Comorbid anxiety and depressive symptoms and the related factors among international medical students in China during COVID-19 pandemic: a cross-sectional study. 2023

Lulu Yuan, and Lu Lu, and Xuehang Wang, and Min Qu, and Yuqin Gao, and Bochen Pan
Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.

The two most prevalent mental health conditions are anxiety and depression and they often coexist (comorbidity) in an individual aggravating the person's psychological or medical conditions. College students suffered from anxiety and depressive symptoms during the COVID-19 pandemic, according to numerous studies. The lack of information on the comorbidity of anxiety and depression (CAD) among international medical students, however, makes it difficult to develop effective policies or strategies to support these students. The present research seeks to investigate the incidence of CAD among international medical students in China and to identify the variables that may be useful in predicting CAD. A cross-sectional study was conducted at China Medical University in Shenyang, China, for international medical students during November 2020. A total of 519 international students provided information on their demographics, stress related to the COVID-19 pandemic, generalized anxiety disorder assessment (GAD-7), patient health questionnaire-9 (PHQ-9), simplified coping style questionnaire (SCSQ), perceived stress scale (PSS-10), the multidimensional scale of perceived social support (MSPSS), revised life orientation test (LOT-R), and resilience scale-14 (RS-14). To investigate the potential predictors of CAD, a chi-square test, a nonparametric test, and multinomial logistic regression analyses were carried out as appropriate. The incidence of anxiety, depression, and CAD in the current study was 5.8%, 8.9%, and 22.7%, respectively. The predictors for students having symptoms of anxiety were observed to be the negative coping style (β = 0.662, OR = 1.938, CI:1.07-3.694) and perceived stress (β = 0.167, OR = 1.181, CI:1.076-1.297); the predictors for students having symptoms of depression were observed to be the COVID-19 pandemic-related stress (β = 0.323,OR = 1.382,CI:1.211-1.577), negative coping style (β = 0.693,OR = 2.000, CI:1.21-3.568), and perceived stress (β = 0.135,OR = 1.145,CI:1.050-1.248); whereas the predictors for students with CAD were observed to be staying up late (Yes VS No) (β = 1.028,OR = 2.794,CI:1.227-6.364), current place of residence (Other continents VS China) (β = -1.413, OR = 0.243,CI:0.065-0.910), COVID-19 pandemic-related stress (β = 0.371,OR = 1.450,CI:1.284-1.636), negative coping style (β = 1.092,OR = 2.979,CI:1.706-5.203), and perceived stress (β = 0.339,OR = 1.403,CI:1.289-1.527). Single anxiety and depressive symptoms were moderately prevalent among international medical students in China. However, CAD turned out to be the most prevalent mental health issue due to its relatively higher incidence. Negative coping style and perceived stress were the communal predictors of the three categories, whereas stress related to the COVID-19 pandemic was linked to both depression and CAD, and staying up late and in residential places were specific predictors for CAD. Study results suggest that COVID-19 pandemic-related stress was related to students' CAD and depressive symptoms, and specific intervention measures with stress reduction, proper coping strategy, and a good lifestyle might be useful in improving the international students' mental health status.

UI MeSH Term Description Entries
D002681 China A country spanning from central Asia to the Pacific Ocean. Inner Mongolia,Manchuria,People's Republic of China,Sinkiang,Mainland China
D003430 Cross-Sectional Studies Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time. Disease Frequency Surveys,Prevalence Studies,Analysis, Cross-Sectional,Cross Sectional Analysis,Cross-Sectional Survey,Surveys, Disease Frequency,Analyses, Cross Sectional,Analyses, Cross-Sectional,Analysis, Cross Sectional,Cross Sectional Analyses,Cross Sectional Studies,Cross Sectional Survey,Cross-Sectional Analyses,Cross-Sectional Analysis,Cross-Sectional Study,Cross-Sectional Surveys,Disease Frequency Survey,Prevalence Study,Studies, Cross-Sectional,Studies, Prevalence,Study, Cross-Sectional,Study, Prevalence,Survey, Cross-Sectional,Survey, Disease Frequency,Surveys, Cross-Sectional
D003863 Depression Depressive states usually of moderate intensity in contrast with MAJOR DEPRESSIVE DISORDER present in neurotic and psychotic disorders. Depressive Symptoms,Emotional Depression,Depression, Emotional,Depressive Symptom,Symptom, Depressive
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000086382 COVID-19 A viral disorder generally characterized by high FEVER; COUGH; DYSPNEA; CHILLS; PERSISTENT TREMOR; MUSCLE PAIN; HEADACHE; SORE THROAT; a new loss of taste and/or smell (see AGEUSIA and ANOSMIA) and other symptoms of a VIRAL PNEUMONIA. In severe cases, a myriad of coagulopathy associated symptoms often correlating with COVID-19 severity is seen (e.g., BLOOD COAGULATION; THROMBOSIS; ACUTE RESPIRATORY DISTRESS SYNDROME; SEIZURES; HEART ATTACK; STROKE; multiple CEREBRAL INFARCTIONS; KIDNEY FAILURE; catastrophic ANTIPHOSPHOLIPID ANTIBODY SYNDROME and/or DISSEMINATED INTRAVASCULAR COAGULATION). In younger patients, rare inflammatory syndromes are sometimes associated with COVID-19 (e.g., atypical KAWASAKI SYNDROME; TOXIC SHOCK SYNDROME; pediatric multisystem inflammatory disease; and CYTOKINE STORM SYNDROME). A coronavirus, SARS-CoV-2, in the genus BETACORONAVIRUS is the causative agent. 2019 Novel Coronavirus Disease,2019 Novel Coronavirus Infection,2019-nCoV Disease,2019-nCoV Infection,COVID-19 Pandemic,COVID-19 Pandemics,COVID-19 Virus Disease,COVID-19 Virus Infection,Coronavirus Disease 2019,Coronavirus Disease-19,SARS Coronavirus 2 Infection,SARS-CoV-2 Infection,Severe Acute Respiratory Syndrome Coronavirus 2 Infection,COVID19,2019 nCoV Disease,2019 nCoV Infection,2019-nCoV Diseases,2019-nCoV Infections,COVID 19,COVID 19 Pandemic,COVID 19 Virus Disease,COVID 19 Virus Infection,COVID-19 Virus Diseases,COVID-19 Virus Infections,Coronavirus Disease 19,Disease 2019, Coronavirus,Disease, 2019-nCoV,Disease, COVID-19 Virus,Infection, 2019-nCoV,Infection, COVID-19 Virus,Infection, SARS-CoV-2,Pandemic, COVID-19,SARS CoV 2 Infection,SARS-CoV-2 Infections,Virus Disease, COVID-19,Virus Infection, COVID-19
D001007 Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with ANXIETY DISORDERS. Angst,Anxiousness,Hypervigilance,Nervousness,Social Anxiety,Anxieties, Social,Anxiety, Social,Social Anxieties
D001008 Anxiety Disorders Persistent and disabling ANXIETY. Anxiety Neuroses,Anxiety States, Neurotic,Neuroses, Anxiety,Anxiety Disorder,Anxiety State, Neurotic,Disorder, Anxiety,Disorders, Anxiety,Neurotic Anxiety State,Neurotic Anxiety States,State, Neurotic Anxiety,States, Neurotic Anxiety
D013337 Students, Medical Individuals enrolled in a school of medicine or a formal educational program in medicine. Medical Student,Medical Students,Student, Medical
D015897 Comorbidity The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.
D058873 Pandemics Epidemics of infectious disease that have spread to many countries, often more than one continent, and usually affecting a large number of people. Pandemic

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