Prevalence of pre-exam Anxiety among Medical and Paramedical Students in The Arab World during COVID-19: a Cross-Sectional Study

Abstract

Background Pre-exam anxiety is a condition that affects students before their exams, and significantly affects their academic performance, mental, and physiological state. Medical and paramedical students are more likely to experience exams related stress and anxiety. Here we aimed to evaluate the prevalence of exam anxiety and its associated risk factors among undergraduate Arab medical and paramedical students. Methods We performed a multicenter cross-sectional study in six Arab countries: Egypt, Syria, Iraq, Palestine, Algeria, and Libya from March to April 2021. We used Epi Info version 7.2 software to calculate the sample size. An online questionnaire including The Depression, Anxiety, and Stress Scale − 21 Items (DASS-21) was used to measure exam-related anxiety. We used IBM SPSS for Windows version 26 statistical software and R programming language version 3.6.3. data analysis. Results A total of 18979 participants filled out the questionnaire, 71.3% of them were females. The majority of the study participants were between the ages of 20 to 21 years 42.4% (n = 8055). On the DASS, 38.8% of participants experienced severe symptoms of depression, 47.6% of them experienced severe symptoms of anxiety, and 30.2% experienced severe symptoms of stress. Of the three subscales of the DASS, Females had a significantly higher risk than males to develop Depression, Anxiety, and Stress (B = 2.454, P < 0.001), (B = 4.256, P < 0.001), (B = 3.516, P < 0.001) respectively. Participants aged 22 years or more were less susceptible to test-related depression (B= -0.907, P < 0.001) and anxiety (B= -0.958, P < 0.001). Students who study between 13 and 18 hours per week were considerably more likely to have lower scores on all DASS subscales than those who study more than 18 hours per week, depression (B= -0.983, P < 0.001), Anxiety (B= -1.334, P < 0.001) and stress (B= -1.693, P < 0.001). Conclusion The prevalence of test-related anxiety, stress, and depression is high among medical and paramedical students in the Arab region. Medical educators should be aware of the impacts of this comorbidity and should work on implementing new and effective strategies to help students cope with psychological changes during exams.