Mental Health Among Medical Students During COVID-19: A Systematic Review and Meta-Analysis

Psychological wellbeing of Italian students and clinical assessment tools at university counseling services during the COVID-19 pandemic: a systematic review

Introduction

The COVID-19 pandemic brought about unprecedented problems for contemporary society. Among the numerous challenges faced following the spread of the virus, the need to provide assessment tools and remote psychological assistance certainly deserves particular attention. Indeed, this profound paradigm shift in psychological assessment and care occurred during a period of fragility for people already suffering from the restrictions imposed to stem the spread of the virus. One population particularly affected by the pandemic was students, including university students. The latter faced the pandemic in a particularly critical formative period.

Methods

For these reasons, our systematic review has two main objectives: (i) identify the assessment tools and psychological dimensions most used/investigated during the pandemic in Italian university students; (ii) systematize and deepen our knowledge about the impact of the pandemic on the psychological wellbeing of Italian university students. Our search used PRISMA 2020 guidelines on Web of Science, Pubmed, Scopus, and EBSCOHost.

Results

The results indicated that the psychological dimensions most investigated in university students during the pandemic were anxiety and depression. At the same time, the most used assessment instruments were the State-Trait Anxiety Inventory (STAI-Y) and the Beck Depression Inventory-II (BDI-II). Furthermore, it is clear from the results that the pandemic has harmed the psychological wellbeing of university students. Finally, we dedicated a section to discuss the interventions implemented by university counseling services during the pandemic.

Discussion

This review could improve the work of university counseling services in this post-pandemic period and contribute to developing specific screening and assessment programs for future emergencies.

Well-being among university students in the post-COVID-19 era: a cross-country survey

University students have to handle crucial challenges for their future lives, such as succeeding in academic studies and finding attachment figures. These processes could potentially involve their well-being and mental health, with possible sociocultural differences based on the country of study. In order to explore such potential differences, a cross-sectional, multi-center survey was performed involving students from the University of Torino (Italy), Sevilla (Spain), and Lusòfona (Portugal). The survey, conducted from May to November 2023, investigated students' demographic and educational details, socioeconomic status, social support, mental health, academic environment, perceived COVID-19 pandemic impact, and future plans. Demographic profiles showed a predominance of female participants and straight sexual orientation, followed by bisexuality. Italian students showed the lowest levels of mental well-being and the highest rates of mental problems (anxiety and depression) and suicidal risk across the three countries despite the relatively similar profiles of social support. The prevalence of the students' confidence in their professional future is higher in Spain than in Italy and Portugal. This study provides a comprehensive examination of university students' mental health and well-being in three Southern European countries, addressing the major mental health challenges among university students and offering valuable insights for public health purposes.

COVID-19: Medical education from the point of view of medical students using the participatory Delphi method

BACKGROUND

The COVID-19 pandemic has prompted a transformation of medical training. Although there were obvious medical education and social interaction challenges, e-learning presented some advantages, which may have generated medical curricula innovation and adjustments to novel technological methodologies. This study aims to generate consensuses among medical students regarding medical education provided during the pandemic in the resource-limited context of a Global South university.

METHODS

The implementation of a participatory Delphi method included a recruitment campaign, training, constitution of Delphi panels and questions, and development of the Delphi exercises. Students from the second to the sixth year of medicine of a university in Quito, Ecuador, constituted two Delphi panels, developed questions about the education received during the pandemic, and answered them over 3.5 rounds.

FINDINGS

Twenty-two medical students participated in the Delphi exercises about their perception of medical education during the COVID-19 pandemic. The analysis consisted of a total of 22 Delphi questions divided into five distinct categories: adaptations and innovations, curriculum and assessment changes, virtual clinical practice, time management, and mental health. The authors established high, medium, and low consensuses for analysis.

CONCLUSIONS

Consensuses were reached based on students' academic year and focused on the changes in lecture delivery, the usage of new technologies, patient care skills, the impact of the educational routine, and the mental health of the COVID-19 pandemic. The way the pandemic affected medical education in the Global South set the stage for the need for a comprehensive review of tools, skills, and curricula for students from culturally diverse backgrounds. This study offers a highly replicable methodology to generate consensuses and introduce students to academic research.

Medical education during the coronavirus disease 2019 pandemic: an umbrella review

Background

The coronavirus disease 2019 (COVID-19) pandemic affected many aspects of lifestyle and medical education during the recent years. We aimed to determine the impacts of COVID-19 pandemic on medical education to provide an overview of systematic reviews on it.

Methods

We searched PubMed, Scopus, Web of Science, Cochrane library, Google Scholar, and medRxiv, with the following keywords: "SARS-CoV-2," "COVID-19," "Medical Education," "E-learning," "Distance Education," "Online Learning," "Virtual Education," "systematic review," and "meta-analysis," up to 15 April 2023. Studies were included if they were systematic reviews assessing the impacts of the COVID-19 pandemic on medical sciences students. We used A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) checklist for quality assessment.

Results

A total of 28 systematic reviews were included. The eligible reviews included between five and 64 primary studies, ranging from 897 to 139,381 participants. Technology-enhanced learning and simulation-based learning were the most frequently used strategies. Virtual teaching has several drawbacks like technical difficulties, confidentiality problems, lower student involvement, connection problems, and digital fatigue. The overall satisfaction rate for online learning was above 50%. Also, favorable opinions about perception, acceptability, motivation, and engagement were reported. The quality of 27 studies were critically low and one was low.

Conclusion

There were reduced clinical exposure and satisfaction for medical students during the pandemic. Further high-quality systematic reviews are required.

The prevalence of depression, anxiety, and sleep disorder among dental students: A systematic review and meta-analysis

BACKGROUND

Despite the increasing concern, the literature lacks a comprehensive synthesis of the prevalence of depression, anxiety, and sleep disturbances among dental students.

METHODS

We conducted a systematic review following Cochrane Manual for Systematic Reviews of Interventions and PRISMA guidelines. Our search, spanning databases like Medline, Web of Science, and Scopus, covered data until June 5, 2023. A random effect model was utilized for the meta-analysis.

RESULTS

From 508 initially identified articles, 45 studies met eligibility criteria. The pooled prevalence of depression, anxiety, and sleep disorders among dental students was estimated as follows: depression [38%, 95% confidence interval (CI): 32%-44%; I2 = 98%], anxiety [48%, 95% CI: 41%-55%; I2 = 97.7%], and sleep disorders [31%, 95% CI: 24%-38%; I2 = 85.7%]. Subgroup analyses based on geographical regions and assessment scales revealed significant between-subgroup differences. Meta-regression identified associations between the prevalence of depression and the year of publication and between the prevalence of anxiety and total sample size, participant age, and year of publication. Publication bias assessments demonstrated a lack of significant bias, strengthening the validity of the findings.

CONCLUSIONS

The prevalence of depression, anxiety, and sleep disturbances in dental students is significant. This study highlighted the need for targeted interventions and support systems within dental education to alleviate the mental health challenges students face, ultimately ensuring their well-being and competence as future healthcare providers. Further research should explore the effectiveness of interventions in this population.

Exploring access to support services for medical students: recommendations for enhancing wellbeing support

BACKGROUND

Medical students have reported facing unique challenges in their academic journey that can have a significant impact on their mental health and wellbeing; therefore, their access to support services and wellbeing resources has been deemed crucial for dealing effectively with the various challenges they tend to face. While previous research has highlighted certain barriers affecting medical students' help-seeking and access to wellbeing support more generally, there is a pressing need for more in-depth research into the factors that may hinder or facilitate medical students' acceptability and uptake of the wellbeing resources available to them within institutional contexts. The current study aims to explore students' perceptions and utilization of wellbeing interventions and welfare resources within a medical school setting, as well as the factors influencing their help-seeking attitudes or behaviours. Additionally, it seeks to instigate medical students' deeper reflections on potential enhancements that could be applied to wellbeing resources so that they are better suited to address their needs.

METHODS

This study employed a qualitative design, involving semi-structured interviews and a series of focus groups with medical students at the University of Nottingham (UK). Post-interview, focus groups were deemed necessary to gain deeper insights into emerging findings from the interviews regarding students' views on wellbeing support services. Qualitative data from the interviews was subjected to thematic analysis while a hybrid thematic analytic approach was applied for the focus group data in order to allow for both pre-defined themes from the interviews and newly emerging patterns to be identified and analysed in a combined manner.

RESULTS

Twenty-five participants took part in the semi-structured interviews and twenty-two participants were recruited in a total of seven focus groups. Thematic analysis findings identified several key barriers to medical students' accessing wellbeing resources, including difficulties in finding relevant information, lengthy processes and difficulties receiving prompt help in urgent situations, learning environment issues, confidentiality concerns, and stigma around mental health. Student suggestions for the enhancement of wellbeing provision were centered around proposed improvements in the format that the relevant information was presented and in the structure underlying the delivery of support services.

CONCLUSION

The study findings shed light on multi-faceted factors contributing to medical students' challenges in accessing support services; and provided a deeper understanding of medical students' wellbeing needs through a consolidation of their recommendations for the implementation of practical steps to address these needs. These steps can potentially inform key medical education stakeholders so that they can actively and proactively foster more supportive environments that may help improve medical students' help-seeking, as well as their acceptability and uptake of wellbeing services.

Medical student wellbeing during COVID-19: a qualitative study of challenges, coping strategies, and sources of support

BACKGROUND

Medical students face challenges to their mental wellbeing and have a high prevalence of mental health problems. During training, they are expected to develop strategies for dealing with stress. This study investigated factors medical students perceived as draining and replenishing during COVID-19, using the 'coping reservoir' model of wellbeing.

METHODS

In synchronous interactive pre-recorded webinars, 78 fourth-year medical students in the UK responded to reflective prompts. Participants wrote open-text comments on a Padlet site. Responses were analysed using reflexive thematic analysis.

RESULTS

Analysis identified five themes. COVID-19 exacerbated academic pressures, while reducing the strategies available to cope with stress. Relational connections with family and friends were affected by the pandemic, leading to isolation and reliance on housemates for informal support. Relationships with patients were adversely affected by masks and telephone consultations, however attending placement was protective for some students' wellbeing. Experiences of formal support were generally positive, but some students experienced attitudinal and practical barriers.

CONCLUSIONS

This study used a novel methodology to elicit medical students' reflections on their mental wellbeing during COVID-19. Our findings reinforce and extend the 'coping reservoir' model, increasing our understanding of factors that contribute to resilience or burnout. Many stressors that medical students typically face were exacerbated during COVID-19, and their access to coping strategies and support were restricted. The changes to relationships with family, friends, patients, and staff resulted in reduced support and isolation. Recognising the importance of relational connections upon medical students' mental wellbeing can inform future support.

Preferential Impairment of Auditory Working Memory in Long COVID: An Observational Study of Undergraduate Medical Students

Background Long COVID is a multisystem condition with prolonged symptoms that develop after recovery from the COVID-19 infection, often following a mild infection. Few studies have been conducted on cognitive function among medical students after recovery from mild COVID-19. This study aimed to assess the attention span and working memory (WM) capacity of medical students after six months of recovery. Methods A cross-sectional study was performed on 17 young adult medical students who had suffered a mild COVID-19 infection at least six months prior. Eighteen age-matched healthy medical students served as the controls. Audio-visual WM tasks and attention spans were assessed using computerized software for both the cases and controls. Results The mean ages of the case and control were 19.67±1.6 and 20.0±1.2 years, respectively. The most common symptoms among cases were fatigue (33%), weight loss (26%), and nasal stuffiness (13%). The overall proportion of correct responses across all visual and auditory WM tasks (p=0.085) and reaction times (p=0.609) did not differ between the cases and controls. However, the overall target hit rate of the auditory WM task was significantly lower in cases than in controls (p=0.002). This difference was not observed in the visual WM task (p=0.374). Conclusion In the current study, the overall WM functions (visual and auditory combined) and attention span did not differ between cases and controls. However, auditory WM performance was significantly impaired in patients compared with controls, indicating selective impairment of auditory WM in patients with long COVID.

Medical students on the COVID-19 frontline: a qualitative investigation of experiences of relief, stress, and mental health

Objective

During the early stages of the COVID-19 pandemic, medical students were abruptly removed from clinical rotations and transitioned to virtual learning. This study investigates the impact of this shift on students' wellbeing and preparedness for advanced training.

Methods

Through qualitative research methods, including semi-structured interviews, the experiences of medical students working on the COVID-19 frontline were explored.

Results

The comprehensive findings of the study shed light on the profound emotional journey that medical students embarked upon during the relentless public health crisis. Within the chaos and overwhelming demands of the pandemic, medical students discovered a profound sense of purpose and fulfillment in their contributions to the welfare of the community. Despite the personal sacrifices they had to make, such as long hours, limited social interactions, and potentially risking their own health, students reported feelings of relief and gratitude.

Conclusion

Tailored support systems for medical students' wellbeing are crucial for improving healthcare delivery during crises. Medical schools should adopt a holistic curriculum approach, integrating interdisciplinary learning and prioritizing student wellbeing. Recognizing the pandemic's impact on students and implementing targeted support measures ensures resilience and contributes to an improved healthcare system.

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

BACKGROUND

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

PRISMA/PROSPERO

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

Find Joy in Sorrows: The Role of Hope in Buffering the Psychological Impact of COVID-19 on Chinese University Students in Hong Kong

The global coronavirus disease 2019 (COVID-19) crisis has exerted significant psychological impacts on university students who have faced drastic changes in the learning mode and suspension of classes. Despite these challenges, many students maintained subjective well-being. In this study, we examined the role of "hope" as a potential protector to maintain their subjective well-being when facing adversity during this global crisis. Specifically, we explored the mediating role of two hope components (agency thinking and pathways thinking) on the association of positive emotions and life satisfaction among Chinese university students. We conducted an online survey at a local university and recruited a total of 315 undergraduates from the humanities, creative arts, and social sciences programs through convenience sampling. Participants confirmed their informed consent and completed a set of self-administered questionnaires measuring positive emotions, hope, life satisfaction, and demographic variables. The results of mediation testing indicated that, during a global crisis such as COVID-19, positive emotions indirectly influenced life satisfaction through agency thinking rather than pathways thinking. The findings highlight the importance of agency thinking among Chinese university students in adverse situations and provide valuable insights for psychological interventions during a crisis. The article concludes by discussing possible explanations and implications of the findings in a post-pandemic world.

Chronic stress and turnover intention of resident physicians after experiencing COVID-19

BACKGROUND

Previous studies have explored the stress and turnover intention of healthcare workers, but as important backup talents in the healthcare system, resident physicians have received little attention from researchers, especially after experiencing COVID-19. Therefore, this study aims to evaluate the chronic stress and turnover intention of resident physicians after experiencing COVID-19.

METHODS

From June to August 2022, we conducted a questionnaire survey on resident physicians in the Children's Hospital of Hebei Province through the online platform (Wenjuanxing) to evaluate their chronic stress and turnover intention after experiencing COVID-19. For the collected data, we used frequency and percentage to make the statistical description, the Chi-square test to make a univariate analysis on the scores of chronic stress and turnover intention scale, and binary logistic regression analysis to explore the influencing factors of turnover intention.

RESULTS

Out of 143 respondents, we finally received 127 questionnaires, with a response rate of 88.81%. Among 127 respondents, 80.31% of resident physicians experienced varying degrees of chronic stress (mild: 36.22%, moderate: 35.43%, severe: 8.66%), and 74.80% of resident physicians showed varying degrees of turnover intention (mild: 23.62%, moderate: 37.79%, severe: 13.39%). Moreover, age (OR = 0.772, P = 0.042), identity (OR = 8.648, P = 0.021), and chronic stress levels (mild: OR = 6.938, P = 0.003; moderate: OR = 44.049, P < 0.003; severe: OR = 46.141, P = 0.004) can significantly affect turnover intention.

CONCLUSION

In this study, we reported a relatively high proportion of resident physicians with high chronic stress and high turnover intention after experiencing COVID-19. We suggest that the relevant departments should pay more attention to the resident physicians' group and formulate corresponding measures to solve the problems faced by the resident physicians and ensure the stability of the health human resources.

Comparison of prevalence of depression symptoms and history of suicidality in students of medical schools and other study programmes of Charles University

OBJECTIVES

Medical students represent a group of undergraduate students who are exposed to specific risk factors that may lead to the onset of depression and the occurrence of suicidal ideation. The aim of the article is to present information about the prevalence of symptoms of depression in medical students of different faculties at Charles University, Prague, compared to other students of this university.

METHODS

We used a standardized Beck's Inventory scale II (BDI-II) with added specific questions electronically distributed to undergraduate students of the full-time forms of study of all faculties of Charles University. The data collection was anonymous and took place in December 2020. The data were statistically assessed in relation to the occurrence of moderate and severe depression using univariate and multivariable analysis.

RESULTS

Moderate and severe depression rate (MSDR) was recorded in 19.6% of medical school students, who returned the questionnaire, compared to 23.4% of students of other faculties (p = 0.001) of Charles University in Prague. Differences in MSDR among students of different faculties of medicine of Charles University were not statistically significant. The total number of previous suicide attempts among respondents was 542, of which 115 were medical students, with the lifetime prevalence of suicide attempts among all students participating in the study 6.96% and in medical students of Charles University 5.73%.

CONCLUSIONS

The findings of our study highlight the need for systematic, accessible and timely assistance to university students, both in terms of prevention and early intervention, which can take place at the university level and within the mental healthcare system.

Association of Emotional Self-Regulation with Psychological Distress and Positive Functioning Dimensions in Brazilian University Students during the COVID-19 Pandemic

Emotional self-regulation is a relevant factor for human development capable of minimizing emotional difficulties in the face of adverse events, as was particularly useful during the COVID-19 pandemic. The present study aimed to evaluate emotional self-regulation in Brazilian health science university students and its relationship with positive psychology constructs (subjective well-being, hope, optimism, spirituality, self-compassion, and self-efficacy) and psychological distress (depression, anxiety, and stress). This was a prospective, cross-sectional, observational, analytic study of 1062 Brazilian undergraduate students with data collected using self-administered online questionnaires. Students in the first years of their undergraduate degree programs had significantly higher dysregulation scores than those in the final years. Multiple linear regression yielded a model that explained 71.8% of the variation in emotion dysregulation. The correlations of emotion dysregulation were significant and strong, scoring negatively with self-compassion, optimism, and subjective well-being and positively with psychological distress.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

UK medical students' mental health during the COVID-19 pandemic: a qualitative interview study

OBJECTIVES

To understand the impact of COVID-19 on medical students with mental health problems.

DESIGN

Qualitative study employing in-depth semistructured interviews with medical students which were analysed using reflexive thematic analysis.

SETTING AND PARTICIPANTS

A purposive sample of 20 students originating from 8 geographically spread UK medical schools were selected, representing various mental health issues and demographic characteristics.

RESULTS

Three themes were identified: (1) medical schools' response to the pandemic-schools increased awareness-raising of mental health support and increased flexibility in regards to academic requirements; (2) disruption to the medical degree-COVID-19 brought change and uncertainty to medical education and missed learning opportunities reduced students' confidence and (3) psychological consequences of the pandemic-COVID-19 had a negative impact on mental health, most notably raising stress and anxiety but also triggering new or existing conditions.

CONCLUSIONS

While there were many negative aspects of the pandemic for medical students experiencing mental ill health, there were also positives. Students felt that the increased focus on mental health support during the pandemic had reduced stigma towards mental health. Given stigma has been identified as a key barrier for help-seeking in medical students, future research should investigate the longer-term impacts of the pandemic and whether medical students are more likely to seek help for mental health difficulties postpandemic.

COVID-19 and common mental health symptoms in the early phase of the pandemic: An umbrella review of the evidence

BACKGROUND

There remains uncertainty about the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health. This umbrella review provides a comprehensive overview of the association between the pandemic and common mental disorders. We qualitatively summarized evidence from reviews with meta-analyses of individual study-data in the general population, healthcare workers, and specific at-risk populations.

METHODS AND FINDINGS

A systematic search was carried out in 5 databases for peer-reviewed systematic reviews with meta-analyses of prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms during the pandemic published between December 31, 2019 until August 12, 2022. We identified 123 reviews of which 7 provided standardized mean differences (SMDs) either from longitudinal pre- to during pandemic study-data or from cross-sectional study-data compared to matched pre-pandemic data. Methodological quality rated with the Assessment of Multiple Systematic Reviews checklist scores (AMSTAR 2) instrument was generally low to moderate. Small but significant increases of depression, anxiety, and/or general mental health symptoms were reported in the general population, in people with preexisting physical health conditions, and in children (3 reviews; SMDs ranged from 0.11 to 0.28). Mental health and depression symptoms significantly increased during periods of social restrictions (1 review; SMDs of 0.41 and 0.83, respectively) but anxiety symptoms did not (SMD: 0.26). Increases of depression symptoms were generally larger and longer-lasting during the pandemic (3 reviews; SMDs depression ranged from 0.16 to 0.23) than those of anxiety (2 reviews: SMDs 0.12 and 0.18). Females showed a significantly larger increase in anxiety symptoms than males (1 review: SMD 0.15). In healthcare workers, people with preexisting mental disorders, any patient group, children and adolescents, and in students, no significant differences from pre- to during pandemic were found (2 reviews; SMD's ranging from -0.16 to 0.48). In 116 reviews pooled cross-sectional prevalence rates of depression, anxiety, and PTSD symptoms ranged from 9% to 48% across populations. Although heterogeneity between studies was high and largely unexplained, assessment tools and cut-offs used, age, sex or gender, and COVID-19 exposure factors were found to be moderators in some reviews. The major limitations are the inability to quantify and explain the high heterogeneity across reviews included and the shortage of within-person data from multiple longitudinal studies.

CONCLUSIONS

A small but consistent deterioration of mental health and particularly depression during early pandemic and during social restrictions has been found in the general population and in people with chronic somatic disorders. Also, associations between mental health and the pandemic were stronger in females and younger age groups than in others. Explanatory individual-level, COVID-19 exposure, and time-course factors were scarce and showed inconsistencies across reviews. For policy and research, repeated assessments of mental health in population panels including vulnerable individuals are recommended to respond to current and future health crises.

Is Satisfaction with Online Learning Related to Depression, Anxiety, and Insomnia Symptoms? A Cross-Sectional Study on Medical Undergraduates in Romania

The objective of this study was to investigate online learning satisfaction in a sample of university students and its relationship with depression, anxiety, insomnia, and the average number of hours spent online. A total of 463 medical students were recruited for an online survey conducted from February to March 2022 with the main objective of estimating online learning satisfaction, while secondary outcomes involved assessing the relationship between online learning and depression, anxiety, insomnia, and the average number of hours spent online. A total of 285 participants were female (71.4%) and the mean age was 20.2 years. The results revealed that depression, anxiety, and insomnia are negatively correlated with overall satisfaction with e-learning. The more time students spent online, the greater the overall satisfaction. There are significant differences regarding student perceptions of interactivity in online learning satisfaction outcomes (p < 0.05, η2 partial Eta Squared-0.284). The opportunity to learn via chat-box presented differences in overall satisfaction while pleasant aspects of online learning, such as “no travel” and “economy”, were related to satisfaction. The students revealed that the higher the psychopathology scores, the less satisfied they were with online learning, while a higher number of hours spent online contributed positively to satisfaction.

"We're Not Going to Be as Prepared": A Qualitative Study of Healthcare Trainees' Experiences after One Year of the COVID-19 Pandemic

The COVID-19 pandemic had significant impacts on the mental health and academic experiences of healthcare trainees. Building on findings from earlier in the pandemic, we explore the impacts on healthcare trainees after a sustained pandemic period of 12-14 months, involving multiple lockdowns, changes in government COVID-19 regulations and the delivery of health education. A qualitative study was conducted between March-May 2021. Participants were 12 healthcare trainees (10 women, 2 men) of medicine, nursing, and midwifery, registered at one of three higher education institutions in the United Kingdom. Interviews were fully transcribed, and data were thematically analysed using a combination of deductive and inductive approaches. We identified three key themes with eight subthemes: (i) academic experiences (adjustment to online learning, loss of clinical experience, confidence in the university), (ii) impacts on wellbeing (psychosocial impacts, physical impacts, pandemic duration and multiple lockdowns), and (iii) support frameworks (university preparedness for increased student support needs, importance of relationship with academic tutors). Findings shed light on the long-lasting and emerging impacts of the pandemic over time. We identify support needs for trainees both during their academic studies, and as they move forwards into professional roles within the healthcare workforce. Recommendations are made for higher education institutions and healthcare employers.

Evaluation of Health-Related Quality of Life and Mental Health in 729 Medical Students in Indonesia During the COVID-19 Pandemic

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has impacted the health-related quality of life (HRQoL) and mental health worldwide. However, its impact on medical students in Indonesia has not been well documented. This study aimed to evaluate HRQoL and mental health in 729 Indonesian medical students during the COVID-19 pandemic. MATERIAL AND METHODS We conducted a cross-sectional study from 31 August to 30 September 2021. The study instrument was an online questionnaire that was distributed via social media platforms. The 12-item short form version 2 (SF12v2) was used to measure HRQoL, and the 21-item Depression, Anxiety, and Stress Scale (DASS-21) was used to measure mental health. RESULTS From 729 Indonesian medical students included in the analyses, 37.3% had impaired physical component and 66.9% had impaired mental component of HRQoL. The determinants were medical students' island of residence, history of hospitalization, and family member's hospitalization and death due to COVID-19. Concerning mental health, the prevalence of reported symptoms of depression, anxiety, and stress were 45.4%, 65.2%, and 60.9%, respectively. Sex, study method, grade, previous COVID-19 disease severity, comorbidities, previous learning experience, and history of family isolation were identified as the determinants of mental health. CONCLUSIONS This study highlights the adverse effects of COVID-19 on HRQoL and mental health in Indonesian medical students. The results identified key associations, including SARS-CoV-2 infection and comorbidities experienced by the students, the health of their families, including grief following bereavement, and the effects of social isolation during the pandemic.

Prevalence of Depression Among Undergraduate Medical Students in India: A Systemic Review and Meta-Analysis

BACKGROUND

Systematic reviews have proved that there is a high rate of depression among medical students when compared with their age-matched peers. Very few studies have evaluated the pooled prevalence of depression among medical students in India.

OBJECTIVES

To determine the pooled prevalence of depression among medical students in India.

MATERIALS AND METHODS

This review was done by searching databases like PubMed, Google Scholar, and Scopus for available original articles published between 2019 and 2022 on depression among Indian medical (MBBS) undergraduate students using PRISMA guidelines.

RESULTS

A total of 19 original research articles were included in this review, involving students at different medical colleges from various regions of India. The pooled prevalence of depression among 5944 medical students was 50.0% (95% CI: (31%-70%)) based on the random effect model. This meta-analysis also found that the pooled prevalence of depression among females (pooled prevalence: 38.0%, 95% CI: 20.0 to 58.0) was slightly higher than among males (pooled prevalence: 34.0%, 95% CI: 15.0 to 55.0).

CONCLUSION

 The high prevalence of depression among medical students demands regular screening for depression along with counselling services. It shows that there is a need to raise awareness among students and other stakeholders, such as parents and medical educators, concerning symptoms and signs of depression among medical students.

Latent profile analysis of adaptation types and stress among medical students during the COVID-19 pandemic in South Korea

Objective

This study aimed to identify profile groups based on personality traits and coping strategies exhibited by medical students in the context of COVID-19.

Methods

We conducted a cross-sectional survey and latent profile analysis to investigate differences in stressors, psychological distress, and stress levels with academic variables. We collected data online (Google survey form) in November and December 2021. The participants included a total of 260 1st and 2nd year medical students, all completed questionnaires containing the following sections: Big Five Inventory, coping strategies, COVID-19 stressors, Kessler Psychological Distress Scale, and stress level with academic variables. For analysis, a latent profile analysis, ANOVA, and χ2 were used.

Results

The results reveal the three following profile groups: adaptive (lowest neuroticism, low mental disengagement), middle-adaptive (moderate neuroticism, low mental disengagement), and maladaptive (highest neuroticism and mental disengagement), respectively comprising 25.0%, 39.2%, and 35.8% of the study sample. There were no statistically significant intergroup differences regarding grade (χ2=3.345, p=0.188) or gender (χ2=1.197, p=0.550). The maladaptive group was strongly associated with perceived stress during the COVID-19 pandemic (p<0.001).

Conclusion

These findings highlight the value of considering profile groups when determining whether students require additional support during pandemics.

The Mediating Role of Sleep Quality in the Relationship between Negative Emotional States and Health-Related Quality of Life among Italian Medical Students

Sleep problems have been shown to be related to adverse outcomes concerning physical and mental well-being. Furthermore, mental health issues and sleep problems were reported to be highly prevalent among medical students and physicians, and were found to be associated with worse academic and clinical performance in these populations. This study aims to investigate the prevalence of poor sleep to examine the associations between sleep quality and health-related quality of life (HRQoL), and to explore the possible mediating role of sleep in the relationship between psychological distress and HRQoL itself in a sample of medical and dental students attending a large Italian university. Participants (n = 407, mean age: 24.2 ± 2.4) answered an online questionnaire comprising the 21-item Depression Anxiety Stress Scale, the Pittsburgh Sleep Quality Index, and the Short Form-12 health survey. Up to 62% of the participants reported poor sleep quality. Controlling for psychological distress, sleep quality components were found to be associated with physical and mental HRQoL. Mediation analysis showed that overall sleep quality mediated all the single associations between anxiety, depression, and stress and HRQoL. These preliminary findings suggest that the quality of sleep is important for the well-being of medical students and that targeting sleep issues in this academic population may be beneficial.

Comparison of Multinational Medical School Students Experiences in the Face of the COVID-19 Pandemic: A Qualitative Analysis

Background:  In the midst of the COVID-19 pandemic, countries, and governments around the world have implemented different measures and guidelines for the containment and mitigation of the COVID-19 virus. In addition to implemented policies and initiatives, social media and personal beliefs have affected medical students’ social, emotional, financial, and academic stability and success both domestically and internationally.  Methods:  This qualitative study, recruited students enrolled in the Global Seminar for Health and Environment elective course in their respective medical schools to complete a weekly, non-graded journaling assignment for 6 weeks. To measure outcomes, open-ended questions within the assignment asked students across four different countries (United States, El Salvador, Dominican Republic, and Honduras) questions regarding the COVID-19 pandemic including personal beliefs and knowledge, policies and initiatives within their country, global policies and initiatives, and social media presentations. Thematic analysis was then completed using the QCoder package in R Studio.  Results:  A total of 142 assignment submissions were collected and analyzed. International medical students reported more restrictions in their country, a larger mental health impact, and more individuals in their country showing a lack of regard for policies and initiatives.  United States medical students were more likely to express a decrease in academic opportunities and academic performance. Conclusion:  The COVID-19 pandemic continues to affect medical students globally. The pandemic has changed the medical school experience for both international and United States medical students and affected them not only academically but mentally, and socially.

Mental Health, Support System, and Perceived Usefulness of Support in University Students in Hong Kong Amidst COVID-19 Pandemic: A Mixed-Method Survey

BACKGROUND

This study explored the association of students' mental health with their support system, identified the preferred ways and sources of support, investigated the perceived usefulness of available university support, and recommended actionable strategies to enhance students' mental health.

METHOD

An online questionnaire survey and semi-structured focus group interviews were conducted in 2021.

RESULTS

Among 1121 university students, 39.4% reported anxiety symptoms, which were less common in Chinese students and those pursuing medical and health programmes. Overall, 32.6% reported depression symptoms, which were more common in undergraduates. Both anxiety and depression symptoms were less common in students with higher resilience and support system and more common in students with family distress. Students with higher resilience had a better support system and less family distress. Perceived support from universities was lower than from peers and families. Peer support and phone contacts were the most preferred sources and ways of support. The most useful available university support was updated university guidelines, and the least useful was the emotional hotline service from universities The qualitative findings corroborated the quantitative results.

CONCLUSION

We suggested that a holistic care approach and more proactive student-oriented university support would help students face adversity and enhance mental health.

COVID-19 related disruption in higher education students' health and wellbeing: Implications for university action

The COVID 19 pandemic has led to substantial disruptions in the lives of students in higher education. Partial or full closures of institutions for face-to-face teaching or consultations over a long-lasting period of time in many countries have had significant consequences on the psychosocial health and wellbeing of many students. This perspectives article summarizes the implications on mental, social, and behavioral aspects of students' wellbeing. Moreover, the need for health promoting und supportive services, programmes, structures, and policies is outlined with recommendations for institutional actions on the level of teaching practice, counseling services, and health monitoring, and with the call to re-affirm the wider policy-oriented approach of the Health Promoting University.