Stress, anxiety, and depression among medical students in a multiethnic setting

The Prevalence of Depression and Anxiety and Its Association with Sleep Quality in the First-Year Medical Science Students

Methods

A total number of 471 freshmen students (NUMS) participated in the study, pinpointing that the data are collected in 2019 and 2020. In line with measuring depression, anxiety, and sleep quality, the Persian Beck Depression Inventory-II, Beck Anxiety Inventory, and Pittsburgh Sleep Quality Index were employed. The associations between depression and anxiety with sleep quality were assessed by using the multiple logistic regression model. All statistical analyses were conducted in STATA14, and the significant level was set at P < 0.05.

Results

The prevalence of depression, anxiety, and poor sleep quality in the study population was 21.4%, 31.9%, and 28%, respectively. Analytical analyses indicated that after adjusting for studied covariates, the odds of poor sleep quality in individuals with depression were 3.5 times higher compared to the counter group (P < 0.001). Moreover, the odds of poor sleep quality in individuals with anxiety were 2.1 times higher compared to the counter group (P < 0.001).

Conclusion

Noticeable proportion of freshmen students suffer from depression and anxiety; in line with such a critical issue, our study found that depression and anxiety had a statistical association with sleep quality in study population. From this respect, it seems that providing essential interventions and psychological counseling services could be constructive for the freshmen medical students.

Predicting anxiety, depression, and insomnia among Bangladeshi university students using tree-based machine learning models

Background and Aims

Mental health problem is a rising public health concern. People of all ages, specially Bangladeshi university students, are more affected by this burden. Thus, the objective of the study was to use tree-based machine learning (ML) models to identify major risk factors and predict anxiety, depression, and insomnia in university students.

Methods

A social media-based cross-sectional survey was employed for data collection. We used Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9) and Insomnia Severity Index (ISI-7) scale for measuring students' anxiety, depression and insomnia problems. The tree-based supervised decision tree (DT), random forest (RF) and robust eXtreme Gradient Boosting (XGBoost) ML algorithms were used to build the prediction models and their predictive performance was evaluated using confusion matrix and receiver operating characteristic (ROC) curves.

Results

Of the 1250 students surveyed, 64.7% were male and 35.3% were female. The students' ages ranged from 18 to 26 years old, with an average age of 22.24 years (SD = 1.30). Majority of the students (72.6%) were from rural areas and social media addicted (56.6%). Almost 83.3% of the students had moderate to severe anxiety, 84.7% had moderate to severe depression and 76.5% had moderate to severe insomnia problems. Students' social media addiction, age, academic performance, smoking status, monthly family income and morningness-eveningness are the main risk factors of anxiety, depression and insomnia. The highest predictive performance was observed from the XGBoost model for anxiety, depression and insomnia.

Conclusion

The study findings offer valuable insights for stakeholders, families and policymakers enabling a more profound comprehension of the pressing mental health disorders. This understanding can guide the formulation of improved policy strategies, initiatives for mental health promotion, and the development of effective counseling services within university campus. Additionally, our proposed model might play a critical role in diagnosing and predicting mental health problems among Bangladeshi university students and similar settings.

Assessment of mental wellbeing of university students in Bangladesh using Goldberg's GHQ-12: A cross-sectional study

Background and Aims

The mental well-being of university students is a primary public health concern worldwide, including in Bangladesh. The objective of this study was to determine the prevalence of the overall mental health status among Bangladeshi university students. The study used larger and more diverse sample compared to previous studies, and also explored factors associated with the mental health well-being of those students.

Methods

Data were collected through an online questionnaire, utilizing the proportional allocation method, from students in various universities across Bangladesh. The sample included 2036 participants. The study applied Goldberg's General Health Questionnaire (GHQ-12) using the GHQ2+ threshold (i.e., having more than two symptoms). A binary outcome variable was created with two levels: "good mental health" and "poor mental health," to assess the mental health status of the university students. The explanatory variables were age, gender, academic year, type of university, and sources of personal expenses. Exploratory data analysis, association tests, and binary logistic regression models were used to identify factors influencing the outcome variable.

Results

A total of 55.9% of students (male: 52.6% and female: 62.8%) exhibited poor mental health status. Female students' mental health was found to be worse (odds ratio [OR]: 1.49, 95% confidence interval [CI]: 1.23-1.81) compared to that of males. Similarly, public university students displayed a worse mental health condition than their counterparts in private universities (OR: 1.29, 95% CI: 1.03-1.61).

Conclusion

The overall mental health of university students in Bangladesh is concerning. There is a pressing need for effective mental health policies and interventions to bolster the mental well-being of university students, with a specific focus on students from public universities and females.

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.

Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints

PURPOSE

Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary.

METHODS

Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed.

RESULTS

221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once.

CONCLUSIONS

Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.

Influence of cyber-victimization and other factors on depression and anxiety among university students in Bangladesh

BACKGROUND AND OBJECTIVES

Cyber-victimization is closely linked with mental health problems such as anxiety, depression, etc., and has become a growing concern among university students in Bangladesh. In the era of globalization, smart gadgets, the internet, and other online resources are readily available, and these tools and devices have now become the primary method for cyberbullying. The authors aim to explore the impacts of cyber-victimization and other factors on anxiety and depression among university students in Bangladesh.

METHODS

The primary data for this cross-sectional study were collected using a well-structured questionnaire. This study employs three widely used scales such as cyberbullying inventory, general anxiety disorder-7 (GAD-7), and patient health questionnaire-9 (PHQ-9). Descriptive statistics and multivariable logistic regression analyses are carried out to identify the factors associated with depression and anxiety among university students in Bangladesh.

RESULTS

Findings depict that the prevalence of depression and anxiety among university students was 52.5% and 44.0%, respectively. Depressed respondents were considerably more likely to have difficulty sleeping (p < 0.001), spend more time on social media (p = 0.002), have suicidal thoughts (p < 0.001), and have a high cyber-victimization score (p < 0.001) compared to non-depressed respondents. In comparison with non-anxious respondents, anxious respondents were significantly more likely to: have sleeping difficulties (p < 0.001); spend more time on social media (p = 0.031); have suicidal thinking (p < 0.001); and have a comparatively high cyber-victimization score (p < 0.001). Multivariable logistic regression analysis identified that a one-unit increase in the cyber-victimization score results in a 1.24 times higher chance of experiencing depression (AOR: 1.24, 95% CI 1.17-1.31, p < 0.001), and a one-unit increase in the cyber-victimization score results in a 1.23 times higher chance of experiencing anxiety (AOR: 1.23, 95% CI 1.17-1.30, p < 0.001).

CONCLUSION

University students are struggling with cyberbullying, which can lead to depression and anxiety levels. Promoting more cyberbullying awareness is necessary since failing to do so could result in a sustained or increased prevalence of anxiety and depression levels among students, which could have disastrous repercussions.

Association of mindfulness on state-trait anxiety in choking-susceptible athletes: mediating roles of resilience and perceived stress

Introduction

It is a well-documented psychological phenomenon for athletes to experience abnormal performance on the field, often called choking. Negative emotions such as perceived stress and state-trait anxiety have been linked to this phenomenon. In an effort to delve into the intricate relationship between mindfulness and state-trait anxiety among athletes susceptible to choking, this study was conducted in Central China during the period from October to November 2022.

Methods

The sample selection process employed a combination of cluster sampling and random sampling, resulting in a total of 377 viable samples encompassing choking-susceptible athletes who frequently grapple with state-trait anxiety and demonstrate performance deviations. The data analysis was executed utilizing AMOS v.26.

Results

The results indicate a negative association between mindfulness and perceived stress (standardized coefficient = -0.224, p < 0.001), resilience and perceived stress (standardized coefficient = -0.237, p < 0.001), as well as perceived stress and state-trait anxiety (standardized coefficient = 0.510, p < 0.001). The positive impact of mindfulness on state-trait anxiety is mediated by resilience and perceived stress (standardized indirect effect = 0.237, p < 0.001). The explanatory power of this study is R2 = 0.35.

Discussion

Drawing from these substantial findings, a key recommendation is to implement mindfulness training programs for athletes prone to choking. This proactive measure, facilitated by sports departments, clubs, and coaches, could potentially alleviate state-trait anxiety, enhancing athletes' mental well-being and optimizing their performance outcomes during competitions.

Depression symptoms, anxiety, and stress among undergraduate entrance admission seeking students in Bangladesh: a cross-sectional study

Background

Intense academic pressure and unhealthy competition have turned the university entrance exam scenario in Bangladesh into a Pandora's Box, which might cause mental health difficulties among young students. However, there is a severe scarcity of studies concerning such issues of university entrance examination-seeking students in Bangladesh.

Methods

This study aimed to assess the prevalence and associated factors of depression symptoms, anxiety, and stress among undergraduate entrance admission-seeking students in Bangladesh. A cross-sectional study design was followed using an online tool including socio-demographic questions, and the 21-item Bangla Depression, Anxiety and Stress Scale (BDASS-21). The survey form was completed by 452 Bangladeshi students who passed the higher secondary certificate (HSC) examination in 2020 and were planning to get admission to the undergraduate level during the data collection.

Results

The prevalence of mild to extremely severe levels of depression symptoms, anxiety, and stress was 57.7%, 61.4%, and 44.6%, respectively. Females were more likely to have depression, anxiety, and stress symptoms than males. The students from science backgrounds were at higher risk of developing depression and stress symptoms when compared with students from business studies backgrounds. Besides, students with a previous history of mental illness, a preference for getting admitted into the public university, and less monthly family income (<25,000 BDT) were more likely to develop depression, anxiety, and stress symptoms. In addition, students with a previous history of neurological disorders were more likely to develop anxiety symptoms than those without.

Conclusion

This study revealed a high level of depression, anxiety, and stress symptoms among undergraduate entrance admission-seeking students, which calls for in-depth exploratory investigations. Adequate low-intensity interventions should be designed to support this young population.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Stress, anxiety, and depression in social work students from Peru

OBJECTIVE

To report the magnitude of symptoms of stress, anxiety, and depression in Social Work Students (SWS) from Peru and the stressors associated with each illness. Moreover, to validate the DASS-21 tool (Spanish version) with a Peruvian SWS sample.

METHOD

Quantitative study that applied the DASS-21 scale to a sample of 152 Peruvian SWS. Sociodemographic data and college stressors over stress, anxiety, and depression were modelled with factorial analysis, multiple regressions, ANOVA, and t-tests. Descriptive statistics were also used. The research started in August 2018 and end in February 2019.

RESULTS

The study concludes that 48% of Peruvian SWS suffer from severe or extremely severe symptoms of stress, anxiety, or depression. Female students are the most affected by these illnesses. The DASS-21 Spanish version was validated in a new sample of Peruvian SWS. The profile of the SWS from Peru is reported.

CONCLUSION

Peruvian SWS are suffering symptoms of stress, anxiety, and depression at different levels. There are college stressors that increase the symptoms of stress, anxiety, and depression in these students.

Mental health knowledge and awareness among university students in Bangladesh

Negative attitudes toward mental illness and treatment are attributed to a lack of or inaccurate mental health knowledge. We aimed to assess the current mental health knowledge and awareness among Bangladeshi university students and identified socio-demographic factors that affect them. Between February and April of 2021, a cross-sectional study of 2036 university students in Bangladesh was conducted. Two different questionnaires (i.e., knowledge and awareness) were developed to assess mental health knowledge and awareness. The two outcome variables in this study were mental health knowledge level and awareness level. The cut-off value was taken as 80% of the total scores of both the knowledge and awareness scales and divided into higher and lower groups. Data were analyzed using different descriptive statistical tools and binary logistic regression model. We found more than half (62.1%) of the students had higher knowledge, and 85.1% of the students had a higher awareness of mental health problems. Female students (OR 1.41, 95% confidence interval (CI): 1.15–1.72) and students managing their expenses by personal income and family support were significantly positively associated with the high knowledge of the mental health (OR 1.79, 95% CI: 1.40–2.29). Similarly, age (OR 1.47, 95% CI: 1.01–2.14) was significantly associated with high awareness. Good mental health was significantly negatively associated with the high knowledge (OR 0.72, 95% CI: 0.6–0.87) and positively associated with the high awareness (OR 1.48, 95% CI: 1.15–1.91). Although mental health awareness is high among Bangladeshi university students, knowledge of mental health is insufficient. As a result, it is essential to comprehend the gaps in knowledge and awareness of mental health disorders, as well as how they are addressed.

Mindfulness practice correlates with reduced exam-induced stress and improved exam performance in preclinical medical students with the "acting with awareness", "non-judging" and "non-reacting" facets of mindfulness particularly associated with improved exam performance

BACKGROUND

Medical students demonstrate higher levels of psychological distress compared with the general population and other student groups, especially at exam times. Mindfulness interventions show promise in stress reduction for this group, and in the reduction of cortisol, an established clinical marker of the body's stress response. This study investigated the relationship of mindfulness to exam-induced stress, salivary cortisol and exam performance in undergraduate medical students.

METHODS

A controlled pre-post analysis design with within-groups comparisons. 67 medical students completed the five facet mindfulness questionnaire (FFMQ) and provided saliva samples, from which cortisol was extracted, during group work (control/baseline) and immediately prior to end of year 2 examinations (experimental). Academic performance data was extracted for comparison with measures.

RESULTS

Exam-induced salivary cortisol concentration showed a significant negative relation with exam performance. Total FFMQ score showed a significant positive relation with exam performance and a significant negative relation with exam-induced salivary cortisol. The specific mindfulness facets of acting with awareness, non-judging and non-reacting also showed a positive correlation with exam performance.

CONCLUSIONS

This study suggests that there exists an important relationship between mindfulness and the physiological biomarker of stress, cortisol, and this manifests into improved assessment outcomes potentially through healthier, more adaptive coping and stress management strategies. In particular, this study identifies the acting with awareness, non-judging and non-reacting facets of mindfulness to be significantly associated with exam performance suggesting that these may be important facets for clinical educators to target when helping students with mindfulness practice.

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.

Psychological Distress During COVID-19 Curfews and Social Distancing in Saudi Arabia: A Cross-Sectional Study

Background: Coronavirus disease 2019 (COVID-19) has spread to over 150 countries worldwide. Since the first case of COVID-19 was confirmed in Saudi Arabia, cases have continued to escalate exponentially. The COVID-19 outbreak has had a negative effect on mental health and well-being. The study aimed to investigate the effects of the strict national regulations associated with the COVID-19 pandemic on mental health. Methods: This was a cross-sectional study of a convenience sample of Saudi residents. Saudi residents aged 18 years or older were invited to complete an online questionnaire after one month of a nationwide 24-h curfew between May 6, 2020 and May 13, 2020. We measured psychological distress using the Depression, Anxiety, and Stress Scale-21 (DASS-21). We ran binary logistic regression analyses to detect variables that significantly predicted DASS-21 scores. Results: A sample of 2252 participants was recruited from the general population of Saudi Arabia. The DASS-21 score means and standard deviations for depression and anxiety for the whole sample (10.73 ± 10.29 and 6.98 ± 8.30, respectively) were in the range of mild depression and anxiety. In contrast, the mean DASS-21 stress score was within the normal range (11.97 ± 10.80). The mean stress score for healthcare workers was within the normal range (13.70 ± 10.68) but was significantly higher than the mean score for the public (11.56 ± 10.89; P = 0.0006). Several variables (e.g., age, gender, and history of contact with confirmed COVID-19 cases) were significantly associated with higher DASS-21 scores. Conclusions: The COVID-19 pandemic has created a psychological burden. Therefore, there is an urgent need to implement emergency public health interventions that ameliorate the risk perception of COVID-19 through the dissemination of adequate and targeted health information that could be a successful measure to mitigate the psychological impact of the Covid-19 pandemic.

Depression and Anxiety among University Students: A Comparison between COVID-19 Pandemic Panic Period and Post-panic Period in Bangladesh

BACKGROUND: In Bangladesh, the rapid spread of COVID-19 virus created a panic situation among the citizen. Specially, the psycho-emotional disorder of the university students is increasing which has not been adequately investigated. AIM: Relating this, the study aimed to assess the psycho-emotional changes of the university students through investigating their level of depression and anxiety during panic and post-panic period of COVID-19 pandemic in Bangladesh. METHOD: A cross-sectional online survey was conducted among the university students in Bangladesh from April to July 2020 (panic period, n = 170) and then from August to November 2020 (post-panic period, n = 170). The Patient Health Questionnaire (PHQ)-9 and Generalized Anxiety Disorder-7 questionnaires were used to assess the depression and anxiety levels of the students, respectively. Various univariate and multivariable statistical techniques were used to analyze the data. RESULTS: The proportion of depression symptoms was 49.4% and 52.4% during the panic period and post-panic period, respectively. Anxiety symptoms were experienced by 38.2% of students during the panic period, and the percentage was nearly identical in the post-panic interval. In post-panic period, depression levels found a slight increase. Urban students reported significantly (p < 0.05) higher levels of depression and anxiety than their counterparts. Female students also exhibited significantly more anxiety symptoms (p < 0.002) than male. Depression symptoms significantly varied by family types and student’s place of residence. CONCLUSIONS: This study compared the depression and anxiety symptoms of the university students during two periods of the COVID-19 pandemic. Although the difference was small, it remains an issue for the university students in Bangladesh due to the disruption to their academic lives.

Prevalence and predicting factors of perceived stress among Bangladeshi university students using machine learning algorithms

Background

Stress-related mental health problems are one of the most common causes of the burden in university students worldwide. Many studies have been conducted to predict the prevalence of stress among university students, however most of these analyses were predominantly performed using the basic logistic regression (LR) model. As an alternative, we used the advanced machine learning (ML) approaches for detecting significant risk factors and to predict the prevalence of stress among Bangladeshi university students.

Methods

This prevalence study surveyed 355 students from twenty-eight different Bangladeshi universities using questions concerning anthropometric measurements, academic, lifestyles, and health-related information, which referred to the perceived stress status of the respondents (yes or no). Boruta algorithm was used in determining the significant prognostic factors of the prevalence of stress. Prediction models were built using decision tree (DT), random forest (RF), support vector machine (SVM), and LR, and their performances were evaluated using parameters of confusion matrix, receiver operating characteristics (ROC) curves, and k-fold cross-validation techniques.

Results

One-third of university students reported stress within the last 12 months. Students’ pulse rate, systolic and diastolic blood pressures, sleep status, smoking status, and academic background were selected as the important features for predicting the prevalence of stress. Evaluated performance revealed that the highest performance observed from RF (accuracy = 0.8972, precision = 0.9241, sensitivity = 0.9250, specificity = 0.8148, area under the ROC curve (AUC) = 0.8715, k-fold accuracy = 0.8983) and the lowest from LR (accuracy = 0.7476, precision = 0.8354, sensitivity = 0.8250, specificity = 0.5185, AUC = 0.7822, k-fold accuracy = 07713) and SVM with polynomial kernel of degree 2 (accuracy = 0.7570, precision = 0.7975, sensitivity = 0.8630, specificity = 0.5294, AUC = 0.7717, k-fold accuracy = 0.7855). Overall, the RF model performs better and authentically predicted stress compared with other ML techniques, including individual and interaction effects of predictors.

Conclusion

The machine learning framework can be detected the significant prognostic factors and predicted this psychological problem more accurately, thereby helping the policy-makers, stakeholders, and families to understand and prevent this serious crisis by improving policy-making strategies, mental health promotion, and establishing effective university counseling services.

Academic and non-academic life stressors and their impact on psychological wellbeing of medical students

Objectives

Among medical students, depression, anxiety, and stress (DAS) are key public wellbeing challenges that require epidemiological research. We aimed to evaluate potential sources of these psychological disturbances and assess the contribution of academic and non-academic life stressors in psychological morbidity among medical students.

Methods

This exploratory questionnaire-based survey was conducted in a Saudi Arabian public sector medical college. A total of 231 medical students were enrolled and completed the depression, anxiety, and stress scale-21 (DASS-21) questionnaire.

Results

More than half of the medical students, 129 (55.8%), had depression, 106 (45.9%) students had anxiety, and 87 (37.7%) students had stress. Academic achievement was the largest explanatory factor for depression and stress, whereas bodily appearance constituted the largest explanatory factor of anxiety among the study sample. Academic and non-academic stressors score was significantly associated with depression (adjusted Odds Ratio, aOR = 1.13, 95% CI 1.07–1.19), anxiety (aOR = 1.07, 95% CI 1.03–1.12), and stress (aOR = 1.12, 95% CI 1.08–1.17).

Conclusions

Medical students have a high incidence of negative emotional states. These negative psychological states were explained by academic achievement and bodily appearance. The studied stressors influenced medical students' psychological wellbeing.

[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.

Role of Restorativeness in Improving the Psychological Well-Being of University Students

Many university students experience high levels of study-related fatigue, hence, necessitating opportunities for restoration. They could potentially benefit from campus-based physical activities that provide them with effective restoration breaks and allow them to return to their studies cognitively refreshed. Thus, a cross-sectional study was conducted to assess the association between perceived restorativeness among postgraduates and their psychological well-being by using the four constructs of Kaplan's attention restoration theory (ART): fascination, being away, extent, and compatibility. In this study, nature view windows were also used as a moderator. Malaysian postgraduate students [n = 192; 94 females; age in years (M = 30.64, SD = 2.73)] completed the Ryff's scale of psychological wellbeing (PWB) and perceived restorativeness scale for activity (PRAS). This study used the partial least squares-structural equation model (PLS-SEM) to examine these relationships. The results demonstrate that three ART constructs, namely, being away, fascination, and compatibility, are significant predictors of psychological well-being across the sample size. Furthermore, for participants who reside in university dormitories, windows that overlook nature can enhance the relationship of being away, compatibility, and fascination to psychological well-being, compared with those with less natural views. Thus, this study confirmed the moderating effect of nature view windows and provided insight into the ART constructs that facilitate and enhance restorative experiences. By strengthening ART with additional factors, this study has also contributed toward the improvement of the psychological well-being of university students.

The relationship between test anxiety and emotion regulation: the mediating effect of psychological resilience

BACKGROUND

Test anxiety has been widely found in medical students. Emotion regulation and psychological resilience have been identified as key factors contributing to anxiety. However, studies on relationships were limited. This study investigated the links between psychological resilience, emotion regulation, and test anxiety in addition to exploring the differences about socio-demographic factors.

METHODS

A sample of 1266 medical students was selected through cross-sectional survey from a medical university in China during 2019. Data were obtained by network technique using designed questionnaire, which assesses the level of test anxiety, emotion regulation and psychological resilience, respectively.

RESULTS

Medical students experienced test anxiety at different levels, 33.7% of these were seriously. It revealed significant effects of the gender and academic performance on test anxiety. Results of logistic regression indicated that test anxiety was significantly associated with emotion regulation and psychological resilience (p < 0.01). Psychological resilience played a mediating role on the relationship between emotion regulation and test anxiety.

CONCLUSIONS

These findings highlight the importance of psychological resilience and emotion regulation in understanding how psychological resilience relates to test anxiety in medical students. Resilience-training intervention may be developed to support students encountering anxiety during the exam.

The Impact of Self-Efficacy, Optimism, Resilience and Perceived Stress on Academic Performance and Its Subjective Evaluation: A Cross-Sectional Study

This study aimed to highlight the contribution of self-efficacy, optimism, resilience and perceived stress on academic performance (GPA) at medical undergraduate students. Additionally, we investigated the relationship established between abovementioned variables, gender and position in the academic cycle and the factors associated with satisfaction regarding own academic results. 118 students (25 men, 93 women, mean age 22.863, SD = 1.763) participated in the study. They were administered the General Self-Efficacy Scale (G-SES), the Revised Life Orientation test (LOT-R), the Brief Resilience Scale (BRS) and the Perceived Stress Scale (PSS). t, Wilcoxon-Mann-Whitney, chi-square tests, and linear regressions were performed, in order to test the strength of the hypothesized associations. Data analysis demonstrates a significant association between low optimism, low resilience, high perceived stress and poor academic performance. Even though preclinical students displayed greater perceived stress, it negatively correlated to GPA only in clinical students, this indicating a possible accumulation of stress-related effects. No gender differences were met for the studied variables. Students in clinical cycle were significantly less satisfied about their own performance. These results indicate solid associations between psychosocial variables and academic performance, and differences in the subjective evaluation of own performance, suggesting key points to address, when designing interventions against academic stress.

Post-traumatic stress disorder following COVID-19 pandemic among medical students in Riyadh: a cross-sectional study

Background

In recent times, COVID-19 has been recognized as a public health emergency and thus far, most papers published on it are focused only on the clinical characteristics of infected patients. This pandemic has also made phenomenal emotional impact among the young and the old. We aimed to find out the impact of the COVID-19 pandemic on the psychological well-being of medical students in a University at Riyadh.

Results

There were 309 participants in the study. Out of them 44% did not have PTSD, 29% had score more than 37 which might contribute to immune suppression, in 18.4% PTSD was a clinical concern and 8.6% had probable PTSD. Female participants were the majority in the group and they also had higher chance of having consequences than the male counterparts (P < 0.001). Avoidance score between male and female gender was significantly different.

Conclusion

COVID-19 pandemic has not just affected the physiological functioning of the affected individuals but also has had a probable post-traumatic stress disorder among young college students. Screening for psychological well-being and the treatment for PTSD is imperative in college, school and general population.

Personality and mental health factors associated with performance at university level: A study of business administration students

BACKGROUND

Performance of students at university level may be influenced by various factors.

AIM

In a sample of business administration students, we explored personality, mental health, and life style factors associated with high and low achievers based on their examination grades (Grade A and higher vs. Grade B and lower).

METHODS

We studied personality factors using big five inventory (BFI)-10, anxiety through generalized anxiety disorder-7 screening scale, and depression by patient health questionnaire-9 scale. In open-ended questionnaires, stress, relationship, and drug uses were enquired about.

RESULTS

Considerable proportions of students had anxiety (33%) and depression (41%) at moderate-to-severe level; however, they were not different in the two groups. Higher examination grades were associated significantly with higher scores on conscientiousness factor of BFI-10 and female gender. There was no difference in self-reported stress or substance use between the two groups.

CONCLUSIONS

While conscientiousness was associated with better performance, mental health factors were comparable between higher and lower grades in examination. The results highlight the need for further research on personality and modifiable factors such as stress, anxiety, and depression and to evaluate effectiveness of interventional approaches on academic performance.

Prevalence and Correlates of Depression, Anxiety, and Suicidality Among High School Students: A National Study

The current study aimed to estimate the prevalence of depression, anxiety, and suicidality and their correlated factors among high school students in Jordan. A descriptive cross-sectional correlational research design was used. Data were collected using self-reported questionnaires completed by students attending high schools in Jordan. Data show that anxiety and depression are prevalent among adolescents and are associated with higher risk of suicide and disease prevalence. Twenty-seven percent of the variance in suicidality is explained by anxiety and depression. This finding indicates that the most significant predictor of suicidality is anxiety and depression among high school students. Results show that mental health issues are a genuine general health issue among high school students. Health care professionals should routinely screen for mental health problems among young people. Mental health and well-being advancement programs should be coordinated and directed by all parties involved in youth mental health. [Journal of Psychosocial Nursing and Mental Health Services, 59(8), 43-51.].

Effects of stress associated with academic examination on the kynurenine pathway profile in healthy students

The effects of stress on the neuroendocrine, central nervous and immune systems are extremely complex. The kynurenine pathway (KP) of the tryptophan metabolism is recognised as a cross-link between the neuroendocrine- and immune systems. However, the effects of acute stress from everyday life on KP activation have not yet been studied. This study aims to investigate changes in the levels of the KP neuroactive metabolites and cytokines in response to stress triggered by academic examinations. Ninety-two healthy first year medical students benevolently participated in the study. Parameters were measured pre- examination, which is considered to be a high-stress period, and post-examination, as a low-stress period. Stress induced by academic examinations significantly increases the perceived stress scores (p<0.001), serum cortisol levels (p<0.001) and brain-derived neurotrophic factor (BDNF) levels (p<0.01). It decreased IL-10 levels (p<0.05) but had no effect on IL-6 and TNF-alpha levels. Only the KP neuroactive metabolite, 3-hydroxykynurenine (3-HK) significantly increased (p<0.01) in the post-examination period. In addition, the stress scores positively correlated with the levels of cortisol (r² = 0.297, p<0.01) at post examination. Acute stress triggered by academic examinations increases cortisol and BDNF production and suppresses the anti-inflammatory cytokine, IL-10, but did not increase significantly the levels of other pro-inflammatory cytokines, tryptophan, kynurenine and downstream KP metabolites. The concomitant increased levels of BDNF under the duress of acute examination stress appear to limit the levels pro-inflammatory markers, which may attenuate the action of cortisol and the neuroinflammatory branch of the KP.

Symptoms of Depression, Anxiety, and Stress and Prevalence of Major Depression and Its Predictors in Female University Students

Depression, anxiety and stress are increasingly concerning phenomena in our society, with serious consequences on physical and mental health. The repercussions may be particularly devastating in particular population subgroups, such as female university students. The purpose of this study was to determine the levels of depression, anxiety, and stress and the prevalence of depression and associated factors, in Spanish university women. A cross-sectional study was conducted with a random sample of 871 students from the Santiago de Compostela University (mean age 20.7 years, SD = 2.8). Information was collected on sociodemographic and academic characteristics; symptoms of depression, anxiety, and stress; diagnosis of major depression; optimism, resilience, social support, life engagement, and five personality domains, using validated instruments. Of the participants, 18.1%, 22.8% and 13.5% presented with severe/very severe levels of depression, anxiety and stress, respectively. A total of 12.9% had major depression. Higher life engagement was associated with lower risk of depression (OR = 0.92, 95% CI 0.87–0.98), while higher levels of neuroticism (OR = 1.20, 95% CI, 1.12–1.28) and openness to experience (OR = 1.08, 95% CI, 1.02–1.14) were associated with greater risk. These findings reveal an alarming percentage of female university students who experience major depression and severe/very severe stress.

Depression, anxiety and stress among medical and non-medical students in Saudi Arabia: An epidemiological comparative cross-sectional study

OBJECTIVES

To quantify the extent and variation of depression, anxiety and stress among medical and non-medical Saudi Arabian students.

METHODS

In this cross-sectional study, students from Umm Al-Qura University, Makkah, Saudi Arabia, were recruited. The Faculty of Education was randomly selected to represent the non-medical colleges. The depression, anxiety and stress scale-21 items (DASS-21) was used to estimate the study outcomes.

RESULTS

Of the 465 undergraduates recruited in this study, 49.68% (n=231) were medical students and 50.32% (n=234) were non-medical students. Approximately 54%, 53%, and 38% of the participants were found to be suffering from depression, anxiety, and stress, respectively. The analyses showed that the two groups did not differ significantly with respect to stress and depression (p=0.934 and 0.423, respectively). However, the non-medical students exhibited a significantly higher anxiety score compared to the medical students (p=0.002). Family conflicts was a common risk factor for the studied psychological disturbances. Female gender and travel time from home to university were significant predictors of depression and anxiety, whereas a positive history of a psychological condition increased the likelihood of depression and stress.

CONCLUSION

There was a high prevalence of anxiety, stress, and depression among the students, with a significantly higher anxiety levels among the non-medical students.

Depressive symptoms associated with loneliness and physical activities among graduate university students in Bangladesh: findings from a cross-sectional pilot study

In low-resource settings like Bangladesh, there is a dearth of research on the mental health of university students. This pilot study aimed to identify the prevalence of depressive symptoms, loneliness, and physical activities as well as the associated factors of depressive symptoms among graduate students in a public university of Bangladesh.

This cross-sectional study was carried out among 323 graduate students between February 2019 and May 2019. By the convenience sampling technique, data were collected by a pretested, structured questionnaire. Depressive symptoms were assessed by the validated Patient Health Questionnaire-9 (PHQ-9) tool with a cut-off score of ≥10 vs. less; University of California, Los Angeles (UCLA) loneliness scale was applied to assess loneliness, International Physical Activity Questionnaire (IPAQ) scale was used to measure physical activity level.

The overall prevalence of depressive symptoms was 52% and about 43% of participants felt most lonely. About 32.8% of students were involved in low physical activity. Being female, from lower income families, having poor academic performance, experiencing shorter sleep time, lower physical activity, and being lonely were potential risk factors for depressive symptoms among graduate university students. A positive correlation was found between loneliness and depressive symptoms of students (r = 0.367, p < 0.001).

The higher prevalence of depressive symptoms among Bangladeshi graduate university students suggests the need for situation analysis, confirmatory clinical diagnosis, in-depth qualitative explorations, and large-scale surveys to explore the burden of such disorders and design appropriate low-intensity interventions like implementing student counselling service, offering mental assistance or other mental health support program in the country.

Immediate psychological responses during the initial period of the COVID-19 pandemic among Bangladeshi medical students

BACKGROUND

The most recent global pandemic of COVID-19 has been creating multidimensional damages, including a detrimental impact on the mental health status of individuals. Medical students, a vulnerable cross-section of the population, may have perceived a myriad of psychological stressors during this crisis in the background of their prevailing stressful academic pressure and preexisting higher psychological and mental health issue.

OBJECTIVE

To determine the prevalence of anxiety and depressive symptoms and to elucidate the psychological impact of COVID-19 pandemic on Bangladeshi medical students.

METHOD

A cross-sectional study design was utilized to conduct this survey. The online survey including demographic questions, COVID-19 related questions, and the Hospital Anxiety and Depression Scale (HADS; higher scores on the subscales indicate higher levels of depressive and anxiety symptoms), was completed by 425 Bangladeshi medical students. Collected data were statistically analyzed by using SPSS (version 25.0) software.

RESULT

The HADS anxiety subscale revealed that 65.9% of the medical students had different levels of anxiety, ranging from mild (27.3%), moderate (26.8%), and severe (11.8%). As per HADS depression subscale, 49.9% of the medical students had varying degrees of depressive symptoms, with 3.3% of the participants had suffered from severe depressive symptoms. Female students had a relatively more anxiety and depressive symptoms when compared with males. The students, who were severely tensed of getting infected by the virus, were at higher risk of suffering from anxiety (3.5-fold) and depressive (2.7-fold) symptoms, when compared with no/minimally stressed students. Besides, fear of getting assaulted or humiliated on the way to hospital or home, not to be able to give maximum concentration on study after COVID-19 pandemic, students' present emotional status (agitation), had statistically significant higher risk of anxiety.

CONCLUSION

A substantial proportion of Bangladeshi medical students are experiencing pandemic-related adverse psychological impact. Poor mental health conditions of these vulnerable medical students pose important threat to their potential contribution in future health care. Thus, medical colleges and health authorities should focus on addressing their psychological needs and formulate effective strategies to ameliorate medical students' mental health status, particularly during any infectious disease outbreak.

Psychological responses during the COVID-19 outbreak among university students in Bangladesh

Mental health problems in students are considered a public health challenge. We assessed the prevalence of depression, anxiety, and stress (DAS) with the DASS-21, as well as associated factors, among university students in Bangladesh early in the COVID-19 outbreak. We hypothesized high levels of DAS and their associations with previously reported factors (e.g., poor sleep, lack of exercise, heavy internet use) and those linked to disadvantage (e.g., low monthly family income). We also enquired about participants' satisfaction with their pursuit of their academic studies while living under COVID-19 restrictions. An internet-based survey was conducted during the month of April 2020, involving 3,122 Bangladeshi university students aged 18 to 29 years (59.5% males; mean age 21.4±2 years). Prevalence estimates of depression, anxiety and stress were, respectively, 76.1%, 71.5% and 70.1% for at least mild symptoms, 62.9%, 63.6% and 58.6% for at least moderate symptoms, 35.2%, 40.3%, and 37.7% for at least severe symptoms and 19.7%, 27.5% and 16.5% for at least very severe symptoms. The present estimates of DAS were more prevalent than in previous pre-COVID-19 studies among Bangladeshi university students. Regression analyses with DASS-21-score as a dependent variable revealed associations with factors mostly as hypothesized. The largest effect size on DAS symptoms was related to students' satisfaction with their academic studies during the pandemic. As this survey used cross-sectional and self-reported methods, causality cannot be inferred. Mental health monitoring of students attempting to cope with the impacts of the COVID-19 outbreak may be useful and feasible.

Anxiety and Stress Among Undergraduate Medical Students of Haramaya University, Eastern Ethiopia

BACKGROUND

The perceived stress and anxiety among medical students have bleak consequences on their academic performances, physical, and psychological wellbeing. However, there is a dearth of reliable epidemiological studies in Ethiopia on medical student's experience of stress and anxiety. Therefore, this study was aimed to determine the prevalence and identify factors associated with stress and anxiety among undergraduate medical students of Haramaya University, Eastern Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted from May 13 to June 12, 2019 among 523 participants selected by simple random sampling technique. Data were collected by using structured questionarie through self-adminstered method. Data were entered by Epidata version 3.1 and analyzed using Stastical Package for Social Science(SPSS) version 22. Bivariableand multivariable logistic regression analysis were conducted to identify factors associated with anxiety and stress. Adjusted Odd Ratio (AOR) and 95% Confidence Interval(CI) was used to show the strength of association, and P-value of 0.05 was used to declare statistical significance.

RESULTS

The prevalence of stress was 44% (95% CI: 40.2%-48.2%) and anxiety was 48.9% (95% CI: 44.6%-53.3%) among undergraduate medical students of Haramaya University. Being female (AOR=1.90, 95% CI: 1.28-2.81) and living off-campus (AOR=1.75, 95% CI: 1.12-2.73) were factors significantly associated with both stress and anxiety. Whereas, alcohol use (AOR=2.26, 95% CI: 1.50-3.50) and smoking cigarette (AOR=3.50, 95% CI: 1.58-7.73) linked with stress. The poor psychosocial support (AOR=1.93, 95% CI: 1.20-3.20) was significantly associated with anxiety.

CONCLUSION

Substantially a higher level of stress and anxiety was reported. Being female and living off-campus were linked with both stress and anxiety. Where as, alcohol use and smoking cigarette were associated with stress and poor psychological support was significantly associated with anxiety.

Psychological responses during the COVID-19 outbreak among university students in Bangladesh

Mental health problems in students are considered a public health challenge. We assessed the prevalence of depression, anxiety, and stress (DAS) with the DASS-21, as well as associated factors, among university students in Bangladesh early in the COVID-19 outbreak. We hypothesized high levels of DAS and their associations with previously reported factors (e.g., poor sleep, lack of exercise, heavy internet use) and those linked to disadvantage (e.g., low monthly family income). We also enquired about participants’ satisfaction with their pursuit of their academic studies while living under COVID-19 restrictions. An internet-based survey was conducted during the month of April 2020, involving 3,122 Bangladeshi university students aged 18 to 29 years (59.5% males; mean age 21.4±2 years). Prevalence estimates of depression, anxiety and stress were, respectively, 76.1%, 71.5% and 70.1% for at least mild symptoms, 62.9%, 63.6% and 58.6% for at least moderate symptoms, 35.2%, 40.3%, and 37.7% for at least severe symptoms and 19.7%, 27.5% and 16.5% for at least very severe symptoms. The present estimates of DAS were more prevalent than in previous pre-COVID-19 studies among Bangladeshi university students. Regression analyses with DASS-21-score as a dependent variable revealed associations with factors mostly as hypothesized. The largest effect size on DAS symptoms was related to students’ satisfaction with their academic studies during the pandemic. As this survey used cross-sectional and self-reported methods, causality cannot be inferred. Mental health monitoring of students attempting to cope with the impacts of the COVID-19 outbreak may be useful and feasible.

The prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients: a systematic review and meta-regression

BACKGROUND

Stress, anxiety, and depression are some of the most important research and practice challenges for psychologists, psychiatrists, and behavioral scientists. Due to the importance of issue and the lack of general statistics on these disorders among the Hospital staff treating the COVID-19 patients, this study aims to systematically review and determine the prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients.

METHODS

In this research work, the systematic review, meta-analysis and meta-regression approaches are used to approximate the prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients. The keywords of prevalence, anxiety, stress, depression, psychopathy, mental illness, mental disorder, doctor, physician, nurse, hospital staff, 2019-nCoV, COVID-19, SARS-CoV-2 and Coronaviruses were used for searching the SID, MagIran, IranMedex, IranDoc, ScienceDirect, Embase, Scopus, PubMed, Web of Science (ISI) and Google Scholar databases. The search process was conducted in December 2019 to June 2020. In order to amalgamate and analyze the reported results within the collected studies, the random effects model is used. The heterogeneity of the studies is assessed using the I2 index. Lastly, the data analysis is performed within the Comprehensive Meta-Analysis software.

RESULTS

Of the 29 studies with a total sample size of 22,380, 21 papers have reported the prevalence of depression, 23 have reported the prevalence of anxiety, and 9 studies have reported the prevalence of stress. The prevalence of depression is 24.3% (18% CI 18.2-31.6%), the prevalence of anxiety is 25.8% (95% CI 20.5-31.9%), and the prevalence of stress is 45% (95% CI 24.3-67.5%) among the hospitals' Hospital staff caring for the COVID-19 patients. According to the results of meta-regression analysis, with increasing the sample size, the prevalence of depression and anxiety decreased, and this was statistically significant (P < 0.05), however, the prevalence of stress increased with increasing the sample size, yet this was not statistically significant (P = 0.829).

CONCLUSION

The results of this study clearly demonstrate that the prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients is high. Therefore, the health policy-makers should take measures to control and prevent mental disorders in the Hospital staff.

Prevalence of Anxiety and Associated Factors among Pharmacy Students in Saudi Arabia: a Cross-Sectional Study

Methods

We used a cross-sectional design, and data collection was carried out over a period of two months from September 2018 to November 2018 using paper-based self-administered questionnaires. The General Anxiety Disorder-7 (GAD-7) scale was used to measure and classify anxiety among the study participants.

Results

The prevalence of anxiety among pharmacy students was 49% (83 students); 44 students (25.9%) had mild anxiety, while 24 (14.1%) students had moderate anxiety, and 15 (8.8%) severe anxiety. There were statistically significant differences in anxiety scores according to faculty type (p = 0.2) and nutritional status (p = 0.4).

Conclusion

The findings of this study revealed that half of the pharmacy students suffered from anxiety incidence during their studies at the university. However, the majority of them are experiencing mild to moderate. This may have a significant impact on academic performance and necessitates special attention.

Medical students’ attitudes towards mental health disclosure: a qualitative study

Purpose

In 2013, the General Medical Council conducted research into best practice for supporting medical students with mental health concerns, producing a document outlining University’s duty of care. It also outlined reasons as to why medical students are susceptible to mental illness. The purpose of this paper is to explore what factors affected medical students' disclosure of mental health problems and their help-seeking behaviour today and if these differed from the GMC’s findings from 2013.

Design/methodology/approach

A questionnaire was issued to all University of Glasgow medical student year groups. In total, 72 people responded. All responses were then analysed by the primary researcher using Mayring’s six-step approach of systematic, rule guided qualitative text analysis.

Findings

Four main barriers to disclosure were revealed: fear of repercussions, medical student “expectations”, judgement and lack of support. Respondents feared being deemed unfit to practise, displaying “weakness” or being treated differently. They believed support provided was inadequate or inaccessible. Less than half felt the Medical School made mental health support easily available and only 11% were even aware of the GMC document. Respondents believed medical students were psychologically vulnerable due to Medical School environment, work load, “expectations” and course content. They perceived the Medical School was “a pressure cooker” for mental health problems and yet student well-being was not prioritised.

Originality/value

The research highlighted some key areas that universities should address, such as promoting support services available, recognising the unique stresses of the medical curriculum and the need for provision of resources that can be accessed without fear, stigmatisation or uncertainty.

The magnitude of COVID-19 related stress, anxiety and depression associated with intense mass media coverage in Saudi Arabia

The Coronavirus Disease 2019 (COVID-19) has resulted in catastrophic consequences in many aspects of life; including negative psychological effects. We aimed to assess the mental health status of a group of Saudi population during this pandemic. Also, we aimed to assess the effect of the intensive media coverage of the pandemic news on mental health status. A questionnaire was distributed online to test depression, anxiety, and stress (using the DASS-21 scale) and their relationship to certain variables. A total of 215 respondents were included. Higher mental health prevalence rates were reported in non-Saudi participants compared to Saudi ones (i.e., 50.74% vs. 30.40%; 34.23% vs. 13.51% and 59.70% vs. 27.70%; for depression, anxiety and stress, respectively). About 55.8% of the participants felt the extensive coverage in the media of COVID-19 news, which caused higher mental sufferings. Higher mental health prevalence rates were reported in females compared to males participants (i.e., 56.97% vs. 23.25%; 30.23% vs. 13.17% and 54.65% vs. 26.35%; for depression, anxiety and stress, respectively). Reasonable following of the COVID-19 news; and less exposure to the pandemic information could help in reducing the mental health issues related to the ongoing pandemic. Special care and attention should be paid to females and younger people who seem to be particularly affected during the era of COVID-19.

Prevalence of stress, anxiety and depression due to examination in Bangladeshi youths: A pilot study

An estimated 25% people suffer from mental health disorders worldwide. Almost 7 million suffer from anxiety and depression in Bangladesh. There are several factors that can cause stress among youths, both academic and non-academic, ranging from socioeconomic, environmental, cultural and psychological attributes. However, these are not widely researched in Bangladesh. This study identified the factors that affect the mental health of students due to examinations in Bangladesh, particularly the socio-demographic, lifestyle and psychological factors. An online cross-sectional survey was conducted on May 2020 with a sample size of 210 tertiary level students in Dhaka. A modified DASS-21 was used to measure stress, anxiety and depression scores related to examination. Binary logistic model showed that those who lived with family, spent time with parents, had regular sufficient (self-assessed) sleeps and consumed balanced (self-assessed) diets had significantly lower stress, anxiety, and depression. Balanced lifestyle with greater social bonding might help to better equip youths to reduce stress, anxiety, and depression during examination, which could be an avenue for future intervention studies.

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

Background

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

Methods

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

Results

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

Conclusion

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

Factors Associated with Acculturative Stress among International Medical Students

There is an array of reasons why acculturation can be stressful, and acculturative stress can be triggered by a plethora of factors. The aim of the study was to identify factors associated with acculturative stress among international students enrolled in a public medical university from Romania. 265 students were included in the research. Sociodemographic, academic, and family data, comfortability with living in study city, satisfaction with administrative staff, colleagues, and professors and Acculturative Stress Scale for International Students were gathered. Data have been processed using SPSS Statistics v23.0.0 for MAC.OSX. Female students are more prone to experience homesickness and stress due to change compared to male students. International students with Romanian origins had lower scores on perceived hate and stress due to change/culture shock compared to those with no Romanian origins. Students with relatives or friends enrolled in the same university had significantly lower levels of acculturative stress, perceived discrimination, perceived hate/rejection, and general/nonspecific concerns. Age and year of study are associated with homesickness and stress due to change/culture shock. The existence of factors associated with acculturative stress demand institutional, social, and psychological support for international students.

Exploration of mental health problems in association with health-promoting lifestyle profile in Iranian medical students: A cross-sectional study

OBJECTIVE

The aim was to explore the relationship between mental health problems (MHPs) and health-promoting lifestyle (HPL) in the medical students.

METHODS

This cross-sectional study was carried out on medical students in 2017 at Semnan University of Medical Sciences applying a stratified random sampling. The Symptom Checklist-25 and the HPL profile scales were used. Logistic regression models were used to analysis.

RESULTS

Of the participants, 84 were male and 148 were female. The mean age was 22.69 years (±2.42). Most students (95.3%) were single and 40.1% were in the preclinical stage. The mean MHP score was 44.14 (±13.99), and 3% were in the severe category. The mean HPL score was 104.88 (±16.84); 95.7% and 4.3% of them had average and satisfactory lifestyles, respectively. The MHP score of the female (P < 0.001), younger (P < 0.001), single (P = 0.045), preclinical (P < 0.001), and who were away from home (P = 0.009) were significantly higher. The HPL score of female (P < 0.001), older (P = 0.041), and married students (P = 0.028) were significantly higher. The female gender (odds ratio [OR] = 4.45, P < 0.001) and studying in the clinical level (OR = 0.30, P < 0.001) were the most important associated factors with MHP. Adjusting for them, there was a significant relationship between an increase in the HPL score and a decrease in the likelihood of MHP (OR = 0.96, P < 0.001).

CONCLUSIONS

The mental health of medical students was shown to be in association with lifestyle independent of other important determinants, including gender and academic level. It seems that modifying the lifestyle to a healthier way can improve students' mental health.

Prevalence and Factors Associated with Depression and Anxiety Among First-Year University Students in Bangladesh: A Cross-Sectional Study

University students, especially those in their first year, not only face challenges related to their personal life but also to their academic performance. Such unfavorable conditions predispose them to psychological illnesses such as depression and anxiety. The present study surveyed first-year undergraduate students to assess the prevalence of depression and anxiety and their potential underlying reasons. A cross-sectional questionnaire was conducted with 400 first-year university students aged between 18 and 23 years residing at Jahangirnagar University (in Bangladesh). After providing informed consent, the participants completed a survey examining socio-demographic variables and behavioral variables, along with the PHQ-9 scale, and the GAD-7 scale. Binary logistic regression was performed to determine the significant associations between the variables under examination. The prevalence rates of moderate to extremely severe levels of depression and anxiety were 69.5% and 61%, respectively, with no significant gender differences. The main risk factors for depression were unsatisfactory sleep quality and lack of physical exercise. The main risk factor for anxiety was excessive internet use. The prevalence of depression and anxiety levels among first-year university students was high in the present study and appears to confirm the notion that first-year university students are a vulnerable group for mental illnesses. The findings suggest the need for intervention programs, alongside adequate and appropriate supportive services for Bangladeshi university students.

An Eight-Week, Web-Based Mindfulness Virtual Community Intervention for Students' Mental Health: Randomized Controlled Trial

BACKGROUND

Innovative interventions are needed to address the increasing mental health needs of university students. Given the demonstrated anxiolytic and antidepressant benefits of mindfulness training, we developed an 8-week, Web-based Mindfulness Virtual Community (MVC) intervention informed by cognitive behavioral therapy (CBT) constructs.

OBJECTIVE

This study investigated the efficacy of the MVC intervention in reducing symptoms of depression, anxiety, and stress among undergraduate students in Toronto, Canada. The secondary outcomes included quality of life, life satisfaction, and mindfulness.

METHODS

The first 4 weeks of the full MVC intervention (F-MVC) comprised: (1) 12 video-based modules with psycho-education on students' preidentified stressful topics and topically applied mindfulness practice; (2) anonymous peer-to-peer discussion forums; and (3) anonymous, group-based, professionally guided, 20-min live videoconferences. The second 4 weeks of F-MVC involved access only to video-based modules. The 8-week partial MVC (P-MVC) comprised 12 video-based modules. A randomized controlled trial was conducted with 4 parallel arms: F-MVC, P-MVC, waitlist control (WLC), and group-based face-to-face CBT; results for the latter group are presented elsewhere. Students recruited through multiple strategies consented and were randomized: WLC=40; F-MVC=40, P-MVC=39; all learned about allocation after consenting. The online surveys at baseline (T1), 4 weeks (T2), and 8 weeks (T3) included the Patient Health Questionnaire-9 item, Beck Anxiety Inventory, Perceived Stress Scale, Quality of Life Scale, Brief Multi-Dimensional Students Life Satisfaction Scale, and Five-Facet Mindfulness Questionnaire. Analyses employed generalized estimation equation methods with AR(1) covariance structures and were adjusted for possible confounders (gender, age, birth country, paid work, unpaid work, physical activities, self-rated health, and mental health counseling access).

RESULTS

Of the 113 students who provided T1 data, 28 were males and 85 were females with a mean age of 24.8 years. Participants in F-MVC (n=39), P-MVC (n=35), and WLC (n=39) groups were similar in sociodemographic characteristics at T1. At T3 follow-up, per adjusted comparisons, there were statistically significant reductions in depression scores for F-MVC (score change -4.03; P<.001) and P-MVC (score change -4.82; P<.001) when compared with WLC. At T3, there was a statistically significant reduction in anxiety scores only for P-MVC (score change -7.35; P=.01) when compared with WLC. There was a statistically significant reduction in scores for perceived stress for both F-MVC (score change -5.32; P<.001) and P-MVC (score change -5.61; P=.005) compared with WLC. There were statistically significant changes at T3 for quality of life and mindfulness for F-MVC and P-MVC vs WLC but not for life satisfaction.

CONCLUSIONS

Internet-based mindfulness CBT-based interventions, such as F-MVC and P-MVC, can result in significant reductions in symptoms of depression, anxiety, and stress in a student population. Future research with a larger sample from multiple universities would more precisely test generalizability.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number ISRCTN92827275; https://www.isrctn.com/ISRCTN92827275.

Prevalence of alexithymia and associated factors among medical students at King Abdulaziz University: a cross-sectional study

BACKGROUND

Medical students are at higher risk of developing alexithymia due to the nature of their studies.

OBJECTIVES

Determine the prevalence of alexithymia and potential risk factors among medical students in Saudi Arabia.

DESIGN

A cross-sectional analytic study.

SETTINGS

University medical school.

PATIENTS AND METHODS

An institutional cross-sectional survey of medical students was conducted using the Toronto Alexithymia Scale (TAS-20) to assess the prevalence of alexithymia and potentially associated factors (gender, parental marital status, grade point average, status of accommodations, smoking status, year of study, childhood abuse, a history of mental illness, and physical activity).

MAIN OUTCOME MEASURES

Gender, parental marital status, grade point average, status of accommodations, smoking status, year of study, childhood abuse, a history of mental illness, and physical activity.

SAMPLE SIZE

347.

RESULTS

The prevalence of alexithymia among medical students was 49% (95% confidence interval [43.8-54.2]). A binary logistic regression model showed significant associations between alexithymia and academic year of study (lower risk of alexithymia in the clerkship (5th, 6th years); odds ratio [OR]: 0.43, 95% CI: 0.26-0.72), smoking (OR: 3.52, 95% CI: 1.60-3.34), grade point average (lowest; OR: 10.44, 95% CI: 4.24-25.77), history of childhood abuse (OR: 2, 95% CI: 1.20-8.77), and history of psychiatric illness (OR: 14.40, 95% CI: 4.76-21.06).

CONCLUSION

Almost half of the medical students suffer from alexithymia. Increasing the awareness about alexithymia among students and directing them where to seek help would facilitate the management of these problems.

LIMITATIONS

Limited only to medical students from the second year to the sixth year in a single medical college, which affects generalizability. The cross-sectional design might have also limited generalizability.

CONFLICT OF INTEREST

None.

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

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

Gender Differences and Prevalence of Mental Health Problems in Students of Healthcare Units

The aim of the present was to assess and compare the mental health of male and female healthcare students in a Health University of Karachi, Pakistan. A cross-sectional study was conducted for which questionnaire was designed along the standard scoring scales of depression (PHQ-9), anxiety (GAD-7) and phobia (IAPT) completed by 300 enrolled students. Females (52%) of the medical institute suffered from mild to moderately-severe depression in contrast to the males (33%). Females were found to be affected by mild anxiety and phobia (42.7 and 26% respectively) exceeding the male population (27.3 and 15.3% respectively). However, severe depression or anxiety was not observed in either gender groups significantly, suggesting a healthy mental picture of these medical students. It can be concluded that health care students in modern upgraded education systems, in contrast to evidence from literature, have been able to adopt better coping mechanisms for maintaining their mental health.

Perceived impact of contextual determinants on depression, anxiety and stress: a survey with university students

Background

Young adults starting college or university education encounter multiple stressors related to transitional life-stage and novel environments. Current studies reveal high rates of symptoms related to common mental health problems like depression, anxiety and stress. However, limited knowledge exists on the determinants on these problems among Canadian students. The primary aim of the study was to investigate the impact of contextual determinants, as perceived by students, on self-reported mental health, and how these impacts varied by depression, anxiety and stress.

Methods

A cross-sectional survey was conducted with students attending a large university in Toronto, Canada. Participants completed a self-administered online questionnaire as part of a larger project. The questions asked about contextual determinants related to personal, interpersonal, family, social, socio-economic and political factors along with levels of depression, anxiety and stress as measured by Patient Health Questionnaire-9, Beck Anxiety Inventory and Perceived Stress Scale.

Results

A total of 148 students completed the questionnaire (37 males and 111 females) with an age range of 19–54 years (median 22, IQR 21–24.8). English was reported as first language by 62.8% while 34.5% self-identified as white and 58.1% reported being born in Canada. Overall, 39.5% reported symptoms of moderate to severe depression, 23.8% reported moderate–severe anxiety and 80.3% reported moderate–severe levels of perceived stress, with no significant differences between males and females. In the final multivariate analysis, variables significantly associated with depression were grade-point-average (aOR 2.46, 95% CI 1.017–5.97), family factors (aOR 3.46, 95% CI 1.50–7.94), social factors (aOR 3.24, 1.30–8.1), self-rated health (aOR 0.34, 95% CI 0.14–0.82) and political factors (aOR 0.40, 95% CI 0.16–0.97). Anxiety was significantly associated with family factors (aOR 2.79, 1.09–7.18), socioeconomic factors (aOR 2.59, 95% CI 1.05–6.42) and age (aOR 0.33, 95% CI 0.11–0.98). The significant factors for stress were grade-point-average (aOR 2.41, 1.01–5.75) and social factors (aOR 3.87, 95% CI 1.59–9.43).

Conclusion

The study found strong to moderate impact of several determinants on depression, anxiety and stress. The results suggest a need to address a variety of factors affecting students’ mental health.

Trial registration Parent trial: http://www.isrctn.com/ISRCTN92827275

Correlation between Internet addiction, depression, anxiety and stress among undergraduate medical students in Azad Kashmir

Objective:

To find out the correlation between internet addiction and depression, anxiety, and stress among undergraduate medical students in Azad Kashmir.

Methods:

A cross-sectional study including 210 undergraduate medical students (first to the fifth year) was done in Poonch Medical College, Azad Kashmir. The data collection tools were DASS21 questionnaire and Young’s internet addiction questionnaire. Spearman rank correlation test was done to see the correlation between internet addiction and depression, anxiety, and stress. Data were analyzed by SPSS v23 at a 95% confidence interval.

Results:

A very high prevalence (52.4%) of moderate to extremely severe internet addiction was observed among the respondents. The mild positive correlation between internet addiction and depression was identified (p <.001) and similar type of correlation was observed between internet addiction and stress (p .003). However, anxiety and internet addiction were not significantly correlated. The prevalence of anxiety and depression among the males were higher than the females, whilst the stress level was almost the same across gender.

Conclusion:

Internet addiction has been found to be associated with various psychiatric diseases. In this study, we also observed such correlation. We have also observed a very high level of internet addiction among medical students. The prevalence of internet addiction may further increase in the coming years as the internet will become more cheap, available and include more high quality psychologically addictive contents.

Mean Scores of Depression, Anxiety and Stress in Iranian University Students Based on DASS-21: A Systematic Review and Meta-analysis

Background and aims: Depression is the most common psychiatric disorder, and students are more predisposed to depression than other populations. This meta-analysis was conducted to estimate the mean depression score in Iranian students based on DASS-21. Methods: The search was carried out using keywords Depression, Student, DASS-21 and Iran in domestic databases, including SID, Medlib, IranMedex, Irandoc, and Magiran. Data were analyzed using a meta-analysis (random effects model). The heterogeneity of studies was studied using the I2 index. Data were analyzed using the Stata software version 11. DASS-21 had been used in all reviewed studies. Results: The sample size was 3229 people included in 17 studies. The mean depression score in Iranian students based on DASS-21 was 9.30 (95% CI: 12.57-6.03), 8.90 in female students (95% CI: 4.50-13.29) and 8.45 in male students (95% CI: 4.03-12.86). The mean scores of anxiety and stress in students were 8.58 (95% CI: 5.95-12.86) and 9.91 (95% CI: 11.28-8.54), respectively. Conclusion: The mean depression score is higher in female students than in male students, and the mean score of stress is slightly higher than those of anxiety and depression.

Psychological Implications of Unemployment Among Bangladesh Civil Service Job Seekers: A Pilot Study

Background: Recent trends suggest that university graduates seeking jobs are more susceptible to common mental disorders, such as depression, anxiety, or stress. However, the mental health issues among unemployed graduates has not been explored in Bangladesh yet. Aims: This study aimed to assess for the first time the prevalence and associated risk factors of depression, anxiety, and stress among Bangladesh Civil Service (BCS) job seekers. Three hundred four graduates residing in Rajshahi, Bangladesh, who were preparing to attend the 40^th BCS examination, the most sought-after employment opportunity in the country, were surveyed. Methods: Measures included socio-demographics, field of study, and career-related variables, and the Bangla Depression Anxiety Stress Scale (DASS-21). Chi-square test, Fisher exact test, and binary logistic regression with "depression," "anxiety," and "stress" as the dependent variables were carried out to identify the factors associated with these. Results: Overall, the prevalence of moderate to extremely severe depression, anxiety, and stress was 49.3%, 53.6%, and 28.3%, respectively, with no detectable differences between genders. Insecurity related to a BCS job (OR = 0.41; CI = 0.26-0.65, p < 0.001; ref: job insecurity), family and social pressure to obtain a BCS job (OR = 4.58; CI = 1.67-12.56, p < 0.001), and stress (OR = 8.33; CI = 4.47-15.51, p < 0.001) emerged as independent predictors for depression. In addition, having part-time job was associated with anxiety (OR = 2.38; CI = 1.34-4.23, p = 0.003), and security in a BCS job and serving the nation through this job were negatively associated with stress (OR = 0.59; CI = 0.35-0.98, p = 0.042 vs. OR = 0.59; CI = 0.36-1.00, p = 0.05). Conclusion: The relatively high rates of depression, anxiety, and stress among graduate job seekers should prompt implementation of market force initiatives that incorporate interventions related to the major risk factors uncovered herein.