PHYSICAL ACTIVITY AND SYMPTOMS OF ANXIETY AND DEPRESSION AMONG MEDICAL STUDENTS DURING A 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.

Impact of the COVID-19 pandemic on the sleep quality of students: A meta-analysis and meta-regression

OBJECTIVE

The present systematic review aims to assess the impact of the COVID19 pandemic on the sleep quality of students.

METHODS

An electronic search was performed in the databases and in gray literature for articles published up to January 2022. The results included observational studies that assessed sleep quality through validated questionnaires, comparing moments pre and postCOVID19 pandemic. The risk of bias was assessed using the Joanna Briggs Institute Critical Assessment Checklist. The Grading of Assessment, Development and Evaluation (GRADE) was used to assess the certainty of scientific evidence. Estimates of interest were calculated using random effects meta-analyses and possible confounding factors were meta-regressed.

RESULTS

Eighteen studies were considered for qualitative synthesis and thirteen were considered for meta-analysis. Considering the comparison of means obtained by the Pittsburgh Sleep Quality Index, there was an increase in the scores obtained during the pandemic period [MD = -0.39; 95% CI = -0.72 - -0.07; I2 = 88.31%], thus evidencing a slight worsening in the sleep quality of these individuals. Risk of bias was considered low in nine studies, moderate in eight studies, and high in one study. The unemployment rate (%) in the country of origin of each included study partially explained the heterogeneity of analysis. GRADE analysis showed a very low certainty of scientific evidence.

CONCLUSION

The COVID-19 pandemic may have a slight negative impact on the sleep quality of high school and college students, but the evidence is still uncertain. The socioeconomic reality must be considered when evaluating this outcome.

Network analysis of physical activity and depressive and affective symptoms during COVID-19 home confinement

INTRODUCTION

The aim of this study was to analyze the network structure of physical activity, frequency, depressive, and affective symptoms in people under home isolation due to COVID-19.

METHOD

A longitudinal study was conducted in two phases (beginning (March 19, 2020) and end of home confinement (April 8, 2020)). The sample consisted of 579 participants from Spain (250 men and 329 women) aged 16 to 92 years (overall sample: M = 47.06, SD = 14.52). A network analysis was performed.

RESULTS

Four clusters emerged (PA, depressive symptoms, positive affect, and negative affect). A higher frequency of physical activity was related to better-sustained attention, increased alertness, and enthusiasm. In addition, feelings of guilt and shame were mitigated, and confinement distress and irritability were reduced. Physical activity also mitigated fatigue in women, whereas feelings of unhappiness were reduced in men.

CONCLUSION

Physical activity seems to be an effective option for mitigating the negative effects of the COVID-19 pandemic. Public health policymakers should develop programs to promote physical activity in order to be able to cope with confinement or similar scenarios in the future.

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.

Medical Students Show Lower Physical Activity Levels and Higher Anxiety Than Physical Education Students: A Cross-Sectional Study During the COVID-19 Pandemic

Objective: This study aimed to compare the time in physical activity (PA) [light (LPA), moderate and vigorous (MVPA)] and sedentary behavior (SB) (weekdays, weekends, or both) between Medical (MED) and Physical Education (PE) students who underwent remote classes imposed by the COVID-19. In addition, we compared symptoms of depression and anxiety and sleep quality. Methods: A cross-sectional study (272 MED and 95 PE students). The International Physical Activity Questionnaire (IPAQ), Beck Inventory (Anxiety, Depression), and Pittsburgh Sleep Quality were used to assess PA and SB, anxiety and depression symptoms, and quality of sleep, respectively. The data are presented as median and interquartile intervals 25-75. Results: We observed statistically significant differences between MED and PE students for MVPA [MED: 165 min per week (0-360) vs. PE: 420 min per week (180-670), p < 0.001], SB Total [MED: 10 h per day (8-12) vs. PE: 7 h per day (5-10), p < 0.001)], and anxiety symptoms [MED: 13 points (5-23) vs. PE: six points (2-16), p < 0.001)]. Conclusion: Together, our findings indicate that MED students spent less time in MVPA and more time in SB than PE students. MED students also presented worse mental health in the pandemic situation imposed by the COVID-19.