Document Type : Original Article

Authors

Department of Public Health, Faculty of Public Health, Sriwijaya University, Ogan Ilir, Indonesia

Abstract

BACKGROUND: Before the COVID-19 pandemic, medical students had reported experiencing high
rates of distress, burnout, anxiety, and depression. The psychological impact of the COVID-19 in the
general population suggested that the mental health impact was increased anxiety, depression, and
stress. There were no exceptions if medical students also experience the same psychological impact.
The aimed to this study is analyze the mental and emotional effects of the COVID-19 pandemic
among medical students.
MATERIALS AND METHODS: An observational analytic study was used with a cross-sectional
approach. Data were obtained with questionnaires distributed through social media platforms from
July 14, 2020, to July 21, 2020. This study using the Fear of COVID-19 (FCV-19) Scale and the
Depression, Anxiety, and Stress Scale-21 to assess FCV-19, anxiety, stress, and depression.
statistical analysis used IBM SPSS Statistics 24 was used to analyze the two-tailed Chi-square test,
the Mann–Whitney test, and the Kruskal–Wallis test, which were used with statistical significance
as P < 0.05 for all tests.
RESULTS: Out of 1027 samples, 44.6% had stressed, 47.8% had anxiety, and 18.6% had depression.
The gender (P = 0.000), educational stage (P = 0.000), and the comorbidity factor (P = 0.001 for
stress and anxiety, P = 0.036 for depression, and P = 0.000 for FCV-19) had a significant association
with stress, anxiety, depression, and FCV-19 in medical students. The hometown that showed zone
risk of infection only showed significant differences in FCV-19 (P = 0.026).
CONCLUSIONS: Protection and psychological support for a medical student is extremely high
importance given that COVID-19 is now a well-established pandemic and there will be other
pandemics in the future.

Keywords

1. COVID-19 Coronavirus Pandemic. Available from:https://www.
worldometers.info/coronavirus/. [Last accessed on 2020 Jul 29].
2. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate
psychological responses and associated factors during the initial
stage of the 2019 coronavirus disease (COVID-19) epidemic
among the general population in China. Int J Environ Res Public
Health 2020;17:1-25. https://doi.org/10.3390/ijerph17051729.
3. Taylor S. The Psychology of Pandemics: Preparing for the Next
Global Outbreak of Infectious Disease, 1st ed. Newcastle upon
Tyne, UK: Cambridge Scholars Publishing; 2019.
4. Zaka A, Shamloo SE, Fiorente P, Tafuri A. COVID-19 pandemic as
a watershed moment: A call for systematic psychological health
care for frontline medical staff. J Health Psychol 2020;25:883-7.
doi: 10.1177/1359105320925148.
5. Cullen W, Gulati G, Kelly BD. Mental health in the COVID-19
pandemic. QJM 2020; 113:311-2. https://doi.org/10.1093/qjmed/
hcaa110.
6. World Socialist Web Site. Nurse Suicides Rise in Europe Amid
Stress of COVID-19 Pandemic; 2020. Available from: https://
www.wsws.org/en/articles/2020/03/31/trez-m31.html. [Last
accessed on 2020 Jul 29].
7. Goldman ML, Bernstein CA, Summers RF. Potential risks and
benefits of mental health screening of physicians. J Am Med Assoc
2018;320:2527-8. doi:10.1001/jama.2018.18403.
8. MacLean L, Booza J, Balon R. The impact of medical school on
student mental health. Acad Psychiatry 2016;40:89-91.https://
doi.org/10.1007/s40596-015-0301-5.
9. Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C,
et al. Prevalence of depression, depressive symptoms, and suicidal
ideation among medical students: A systematic review and metaanalysis. JAMA 2016; 316: 2214-36. doi:10.1001/jama.2016.17324.
10. Samouei R, Fooladvand M, Janghorban S, Khorvash F. Predicting
the educational performance of Isfahan University students of
medical sciences based on their behaviour profile, mental health
and demographic characteristic. J Edu Health Promot 2015; 4:44.
doi: 10.4103/2277-9531.157230.
11. Safaie N, Ketabi S, Kia N, Mirmohammadkhani M, Moonesan MR,
Paknazar F. Exploration of mental health problems in association
with health-promoting lifestyle profile in Iranian medical
students: A cross-sectional study. J Educ Health Promot 2020;
9:84. doi: 10.4103/jehp.jehp_582_19.
12. Komer L. COVID-19 amongst the pandemic of medical student
mental health. Inte J Med Stud 2020;8:56-7. DOI: https://doi.
org/10.5195/ijms.2020.501.
13. 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:e1-7. https://doi.org/10.1016/j.jcrc.2009.06.003.
14. 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 Netw Open 2020;3:e203976.
doi:10.1001/jamanetworkopen.2020.3976.
15. 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;63:21-8. http://dx.doi.org/10.1590/1806-
9282.63.01.21.
16. 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;88:901-7. https://doi.org/10.1016/j.
bbi.2020.05.026.
17. Puthran R, Zhang MW, Tam WW, Ho RC. Prevalence of
depression amongst medical students: A meta-analysis. Med
Educ 2016; 50:456-68.https://doi.org/10.1111/medu.12962.
18. Syakurah RA, Moudy J. Pengetahuan terkait Usaha Pencegahan
Coronavirus Disease (COVID-19) di Indonesia. HIGEIA (Journal
of Public Health Research and Development), 2020;4(3): 333-346.
DOI: 10.15294/higeia.v4i3.37844.
19. 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;94:1781-91. doi: 10.1097/ACM.0000000000002958.
20. 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;31:584-7. https://doi.org/10.1
080/09540261.2019.1675927.
21. 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: https://doi.org/10.1016/j.eurpsy.2018.08.006.
22. Quek TT, Tam WW, Tran BX, Zhang M, Zhang Z, Ho CS, et al. The
global prevalence of anxiety among medical students: A metaanalysis. Int J Environ Res Public Health 2019;16:1-18. https://
doi.org/10.3390/ijerph16152735.
23. Newman NA, Lattouf OM. Coalition for medical education-A
call to action: A proposition to adapt clinical medical education to
meet the needs of students and other healthcare learners during
COVID-19. J Card Surg. 2020;35:1174-5. doi:10.1111/jocs.14590.
24. 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. International journal of
environmental research and public health, 2020;17:6603. https://
doi.org/10.3390/ijerph17186603.
25. Fletcher I, Castle M, Scarpa A, Myers O, Lawrence E. An
exploration of medical student attitudes towards disclosure of
mental illness. Med Educ Online 2020;25:1-8. https://doi.org/1
0.1080/10872981.2020.1727713.
26. Panagioti M, Geraghty K, Johnson J, Zhou A, Panagopoulou E,
Chew-Graham C, et al. Association between physician burnout
and patient safety, professionalism, and patient satisfaction:
A systematic review and meta-analysis. JAMA Intern Med 2018;178:1317-31. doi:10.1001/jamainternmed.2018.3713.
27. Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD,
Pakpour AH. The fear of COVID-19 scale: Development and
initial validation. Int J Ment Health Addict 2020:1-9. https://doi.
org/10.1007/s11469-020-00270-8.
28. Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP.
Psychometric properties of the 42-item and 21-item versions
of the depression anxiety stress scales in clinical groups and a
community sample. Psychol Asses 1998; 10:176-81. https://doi.
org/10.1037/1040-3590.10.2.176.
29. Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, et al.
Burnout among U.S. Medical students, residents, and early career
physicians relative to the general U.S. population. Acad Med 2014;
89:443-51. doi: 10.1097/ACM.0000000000000134.
30. Huckins J, Hedlund EL, Rogers C, Nepal SK, Wu J, Obuchi M,
et al. Mental health and behavior during the early phases of the
COVID-19 pandemic: A longitudinal mobile smartphone and
ecological momentary assessment study in college students. J
Med Int Res 2020;22:e20185.
31. Slavin SJ. Medical student mental health: Challenges and
opportunities. Med Sci Educ 2018;28 Suppl 1:13-5. https://doi.
org/10.1186/s12909-020-02075-8.
32. Jacob R, Li TY, Martin Z, Burren A, Watson P, Kant R, et al. Taking
care of our future doctors: A service evaluation of a medical
student mental health service. BMC Med Educ 2020;20:172.
https://doi.org/10.1186/s12909-020-02075-8.
33. Grant A, Rix A, Mattick K, Jones D, Winter P. Identifying good
practice among medical schools in the support of students with
mental health concerns. General Medical Council. 6 Mar 2013.
Available from: www.gmc-uk.org/about/research/23295.asp.
[Last accessed on 2020 Jul 29].
34. Chew-Graham CA, Rogers A, Yassin N. ‘I wouldn’t want it on
my CV or their records’: Medical students’ experiences of helpseeking for mental health problems. Med Educ 2003;37:873-80.
https://doi.org/10.1046/j.1365-2923.2003.01627.x.
35. Henderson M. Research into medical student mental health: What
is it for, and where might it lead? Med Educ 2016;50:602-4. DOI:
10.1111/medu.13027.
36. Iqbal S, Gupta S, Venkatarao E. Stress, anxiety and depression
among medical undergraduate students and their sociodemographic correlates. Indian J Med Res 2015;141:354-7. https://
doi.org/10.4103/0971-5916.156571.
37. O’Byrne L, Gavin B, McNicholas F. Medical students and
COVID-19: The need for pandemic preparedness. J Med Ethics 2020;
46:623-6. http://dx.doi.org/10.1136/medethics-2020-106353.