The impact of the COVID-19 pandemic on the mental health of medical students

Öz

Background/Aim: Medical students are at high risk for mental problems with already increased levels of stress and depression. The literature shows that the COVID-19 pandemic has affected the mental health of the population including medical students. However, yet, there is insufficient data to compare the mental health of medical students before and after the pandemic. In this study, it was aimed to investigate the impact of COVID-19 pandemic on medical students’ mental health. Methods: First part of these two cross- sectional studies was conducted in 2019, before the pandemic, and the second one was performed in 2021. A sociodemographic data form, The Center for Epidemiologic Studies Depression Scale (CES-D), Perceived Stress Scale (PSS), and Maslach Burnout Inventory-Student Survey (MBI-SS) were applied to 1306 students in 2019 and 898 students in 2021, from all 6 grades studying at a Turkish medical school. Prevalence of depression, PSS and MBI-SS scale scores were compared in terms of year of the study, grades and some demographic variables. Results: The prevalence of depression was 64.2% in 2019 and increased to 90.9% after the pandemic. Participants with a personal or family history of being COVID-19 (+) had higher scores in CES-D (P=0.002 and P=0.001, respectively) and PSS (P=0.015 and P=0.004, respectively). Regression analysis showed that female gender, studying in preclinical phases, and living alone were significant predictors of CES-D and PSS scores. Conclusion: The COVID-19 pandemic negatively affected the mental health of medical students as well as the entire society. Preventive mental health practices are required for this vulnerable population, especially for groups determined to be at risk.

Anahtar Kelimeler

• Medical student
• Mental health
• Depression
• Stress
• Burnout
• Covid-19 pandemic

Kaynakça

1. 1. Goebert D, Thompson D, Takeshita J, Beach C, Bryson P, Ephgrave K, et al. Depressive symptoms in medical students and residents: a multischool study. Acad Med. 2009 Feb;84(2):236-41. doi: 10.1097/ACM.0b013e31819391bb. PMID: 19174678.
2. 2. Quek TTC, Tam WWS, Tran BX, Zhang M, Zhang Z, Ho CSH, et al. The global prevalence of anxiety among medical students: A meta-analysis. Int. J. Environ. Res. Public Health. 2019;16(15):2735. doi:10.3390/ijerph16152735
3. 3. Rotenstein LS, Ramos MA, Torre M, Bradley Segal J, Peluso MJ, Guille C, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students a systematic review and meta-analysis. JAMA. 2016;316(21):2214–36. doi: 10.3390/ijerph16152735
4. 4. Ishak W, Nikravesh R, Lederer S, Perry R, Ogunyemi D, Bernstein C. Burnout in medical students: A systematic review. Clin Teach. 2013;10(4):242-5. doi: 10.1111/tct.12014
5. 5. Molodynski A, Lewis T, Kadhum M, Farrell SM, Lemtiri Chelieh M, Falcão De Almeida T, et al. Cultural variations in wellbeing, burnout and substance use amongst medical students in twelve countries. Int Rev Psychiatry. 2021;33(1–2):37–42. doi: 10.1080/09540261.2020.1738064
6. 6. Giliyaru S, Hegde G, Gajjala S, Vemuri O, Azzopardi C, Hurley P, et al. COVID-19 pandemic and medical education. Indian J Med Sci. 2020;0(1):1–2. doi: 10.25259/ijms_291_2020
7. 7. Deshetler L, Gangadhar M, Battepati D, Koffman E, Mukherjee RK, Menon B. Learning on Lockdown: A Study on Medical Student Wellness, Coping Mechanisms and Motivation during the COVID-19 Pandemic. MedEdPublish. 2021;10(1):1–9. doi: 10.15694/mep.2021.000050.1
8. 8. Nishimura Y, Ochi K, Tokumasu K, Obika M, Hagiya H, Kataoka H, et al. Impact of the COVID-19 Pandemic on the psychological distress of medical students in Japan: Cross-sectional survey study. J Med Internet Res. 2021;23(2):1–14. doi: 10.2196/25232

9. 9. Elbay RY, Kurtulmuş A, Arpacıoğlu S, Karadere E. Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics. Psychiatry Res. 2020;290:113130. doi: 10.1016/j.psychres.2020.113130
10. 10. Vahedian-Azimi A, Moayed MS, Rahimibashar F, Shojaei S, Ashtari S, Pourhoseingholi MA. Comparison of the severity of psychological distress among four groups of an Iranian population regarding COVID-19 pandemic. BMC Psychiatry. 2020;20(1):1–7. doi: 10.1186/S12888-020-02804-9
11. 11. Brimstone R, Thistlethwaite JE, Quirk F. Behaviour of medical students in seeking mental and physical health care: Exploration and comparison with psychology students. Med Educ. 2007;41(1):74-83.doi: 10.1111/j.1365-2929.2006.02649.x
12. 12. 2020-Yükseköğretim Kurumları Sınavı (YKS) Yükseköğretim Programları ve Kontenjanları Kılavuzu [Internet]. [cited 2021 May 7]. Available from: https://www.osym.gov.tr/TR,19431/2020-yuksekogretim-kurumlari-sinavi-yks-yuksekogretim-programlari-ve-kontenjanlari-kilavuzu.html
13. 13. Sheehan TJ, Fifield J, Reisine S, Tennen H. The Measurement Structure of the Center for Epidemiologic Studies Depression Scale. J Pers Assess. 1995;64(3):507–21. doi: 10.1207/s15327752jpa6403_9
14. 14. Tatar A, Saltukoglu G. The adaptation of the CES-depression scale into Turkish through the use of confirmatory factor analysis and item response theory and the examination of psychometric characteristics. Klinik Psikofarmakol Bülteni. 2010;20(3): 213-227. doi: 10.1080/10177833.2010.11790662
15. 15. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983 Dec;24(4):385-96. PMID: 6668417
16. 16. Eskin M, Demirkiran F. The adaptation of the perceived stress scale into Turkish: A reliability and validity analysis.New Symposium Journal. 2013;51(3):132-140.
17. 17. Hu Q, Schaufeli WB. The factorial validity of the maslach burnout inventory-student survey in China. Psychol Rep. 2009;105(2):394–408. doi: 10.2466/PR0.105.2.394-408
18. 18. Çapri B, Gündüz B, Gökçakan Z. Maslach tükenmişlik envanteri-öğrenci formu’nun (MTE-ÖF) Türkçe’ye uyarlamasi: geçerlik ve güvenirlik çalişmasi. Cukurova University Faculty of Education Journal. 2011;40(1):134–47. (in Turkish)
19. 19. Confederation of Turkish Trade Unions [Internet]. [cited 2021 Aug 17]. Available from: http://www.turkis.org.tr/default.asp
20. 20. Xiong J, Lipsitz O, Nasri F, Lui LMW, Gill H, Phan L, et al. Impact of COVID-19 pandemic on mental health in the general population: A systematic review. J Affect Disord. 2020 Dec 1;277:55–64. doi: 10.1016/J.JAD.2020.08.001
21. 21. Lestari R, Setyawan FEB. Mental health policy: protecting community mental health during the COVID-19 pandemic. J Public Health Res. 2021;10(2). doi: 10.4081/JPHR.2021.2231
22. 22. Saraswathi I, Saikarthik J, Kumar KS, Srinivasan KM, Ardhanaari M, Gunapriya R. Impact of COVID-19 outbreak on the mental health status of undergraduate medical students in a COVID-19 treating medical college: A prospective longitudinal study. Peer J 2020;8. doi: 10.7717/peerj.10164
23. 23. Alsoufi A, Alsuyihili A, Msherghi A, Elhadi A, Atiyah H, Ashini A, et al. Impact of the COVID-19 pandemic on medical education: Medical students' knowledge, attitudes, and practices regarding electronic learning. PLoS One. 2020 Nov 25;15(11):e0242905. doi: 10.1371/journal.pone.0242905. PMID: 33237962; PMCID: PMC7688124.
24. 24. Loda T, Löffler T, Erschens R, Zipfel S, Herrmann-Werner A. Medical education in times of COVID-19: German students' expectations - A cross-sectional study. PLoS One. 2020 Nov 18;15(11):e0241660. doi: 10.1371/journal.pone.0241660. PMID: 33206678; PMCID: PMC7673791.
25. 25. Lyons Z, Wilcox H, Leung L, Dearsley O. COVID-19 and the mental well-being of Australian medical students: impact, concerns and coping strategies used. Australas Psychiatry. 2020;28(6):649–52. doi: 10.1177/1039856220947945
26. 26. Saddik B, Hussein A, Sharif-Askari FS, Kheder W, Temsah MH, Koutaich RA, et al. ncreased Levels of Anxiety Among Medical and Non-Medical University Students During the COVID-19 Pandemic in the United Arab Emirates. Risk Manag Healthc Policy. 2020 Nov 3;13:2395-406. doi:10.2147/RMHP.S273333. PMID: 33177898; PMCID: PMC7652570.
27. 27. Ghazawy ER, Ewis AA, Mahfouz EM, Khalil DM, Arafa A, Mohammed Z, et al. Psychological impacts of COVID-19 pandemic on the university students in Egypt. Health Promot Int. 2020;6(4):1116-25. doi: 10.1093/heapro/daaa147
28. 28. Aker S, Mıdık Ö. The Views of Medical Faculty Students in Turkey Concerning the COVID-19 Pandemic. J Community Health 2020;45(4):684–8. doi:10.1007/s10900-020-00841-9
29. 29. Li HY, Cao H, Leung DYP, Mak YW. The psychological impacts of a covid-19 outbreak on college students in China: A longitudinal study. Int J Environ Res Public Health. 2020;17(11). doi: 10.3390/ijerph17113933
30. 30. Huckins JF, da Silva AW, Wang W, Hedlund E, Rogers C, Nepal SK, et al. Mental health and behavior of college students during the early phases of the COVID-19 pandemic: Longitudinal smartphone and ecological momentary assessment study. J Med Internet Res. 2020;22(6). doi: 10.2196/20185
31. 31. Isralowitz R, Konstantinov V, Gritsenko V. Elena Vorobeva & Alexander Reznik (2021) First and Second Wave COVID-19 Impact on Russian Medical Student Fear, Mental Health and Substance Use. J Loss Trauma. 2021;26(1):94–6. doi:10.1080/15325024.2021.1872274
32. 32. Bandyopadhyay S, Georgiou I, Baykeens B, Gillespie C, Crespo M de A, Bashir MT, et al. Medical students’ mood adversely affected by COVID-19 pandemic: An interim analysis from the SPICE-19 prospective cohort study of 2075 medical students and interim foundation doctors. 2020;1–18. doi:10.21203/rs.3.rs-40503/v1
33. 33. Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020;7(7):611–27. doi: 10.1016/S2215-0366(20)30203-0
34. 34. Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res. 2020 May;287:112934. doi: 10.1016/j.psychres.2020.112934. Epub 2020 Mar 20. PMID: 32229390; PMCID: PMC7102633.
35. 35. Yuan Yuan Wang Yu Jin, Wen Li Y-TX. he prevalence of psychiatric comorbidities during the SARS and COVID-19 epidemics: a systematic review and meta-analysis of observational studies. J Affect Disord. 2021 May 15;287:145-57. doi: 10.1016/j.jad.2021.03.016. Epub 2021 Mar 11. PMID: 33799032; PMCID: PMC7948672.
36. 36. Filho CIS, Rodrigues WC de LV, Castro RB de, Marçal AA, Pavelqueires S, Takano L, et al. Impact Of Covid-19 Pandemic On Mental Health Of Medical Students: A Cross-Sectional Study Using GAD-7 And PHQ-9 Questionnaires. medRxiv. 2020;2020.06.24.20138925. doi:10.1101/2020.06.24.20138925
37. 37. Ertek IE, Ozkan S, Candansayar S, Ilhan MN. Depression, Stress, Burnout and Associated Factors in Medical Students: A Cross-Sectional Study from a Turkish Medical School. PBS. 2021;11(2):130-40. doi: 10.5455/PBS.20210220065005.