Impact of the COVID-19 Pandemic on the Mental Health of Medical Undergraduates of a Tertiary Care Teaching Hospital in Eastern Odisha: A Cross-Sectional Study

Manika Bose; Debasish Misra; Smita Das; Tapaswini Mishra; Jitendriya Biswal; Swati Mishra

doi:10.54133/ajms.v5i1S.278

Authors

Manika Bose Department of Pharmacology, IMS and SUM Hospital, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar 751003, Odisha, India https://orcid.org/0000-0002-0848-0315
Debasish Misra Department of Pharmacology, IMS and SUM Hospital, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar 751003, Odisha, India https://orcid.org/0000-0002-8273-2787
Smita Das Department of Pharmacology, IMS and SUM Hospital, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar 751003, Odisha, India
Tapaswini Mishra Department of Physiology, IMS and SUM Hospital, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India https://orcid.org/0000-0002-2057-4517
Jitendriya Biswal Department of Psychiatry, IMS and SUM Hospital, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India https://orcid.org/0000-0003-4343-4880
Swati Mishra Department of Pharmacology, IMS and SUM Hospital, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar 751003, Odisha, India https://orcid.org/0000-0002-8827-2769

DOI:

https://doi.org/10.54133/ajms.v5i1S.278

Keywords:

Anxiety, Depression, Medical undergraduates, Psychological impact, QoL, Stress

Abstract

Background: The Corona virus pandemic had a crushing impact on the mental health of medical undergraduates. Objective: The current research was conducted to evaluate the prevalence of psychological impacts, viz., anxiety, stress, and depression, in undergraduates undertaking medicine courses and assess their quality of life. Methods: A prospective cross-sectional study was undertaken with an online questionnaire using Google with a WhatsApp link. Informed consent (online) was obtained before enrollment in the study. This study used the DASS-21 questionnaire and a Quality of Life questionnaire for analysis. The total number of participants was 559 during the study period. Descriptive statistics, the non-parametric Chi-square test, the binomial test, the Kruskal-Wallis test, and the Mann-Whitney test were used for analysis. p<0.05 was considered to be statistically significant. Results: Out of 559 respondents, the majority were 21 years of age or older, with a male predominance of 60.6%. It was found that those who were smoking or consuming alcohol had higher DAS scores. Quality of life (QoL) was lower for those who were on medication for hypertension. Stress levels were significantly higher in males. The relationship between anxiety levels and males was statistically significant. Conclusions: COVID-19 had a psychological impact on the medical students. Therefore, early evaluation, timely intervention, and student counseling services need to be made available to solve this problem and remain prepared for all potential future pandemics.

Downloads

Download data is not yet available.

References

WHO. Characterizes COVID-19 as a pandemic. World Heal Organ. 2020; Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.

Koochaki GM, Charkazi A, Hasanzadeh A, Saedani M, Qorbani M, Marjani A. Prevalence of stress among Iranian medical students: A questionnaire survey. East Mediterr Health J. 2011;17:593-598. PMID: 21972483. DOI: https://doi.org/10.26719/2011.17.7.593

Aebischer O, Weilenmann S, Gachoud D, Méan M, Spiller TR. Physical and psychological health of medical students involved in the coronavirus disease 2019 response in Switzerland. Swiss Med Wkly. 2020;150:w20418. doi: 10.4414/smw.2020.20418. DOI: https://doi.org/10.4414/smw.2020.20418

Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. 2020. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res. 2020;287:112934. doi: 10.1016/j.psychres.2020.112934. DOI: https://doi.org/10.1016/j.psychres.2020.112934

Lin Y, Hu Z, Alias H, Wong LP. Influence of mass and social media on psychobehavioral responses among medical students during the downward trend of COVID-19 in Fujian, China: cross-sectional study. J Med Internet Res. 2020;22 (7):e19982. doi: 10.2196/19982. DOI: https://doi.org/10.2196/19982

Liu J, Zhu Q, Fan W, Makamure J, Zheng C, Wang J. Online mental health survey in a medical college in China during the COVID-19 outbreak. Front Psychiatry. 2020;11:459. doi: 10.3389/fpsyt.2020.00459.

Sahu P. Closure of universities due to coronavirus disease 2019 (COVID-19): Impact on education and mental health of students and academic staff. Cureus. 2020;12(4):e7541. doi: 10.7759/cureus.7541. DOI: https://doi.org/10.7759/cureus.7541

Ahmed I, Banu H, Al-Fageer R, Al-Suwaidi R. Cognitive emotions: Depression and anxiety in medical students and staff. J Crit Care. 2009;24(3):e1. doi: 10.1016/j.jcrc.2009.06.003. DOI: https://doi.org/10.1016/j.jcrc.2009.06.003

Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Ntew Open. 2020;3(3):e203976. doi: 10.1001/jamanetworkopen.2020.3976. DOI: https://doi.org/10.1001/jamanetworkopen.2020.3976

Moutinho ILD, De Castro Pecci Maddalena N, Roland RK, Lucchetti ALG, TibiriçÁ SHC, et al. Depression, stress, and anxiety in medical students: A cross-sectional comparison between students from different semesters. Rev Assoc Med Bras. 2017;63(1):21-28. doi: 10.1590/1806-9282.63.01.21.

Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun. 2020;88:901-907. doi: 10.1016/j.bbi.2020.05.026. DOI: https://doi.org/10.1016/j.bbi.2020.05.026

Puthran R, Zhang MW, Tam WW, Ho RC. Prevalence of depression amongst medical students: a meta-analysis. Med Educ. 2016;50(4):456-468. doi: 10.1111/medu.12962. DOI: https://doi.org/10.1111/medu.12962

Cullen W, Gulati G, Kelly BD. Mental health in the COVID-19 pandemic. QJM. 2020;113(5):311-312. doi: 10.1093/qjmed/hcaa110. DOI: https://doi.org/10.1093/qjmed/hcaa110

Araújo FJO, de Lima LSA, Cidade PIM, Nobre CB, Neto MLR. Impact of sars-cov-2 and its reverberation in global higher education and mental health. Psychiatry Res. 2020;288:112977. doi: 10.1016/j.psychres.2020.112977. DOI: https://doi.org/10.1016/j.psychres.2020.112977

UNESCO. COVID-19 educational disruption and response, 2020. Available at: https://en.unesco.org/themes/education-emergencies/coronavirus-school-closures

Tull MT, Edmonds KA, Scamaldo KM, Richmond JR, Rose JP, Gratz KL. Psychological outcomes associated with stay-at-home orders and the perceived impact of COVID-19 on daily life. Psychiatry Res. 2020;289:113098. doi: 10.1016/j.psychres.2020.113098. DOI: https://doi.org/10.1016/j.psychres.2020.113098

Al-Rabiaah A, Temsah MH, Al-Eyadhy AA, Hasan GM, Al-Zamil F, Al-Subaie S, et al. Middle east respiratory syndrome-corona virus (MERS-CoV) associated stress among medical students at a university teaching hospital in Saudi Arabia. J Infect Public Health. 2020;13(5):687-691. doi: 10.1016/j.jiph.2020.01.005. DOI: https://doi.org/10.1016/j.jiph.2020.01.005

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):3933. doi: 10.3390/ijerph17113933. DOI: https://doi.org/10.3390/ijerph17113933

Huckins JF, DaSilva 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):e20185 doi: 10.2196/20185. DOI: https://doi.org/10.2196/20185

Pierce M, Hope H, Ford T, Hatch S, Hotopf M, John A, et al. Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. Lancet Psychiatr. 2020;7(10):P883-P892 doi: 10.1016/S2215-0366(20)30308-4. DOI: https://doi.org/10.1016/S2215-0366(20)30308-4

Moutinho IL, de Castro Pecci Maddalena N, Roland RK, Lucchetti AL, TibiriçÁ SH, Da Silva Ezequiel O, et al. Depression, stress and anxiety in medical students: A cross-sectional comparison between students from different semesters. Rev Assoc Med Bras. 2017;63:21-28. doi: 10.1590/1806- 9282.63.01.21. DOI: https://doi.org/10.1590/1806-9282.63.01.21

Tran TD, Tran T, Fisher J. Validation of the depression anxiety stress scales (DASS) 21 as a screening instrument for depression and anxiety in a rural community-based cohort of northern Vietnamese women. BMC Psychiatr. 2013;13:24. doi: 10.1186/1471-244X-13-24. DOI: https://doi.org/10.1186/1471-244X-13-24

Maheshwari M, Awasthi A, Tilwani K, Jangid P. Mental health of medical students during corona virus disease 19 pandemic: A cross sectional study. Ann Ind Psych. 2022;6(3):238-243. doi: 10.4103/aip.aip_120_21. DOI: https://doi.org/10.4103/aip.aip_120_21

Lasheras I, Gracia-García P, Lipnicki DM, Bueno-Notivol J, López-Antón R, de la Cámara C, et al. Prevalence of anxiety in medical students during the covid-19 pandemic: a rapid systematic review with meta-analysis. Int J Environ Res Public Health. 2020;17:1-12. doi: 10.3390/ijerph17186603. DOI: https://doi.org/10.3390/ijerph17186603

Essangri H, Sabir M, Benkabbou A, Majbar MA, Amrani L, Ghannam A, et al. Predictive factors for impaired mental health among medical students during the early stage of the COVID-19 pandemic in Morocco. Am J Trop Med Hyg. 2021;104(1):95-102. doi: 10.4269/ajtmh.20-1302. DOI: https://doi.org/10.4269/ajtmh.20-1302

Kalok A, Sharip S, Abdul Hafizz AM, Zainuddin ZM, Shafiee MN. 2020. The psychological impact of movement restriction during the COVID-19 outbreak on clinical undergraduates: a cross-sectional study. Int J Environ Res Public Health. 2020;17(22):8522. doi: 10.3390/ijerph17228522. DOI: https://doi.org/10.3390/ijerph17228522

Nguyen HT, Do BN, Pham KM, Kim GB, Dam H, Nguyen TT, et al. Fear of COVID-19 scale associations of its scores with health literacy and health-related behaviours among medical students. Int J Environ Res Public Health. 2020;17(11):4164. doi:10.3390/ijerph17114164. DOI: https://doi.org/10.3390/ijerph17114164

Saraswathi I, Saikarthik J, Senthil Kumar K, Madhan Srinivasan K, Ardhanaari M, Gunapriya R. Impact of COVID 19 outbreak on the mental health status of undergraduate medical students in a COVID19 treating medical college: A prospective longitudinal study. PeerJ. 2020;8:e10164. doi: 10.7717/peerj.10164. DOI: https://doi.org/10.7717/peerj.10164

Wang C, Pan R, Wan X, TanY, Xu L, McIntyre RS, et al. A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain Behav Immun. 2020;87:40-48. doi: 10.1016/j.bbi.2020.04.028. DOI: https://doi.org/10.1016/j.bbi.2020.04.028

Liu J, Zhu Q, Fan W, Makamure J, Zheng C, Wang J. Online mental health survey in a medical college in China during the COVID-19 outbreak. Front Psychiatry. 2020;11:459. doi: 10.3389/fpsyt.2020.00459. DOI: https://doi.org/10.3389/fpsyt.2020.00459

Arima M, Takamiya Y, Furuta A, Siriratsivawong K, Tsuchiya S, Izumi M. Factors associated with the mental health status of medical students during the COVID-19 pandemic: a cross-sectional study in Japan. BMJ Open. 2020;10(12):e043728. doi: 10.1136/bmjopen-2020-043728. DOI: https://doi.org/10.1136/bmjopen-2020-043728

Sartorao-Filho CI, de Las Villas Rodrigues WC, de Castro RB, Marçal AA, Pavelqueires S, Takano L, et al. Moderate and severe symptoms of anxiety and depression are increased among female medical students during the COVID-19 pandemic. Res Soc Develop. 2021;10(6):e34610615406. doi:10.33448/rsd-v10i6.15406. DOI: https://doi.org/10.33448/rsd-v10i6.15406

Essadek A, Rabeyron T. 2020. Mental health of French students during the Covid-19 pandemic. J Affect Disord. 2020;277:392-393. doi: 10.1016/j. jad.2020.08.042. DOI: https://doi.org/10.1016/j.jad.2020.08.042

Wilkes C, Lewis T, Brager N, Bulloch A, MacMaster F, Paget M, et al. Wellbeing and mental health amongst medical students in Canada. Int Rev Psychiatry. 2019;31(7-8):584-587. doi: 10.1080/09540261.2019.1675927. DOI: https://doi.org/10.1080/09540261.2019.1675927

Frajerman A, Morvan Y, Krebs MO, Gorwood P, Chaumette B. Burnout in medical students before residency: A systematic review and meta-analysis. Eur Psychiatry. 2019;55:36-42. doi: 10.1016/j.eurpsy.2018.08.006. DOI: https://doi.org/10.1016/j.eurpsy.2018.08.006

Maser B, Danilewitz M, Guérin E, Findlay L, Frank E. Medical student psychological distress and mental illness relative to the general population: A Canadian cross-sectional survey. Acad Med. 2019;94:1781-1791. doi: 10.1097/ACM.0000000000002958. DOI: https://doi.org/10.1097/ACM.0000000000002958

Taneja N, Sachdeva S, Dwivedi N. Assessment of depression, anxiety, and stress among medical students enrolled in a medical college of New Delhi, India. Indian J Soc Psychiatry. 2018;34:157-162. doi: 10.4103/ijsp.ijsp_114_17. DOI: https://doi.org/10.4103/ijsp.ijsp_114_17

Mandal A, Ghosh A, Sengupta G, Bera T, Das N, Mukherjee S. Factors affecting the performance of undergraduate medical students: A perspective. Indian J Community Med. 2012;37:126-129. DOI: https://doi.org/10.4103/0970-0218.96104

Quek TT, Tam WW, Tran BX, Zhang M, Zhang Z, Ho CS, et al. The global prevalence of anxiety among medical students: A meta-analysis. Int J Environ Res Public Health. 2019;16:1-18. doi: 10.3390/ijerph16152735. DOI: https://doi.org/10.3390/ijerph16152735

Alyoubi A, Halstead EJ, Zambelli Z, Dimitriou,D. The impact of the COVID-19 Pandemic on students’ mental health and sleep in Saudi Arabia. Int J Environ Res Public Health. 2021;18:9344. doi: 10.3390/ijerph18179344. DOI: https://doi.org/10.3390/ijerph18179344

Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med. 2013;43:897-910. doi: 10.1017/s003329171200147x. DOI: https://doi.org/10.1017/S003329171200147X

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;277:55-64. doi 10.1016/j.jad.2020.08.001. DOI: https://doi.org/10.1016/j.jad.2020.08.001

Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Netw Open. 2020;3:e2019686. doi: 10.1001/ jamanetworkopen.2020.19686. DOI: https://doi.org/10.1001/jamanetworkopen.2020.19686

Shehata GA, Gabra R, Eltellawy S, Elsayed M, Gaber DE, Elshabrawy HA. Assessment of anxiety, depression, attitude, and coping strategies of the egyptian population during the COVID-19 pandemic. J Clin Med. 2021;10(17):3989. doi: 10.3390/jcm10173989. DOI: https://doi.org/10.3390/jcm10173989

Skevington SM, Wright A. Changes in the quality of life of patients receiving antidepressant medication in primary care: validation of the WHOQOL-100. Br J Psychiatry. 2001;178:261-267. doi: 10.1192/bjp.178.3.261. DOI: https://doi.org/10.1192/bjp.178.3.261

Singh R, Goyal M, Tiwari S, Ghildiyal A, Nattu SM, Das S. Effect of examination stress on mood, performance and cortisol levels in medical students. Indian J Physiol Pharmacol. 2012;56(1):48-55.

Jia N, Fan N, Lu Z. A survey of the undergraduate anxiety in the SARS-infected areas. J Hebei Norm Univ. 2003;5:57-60.