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 Table of Contents  
STUDENT CONTRIBUTION
Year : 2022  |  Volume : 35  |  Issue : 1  |  Page : 20-25

Psychological distress among first-year medical students amidst COVID-19-related uncertainty at a medical college in Western India: A cross-sectional study


1 Undergraduate Medical Student, Goa Medical College, Bambolim, Goa, India
2 Department of Community Medicine, Goa Medical College, Bambolim, Goa, India
3 Department of Biochemistry, Goa Medical College, Bambolim, Goa, India

Date of Submission16-Dec-2020
Date of Decision02-Oct-2021
Date of Acceptance17-Feb-2022
Date of Web Publication29-Sep-2022

Correspondence Address:
Frederick S Vaz
Department of Community Medicine, Goa Medical College, Bambolim - 403 202, Goa
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/efh.efh_612_20

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  Abstract 


Background: The sudden and rapid spread of the COVID-19 pandemic has created fear, worry and uncertainty in the student community. First-year medical students are likely to be doubly affected, for in addition to the stress of adapting to new learning processes, they are also now faced with uncertainties due to the COVID-19 pandemic. It was therefore decided to estimate psychological distress among the 1st-year medical students among the COVID-19 pandemic-related uncertainty. Methods: A cross-sectional study was conducted on 1st-year medical students studying at a Medical College in western India. Demographic and COVID-19 related data was collected from the students through Google Forms and psychological distress was measured by using the 20 point World Health Organization-Self Reporting Questionnaire (WHO-SRQ 20). The study was approved by the Institutional ethics committee. Informed consent was taken before administering the questionnaire to the study participants. Statistical analysis was conducted using the SPSS statistical software. Results: Prevalence of Psychological distress among the study participants by WHO-SRQ 20 Scale with cut off 7/8 as found to be 25.5%. Worried about themselves contracting COVID-19 Infection (odds ratio [OR]: 3.44; 95% confidence interval [CI]: 1.25–9.42), worried of the adverse financial effect on self and family due to COVID-19 pandemic (OR: 3.01; 95% CI: 1.29–7.04), worried that online mode of learning was putting them at disadvantage compared to traditional Teaching-Learning method (OR: 3.44; 95% CI: 1.25–9.42), and worried about adverse effects on social support due to COVID-19 pandemic (OR: 2.63; 95% CI: 1.27–5.43), were the factors significantly associated with psychological distress among the medical students. Discussion: There is an urgent need to develop a system to render counseling/professional help to all the students in need. This would ensure better mental health and would minimize any adverse academic outcomes among the students due to the COVID-19 Pandemic.

Keywords: COVID-19, distress, medical students, psychological, world health organization-self reporting questionaire 20


How to cite this article:
Shyadligeri AA, Vaz FS, Lokapure SR. Psychological distress among first-year medical students amidst COVID-19-related uncertainty at a medical college in Western India: A cross-sectional study. Educ Health 2022;35:20-5

How to cite this URL:
Shyadligeri AA, Vaz FS, Lokapure SR. Psychological distress among first-year medical students amidst COVID-19-related uncertainty at a medical college in Western India: A cross-sectional study. Educ Health [serial online] 2022 [cited 2022 Nov 30];35:20-5. Available from: https://educationforhealth.net//text.asp?2022/35/1/20/357527




  Background Top


The World Health Organization (WHO) defined health as a “state of complete physical, mental, and social well-being and not merely an absence of disease or infirmity.”[1] WHO further defined mental health as a “state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life and is able to make a contribution to his or her community.”[2] Psychological distress has been defined as a “state of emotional suffering with predominant symptoms of depression and anxiety.”[3]

The sudden and rapid spread of the COVID-19 pandemic has created fear, worry, and uncertainty. This is especially true for the student community. First-year medical students are likely to be doubly affected, for in addition to the stress of adapting to new learning processes in a professional institute, they are also now faced with uncertainties due to the COVID-19 pandemic. It was therefore decided to estimate psychological distress among the 1st-year medical students amidst the COVID-19 uncertainty. The objectives of the study were to estimate psychological distress among the 1st-year medical students using WHO-Self Reporting Questionnaire (SRQ) 20 Scale during the ongoing COVID-19 pandemic and to identify some key COVID-19-related factors associated with the psychological distress.


  Methods Top


Study setting

The study was conducted on 1st-year medical students studying at a Medical College in Western India, in July 2020.

Study participants

All 180 students enrolled in the first professional MBBS course were invited to participate in the study.

Exclusion criteria

Students not consenting to participate in the study and students turning in incomplete questionnaire forms were excluded from the study.

Study instruments

The data were collected in a structured questionnaire prepared using Google Forms which were sent to the study participants through electronic media. Demographic and COVID-19 related data was collected from the students in addition; psychological distress was measured by using the 20 point WHO-SRQ.[4] The WHO-SRQ 20 uses recall of the past 30 days only and was best suited to the stated objectives of the study. A cut-off score of 7/8 was used to identify psychological distress. A score of 7/8 was found to have the sensitivity of 79%, specificity of 96%, and positive predictive value of 75% in an earlier study.[5]

Ethics approval

The study protocol and consent form were approved by the Institutional Ethics Committee of the institute. Informed consent was taken through google forms before administering the questionnaire to the study participants.

Statistical analysis

Data were collated in MS excel spreadsheet, thereafter statistical analysis was conducted using IBM SPSS Statistics for Windows (Version 22.0. Armonk, NY, USA: IBM Corp). Background sociodemographic characteristics, COVID-19-related uncertainty, and COVID-19 related positive factors were presented as descriptive statistics. Continuous variables were presented as mean and standard deviation (SD) and for categorical variables, the percentages were calculated. Prevalence of psychological distress was calculated considering the WHO-SRQ cut-off score ≥8 as indicative of the presence of psychological distress. Associations between psychological distress and variables of interest were studied by dichotomizing psychological distress as present (WHO-SRQ score ≥8) and absent (WHO-SRQ score <8). We used χ2 as the test of significance and a P ≤ 0.05 was considered statistically significant. In addition, unadjusted Odds Ratios (OR) along with 95% CI were also calculated for each variable of interest.


  Results Top


The cross-sectional study was conducted among medical students studying in the first professional year of the MBBS course. Out of the 180 1st-year medical students invited to participate in the study, a total of 165 students participated in the study giving a response rate of 91.6%.

The mean age of the study participants was 19.16 ± 0.85. Around 55.8% of the participants were urban residents while 44.2% resided in rural areas. The majority of study participants were Hindu by religion (74.5%). The majority of the students (98.8%) reported that they were currently living with their families [Table 1].
Table 1: Background demographic characteristics of the medical students

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COVID-19-related uncertainty factors among the students are described in [Table 2]. Only 8.5% of study participants reported a relative/acquaintance having had COVID-19 infection whereas 29% reported that there were COVID-19 cases in their immediate neighborhood.
Table 2: Corona virus disease.2019 related uncertainty factors among the medical students

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Most study participants were worried about themselves (73.3%) and family members (95.2%) contracting COVID-19 infection. Majority of study participants were also worried about social discrimination (61.2%) and adverse financial effect on self and family (64.2%) due to the COVID-19 pandemic.

Study participants were worried about academic delay in medical studies (76.4%) and were also concerned that online mode of learning might be putting them at a disadvantage when compared to traditional Teaching-Learning methods (73.3%). Many students were worried about adverse effects on daily life (78.2%) due to the COVID-19 pandemic. Around 46.7% of the students worried that COVID-19 might have an adverse effect on their social support system.

Most of the study participants (64.8%) felt adequately prepared to protect themself from COVID-19 infection while, 58.2% of the students felt they were adequately prepared to undergo isolation/quarantine in case they tested positive for COVID-19. About 46.1% of the students reported that the COVID-19 pandemic made them rethink positively regarding the choice of medicine as their profession, 51.5% of study participants reported they had no rethink on their choice of profession. Only 2.4% of students felt that the COVID-19 pandemic has made them rethink negatively about their choice of medicine as their profession [Table 3].
Table 3: Corona virus disease.2019 related positive factors among the medical students

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Prevalence of Psychological distress among the study participants by WHO-SRQ 20 Scale with cut off 7/8 as found to be 25.5%. The mean score was 4.91 ± SD 4.48 while the score range varied from Zero to as high as 19 [Table 4].
Table 4: Psychological distress among the medical students by World Health Organization-self reporting questionnaire Scale with cut-off 7/8

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[Table 5] describes COVID-19 related uncertainty factors which were found to be significantly associated with psychological distress in the study participants. Students who reported that they were worried about themselves contracting COVID-19 Infection were 3.44 times more likely to have psychological distress compared to those who didn't express the same apprehension (OR = 3.44; 95% CI: 1.25–9.42). Participants who were worried about adverse financial effects on self and family due to the COVID-19 pandemic were almost three times more likely to have psychological distress (OR = 3.01; 95% CI: 1.29–7.04). The other two factors significantly associated with psychological distress were worry that online mode of learning was putting students at a disadvantage compared to the traditional Teaching-Learning method (OR = 3.44; 95% CI: 1.25–9.42 and worry about the adverse effects on social support due to COVID-19 pandemic (OR = 2.63; 95% CI: 1.27–5.43).
Table 5: Coronavirus disease-2019-related factors significantly associated with psychological distress in the the study participants

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  Discussion Top


In the study, most of the study participants reported that they were worried about themselves (73.3%) or someone in their family (95.2%) contracting COVID-19 and feared social discrimination (61.2%) associated with COVID-19 infection.

The study also found that 64.2% of study participants were worried about adverse financial effects on self and family due to the COVID-19 pandemic. Similar findings were reported in the study conducted by Carlos Filho et al. in Brazil.[6]

The study found that 76.4% of study participants worried about delays in medical studies and 73.3% felt that online teaching put them at a disadvantage compared to traditional teaching while 78.2% feared about adverse effects on daily life due to the COVID-19 pandemic. These findings are similar to those reported by Cao et al. in China.[7]

It was found that 35.2% of the study participants felt they were inadequately prepared to protect themselves from COVID-19 infection and 41.8% felt they were inadequately prepared to undergo isolation/quarantine in case they tested positive for COVID-19.

The present study reported the Prevalence of Psychological distress among the study participants by the WHO-SRQ Scale with cut-off 7/8 as 25.5% with a mean score of 4.91 ± SD 4.48 and a score range of zero to 19. Since we do not have information on the baseline prevalence of psychological distress among the students in pre-COVID times, how much of this distress could be attributed to the COVID-19 pandemic remains unknown.

A study conducted by Xiao et al.[8] in February 2020 at the height of the COVID-19 pandemic in China among medical students using Patient Generalized Anxiety Disorder-7 and Health Questionnaire-9 to measure anxiety disorders and depression reported prevalence of anxiety disorder at 17.1% and depression at 25.3%. A study conducted by Wang and Zhao[9] in China, using SAS (Self Rating Anxiety) scale, showed higher anxiety due to COVID-19 among Chinese university students. In the study conducted by Li et al.[10] using Kessler-6 Psychological distress scale and IES-R (Impact of Event Scale-Revised), 26.63% of health professional students demonstrated Clinically Significant Psychological distress, while 11.10% had probable Acute Stress Reaction during the COVID-19 outbreak.

As far as studies in pre-COVID times were concerned, a study conducted in 2014 by Saravanan and Wilks[11] in Malaysia, using (Depression Anxiety Stress Scale 21) showed 44% of medical students were anxious and 34.9% were depressed.

In this study, the COVID-19 related uncertainty factors significantly associated with psychological distress in the study participants were Fear about themselves contracting COVID-19 Infection, worry of the adverse financial effect on self and family due to COVID-19 pandemic, worry of online mode of learning putting them at a disadvantage compared to the traditional method and worry about the adverse effect on social support due to COVID-19 pandemic. Cao et al.[7] also reported that economic effects, and effects on daily life, as well as delays in academic activities, were positively associated with anxiety symptoms. Carlos Filho et al.[6] reported a higher prevalence of moderated and severe anxiety and depression symptoms among medical students during the COVID-19 pandemic, significantly among women and on medical students relating financial impairment related to the COVID-19 epidemic. It was interesting and reassuring that students while experiencing psychological distress themselves have also been able to contextualize the wider impact of the COVID-19 pandemic on societal well-being.

Fear, worry, and stress are normal responses to perceived or real threats, at times when we are faced with uncertainty or the unknown. So it is normal and understandable that people are experiencing fear in the context of the COVID-19 pandemic. While Healthcare workers and frontline warriors continue to be under the most stress in harsh working conditions, the pandemic has also affected the mental health of a large majority of the general population.

The Educational System and the Student Community have also been affected due to the Pandemic. The Lockdowns have forced Educational Institutions shut and teaching has moved online, the world over. Fear and anxiety about a new disease can be overwhelming and cause strong emotions in adults and children. Public health measures, such as social distancing, can make people feel isolated and lonely and can increase stress and anxiety.

This study has provided evidence in support of the presence of psychological distress among the 1st year medical students at the medical college during the COVID-19 pandemic. The study has also helped identify some factors behind the Psychological Distress among the students.

The findings were consistent with the role played by a stable financial condition; social support groups as well as the absence of uncertainty or fear in helping an individual maintain a good quality of Mental Health. The indefinite delays in academic schedule and disadvantages of an online mode of teaching, especially in a hands-on and skill-based curriculum such as medicine is proving to be a major cause of concern for the medical students.

Limitations of the study

Firstly, the study was conducted at a single medical school in western India and hence the study findings cannot be generalized to medical students at other medical schools in India. Secondly, we do not have data on pre-COVID-19 levels of psychological distress among the medical students and therefore we are unable to specify as to how much of this distress could be attributable to the COVID-19 pandemic-related uncertainty.


  Conclusion Top


The rates of psychological distress among the medical students were high enough to warrant intervention. The COVID-19 pandemic and the subsequent lockdown have proved to be a major cause of concern for the mental well-being of students. There is an urgent need to develop a system to render counseling/professional help to all the students in need. This would ensure better mental health and would minimize any adverse academic outcomes among the students due to the COVID-19 Pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Constitution of the World Health Organization. Geneva: World Health Organization; 1948.  Back to cited text no. 1
    
2.
World Health Organization. Mental Health. A State of Well-Being.Geneva:World Health Organization; 2020 Available from: https://www.who.int/features/factfiles/mental_health/en.accessed on November 31, 2020  Back to cited text no. 2
    
3.
Drapeau, A., Marchand, A., Beaulieu-Prèvost, D. Epidemiology of Psychological Distress. In: L'Abate, L., editor. Mental Illnesses-Understanding, Prediction and Control [Internet]. London: IntechOpen; [cited 2022 Mar 05]. Available from: https://www.intechopen.com/chapters/25512 doi: 10.5772/30872accessed on November 25, 2020.  Back to cited text no. 3
    
4.
World Health Organization. A User's Guide to Self Reporting Questionaire (SRQ). Geneva: Division of Mental Health, World Health Organization; 1994.  Back to cited text no. 4
    
5.
Chipimo PJ, Fylkesnes K. Comparative validity of screening instruments for mental distress in Zambia. Clin Pract Epidemiol Ment Health 2010;6:4-15.  Back to cited text no. 5
    
6.
Filho C, Rodrigues W, Castro R, Marcal A, 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 2020.06.24.20138925: 2020 [doi: 10.1101/2020.06.24.20138925].  Back to cited text no. 6
    
7.
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;287:112934.  Back to cited text no. 7
    
8.
Xiao H, Shu W, Li M, Li Z, Tao F, Wu X, et al. Social distancing among medical students during the 2019 coronavirus disease pandemic in China: Disease awareness, anxiety disorder, depression, and behavioral activities. Int J Environ Res Public Health 2020;17:5047.  Back to cited text no. 8
    
9.
Wang C, Zhao H. The impact of COVID-19 on anxiety in Chinese university students. Front Psychol 2020;11:1168.  Back to cited text no. 9
    
10.
Li Y, Wang Y, Jiang J, Valdimarsdóttir UA, Fall K, Fang F, et al. Psychological distress among health professional students during the COVID-19 outbreak. Psychol Med 2021;51:1952-4.  Back to cited text no. 10
    
11.
Saravanan C, Wilks R. Medical students' experience of and reaction to stress: The role of depression and anxiety. ScientificWorldJournal 2014;2014:737382.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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