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Background Digital addictions and their influence on mental health are being intensively studied nowadays but scientific data about Bulgaria is still scarce. The study is focused on the prevalence of nomophobia among medical students, its relationship with anxiety and motivation for seeking professional help. Methods The cross-sectional study included 369 medical students, age 19-34 (mean 23) years. We analyzed the whole group and subgroups of Bulgarian/foreign students and second-/sixth-year students. Data were collected by a self-administered questionnaire including smartphone addiction scale (SAS) with a 4-point Lickert scale, a 7-item generalized anxiety disorder scale and socio-demographic questions. Results The prevalence of mild smartphone addiction was 55% and of moderate one 30%. The dependency score was higher in the groups with a moderate and severe level of anxiety (P < 0.001). There was no difference in dependency score by age and gender but it was higher among foreign students compared to Bulgarian students and lower in the sixth-year group compared to the second- year one. The anxiety score was higher in females compared to males and among second-year students compared to the sixth-year (P < 0.001). Only 40% of males and 50% of females reported motivation to look for professional help. Conclusions The prevalence of smartphone addiction is high among both Bulgarian and foreign medical students. Our results reveal co-morbidity of smartphone addiction and generalized anxiety disorder. The low motivation to consult a specialist points out underestimation of the problem. Implementation of educational programmes, individual and group therapy can help young people to curb smartphone use. Key messages Smartphone addiction is related to increased anxiety level and affects adversely mental health. The establishment of a healthy relationship between young people and technologies has to be considered as part of health promotion.

PURPOSE: The objective of this study is to examine the health literacy of medical students. METHODS: In October 2017 a cross-sectional study was conducted among a representative sample of second year medical students of the Medical University-Sofia. Health literacy of students was measured by an adapted version of the European Health Literacy Survey Questionnaire (EU-HLS-Q). RESULTS: Students demonstrated a good self-reported ability to find health information. However, they reported difficulties in understanding and assessing different aspects of health information. CONCLUSIONS: Although medical students assess their ability to search and find health information as good and very good, they find it difficult to interpret the information.

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Background Medical education is often related to serious distress for students, that affects negatively their mental well-being. Depression, poor academic performance, increased alcohol consumption, suicidal thoughts, are some of the detrimental effects of diminished mental health. Studies on depression in medical students reveal a higher prevalence (1.4-73.5%) than in the general population. This study aimed to assess and compare depression prevalence and severity in three cohorts of medical students in Bulgaria and Turkey. Methods We conducted a cross-sectional online survey with 257 Bulgarian and 288 foreign medical students from Medical University-Sofia, Bulgaria, and with 270 Turkish medical students from Ankara in the winter semester of 2019-2020 academic year. We used the Beck depression inventory (BDI) as valid and reliable instrument to assess depression. The students were categorised according to BDI scores in three groups: with mild depression (10- 18 points); moderate depression (19-29); severe depression (30- 63). Data were analysed with program product Python 3 (v3.6.9) with Pandas v0.25.3 and Scipy v1.4.1. Results Depressive symptoms reported 71.5% of Turkish students, 47.1% of Bulgarian and 48.7% of foreign medical students. The depression frequency among Turkish and Bulgarian medical students was significantly different (chi2 = 35.31; p = 0,001). Mean BDI scores were similar for Bulgarian medical students (11.0) and foreign medical students, studying in Bulgaria (11.6). Turkish medical students scored highest on BDI (15.3). Severe depression was detected in 5.6% of foreign, 4.3% of Bulgarian and 6.3% of Turkish students. Conclusions Depression prevalence was high in all studied medical students cohorts, with Turkish cohort affected most, probably because of cultural and curriculum differences. Key messages Support of student’s mental health should be an integral part of the educational policies of all Medical Universities worldwide. Depression among medical students has to be prevented by comprehensive approach.