Anxiety and Depression in Medical Students

During the epidemic, the mental health of college students was generally poor, especially anxiety and depression, which should be treated using counseling and intervention. This study aimed to observe the influence of dialectical behavior therapy on the anxiety and depression of medical students during the normalization of the prevention and control of the COVID-19 epidemic. A total of 26 medical students (experimental group) were treated with dialectical behavior therapy intervention for 4 weeks. Changes in depression, anxiety, and stress levels were assessed by the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder (GAD-7) scale, the Somatic Self-rating Scale (SSS), and the Perceived Stress Scale (PSS-10). This group was compared with 26 medical students (control group) without intervention. The value-added scores of the PHQ-9 (t=2.543, P=0.014) and GAD-7 scales (t=3.790, P=0.000) in the experimental group were significantly higher than those in the control group, while in the SSS scale, the value-added score of the depressive symptoms subscale (t=2.234, P=0.030) in the experimental group was significantly higher than that of the control group. For the total score of the PSS-10 scale (t=2.435, P=0.018), the value-added score of the experimental group was significantly higher than that of the control group. The intervention of dialectical behavior therapy can effectively alleviate the depression and anxiety of medical students during the normalization of epidemic prevention and control. Chinese Clinical Trial Registry ChiCTR2100048784.

North American medical students are more depressed and anxious than their peers. In the UK, the regulator now has responsibility for medical students, which may potentially increase scrutiny of their health. This may either help or hinder medical students in accessing appropriate care. The prevalences of anxiety, depression and psychological distress in medical students outside North America are not clear. A better understanding of the prevalence of, risk factors for and results of psychological distress will guide the configuration of support services, increasingly available for doctors, for medical students too. The aim of this study was to examine the prevalences of depression, anxiety and psychological distress in students in medical schools in the UK, Europe and elsewhere in the English-speaking world outside North America. A systematic review was conducted using search terms encompassing psychological distress amongst medical students. OvidSP was used to search the following databases: Ovid MEDLINE (R) from 1948 to October 2013; PsycINFO from 1806 to October 2013, and EMBASE from 1980 to October 2013. Results were restricted to medical schools in Europe and the English-speaking world outside North America, and were evaluated against a set of inclusion criteria including the use of validated assessment tools. The searches identified 29 eligible studies. Prevalences of 7.7-65.5% for anxiety, 6.0-66.5% for depression and 12.2-96.7% for psychological distress were recorded. The wide range of results reflects the variable quality of the studies. Almost all were cross-sectional and many did not mention ethical approval. Better-quality studies found lower prevalences. There was little information on the causes or consequences of depression or anxiety. Prevalences of psychological distress amongst medical students outside North America are substantial. Future research should move on from simple cross-sectional studies to better-quality longitudinal work which can identify both predictors for and outcomes of poor mental health in medical students.

Aim: We aimed to investigate the relationship between chronotype and depression schemas and sensitivity to depression in healthy medical students with sensitivity and cognitive scales.Materials and Methods: The study included 38 healthy fifth-year medical students enrolled in Van Yuzuncu Yil University Medical Faculty. All the participants were administered a sociodemographic background questionnaire, followed by the Morningness-Eveningness Questionnare (MEQ), the Dysfunctional Attitude Scale (DAS), and the Leiden Index of Depression Sensitivity-Revised (LEIDS-R).Results: The average total MEQ score was 51.60 ± 8.71. No significant correlation was found between total DAS score total LEIDS-R score (p: 0.5847; r: 0.09154) and LEIDS-R type (p: 0.9081, r: 0.01936). Both MEQ type and total MEQ score established a significant correlation with the ‘perfectionism’ parameter on LEIDS-R. Moreover, the correlation between total MEQ score and ‘perfectionism’ was at a moderate level (p: 0.0014, r: 0.50021), it indicated that the level of perfectionism increases with the increase in the tendency towards morningness.Conclusion: No relationship was found between chronotype and tendency to depression among medical students. It was determined that the perfectionism scheme was strengthened with the increasing tendency towards the morningness. Hypothetically, the hyperactivation of morning-type features can be a protective factor against depression.

This study investigated the interaction of genetic, environmental, and psychological factors in predicting depression and anxiety symptoms in medical students. First-year medical students (n = 141) completed measures of anxiety, depression, hope, and spiritual meaning at three time points during the first year. Buccal samples were utilized to genotype each individual at the s/l variant in the promoter region of the serotonin transporter gene (5-HTTLPR). A subset (n = 91) completed a measure of recent stressors. Mean levels of depression increased during year one of medical school. Presence of the s/s genotype in the promoter region of the 5-HTT gene was associated with greater increases in depression, but only in association with higher numbers of recent stressors. Spiritual meaning and hope were found to counteract genetic susceptibility to stress-related depressive symptoms in the more vulnerable s/s group.

The objectives of this study were to find out the frequency of anxiety and depression in medical students and various coping mechanisms adopted by them to identify the coping trends and to stress the need of equipping these students with positive coping tools to deal with anxiety and depression. A cross-sectional, questionnaire-based observational study was conducted on a population of 500 medical students of Federal Medical and Dental College, Islamabad. The duration of the study was three months. By using the WHO sample size calculator, taking the confidence level 95%, anticipated population proportion 70% and absolute precision required 7%, the sample size was calculated at 165. The samples were collected by non-probability consecutive sampling via a questionnaire. In the study, two instruments were used: 1) Aga Khan University Anxiety and Depression Scale (AKUADS), and 2) Brief Cope Inventory. Self-administered questionnaires were filled by the students and the data collected from these questionnaires was analysed on SPSS version 19. Out of the sample size of 165 (98 female, 67 male) students, excluding 12 students with previous history of mental and physical illness, the prevalence of depressed students found after calculating their scores according to the Aga Khan Anxiety and Depression Scale (AKUADS score ≥19) was 95 (57.57%). The most used positive coping mechanisms by these students were religion (5.55±1.91), acceptance (5.28±1.56), planning (5.27±1.58) and active coping (4.85±1.45). The most used negative coping mechanisms were self-blame (5.52±1.83), self-distraction (5.29±1.56), and venting (4.67±1.49). The high presence of negative coping mechanisms indicates the urgency of the need for proper counselling and guidance of medical students about dealing correctly with anxiety and depression.

BACKGROUNDMedical students have high rates of depression, anxiety, and burnout that have been found to affect their empathy, professional behaviors, and performance as a physician. While studies have examined predictors for burnout and depression in the United States (US), no study, to our knowledge, has compared depression in medical students cross-culturally, or has attempted to examine the effect of factors influencing rates including burnout, exercise, stress, unmet mental health needs, and region.AIMTo examine rates of depression in three international cohorts of medical students, and determine variables that may explain these differences.METHODSConvenience samples of medical students from three countries (US, China, and a Middle Eastern country whose name remains anonymous per request from the school) were surveyed in this observational study. Using the Patient Health Questionnaire-2 (PHQ-2) and a modified Maslach Burnout Inventory, depression and burnout were examined among medical students from the three cohorts (n = 473). Chi-square test and analysis of variance were used to examine differences in demographics, behavioral, and psychological variables across these three schools to identify potentially confounding descriptive characteristics. Analysis of covariance compared depression and the emotional exhaustion component of burnout identified through Principal Component Analysis across countries. Multiple linear regression was used to analyze the impact of demographic, behavioral, and psychological variables on screening positive for depression.RESULTSMedical students from the Middle Eastern country had the highest rates of positive depression screens (41.1%), defined as a PHQ-2 score of ≥ 3, followed by China (14.1 %), and then the US (3.8%). More students in the Middle Eastern school had unmet mental health needs (50.8%) than at the medical school in China (34.8%) or the school in the US (32.8%) (Pearson chi-square significance < 0.05). Thus, PHQ-2 scores were adjusted for unmet mental health needs; however, the Middle Eastern country continued to have the highest depression. Adjusting for PHQ-2 score, medical students from the US scored the highest on emotional exhaustion (a measure of burnout). Demographic variables did not significantly predict medical student depression; however, lack of exercise, unmet mental health needs, stress, and emotional exhaustion predicted nearly half of depression in these cohorts. In comparison to the US, coming from the Middle Eastern country and China predicted higher levels of depression.CONCLUSIONDepression rates differ in three international cohorts of medical students. Measured factors contributed to some observed differences. Identifying site-specific prevention and intervention strategies in medical student mental health is warranted.

Background & Objectives: The COVID-19 second wave has lethally affected the lives of the younger age-group. Medical students faced illness and many witnessed the deaths of close relatives. The aim of this study is to assess the mental health of medical students in the context of second wave of the pandemic. The main objective is to assess the level of stress, anxiety and depression in medical students after the COVID-19 second wave. Material and Methods: With due ethical permission and taking the written informed consent of participation, a web-based cross-sectional study using the DASS-42 scale was conducted online among 117 medical students in the vicinity of Raipur city in July 2021; 62 (53%) boys and 55 (47%) girls between the age group of 18-23 years. Results: On data analysis we found 79% participants (95% C.I : 10.7-12.8, M=11.78,S.D=5.771) under anxiety (82% boys, 74% girls), 59% participants (95% C.I : 14.9-17.4, M=16.18, S.D=6.890) under stress (52% boys, 67% girls) and 51% participants (95% C.I : 10.2-12.9, M=11.61, S.D=7.50) under depression (50% boys, 52% girls). Conclusion: The result concludes that the level of anxiety is highest among study participants followed by the increased level of stress and then depression at last.

BackgroundCoronavirus disease 2019 (COVID-19) pandemic has caused serious psychological problems, including panic attack, anxiety, stress, and depression. The main objective of this study was to measure the prevalence and compare the severity of this psychological distress among four groups of an Iranian population.MethodIn a cross-sectional survey, the mental health status of four groups of an Iranian society including community population, patients with COVID-19, medical staff, and medical students were investigated by the self-report questionnaire of Depression, Anxiety, and Stress Scale (DASS). DASS-21 questionnaire and the demographic data sheet were filled out by the participants. All statistical analyses were done using R version 3.6.1 software. P-values less than 0.05 were considered as statistically significant. ANOVA test was used to compare the severity of stress, anxiety, and depression between the four study groups.ResultsOf the 886 participants in this survey, 554 (62.5%) were men and 332 (37.5%) were women, and the mean ± standard division of age was 40.91 ± 10.7 years. Among these participants, 241 (27.2%) were selected from community population, 221 (24.9%) were patients with COVID-19, 217 (24.5%) were medical staff, and 207 (23.4%) were medical students. The mean score of stress, anxiety, and depression in medical students and patients with COVID-19 was significantly higher than in medical staff and community population (P < 0.05). Overall, the anxiety score in men was higher than that in women (27.4 ± 4.6 vs. 26.48 ± 4.8, P = 0.006), and unmarried participants had a significantly higher depression score compared with the married group (27.5 ± 4.8 vs. 26.7 ± 4.6, P = 0.023). In addition, the score of depression was higher in female medical staff (27.08 ± 4.6 vs. 25.33 ± 4.3, P = 0.011) and community population (26.6 ± 4.3 vs. 25.3 ± 4.3, P = 0.02) than in male.ConclusionCOVID-19 patients and medical students in contact with these patients were at a high risk for mental illness due to lower experience compared with professional medical staff and community population. Continuous surveillance and monitoring of psychological distress for outbreaks should become a routine part of preparedness efforts worldwide.

New York University School of Medicine

The mental health of medical students around the world has been affected by the presence of anxiety and depression. According to the World Health Organization, more than 260 million people suffer from anxiety and approximately 300 million people suffer from depression. Objective: To determine the association between anxiety and depression in medical students at Ricardo Palma University during the 2021-II academic year. Materials and Methods: Observational, analytical, cross-sectional and quantitative study. From a population of 2046 medical students from the first to the seventh year of studies, the size of the sample obtained was 110 students. The data obtained was collected through Google Forms. Results: Of the medical students, 85.46% manifested some degree of anxiety and 50% manifested some degree of depression. These pathologies occurred more frequently in the female sex, low socioeconomic level and in those who had clinical courses. A statistically significant association was found between anxiety and depression (p: 0.038), and between low socioeconomic status and depression (p: 0.004). No statistically significant association was found between female sex and depression, nor between pre-clinical courses and depression. Conclusions: High prevalences of anxiety and depression were found in medical students at the Ricardo Palma University. In addition, a statistically significant association between anxiety and depression was evidenced (p: 0.038). For this reason, it is recommended to implement a psychological accompaniment throughout the medical university career.

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OBJECTIVESThe objective of this study was to estimate the prevalence of depression in medical students and to evaluate whether interpersonal social support, health-related behaviors, and socio-economic factors were associated with depression in medical students.METHODSThe subjects in this study were 120 medical students in Seoul, Korea who were surveyed in September, 2008. The subjects were all women and over the age of 20. Their age, body mass index (BMI), quality of sleep, diet, household income, smoking, alcohol consumption, exercise levels, and self-reported health status were surveyed. The degree of perceived social support was measured using the interpersonal support evaluation list (ISEL). Depression was evaluated using the center for epidemiology studies depression scale (CES-D).RESULTSThe mean CES-D score was 14.1±8.6 and 37.1% of the participants appeared to suffer from depression. Low levels of perceived interpersonal support increased the risk of depression by more than 10 times and having higher household income did not necessarily decrease the risk of depression.CONCLUSIONMedical students have a relatively high level of depression. Efforts should be made to encourage social support in order to promote mental health in medical students.

BackgroundMedical students in China face severe depression and anxiety because of their difficult circumstances, such as the long length of schooling, academic pressure, and the stress of clinical practice. Although there have been many empirical studies about depression or anxiety in medical students in China, no previous studies have conducted a related systematic review about this topic in English. This analysis can convey the general findings from China to other areas of the world.MethodsA systematic review and meta-analysis of depression or anxiety in medical students and related determinants were conducted. Three Chinese and three English databases were searched for the review, with no restrictions on language. Articles published between January 1, 2000 and April 1, 2018 were included.ResultsTwenty-one articles investigating a total of 35,160 individual Chinese medical students were included in this review. The prevalence of depression ranged from 13.10 to 76.21% with a mean of 32.74%, and the prevalence of anxiety ranged from 8.54 to 88.30% with a mean of 27.22%. Based on the meta-analysis, gender, grade level, residence, satisfaction with current major and monthly household income per capita were significantly associated with depression. Grade level and satisfaction with current major were significantly associated with anxiety. Other risk factors were identified and described using a narrative approach.ConclusionThe mean prevalence of depression was 32.74% amongst medical students in China, whereas the mean prevalence of anxiety was 27.22%. The determinants of depression and anxiety included individual factors, social and economic factors, and environmental factors. More measures should be taken towards at-risk medical students based on the identified risk factors.

The COVID-19 pandemic with its restrictive measures affected the entire education system, causing anxiety and depression in medical students. This research addressed the psychological resources and coping strategies which medical students appealed to during the pandemic. The authors developed a questionnaire to classify various attitudes and coping strategies. High stress and non-constructive coping strategies were typical for students with anxiety and pessimism. The subjects with high anxiety levels that experienced the lockdown measures as severe psychological stress tended to rely on avoidance strategies. They felt high responsibility, lacked relevant information, and assessed their own resources as low. Those with prominent self-efficacy demonstrated an optimistic and more realistic type of perception: they were confident in their ability to cope with the challenges of the pandemic. The subjects with a subjective and optimistic perception believed that they were able to select relevant information on preventive measures and reduce psychological stress.

A healthy lifestyle is fundamental for the prevention and treatment of cardiovascular disease and other noncommunicable diseases (NCDs). Investment in primary prevention, including modification of health risk behaviors, could result in a 4-fold improvement in health outcomes compared with secondary prevention based on pharmacological treatment. The American Heart Association (AHA) emphasized the importance of lifestyle in its 2020 goals for cardiovascular health promotion and disease reduction. In addition to defining “cardiovascular health” based on criteria for blood pressure and biochemical markers (lipids and glycemia), the AHA Strategic Planning Committee further identified lifestyle characteristics of central importance: nutrition, physical activity, smoking, and maintenance of a healthy body weight.1 The World Health Organization estimated that ≈80% of NCDs could be prevented if 4 key lifestyle practices were followed: a healthy diet, being physically active, avoidance of tobacco, and alcohol intake in moderation.2 To support healthy lifestyle initiatives, major changes are necessary at the societal level to improve population health. Numerous strategies might help to create a culture that promotes and facilitates healthy behaviors, including creating laws and regulations, mounting large-scale public awareness and education campaigns, implementing local community programs, and providing individual counseling.3 Physicians are uniquely positioned to encourage individuals to adopt healthy lifestyle behaviors: Approximately 80% of Americans visit their primary care physician at least once a year. Physicians directly communicate with their patients during clinical encounters across numerous settings, and research indicates that patients highly value recommendations provided by their physicians.4,5 However, data further indicate that lifestyle counseling does not routinely occur in physicians’ offices, thereby representing a lost opportunity. Physicians report that they perform lifestyle counseling during ≈34% of clinic visits.4 Patients, in turn, report an even lower frequency of physician lifestyle counseling. For example, obese patients reported receiving physical activity and …