Symptoms of depression and anxiety in Indonesian medical students: association with coping strategy and resilience

Abstract

Background Depression and anxiety are prevalent mental health issues among medical students due to the various challenges during medical education. These issues affect not only their quality of life, but also their academic and professional development. Coping strategy and resilience are two factors that may influence students’ mental health outcomes. Data of medical student mental health in Indonesia is scarce, hampering efforts to systematically address the problem. Hence, this study aims to estimate the prevalence of depressive and anxiety symptoms in Indonesian medical students, and their association with coping strategy and resilience. Methods Undergraduate medical students from each year of study (Preclinical Year 1 to 4, Clinical Year 1 and 2) in the Faculty of Medicine Universitas Indonesia were randomly selected to participate in this cross-sectional study. The study questionnaire included sociodemographic characteristics, Depression Anxiety Stress Scale (DASS) to measure symptoms of depression and anxiety, Brief COPE to measure coping strategy, and Connor-Davidson Resilience Scale (CD-RISC) to measure resilience. Scores of depression and anxiety symptoms were analyzed by comparing them between different sociodemographic groups and by measuring their correlation with coping strategies and resilience. Multiple regression analyses were conducted to identify predictors of depression and anxiety symptoms. Results Among 532 respondents, 22.2% reported symptoms of depression and 48,1% reported anxiety, including 3.0% and 8.1% with extremely severe depression and anxiety, respectively. Students not living with immediate family had higher depression score; female students and those in Preclinical Year 1 and Clinical Year 1 showed higher anxiety scores. Dysfunctional coping strategies and lower resilience are predictors of higher depression and anxiety symptoms. Conclusions Students show different levels of depressive and anxiety symptoms, signifying different levels of mental health support needs from universal mental health promotion to psychiatric treatment. Prevention programs can be targeted towards students with risk factors, such as not living with immediate family, undergoing first year of preclinical studies or clinical rotations, coping with dysfunctional strategies, and having low resilience. Additionally, medical educators must be aware of other, non-student factors that may impact student mental health, such as curriculum design and learning experience.

Evaluation of Health-Related Quality of Life and Mental Health in 729 Medical Students in Indonesia During the COVID-19 Pandemic

“…In a recent systematic review and meta-analysis, the pooled prevalence of depression and anxiety among medical students during the COVID-19 pandemic was 37.9% and 33.7%, respectively [ 8 ]. There are 3 previous studies from Indonesia that also evaluated the prevalence of mental health problems among medical students where the DASS-21 was also used as the study instrument; the prevalence of depression, anxiety, and stress was 13.5–18.6%, 15–48.1%, and 7.5–44.6%, respectively [ 17 , 30 , 40 ]. One of the possible explanations of the high prevalence in our study is because we collected the data shortly after Indonesia faced the peak of the second wave, which was caused by the Delta variant outbreak, and which placed Indonesia as the epicentrum of the pandemic in Asia [ 18 , 19 ].…”

“…Each subscale score must be multiplied by 2 to obtain the final score. The total score is then categorized into normal, mild, moderate, severe, and extremely severe, with the cut off values as follows: normal (0-9), mild (10)(11)(12), moderate (13)(14)(15)(16)(17)(18)(19)(20), severe (21)(22)(23)(24)(25)(26)(27), and extremely severe (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42) for depression; normal (0-6), mild (7)(8)(9), moderate (10)(11)(12)(13)(14), severe (15)(16)(17)(18)(19), and extremely severe for anxiety; and normal (0-10), mild (11)(12)(13)…”

Sintomas depressivos e ansiosos em estudantes de medicina e seus fatores associados

“…Neste presente trabalho, conforme já mencionado, foram analisados 20 artigos, dos quais 15 artigos (Bassols et al 2014;Bertani et al 2020;Costa et al 2020;Kumar et al 2019;Leão et al 2018;Liasi et al 2021;Moutinho et al 2017;Ramadianto et al 2022;Sacramento et al 2021;Santiago et al 2021;Serra et al 2015;Shao et al 2020;Shawahna et al 2020;Tabalipa et al 2015;Zafar et al 2017) trouxeram estudos que abrangeram o índice de depressão e ansiedade entre graduandos do curso de medicina, 3 artigos (Elsawy et al 2020;Neres et al 2021;Silva et al 2017) O desenvolvimento das sintomatologias acima abordadas está cercado de fatores predisponentes trazidos por autores de 17 dos artigos selecionados. Conhecer estes fatores de risco pode ser um facilitador na promoção de medidas preventivas quanto ao desenvolvimento de desordens psíquicas.…”

“…Conhecer estes fatores de risco pode ser um facilitador na promoção de medidas preventivas quanto ao desenvolvimento de desordens psíquicas. Alguns dos fatores citados foram: sexo feminino, com maior incidência para ansiedade, mas também presente na depressão (Bassols et al 2014;Capdevila-Gaudens et al 2021;Elsawy et al 2020;Moutinho et al 2017;Neres, et al 2021;Nogueira et al 2021;Ramadianto et al 2022;Serra et al 2015;Tabalipa et al 2015), vivências estressantes nos últimos 6 meses, ambiente de estudo prejudicado, insatisfação acadêmica, nível socioeconômico mais baixo (Elsawy et al 2020), distância entre local de moradia e hospital universitário (Liasi et al 2021), não morar com os pais (Ramadianto et al 2022), idade >20 anos (Shao et al 2020), estresse causado pelos estudos, baixa qualidade de sono, morar sozinho e relacionamento de baixa qualidade com parceiros, colegas e amigos (Shao et al 2020), possuir pais médicos como indicador de risco para a depressão e pais não médicos para a ansiedade (Tabalipa et al 2015), viver de acordo com as expectativas dos familiares, insatisfação quanto a administração do curso (Kumar et al 2019), insônia predispondo à ansiedade moderada a grave (Nogueira et al 2021), relacionamento familiar insatisfatório (Leao et al 2018), consumo de drogas lícitas e ilícitas e proximidade reduzida com os amigos (Neres et al 2021).…”

Depression, anxiety and stress (according to DASS-21 test results) among students of Vinnytsya national medical university

“…Додатковими факторами, що здатні викликати зміни в емоційній сфері, є економічні фактори, відірваність від сім'ї та дія соціальних чинників. Існує гендерна сприй-нятливість до розвитку депресії, тривоги та стресу [4,8].…”