Depression, Occupational Anxiety, and Related Factors in Medical Students

Introduction: Study in Medical College can act as a contributing factor in developing depression in medical students which may have possible negative academic and professional consequences. Study in any medical course is perceived as being inherently stressful across the globe. Studies on psychological problems such as academic stress, anxiety and depression among medical students have seen that these disorders are under diagnosed and under treated. In this background the present study was carried out with an aim to assess the magnitude of depression and its associated factors in medical students in AFMC.
 Objective: To find out the prevalence of depressive symptoms and its associated factors among the students of Armed Forces Medical College (AFMC), Dhaka, Bangladesh.
 Materials and Methods: This descriptive type of cross sectional study was carried out in AFMC, Dhaka, Bangladesh for a period from February to April 2014. A total of 211 students studying from 1styear to 4th year MBBS participated in the study. Depression was assessed by Goldberg’s General Health Questionnaire (GHQ-28) and Beck Depression Inventory(BDI) scoring was used to find out the level of depression. BDI scoring 0-10 was considered as normal ups and downs, 11-20 as mild depression, 21-30 as moderate depression, 31-40 as severe depression and more than 40 as extreme depression. Additional questions regarding socio demographic variables were also included. Data analysis was done by software SPSS 19 for windows.
 Results: A total of 211 students participated in the study. Among them 86(40.8%) students were reported as having mild to moderate depressive symptoms. Depression was very significantly (p<0.001) higher in 1st year 55(83.3%) than 2nd year 25(38.46%), 3rd year 03(5.45%) and 4th year 03(12%) students. Depression was significantly (p<0.05) higher in Non English Medium background 82(38.8%) than English Medium background 04(1.9%).
 Conclusion: Depression may be a significant hidden problem for few of the Medical students and mechanisms to identify and help students with mental health problems should be seriously considered. This calls for in-house counseling service and mentorship program at medical colleges for early detection and treatment of these problems that may help in the improvement of academic performance.
 Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 79-82

Cognitive behavioral therapy for insomnia (CBT-I) has been shown to improve both sleep and depressive symptoms, but predictors of depression outcome following CBT-I have not been well examined. This study investigated how chronotype (i.e., morningness-eveningness trait) and changes in sleep efficiency (SE) were related to changes in depressive symptoms among recipients of CBT-I. Included were 419 adult insomnia outpatients from a sleep disorders clinic (43.20% males, age mean ± standard deviation = 48.14 ± 14.02). All participants completed the Composite Scale of Morningness and attended at least 4 sessions of a 6-session group CBT-I. SE was extracted from sleep diary; depressive symptoms were assessed using the Beck Depression Inventory (BDI) prior to (Baseline), and at the end (End) of intervention. Multilevel structural equation modeling revealed that from Baseline to End, SE increased and BDI decreased significantly. Controlling for age, sex, BDI, and SE at Baseline, stronger evening chronotype and less improvement in SE significantly and uniquely predicted less reduction in BDI from Baseline to End. Chronotype did not predict improvement in SE. In an insomnia outpatient sample, SE and depressive symptoms improved significantly after a CBT-I group intervention. All chronotypes benefited from sleep improvement, but those with greater eveningness and/or less sleep improvement experienced less reduction in depressive symptom severity. This suggests that evening preference and insomnia symptoms may have distinct relationships with mood, raising the possibility that the effect of CBT-I on depressive symptoms could be enhanced by assessing and addressing circadian factors.

Purpose In this study, we investigate association of biological rhythm impairment with levels of anxiety, depression and dream anxiety and other sociodemographic correlates of Baskent University medical students. Methods 193 students who accepted to participate in the study from Baskent University School of Medicine Grades 1, 2, 3, 4 and 5, were enrolled to our study. Participants were administered the Beck Anxiety Inventory, Beck Depression Inventory, Dream Anxiety Scale, Biological Rhythm Scale and Sociodemographic Data Form. Results Participants’ biological rhythm (impairment) scores were found to be significantly associated with the Dream Anxiety Scale, Beck Depression Inventory and Beck Anxiety Inventory scores. Female students were found to have higher biological rhythm, activity rhythm, sleep rhythm, anxiety and dream anxiety scores, which means that they have higher anxiety levels and more impaired biological rhythms. Students who drowse in the lectures were found to have higher sleep, activity, social and dominant rhythm patterns with higher levels of dream anxiety and Beck Depression Inventory scores as well. Conclusions Biological rhythm impairment is related to dream anxiety, anxiety and increased depression levels. Smoking, alcohol consumption and having pet are factors negatively effecting biorhythms and increasing dream anxiety in medical students. Drowsing during the lectures is a common complaint of medical students and can be a sign of irregularity in the biological rhythms and psychiatric disorders like anxiety and depression as well. Encouraging medical students for having more regular biorhythms can help them ensuring their own mental health.

Association of Zinc Deficiency and Depression in the Patients With End-stage Renal Disease on Hemodialysis

BackgroundFactors associated with depression of medical students are poorly understood. The purpose of this study is to determine the prevalence of depression in medical students, its change during the course, if depression persists for affected students, what are the factors associated with depression and how these factors change over time.MethodsA prospective, longitudinal observational study was conducted at the Medical School of the University of Minho, Portugal, between academic years 2009–2010 to 2012–2013. We included students who maintained their participation by annually completing a questionnaire including Beck Depression Inventory (BDI). Anxiety and burnout were assessed using the State Trait Anxiety Inventory and Maslach Burnout Inventory. Surveys on socio-demographic variables were applied to evaluate potential predictors, personal and academic characteristics and perceived difficulties. ANOVA with multiple comparisons were used to compare means of BDI score. The medical students were organized into subgroups by K-means cluster analyses. ANOVA mixed-design repeated measurement was performed to assess a possible interaction between variables associated with depression.ResultsThe response rate was 84, 92, 88 and 81% for academic years 2009–2010, 2010–2011,2011-2012 and 2012/2013, respectively. Two hundred thirty-eight medical students were evaluated longitudinally. For depression the prevalence ranged from 21.5 to 12.7% (academic years 2009/2010 and 2012/2013). BDI scores decreased during medical school. 19.7% of students recorded sustained high BDI over time. These students had high levels of trait-anxiety and choose medicine for anticipated income and prestige, reported more relationship issues, cynicism, and decreased satisfaction with social activities. Students with high BDI scores at initial evaluation with low levels of trait-anxiety and a primary interest in medicine as a career tended to improve their mood and reported reduced burnout, low perceived learning problems and increased satisfaction with social activities at last evaluation. No difference was detected between men and women in the median BDI score over time.ConclusionsOur findings suggest that personal factors (anxiety traits, medicine choice factors, relationship patterns and academic burnout) are relevant for persistence of high levels of BDI during medical training. Medical schools need to identity students who experience depression and support then, as early as possible, particularly when depression has been present over time.

Background Medical education is often related to serious distress for students, that affects negatively their mental well-being. Depression, poor academic performance, increased alcohol consumption, suicidal thoughts, are some of the detrimental effects of diminished mental health. Studies on depression in medical students reveal a higher prevalence (1.4-73.5%) than in the general population. This study aimed to assess and compare depression prevalence and severity in three cohorts of medical students in Bulgaria and Turkey. Methods We conducted a cross-sectional online survey with 257 Bulgarian and 288 foreign medical students from Medical University-Sofia, Bulgaria, and with 270 Turkish medical students from Ankara in the winter semester of 2019-2020 academic year. We used the Beck depression inventory (BDI) as valid and reliable instrument to assess depression. The students were categorised according to BDI scores in three groups: with mild depression (10- 18 points); moderate depression (19-29); severe depression (30- 63). Data were analysed with program product Python 3 (v3.6.9) with Pandas v0.25.3 and Scipy v1.4.1. Results Depressive symptoms reported 71.5% of Turkish students, 47.1% of Bulgarian and 48.7% of foreign medical students. The depression frequency among Turkish and Bulgarian medical students was significantly different (chi2 = 35.31; p = 0,001). Mean BDI scores were similar for Bulgarian medical students (11.0) and foreign medical students, studying in Bulgaria (11.6). Turkish medical students scored highest on BDI (15.3). Severe depression was detected in 5.6% of foreign, 4.3% of Bulgarian and 6.3% of Turkish students. Conclusions Depression prevalence was high in all studied medical students cohorts, with Turkish cohort affected most, probably because of cultural and curriculum differences. Key messages Support of student’s mental health should be an integral part of the educational policies of all Medical Universities worldwide. Depression among medical students has to be prevented by comprehensive approach.

Introduction: Depression is a common mental health conditions in the world. Compare to general population, the prevalence of depression in medical students are higher. There are several risk factors that might contribute to the higher rate of depression in medical students, including being a gifted student. However, no study has been published regarding the depression of the gifted medical students until now.Aim: To find out the difference in the level of depression between gifted and non-gifted medical students. Methods: This study was a descriptive cross-sectional study, conducted from October to December 2016. Subjects were third year medical students from Faculty of Medicine Universitas Airlangga. There were 2 groups in this study. Samples from gifted students group was obtained using total sampling method, while number of samples from non-gifted students group was equated with gifted students group. Depression was measured using Beck Depression Inventory (BDI). Mann-Whitney U test was used for statistical analysis. Results: 34 students, 17 students in the gifted students group and 17 students in the non-gifted students group, were included in this study. Based on the BDI score results category, 2 students from the gifted students group and 1 student from non-gifted students group were in the mild category, and 1 student from the gifted students group was in the borderline category. The highest BDI score in gifted students group were 14, while in non- gifted students group were 17. There was no significant difference of the BDI score and BDI category between groups (p = 0.154; 0.951, respectively).Conclusion: There was no significant difference of depression level between gifted and non-gifted medical students.

Introduction:To evaluate the personality and temperament traits in patients with chronic hepatitis B in comparison to healthy subjects and to determine whether there is a relation between personality trait and level of anxiety or depression.Material and Methods:This was a case-control study in which 67 patients who had been under follow-up with diagnosis of chronic hepatitis B and 103 aged-matched healthy subjects were included. Study participants were asked to complete three self-report questionnaires— Temperament and Character Inventory (TCI) to define personality traits, Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) to evaluate presence and severity of depression and anxiety.Results:Total and sub-scale scores of five out of seven dimensions of TCI—reward dependence, persistence, self-directedness, cooperativeness, and self-transcence—were significantly higher in Group 1 than Group 2. Total BDI and BAI scores were significantly higher in Group 1 than Group 2 .Significantly more patients had a BDI score of 17 or over in Group 1 than Group 2. There was no significant correlation between total scores of TCI dimensions and total BAI or BDI scores except weak correlations between harm avoidance or self-directedness and total BAI or BDI scores.Conclusions:In terms of personality trait, patients with chronic hepatitis B exhibit higher reward dependence, persistence, self-directedness, cooperativeness, and self-transcendence from healthy population. The personality traits of patients should be considered during the management of hepatitis B in order to optimize treatment outcome and to prevent development of new mental health problems during the course of the disease.

IntroductionDepression, a pervasive mood disorder, significantly impairs one’s quality of life. Early Maladaptive Schemas (EMS), ingrained thought patterns stemming from early life experiences, play a pivotal role in shaping adult beliefs and behaviors. This study delves into the relevance of specific EMS domains—Emotional Inhibition (EI), Negativity/Pessimism (NP), and Social Isolation/Alienation (SI)—in influencing the severity of depression among medical students and diagnosed patients.ObjectivesOur primary goal was to assess the correlation between specific EMS domains and depression severity in medical students and clinically diagnosed patients. We aimed to elucidate whether these schemas could serve as indicators for potential depressive tendencies or if they had a stronger association in those already diagnosed with depression.MethodsWe conducted a prospective cross-sectional analysis involving 73 medical students and 61 diagnosed depression patients (aged 18-32). Four key variables—Depression, EI, NP, and SI—were measured using the Beck Depression Inventory-2 and The Young Schema Questionnaire-Short-form-3 in the Romanian context. Statistical analyses, including correlation coefficients and t-tests, were employed to explore the relationships between EMS domains and depression severity.ResultsIn the non-clinical sample, we identified moderate, statistically significant correlations between depression and EI (r=0.63), NP (r=0.71), and SI (r=0.59). Conversely, the clinical sample exhibited slightly weaker, yet significant correlations (EI-r=0.42, NP-r=0.39, SI-r=0.29). Notably, significant differences emerged between the groups in all measured variables. These findings imply that while a positive correlation between EMS variables and depression exists in both samples, the association weakens in diagnosed patients, indicating that these schemas may be less predictive in this population.ConclusionsOur study underscores the importance of understanding EMS domains in assessing depression severity. While specific schemas—EI, NP, and SI—correlate with depression in both medical students and diagnosed patients, this link is notably weaker in the latter group. Elevated EMS variables suggest a potential for future subclinical depression in medical students, but they might not strongly predict depression in those already diagnosed. These nuanced insights have implications for preventive interventions and therapeutic approaches tailored to individuals at different stages of depression, thereby enhancing targeted mental health care strategies.Disclosure of InterestNone Declared

Background: Mental problems are common among medical school students, and these problems affect social and academic functionality. It was aimed to determine depression, stress and burnout levels of medical school students in a university which constitutes 3.25% of the all medical students in Turkey. Methods: 1306 students studying in all classes at Gazi University Faculty of Medicine participated in this cross-sectional study. Sociodemographic data form, CES-Depression Scale (CES-D), Perceived Stress Scale (PSS), and Maslach Burnout Inventory Student Scale (MBI-SS) were applied to the participants. Results: The mean score of the MBI-SS exhaustion subscale was 15.6, cynicism was 10.4, and the efficacy subscale was 11.7. The mean score of CES- D was 21.2 and PSS was 28.3. The prevalence of depression was estimated as 64.2%. Female participants showed higher scores in PSS, but lower scores in cynicism and efficacy. For exhaustion and cynicism, 1st graders’ scores were significantly lower than all the others. For efficacy, 4th graders’ scores were significantly lower than 1st and 6th graders’. In CES-D; the 4th graders’ scores were significantly higher than the 1st and 3rd graders’. In PSS; 4th graders’ scores were significantly higher than 1sts. Conclusion: Stress, burnout, and depressive symptoms are high in medical students, especially in 4th graders and female students. It is considered to be important to raise awareness and plan preventive services on this issue.

Objective: To find out the level of depression, anxiety and stress on the basis of education among female medical and non medical students. Study Design: Cross sectional descriptive study. Study place and duration: Study was conducted at Nishtar medical college, Multan and Bahaudin Zakarya University Multan from October 2020 to October 2021. Methodology: The study was conducted on 100 medical students and 100 non medical students from two institutions of Multan. Depression and Anxiety stress scale (DASS) was used for evaluation of outcomes. SPSS version 23 was used for data analysis. T-test was applied to assess score differences of depression, anxiety and stress between medical and non medical students. Quantitative variables were presented as mean and standard deviation, whereas qualitative variables were presented as frequency and percentages. Probability value≤0.05 was considered as significant. Results: Mean age of participants was 24.2±1.80 years and 14.5% were living away from their families. Mean score for depression in medical students were: 13.96±7.289 and for depression in non medical students were: 16.02±6.374, for anxiety in medical students were: 17.15±6.936 for anxiety in non medical students were: 14.33±5.829, for stress in medical students were: 14.61±5.148 and for stress in non medical students were:14.73±6.078. Correlation of stress with depression was significant: r =.045, p<0.05, whereas correlation of stress with anxiety was non-significant r=.131, p˃0.05. Conclusion: Female medical students had low level of depression but high level of anxiety and stress as compared to non medical students. Presence of stress was correlated with presence of depression among medical and non medical students. Keywords: Depression, Anxiety, stress, Medical students, Non medical students, Pakistan

Medical students are prone to anxiety and depression, largely due to the nature of their coursework. During the COVID-19 pandemic, many medical students were required to study from home without being involved in clinical practice. The aim of this study was to investigate depression and generalized anxiety disorder (GAD), plus possible risk factors in medical students around the world during the pandemic. A primary search was conducted using PubMed, limited to the period 2020–2021. A second search was conducted to acquire studies published before the pandemic, aiming to have a baseline prevalence value for these disorders in medical students. During the pandemic, the prevalence of depression in the USA (31.7%, 12.5%, and 10.8% for mild, moderate, and severe depression, respectively) was higher than the reported prevalence in Pakistan, Nepal, and Iran, although the four countries used different psychiatric instruments, making comparison difficult (9-item Patient Health Questionnaire, Self-rating Depression Scale, Hospital Anxiety and Depression Scale-Depression [HADS-D], and Beck Depression Inventory [BDI-II). The prevalence of GAD in the USA was also higher (35.3%, 19.5%, and 11.1%, for mild, moderate, and severe GAD) than the prevalence in China (21.3%, 2.7%, and 0.9%, for mild, moderate, and severe anxiety), and the overall prevalence in Brazil, (46.2%), using the same instrument (GAD-7). The prevalence of GAD in the USA was also higher than the prevalence in Nepal, Pakistan, and Iran, although the researchers used a different psychiatric instrument (HADS-A, Self-rating Anxiety Scale, and Beck Anxiety Inventory instruments, respectively). Before the pandemic, the reported prevalence of depression in the USA was lower (11.6%, 9.0%, and 3.0% for mild, moderate, and severe depression), than in Pakistan (31.0%, 13.6%, and 4.8%), using the BDI instrument. In Nepal, the prevalence of depression (5.2%) was higher than in Portugal (2.3%), ascertained with the HADS-D instrument. The prevalence in Egypt (65% using Depression Anxiety Stress Scale DASS-21]) and India (14.7%, 19%, and 17.5% mild, moderate, and severe depression, using DASS 42) were the highest prevalence values reported before the pandemic. For anxiety, the prevalence of overall GAD in Nepal (16.2%) was comparable to the one reported in Portugal (14.2%), both identified with the HADS-A instrument. The prevalence of GAD reported in India and in Egypt were the highest values, determined with the DASS 42 and DASS 21, respectively. Studies have reported that general social isolation and loneliness are risk factors contributing factors toward depression. Other risk factors identified with depression and/or anxiety disorders were being female, having a lower GPA, lower COVID-19 awareness, and having more experience with COVID symptoms. High prevalence of depression and GAD was identified in medical students in various countries. It is imperative that during any crisis such as the one experienced in the present COVID-19 pandemic, vulnerable populations to mental health disorders, such as medical students, are identified and supported. Further research needs to be done to explore other possible factors, such as living conditions, marital status, social-cultural influences, financial issues, and their relationship to depression and anxiety in this population, to further understand the best interventions to support this population.

Background: Both asthma and COPD affect mental health due to their impact on activities, sleep and social life of patients and can be resulted in anxiety and depression. Objective: To determine and compare the prevalence of anxiety and depression in asthma and COPD patients. Methods: Subjects without known psychiatric diseases were consecutively recruited from pulmonary and allergy out-patient clinics at the third level hospitals. Diagnosis of asthma and COPD was based on GINA and GOLD guideline, respectively. Depression and anxiety symptoms were evaluated using Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Results: Study group consisted of 53 patients-30 with asthma and 23 with COPD. All patients had moderate-to severe diseases. COPD group was older, had more smoking history and higher number of hospitalization than those in asthmatics. Atopy rate and education level was higher in asthmatics than those in COPD group. The mean BDI and BAI scores were 17.96±12.39 and 20.57± 12.67 in the whole group. Both group had similar degree of anxiety (21.23±11.7 vs. 19.7±14), whereas BDI score was significantly higher in COPD group than that in asthmatics (15.63±13.6 vs. 21±10.1) (p=0.02). Age, gender, smoking history, education level, atopy status, number of emergency room admission was not correlated with scores of BDI and BAI for both group. The only effective parameter on BDI score in COPD patients was having comorbidities. Conclusion: Both asthmatics and COPD patients regardless of their socio demographic and clinical features have similar degree of anxiety. In addition, COPD patients are more depressive than asthmatics. The study indicates that psychiatric evaluation should be a part of tailoring therapy in chronic respiratory

In this study, we investigated the anti-stress effects of chewing gum prepared with yeast hydrolysate (SCP) in the general Korean population using heart rate value (HRV) analysis and the Beck depression inventory (BDI) and Beck anxiety inventory (BAI). Four different kinds of chewing gum (weight 960 ± 2 mg) were designed: three with different concentrations of SCP (30, 85, and 250 mg/piece) combined with xylitol and a placebo chewing gum. Displacement studies of 3H-paroxetine showed that SCP interacted with serotonin transporters with an IC50 of 1.72 mg/mL. In the placebo group, there were significant differences in the BDI and BAI scores before and after chewing gum (p < 0.05). There were also significant differences in the SCP groups in BDI and/or BAI scores between before and after chewing gum (p < 0.05). In addition, the SCP-30 and 85 groups were significantly different in low frequency (LF) or standard deviation of RR interval (SDNN) value, respectively, before and after the act of chewing gum (p < 0.05). After the chewing gum tests, some HRV (HR, SDNN, TP, and HF) were significantly different between the groups. In particular, the SCP-85 group was significantly different in HR, SDNN, TP, and HF compared to the placebo group (p < 0.05). In the improvement of BAI and BDI scores after the chewing gum test, the SCP-30 and SCP-250 groups exhibited significant improvements in BAI scores compared to placebo (p < 0.05). These findings suggest that SCP intake may be associated with a reduced risk of depression and stress. The SCP might have a synergistic effect on the anti-stress properties of chewing gum.

Correlations between Academic Achievement and Anxiety and Depression in Medical Students Experiencing Integrated Curriculum Reform