Document Type : Original Article


1 Department of Psychiatry, Father Muller Medical College, Mangalore, Karnataka, India

2 Department of Psychiatry, Kanachur Institute of Medical Sciences, Mangalore, Karnataka, India


BACKGROUND: The COVID‑19 pandemic has negatively impacted the mental health of health‑care
workers worldwide. This study aimed to estimate the prevalence of psychological distress in medical
interns during the pandemic and examine the factors influencing it.
MATERIALS AND METHODS: A cross‑sectional online survey was conducted using snowball
sampling among 764 medical interns across India, who were evaluated using the Kessler
Psychological Distress Scale, Fear of COVID‑19 Scale, and semi‑structured questionnaires. Univariate
analysis was done using Chi‑square test, unpaired t‑test, and ANOVA, while multivariate analysis
was conducted using binary logistic regression.
RESULTS: 57.5% of the interns reported psychological distress, with 39.8% having moderate‑to‑severe
distress. Past consultation with a mental health professional (odds ratio [OR]: 2.15; 95% confidence
interval [CI]: 1.42–3.26) and perceived lack of support from friends (OR: 2.33; 95% CI: 1.33–3.99)
and faculty (OR: 2.15; 95% CI: 1.41–3.28) were the most significant predictors of distress. Fear
of COVID‑19 was higher in interns who were female, were medically ill, were dissatisfied with the
pandemic preparedness at the hospital, and perceived the faculty to be less approachable and
supportive. Majority of the interns felt that the pandemic had hampered their learning and were
worried about an extension to their internship and their performance in the postgraduate entrance
CONCLUSIONS: Psychological distress was highly prevalent among interns, with several workplaces
and personal factors affecting the distress levels. Most interns perceived a negative impact of the
pandemic on their learning and career. Addressing these issues could help alleviate the distress
and bolster the mental health of interns.


1. Xiong J, Lipsitz O, Nasri F, Lui LM, 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.
2. Lee SA, Jobe MC, Mathis AA. Mental health characteristics
associated with dysfunctional coronavirus anxiety. Psychol Med
2020 Apr 16:1‑2.
3. Limcaoco RS, Mateos EM, Fernandez JM, Roncero C. Anxiety,
worry and perceived stress in the world due to the COVID‑19
pandemic, March 2020. Preliminary results. medRxiv [Preprint]
2020 [cited 2020 Sep 21]. [doi: 10.1101/2020.04.03.20043992].
4. Zhang Y, Ma ZF. Impact of the COVID‑19 pandemic on mental
health and quality of life among local residents in liaoning
province, China: A cross‑sectional study. Int J Environ Res Public
Health 2020;17:2381.
5. 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;17:1729.
6. GroverS, SahooS, MehraA, AvasthiA, TripathiA, SubramanyanA,
et al. Psychological impact of COVID‑19 lockdown: An online
survey from India. Indian J Psychiatry 2020;62:354‑62.
7. Mohindra R, Ravaki R, Suri V, Bhalla A, Singh SM. Issues relevant
to mental health promotion in frontline health care providers
managing quarantined/isolated COVID19 patients. Asian J
Psychiatr 2020;51:102084.
8. Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al. Psychological
impact and coping strategies of frontline medical staff in hunan
between January and March 2020 during the outbreak of
coronavirus disease 2019 (COVID19) in Hubei, China. Med Sci
Monit 2020;26:e924171.
9. Kang L, Ma S, Chen M, Yang J, Wang Y, Li R, et al. Impact on
mental health and perceptions of psychological care among
medical and nursing staff in Wuhan during the 2019 novel
coronavirus disease outbreak: A cross‑sectional study. Brain
Behav Immun 2020;87:11‑7.
10. 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
11. Liang Y, Chen M, Zheng X, Liu J. Screening for Chinese medical
staff mental health by SDS and SAS during the outbreak of
COVID‑19. J Psychosom Res 2020;133:110102.
12. Wilson W, Raj JP, Rao S, Ghiya M, Nedungalaparambil NM,
Mundra H, et al. Prevalence and Predictors of Stress, anxiety, and
Depression among Healthcare Workers Managing COVID‑19
Pandemic in India: A Nationwide Observational Study. Indian J
Psychol Med 2020;42:353‑8.
13. Chatterjee SS, Bhattacharyya R, Bhattacharyya S, Gupta S,
Das S, Banerjee BB. Attitude, practice, behavior, and mental
health impact of COVID‑19 on doctors. Indian J Psychiatry
14. Xiao H, Zhang Y, Kong D, Li S, Yang N. The effects of social
support on sleep quality of medical staff treating patients with
coronavirus disease 2019 (COVID‑19) in January and February
2020 in China. Med Sci Monit 2020;26:e923549.
15. Medical Council of India. Regulations on Graduate Medical
Education, 1997 (Amended Upto May, 2018). New Delhi:
Medical Council of India; 2018 [cited 2020 Sep 19]. Available
16. Chandramouleeswaran S, Edwin NC, Braganza D. Job stress,
satisfaction, and coping strategies among medical interns
in a South Indian tertiary hospital. Indian J Psychol Med
17. Merchant H, Nayak A, Mulkalwar A. A study to assess the
prevalence of depression, anxiety and stress among interns
across the State of Maharashtra, India. Indian J Ment Health
18. Ranjan R, Singh M, Garg V, Jiloha RC, Gupta VP, Mohapatra NC.
Prevalence of Stress and its Determinants among Interns
in Medical Colleges of Delhi, India. Ann Int Med Dent Res
19. Rose S. Medical student education in the time of COVID‑19. JAMA
20. Landis MS, Bradley JW. The impact of the 2003 SARS outbreak
on medical students at the University of Toronto. Univ Toronto
Med J 2005;82:158‑64.
21. Sen S, Kranzler HR, Krystal JH, Speller H, Chan G, Gelernter J,
et al. A prospective cohort study investigating factors associated
with depression during medical internship. Arch Gen Psychiatry
22. Kessler RC, Barker PR, Colpe LJ, Epstein JF, GfroererJC, Hiripi E,
et al. Screening for serious mental illness in the general population.
Arch Gen Psychiatry 2003;60:184‑9.
23. Patel V, Araya R, Chowdhary N, King M, Kirkwood B, Nayak S,
et al. Detecting common mental disorders in primary care in
India: A comparison of five screening questionnaires. Psychol
Med 2008;38:221‑8.
24. 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 Mar 27:1‑9.‑020‑00270‑8
25. Chua SE, Cheung V, Cheung C, McAlonan GM, Wong JW,
Cheung EP, et al. Psychological effects of the SARS outbreak in
Hong Kong on high‑risk health care workers. Can J Psychiatry
26. Chakraborty K, Chatterjee M. Psychological impact of COVID‑19
pandemic on general population in West Bengal: A cross‑sectional
study. Indian J Psychiatry 2020;62:266‑72.
27. Centers for Disease Control and Prevention. People with Certain Medical Conditions, 2020. Available from: https://www.‑ncov/need‑extra‑precautions/
people‑with‑medical‑conditions.html. [Last accessed on
2020 Nov 18].
28. Alessi J, de Oliveira GB, Franco DW, Brino do Amaral B,
Becker AS, Knijnik CP, et al. Mental health in the era of COVID‑19:
Prevalence of psychiatric disorders in a cohort of patients with
type 1 and type 2 diabetes during the social distancing. Diabetol
Metab Syndr 2020;12:76.
29. Hajure M, Tariku M, Mohammedhussein M, Dule A. Depression,
anxiety and associated factors among chronic medical patients
amid COVID‑19 pandemic in Mettu Karl Referral Hospital, Mettu,
Ethiopia, 2020. Neuropsychiatr Dis Treat 2020;16:2511‑8.
30. Felice C, Di Tanna GL, Zanus G, Grossi U. Impact of COVID‑19
outbreak on healthcare workers in Italy: Results from a National
E‑Survey. J Community Health 2020;45:675‑83.
31. Gallagher TH, Schleyer AM. “We Signed Up for This!”‑Student
and trainee responses to the Covid‑19 pandemic. N Engl
J Med 2020;382:e96.