Predictive Factors for Impaired Mental Health among Medical Students during the Early Stage of the COVID-19 Pandemic in Morocco

Abstract

The COVID-19 pandemic has great consequences on mental health. We aimed to assess medical students’ psychological condition and influencing factors as a baseline evidence for interventions promoting their mental wellbeing. We conducted an online survey from April 8 to April 18, 2020 to examine the mental health of medical students by the nine-item Patient Health Questionnaire, seven-item Generalized Anxiety Disorder Scale, seven-item Insomnia Severity Index, and six-item Kessler psychological distress scale. Factors associated with mental health outcomes were identified by multivariable logistic regression analysis. Five hundred forty-nine students completed the survey; 341 (62.3%), 410 (74.6%), 344 (62.6%), and 379 (69%) reported anxiety, depression, insomnia, and distress, respectively. Female students, living in high COVID-19 prevalence locations, more than 25 days confinement, psychiatric consult history, and being in a preclinical level of studies had higher median scores and severe symptom levels. Multivariable logistic regression showed female gender as a risk factor for severe symptoms of anxiety (odds ratio [OR]: 1.653; 95% CI: 1.020–2.679; P = 0.042), depression (OR: 2.167; 95% CI: 1.435–3.271; P < 0.001), insomnia (OR: 1.830; 95% CI: 1.176–2.847; P = 0.007), and distress (OR: 1.994; 95% CI: 1.338–2.972; P = 0.001); preclinical level of enrollment as a risk factor for depression (OR: 0.679; 95% CI: 0.521–0.885; P = 0.004), insomnia (OR: 0.720; 95% CI: 0.545–0.949; P = 0.02), and distress (OR: 0.650; 95% CI: 0.499–0.847; P = 0.001), whereas living in high COVID-19 prevalence locations was a risk factor for severe anxiety (OR: 1.628; 95% CI: 1.090–2.432; P = 0.017) and depression (OR: 1.438; 95% CI: 1.002–2.097; P = 0.05). Currently, medical students experience high levels of mental health symptoms, especially female students, those at a preclinical level and living in regions with a high prevalence of COVID-19 cases. Screening for mental health issues, psychological support, and long-term follow-up could alleviate the burden and protect future physicians.

COVID-19 Pandemic Affects the Medical Students’ Learning Process and Assaults Their Psychological Wellbeing

“…The highest number of students (92.3%) were suffering from depression of various severity, mostly minimum to mild (58.5%) compared to other common psychiatric illnesses, including anxiety, OCD, and PTSD. This finding is similar to a recent study [ 23 ] conducted in Morocco using the same measuring tools for depression and anxiety and revealing that among all the common psychiatric illnesses, depression was more common than the others. In their study with a sample of 549 medical students, 410 (74.6%) reported depression while 341 (62.3%) had anxiety, 344 (62.6%) insomnia, and 379 (69%) distress.…”

“…The study shows a very high proportion (93.1%) of undergraduate and postgraduate medical students having some degree of psychological problem while only 17% of them had any history of psychiatric illness in the pre-pandemic period; this assault on psychiatric wellbeing during the pandemic period is in accord with studies on medical students in Pakistan [ 19 ], UK [ 20 ], Japan [ 21 ], India [ 22 ], Morocco [ 23 ] and nursing students in Indonesia [ 18 ]. Also, several studies reflect increased stress, anxiety, and depression as an influence of the COVID-19 epidemic among all strata of society, including the general public [ 5 , 6 , 17 ], health care workers [ 3 , 8 ], older adults [ 24 ] and students of all categories [ 25 ], In contrast, a study from Iran [ 26 ] shows only 27.6% of medical students having depression.…”

“…Depression and PTSD were significantly related to the female gender. Such association was shown in multiple studies among medical students and the general population before the pandemic [ 27 ] and also after the COVID-19 pandemic [ 19 , 23 , 28 ]. This may reflect the biological difference in females, as discussed in a research article [ 29 ], while a study from India [ 22 ] did not show such an association.…”

“…While there are few studies throwing light on the psychological impact of the COVID-19 pandemic on medical students. [ 18 , 19 , 20 , 21 , 22 , 23 ].…”

Undergraduate medical education amid COVID-19: a qualitative analysis of enablers and barriers to acquiring competencies in distant learning using focus groups

“…In their BEME Guide to developments in response to the COVID-19 pandemic, Daniel et al identified several publications, but only three focussing on wellbeing in undergraduate medical education [2]. The comprehensive measures of social distancing with school and university closures, restricted social connections, and loss of routine potentially have a huge negative effect on individuals' social networks [9] and mental wellbeing [9][10][11][12][13][14][15][16][17][18][19][20] although risk factors in principle remain the same: low income, living alone, younger age, female gender, and pre-existing mental health conditions [12,13,15,21]. Thus, in addition to examining the primary impact of COVID-19, a second focus of research is needed to not only map but to explain the impact of secondary measures such as the fundamental shift of faculties to replacing or supplementing on-site teaching with e-learning on students' learning and mental wellbeing.…”