Mental health of medical students during the COVID19: Impact of studies years

Anxiety and Depression Disorders in Undergraduate Medical Students During the COVID-19 Pandemic: An Integrative Literature Review

INTRODUCTION

The COVID-19 pandemic has triggered several challenges on the front of mental health. Undergraduate medical students face considerable stress in their academic routines. Thus, there is a need to explore the implications for the mental health of undergraduate medical students during the COVID-19 pandemic.

OBJECTIVE

To review the global literature about anxiety and depressive disorders in undergraduate medical students during the COVID-19 pandemic.

METHOD

We developed an integrative literature review on the occurrence of anxiety and depressive symptoms in undergraduate medical students during the COVID-19 pandemic. We included the manuscripts that used the PHQ-9 and/or GAD-7 questionnaires. We excluded systematic reviews, narrative reviews, integrative reviews, meta-analyses, and qualitative analytical studies. We assessed the results on the occurrence of anxiety and depression and the severity of symptoms in medical students during the COVID-19 pandemic using quantitative studies applying the GAD-7 questionnaire for anxiety or the PHQ-9 for depression.

RESULTS

We reviewed 85 selected studies, and the results showed a significant prevalence of moderate and severe symptoms of anxiety and depression, with 28.2% of participants presenting scores of ≥10 on the GAD-7 and 38.9% on the PHQ-9. Statistical analyses using simple and multiple regression tests revealed associations between higher rates of anxiety symptoms among students from developing countries and data collected after the lockdown period in 2020 during the pandemic lockdown. In addition, female students were at risk of depressive disorders. We emphasize as a limitation that the diagnosis of depression and anxiety requires a detailed clinical evaluation, which is not focused on in this actual study.

CONCLUSIONS

Our findings highlight the need for specific interventions to support the mental health of undergraduate medical students, especially female students from developing countries, during a pandemic crisis.

Clinical psychologists' perceptions of telephone consultation for low-income patients during the COVID-19 pandemic: an interview study

AIMS

We will examine the processes of change in psychological practice that have been altered by the lockdown.

BACKGROUND

During the COVID-19 pandemic, low-income populations, notably residents of social homes or shelters, were shown to be particularly susceptible to contagion. During lockdown, telephone-based psychological consultations became the norm.

METHODS

In this qualitative research, we carried out semi-structured interviews with 10 psychologists working in social homes or shelters. Interviews were transcribed verbatim. Data were studied using consensus qualitative research.

FINDINGS

During lockdown, participants felt that isolation increased while medical and social support decreased. Psychologists had to adapt their work methods and work more closely with on-site staffs. After lockdown, there was an increase in mental health issues. Participants perceived that telephone consulting seemed to facilitate access to psychological help. Although psychologists have quickly adapted, a decrease in the quality of clinical work was a general assessment. Results stress the necessity to train French psychologists in telemental health practices.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Impact of COVID-19 on Academic and Psychological Aspects in Students of Medicine: A Cross-Sectional Study

Background The COVID-19 pandemic has caused a devastating disruption in medical education worldwide. The influence on training, mainly for undergraduate MBBS pupils, has been noteworthy, especially the significant and unexpected shift to online learning. Materials and methods We performed a two-month, cross-sectional study from June to August 2022 at Kasturba Medical College in Mangalore, India. The study participants were second- and third-year MBBS students at Kasturba Medical College. The sample size was 319. We collected data using a pre-structured, validated, printed questionnaire, then coded and entered the data into SPSS Statistics for Windows, version 25.0, for interpretation. Results A total of 319 people took part in the study. Of these, 60.2% were females, 39.4% were males, 71.8% were from the batch of 2019-2020, and the remaining 28.2% were from the batch of 2018-2019. Among the participants, 90 students suffered from COVID-19, including 72.7% (n = 65) from the second year. Twenty-four percent of the population did not contract COVID-19, including 88 from the second year. A total of 153 participants were unsure whether they were infected with COVID-19, including 57.5% from the second year and 42.5% from the third year. The study group's p-value of <0.0001 is statistically significant. On multivariate analysis, 54.5% of the study participants said the pandemic caused a significant disruption to their medical education. A majority of students (51.7%) agreed that the pandemic hampered practical/clinical work; 42.9% of participants somewhat disagreed that the pandemic hampered their interest in pursuing medical education in the future; and 21.9% of students said the pandemic hindered their interest in further studying medicine. Regardless of gender, a majority of the participants (78.1%) felt that online education negatively affected their time management skills and ability to cover the syllabus. Nearly half (46.4%) reported proficiency in using electronic devices. The medical students encountered multiple challenges: approximately 88% indicated that anxiety over the possibility of contracting the disease led to changes in personal behavior and interactions with family and friends. The study also revealed that 71% exhibited anxiety traits, and 11% displayed depressive symptoms, which may have been pre-existing. Furthermore, 77.1% of the participants experienced poor sleep quality, which, according to another study, is a significant predictor of depression and anxiety during COVID-19. Our findings show a significant correlation between undergoing COVID-19 testing and increased anxiety and stress levels among students, most of whom were infected during the pandemic's second wave in India. Conclusion The study has shed light on the effect of the COVID-19 pandemic on MBBS scholars and the students' reactions to this unparalleled situation. This aligns with Sustainable Development Goal 3, which focuses on "good health and well-being." The medical community has been significantly impacted by the pandemic due to its frontline position, and medical students' struggles to thrive academically. The knowledge gained from this study will assist facilitators and students of the medical fraternity in carrying out effective teaching modalities during this pandemic and any future outbreaks.

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

Aim

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

Methods

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

Results

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

Conclusion

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

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

BACKGROUND

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

METHOD

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

Qualitative study to explore UK medical students' and junior doctors' experiences of occupational stress and mental health during the COVID-19 pandemic

OBJECTIVES

This qualitative study aimed to explore the occupational experiences of medical students and junior doctors working during the COVID-19 pandemic. In particular, the research sought to identify factors which mediated work stress, barriers to disclosing mental health problems and levels of support medical students and junior doctors received during the pandemic.

DESIGN

This study was a form of thematic analysis and adopted an inductive, 'bottom-up' approach, in which coded categories were derived from rich, descriptive data.

SETTING

Semistructured interviews were conducted online with UK-based medical students and junior doctors. Interviews were recorded, and analysis was done by coding salient quotes into themes.

PARTICIPANTS

The final sample consisted of seven junior doctors and eight medical students, during the summer of 2021.

RESULTS

High levels of occupational stress were identified, which were exacerbated by COVID-19. A number of organisational difficulties associated with the pandemic compounded participants' experiences of work stress. Participants recognised progress towards promoting and managing mental health within the profession but may still be reluctant to access support services. Barriers to disclosure included fear of stigmatisation, concerns about adding to colleagues' workloads, lack of clarity about career implications and mistrust of occupational health services.

CONCLUSIONS

While attitudes towards mental health have improved, medical students and junior doctors may avoid seeking help. Given the immense pressures faced by health services, it is imperative that extra measures are implemented to minimise work-stress, encourage help-seeking behaviours and promote supportive work cultures.

Post-traumatic stress in healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

The SARS-CoV-2 (COVID-19) pandemic has increased healthcare worker (HCW) susceptibility to mental illness. We conducted a meta-analysis to investigate the prevalence and possible factors associated with post-traumatic stress disorder (PTSD) symptoms among HCW during the COVID-19 pandemic. We searched PubMed, SCOPUS and EMBASE databases up to May 4th, 2022. We performed random effects meta-analysis and moderator analyses for the prevalence of PTSD-relevant symptoms and severe PTSD symptoms. We identified 1276 studies, reviewed 209 full-text articles, and included 119 studies (117,143 participants) with a total of 121 data points in our final analysis. 34 studies (24,541 participants) reported prevalence of severe PTSD symptoms. Approximately 25.2% of participants were physicians, 42.8% nurses, 12.4% allied health professionals, 8.9% auxiliary health professionals, and 10.8% "other". The pooled prevalence of PTSD symptoms among HCWs was 34% (95% CI, 0.30-0.39, I² >90%), and 14% for severe PTSD (95% CI, 0.11 - 0.17, I² >90%). The introduction of COVID vaccines was associated with a sharp decline in the prevalence of PTSD, and new virus variants were associated with small increases in PTSD rates. It is important that policies work towards allocating adequate resources towards protecting the well-being of healthcare workers to minimize adverse consequences of PTSD.

Mental problems and risk factors for depression among medical students during the COVID-19 pandemic: A cross-sectional study

Prevalence of depression is high among medical students and several mental problems are identified as risk factors. Coronavirus disease 2019 (COVID-19) pandemic causes difficulties that could adversely affect mental health. However, data concerning prevalence of mental problems, and whether or not these problems remain risk factors for depression during the COVID-19 pandemic in medical students are scarce. To investigate the prevalence of depression, social media addiction, game addiction, sleep quality, eating disorder risk, and perceived stress among Thai medical students, risk factors for depression were investigated. Online surveys via our faculty's learning portals were advertized to medical students who engaged online learning and 224 respondents provided complete data. Study-related medical students' data were collected using the Patient Health Questionnaire-9 for depression, the Social-Media Addiction Screening Scale for social media addiction, the Game Addiction Screening Test for game addiction, the Pittsburgh Sleep Quality Index for sleep quality, the Eating Attitudes Test for eating disorder risk, and the Perceived Stress Scale for perceived stress. Depression was reported in 35.7% of medical students, social-media addiction in 22.3%, game addiction in 4.5%, eating disorder risk in 4.9%, poor sleep quality in 80.8%, and moderate-to-high perceived stress in 71.4%. The independent predictors of depression were lower grade point average, social media addiction, and moderate-to-high perceived stress. A high prevalence of depression, stress, and poor sleep was found among medical students during the COVID-19 pandemic. Medical students who are stressed, have lower grades, and/or who are addicted to social media warrant depression screening.