their significant workload during pre-lockdown and that even subtle changes in their day schedule might contribute to the well-being of MS.

Competency-based medical education (CBME) curriculum and its effect on prevalence of anxiety, depression and stress amongst medical undergraduates

BACKGROUND

A growing body of literature now identifies higher levels of anxiety, depression, and stress among medical students as a distinct mental health domain. The competency-based medical education (CBME) curriculum was introduced to revamp the existing curriculum with an aim to garner constructive impact on the mental health of undergraduate medical students. As such, we sought to draw comparisons between the mental health of medical students, studying the old (2018 batch) and the new (2019 batch) medical education systems in India.

MATERIALS AND METHODS

We designed a survey that contained structured questions pertained to anxiety (HAM-A, GAD-7), depression (HAM-D, BDI), and stress (PSS) amongst medical undergraduate students of 2018 and 2019 batches at the Government Doon Medical College (GDMC), Dehradun, India.

RESULTS

Contrasting the 2018 and 2019 batches, the introduction of CBME resulted in a significant two-fold decrease in moderate anxiety, as exhibited by both HAM-A (6.0 vs 3.0, P = 0.016) and GAD-7 (3.5 vs 1.0, P = 0.037) scales, although no significant change in mild and severe anxiety, and overall depression (BDI: P = 0.05, HAM-D: P = 0.05) or stress (PSS: P = 0.86) was found.

CONCLUSION

The CBME system has made a significant impact on the mental health of undergraduate medical students for anxiety, albeit its effect on depression and stress remains equivocal. Future studies are warranted to compare the effect of CBME in other undergraduate and postgraduate courses across the country to help predict the psychological impact of the newfangled CBME education system.

The Appraisal of Self-Care Agency Scale-Revised (ASAS-R): Reliability and Validity among Portuguese Medical Students

Self-care agency plays an important role in an individual's health. Considering the particularities of their education, it can be a protective factor for the mental health of medical students. This study aims to validate the Portuguese version of the Appraisal of Self-care Agency Scale-Revised (ASAS-R) in Portuguese medical students. A cross-sectional, quantitative, and analytical online study was conducted between 23 April 2021, and 15 July 2021. Exploratory factor analysis (EFA) was performed to test the internal structure of the ASAS-R. Correlations with the SHS (Subjective Happiness Scale), SWLS (Satisfaction with Life Scale), and MHI (Mental Health Inventory) were calculated using Pearson's coefficient so as to test convergent validity. Internal consistency was evaluated using inter-item correlation, corrected item-total correlation, and Cronbach's alpha. The total sample included 781 individuals. EFA yielded a 3-factor solution accounting for 53.9% of the explained variance. Pearson's coefficients obtained between the 3 factors of ASAS-R and the total scores of the 3 construct-related scales demonstrated adequate convergent validity. Total Cronbach's alpha value was 0.85, while the Cronbach's alpha of the three factors was 0.81, 0.55, and 0.83, respectively. This study demonstrated that ASAS-R is a valid and reliable instrument for measuring self-care agency among Portuguese medical students.

Stress among Medical Students Presented with an EEG at Suranaree University of Technology, Thailand

Purpose

A high level of stress among medical students is perceived as stress caused by strenuous medical programs and medical school is an extremely stressful environment, to begin with. For this reason, identifying stressors facing medical students is expected to enhance medical school lecturers’ understanding, leading to a provision of assistance for adequate supervision. The purposes of this study were to investigate stress levels in daily life and the electroencephalogram (EEG) characteristics during daily life and pre-examination period of 2nd-year medical students at Suranaree University of Technology (SUT), Thailand, and to compare the EEG characteristics between these two periods.

Methods

Medical Student Stressor Questionnaire (MSSQ) was used as a research instrument to collect data from sixty medical students. After that, EEG was administered in two periods for these studies (in daily life (baseline) and pre-examination 1 week). Paired t-test was used for analyzing the difference in the EEG characteristics in the 2 periods.

Results

The results indicated that the stress levels among medical students were mild (3.33%), moderate (53.33%), and high (43.33%). Academic Related Stressor (ARS) was found to be the main cause of stress among the subjects. All had a beta wave in 2 periods.

Conclusion

In conclusion, stress among medical students can alter brain function as measured by EEG. The findings could assist medical schools in better understanding medical students’ stress levels and planning how to teach in order to improve student achievement.

Association Between Socio-Affective Symptoms and Glutathione and CD4 and CD8 Lymphocytes in College Students

Background: The prevalence of anxiety and depression in young students is associated with biosocial factors and scholastic stress. However, few studies have evaluated emotional-affective symptoms that are related to the immune system and antioxidant parameters in young individuals without diagnoses of affective disorders. Aim: This study aims to assess the relationship between emotional-affective symptoms and glutathione concentrations and CD4 and CD8 lymphocyte counts in college students. Methods: College students (n = 177) completed standardized psychometric instruments, including the Perceived Stress Scale, Hamilton Anxiety Scale, Beck Depression Inventory, Familiar Social and Friends Support Scale, and Rosenberg Scale. Blood samples were biochemically analyzed. Analyses of variance were conducted between four groups according to symptom severity. Results: A considerable prevalence of stress, anxiety, and depression symptoms was observed and negatively correlated with self-esteem and socio-familiar support. Perceived stress was sexually dimorphic. Although biochemical parameters were within reference ranges, glutathione, CD4, and CD8 tended to be lower in participants with anxiety and depression symptoms, which may be of predictive value. Conclusion: The relationship between antioxidant/immune parameters and socio-affective scores is latent in undiagnosed college students who might develop affective disorders. The findings suggest that during the initial development of affective disorders, stress management strategies should be implemented to help college students cope with the academic load and monitor negative changes in their physiological state.

Cardiovascular disease risk factors among undergraduate medical students in a tertiary care centre of eastern India: a pilot study

BACKGROUND

Handful studies report the prevalence of cardiovascular disease (CVD) risk factors among medical students from India and none from the eastern part of the country.

AIM

To estimate the prevalence of risk factors of CVD and their correlation with CVD risk ratio among the MBBS students from eastern India.

METHODS

433 students were studied. International Physical Activity Questionnaire-long form was used for assessment of physical activity and Perceived Stress Scale (PSS) to elicit psychological stress levels. Waist-to-height ratio (WHtR) was calculated. Total cholesterol to high-density lipoprotein ratio was calculated as the CVD risk ratio.

RESULTS

39.3% were women and 68.6% of the subjects were in junior classes. 22.4% subjects had high PSS while 30% performed low physical activity. Tobacco and alcohol intake was prevalent in 29.3% and 21.0% respectively. High CVD risk ratio was found in 14.3%. Most risk factors were more prevalent among juniors except diabetes. Among the non-overweight and non-obese subjects there was a significant positive correlation between WHtR and CVD risk score (R = 0.33, p < 0.001). 82.7% of the variance in CVD risk ratio could be explained by WHtR, Body mass index, Triglycerides and Low-density lipoprotein (F(7, 425) = 296.085), of which LDL (β = 0.755) contributed the most.

CONCLUSIONS

High prevalence of different modifiable CVD risk factors revealed among the subjects in this study is concerning. WHtR appears promising as an independent early predictor of CVD risk in Indian population. A dedicated CVD risk assessment tool for the young population is necessary.

Association between perceived stress and depression among medical students during the outbreak of COVID-19: The mediating role of insomnia

BACKGROUND

The purpose of this study was to explore the association between perceived stress and depression among medical students and the mediating role of insomnia in this relationship during the COVID-19 pandemic in China.

METHODS

A cross-sectional survey was conducted from March to April 2020 in medical university. Levels of perceived stress, insomnia and depression were measured using Perceived Stress Scale (PSS), Insomnia Severity Index (ISI) and Patient Health Questionnaire 9 (PHQ-9). The descriptive analyses of the demographic characteristics and correlation analyses of the three variables were calculated. The significance of the mediation effect was obtained using a bootstrap approach with SPSS PROCESS macro.

RESULTS

The mean age of medical students was 21.46 years (SD=2.50). Of these medical students, 10,185 (34.3%) were male and 19,478 (65.7%) were female. Perceived stress was significantly associated with depression (β=0.513, P < 0.001). Insomnia mediated the association between perceived stress and depression (β=0.513, P < 0.001). The results of the non-parametric bootstrapping method confirmed the significance of the indirect effect of perceived stress through insomnia (95% bootstrap CI =0.137, 0.149). The indirect effect of insomnia accounted for 44.13% of the total variance in depression.

CONCLUSIONS

These findings contribute to a better understanding of the interactive mechanisms underlying perceived stress and depression, and elucidating the mediating effects of insomnia on the association. This research provides a useful theoretical and methodological approach for prevention of depression in medical students. Findings from this study indicated that it may be effective to reduce depression among medical students by improving sleep quality and easing perceived stress.

Alcohol Consumption and Behavioral Consequences in Romanian Medical University Students

Alcohol consumption is a major public health problem facing universities. The objectives of the present study were to investigate alcohol consumption and the behaviors associated with it among Romanian university medical students, with particular reference to sex differences, behavioral consequences, and lifestyle patterns. We performed a cross-sectional study on 722 medical students (60.4% females; 39.6% males); the participants filled out a validated questionnaire containing the following items co-occurring with alcohol consumption: smoking, illicit drug use, energy drink consumption, and other behavioral drinking consequences. Physical activity was estimated using the IPAQ questionnaire. We statistically analyzed the interrelation between alcohol consumption and target factors. The present study showed a high percentage of at-risk drinkers among male (15.0%) and female medical students (14.9%) in the studied group. Male students reported higher illicit drug use and physical activity than female students, but the at-risk female drinkers' group consumed more drugs than the low-risk female drinkers. Both male and female drinkers engaged in other risky behaviors correlated with drinking (e.g., smoking, low academic performance, and driving a car after drinking). Public health policies, strategies, and interventions should be initiated to reduce alcohol consumption and associated behaviors in medical students.