Severe Psychological Distress Among Medical Students During the COVID-19 Pandemic: Toward a Safer Mental Health

Main Article Content

Hajar Essangri Nezha El Bahaoui Amine Benkabbou Mohammed Anass Majbar Brahim Lekehal Raouf Mohsine Amine Souadka

Abstract

Objective: As we learn how to live with the COVID pandemic, understanding this psychological impact of the coronavirus outbreak and its determinants is the first step towards finding solutions. The aim of the study is to  examine the status of medical students' mental health and assess psychological distress determinants and pathways in order to suggest adapted strategies to help them.


 


Methods: We performed a convergent parallel mixed-methods analysis of an online survey administered to medical students from March 23 to March 28, 2020. Psychological distress was assessed through the Kessler 6 (K6) questionnaire. Factors associated with severe psychological distress (SPD, K6>13) were identified by multivariable logistic regression. The qualitative part analyzed responses to open-ended questions addressing medical students' perspectives on the impact of the pandemic and relieving factors.


 


Results: 808 medical students completed the survey. Severe psychological distress was reported by 234(28.96%) respondents and was independently associated with: Female sex (OR,2.8;[ 95%CI ,1.791-4.363];P<0.001), clinical study level (OR,0.621;[95%CI,0.437-0.881];P =0.008), Tobacco use (OR, 3.664;[95% CI,1.9 - 7.07];P =0.001), history of psychiatric meds  (OR, 2.454 ;[95%CI,1.384 - 4.454];P=0.001) and quarantine (OR, 1.5 ;[95%CI, 1.015 - 2.337];P =0.04). Students submitted a total of 2424 concerns about ways the pandemic affected different areas of their lives and redundants determinants were summarized.


 


Conclusion: During the COVID crisis, 28% of our students experienced severe mental distress due to multifactorial determinants including social and individual psychological and behavioral contributors. This crisis is an opportunity to address the well known mental health morbidities of future physicians and increase the awareness about the important role that medical schools could have as a safety net and support system.


 


Keywords: COVID-19, Medical student, Mental health, Psychological distress, lifting lockdown measures

Article Details

How to Cite
ESSANGRI, Hajar et al. Severe Psychological Distress Among Medical Students During the COVID-19 Pandemic: Toward a Safer Mental Health. Medical Research Archives, [S.l.], v. 10, n. 10, oct. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3153>. Date accessed: 06 dec. 2022. doi: https://doi.org/10.18103/mra.v10i10.3153.
Section
Review Articles

References

Moir F, Yielder J, Sanson J, Chen Y. Depression in medical students: current insights. Adv Med Educ Pract. 2018; 9:323-333.
2. Schwenk TL, Davis L, Wimsatt LA. Depression, stigma, and suicidal ideation in medical students. JAMA. 2010; 304(11):1181-1190.
3. Molodynski A, Lewis T, Kadhum M, et al. Cultural variations in wellbeing, burnout and substance use amongst medical students in twelve countries. Int Rev Psychiatry. Published online March 18, 2020:1-6.
4. Essangri H, Sabir M, Benkabbou A, et al. Predictive Factors for Impaired Mental Health among Medical Students during the Early Stage of the COVID-19 Pandemic in Morocco. Published online November 17, 2020:tpmd201302.
5. Hill MR, Goicochea S, Merlo LJ. In their own words: stressors facing medical students in the millennial generation. Med Educ Online. 2018;23(1):1530558.
6. Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc. 2005;80(12):1613-1622.
7. Singh DS. Study of Factors Affecting Academic Achievement in Medical Students. jmscr. 2016; 04(12): 1968-14972.
8. COVIDSurg Collaborative, GlobalSurg Collaborative. SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study. Anaesthesia. 2022;77(1):28-39.
9. COVIDSurg Collaborative. Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: the COVIDSurg mortality score. Br J Surg. 2021;108(11):1274-1292.
10. Souadka A, Benkabbou A, Al Ahmadi B, Boutayeb S, Majbar MA. Preparing African anticancer centres in the COVID-19 outbreak. Lancet Oncol. 2020; 21(5): e237.
11. Souadka A, Habbat H, Majbar MA, et al. Cancer patients should be considered as a high risk priority target in the coronavirus disease 2019 vaccination process. J Surg Oncol. 2021;124(3):453-454.
12. Rose S. Medical Student Education in the Time of COVID-19. JAMA. Published online March 31, 2020. doi: 10.1001/jama.2020.5227
13. Birch E, de Wolf M. A novel approach to medical school examinations during the COVID-19 pandemic. Med Educ Online. 2020;25(1):1785680.
14. Schulte TL, Gröning T, Ramsauer B, et al. Impact of COVID-19 on Continuing Medical Education-Results of an Online Survey Among Users of a Non-profit Multi-Specialty Live Online Education Platform. Front Med. 2021;8:773806.
15. Bensbih S, Essangri H, Souadka A. The Covid19 outbreak: a catalyst for digitization in African countries. J Egypt Public Health Assoc. 2020;95(1):17.
16. Lee ICJ, Koh H, Lai SH, Hwang NC. PRIME PubMed | Academic Coaching of Medical Students During COVID-19. Published June 13, 2020. Accessed June 16, 2020. https://www.unboundmedicine.com/medline/citation/32531804/Academic_Coaching_of_Medical_Students_During_COVID-19.
17. Compton S, Sarraf-Yazdi S, Rustandy F, Kumar Radha Krishna L. Medical students’ preference for returning to the clinical setting during the COVID-19 pandemic. Med Educ. Published online June 10, 2020. doi:10.1111/medu.14268
18. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912-920.
19. Arowoshola L. Medical education engagement during the COVID-19 era - A student parents perspective. Med Educ Online. 2020;25(1):1788799.
20. De Micheli G, Vergani L, Mazzoni D, Marton G. After the Pandemic: The Future of Italian Medicine. The Psychological Impact of COVID-19 on Medical and Other Healthcare-Related Degrees Students. Front Psychol. 2021;12:648419.
21. Xiang D, Liang B, Wang Y, et al. Factors Influencing Residents’ Psychological Status During Standardized Training in COVID-19. Front Psychiatry. 2021; 12:737717.
22. Souadka A, Essangri H, Benkabbou A, Amrani L, Majbar MA. COVID-19 and Healthcare worker’s families: behind the scenes of frontline response. EClinicalMedicine. 2020;23:100373.
23. Mental Health and Psychosocial Support Resources During the COVID-19 Outbreak. Accessed June 16, 2020. https://globalhealth.harvard.edu/mentalhealth-resources-covid19
24. FADLI Taibi, archos technology. Covid-19: Marrakech “Cadi Ayyad” University Sets up Psychological Support System for Students | MapNews. Accessed June 16, 2020.
https://www.mapnews.ma/en/actualites/regional/covid-19-marrakech-cadi-ayyad-university-sets-psychological-support-system
25. Wisdom J, Creswell JW. Mixed methods: integrating quantitative and qualitative data collection and analysis while studying patient-centered medical home models. Rockville: Agency for Healthcare Research and Quality. Published online 2013.
26. البوابة الرسمية لفيروس كورونا بالمغرب. Accessed April 12, 2020. http://www.covidmaroc.ma/Pages/SituationCovid.aspx
27. Survey Disclosure Checklist - AAPOR. Accessed June 8, 2020.
https://www.aapor.org/Standards-Ethics/AAPOR-Code-of-Ethics/Survey-Disclosure-Checklist.aspx
28. for Public Opinion Research AA. Standard definitions: Final dispositions of case codes and outcome rates for surveys. ”. Published online 2011.
29. Cuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019;13(Suppl 1):S31-S34.
30. Lai J, Ma S, Wang Y, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976.
31. Stansfield J, Bell R. Applying a psychosocial pathways model to improving mental health and reducing health inequalities: Practical approaches. Int J Soc Psychiatry. 2019;65(2):107-113.
32. Dunn LB, Iglewicz A, Moutier C. A conceptual model of medical student well-being: promoting resilience and preventing burnout. Acad Psychiatry. 2008;32(1):44-53.
33. Mavor KI, McNeill KG, Anderson K, Kerr A, O’Reilly E, Platow MJ. Beyond prevalence to process: the role of self and identity in medical student well-being. Med Educ. 2014;48(4):351-360.
34. Arnaud B, Malet L, Teissedre F, et al. Validity Study of Kessler’s Psychological Distress Scales Conducted Among Patients Admitted to French Emergency Department for Alcohol Consumption-Related Disorders. Alcoholism: Clinical and Experimental Research. Published online 2010:no - no. doi:10.1111/j.1530-0277.2010.01201.x
35. Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23):3095-3105.
36. Bordage G. Conceptual frameworks to illuminate and magnify. Med Educ. 2009;43(4):312-319.
37. Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res. 2020;288:112954.
38. Zhou C, Li R, Yang M, Duan S, Yang C. Psychological Status of High School Students 1 Year After the COVID-19 Emergency. Front Psychiatry. 2021; 12:729930.
39. Durbas A, Karaman H, Solman CH, Kaygisiz N, Ersoy Ö. Anxiety and Stress Levels Associated With COVID-19 Pandemic of University Students in Turkey: A Year After the Pandemic. Front Psychiatry. 2021;12:731348.
40. Ghannam A, Souadka A. Beware of Time Delay and Differential Diagnosis when Screening for Symptoms of COVID-19 in Surgical Cancer Patients. J Am Coll Surg. 2020;231(2):303.
41. Souadka A, Benkabbou A, Majbar MA, et al. Oncological Surgery During the COVID-19 Pandemic: The Need for Deep and Lasting Measures. Oncologist. 2020;25(9):e1424-e1425.
42. Satici B, Saricali M, Satici SA, Griffiths MD. Intolerance of Uncertainty and Mental Wellbeing: Serial Mediation by Rumination and Fear of COVID-19. Int J Ment Health Addict. Published online May 15, 2020:1-12.
43. Yao H, Chen JH, Xu YF. Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry. 2020; 7(4): e21.
44. Abrams EM, Szefler SJ. COVID-19 and the impact of social determinants of health. Lancet Respir Med. Published online May 18, 2020.
doi: 10.1016/S2213-2600(20)30234-4
45. Allen J, Balfour R, Bell R, Marmot M. Social determinants of mental health. Int Rev Psychiatry. 2014;26(4):392-407.
46. Zhou S, Banawa R, Oh H. The Mental Health Impact of COVID-19 Racial and Ethnic Discrimination Against Asian American and Pacific Islanders. Front Psychiatry. 2021;12:708426.
47. Evans DJR, Bay BH, Wilson TD, Smith CF, Lachman N, Pawlina W. Going Virtual to Support Anatomy Education: A STOPGAP in the Midst of the Covid‐19 Pandemic. Anatomical Sciences Education. 2020; 13(3): 279-283. doi: 10.1002/ase.1963
48. Calhoun KE, Yale LA, Whipple ME, Allen SM, Wood DE, Tatum RP. The impact of COVID-19 on medical student surgical education: Implementing extreme pandemic response measures in a widely distributed surgical clerkship experience. Am J Surg. Published online April 28, 2020. doi: 10.1016/j.amjsurg.2020.04.024
49. Kanneganti A, Lim KMX, Chan GMF, et al. Pedagogy in a pandemic - COVID-19 and virtual continuing medical education (vCME) in obstetrics and gynecology. Acta Obstet Gynecol Scand. 2020; 99(6): 692-695.
50. Roberts V, Malone K, Moore P, Russell-Webster T, Caulfield R. Peer teaching medical students during a pandemic. Med Educ Online. 2020;25(1):1772014.
51. Cecilio-Fernandes D, Parisi MCR, Santos TM, Sandars J. The COVID-19 pandemic and the challenge of using technology for medical education in low and middle income countries. MedEdPublish. 2020; 9(1). doi: 10.15694/mep.2020.000074.1
52. Miller DG, Pierson L, Doernberg S. The Role of Medical Students During the COVID-19 Pandemic. Ann Intern Med. Published online April 7, 2020. doi:10.7326/M20-1281
53. Liao Z, Zhang X, Wang Y, et al. Delayed-Onset PTSD and Coping Strategies of Chinese College Students During the COVID-19 Pandemic. Front Sociol. 2021;6:734738.