Mental health of Turkish medical students during the COVID-19 pandemic

Global prevalence of anxiety and depression among medical students during the COVID-19 pandemic: a systematic review and meta-analysis

PURPOSE

As future physicians, medical students have experienced tremendous pressure during the ongoing COVID-19 pandemic, which is associated with a high risk of depression and anxiety. We aimed to investigate an overview of the prevalence of anxiety and depression among medical students in various countries during the global COVID-19 pandemic, and discuss associated stressors.

METHODS

We systematically searched CINAHL, EMBASE, MEDLINE, PubMed, and Web of Science for relevant articles from December 1, 2019 to March 15, 2023. We performed meta-analysis using a random-effects model with REML method to calculate the pooled prevalence of anxiety and depression. Begg's and Egger's tests were used to identify the potential risk of publication bias. Meta-regression was used to explore potential sources of heterogeneity.

RESULTS

We identified 130 studies reporting anxiety and depression among 132,068 medical students during the COVID-19 pandemic. Eight screening tools were identified for anxiety and six for depression. The pooled prevalence of mental health outcomes for anxiety and depression was 45% (95% confidence interval [CI], 40%-49%) and 48% (95% CI, 43%-52%), respectively. The pooled prevalence of mental health outcomes for moderate and severe anxiety and moderate and severe depression was 28% (95% CI, 24%-32%) and 30% (95% CI, 26%-35%), respectively. There was high heterogeneity between studies, with I2 ranging from 99.58%-99.66%. Continent and survey date were included in the meta-regression model. The results of meta-regression revealed that medical students in Asia had a lower prevalence of anxiety, and depression than those in other regions. The survey date (from February to June, 2020) showed a significantly positive correlation with the prevalence of anxiety and depression.

CONCLUSIONS

We demonstrated the global prevalence of anxiety and depression among medical students during the COVID-19 pandemic. The data highlight that medical students worldwide are at high risk of experiencing anxiety and depression. The reported stressors can be categorized into personal, academic, environmental and cultural, and pandemic factors. Schools and institutions should ensure optimal alternative learning environments for uninterrupted provision of medical education. The appropriate authorities should prioritize the provision of adequate protection for medical students and establish policies to promote new methods of training and education during a disaster, such as via distance learning.

Association between breakfast consumption, breakfast quality, mental health and quality of life in Turkish adolescents: A high school-based cross-sectional study

This study aimed to determine the frequency of breakfast consumption and breakfast quality among adolescents and to evaluate the relationships between breakfast consumption, breakfast quality, mental health, and health-related quality of life. This cross-sectional study included 449 students from 17 high schools between December 2022 and May 2023. A face-to-face questionnaire measuring the frequency of breakfast consumption, Mediterranean diet quality index (KIDMED), health-related quality of life (KIDSCREEN), and depression, anxiety and stress scales (DASS-21) was performed. Of the students, 54.1% skipped breakfast 2 or more times a week and 75.9% had poor breakfast quality. There were significant differences in breakfast quality classification according to the frequency of breakfast consumption (p = 0.003). Breakfast consumption ≤1 time/week or 2-5 times/week was associated with depression, anxiety and low adherence to the Mediterranean diet. No relationship was observed between breakfast quality and stress, depression or anxiety (p = 0.620, p = 0.586, p = 0.539, respectively) or between breakfast quality and the KIDSCREEN-27 subscales (p > 0.05). However, those eating poor-quality breakfasts had better results in physical wellbeing (p = 0.022), psychological wellbeing (p = 0.024), autonomy and parent relations (p = 0.017) than breakfast-skippers and also scored lower for depression, stress and anxiety (all p < 0.001). In conclusion, the frequency of breakfast consumption had a stronger association with reduced symptoms of stress, depression and anxiety, as well as improvements in all dimensions of health-related quality of life, compared to the quality of breakfast consumed. Given the association of breakfast consumption with mental health outcomes in adolescents, our findings are of great importance, especially to parents, clinicians and nutritional educators.

Depression, anxiety, and stress in medical students in Peru: a cross-sectional study

Objective

To determine the prevalence and factors associated with depressive, anxious, and stress symptoms in medical students in Peru, during the second pandemic wave of COVID-19.

Methods

We conducted an analytical cross-sectional study in 405 medical students from a university in northern Peru. The DASS-21 instrument was used to evaluate mental health outcomes (depression, anxiety, and stress), and to investigate their association with socio-educational characteristics.

Results

We found a prevalence of depressive, anxious, and stress symptoms of 71.6% (95% CI: 66.94-75.95), 71.9% (95% CI: 67.2-76.2), and 62.7% (95% CI: 57.8-67.4); respectively. Students with eating behavior disorders had a higher prevalence of depressive symptoms (PR: 1.35), anxious symptoms (PR: 1.27), and stress symptoms (PR: 1.31). The prevalence of depressive symptoms (PR: 1.57), anxious symptoms (PR: 1.27), and stress symptoms (PR: 1.24) increased in students who did not report regular physical activity. In addition, having almost always academic exhaustion increased the prevalence of depressive symptoms (PR: 1.46), stress symptoms (PR: 1.72). On the contrary, the prevalence of depressive symptoms (PR: 0.79), anxious symptoms (PR: 0.73) and stress symptoms (PR: 0.82) decreased in male students. Students who reported sleeping 8 or more hours daily had a lower prevalence of stress symptoms (PR: 0.82).

Conclusion

Symptoms of depression and anxiety occurred in 7 out of 10 students, and stress in 6 out of 10. Among the factors associated with the presence of anxiety, depression, and stress were eating behavior disorder and not regularly exercising. Periodic evaluations of mental symptomatology are required and counseling should be promoted in medical schools.

Investigation of contemporary college students' mental health status and construction of a risk prediction model

BACKGROUND

Due to academic pressure, social relations, and the change of adapting to independent life, college students are under high levels of pressure. Therefore, it is very important to study the mental health problems of college students. Developing a predictive model that can detect early warning signals of college students' mental health risks can help support early intervention and improve overall well-being.

AIM

To investigate college students' present psychological well-being, identify the contributing factors to its decline, and construct a predictive nomogram model.

METHODS

We analyzed the psychological health status of 40874 university students in selected universities in Hubei Province, China from March 1 to 15, 2022, using online questionnaires and random sampling. Factors influencing their mental health were also analyzed using the logistic regression approach, and R4.2.3 software was employed to develop a nomogram model for risk prediction.

RESULTS

We randomly selected 918 valid data and found that 11.3% of college students had psychological problems. The results of the general data survey showed that the mental health problems of doctoral students were more prominent than those of junior college students, and the mental health of students from rural areas was more likely to be abnormal than that of urban students. In addition, students who had experienced significant life events and divorced parents were more likely to have an abnormal status. The abnormal group exhibited significantly higher Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 scores than the healthy group, with these differences being statistically significant (P < 0.05). The nomogram prediction model drawn by multivariate analysis included six predictors: The place of origin, whether they were single children, whether there were significant life events, parents' marital status, regular exercise, intimate friends, and the PHQ-9 score. The training set demonstrated an area under the receiver operating characteristic (ROC) curve (AUC) of 0.972 [95% confidence interval (CI): 0.947-0.997], a specificity of 0.888 and a sensitivity of 0.972. Similarly, the validation set had a ROC AUC of 0.979 (95%CI: 0.955-1.000), with a specificity of 0.942 and a sensitivity of 0.939. The H-L deviation test result was χ2 = 32.476, P = 0.000007, suggesting that the model calibration was good.

CONCLUSION

In this study, nearly 11.3% of contemporary college students had psychological problems, the risk factors include students from rural areas, divorced parents, non-single children, infrequent exercise, and significant life events.

Sense of Coherence or resilience as predictors of psychological distress in nursing students during the COVID-19 pandemic

Background

The COVID-19 pandemic lead to the occurrence of numerous psychological distress among students. This study aimed to determine the level of psychological distress as well as the predictive role of Sense of Coherence (SOC) and resilience in nursing students.

Methods

A cross-sectional descriptive study was conducted on 310 nursing students in Ahvaz Jundishapur University of Medical Sciences, Iran. The data of the study was collected through the demographic information questionnaire, the General Health Questionnaire (GHQ), the Academic Resilience Inventory (ARI), and the Sense of Coherence Scale (SOC-13).

Results

Students' mean scores for the GHQ, ARI, and SOC were 5.81 ± 1.37, 102.88 ± 11.91, and 54.54 ± 6.46, respectively. Regression models showed that two domains of SOC [meaningfulness (β = -0.28, p < 0.001), manageability (β = -0.19, p = 0.001)], female gender (β = 0.12, p = 0.015), and overall ARI (β = -0.12, p = 0.037), were significantly associated with the GH of nursing students. SOC domains [meaningfulness (β = -0.19, p = 0.002), manageability (β = -0.15, p = 0.006)], problem-oriented/positive thinking domain of ARI (β = -0.15, p = 0.011), sex (β = 0.12, p = 0.015), and history of death in first-degree relatives (β = 0.12, p = 0.021) were significantly associated with social dysfunction domain of GH. Three domains of SOC [meaningfulness (β = -0.26, p < 0.001), manageability (β = -0.13, p = 0.032), and comprehensibility (β = -0.13, p = 0.039)], were significantly associated with psychological distress domain of GH.

Conclusion

Our results indicated that low SOC and resilience were predictors of psychological distress in nursing students. Accordingly, interventions such as teaching stress management skills, the skills of using positive coping methods in dealing with stressful situations, and self-management skills are necessary to improve the level of resilience and SOC in nursing students.

Depression, anxiety, stress, and fear of COVID-19 among Bangladeshi medical students during the first wave of the pandemic: a mixed-methods study

Aim

This study aims to investigate depression, anxiety, stress, and fear of the COVID-19 pandemic and the associated risk factors among Bangladeshi medical students. It also explored qualitative insights on mental health from medical students during the first wave of the pandemic.

Methods

This mixed-methods study was conducted online in Bangladesh from June 2020 to September 2020. Participants were Bangladeshi medical students from the first year to the final year. The quantitative part included a structured online survey. One focus group discussion (FGD) was organized using the Zoom platform to collect qualitative insights from the students. To determine levels of stress, anxiety, and depression, the Bangla-validated version of the Depression, Anxiety, and Stress Scale 21 (DASS-21) was used. A 7-item and Bangla-validated Fear of COVID-19 Scale, also known as FCV-19S, was used to explore the COVID-19-specific fear of the students. A semi-structured topic guide was used for exploring the qualitative insights of medical students' perceptions of fear of COVID-19, mental health impacts during COVID-19, overall recommendations to support students, and the impact of the pandemic on the future of the medical curriculum.

Results

The study reported that 51.20%, 59.40%, and 64% of the 406 respondents had moderate to severe stress, anxiety, and depressive symptoms, respectively, according to the DASS-21. The mean fear score for the COVID-19 scale was 19.4 (SD 6.4). Respondents with family members aged 50 years or older (B = 2.1; CI: 0.3-3.9) and those who had infected family members (B = 1.9; 95% CI: 0.1-3.7) exhibited a higher level of fear of COVID-19. Moreover, depression was associated with a history of having cancer among family members (AOR = 2.9, CI: 1.1-7.5), anxiety was strongly associated with having symptoms of COVID-19 (AOR = 2, CI: 1.3-3.2), and stress was associated with having symptoms of COVID-19 infection among family members (AOR = 1.9, CI: 1.3-3). Altered sleep was a potential risk factor for developing stress, anxiety, and depression symptoms. Manual thematic analysis of qualitative data generated four major themes, including the perception of fear of COVID-19, the perception of mental health impacts during COVID-19, the change in the medical curriculum along with the pandemic, and recommendations from the medical students to support the mental health concerns of medical students during public health crises like this pandemic. Qualitative findings showed that the participants experienced fear of their parents becoming infected by COVID-19, and this fear was more prominent in those who had their loved ones hospitalized. They were also stressed and anxious, with thoughts of death. Their fear also extended to their thoughts on academic progress and the effectiveness of online classes.

Conclusion

A substantial proportion of medical students experienced mental health difficulties in Bangladesh. Appropriate interventions should be designed, and adequate support should be provided to the medical students to protect their mental health and wellbeing, considering their potential impact on the future health system in a low-resource setting like Bangladesh.

Mental health and cognitive function among medical students after the COVID-19 pandemic in China

Background

Chinese people experienced a nationwide coronavirus disease 2019 (COVID-19) pandemic after the adjustment of epidemic response policies from December 2022 to January 2023. This study aims to explore the prevalence of mental and cognitive symptoms and their associated factors among medical students after the COVID-19 pandemic.

Methods

A cross-sectional study was conducted between February 27th and March 8th, 2023. The symptoms of anxiety, depression, insomnia, post-traumatic stress disorder (PTSD), and cognitive function among medical students were examined using the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Athens Insomnia Scale (AIS), the Impact of Event Scale-6 (IES-6), and the Perceived Deficits Questionnaire-Depression-5 (PDQ-D-5). Data on demographic information was also collected. Statistical analyses were conducted to describe the prevalence and explore the associated factors of mental and cognitive symptoms.

Results

Among 947 participants, the proportion of students experiencing anxiety, depression, insomnia, and PTSD symptoms was 37.8, 39.3, 28.3, and 29.5%, respectively. The self-reported COVID-19 infection rate was 72.2%. Higher grades, childhood, and current rural residence were identified as potential risk factors for mental and cognitive symptoms. Gender, age, average monthly household income, and COVID-19 diagnosis were not associated with mental and cognitive symptoms among medical students.

Conclusion

Our findings revealed a high prevalence of mental and cognitive symptoms among Chinese medical students after the COVID-19 pandemic. Special attention should be paid to the mental health of higher-grade students and those residing in rural areas.

The prevalence and risk factors of mental problems in medical students during COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

This meta-analysis and systematic review aimed to evaluate the global prevalence and risk factors of mental problems (i.e., depression, anxiety, stress, sleep disorder, posttraumatic stress disorder (PTSD), burnout, psychological distress, and suicidal ideation) among medical students during the COVID-19 pandemic.

METHOD

We searched PubMed, Embase, Web of Science, psycARTICLES, PsycINFO, CNKI, and Wan Fang for studies on the prevalence of mental problems among medical students from January 1, 2020, to April 1, 2022. The pooled prevalence was calculated by random-effect models. We performed a narrative review to identify the risk factors.

RESULTS

The meta-analysis included 201 studies (N = 198,000). The prevalence of depression (41 %, 95 % CI, 37-45 %,), anxiety (38 %,95 % CI, 34 %-42 %), stress (34 %, 95 % CI, 27 %-42 %), sleep disorder (52 %, 95 % CI, 44 %-60 %), psychological distress (58 %, 95 % CI, 51 %-65 %), PTSD (34 %, 95 % CI, 22 %-46 %), suicidal ideation (15 %, 95 % CI, 11 %-18 %) and burnout (38 %, 95 % CI, 25 %-50 %) was high. The major risk factors were being female, being junior or preclinical students, exposure to COVID-19, academic stress, psychiatric or physical disorders history, economic trouble, fear of education impairment, online learning trouble, fear of infection, loneliness, low physical activity, low social support, problematic internet or smartphone use, and young age.

LIMITATIONS

Most studies were cross-sectional. Few studies provided a reasonable response rate, suggesting potential selection bias.

CONCLUSIONS

The study demonstrated a high prevalence and risk factors for mental problems during COVID-19, calling for mental health services. Our findings are valuable for college and health authorities to identify high-risk students and provide targeted intervention.

The Role of Physical Activity in the Reduction of Generalised Anxiety Disorder in Young Adults in the Context of COVID-19 Pandemic

Physical activity is critically important not only for physical but also for mental health. Exercise may be a beneficial form of therapy for young adults with anxiety disorders. The global outbreak of the COVID-19 pandemic adversely affected the public, including young adults, in terms of their mental well-being and opportunities for physical activity. The study aimed to identify the influence of physical activity (PA) on generalised anxiety in young adults. It also assessed the changes which occurred in the level of PA and in generalised anxiety in young adults as a result of COVID-19 pandemic. A cross-sectional survey was carried out online with 506 young adults aged 18 to 34 years (=24.67 years ± 4.23 years). Respondents provided two answers to each question, i.e., information relating to the last 7 days during the pandemic (first hard lockdown), and to a period of 7 days before the pandemic (retrospective). The levels of physical activity were measured using 7-item International Physical Activity Questionnaire-Short Form (IPAQ-SF), whereas the level of generalised anxiety was assessed using the Generalised Anxiety Disorder 7 (GAD-7) questionnaire. During the pandemic there was a significant correlation between the level of generalised anxiety and the level of physical activity reported by the respondents (p = 0.048). A higher level of physical activity corresponded to lower level of generalized anxiety in young adults. During the pandemic, young adults spent significantly less time performing physical activity (8752.5 vs. 6174.6 metabolic equivalents (MET) min/week, p < 0.001), they spent more time engaging in sedentary behaviours (Me = 240 vs. Me = 300 min/day, p < 0.001), and they walked much less (from Me = 6930.0 (MET) min/week vs. 3861.0 (MET) min/week (44.29% decrease). Furthermore, after the outbreak of the pandemic the level of perceived generalised anxiety increased significantly (p < 0.001). Physical activity may play an important role in reducing anxiety disorder in young adults. During the COVID-19 pandemic young adults were significantly less involved in PA, which adversely affected their physical and mental condition. The importance of sufficient PA should be emphasised during this specific period, particularly among young adults.

The impact of covid-19: Anxiety, depression, and wellbeing among medical students

BACKGROUND

Medical students have been considered as a vulnerable group at higher risk of mental health issues during the COVID-19 outbreak.

AIMS

We set out to detect symptoms of depression and anxiety in medical students in St. Petersburg (Russia) during the first wave of COVID-19 outbreak and explore the associations between psychosocial factors related to the pandemic and students' psychological well-being.

METHOD

An anonymous online survey of medical students was conducted in May-June 2020. The Hospital Anxiety and Depression Scale (HADS) was used for screening anxiety and depression symptoms. The final sample consisted of 144 students (78.5% females).

RESULTS

About 69.4% of respondents reported that COVID-19 pandemic and social restrictions were a new source of stress in their lives. More than one-third (38.9%) of respondents reported a need for psychological (emotional) support due to a change in their daily life during the COVID-19 pandemic, with the vast majority (83.9%) of these respondents indicated an increased need for support in this specific period. Symptoms of anxiety were reported by 55.8% of females (HADS score: 9.05 ± 4.69) and 48.4% of males (8.09 ± 5.0), and symptoms of depression were found in 38.9% of females (6.40 ± 3.57) and 41.9% of males (6.16 ± 3.21).

CONCLUSIONS

These findings indicate that it is necessary to develop additional measures for the prevention and early diagnosis of mental disorders along with right levels of support for wellbeing and mental health of medical students in this ongoing pandemic.

Mental health help-seeking among Brazilian medical students: Who suffers unassisted?

INTRODUCTION

Several barriers for mental health help-seeking were identified among medical students, including minimizing mental illness. Studies examining aspects particular to those who perceive psychological impairment but do not access treatment are necessary for planning interventions.

AIMS

To identify help-seeking barriers based on the students' perception about their need for treatment and psychiatric symptoms. Methods: Cross-sectional study assessing 436 Brazilian medical students (833 attending the medical school = 52.3% response rate). Data collection covered sociodemographic data, mental health, academic environment, and Beck Inventories of Depression (BDI) and Anxiety (BAI). Non-parametric tests and hierarchical logistic regression were used to compare students undergoing treatment, those willing to access treatment, and the ones reporting no need for treatment.

RESULTS

Among the 382 students who completed the survey (87.6% completion rate), 38.5% (n = 147) were in treatment, and 33% (n = 126) were in need. Moderate to severe risk of alcohol abuse was observed in 45.9% (n = 50) of students reporting no need for treatment. Regression models suggested that perceiving need for treatment - whether already undergoing it or not - was associated with the severity of depressive symptoms (OR 1.14 [95% CI 1.07-1.21]), female assigned sex (OR 2.18 [95% CI 1.23-3.88]), LGBTQ+ (OR 2.47 [95% CI 1.09-5.60]) and reporting good relationship with the family (OR 0.26 [95% CI 0.08-0.83]). Models comparing students in treatment and those in need, pointed that the factors associated with lacking mental health care were age (OR 0.90 [95% CI 0.82-0.99]), perception of a heavy workload (OR 2.43 [95% CI 1.35-4.38]) and good relationship with colleagues (OR 3.51 [95% CI 1.81-6.81]).

DISCUSSION

Social variables and the severity of depressive symptoms are positively associated with perceived need for treatment. Age and academic environment factors were related to help-seeking behavior among students with appropriate self-awareness. We discuss these findings' implications for planning interventions.

Internet Addiction, Symptoms of Anxiety, Depressive Symptoms, Stress Among Higher Education Students During the COVID-19 Pandemic

Poor mental health is a growing concern among young people during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to assess the associations of Internet addiction with depressive symptoms, anxiety symptoms, and stress in higher education students during the COVID-19 pandemic, as well as to examine these mental health problems in the context of study-related characteristics. The research sample consisted of 3,099 participants from the Czech Republic (CZ: 1,422) and Slovak Republic (SK: 1,677). The Internet Addiction Test (IAT), the Generalized Anxiety Disorder (GAD-7) scale, the Patient Health Questionnaire for depressive symptoms (PHQ-9), and the Perceived Stress Scale (PSS) were used to measure mental health problems. The analyses also included demographic data (gender and age) and study-related characteristics (form of study, degree of study, field of study, distance between college and home, and housing during the semester). Based on the results of frequency and descriptive analyses, the prevalence of mental health problems was high. The most serious levels of Internet addiction (IAT cut-off point ≥ 50), to which attention should be paid, were found in 3.5% of Czech and 6.2% of Slovak students. Using the standard cut-off point of GAD-7 ≥ 10, 14.1% of Czech and 11.6% of Slovak students were identified with anxiety symptoms. Regarding the PHQ-9 with the cut-off point ≥ 10, 23.4% of Czech and 19.1% of Slovak students had depressive symptoms, which should be addressed. Using the PSS cut-off point ≥ 27, 12.9% of Czech students and 9.1% of Slovak students perceived high stress. The quantile regression analysis showed that Internet addiction was positively associated with anxiety symptoms, depressive symptoms, and stress in all of the analyzed cases (p-value < 0.001). In terms of study-related characteristics, the binomial logistic regression analysis revealed that risk factors for mental health problems in Czech and Slovak students were mainly full-time form of study and living away from home during the semester. Internet addiction, anxiety symptoms, depressive symptoms, and stress are issues that require increased attention, and professionals and policy-makers should implement interventions to effectively prevent and help students with psychological problems.