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ORIGINAL ARTICLE
Year : 2022  |  Volume : 49  |  Issue : 1  |  Page : 35-39

A comparative study to assess mental health literacy, impact of event, depression, anxiety, and stress levels of medical and other students during the second wave of the COVID-19 pandemic


1 Department of Physiology, Burdwan Medical College, Burdwan, West Bengal, India
2 Department of Pharmacology, Burdwan Medical College, Burdwan, West Bengal, India

Date of Submission07-Oct-2021
Date of Acceptance14-Nov-2021
Date of Web Publication22-Apr-2022

Correspondence Address:
Arunima Chaudhuri
Krishnasayar South, Borehat, Burdwan, Purba Bardhaman - 713 102, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_143_21

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  Abstract 


Background: COVID-19 pandemic is negatively affecting the mental health of medical professionals as well as medical students, as they stand in the frontline. Medical education is recognized as stressful across the globe and in the hour of present crisis, students have to stay back home and continue their studies online. Aims: The aim of the study is to compare the emerging evidence of the effects of the COVID-19 outbreak on mental health and assess mental health awareness of medical students and other students studying in a Medical College of Eastern India. Materials and Methods: This cross-sectional observational study was conducted in a period of 3 months after taking Institutional ethical clearance and informed consent of the subjects. 212 medical students and 101 students of other courses studying in the college participated in the study. The present survey was conducted online using Google Forms. In the first section of the form, purpose of the study was explained and informed consent was taken from the participants. In the second part of the form, participants were asked to fill up demographic details and relevant history; in the third part, participants had to fill up three scales: Depression, Anxiety and Stress Scale-21, Impact of Event Scale-Revised (IRE-R), Mental Health Literacy Scale. Results: There was no significant difference in depression scores between the two groups. Anxiety scores and stress scores were significantly higher among medical students as compared to the other group with P = 0.0017 and 0.008, respectively. Group A: Anxiety scores 12.34 ± 8.5; Stress scores - 13.07 ± 8.01. Group B: Anxiety scores 9.34 ± 7.34; Stress scores - 10.55 ± 7.62. There was no significant difference in mental health literacy scores between the two groups. Mental Health literacy scores of Group A: 96.84 ± 17.29; Mental health literacy score of Group B: 99.86 ± 13.39; P = 0.09. No difference in IRE-R scores between the two groups was observed. Group A: Total score - 21.81 ± 14.34; Avoidance scale - 9.43 ± 6.1; intrusion scale 8.58 ± 5.12; Hyperarousal scale - 3.79 ± 2.94. Group B: Total score - 20.39 ± 14.34; Avoidance scale - 9.06 ± 6.5; Intrusion scale - 7.84 ± 5.95; Hyperarousal scale - 3.49 ± 3.21. Conclusions: Mental health literacy scores and impact of event score were similar in medical and other students studying in the same medical institution. Medical students had significantly higher levels of anxiety and stress as compared to the other group, though depression scores of both groups were comparable. Hence, it may be concluded that medical students perceived higher levels of anxiety and stress during the second wave of the present COVID-19 pandemic.

Keywords: Depression and anxiety, medical students, mental health awareness, stress


How to cite this article:
Chaudhuri A, Paul S, Saha E. A comparative study to assess mental health literacy, impact of event, depression, anxiety, and stress levels of medical and other students during the second wave of the COVID-19 pandemic. J Sci Soc 2022;49:35-9

How to cite this URL:
Chaudhuri A, Paul S, Saha E. A comparative study to assess mental health literacy, impact of event, depression, anxiety, and stress levels of medical and other students during the second wave of the COVID-19 pandemic. J Sci Soc [serial online] 2022 [cited 2022 May 19];49:35-9. Available from: https://www.jscisociety.com/text.asp?2022/49/1/35/343701




  Introduction Top


COVID-19 pandemic has the potential to significantly affect the mental health of medical professionals as well as Medical students, as they are in the frontline during this hour of crisis.[1],[2] Medical education is recognized as stressful across the globe. In the hour of present crisis, students have to stay back home and continue their studies online.[1],[2],[3],[4],[5],[6] Isolation and loss of social support, risk or infections of friends and relatives, and unsettling changes in the working conditions are further compromising the resilience of these students. Medical students are, therefore, especially vulnerable to mental health problems, including stress, anxiety, depression.[1],[2] Studies have demonstrated that there is a lack of awareness of own mental health problems among health-care professionals and psychological problems be more prevalent among younger age group.[5],[6],[7],[8]

Health-care workers treating and caring for patients with COVID-19 are under immense psychological pressure which is posing a huge challenge worldwide. A recent review provided information on potential mental health risks associated with exposure of health professionals during the COVID-19 pandemic. Extensive literature search has highlighted that health-care professionals are at an increased risk of psychological problems. High levels of stress, anxiety, depression, burnout, addiction, and posttraumatic stress disorder are some of the psychological health concerns which may have long-term implications in both the mental and physical well-being of health personnel.[2]

The medical students of today will be doctors of tomorrow and doctors need to be physically and mentally healthy to provide quality patient care. Attention to the mental health of medical students in early medical schools is of immense importance to make them ready for multiple unprecedented future challenges. Medical schools urgently need to implement strategies to improve the mental well-being of students. Supporting the understanding of crisis management, self-mental care, and other principal measures to strengthen coping skills and mental preparedness are some of the essential components to enhance positive mental health outcomes.[1],[8]

This tragic pandemic crisis, in the long run, may significantly enhance our understanding of the mental health risk factors among the health professionals who are facing the COVID-19 pandemic as frontline warriors. Reporting information is essential to plan future prevention strategies. Protecting health-care professionals is an important component of public health measures to address the large-scale health crisis. Interventions to promote mental well-being in health-care professionals and medical students exposed to COVID-19 need to be immediately implemented, by training health-care professionals on mental health and crisis management.[2]

It has been observed in previous studies that medical students are more stressed as compared to other students, more so in early medical schools and suffer from various mental health issues.[9],[10],[11],[12],[13] The present pilot project was conducted to compare the emerging evidence of the effects of the COVID-19 outbreak on mental health and assess mental health awareness of medical students and other students studying in a Medical College of Eastern India.


  Materials and Methods Top


This cross-sectional observational study was conducted in Burdwan Medical College in a period of 3 months after taking Institutional ethical clearance and informed consent of the subjects.

Inclusion criteria

First and 2nd-year MBBS students and other students studying in Burdwan Medical College aged between 18 and 22 years willing to participate in the study.

Exclusion criteria

Students who are already having major psychiatric problems previously and taking medications due to major psychiatric problems were excluded.

Sample size

400 medical students are studying in Burdwan Medical College in the 1st and 2nd years. This age group was chosen as in different studies, this age group is more vulnerable to mental health problems. The sample size was calculated at calculator.net. Confidence level 95%; Margin of error 5%; Population proportion 50% (this is followed if not sure); Sample size came to 197. Considering error in the response and other issues 212 medical students studying in Burdwan Medical College willing to participate in the study were included. 101 students of other courses studying in the college participated in the study. The subjects of the two groups (Group A: Medical Students of Burdwan Medical College; Group B: Other Students of Burdwan Medical College) were age and sex-matched. The gender-sensitive viewpoint of psychological theories is known as alpha bias. Alpha bias may be rooted in the social conditioning and power structure of the societies. Hence, the two groups were gender matched.[14]

Study tools

The present survey was conducted online using Google Forms. Two Google forms were created: Form A – For Medical students; Form B – For other students studying in Burdwan Medical College.

The participants were ensured that their information will not be disclosed anywhere. In the first section of the form, purpose of the study was explained and informed consent was taken from the participants. In the second part of the form, participants were asked to fill up demographic details and relevant history; in the third part, participants had to fill up three scales: Depression, Anxiety and Stress Scale-21 (DASS-21), Impact of Event Scale-Revised (IRE-R), Mental Health Literacy Scale.

Faculties of this Institution were requested to share these links with their students.

Depression, Anxiety and Stress Scale-21 Items

The DASS-21 is a set of three self-report scales designed to measure the emotional states of depression, anxiety, and stress. The DASS-21 was used to assess the mental status of the subjects.[15]

Impact of Event Scale-Revised (IRE-R)

People sometimes have stressful life events. This scale helps to assess how difficult each event has been in a person during the past 7 days. How much were an individual is distressed or bothered by these difficulties?[16]

Mental Health Literacy Scale

The purpose of this questionnaire is to gain an understanding of a person's knowledge of various aspects of mental health.[17]

Participants who had high Depression, Anxiety, or Stress scores were contacted through E-mail available in the Google sheet and advised accordingly. This study helped in screening mental health problems of students (first and second MBBS) of the Institution so that early intervention could be carried.

Statistical analysis

Data were analyzed using SPSS version 16 (SPSS Inc. Released 2007. Chicago, SPSS Inc.). Unpaired t-test was used to compare the two groups. P < 0.05 was considered significant.


  Results Top


Two hundred and twelve MBBS students (Group A) and hundred one other UG students (Group B) studying in the early medical school participated in the present cross-sectional study. Subjects in the two groups were gender and age-matched. Among Medical students, 66 female students and 146 male students participated in the study. 32 female and 69 male students studying in Burdwan Medical College in other courses were included in the present study. DASS scores of Group A: Depression scores - 10.82 ± 8.4; Anxiety scores - 12.34 ± 8.5; Stress scores - 13.07 ± 8.01. DASS scores of Group B: Depression scores - 10.36 ± 8.97; Anxiety scores - 9.34 ± 7.34; Stress scores - 10.55 ± 7.62. There was no significant difference in depression scores between the two groups (P: 0.66). Anxiety scores and stress scores were significantly higher among medical students as compared to the other group with P = 0.0017 and 0.008, respectively [Table 1] and [Figure 1]. There was no significant difference in Mental health literacy scores between the two groups. Mental Health literacy scores of Group A: 96.84 ± 17.29; Mental health literacy score of Group B: 99.86 ± 13.39; P = 0.09. There was no difference in IRE-R scores between the two groups. Group A: Total score - 21.81 ± 14.34; Avoidance scale - 9.43 ± 6.1; Intrusion scale - 8.58 ± 5.12; Hyperarousal scale - 3.79 ± 2.94. Group B: Total score - 20.39 ± 14.34; Avoidance scale - 9.06 ± 6.5; Intrusion scale - 7.84 ± 5.95; Hyperarousal scale - 3.49 ± 3.21. P value: Total score - 0.4; Avoidance scale - 0.63; Intrusion scale - 0.29; Hyperarousal scale - 0.43. Among 212 Medical students (Group A), 51.4% had normal depression scores, 13.3% had mild depression scores, 24.5% had moderate depression scores, 4.7% had severe depression scores, and 6.13% had extremely severe depression scores. Among other 101 participants (Group B), 69.3% had normal depression scores, 11.88% had mild depression scores, 6.9% had moderate depression scores, 2.96% had severe depression scores, and 8.91% had extremely severe depression scores. In Group A, 33.4% had normal anxiety scores, 5.66% had mild anxiety scores, 33.49% had moderate anxiety scores, 9.43% had severe anxiety scores, and 17.92% had extremely severe anxiety scores. In Group B, 52.47% had normal anxiety scores, 11.88% had mild anxiety scores, 14.85% had moderate anxiety scores, 8.91% had severe anxiety scores, and 11.88% had extremely severe anxiety scores. Among Medical students, 63.67% had normal stress scores, 17.92% had mild stress scores, 8.49% had moderate stress scores, 8.02% had severe stress scores, and 1.89% had extremely severe stress scores. Among other participants, 78.21% had normal stress scores, 10.89% had mild stress scores, 2.97% had moderate stress scores, 6.93% had severe stress scores, and 0.99% had extremely severe stress scores [Figure 2] and [Figure 3].
Table 1: Comparison of Depression, Anxiety and Stress Scale-21 scores and mental health literacy scores of the two groups

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Figure 1: Comparison of Depression, Anxiety and Stress Scale-21 scores of the two groups

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Figure 2: The distribution of subjects with different levels of depression, anxiety, and stress among participants of Group A according to Depression, Anxiety and Stress Scale-21 scores

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Figure 3: The distribution of subjects with different levels of depression, anxiety, and stress among participants of Group B according to Depression, Anxiety and Stress Scale-21 scores

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  Discussion Top


The COVID-19 pandemic has a negative impact on both physical and psychological health and well-being. The negative psychological impact of COVID-19 has been reported in many studies and includes depressed mood, anxiety, poor sleep, increased stress levels. The COVID-19 pandemic has been marked as an uncontrollable stressor due to its high infectivity, morbidity, and mortality. It is well known that when an individual fail to cope with the stress, it can have a significant effect on individuals' psychological health.[18],[19] The present study was conducted to assess the mental health status of medical students during the second wave of the present and mental health awareness and impact of an event among them and to compare these parameters with other students studying in the same institution. 212 medical students and 101 other students participated in the study. As medical students and educators are functioning as frontline warriors during the present pandemic so they were included in the present study. Assessment of their mental health issues may help to implement mental health facilities for their psychological well-being. The development and design of a service conducted by Jacob et al. may serve as an example for medical schools in developing mental support programs for medical students. The students were initially reviewed by a psychiatrist, who referred them to psychologists delivering therapies. Cognitive Behavioral Therapy; Interpersonal Therapy; Eye Movement Desensitization Reprocessing Therapy; Cognitive Analytic Therapy were a few of the therapies delivered. During the initial evaluation, a significant proportion of medical students attending the service scored highly on validated rating scales measuring emotional distress; suicidality; mental illness. They benefitted from timely specialist mental health input and showed improvements in mental well-being.[20] After analysis of the results in the present study, we had also contacted students with high Depression, Anxiety, or Stress scores through E-mail and advised them accordingly.

There was no significant difference in depression scores between the two groups in the present study. Anxiety scores and stress scores were significantly higher among medical students as compared to the other group with P value of 0.0017 and 0.008, respectively. Group A: Anxiety scores 12.34 ± 8.5; Stress scores-13.07 ± 8.01. Group B: Anxiety scores 9.34 ± 7.34; Stress scores - 10.55 ± 7.62. There was no significant difference in Mental health literacy scores between the two groups. Mental Health literacy scores of Group A: 96.84 ± 17.29; Mental health literacy score of Group B: 99.86 ± 13.39; P value 0.09. No difference in IRE-R scores between the two groups was observed. Group A: Total score - 21.81 ± 14.34; Avoidance scale - 9.43 ± 6.1; Intrusion scale - 8.58 ± 5.12; Hyperarousal scale - 3.79 ± 2.94. Group B: Total score - 20.39 ± 14.34; Avoidance scale - 9.06 ± 6.5; Intrusion scale - 7.84 ± 5.95; Hyperarousal scale - 3.49 ± 3.21.

An online survey was conducted at six Jordanian medical schools[21] on 553 medical students during the present pandemic. Mental well-being status was assessed by Kessler's psychological stress scale (K10). 40.1% were female and 59.9% were male. 73.1% of students reported that COVID-19 has negatively affected physical fitness, while 68.4% reported problems with academic performance and 65.6% reported social relationships problems during the pandemic. 58.4% were worried about the inability to get clinical sessions during the curriculum. The study also indicated that half of the medical students were suffering from severe mental disorders. These findings are in concordance with the present study.

A longitudinal study[22] was carried on 217 undergraduate medical students in Chennai. Depression, anxiety, and stress levels were recorded using DASS 21 before and during the COVID-19 pandemic. The depression, anxiety, and stress levels during the baseline survey were 7.55 ± 7.86; 4.6 ± 6.19; 7.31 ± 7.34; with the prevalence of depression in 33.2%, anxiety 21.2%, and stress in 20.7%. During follow-up, the scores of depression, anxiety, and stress were 8.16 ± 8.9; 6.11 ± 7.13; 9.31 ± 8.18, respectively, and prevalence of depression, anxiety, and stress was 35.5%; 33.2%; 24.9%. There was a significant increase in both the prevalence and levels of anxiety and stress with no significant change in depression scores. We also did not observe any significant difference in depression between the two groups.

During the COVID-19 pandemic in China,[23] the mental health status of University students was negatively affected. A cross-sectional online survey was conducted in 2020 using DASS-21 on 563 University students. 382 medical students participated in the study. 12.26%, 18.47%, and 8.53% had moderate to severe levels of depression, anxiety, and stress scores, respectively. In the present study conducted during the second wave of the pandemic among 212 Medical students (Group A), 24.5% had moderate depression scores, 4.7% had severe depression scores, and 6.13% had extremely severe depression scores. Among other 101 participants (Group B), 6.9% had moderate depression scores, 2.96% had severe depression scores, and 8.91% had extremely severe depression scores. In Group A, 33.49% had moderate anxiety scores, 9.43% had severe anxiety scores, and 17.92% had extremely severe anxiety scores. In Group B, 14.85% had moderate anxiety scores, 8.91% had severe anxiety scores, and 11.88% had extremely severe anxiety scores. Among Medical students, 8.49% had moderate stress scores, 8.02% had severe stress scores, and 1.89% had extremely severe stress scores. 2.97% had moderate stress scores, 6.93% had severe stress scores, and 0.99% had extremely severe stress scores. These findings are similar to findings of the study conducted in China during the Pandemic.

Limitations and future scope

This was a cross-sectional study and although we had screened students with mental health issues, we had just made them aware of their problem and advised accordingly. However, longitudinal follow-up was not done in the present study and only 1st and 2nd-year students were included. However, we could make the students aware of their mental health issues. We are conducting another longitudinal project including students from all years for screening and improving the mental health status of medical students.


  Conclusions Top


Mental health literacy scores and impact of event score were similar in medical and other students studying in the same Medical Institution. Medical students had significantly higher levels of anxiety and stress as compared to the other group, though depression scores of both groups were comparable. Hence, it may be concluded that medical students perceived higher levels of anxiety and stress during the second wave of the present COVID-19 pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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