Jian Cemal, Medical Faculty VI Psychiatry department
Aida Kunigeliene, MD, PhD Kaunas 2018/2019
The manifestation of depression and anxiety
among international medical students at
Lithuanian University of Health Sciences (LUHS)
[Document Subtitle]
TABLE OF CONTENT
1. SUMMARY ………3
2. ACKNOWLEDGEMENT……….4
3. CONFLICT OF INTEREST ………5
4. ETHICS COMMITTEE CLEARANCE ……….5
5. ABBREVATION LIST ……….5
6. INTRODUCTION ……….6
7. AIM AND OBJECTIVES OF THE THESIS .………7
8. LITERATURE REVIEW ……….7
9. RESEARCH METHODOLOGY AND METHODS ……….13
10. RESULTS AND THEIR DISCUSSION ……….15
11. CONCLUSION ……….31
12. PRACTICAL RECOMMENDATIONS ……….32
13. LITERATURE LIST ………33
SUMMARY
The aim of the study: To evaluate the symptoms of depression, anxiety and gender differences among
international medical students at Lithuanian University of Health Sciences (LUHS).
The objectives of the study:
1. To evaluate the socio-demographic characteristics of international medical students of LUHS 2. To measure the symptoms of depression among international medical students at LUHS 3. To measure the symptoms of anxiety among international medical students at LUHS 4. To investigate the gender differences in symptoms of depression and anxiety.
Study population and method: 100 international medical students of LUHS from all the years,
proportionately. Firstly students will sign a consent form and will be anonymously evaluated for depression and anxiety by using BECK rating scale questionnaire. Medical students also fill a socio-demographic questionnaire.
Results: There were a total of 100 medical students from LUHS that responded to the questionnaires, 50
(50%) of which were male students and 50 (50 %) female students. The participants where divided into 2 age groups: 17-21 years and 22+, where 29 (29%) students were between17-21 years old and 71 (71 %) students were 22+ years old. Medical faculty has a 6-years programme. The students participating in this study were from all the years, where 1st year medical students was 11 (11%), 2nd year was 16 (16%), from
3rd year 18 (18%), 4th year there was 11 (11%) students, 5th year 22 (22%) and from 6th year there was 22
also found that 62% of the medical students are suffering from mild anxiety, 34% with moderate anxiety and 4% students with severe anxiety. Amongst female students (n=50) there was 44% with mild anxiety, 50% with moderate and 6% with severe anxiety. For male students (n=50) there was 80% with mild anxiety, 18% with moderate anxiety and 2% with severe anxiety. There was a statistical significance between these groups. There was no statistical significance between in anxiety symptom severity and the age groups (17-21 years and 22+ years), there was no statistical significance between in depression symptom severity and the age groups. Showing that amongst the medical student age is not a factor that is associated with their depressive and anxiety symptoms severity. There was no statistical significance between the study years of the students and their depressive/anxiety symptom severity as well as there is no statistical significance between the different nationalities of the students and their depressive and anxiety symptoms. There is a statistical significance between the relationships groups and their depressive and anxiety symptoms, meaning that students in a relationship/married have a lower depressive symptoms severity compared to medical students that are single.
Conclusion:
Out of a study sample of students, most common picture of an international medical student was a female/male person from Europe. Is single, with an age of 22+ years olds.
Most of international medical students at LUHS were meeting the criteria for mild depression.
Single medical students are suffering more from depressive symptoms then students that are in a relationship/married.
Most of international medical students at LUHS reported to experiencing mild anxiety. Female medical students reported to suffer from higher depressive and anxiety symptoms then male medicals students.
ACKNOWLEDGEMENT
CONFLICT OF INTEREST
No conflicts of interestETHICS COMMITTEE CLEARANCE
Title: The manifestation of depression and anxiety among international medical students at Lithuanian University of Health Sciences (LUHS)
Number: BEC-MF-25 Date of issue: 2018-11-02
TERMS
BDI (Beck depression inventory) BAI (Beck anxiety inventory)
ABBREVATION LIST
INTRODUCTION:
To study medicine abroad has increased significantly over the last couple of years. Students chose to leave their home and comfort zone to attend the university and follow their dreams to study medicine. Since LUHS made an international medical faculty there are people from all over the world coming to Lithuania to study medicine, and this is increasing significantly for each year that is passing. When making such a big change in a person’s life such as leaving your home to start university studies there are a lot of changes a person goes through such as a new social and educational environment, experiencing cultural differences and trying to adapt to a new language. Students are struggling trying to adapt to their new environment and at the same time discovering their own identity. The adjustments to all these new situations are also the reason why most of the students are experiencing symptoms of
depression and anxiety.
Students have to deal with the social and academicals demands that they meet in university studies and in their preparation for their professional carers after finishing University. This period that the students are going through is a very delicate time in their lives and is therefore a important time because with the right intervention methods in early stages it may prevent or reduce some of the metal problems that commonly students are experiencing.
According to WHO depression is defined as: a common mental disorder, characterized by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks [1]. When talking about depression there is normally following signs seen: loss of energy, changes in sleeping pattern and appetite, loss of interest, restlessness, feeling of hopelessness, worthlessness and thoughts of self-harm or suicide [2].
AIM AND OBJECTIVE OF THE THESIS
The aim of this study: To evaluate the symptoms of depression, anxiety and gender differences among international medical students at Lithuanian university of Health sciences (LUHS).
Objectives:
1. To evaluate the socio-demographic characteristics of international medical students of LUHS 2. To measure the symptoms of depression among international medical students at LUHS 3. To measure the symptoms of anxiety among international medical students at LUHS 4. To investigate the gender differences in symptoms of depression and anxiety.
LITERATURE REVIEW:
Many studies have been done regarding the symptoms of depression an anxiety amongst students, especially medical students. Many of the researches were done for the same reasons and that is to
understand what is causing students to feel symptoms of depression and anxiety, and try to prevent students from experiencing these symptoms.
A cross sectional study was made amongst medical students in Bahrain where self administered questionnaires was used and evaluated by using Becks depression inventory and Becks anxiety inventory scale [4]. This research studied the prevalence of anxiety and depressive symptoms amongst medical international students in the Kingdom of Bahrain and to determine the association between these
In another research conducted in Nepal, a cross sectional questionnaires based study was performed to determine the prevalence of depression, anxiety and stress among medical students and its association with socio-demographics characteristics [5]. Total of 538 students from first to fifth years were participating from Kathmandu University Medical School (KUSMS), Dhulikhel and Manipal College of Medical Science (MCOMS), Pokhara [5]. Depression, anxiety and stress were assessed using the Depression, Anxiety and Stress scale (DASS) and additional questions were added to the survey regarding demographic variables [5]. From 538 students that participated there was 89,6 % that gave response [5]. Among the 56,5 % were aged between 21-25 years, 42,2 % were below and 1,3 % were above 25 years old [5]. Among these students 52 % were female and 48 % were male [5]. This study found that the prevalence of depression was 29,9 % and anxiety was 41,1 % and stress 27 % among all participating medical students [5]. The most significant association with depression were the living conditions such as living in a hostel or rented house [5]. It was concluded that the higher level of
depression 29%, anxiety 41,1 % and stress 27 % amongst students shows the needs for a strategic plan to alleviate these symptoms of depression, anxiety and stress that students are feeling right from the start when they join medical school and needs to be continued until they finish their course [5].
Another cross sectional study was performed in India where the presence of depression, anxiety and stress were assessed using Depression anxiety stress Scale (DASS-42) as well as the association with their socio-demographics and personal characteristics were indentified amongst medical undergraduate students [6]. The results obtained from the self-administered questionnaires showed that more than half of the students were affected by depression (51,3%), anxiety (66,9%) and stress (53 %) [6]. Females were reported to have higher score when compared to male students [6]. They concluded that a substantial proportions of medical undergraduate students were found to be affected by depression, anxiety and stress revealing that a neglected area of the students psychology needs serious attention where there needs to be counselling services available and accessible for the students [6].
A cross-sectional study was performed in a public university in Egypt where the aim was to estimate the prevalence of depression, anxiety and stress symptoms among medical students and to determine the association with socio-demographic variables [7]. A self-administered questionnaire for socio-demographic characteristics and DASS 21 and Pittsburgh sleep quality index (PSQI) was used for assessment [7]. A total of 700 students responded and out of these 65 % were depressed, 78% were feeling anxiety and 59,9 % were feeling stressed [7]. They concluded that depression, anxiety and stress
A cross sectional study examined a sample from four public universities in the Klang Valley, Malaysia, between the ages of 18 and 24 years of age [8]. The aim of this research was to assess the prevalence of depression, anxiety and stress and to identify their correlates among university students [8]. An anonymous self-administered questionnaire was given to 506 students to answer [8]. The results from the questionnaires were evaluated by using the Depression Anxiety and stress Scale (DASS 21) [8]. The data of socio-demographics were also added to the survey [8]. The results showed that amongst all
students 27,5 % had moderate depression and 9,7 % had severe or extremely severe depression; 34 % had moderate symptoms of anxiety and 29 % was having symptoms of severe/ extremely severe anxiety; 18,6% had moderate and 5,1 % had severe or extremely severe stress score based on DASS 21 [8]. It was concluded that both depression and anxiety were significantly higher among older students (20 years and above) and those born in rural areas [8]. Whereas stress was higher among older students (20 years and above), females, Malays and those whose family had either low or high incomes compared to those with middle income [8]. It was concluded in this research that the prevalence of anxiety is much higher than depression or stress with some differences in their correlates except for age. This needs to be further evaluated for a development for better support services targeting and intervention program for this group [8].
Another cross sectional study was conducted among medical students in Brazil [9]. The aim of this study was to evaluate the prevalence of anxiety, depression and stress among medical students from all semesters of a Brazilian medical university and to assess their associated factors [9]. A total of 761 students filled out a questionnaire including socio-demographics, religiosity (DUREL-Duke religion index) and mental health (DASS 21 depression, anxiety and stress scale) [9]. Among the 761 students that answered the questionnaires; 34,6% reported depressive symptoms, 37,2 % showed anxiety symptoms and 47,1 % were experiencing stress symptoms [9]. The findings in this research were that higher level of depression, anxiety and stress was found in medical students, with marked differences among course semesters [9]. Students from first semester showed higher level of anxiety, exceeding that of students from the tenth and eleventh semester [9]. Regarding depressive symptoms it is shown that students have a sharp rise in the second period of the course compared with the first [9].
regularly and were from the first year and sixth year [10]. A self-administered questionnaire was used including socio-demographic questions, Beck depression inventory (BDI) and Beck anxiety inventory (BAI) scale [10]. A total of 232 students answered the questionnaires (110 first year and 122 sixth year students) [10]. Overall 50,4 % was male students (56,4 % first year and 45,1 % sixth year students) [10]. The results showed that 30,8 % of first year students and 9,4 % of sixth year students were experiencing anxiety symptoms [10]. It was also reported that female students were more affected by anxiety than male students. There were no significant between-group differences in depressive symptoms [10]. It was concluded in this study that the prevalence of anxiety symptoms was found in first year medical students as with sixth year students [10]. It was stated that there should be a developed strategy to help the medical students to manage these symptoms in the beginning of their medical education especially female students [10].
Another study was conducted amongst medical students at Nishtar Medical College, Multan, where the aim of the research was to determine the prevalence of anxiety and depression amongst medical students [11]. A cross sectional study was carried out at Nishtar medical college where self administered questionnaire was given to 815 medical students who had spent more than 6 months in college and had no precious self reported physical illness [11]. Assessment of anxiety and depression was done using a structured validated questionnaire, the Aga Khan University Anxiety and depression scale with a cut-off score of 19 [11]. Out of 815 students, 482 completed the questionnaires [11]. The mean age of students was 20.66 +/- 1,8 years [11]. It was shown that there was a high prevalence of anxiety and depression (43,89 % found among medical students) [11]. Anxiety and depression amongst first, second, third and fourth and final years was 45,86 %, 52,58%, 47,14 %, 28,75 % and 45,10 % respectively [11]. It was found that female students were more depressed than male students [11]. There was also a significant association between the prevalence of anxiety and depression and the respective years of medical students [11]. The age, marital status, locality and total family income did not significantly affect the prevalence of anxiety and depression [11]. It was concluded that medical students has a high prevalence of psychiatric morbidity comprising of anxiety and depression [11].
A cross sectional study was conducted among medical students of Foundation University
with mild depression, moderate to severe depression was observed in 14%. About 19 % of the students expressed to have moderate to severe anxiety [12]. Students from second year were more significantly related to depression and anxiety [12]. Female medical students have higher association with depression in their final years [12]. In this study it was concluded that high psychiatric morbidity was found needs to be detected early otherwise it can lead to serious consequences such as suicide and burnouts [12].
A cross sectional study was conducted to asses the symptoms of depression, anxiety and stress among medical students of Alfaisal University in Riyad, Saudi Arabia [13]. A total of 575 medical
students across the 5 years of study participated by answering self administered questionnaires made from Depression, anxiety and stress scale- 21 (DASS-21) anonymously twice [13]. Firstly it was answered 2-3 weeks before a major examination and secondly during regular classes (post-examination). A total of 76,8% and 74,9 % of students were participated in pre and post examination groups, respectively [13]. The prevalence of depression, anxiety and stress was high (43 %, 63%, 41% respectively) during pre examinations and was reduced to some extent after examinations (30%, 47%, 30%, respectively) [13]. Female students and smoking students showed higher levels of depression, anxiety and stress [13]. It was concluded in this study that the students had higher levels of depression, anxiety and stress if an
examination was near, as well as smoking and female sex had higher levels of depression, anxiety or stress [13]. Students suggested that study burden and a busy schedule was the major reason for their high DASS-21 score [13].
A cross sectional study was performed in a sample of 750 students; 512 medical students and 238 non-medical students [15]. The aim of this research was to evaluate the prevalence of anxiety and
depressive symptoms in Portuguese medical students compared to students of other faculties and the possible impact these symptoms will have on their academic performance [15]. All students were answering anonymously a socio-demographic survey and the Hospital anxiety and depression scale (HADS) [15]. The results showed that 21,5 % (n=161) were experiencing anxiety symptoms and 3,7 % (n=28) for depressive symptoms [15]. Medical students were significantly more associated with symptoms of anxiety compared with other students [15]. Poor academic performances were slightly associated with depressive symptoms [15]. It was concluded that high levels of anxiety symptoms and the possible impact of depressive symptoms in academic performance and the lack of psychiatric or psychological follow up report, it is urgent to develop support for the students to improve their well being and mental health [15].
In this research a cross sectional study was carried out in four state medical schools in four different regions in Cameroon, from December 2015 to January 2016 [16]. The aim of this study was to determine the prevalence and predisposing factors associated with depression among medical students in Cameroon and to evaluate the impact of depression on self-reported academic performance. To evaluate depression, major depression and its associated factor the 9-Item-Patient Heath Questionnaire (PHQ-9) and a structured questionnaire was used [16]. A total of 618 medical students were included (response rate: 90,4%). About one third of them were found to have major depressive disorder (30,6%) [16]. With the regards to the severity of depression, 214 (34,6%), 163(26,4%), 21 (3,4%) and 5 (0,80%) students were classified as having mild, moderate, moderately severe, and severe depression respectively [16]. There was no association between depression and self-reported academic performance [16]. It was concluded in this research that the prevalence of major depressive disorder among medical students in Cameroon is high and despite the high levels of major depression among medical students there was no association with self-report academic performance [16].
students. It was shown that students with age less or equal to 21 years were showed to have higher mental distress [17]. In this research it was shown that being a pre-medicine students, perceiving medical school as stressful, perceiving living environment as very crowdy and having a feeling of insecurity about ones safety had statistically significant association with mental distress [17]. In this study it was concluded that one-third of medical students were found to have mental distress and that developing prevention and treatment programs to address relevant factors is very important [17].
A cross sectional study was conducted of medical students in Trinidad and Tobago, the southernmost Caribbean island [18]. The aim of this study was to evaluate the prevalence of stress, burnout and depressive symptoms and associated risk factors among medical students [18]. Information was collected using standardized questionnaires that assess stress, burnout and depressive symptoms [18]. A total of 450 questionnaires were distributed and 381 completed responses were obtained (response rate 85%) [18]. The results demonstrated high levels of stress and a significant prevalence of burnout (52%) as well as depressive symptoms (40%) [18]. It was shown that final years students had higher levels of burnout and depressive symptoms. Medical students that felt that they lacked emotional support, had little time for relaxation and exercise and did not feel that they had control of their daily schedule all were associated with higher levels of burnout and depressive symptoms [18]. Students that practice from a high base and considered their religion important demonstrated lower levels of both [18]. It was concluded in this research that medical students in Trinidad and Tobago are experiencing higher level of stress with a large proportion suffering from burnout and depressive symptoms [18]. This suggests that immediate interventions are necessary to help students to cope with their difficulties that they are challenging during their medical studies [18].
METHODOLOGY
The research was conducted at the Lithuanian University of Health Sciences (LUHS). This study is a cross-sectional survey that was carried out during the period November 1st, 2018 to January 9th, 2019
amongst international medical students of LUHS. The research permit was issued by Kaunas regional biomedical research ethics Committee (No BEC-MF-25).
responded and gave back the questionnaires. Sample size is therefore 100 international medical students from all years.
The research data were collected by handing out questionnaires to international medical students at classes and in the dormitory of LUHS. The participants were explained to that they had all the time needed to answer the questionnaires and that participating in the study was optional.
The socio-demographic questionnaire consisted of general questions regarding gender, age, year of studies, relationship status and nationality. The age of the respondents was divided into the following groups: 17-21 years old and >22 years old. The question about their year of studies, the participants could chose from first year medicine until sixth year medicine. The respondents relationship status could be answers from one of the following 2 replies: ‘single’ or ‘in a relationship/married’. In response to the respondents nationality the participants could chose one out of 4 options: ‘Asian, ‘European’, ‘Middle East’ or ‘African’.
There were 2 different scales with two different questionnaires used within this research.
One of the scales was BDI (Becks depression inventory, which is used to assess the severity of depression symptoms. The second scale was BAI (Becks anxiety inventory), which is used to assess the severity of anxiety symptoms. BDI is a multiple-choice self-report inventory consisting of 21 questions, each answer is being scored on a value from 0-3. These questions are composed of items related to different symptoms of depression such as irritability and hopelessness, feelings of being punished or guilt, physical symptoms such as fatigue, change in sleep pattern and lack of sex interest. Afterwards the answers are being summed up into lower and high scores. Higher total score indicates more severe depressive symptoms.
Lower score in depressive symptoms were set from 0-19 points, where minimal depression was scored between 0-13 and mild depression 14-19. Higher scores in depressive symptoms were from 20-63 points according to BDI. Where from 20-28 were set as moderate depression and from 29-63 points was assessed as severe depression according to BDI.
Statistical analyses were conducted with the SPSS version 25th version for Windows (SPSS inc.,
Chicago, IL, USA.). The collected data was analysed by assessing the severity of anxiety and depression symptoms and its correlation with socio-demographic findings.
Chi square test was conducted to analyze categorical data. Statistically significant differences were established when p-value was <0.05.
RESULTS AND THEIR DISCUSSION:
There were a total of 100 medical students from LUHS that responded to the questionnaires, 50 (50%) of which were male students and 50 (50 %) female students. The participants where divided into 2 age groups: 17-21 years and 22+, where 29 (29%) students were between17-21 years old and 71 (71 %) students were 22+ years old. Medical faculty has a 6-years programme. The students participating in this study were from all the years, where 1st year medical students was 11 (11%), 2nd year was 16 (16%), from
3rd year 18 (18%), 4th year there was 11 (11%) students, 5th year 22 (22%) and from 6th year there was 22
(22%) students. 54 (54%) students answered that they were single whereas 46 (46%) students answered that they were either married or in a relationship. Most of the students came from Europe with a total of 50 (50%). From Middle East there where 25 (25%) students. There were 15 (15%) students from Asia and 10 (10%) students from Africa that are studying in LUHS. Complete results of socio-demographics
characteristics are presented in table 1.
Table 1: Socio-demographics characteristics of participants.
4 5 6 11 (11%) 22 (22%) 22 (22%) Status Single Relationship, married. 54 (54%) 46 (46%) Nationality Europe Africa Middle east Asia 50 (50%) 10 (10%) 25 (25%) 15 (15%)
In table 2 the results are presented from the questionnaires concerning depressive symptom severity. There were a total of 100 students, where 50 (50%) students are female and 50 (50%) students are male. For all the students (n=100) the results showed that 64 (64%) were not suffering from depressive symptoms and 36 % (n=36) had depressive symptoms. Amongst the students with reported depressive symptom 17 (17%) students was meeting the criteria for mild depression, 11(11%) with moderate depression and a total of 8 (%) students with severe depression. The result shows that amongst female there are 25 (50%) students with depressive symptoms where 9 (18%) students were meeting the criteria’s for mild depression, 10 (20%) with moderate depression and 6 (12%) female students with severe
depression. This was Statistically significant (p<0.05). The result amongst male students shows that 11% (11%) were experiencing depressive symptoms. Amongst them 8 (16%) students were assessed to have mild depression, 1 (2%) with moderate depression and 2 (4%) students with severe depression. This was Statistically significant (p<0.05).
The evaluation of the obtained results are that international medical students of LUHS mostly suffering with minimal depression. Female students are suffering more from mild, moderate and severe depression than what the male students are.
Amongst male students they are mostly experiencing minimal and mild depression whereas female students are mostly suffering from minimal and moderate depression.
to feel these depressive symptoms and to prevent these symptoms to progress into a more severe depression.
Table 2: Distribution of depression symptom severity among based on score range from the BDI scale, among gender of the students.
Students Male n (%) Students Female n (%) Total students n (%) No depression 39 (78%) 25 (50%) 64 (64%) Mild depression 8 (16%) 9 (18%) 17 (17%) Moderate Depression 1 (2%) 10 (20%) 11 (11%) Severe depression 2 (4%) 6 (12%) 8 (8%) Total (n) 50 (100%) 50 (100%) 100 (100%) p-value 0,006
In table 3 it is reported that 62 (62%) medical students are suffering with mild anxiety, 34 (34%) with moderate anxiety and a total of 4 (4%) students with severe anxiety. Amongst the female medical students it was shown that 22 (44%) students are experiencing mild anxiety, 25 (50%) with moderate anxiety and 3 (6%) with severe anxiety, that was statistically significant (p<0.05). The result for the male students showed that 40 (80%) students have mild anxiety, 9 (18%) with moderate anxiety and 1 (2%) student with severe anxiety that was statistically significant (p<0.05). It is shown that out of all the students the majority are mostly suffering with mild anxiety (62%). Male students are experiencing more of mild anxiety (n=40, 80%) and female students are suffering more of moderate anxiety (n=25, 50%).
whether it’s mild moderate or severe. There should be a lot of effort put into helping these students to cope with that is causing them to feel these anxiety symptoms.
Table 3: Distribution of anxiety symptom severity among based on score range from the BAI scale, among gender of the students.
Students Male n (%) Students Female n (%) Total students n (%) Mild anxiety 40 (80%) 22 (44%) 62 (62%) Moderate anxiety 9 (16%) 25 (50%) 34 (34%) Severe anxiety 1 (2%) 3 (6%) 4 (4%) Total (n) 50 (100% 50 (100%) 100 (100%) P-value 0.001
When answering the questionnaire the students had 2 options to choose from when it came to their age, one of the options was 17-21 years and second option was 22+ years. There were 29 (29%) medical students with the age of 17-21 and 71 (71%) students with the age 22 and more. There were 64 (64%) medical students that were reported with no depressive symptoms, 17 (17%) with mild depression, 11 (11%) students with moderate depression and 8 (8%) students with severe depression. In table 4 the results amongst age group 17-21 years are reported to have 19 (65%) medical students with no depressive symptoms, 5 (17%) students with mild depression, 4 (14%) students with moderate depression and 1 (4%) student with severe depression. For the age group 22+ years there are 45 (63%) students with no
depression, 12 (15%) with mild depression, 7 (24%) with moderate depression and 7 (%) with severe depressive symptoms. There was no statistical significance between the groups.
Table 4: Distribution of depression symptom severity among based on score range from the BDI scale, among age group of the students.
Age group 17-21 n (%)
Age group 22+ n (%) Total students n (%)
None 19 (65%) 45 (63%) 64 (64%)
Mild depression 5 (17%) 12 (15%) 17 (17%)
Severe depression 1 (4%) 7 (8%) 8 (8%)
Total (n) 29 (100%) 71 (100%) 100 (100%)
P-value 0.714
In total there were 62 (62%) medical students with mild anxiety, 34 (34%) with moderate anxiety and 4 (4%) students with severe anxiety. Looking at table 5 it is shown that amongst students from age group 17-21 years there was 19 (65%) medical students with mild anxiety, 9 (31%) with moderate anxiety and 1 (4%) student with severe anxiety. Medical students from the age 22 and more where in total 71 students where they have 43 (60%) students with mild anxiety, 25 (35%) with moderate anxiety, and 3 (5%) students with severe anxiety. There is no statistical significance between the groups.
Table 5: Distribution of depression symptom severity among based on score range from the BAI scale, among age group of the students.
Age group 17-21 n (%)
Age group 22+ n (%) Total students n (%) Mild anxiety 19 (65%) 43 (60%) 62 (62%) Moderate anxiety 9 (31%) 25 (35%) 34 (34%) Severe anxiety 1 (4%) 3 (5%) 4 (4%) Total (n) 29 (100%) 71 (100%) 100 (100%) P-value 0.897
The sample of students from each year of studies was somewhat the same amount in each year. In first year there were 6 (55%) students out of 11 (11%) students that were reported to have no symptoms of depression. There were 2 (18%) students meeting the criteria’s of mild depression, 2 (18%) with moderate depression and 1 (9%) student with severe depression. For 2nd year students there were a total of 16
students (16%) where 11 (69%) of them did not have any depression, 4 (25%) had mild depression, 1 (6%) with moderate and no student with severe depression. 3rd students was a total of 18 students where
10 (56%) of them reported to have no symptoms of depression, 5 (28%) had mild depression, 2 (11%) with moderate depression and 1 (5%) student with severe depression. Looking at 4th year students there
was in this study were of a total of 22 (22%) where it was reported that 15 (67%) had no depression, 3 (14%) was with mild depression, 3 (14%) with moderate depression and 1 (5%) with severe depression. The last years of studies (6th year) there were also 22 (22%) students, 16 (72%) with no depression, 1 (5%)
with mild depression, 2 (9%) with moderate depression and 3 (14%) with severe depression. There was no statistically difference between the groups, p= 0.817.
Table 6: Distribution of depression symptom severity among based on score range from the BDI scale, among study year of the students.
1st year n (%) 2nd year n (%) 3rd year n (%) 4th year n (%) 5th year n (%) 6th year n (%) Total students n (%) None 6 (55%) 11 (69%) 10 (56%) 6 (55%) 15 (67%) 16 (72%) 64 (64%) Mild depression 2 (18%) 4 (25%) 5 (28%) 2 (18%) 3 (14%) 1 (5%) 17 (17%) Moderate depression 2 (18%) 1 (6%) 2 (11%) 1 (9%) 3 (14%) 2 (9%) 11 (11%) Severe depression 1 (9%) 0 (0%) 1 (5%) 2 (18%) 1 (5%) 3 (14%) 8 (8%) Total: 11 (100%) 16 (100%) 18 (100%) 11 (100%) 22 (100%) 22 (100%) 100 (100%) P-value: 0,817
As mentioned previously there are a total of 100 medical students that participated and amongst them are 11 (11%) from 1st year, 16 (16%) from 2nd year, 18 (18%) from 3rd year, 11 (11%) from 4th year,
22 (22%) from 5th year and lastly 22 (22%) from 6th year of studies. In table 7 are the results from the
assessment of the severity of the symptoms of anxiety amongst students from different years of studies. 1st
year students have 7 (64%) students that meet the criteria for mild anxiety, 4 (4%) students of moderate anxiety and no students with severe anxiety. For 2nd year students there are 8 (50%) with mild anxiety, 8
(50%) with moderate anxiety and also here are no student with severe anxiety. In 3rd years of studies there
anxiety. For 4th year students there were 6 (55%) students with mild anxiety, 4 (36%) with moderate
anxiety and 1 (9%) with severe anxiety. 5th year students have 16 (73%) participants with mild anxiety, 6
(27%) with moderate anxiety and no students with severe anxiety symptoms. Lastly 6th year students have
as well 16 (73%) students with mild anxiety, 4 (18%) with moderate anxiety and 2 (9%) students with severe anxiety. There is no statistically significance between the different groups, p=0.472.
Table 7: Distribution of depression symptom severity among based on score range from the BAI scale, among study year of the students. (Table 7)
1st year n (%) 2nd year n (%) 3rd year n (%) 4th year n (%) 5th year n (%) 6th year n (%) Total students n (%) Mild anxiety 7 (64%) 8 (50%) 9 (50%) 6 (55%) 16 (73%) 16 (73%) 62 (62%) Moderate anxiety 4 (36%) 8 (50%) 8 (44%) 4 (36%) 6 (27%) 4 (18%) 43 (43%) Severe anxiety 0 (0%) 0 (0%) 1 (6%) 1 (9%) 0 (0%) 2 (9%) 4 (4%) Total: 11 (100%) 16 (100%) 18 (100%) 11 (100%) 22 (100%) 22 (100%) 100 (100%) P-value: 0,472
Out of a total of 100 (100%) medical students at LUHS there are 54 (54%) students that are single and 46 (46%) students that are in a relationship/married. Amongst the single medical students there were 28 (52%) reported not being depressed, 11 (20%) with mild depression, 8 (15%) with moderate depression and 7 (13%) with severe depression. Looking at the students in a relationship/married there are 36 (78%) that are not depressed, 6 (13%) students that have mild depression, 3 (7%) with moderate depression and 1 (2%) student with severe depression. The prevalence of depression amongst medical students is not so high and comparing single students with the ones in a relationship the number is higher amongst the single medical students. There are 20 % single students that meet the criteria for mild
relationship/married have 6 % that meets the criteria of mild depression and 7% for moderate depression. Showing that being in a relationship/married reduces the prevalence of having symptoms of depression compared to being single. There is a statistical significance between the groups, p<0.05 (Results are
presented in table 8).
Table 8: Distribution of depression symptom severity among based on score range from the BDI scale, among relationship status of the students.
Single In relationship/married Total None 28 (52%) 36 (78%) 64 (64%) Mild depression 11 (20%) 6 (13%) 17 (17%) Moderate depression 8 (15%) 3 (7%) 11 (11%) Severe depression 7 (13%) 1 (2%) 8 (8%) Total 54 (100%) 46 (100%) 100 (100%) P-value: 0.034
Looking at table 9 there are 54 single students and amongst them there are 31 (57%) students that are experiencing mild anxiety, 20 (37%) students with moderate anxiety and 3 (6%) with severe anxiety. The ones in a relationship/married there are a total of 46 medical students that were reported to have 31 (67%) students with mild anxiety, 14 (30) with moderate anxiety and 1 (3%) student with severe anxiety. There is no statistically significance between the groups.
Table 9: Distribution of depression symptom severity among based on score range from the BAI scale, among relationship status of the students.
In table 10 the results for the student’s nationality and the severity of depression are presented. There are 50 (50%) medical students from Europe out of a total 100 (100%) students participating in this study. Amongst them there are 30 (60%) students with no depression, 12 (24%) with mild depression, 4 (8%) with moderate and 4 (8%) with severe depressed symptoms. There are 10 (10%) African students and between them there are 7 (70%) students with no depression, 1 (19%) with mild depression, 1 (10%) with moderate depression and 1 (10%) student with severe depression. There are 25 (25%) students from Middle East participating with a number of 15 (60%) students reported to have no depression, 3 (12%) with mild depression, 5 (20%) with moderate depression and 2 (8%) with severe depression. There are 15 (15%) Asian medical students and between them there are 12 (79%) with no depression, 1 (7%) with mild depression, 1 (7%) with moderate depression, and 1 (7%) student with severe. There is no statistical significance between the different groups.
Table 10: Distribution of depression symptom severity among based on score range from the BDI scale, among nationality of the students.
Europe Africa Middle eat Asia Total
None 30 (60%) 7 (70%) 15 (60%) 12 (79%) 64 Mild depression 12 (24%) 1 (10%) 3 (12%) 1 (7%) 17 Moderate depression 4 (8%) 1 (10%) 5 (20%) 1 (7%) 11 Severe depression 4 (8%) 1 (10%) 2 (8%) 1 (7%) 8 Total 50 10 (100%) 25 (100%) 15 (100%) 100 p-value: 0,691
(28%) with moderate anxiety and 1 (4%) with severe anxiety. Medical students from Asia have 6 (40%) with mild anxiety, 8 (53%) with moderate anxiety and 1 (7%) with severe anxiety. The severity of anxiety is almost the same when looking at the student’s different nationality. The severity of their anxiety is not correlated to what the student’s nationality is. There is no statistical significance between the groups.
Table 11: Distribution of depression symptom severity among based on score range from the BAI scale, among nationality of the students.
Europe Africa Middle eat Asia Total
Mild anxiety 33 (66%) 6 (60%) 17 (68%) 6 (40%) 62 Moderate anxiety 16 (32%) 3 (30%) 7 (28%) 8 (53%) 34 Severe anxiety 1 (2%) 1 (10%) 1 (4%) 1 (7%) 4 Total 50 (100%) 10 (100%) 25 (100%) 15 (100%) 100 p-value: 0,526
Common symptoms of Anxiety
Some of the symptoms that the students were asked to answer when it came to assessing their anxiety severity are presented in table 12. These symptoms were taken from Beck anxiety inventory. The symptoms that contributed the most to their anxiety were; “unable to relax”, “fear of worst happening” and “nervous”. Around 20 % of the total students participating were experiencing the mentioned
Table 12: Investigation of common anxiety symptom severity experienced by international medical students at LUHS.
Not at all Mildly Moderately Severely Total
Numbness/tingling 61 22 14 3 100 Feeling Hot 46 26 20 8 100 Wobbliness in legs 57 29 12 2 100 Unable to relax 20 32 28 20 100 Fear of worst happening 24 26 26 24 100 Dizzy/lightheaded 51 31 15 3 100 Heart pounding/racing 34 30 27 9 100 Unsteady 46 36 17 1 100 Terrified or afraid 39 32 20 9 100 Nervous12 12 31 34 23 100 Feeling of choking 74 15 7 4 100 Hands trembling 55 27 10 8 100 Shaky/unsteady 60 25 11 4 100 Fear of losing control 56 21 15 8 100 Difficulty of breathing 62 23 12 3 100 Fear of dying 80 12 4 4 100 Scared 51 25 20 4 100 Indigestion 54 23 18 5 100 Faint/lightheaded 70 17 7 6 100 Face flushed 76 11 11 2 100 Hot/cold sweats 54 23 11 12 100
inventory scale. There were a total of 21 statements that the students got to choose how they were feeling about each statement. There were some statements that contributed to the high scores when assessing the depression symptom severity. Some of these statements were: “I don’t enjoy things as much as I used to” , “I feel guilty over many things I have done/should have done” I am more critical of myself than I used to be”, “I am less interested in other people or things than before”, “I have less energy than I used to have”, “I sleep somewhat less/more than usual”, “I get more tired or fatigued more easily than usual”. Around 35 % out of a total of 100 medical students answered to feel as the mentioned statements above. This shows that students have developed negative emotions since they came to Lithuania to study medicine. Some of the reasons can be that they have left their families and friend to move to a new country where they don’t know the language or the culture there. It can be because the study of medicine are tuff and demands a lot of effort to pass the exams. There can be a lot of reasons that can be the cause of students to feel these negative emotions. This is why it is important to help students that come from abroad to adjust as good as possible into their new environment. As seen in table 13 there is a high number of students experiencing some kind of negative emotions showing that there should be support and guidance offered to them.
Table 13: Assessing common statements of depression amongst medical students at LUHS.
Sadness: “I Don’t feel sad” “I Feel sad much of the time” “I am sad much of the time” “ I am so sad or unhappy that I cant stand it” Total n (%) 61 26 12 1 100 Pessimism: I am not discouraged about my future. I feel more discouraged about my future that I used to be I do not expect things to work out for me I feel my future is hopeless and will only get worse
n (%) 66 25 8 1 100
Loss of pleasure:
I get as much pleasure as I ever did from the things I enjoy I don’t enjoy things as much as I used to I get very little pleasure from the things I used to enjoy
I cant get any pleasure from the things I used to enjoy
n (%) 57 34 7 2 100
Guilty feelings I don’t feel particularly guilty I feel guilty over many things I have done/should have done I feel quite guilty most of the time I feel guilty all of the time
n (%) 56 32 10 2 100 Punishment feelings I don’t feel I am being punished I feel I may be punished I expect to be punished I feel I am being punished n (%) 72 16 6 6 100
Self- dislike I feel the same about myself as ever I have lost confidence in myself I am disappointed in myself I dislike myself n (%) 60 25 11 4 100 Self criticalness I don’t criticize/blame myself more than usual I am more critical of myself than I used to be I criticise myself for all my faults I blame myself for everything bad that happens n (%) 43 37 15 5 100 Suicidal thoughts or whishes
n (%) 83 15 1 1 100 Crying I don’t cry
anymore than I used to do I cry more than I used to I cry over every little I feel like crying but I cant n (%) 67 19 5 9 100 Agitation I am no more restless or wound up than usual I feel more restless or wound up than usual I am so restless or agitated that its hard to stay still I am so restless or agitated that I have to keep moving or doing something n (%) 67 23 7 3 100
Loss of interest I have not lost interest in other people/activities I am less interested in other people or things than before I have lost most of my interest in other people or things It is hard to get interested in anything n (%) 52 33 12 3 100
Indecisiveness I make decisions about as well as ever I find it more difficult to make decision than usual I have much greater difficulty in making decisions than I used to I have trouble making any decisions n (%) 65 25 7 3 100
n (%) 77 13 9 1 100 Loss of energy I have as much
energy as ever I have less energy than I used to have I don’t have enough energy to do very much I don’t have enough energy to do anything n (%) 49 34 13 4 Changes in sleeping pattern I have not experienced any change in my sleeping pattern I sleep somewhat less/more than usual I sleep a lot/less than usual I wake up 1-2 hours ealy and cant get back to sleep n (%) 36 37 16 11 100 Irritability I am no more irritable than usual I am more irritable than usual I am much more irritable than usual I am irritable all the time
n (%) 59 27 12 2 100 Changes in my appetite I have not experienced any changes in my appetite My appetite is somewhat less/more than usual My appetite is much less/more than usual I crave food all the time
58 58 18 17 7 100 Concentration difficulty I can concentrate as well as ever I cant concentrate as well as usual Its hard to keep my mind on anything for very long
I find I cant concentrate on anything n (%) 55 28 12 5 100 Tiredness or fatigue I am no more tired or fatigued than usual I get more tired or fatigued more easily than usual I am too tired or fatigue to do a lot of the things I used to do I am too tired or fatigued to do most of the things I used to do n (%) 42 46 7 5 100
in sex any recent change in my interest in sex
interested in sex than used to be
interest in sex completely
had sex
n (%) 65 14 3 18 100
In this research it was found that 36 % of medical students out of a study sample of 100 students at LUHS were suffering from depressive symptoms. Out of these 100 medical students 17 % were
meeting the criteria of mild depression, 11 % had moderate depression and 8% with severe depression. Amongst female students (n=50) there were 50 % students with depressive symptoms, 18 % with mild depression, 20% with moderate depression and 12% students with severe depression. For male students (n=50) there were 11 % experiencing depressive symptoms whereas 16 % with mild depression, 2% with moderate depression and 4 % with severe depression. It was also found that 62% of the students are suffering from mild anxiety, 34% with moderate anxiety and 4% students with severe anxiety. Amongst female students (n=50) there was 44% with mild anxiety, 50% with moderate and 6% with severe anxiety. For male students (n=50) there was 80% with mild anxiety, 18% with moderate anxiety and 2% with severe anxiety. There was a statistical significance between these groups. Similar results were found in a cross sectional study found in Bahrain [4]. In that study the prevalence of depressive symptoms amongst students were 40% and amongst them 18,9% (n=54) was experiencing mild depressive symptoms, 13% (n=40) was moderate and 8,5 % (n=26) was experiencing severe depressive symptoms [4]. It was also found that female gender was more associated to having depressive symptoms as for in this study [4]. In the same study it was found that 51% (n=158) students were suffering from anxiety symptom and these symptoms were mostly associated with the female gender, which is a similar finding to this current research [4]. In another cross sectional study conducted in Nepal there were similar results as to this current research [5). It was found that the prevalence of depression was 29,9% and anxiety was 41,15 amongst their students participating showing that depression and anxiety symptoms are a common condition amongst students [5]. It was also seen in a cross sectional study in India that 51,1 % of medical students were affected by depression and 66,9% by anxiety and amongst these students female were reported to have higher score when compared to male students [6]. In other studies it was also reported that female students were experiencing depression and anxiety symptom more than male students [10-12].
their depressive and anxiety symptoms severity. Other results have been obtain in a study conducted in Malaysia where it was found that both depression an anxiety were significantly higher amongst older students (>20 years of age) which was not a finding in this current study [8]. This can be due to the study sample being small and needs more participants to get a more accurate result. In this research the study sample was 100 medical students whereas the study in Malaysia had a study sample of 506 medical students. There was no statistical significance between the study years of the students and their depressive/anxiety symptom severity.
There is a statistical significance between the relationships groups and their depressive/anxiety symptom severity meaning that students in a relationship/married has a lower depressive symptoms severity compared to medical students that are single. This shows that being in a relationship/married gives a significant comfort to the people in the relationship that can prevent some of the depressive symptoms to develop compared to if the student was single and alone. There is no statistical significance between the different nationalities of the students and their depressive and anxiety symptoms.
CONCLUSION:
Evaluating the socio-demographic characteristics of the international medical students of LUHS, out of a study sample of students, most common picture of an international medical student was a female/male person from Europe. Is single with an age of 22+ years olds.
1/3 of international medical students at LUHS were reported to suffer from depressive symptoms. Most of them were meeting the criteria for mild depression. Single medical students are suffering more from depressive symptoms then
students that are in a relationship/married.
PRACTICAL RECOMMEDATIONS:
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