ORIGINAL RESEARCH |
https://doi.org/10.5005/jp-journals-10015-2105 |
Assessment of Mental Health in Medical and Dental College Students in Jazan Province to See the Delayed Psychological Impact of COVID-19 Pandemic: An Online Survey
1,2,8Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
3General Dentist, Private Clinic, Kingdom of Saudi Arabia
4,5General Dentist, Ministry of Health, Kingdom of Saudi Arabia
6Specialist Orthodontist, Pure Smile Dental and Derma Hospital, Sabya, Kingdom of Saudi Arabia
7Dental Public Health, Private Clinic, India
Corresponding Author: Kulashekar R Nandalur, Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia, Phone: +966 548518184, e-mail: shekarblues@gmail.com
Received on: 09 November 2022; Accepted on: 16 December 2022; Published on: 25 March 2023
ABSTRACT
Aim: The present study aimed to assess the depression and anxiety among medical and dental students of Jazan University, Jazan, Saudi Arabia, during the COVID-19 pandemic using the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7).
Materials and methods: An online descriptive cross-sectional survey was conducted among 117 students of Jazan University. Depression and anxiety among the students were assessed using the PHQ-9 and GAD-7. Descriptive statistics were calculated. Association between independent variables and questionnaire scores was calculated using the Chi-square test. Statistical significance was considered at a p-value less than 0.05.
Results: Eighty-one students (69.2%) and 72 (61.5%) who participated in the survey were suffering from depression and anxiety, respectively. The medical students had significantly more severe anxiety (p = 0.028) than dental students. No significant association of gender with the presence of depression and anxiety was observed (p > 0.05).
Conclusion: Two-thirds of the participants were suffering from some form of depression or anxiety. Medical students reported higher levels of anxiety than dental students. No association was found between depression and anxiety with gender.
Clinical significance: COVID-19 had an impact on the mental health of the students and proper counseling from time to time should be provided.
How to cite this article: Nandalur KR, Porwal A, Masmali SM, et al. Assessment of Mental Health in Medical and Dental College Students in Jazan Province to See the Delayed Psychological Impact of COVID-19 Pandemic: An Online Survey. World J Dent 2023;14(1):36-40.
Source of support: Nil
Conflict of interest: None
Keywords: Anxiety, COVID-19, Dental, Depression, GAD-7, Medical, PHQ-9, Student.
INTRODUCTION
The Coronavirus disease 2019 (COVID-19), caused by the strains of severe acute respiratory syndrome coronavirus (SARS-CoV-2), first appeared in Wuhan in China, in December 2019 and has affected millions of people globally since then. The World Health Organization (WHO) declared COVID-19 a pandemic on 11 March 2020.1 On 7th March 2020, the first case was announced in Saudi Arabia. As the virus became a threat worldwide on 23March 2020, the Saudi government announced the beginning of imposing a curfew from 7 pm to 6 am for 21 days, and then 14 days later, it became 24 hours in certain cities.2 The stress and uncertainty of the pandemic and constraining effects of the lockdown lead to undesirable psychological effects in many individuals.
The Saudi Ministry of Education closed all educational institutions nationwide, on 9 March 2020, to prevent the spread of COVID-19, and all educational activities were shifted to online platforms.3 The COVID-19 pandemic posed many challenges to medical and dental institutions: change to online learning, travel restrictions on students and teachers, social restrictions, influence on examinations and evaluation programs, personal financial impairment due to pandemic time, and detrimental effects on mental health.4,5
Medical and dental education is emotionally, psychologically, and physically demanding, competitive, and rigorous. Several researchers have opined that dental and medical students suffer from psychological distress more than students from other streams of higher education.6-9 The continued implementation of online learning could significantly affect the academic performance of the students and have a detrimental effect on their psychological health.9 Online education also poses challenges with various aspects of their learning, such as lack of motivation, and the change in examination patterns and clinical requirements, further elevating stress and anxiety.9-11 Students pursuing medicine have a more thorough understanding of the pathophysiology of the disease, thereby, rendering them more worried about their and their loved ones’ health.12
Various authors have reported that the negative impact of pandemics on mental health is higher in healthcare workers than in the general population.13-16 However, limited research explores the effects of the pandemic on the mental health of medical students. The present study aimed to assess the depression and anxiety among medical and dental students of Jazan University, Jazan, Saudi Arabia, during the COVID-19 pandemic using the PHQ-9 and GAD-7.
Subjects and Methods
Study Design and Settings
This present descriptive cross-sectional online survey was conducted to investigate the psychological effects of the COVID-19 pandemic on students from a medical and dental college in Jazan province, Saudi Arabia, during the period January 2021.
Ethical Approval and Informed Consent
Ethical approval for the study was obtained from Ethical Committee at the College of Dentistry, Jizan University (EC-CODJU). The online self-reported questionnaire had a consent form attached to it.
Selection of the Students
The information of the medical and dental students was obtained from the students’ administrative department, Jazan University, Jazan, Saudi Arabia. The students were selected randomly, and their information was kept confidential.
QUESTIONNAIRE
A Google form-based survey program was distributed to 600 medical and dental students. A total of 117 students participated in the survey. The sociodemographic variables like gender, age, and occupation were included. In the present study, depression was assessed using the PHQ-9. The scores range from “0 = not at all” to “3 = nearly every day.“17 PHQ-9 is a reliable and quick tool for revealing depression.18 The stages of depression in PHQ-9 are summarized as: “mild = score 5–9,” “moderate = score 10–14,” “moderately severe = score 15–19,” “severe = score > 20.” Anxiety was assessed using the GAD-7. The scores in the questionnaire range from “0 = not at all sure” to “3 = nearly every day.”19 GAD-7 is a reliable tool to assess anxiety levels among different populations.20 The stages of anxiety in GAD-7 are categorizedas “non-minimal = < 5,” “mild = 5–9,” “moderate = 10–14,” and “severe = > 15.”21 The survey included the informed consent of the participants. No incentive of any kind was offered for participation. The collected information was kept completely confidential. The students needing necessary care and counseling were referred to Al Amal Hospital and Mental Health, King Abdulaziz Road Behind Prince Mohammed Bin Nasser Hospital, Jazan.
Statistical Analysis
The data were analyzed using IBM SPSS v. 24.0 (IBM Statistics, SPSS, Chicago, USA). Descriptive statistics were calculated. Association between variables was calculated using Chi-square Test. p-value less than 0.05 was taken as statistically significant, and p < 0.001 was considered highly significant.
RESULTS
The present study was conducted to investigate the mental health status of medical and dental students at Jazan University, Jazan, Saudi Arabia. A total of 117 students (males = 92 and females = 25) participated in the study. The majority (81.2%) of the participants were from dental school, while the remaining (18.8%) were from medical school (Table 1).
| Gender | p-value | Occupation | p-value | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Male | Female | Dental | Medical | |||||||
| N | % | N | % | N | % | N | % | |||
| PHQ-9 | 0.408 | 0.528 | ||||||||
| Without depression | 30 | 32.6 | 6 | 24.0 | 28 | 29.5 | 8 | 36.4 | ||
| With depression | 62 | 67.4 | 19 | 76.0 | 67 | 70.5 | 14 | 63.6 | ||
| Stage | 0.035* | 0.525 | ||||||||
| Mild dep. | 32 | 34.8 | 8 | 32.0 | 35 | 36.8 | 5 | 22.7 | ||
| Moderate dep. | 13 | 14.1 | 9 | 36.0 | 17 | 17.9 | 5 | 22.7 | ||
| Moderate to severe dep. | 14 | 15.2 | – | – | 12 | 12.6 | 2 | 9.1 | ||
| Severe dep. | 3 | 3.3 | 2 | 8.0 | 3 | 3.2 | 2 | 9.1 | ||
| GAD-7 | 0.225 | 0.085 | ||||||||
| Without anxiety | 38 | 41.3 | 7 | 28.0 | 33 | 34.7 | 12 | 54.5 | ||
| With anxiety | 54 | 58.7 | 18 | 72.0 | 62 | 65.3 | 10 | 45.5 | ||
| Stage | 0.485 | 0.028* | ||||||||
| Mild anxiety | 27 | 29.3 | 10 | 40.0 | 30 | 31.6 | 7 | 31.8 | ||
| Moderate anxiety | 21 | 22.8 | 5 | 20.0 | 26 | 27.4 | – | – | ||
| Severe anxiety | 6 | 6.5 | 3 | 12.0 | 6 | 6.3 | 3 | 13.6 | ||
N, Number of participants; %, Percentage; *, p ≤ 0.05
Eighty-one students (69.2%) who participated in the survey were suffering from depression, and 72 (61.5%) were having symptoms of anxiety. Additionally, the majority (approximately 53%) of students who were depressed had mild or moderate states (Table 1). Furthermore, two-thirds of the participants had some form of anxiety ranging from mild to severe, with medical students having significantly more severe anxiety (p = 0.028) than dental students (Fig. 1). There was no statistically significant association between gender and the presence of depression and anxiety (Fig. 2, Table 2). More than half of the participants expressed difficulty carrying out their work and home routines and interpersonal interactions (Table 1).
| Number of participants (N) | Percentage % | |
|---|---|---|
| Gender | ||
| Male | 92 | 78.6 |
| Female | 25 | 21.4 |
| Occupation | ||
| Dental | 95 | 81.2 |
| Medical | 22 | 18.8 |
| PHQ-9 | ||
| Without depression | 36 | 30.8 |
| Mild dep. | 40 | 34.2 |
| Moderate dep. | 22 | 18.8 |
| Moderate to severe dep. | 14 | 12.0 |
| Severe dep. | 5 | 4.3 |
| GAD | ||
| Without anxiety | 45 | 38.5 |
| Mild anxiety | 37 | 31.6 |
| Moderate anxiety | 26 | 22.2 |
| Severe anxiety | 9 | 7.7 |
| If you checked any problems, how difficult have they made it for you to do your work, take care of things at home, or get along with other people? | ||
| Not difficult at all | 30 | 25.6 |
| Somewhat difficult | 66 | 56.4 |
| Very difficult | 15 | 12.8 |
| Extremely difficult | 6 | 5.1 |
Fig. 1: Distribution of stages of depression and anxiety according to gender
Fig. 2: Distribution of stages of depression and anxiety according to occupation
DISCUSSION
The present study assessed the depression and anxiety among medical and dental students of Jazan University during the COVID-19 pandemic using the PHQ-9 and GAD-7. PHQ-9 and GAD-7 are easy and reliable tools for measuring depression and anxiety, respectively. This was an online survey with a low response rate. A low response rate has been reported as a drawback of online surveys.12 However, this was the most convenient and safe method of conducting the study during the pandemic.
The present survey results revealed that two-thirds of the participants were suffering from some form of depression or anxiety. The finding is in accordance with research conducted among medical students by several other researchers. Aker and Midik conducted a survey to assess the views of medical faculty students regarding the COVID-19 pandemic in Turkey and reported that 52.4% of the participants felt mentally unwell.22 Filho CIS et al. reported that 64.4 % of students were suffering from moderate or severe depression in Brazil.5 Hakami et al. assessed the psychological impact of the pandemic on dental students in Saudi Arabia and reported elevated levels of depression and anxiety among 60.64% and 37.02%, respectively, of the students.9 Saraswathi et al. assessed the impact of the pandemic on the mental health of medical students in a COVID-19 treating medical college in India and reported at least one-third of the students to be suffering from depression and anxiety.16 Meo et al. reported that 25% of medical students in a University in Riyadh were depressed due to the restriction placed as a part of the precautions against COVID-19.23 Liu et al. used the PHQ-9 and GAD-7 to investigate students’ mental health status from a medical college in Hubei, China, and reported 35.5% and 22.1% of the students were suffering from depression, and anxiety, respectively.12 Khanagar and Alfadley studied the psychological impact of the pandemic on dental interns in Saudi Arabia and reported around 12% of the participants with depression which is lower than our study.24
Furthermore, in our study, we found no association between depression and anxiety with gender. However, this may have been due to the unequal distribution of gender in the present study. The majority of the papers that assessed the relationship between gender and mental health status among medical students reported no effect of gender.12,16,22-24 However, Filho CIS et al.5 and Hakami et al.9 reported higher levels of depression among females as compared to males. This might suggest both males and females were equally affected by the pandemic. However, the data regarding the effect of the pandemic on the mental health of both genders are highly contradictory;5,9,12,16,22-28 hence more research into other factors that affect the mental status among males and females is warranted.
Additionally, we found that medical students reported higher anxiety levels in the present study than dental students. The exhaustive literature search did not reveal any other studies that compared the anxiety levels of medical and dental students. However, the higher levels of anxiety among the medical students might be because they understand the disease process more thoroughly.12 They may be more concerned about contracting the disease more than dental students due to more contact with patients suffering from Covid.
Although students are young and not at a higher risk of coronavirus infection, their lives have been altered dramatically due to the pandemic. Most countries imposed drastic measures to mitigate the spread of the coronavirus.29,30 The closure of educational institutions and the shift to online learning have posed a myriad of challenges for both students and teachers. Moreover, COVID-19 has significantly impacted the practices of professional students regarding academics and social life. Additionally, they are worried about their future education and careers. All the aforementioned factors can negatively impact students’ mental well-being.31-34
The pressures of education during the pandemic and frequent exposure to huge patient volumes might have a long-term detrimental psychological impact on the young doctors. The role of the educators and the university think tank must be to have a deeper insight into the psychological upheavals caused by the COVID-19, and further research is needed in this area.
The present study has several limitations. The present study was a cross-sectional study, and a long-term evaluation of the psychological effects of the pandemic on the students must be conducted to identify ways to help the students. The sample size of the present study was small, hence, lacked external validity. Also, unequal representation of medical and dental students, as well as both genders, may have led to skewed results. Finally, there is a possibility of reporting bias as the present study was conducted online.
CONCLUSION
Within limitations, the following conclusions can be drawn from the study: Two-thirds of the participants were suffering from some form of depression or anxiety. Medical students reported higher levels of anxiety than dental students. No association was found between depression and anxiety with gender.
REFERENCES
1. Wang C, Horby PW, Hayden FG, et al. A novel coronavirus outbreak of global health concern. Lancet 2020;395(10223):470–473. DOI: 10.1016/S0140-6736(20)30185-9
2. The official Saudi Press Agency; 2020 https://www.spa.gov.sa/viewfullstory.php?lang=en≠wsid=2050402 (accessed February 11, 2021).
3. Alkhamees AA, Aljohani MS. The psychological impact of COVID-19 pandemic on the students of Saudi Arabia. Compr Psychiatry 2020;102:152192. DOI: 10.1016/j.comppsych.2020.152192
4. 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
5. Sartorao Filho CI, Rodrigues WC, de Castro RB, 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. DOI: 10.1101/2020.06.24.20138925
6. Alzahem AM, van der Molen HT, Alaujan AH, et al. Stress amongst dental students: a systematic review. Eur J Dent Educ 2011;15(1):8–18. DOI: 10.1111/j.1600-0579.2010.00640.x
7. Burk DT, Bender DJ. Use and perceived effectiveness of student support services in a first-year dental student population. J Dent Educ 2005;69(10):1148–1160. PMID: 16204681.
8. Lloyd C, Musser LA. Psychiatric symptoms in dental students. J Nerv Ment Dis 1989;177(2):61–69. DOI: 10.1097/00005053-198902000-00001
9. Hakami Z, Khanagar SB, Vishwanathaiah S, et al. Psychological impact of the COVID-19 pandemic on dental students: a nationwide Study. J Dent Educ 2021;85(4):494–503. DOI: 10.1002/jdd.12470
10. Al-Rabiaah A, Temsah MH, Al-Eyadhy AA, 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
11. Al-Sowygh ZH, Alfadley AA, Al-Saif MI, et al . Perceived causes of stress among Saudi dental students. King Saud University J Dent Sci 2013;4(1):7–15. DOI: 10.1016/j.ksujds.2012.11.002
12. Liu J, Zhu Q, Fan W, et al. Corrigendum: online mental health survey in a medical college in China during the COVID-19 outbreak. Front Psychiatry 2020;11:845. DOI: 10.3389/fpsyt.2020.00845
13. Lee SM, Kang WS, Cho AR, et al. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry 2018;87:123–127. DOI: 10.1016/j.comppsych.2018.10.003
14. Lu YC, Shu BC, Chang YY, et al . The mental health of hospital workers dealing with severe acute respiratory syndrome. Psychother Psychosom 2006;75(6):370–375. DOI: 10.1159/000095443
15. McAlonan GM, Lee AM, Cheung V, et al. Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers. Can J Psychiatry 2007;52(4):241–247. DOI: 10.1177/070674370705200406
16. Saraswathi I, Saikarthik J, Senthil Kumar K, et al. Impact of COVID-19 outbreak on the mental health status of undergraduate medical students in a COVID-19 treating medical college: a prospective longitudinal study. PeerJ 2020;8:e10164. DOI: 10.7717/peerj.10164
17. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16(9):606–613. DOI: 10.1046/j.1525-1497.2001.016009606.x
18. Martin A, Rief W, Klaiberg A, et al. Validity of the brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. Gen Hosp Psychiatry 2006;28(1):71–77. DOI: 10.1016/j.genhosppsych.2005.07.003
19. Spitzer RL, Kroenke K, Williams JBW, et al . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166(10):1092–1097. DOI: 10.1001/archinte.166.10.1092
20. Hossain S, Anjum A, Uddin ME, et al. Impacts of socio-cultural environment and lifestyle factors on the psychological health of university students in Bangladesh: A longitudinal study. J Affect Disord 2019;256:393–403. DOI: 10.1016/j.jad.2019.06.001
21. Islam MA, Barna SD, Raihan H, et al. Depression and anxiety among university students during the COVID-19 pandemic in Bangladesh: A web-based cross-sectional survey. PLoS One 2020;15(8):e0238162. DOI: 10.1371/journal.pone.0238162
22. Aker S, Mıdık Ö. The views of medical faculty students in Turkey concerning the COVID-19 pandemic. J Community Health 2020;45(4):684–688. DOI: 10.1007/s10900-020-00841-9
23. Meo SA, Abukhalaf AA, Alomar AA, et al. COVID-19 pandemic: impact of quarantine on medical students’ mental wellbeing and learning behaviors. Pak J Med Sci 2020;36(COVID19-S4):S43–S48. DOI: 10.12669/pjms.36.COVID19-S4.2809
24. Khanagar SB, Alfadley A. Psychological impact of the COVID-19 pandemic on dental interns in Riyadh, Saudi Arabia: a cross-sectional survey. Int J Clin Pediatr Dent 2020;13(5):508–512. DOI: 10.5005/jp-journals-10005-1773
25. Peker I, Alkurt MT, Usta MG, et al . The evaluation of perceived sources of stress and stress levels among Turkish dental students. Int Dent J 2009;59(2):103–111. PMID: 19489290.
26. Holtzman JM, Berg RG, Mann J, et al. The relationship of age and gender to fear and anxiety in response to dental care. Spec Care Dentist 1997;17(3):82–87. DOI: 10.1111/j.1754-4505.1997.tb00873.x
27. Stecker T. Well-being in an academic environment. Med Educ 2004;38(5):465–478. DOI: 10.1046/j.1365-2929.2004.01812.x
28. Peretz B, Rosenblum A, Zadik D. Stress levels and related variables among dental students in Jerusalem, Israel. Eur J Dent Educ 1997;1(4):162–166. PMID: 9516285.
29. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020;395(10227):912–920. DOI: 10.1016/S0140-6736(20)30460-8
30. Owusu-Fordjour C, Koomson CK, Hanson D. The impact of COVID-19 on learning—the perspective of the Ghanaian student. Eur J Educ Stud 2020;7(3):88–101. DOI: 10.5281/zenodo.3753586
31. Liu X, Liu J, Zhong X. Psychological state of college students during COVID-19 epidemic. Lancet Prepr 2020. DOI: 10.2139/ssrn.3552814
32. Pan H. A glimpse of university students’ family life amidst the COVID-19 virus. J Loss Trauma 2020;25(6–7):594–597. DOI: 10.1080/15325024.2020.1750194
33. De Vos J. The effect of COVID-19 and subsequent social distancing on travel behavior. Transp Res Interdiscip Perspect 2020;5:100121. DOI: 10.1016/j.trip.2020.100121
34. Aristovnik A, Keržič D, Ravšelj D, et al. Impacts of the COVID-19 pandemic on life of higher education students: a global perspective. Sustainability 2020;12(20):8438. DOI: 10.3390/su12208438
________________________
© The Author(s). 2023 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.