Prevalence and Predictors of Anxiety and Depressive Symptoms Among International Medical Students in China During COVID-19 Pandemic

Background: The rapid spread of Coronavirus Disease-19 (COVID-19) infection has been the most important public health crisis across the globe since the end of 2019. Anxiety and depression are the most common mental health problems among people during the pandemic, and many studies have reported anxiety and depressive symptoms in college students. However, information on the mental health status of international medical students during this critical period of time has been scarce, which hinders the efforts in making proper policy or strategies to help these students. The present study aims to explore the prevalence of anxiety and depressive symptoms in international medical students in China and to find out the factors that have potential predictive value for anxiety and depressive symptoms.Method: A cross-sectional study was carried out for international medical students during November 2020 at China Medical University in Shenyang, China. Five hundred and nineteen international students were interviewed with questionnaires containing demographic variables, Stressors in school, Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Simplified Coping Style Questionnaire (SCSQ), Perceived Stress Scale (PSS-10), the Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test (LOT-R) and Resilience Scale-14 (RS-14). Univariate logistic regression and stepwise multiple logistic regression analyses were conducted where appropriate to explore the predictive factors of anxiety symptoms and depressive symptoms.Results: The prevalence of anxiety symptoms and depressive symptoms in the sample population was 28.5% (148/519) and 31.6% (164/519), respectively. Stressors in school (β = 0.176, OR = 1.192, CI: 1.102–1.289), negative coping style (β = 0.639, OR = 1.894, CI: 1.287–2.788) and perceived stress (β = 0.230, OR = 1.258, CI: 1.184–1.337) were found to be the predictors of anxiety symptoms among the international medical students; while gender (β = −0.594, OR = 0.552, CI: 0.315–0.968), stay up late (β = 0.828, OR = 2.288, CI: 1.182–4.431), current place of residence (β = 1.082, OR = 2.951, CI: 1.256–6.931), stressors in the school (β = 0.303, OR = 1.354, CI: 1.266–1.496), negative coping style (β = 0.866, OR = 2.377, CI: 1.516–3.725), perceived stress (β = 0.233, OR = 1.262, CI: 1.180–1.351) were found to be predictors of depressive symptoms.Conclusion: The prevalence of anxiety symptoms and depressive symptoms was moderate among international medical students in China. The communal predictors of anxiety and depressive symptoms were stressors in school, negative coping style and perceived stress; while demographic factors such as gender (male), stay up late at night and current place of residence were found associated with depressive symptoms. These results suggest that proper stress management and specific interventions are needed to help students maintain their mental health during the COVID-19 pandemic period.

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Job Dissatisfaction Mediated the Associations Between Work Stress and Mental Health Problems

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.711263 ◽

2021 ◽

Vol 12 ◽

Author(s):

Dan Qiu ◽

Ruiqi Li ◽

Yilu Li ◽

Jun He ◽

Feiyun Ouyang ◽

...

Keyword(s):

Mental Health ◽

Logistic Regression ◽

Depressive Symptoms ◽

Path Analysis ◽

Work Stress ◽

Mental Health Problems ◽

Health Problems ◽

Anxiety Symptoms ◽

Job Dissatisfaction ◽

Working Adults

Objective: This study aimed to explore the relationships and the underlying mechanisms between work stress and mental health problems, and potential mediation effects through job dissatisfaction in a working population.Methods: A large population-based study among workers in China was conducted. The self-reported scales of assessing job dissatisfaction and work stress were included in the questionnaire. Generalized Anxiety Disorder-2 and Patient Health Questionnaire-2 were used for assessment of mental health. Univariate logistic regression was conducted to test the associations between work stress and mental health. Path analysis was conducted to test the proposed mediation model.Results: Of the 6,190 included employees, 27.72% reported that they perceived work stress, 14.84% of them reported that they were not satisfied with their work, 5.01% of the employees reported depressive symptoms, and 3.75% of the employees reported anxiety symptoms. The results of univariate logistic regression showed that employees who perceived work stress were more likely to report anxiety symptoms (adjusted odds ratio (AOR) = 2.78; 95% CI: 2.03–3.79) or depressive symptoms (AOR = 1.61; 95% CI: 1.22–2.12). The path analysis showed that work stress was positively associated with job dissatisfaction. Job dissatisfaction mediated the relationship between work stress and mental health problems among Chinese working adults.Conclusion: This study suggests the importance of psychosocial work environment for mental health among Chinese working adults. Work dissatisfaction is a stressor that may induce negative consequences on the mental health among Chinese workers. Interventions to help workers with stress management may be beneficial for their mental health.

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Mental health status of Chinese residents during the COVID-19 epidemic

10.21203/rs.3.rs-38662/v3 ◽

2020 ◽

Author(s):

Wen Jiang ◽

Xuerong Liu ◽

Jingxuan Zhang ◽

Zhengzhi Feng

Keyword(s):

Mental Health ◽

Logistic Regression ◽

Regression Analysis ◽

Depressive Symptoms ◽

Cognitive Processing ◽

Multiple Logistic Regression Analysis ◽

Anxiety Symptoms ◽

Multiple Logistic Regression ◽

Processing Bias ◽

Cognitive Processing Bias

Abstract Background: To investigate the mental health status of Chinese residents during the epidemic of COVID-19, as well as to identify the positive and negative factors and regulatory effect of negative cognitive processing bias on mental health.Methods: A total of 60199 residents in China were surveyed via an internet-based survey containing a general questionnaire, such as the self-rating depression scale, the state anxiety inventory, and the negative cognitive processing bias questionnaire. An ordered multiple logistic regression analysis model was used to analyze the collected data. Results: The survey revealed mild, moderate, and severe depressive symptoms in 62.65%, 11.33%, and 6.14% participants, respectively, and mild, moderate, and severe anxiety symptoms in 33.21%, 41.27%, and 22.99% participants, respectively. Multiple logistic regression analysis showed that factors, such as female gender, being older than 55 years, high school education level, medical staff, marital conflicts, negative attention bias, rumination, and death growth rate, positively affected depression and anxiety symptoms. The good family functionality, democratic working atmosphere, and a myriad of social activities negatively affected the level of depressive and anxiety symptoms.Conclusion: Chinese residents exhibited a high prevalence of anxiety and depressive symptoms during the epidemic. Thus, psychological interventions should focus on the vulnerable groups, and cognitive training should focus on reducing the negative cognitive processing bias. This might be an effective way to alleviate the mental stress of the general public during the COVID-19 pandemic.

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Mental health condition of college students compared to non-students during COVID-19 lockdown: the CONFINS study

BMJ Open ◽

10.1136/bmjopen-2021-053231 ◽

2021 ◽

Vol 11 (8) ◽

pp. e053231

Author(s):

Julie Arsandaux ◽

Ilaria Montagni ◽

Mélissa Macalli ◽

Nathalie Texier ◽

Mathilde Pouriel ◽

...

Keyword(s):

Mental Health ◽

College Students ◽

Depressive Symptoms ◽

Perceived Stress ◽

Health Condition ◽

Anxiety Symptoms ◽

Secondary Outcome ◽

Mental Health Condition ◽

Online Questionnaire ◽

Suicidal Thoughts

ObjectivesTo estimate the effect of student status on mental health condition during COVID-19 general lockdown in France.DesignCross-sectional analysis comparing students and non-students recruited in the same study.SettingParticipants of the web-based CONFINS study implemented during the general lockdown in France in spring 2020.Participants2260 participants (78% women) including 1335 students (59%).Primary and secondary outcome measuresThrough an online questionnaire, participants declared if they have experienced suicidal thoughts, coded their perceived stress on a 10-points scale and completed validated mental health scales (Patient Health Questionnaire-9 for depressive symptoms, Generalised Anxiety Disorder-7 for anxiety symptoms) during the last 7 days. The effect of college student status on each mental health condition was estimated using multivariate logistic regression analyses. Stratified models for students and non-students were performed to identify population-specific factors.ResultsStudent status was associated with a higher frequency of depressive symptoms (adjusted OR (aOR)=1.58; 95% CI 1.17 to 2.14), anxiety symptoms (aOR=1.51; 95% CI 1.10 to 2.07), perceived stress (n=1919, aOR=1.70, 95% CI 1.26 to 2.29) and suicidal thoughts (n=1919, aOR=1.57, 95% CI 0.97 to 2.53). Lockdown conditions that could be potentially aggravating on mental health like isolation had a higher impact on students than on non-students.ConclusionsCollege students were at higher risk of mental health disturbances during lockdown than non-students, even after taking into account several potential confounding factors. A close follow-up and monitoring of students’ mental health status is warranted during lockdown periods in this vulnerable population.

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Mental health difficulties of adults with COVID-19-like symptoms in Bangladesh: a case control-study

10.31234/osf.io/ubwxv ◽

2020 ◽

Author(s):

Musammet Rasheda Begum ◽

Shafiqul Islam Khan ◽

Hasan Al Banna ◽

Satyajit Kundu ◽

Munnaf Hossen ◽

...

Keyword(s):

Mental Health ◽

Logistic Regression ◽

Depressive Symptoms ◽

Online Survey ◽

Case Control Study ◽

Case Control ◽

Anxiety Symptoms ◽

Multivariate Logistic Regression ◽

Mental Health Difficulties ◽

Control Study

IntroductionThe rapid spread of SARS-CoV-2 coupled with inefficient testing capacities in Bangladesh has resulted in a number of deaths from COVID-19-like symptoms that have no official test results. Insufficient test sites and healthcare facilities catered to COVID-19 has led to feelings of fear and frustration in those who are sick. This study was the first study which explored the mental health of adults with the most common COVID-19-like symptoms in Bangladesh.MethodsThis retrospective case control study gathered data via an online survey to explore the mental health of Bangladeshi adults with symptoms akin to COVID-19. Level of stress, anxiety symptoms, and depressive symptoms were measured with the DASS-21. Chi-square tests and multivariate logistic regression was performed to examine the association of variables. ResultsThe prevalence rates of anxiety symptoms, and depressive symptoms of overall population were 26.9% and 52.0% respectively and 55.6% reported mild to extremely severe levels of stress. Multivariate logistic regression determined that respondents with COVID-19-like symptoms (case) reported higher odds for stress level (AOR: 2.043; CI: 1.51-2.76), anxiety symptoms (AOR: 2.770; CI: 2.04-3.77) and depressive symptoms (AOR: 1.482; CI: 1.12-1.96) than asymptomatic respondents (control). ConclusionPatients with symptoms like those of COVID-19 should be prioritized in the healthcare setting in order to reduce mental health difficulties throughout the pandemic.

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Mental health status of Chinese residents during the COVID-19 epidemic

BMC Psychiatry ◽

10.1186/s12888-020-02966-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Wen Jiang ◽

Xuerong Liu ◽

Jingxuan Zhang ◽

Zhengzhi Feng

Keyword(s):

Mental Health ◽

Logistic Regression ◽

Regression Analysis ◽

Depressive Symptoms ◽

Cognitive Processing ◽

Multiple Logistic Regression Analysis ◽

Anxiety Symptoms ◽

Multiple Logistic Regression ◽

Processing Bias ◽

Cognitive Processing Bias

Abstract Background To investigate the mental health status of Chinese residents during the epidemic of COVID-19, as well as to identify the positive and negative factors and regulatory effect of negative cognitive processing bias on mental health. Methods A total of 60,199 residents in China were surveyed via an internet-based survey containing a general questionnaire, such as the self-rating depression scale, the state anxiety inventory, and the negative cognitive processing bias questionnaire. An ordered multiple logistic regression analysis model was used to analyze the collected data. Results The survey revealed mild, moderate, and severe depressive symptoms in 62.65, 11.33, and 6.14% participants, respectively, and mild, moderate, and severe anxiety symptoms in 33.21, 41.27, and 22.99% participants, respectively. Multiple logistic regression analysis showed that factors, such as female gender, being older than 55 years, high school education level, medical staff, marital conflicts, negative attention bias, rumination, and death growth rate, positively affected depression and anxiety symptoms. The good family functionality, democratic working atmosphere, and a myriad of social activities negatively affected the level of depressive and anxiety symptoms. Conclusion Chinese residents exhibited a high prevalence of anxiety and depressive symptoms during the epidemic. Thus, psychological interventions should focus on the vulnerable groups, and cognitive training should focus on reducing the negative cognitive processing bias. This might be an effective way to alleviate the mental stress of the general public during the COVID-19 pandemic.

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Psychological Distress, Social Support, Coping Style, and Perceived Stress Among Medical Staff and Medical Students in the Early Stages of the COVID-19 Epidemic in China

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.664808 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zhe Li ◽

Xin Yi ◽

Mengting Zhong ◽

Zhixiong Li ◽

Weiyi Xiang ◽

...

Keyword(s):

Mental Health ◽

Social Support ◽

Psychological Distress ◽

Medical Students ◽

Perceived Stress ◽

Medical Staff ◽

Coping Style ◽

Early Stages ◽

Positive Coping ◽

Factors Influencing

Background: The COVID-19 pandemic has had impact that may contribute to a rise in mental health problems. The present study was aimed to better understand psychological status among medical staff and medical students during the early epidemic and to explore the influence factors of psychological distress.Methods: A cross-sectional survey was conducted online from February 2–14, 2020. We collected general information related to the COVID-19 outbreak. Respondents were assessed using the Kessler-6 Psychological Distress Scale (K6), Social Support Rating Scale (SSRS), Perceived Stress Scale (PSS) and Simplified Coping Style Questionnaire (SCSQ). Stepwise multiple linear regression was performed to identify factors influencing psychological distress.Results: Five hundred and twenty-eight respondents returned valid questionnaires. Medical staff and Medical students scored averages of 6.77 ± 5.04, 15.48 ± 8.66 on the K6, 37.22 ± 11.39, 22.62 ± 11.25 on the SSRS and 18.52 ± 7.54, 28.49 ± 11.17 on the PSS, respectively. Most medical staff (279, 91.77%) and 148 medical students (66.07%) showed a positive coping style. Social support, perceived stress, hours spent watching epidemic-related information per day and frequency of epidemic-related dreams were identified as factors influencing psychological distress among medical staff and medical students. Coping style emerged as a determinant of psychological distress among medical staff.Conclusions: In the early stages of the COVID-19 epidemic in China, medical staff and medical students were at moderate to high risk of psychological distress. Our results suggest that psychological interventions designed to strengthen social support, reduce perceived stress and adopt a positive coping style may be effective at improving the mental health of medical staff and medical students.

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Association of Covid-19 pandemic-related stress and depressive symptoms among international medical students

BMC Psychiatry ◽

10.1186/s12888-021-03671-8 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Lu Lu ◽

Xiaobin Wang ◽

Xuehang Wang ◽

Xiaoxi Guo ◽

Bochen Pan

Keyword(s):

Social Support ◽

Depressive Symptoms ◽

International Students ◽

Medical Students ◽

Online Survey ◽

Perceived Social Support ◽

Positive Association ◽

International Medical ◽

Negative Coping ◽

Related Stress

Abstract Background The outbreak of Covid-19 had negative impacts on the mental stress and induced psychological distress among university students worldwide. This study proposed a moderated mediation model, and hypothesized that the Covid-19 pandemic-related stress was positively related to depressive symptoms among international medical students. Methods An online survey on stress and depressive symptoms of international students was conducted in a medical university. Questions on Covid-19 pandemic-related stress, Patient Health Quesionnaire-9, Simplified Coping Style Questionnaire and the Perceived Social Support Scale were used as measurements, and model analyses were conducted using Hayes’ PROCESS macro for SPSS. Results It was found that 9.83%, 3.08% and 2.12% students had mild, moderate and severe depressive symptoms, respectively, and the positive association between Covid-19 pandemic-related stress and depressive symptoms was significant (β = 0.27, t = 6.87, P < 0.01). Negative coping was also significantly correlated to depressive symptoms (β = 0.26, t = 6.60, P < 0.01), and partially mediated the association between Covid-19 pandemic-related stress and depressive symptoms. Perceived social support had a negative association with depressive symptoms (β=-0.26, t=-6.25, P < 0.01), played a negative moderating role in the relationship between negative coping and depressive symptoms, and moderated the indirect effect of Covid-19 pandemic-related stress on depressive symptoms via negative coping. Conclusions Results of the study suggested that under the background of continuing pandemic, intervention or prevention of mental health problem is urgently needed for the international students, and depression may be alleviated through reducing negative coping and increasing perceived social support.

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Mental health status of Chinese residents during the COVID-19 epidemic

10.21203/rs.3.rs-38662/v4 ◽

2020 ◽

Author(s):

Wen Jiang ◽

Xuerong Liu ◽

Jingxuan Zhang ◽

Zhengzhi Feng

Keyword(s):

Mental Health ◽

Logistic Regression ◽

Regression Analysis ◽

Depressive Symptoms ◽

Cognitive Processing ◽

Multiple Logistic Regression Analysis ◽

Anxiety Symptoms ◽

Multiple Logistic Regression ◽

Processing Bias ◽

Cognitive Processing Bias

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Demographics Associated With Stress, Severe Mental Distress, and Anxiety Symptoms During the COVID-19 Pandemic in Japan: Nationwide Cross-sectional Web-Based Survey (Preprint)

10.2196/preprints.29970 ◽

2021 ◽

Author(s):

Haruhiko Midorikawa ◽

Hirokazu Tachikawa ◽

Takaya Taguchi ◽

Yuki Shiratori ◽

Asumi Takahashi ◽

...

Keyword(s):

Mental Health ◽

Logistic Regression ◽

Regression Analysis ◽

Perceived Stress ◽

Logistic Regression Analysis ◽

Mental Distress ◽

Mental Health Problems ◽

Health Problems ◽

Anxiety Symptoms ◽

Web Based

BACKGROUND With the spread of COVID-19, the deterioration of public mental health has become a major global and social problem. OBJECTIVE The purpose of this study was to elucidate the relationship between the 3 mental health problems associated with COVID-19, that is, perceived stress, severe mental distress, and anxiety symptoms, and the various demographic factors, including occupation. METHODS A nationwide web-based questionnaire survey was conducted in Japan from August 4 to 31, 2020. In addition to sociodemographic data, the degrees of perceived stress, severe mental distress, and anxiety symptoms associated with COVID-19 were measured. After performing a descriptive statistical analysis, factors related to stress, severe mental distress, and anxiety symptoms were analyzed using logistic regression analysis. RESULTS A total of 8203 respondents submitted survey responses, among whom 34.9% (2861/8203) felt intense stress associated with COVID-19, 17.1% (1403/8203) were depressed, and 13.5% (1110/8203) had severe anxiety symptoms. The logistic regression analysis showed that each of the 3 mental health problems were prevalent in females, nonbinary gender, people in their 50s, 60s and older, respondents who visited psychiatrists, and those currently in psychiatric care. Severe mental distress and anxiety symptoms were associated with the number of effective lifestyle coping strategies during the lockdown period. Severe mental distress was only prevalent in teenagers and respondents in their 20s, as students tended to develop stress and severe mental distress. With regard to occupation, working in nursing care and welfare, education and research, and medical and health sectors was associated with stress; however, working in these occupations was not associated with severe mental distress and anxiety symptoms. Unemployment was associated with severe mental distress and anxiety symptoms. All 3 mental health problems were prevalent in part-time workers and those working in entertainment and arts sectors. CONCLUSIONS Gender, age, occupation, history of psychiatric visits, and stress coping mechanisms were associated with mental health during the COVID-19 pandemic, but their associations with stress, severe mental distress, and anxiety symptoms differed. In addition, the actual state of mental health varied according to the respondents’ occupation. It is necessary to consider the impact of the COVID-19 pandemic on mental health not only at the individual level but also at the occupational level.

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The Association Between Social Support, COVID-19 Exposure, and Medical Students' Mental Health

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.555893 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yi Yin ◽

Xingjie Yang ◽

Lan Gao ◽

Suoyuan Zhang ◽

Meng Qi ◽

...

Keyword(s):

Mental Health ◽

Social Support ◽

Depressive Symptoms ◽

Medical Students ◽

Online Survey ◽

Rating Scale ◽

Anxiety Symptoms ◽

Psychological Status ◽

Increased Risk ◽

Virus Exposure

Background: The coronavirus disease−2019 (COVID-19) pandemic has halted in-person medical education worldwide. Limited studies have reported on the mental health status of medical students during this public health emergency. This study aimed to explore the association of personal virus exposure, regional epidemic condition, and social support with medical students' depressive and anxiety symptoms during the COVID-19 outbreak in China.Methods: In February 2020, 5,982 medical students (60.0% females, Meanage = 21.7 years, Medianage = 22 years) completed an online survey consisting of demographics, personal virus exposure, the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, and the Social Support Rating Scale.Results: The prevalence rates of mild to severe depressive symptoms and anxiety symptoms were 35.2 and 22.8%, respectively. Multivariate linear regression showed that students with low- or medium-level social support had a higher risk of experiencing depressive or anxiety symptoms than those with high-level social support. COVID-19 exposure was positively associated with mild to severe depressive or anxiety symptoms. Respondents living in provinces with 500–1,000 confirmed COVID-19 cases had an increased risk of experiencing mild to severe depressive symptoms compared with those living in provinces with <100 cases. Other related factors were gender and years of training.Conclusions: Some medical students suffered from a poor psychological status during the COVID-19 outbreak. Low social support was a stronger factor related to poor mental status compared with COVID-19 exposure or the provincial epidemic condition. Thus, we suggest that colleges or universities provide social support and mental health screening.

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