Psychological Impact of the Civil War and COVID-19 on Libyan Medical Students: A Cross-Sectional Study

Abstract

Objective: We aim to determine the psychological status of medical students during the COVID-19 outbreak and civil war in Libya. Methods: A cross-sectional study was conducted among medical students from 15 medical schools between April 20 and May 1, 2020. The demographic characteristics, generalized anxiety disorder 7-item (GAD-7) scale, and patient health questionnaire (PHQ-9) results were collected. Results: Of the 3,500 students, 2,430 completed the survey. The mean (± SD) score of anxiety symptoms determined by the GAD-7 was 7.2 (5.1). A total of 268 (11%) students had a GAD-7 score of ≥15, which is indicative of moderate to severe anxiety. A total of 1,568 (64.5%) students showed different degrees of anxiety: mild, 910 (37.5%); moderate, 390 (16%); and severe, 268 (11%). Anxiety was significantly associated with living status and internal displacement (P < 0.05). The mean (+ SD) score of depressive symptoms determined by the PHQ-9 was 9.7 (6.3). A total of 525 (21.6%) students had a PHQ-9 score of ≥15, which is indicative of moderate to severe depression. A total of 1,896 (88%) students were diagnosed with mild (PHQ ≥ 5) depression. Suicidal ideation was present in 552 patients (22.7%). Depression was only statistically associated with the year of study (P = 0.009). Conclusion: These data highlight that medical students in Libya are at risk for depression, especially under the current stressful environment of the civil war and the COVID-19 outbreak.

Knowledge, attitude, and practice towards COVID-19 among Libyan people- a web-based cross-sectional study

“…At the local level, two independent studies conducted by Hweissa NAB, et al [26] and Elshwekh H, et al [27] found that 79.9% and 89.3% of the surveyed Libyan healthcare workers have adequate knowledge about the COVID-19, respectively. Elhadi M, et al [28] surveyed 3,669 medical and non-medical students from fifteen universities in Libya. The authors found that 71.8% had adequate knowledge accompanied by a positive attitude and professional behavior towards COVID-19.…”

COVID-19 pandemic and mental health of universities’ students in Africa: a systematic review

“…We excluded 63 articles and therefore retrieved and appraised the 20 lasting articles based on their full-texts and also considering our selection criteria. Finally, 12 articles [24][25][26][27][28][29][30][31][32][33][34][35] were systematically reviewed and qualitatively summarized. The PRISMA flow chart showing our study selection process is shown in figure 1.…”

“…Amid selected studies, 11 were reported as cross-sectional studies, and one as a transversal descriptive study [33]. Data were collected exclusively electronically (online surveys) in 9/12 studies, only with a paper version form in one study [32], both with online and paper forms in one study [29], and through phone calls in one study [26]. Most of studies (7/12) used a non-probabilistic sampling method, 4 studies reported a probabilistic sampling technique, and one article reported no details on the sampling method used.…”

“…These thresholds respectively corresponding to mild cases of depression, anxiety and stress. Regarding depression, two studies [29,30] used the Patient Health Questionnaire 9-items (PHQ-9) with a positive screening cut-off score of [?] 05 (mild cases) for one study and [?]…”

“…10) [27]. Concerning anxiety, two studies [29,30] used the Generalized Anxiety Disorder 7-item (GAD-7) scale with one study's threshold at 15 (severe anxiety) and the other's one at 05 (mild anxiety), and one used the Beck Anxiety Inventory (BAI) [24]. For the BAI, a score of 0-21 was classified as low anxiety, 22-35 as moderate anxiety, and 36 or above as potentially concerning level of anxiety.…”