Next Article in Journal
Experiences of Preconception Counseling among Pregnant Women with Preexisting Diabetes: Opportunities to Improve Patient-Centered Care
Next Article in Special Issue
How Does Organizational Toxicity Affect Depression? A Moderated Mediation Model
Previous Article in Journal
The Value of Recreational Physical Activity in Aotearoa New Zealand: A Scoping Review of Evidence and Implications for Social Value Measurement
Previous Article in Special Issue
Factors Determining the Mood and Emotions of Nurses Working in Pediatric Wards—A Pilot Study
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
IJERPH
Volume 20
Issue 4
10.3390/ijerph20042907
ijerph-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Prevalence and Factors Associated with Anxiety and Depression in Peruvian Medical Students

by
Jorge L. Piscoya-Tenorio
1,
Walter V. Heredia-Rioja
1,
Noelia Morocho-Alburqueque
2,
Sandra Zeña-Ñañez
3,*,
Palmer J. Hernández-Yépez
4,
Cristian Díaz-Vélez
5,6,
Virgilo E. Failoc-Rojas
7,* and
Mario J. Valladares-Garrido
4,8,*
1
School of Medicine, Universidad Nacional Pedro Ruiz Gallo, Lambayeque 14013, Peru
2
Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Piura (SOCIEMUNP), Piura 20007, Peru
3
School of Medicine, Universidad Continental, Lima 15046, Peru
4
South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima 15046, Peru
5
School of Medicine, Universidad Privada Antenor Orrego, Trujillo 13008, Peru
6
Hospital Nacional Almanzor Aguinaga Asenjo, EsSalud, Chiclayo 14001, Peru
7
Unidad de Investigación para Generación y Síntesis de Evidencia en Salud, Universidad San Ignacio de Loyola, Lima 15024, Peru
8
Oficina de Epidemiología, Hospital Regional Lambayeque, Chiclayo 14012, Peru
*
Authors to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2023, 20(4), 2907; https://doi.org/10.3390/ijerph20042907
Submission received: 22 November 2022 / Revised: 1 January 2023 / Accepted: 13 January 2023 / Published: 7 February 2023
(This article belongs to the Special Issue Development of Stress, Burnout and Occupational Hygiene)
Versions Notes

Abstract

:
During medical training, students are exposed to stressors that deteriorate mental health. This study determined depression and anxiety prevalence and their associated factors in students from four medical schools in northern Peru. A cross-sectional study was conducted among medical students from Lambayeque, Peru. The Goldberg Anxiety and Zung Depression tests were applied. The dependent variables were depression and anxiety, and their association with covariates (age, sex, type of university, socioeconomic level, experience, family problem, and physical activity) was evaluated. Prevalence ratios were calculated using generalized linear models. Of 482 students, the prevalence of anxiety was 61.8% and depression was 22.0%. A severe level of anxiety was observed in 6.2% in the group between 16 and 20 years old. It was observed that private university students had higher frequencies of having depression (PR = 2.01) and anxiety (PR = 1.35); males had a lower risk of anxiety (PR = 0.82), but higher risk of depression compared to females (PR = 1.45). Performing physical activity decreased the prevalence of depression (PR = 0.53); however, it increased the frequency of anxiety (PR = 1.26). Having family problems increased the prevalence of anxiety (PR = 1.26). Medical students from private universities experienced higher rates of depression and anxiety. Depression and anxiety were associated with gender and physical activity. These findings highlight the importance of mental health promotion due to its link with quality of life and academic performance.

1. Introduction

Medical students are exposed to various stressors, which deteriorates their mental health within medical training [1,2,3]. The global prevalence of symptoms of anxiety and depression in health science students is high. Around 30% of students experience some form of mental disorder [4,5,6,7]. However, these figures could be higher and more heterogeneous in Latin American countries [8], including Peru, where a prevalence higher than 60% has been reported [9,10,11,12]. These high estimates are attributed to various intrinsic and extrinsic factors [13]. In this context, several studies have demonstrated the existence of risk factors, such as female sex [14], academic overload [15], socio-economic level [1,5], and protective factors such as year of study [16], spirituality [17], motivation [2], resilience, and other coping strategies [15].
Although there is evidence in this regard, some limitations can be recognized in the literature. In addition to the inherent subjective bias resulting from the “self-reported” nature of data collection [13], the cross-sectional design of many studies limits their ability to establish causality between variables [13,15]. On the other hand, some investigations have been conducted with a small sample of students from a single educational center [14,18]. Likewise, there are some factors that have been little explored [5], such as family history, physical activity, mode of living, and year of study. This study seeks to investigate these little-explored variables, including a larger sample of medical students and enhancing the identification of the study population variability using a multicenter approach.
This study determined depression and anxiety prevalence and their associated factors in students from four medical schools in northern Peru.

2. Materials and Methods

2.1. Study Design

A cross-sectional multicenter study was conducted in medical students during September–November 2019.

2.2. Population and Sample

The population consisted of medical students from 4 universities in the Lambayeque region, located in northern Peru. The target population was all medical students of the 4 universities, which was 5800, based on the students enrolled during the semester in which the study was conducted. OpenEpi v.3.01 was used to determine the sample size, estimating a 60% expected proportion by background, an absolute precision of 5%, a confidence level of 95%, and a design effect of 1.3 (due to stratification of universities), resulting in a minimum sample size of 451 students. A random sampling was carried out in each university, reaching 482 students distributed as follows: 240 from the Universidad Nacional Pedro Ruiz Gallo, 109 from the Universidad Particular de Chiclayo, 89 from the Universidad de San Martín de Porres, and 44 from the Universidad Señor de Sipán.

2.3. Instrument

The instrument was a questionnaire that included three sections (see Supplementary Material). The first consisted of general socio-educational information, measured by self-report, such as age (years), sex (female, male), socioeconomic level (What is your socioeconomic level? Low, medium, high), type of university (public, private), people with whom the student lives (with family, alone), family problems (Did you have family problems during the last semester? No, yes), and physical activity (Do you perform physical activity? No, yes).
The second section included the Goldberg scale. This scale is useful for detecting symptoms of anxiety. This scale is composed of nine dichotomous response questions, where each affirmative response is assigned a point, and a point of ≥ 4 is considered as presence of anxiety [19]. Higher values indicate more symptom severity, with 9 points as the highest scale value. Reivan-Ortiz et al., in their study, found that the reliability determined by Cronbach’s alpha coefficient was 0.80, concluding that the scale met reliability criteria [20]. Likewise, Martin-Carbonell found sensitivity values of 71% and a specificity of 77% [21].
The last section included the Zung Self-Assessment Scale for Depression. It is a short self-assessment survey consisting of 20 questions where symptoms related to depressive episodes are explored (mood state, with two items, and cognitive and somatic symptoms, each with eight items, and two psychomotor symptoms); there are ten questions formulated in a positive way and another ten formulated in a negative way. Each question uses a four-point Likert scale, with four response options: 1 (very rarely), 2 (sometimes), 3 (frequently), and 4 (almost always). A global score of 40 or more is considered as depressive symptoms with clinical significance [22]. Novara et al. reported a reliability coefficient of 0.75 [23].

2.4. Variables

The dependent variables were depression and anxiety. Depression was defined with the Zung Self-Assessment Scale when a score of 40 or more points was obtained. Anxiety was defined with an average score ≥ 4 points from the Goldberg scale.
The independent variables were categorized as age (categorized: 16 to 20, >20), sex (female, male), type of university (public, private), economic level (low, medium, high), self-reported having family problems (no, yes), self-reported physical activity (no, yes), and living alone/accompanied

2.5. Study Procedure

The selected medical students from each university were explained the objective of the study and provided with details of the collection instrument and the time for completion, emphasizing that the survey would be anonymous and completion would be voluntary. Immediately afterwards, they were given the printed questionnaire, which they filled out in writing and individually. The data obtained were entered into the Microsoft Excel program.

2.6. Statistical Analysis

Analyses were carried out with STATA 15.0. Frequencies and percentages were reported for categorical variables. For categorical variables, Chi-square or Fischer’s exact tests were applied to estimate the association between depression and anxiety and socio-educational variables, after assessing statistical assumptions. In the simple regression analysis, generalized linear models (GLM), Poisson distribution family, log link function, and robust variance were used to investigate the factors associated with depression and anxiety. Prevalence ratios (PR) and 95% confidence intervals were estimated. We considered p values <0.05 as statistically significant.

2.7. Ethical Considerations

The study protocol was reviewed and approved by the ethics committee of the Universidad Nacional Pedro Ruiz Gallo, with file N° CIEI-FM-UNPRG-017-2019. Informed consent was provided to participants, highlighting that the study was voluntary and anonymous. Participants’ confidentiality was preserved using assigned codes.

3. Results

Table 1 shows the socio-educational characteristics of the students. A total of 482 students were surveyed. The proportion of sex was similar, and it was observed that students older than 20 years made up 60.2%. A large percentage belonged to middle socioeconomic level (86.3%) and also had family problems (64.5%).
Table 2 shows the bivariate analysis. It was observed that students in private universities had higher frequencies of having depression (29.3% vs. 14.6%) and anxiety (71.1% vs. 52.5%) compared to students in public universities; males were less likely to have anxiety (56.0% vs. 68.8%), but more likely to develop depression (25.8% vs. 17.8%) compared to females.
Table 3 shows the simple regression results. Students from private universities had higher frequencies of having depression (PR = 2.01) and anxiety (PR = 1.35); males had a lower risk of anxiety, but a higher risk of depression compared to females. Likewise, having family problems increased the probability of having anxiety by 26% with respect to those who did not have family problems (PR = 1.26, 95%CI: 1.04–1.53, p = 0.019); physical activity decreased the probability of having depression by 47% compared with individuals not performing physical activity (PR = 0.53, 95%CI: 0.34–0.81, p = 0.002).

4. Discussion

4.1. Prevalence of Mental Health Disorders

Almost one out of five students experienced depression in universities from Lambayeque. Previous studies corroborate this result [24,25,26]. This is consistent with the results of Sanchez-Marín et al. (2016), who found that 17.3% of students presented some depressive episode [27]. In Peru, 13.5% were found to have some degree of depression [28]. However, this differs from the result of Vilchez-Cornejo (2016), who reported a prevalence of depression in 32.5% of students [29]. These differences could have occurred because different measurement scales were used (Zung and DASS-21, respectively) and because they were conducted in three different departments of Peru.
Almost three out of five students experienced anxiety at universities in Lambayeque. This finding is consistent with that documented in other studies [30,31]. Likewise, Kulsoom et al. (2015) found that 63% of medical students presented anxiety [32]. However, it differs from that evidenced by Jafari et al. (2017), where 78.33% of students presented anxiety, and by Lemos et al. (2018), where the percentage was 48.3%. [33,34]. In both cases, the differences could be due to the context where the studies were conducted, Iran and Colombia, respectively.

4.2. Factors Associated with Mental Health Disorders

We found that attending a private university increases the prevalence of depression and anxiety. Previous studies reported similar results [35,36]; however, in Bangladesh [37] and Nigeria [38], it was found that students from public universities had higher estimates. The association between studying at a private university and depression and anxiety could be explained by the pressure on students to repay high payments from their parents or funders by obtaining high grades.
Students older than 20 years had a 17% lower prevalence of anxiety. Similarly, Carbonell et al. (2019) showed that lower anxiety was associated with higher student age [31]. Likewise, in Peru, students in their third or fourth year had a lower frequency of anxiety than those in early academic years [39]. However, in China, students older than 20 years had higher depression and anxiety estimates [40]. This could be because younger students, as they are finishing adolescence and beginning early adulthood, are in a period of vulnerability for the development of mental health problems, added to the process of adaptation to a medical career [41].
Male students had 45% higher prevalence of depression than female students. In contrast, males had 18% lower anxiety prevalence. Likewise, two systematic reviews showed that female students had higher anxiety levels [5] and male students had higher depression levels [1]. However, previous studies have shown opposite results [16,35], where higher levels of depression and anxiety were found in the female sex. These differences may be due to the period in which the questionnaire was taken (e.g., after exams) and to the different populations evaluated and different scales used. In Latin America, depression was also associated with being female [14] and, in Peru, female sex was associated with 1.03 times higher risk of depression, but this was not statistically significant [42].
Having family problems increases anxiety prevalence by 26%. Obregón-Morales (2020) reported a similar result, showing that having a dysfunctional family increased, by more than two times, the probability of having depression [42]. Shao et al. (2020) reported that social support and family functioning were associated with symptoms of depression and anxiety [40]. This could be explained because family social support is key to coping with depression, and dysfunctional families would not be prepared to exercise this support, which would increase depressive symptoms in students [43,44]. On the other hand, in those who lived alone, depression and anxiety levels were higher [40].
Physical activity was associated with a 47% decrease of depression prevalence. Conversely, it increases, by 26%, the prevalence of anxiety. Likewise, Carbonell et al. (2019) showed that a greater number of weekly sports hours was considered a protective factor for depression, but also for anxiety [31]. De Souza et al. (2021) reported that deficient physical activity was linked to greater symptoms of depression and anxiety [45]. However, another study [46] found no significant association between physical activity and depression or anxiety, although data were collected within the context of the COVID-19 pandemic, so other factors may have played a role. It is reported that adults should perform regular physical activity to have a lower risk of depression [47]. This is supported by the fact that exercise generates physiological changes such as increased endorphin levels and maintenance of mitochondrial function and of the neurotransmitters serotonin, dopamine, and noradrenaline, which contribute to improved mood and decreased stress [48,49,50].

4.3. Limitations and Strengths

This research has limitations. First, non-probabilistic sampling was performed, so there may be a possible selection bias. Second, some of the variables, such as family problem and physical activity, were measured by self-report, so it would not be known if the considerations were real. Third, there may be some residual confounding because covariates that could influence depression and anxiety in medical students were not explored; for example, smartphone use and its relationship with mental health outcomes [51]. Fourth, the study design limits the establishment of causality. Fifth, we applied an exploratory epidemiological approach, performing only unadjusted analysis. To perform multiple regression analysis, the type of relationship between variables should be identified through a more sophisticated theoretical model (e.g., classifying confounders and mediators by a directed acyclic graph). Therefore, we suggest performing studies with confirmatory epidemiological approaches based on the present results. Despite these limitations, the main strength of the present study lies in its quality of recognizing that there are characteristics associated with anxiety and depression among medical students in the first university years, which may guide and strengthen wellness programs related to the preservation of mental health in medical students.

5. Conclusions

Medical students from private universities experienced a higher prevalence of depression and anxiety. Depression and anxiety prevalence were associated with gender and physical activity. These findings highlight the importance of mental health promotion among medical students because it influences their quality of life and academic well-being.

Author Contributions

Conceptualization, J.L.P.-T. and W.V.H.-R.; methodology, J.L.P.-T., W.V.H.-R. and V.E.F.-R.; software, V.E.F.-R. and M.J.V.-G.; validation, J.L.P.-T., W.V.H.-R., N.M.-A., S.Z.-Ñ., P.J.H.-Y., V.E.F.-R. and M.J.V.-G.; formal analysis J.L.P.-T. and W.V.H.-R.; resources, C.D.-V.,V.E.F.-R. and M.J.V.-G.; data curation, V.E.F.-R. and M.J.V.-G.; writing—original draft preparation, J.L.P.-T., W.V.H.-R., N.M.-A., S.Z.-Ñ., P.J.H.-Y., C.D.-V., V.E.F.-R. and M.J.V.-G.; writing—review and editing, J.L.P.-T., W.V.H.-R., N.M.-A., S.Z.-Ñ., P.J.H.-Y., C.D.-V., V.E.F.-R. and M.J.V.-G.; visualization, J.L.P.-T., W.V.H.-R., N.M.-A., S.Z.-Ñ., P.J.H.-Y., C.D.-V., V.E.F.-R. and M.J.V.-G.; supervision, P.J.H.-Y. and M.J.V.-G.; project administration, J.L.P.-T., W.V.H.-R., V.E.F.-R. and M.J.V.-G.; funding acquisition, J.L.P.-T., W.V.H.-R., C.D.-V., V.E.F.-R. and M.J.V.-G. All authors have read and agreed to the published version of the manuscript.

Funding

M.J.V.-G. was supported by the Fogarty International Center of the National Institutes of Mental Health (NIMH) under Award Number D43TW009343 and the University of California Global Health Institute (UCGHI).

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Universidad Nacional Pedro Ruiz Gallo. Reference: Exp. CIEI-FM-UNPRG-017-2019.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The dataset generated and analyzed during the current study is not publicly available because the ethics committee has not provided permission/authorization to publicly share the data but are available from the corresponding author on reasonable request.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Mao, Y.; Zhang, N.; Liu, J.; Zhu, B.; He, R.; Wang, X. A systematic review of depression and anxiety in medical students in China. BMC Med. Educ. 2019, 19, 327. [Google Scholar] [CrossRef] [PubMed]
  2. Moir, F.; Yielder, J.; Sanson, J.; Chen, Y. Depression in medical students: Current insights. Adv. Med. Educ. Pract. 2018, 9, 323–333. [Google Scholar] [CrossRef] [PubMed]
  3. Mejia, C.R.; Valladares-Garrido, M.J.; Talledo-Ulfe, L.; Sánchez-Arteaga, K.; Rojas, C.; Ruiz-Arimuya, J.J. Burnout syndrome and associated factors in medical students. Multicenter study in seven schools peruvian medicine. Rev. Chil. Neuro-psiquiat. 2016, 54, 207–214. [Google Scholar] [CrossRef]
  4. Puthran, R.; Zhang, M.W.B.; Tam, W.W.; Ho, R.C. Prevalence of depression amongst medical students: A meta-analysis. Med. Educ. 2016, 50, 456–468. [Google Scholar] [CrossRef]
  5. Quek, T.T.; Tam, W.W.; Tran, B.X.; Zhang, M.; Zhang, Z.; Ho, C.S. The Global Prevalence of Anxiety among Medical Students: A Meta-Analysis. Int. J. Environ. Res. Public Health 2019, 16, 2735. [Google Scholar] [CrossRef]
  6. Ngasa, S.N.; Sama, C.B.; Dzekem, B.S.; Nforchu, K.N.; Tindong, M.; Aroke, D.; Dimala, C.A. Prevalence and factors associated with depression among medical students in Cameroon: A cross-sectional study. BMC Psychiatry 2017, 17, 216. [Google Scholar] [CrossRef]
  7. Rotenstein, L.S.; Ramos, M.A.; Torre, M.; Segal, J.B.; Peluso, M.J.; Guille, C.; Sen, S.; Mata, D.A. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation among Medical Students: A Systematic Review and Meta-Analysis. JAMA 2016, 316, 2214–2236. [Google Scholar] [CrossRef]
  8. Quezada-Canalle, M.A. Factores asociados a trastornos psicológicos en estudiantes de medicina. Rev. Fac. Med. 2017, 17, 92–101. [Google Scholar] [CrossRef]
  9. Piscoya-Tenorio, J.L.; Heredia-Rioja, W.V. Niveles de Ansiedad y Depresión en Estudiantes de Medicina de Universidades de Lambayeque 2018. Tesis de Grado, Universidad Nacional Pedro Ruiz Gallo, Lambayeque, Peru, 2018. [Google Scholar]
  10. Pisconte-Ato, C.E. Depresión y Trastornos de Ansiedad en Internos de Medicina de dos Hospitales del Norte del Perú—2018. Tesis de Grado, Universidad Nacional de Piura, Piura, Peru, 2018. [Google Scholar]
  11. Aveiro-Róbalo, T.R.; Garlisí-Torales, L.D.; Chumán-Sánchez, M.; Pereira-Victorio, C.J.; Huaman-García, M.; Failoc-Rojas, V.E.; Valladares-Garrido, M.J. Prevalence and Associated Factors of Depression, Anxiety, and Stress in University Students in Paraguay during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health 2022, 19, 12930. [Google Scholar] [CrossRef]
  12. Hernández-Yépez, P.J.; Muñoz-Pino, C.O.; Ayala-Laurel, V.; Contreras-Carmona, P.J.; Inga-Berrospi, F.; Vera-Ponce, V.J.; Failoc-Rojas, V.E.; Pereira-Victorio, C.J.; Valladares-Garrido, M.J. Factors Associated with Anxiety, Depression, and Stress in Peruvian University Students during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health 2022, 19, 14591. [Google Scholar] [CrossRef]
  13. Shawahna, R.; Hattab, S.; Al-Shafei, R.; Tab’ouni, M. Prevalence and factors associated with depressive and anxiety symptoms among Palestinian medical students. BMC Psychiatry 2020, 20, 244. [Google Scholar] [CrossRef] [PubMed]
  14. Moutinho, I.L.D.; Maddalena, N.C.P.; Roland, R.K.; Lucchetti, A.L.G.; Tibiriçá, S.H.C.; Ezequiel, O.d.S.; Lucchetti, G. Depression, stress and anxiety in medical students: A cross-sectional comparison between students from different semesters. Rev. Assoc. Médica Bras. 2017, 63, 21–28. [Google Scholar] [CrossRef] [PubMed]
  15. Romo-Nava, F.; Bobadilla-Espinosa, R.I.; Tafoya, S.A.; Guízar-Sánchez, D.P.; Gutiérrez, J.R.; Carriedo, P.; Heinze, G. Major depressive disorder in Mexican medical students and associated factors: A focus on current and past abuse experiences. J. Affect. Disord. 2019, 245, 834–840. [Google Scholar] [CrossRef] [PubMed]
  16. Mahroon, Z.A.; Borgan, S.M.; Kamel, C.; Maddison, W.; Royston, M.; Donnellan, C. Factors Associated with Depression and Anxiety Symptoms among Medical Students in Bahrain. Acad. Psychiatry 2018, 42, 31–40. [Google Scholar] [CrossRef] [PubMed]
  17. Wachholtz, A.; Rogoff, M. The relationship between spirituality and burnout among medical students. J. Contemp. Med. Educ. 2013, 1, 83–91. [Google Scholar] [CrossRef]
  18. Tello-Arroyo, J. Niveles de Depresión y Rendimiento Académico en Estudiantes de Medicina Humana, Universidad Nacional Pedro Ruiz Gallo, Lambayeque 2015; Universidad Nacional Pedro Ruiz Gallo: Lambayeque, Peru, 2015. [Google Scholar]
  19. Martín-Carbonell, M.; Pérez-Díaz, R.; Riquelme-Marín, A. Valor diagnóstico de la Escala de Ansiedad y Depresión de Goldberg (EAD-G) en adultos cubanos. Univ. Psychol. 2016, 15, 177–192. [Google Scholar] [CrossRef]
  20. Reivan-Ortiz, G.; Pineda-García, G.; León-Parias, B.D. Psychometric Properties of the Goldberg Anxiety and Depression Scale (GADS) in Ecuadorian Population. Int. J. Psychol. Res. 2019, 12, 41–48. [Google Scholar] [CrossRef]
  21. Martín-Carbonell, M.; Pérez-Díaz, R.; Riquelme-Marín, A. Diagnostic usefulness of Anxiety and Depression Scale Goldberg (EAD-G) in Cuban adults. Univ. Psychol. 2016, 15, 177–192. [Google Scholar] [CrossRef]
  22. Campo-Arias, A.; Díaz-Martínez, L.A.; Rueda-Jaimes, G.E.; Barros-Bermúdez, J.A. Validación de la escala de Zung para depresión en universitarias de Bucaramanga, Colombia. Rev. Colomb. Psiquiatr. 2005, 34, 54–62. [Google Scholar]
  23. Novara, J.; Sotillo, C.; Warthon, D. Estandarización y Correlación de las Escalas de Beck, Hamilton y Zung Para Depresión en Población de Lima Metropolitana; Instituto Nacional de Salud Mental: Lima, Peru, 1985. [Google Scholar]
  24. Jackson, E.R.; Shanafelt, T.D.; Hasan, O.; Satele, D.V.; Dyrbye, L.N. Burnout and Alcohol Abuse/Dependence among U.S. Medical Students. Acad. Med. J. Assoc. Am. Med. Coll. 2016, 91, 1251–1256. [Google Scholar] [CrossRef]
  25. Egúsquiza-Gorriti, L. Ansiedad, Depresión y Bajo Rendimiento Académico en Estudiantes de Medicina en una Universidad Privada. Tesis de Grado, Universidad Privada Antenor Orrego, Trujillo, Peru, 2017. [Google Scholar]
  26. Pabón, J.B.; Espinosa, J.F.S.; Correa, Y.M.; Ríos, D.A.V.; Gutiérrez, U.R. Prevalencia de Sintomatología Depresiva en estudiantes del programa de Medicina de la Universidad de Caldas, Manizales—Colombia. Rev. Médica Risaralda 2018, 24, 20–23. [Google Scholar] [CrossRef] [Green Version]
  27. Sánchez-Marín, C.; Chichón-Peralta, J.; Leon-Jimenez, F.; Alipazaga-Pérez, P. Trastornos mentales en estudiantes de medicina humana en tres universidades de Lambayeque, Perú. Rev. Neuro-Psiquiatr. 2016, 79, 197–206. [Google Scholar] [CrossRef]
  28. Vargas, M.; Talledo-Ulfe, L.; Heredia, P.; Quispe-Colquepisco, S.; Mejia, C.R. Influencia de los hábitos en la depresión del estudiante de medicina peruano: Estudio en siete departamentos. Rev. Colomb. Psiquiatr. 2018, 47, 32–36. [Google Scholar] [CrossRef] [PubMed]
  29. Vilchez-Cornejo, J.; Quiñones-Laveriano, D.; Failoc-Rojas, V.; Acevedo-Villar, T.; Larico-Calla, G.; Mucching-Toscano, S.; Torres-Roman, J.S.; Nuñez, P.A.; La Cruz, J.C.-D.; Rosario, A.H.; et al. Salud mental y calidad de sueño en estudiantes de ocho facultades de medicina humana del Perú. Rev. Chil. Neuro-Psiquiatr. 2016, 54, 272–281. [Google Scholar] [CrossRef]
  30. Espinoza-Henriquez, R.; Diaz-Mejia, E.; Quincho-Estares, Á.J.; Toro-Huamanchumo, C.J. Ansiedad y calidad de sueño en estudiantes de medicina: ¿Existe una relación con la anemia? Rev. Habanera. Cienc. Médicas 2019, 18, 942–956. [Google Scholar]
  31. Carbonell, D.; Arevalo, S.V.C.; Morales, M.; Ocampo, M.B.; Cepeda, I.L. Prevalencia de síntomas depresivos, ansiedad, estrés y factores asociados en estudiantes de medicina. Interdiscip. J. Epidemiol. Public Health 2019, 2, e-021. [Google Scholar] [CrossRef]
  32. Kulsoom, B.; Afsar, N.A. Stress, anxiety, and depression among medical students in a multiethnic setting. Neuropsychiatr. Dis. Treat. 2015, 11, 1713–1722. [Google Scholar]
  33. Jafari, P.; Nozari, F.; Ahrari, F.; Bagheri, Z. Measurement invariance of the Depression Anxiety Stress Scales-21 across medical student genders. Int. J. Med. Educ. 2017, 8, 116–122. [Google Scholar] [CrossRef]
  34. Lemos, M. Estrés y Salud Mental en Estudiantes de Medicina: Relación con Afrontamiento y Actividades Extracurriculares. Arch. Med. 2018, 14, 9. [Google Scholar]
  35. Azad, N.; Shahid, A.; Abbas, N.; Shaheen, A.; Munir, N. Anxiety and depression in medical students of a private medical college. J. Ayub. Med. Coll. Abbottabad 2017, 29, 123–127. [Google Scholar]
  36. Uzma, Z.; Seema, D.; Attiqa, K. Determinants of depression among undergraduate medical students of a private medical college in Lahore. J. Pak. Med. Assoc. 2020, 70, 467–471. [Google Scholar]
  37. Hossain, M.A.; Islam, M.; Mouly, S.S.; Nikhat, N. Depression, Anxiety and Stress among the Students and Their Academic Performance in Selected Medical Colleges of Bangladesh. Mymensingh Med. J. MMJ 2021, 30, 1043–1050. [Google Scholar]
  38. Falade, J.; Oyebanji, A.H.; Babatola, A.O.; Falade, O.O.; Olumuyiwa, T.O. Prevalence and correlates of psychiatric morbidity, comorbid anxiety and depression among medical students in public and private tertiary institutions in a Nigerian state: A cross-sectional analytical study. Pan. Afr. Med. J. 2020, 37, 53. [Google Scholar] [CrossRef] [PubMed]
  39. Sandoval, K.D.; Morote-Jayacc, P.V.; Moreno-Molina, M.; Taype-Rondan, A. Depresión, estrés y ansiedad en estudiantes de Medicina humana de Ayacucho (Perú) en el contexto de la pandemia por COVID-19. Rev. Colomb. Psiquiatr 2021, in press. [Google Scholar] [CrossRef]
  40. Shao, R.; He, P.; Ling, B.; Tan, L.; Xu, L.; Hou, Y.; Kong, L.; Yang, Y. Prevalence of depression and anxiety and correlations between depression, anxiety, family functioning, social support and coping styles among Chinese medical students. BMC Psychology 2020, 8, 38. [Google Scholar] [CrossRef]
  41. Espinosa-Fernández, L.; García-López, L.J.; Muela-Martínez, J.A. Una mirada hacia los jóvenes con trastornos de ansiedad. Rev. Estud. Juv. 2020, 121, 11–24. [Google Scholar]
  42. Obregón-Morales, B.; Montalván-Romero, J.C.; Segama-Fabian, E.; Dámaso-Mata, B.; Panduro-Correa, V.; Arteaga-Livias, K. Factores asociados a la depresión en estudiantes de medicina de una universidad peruana. Educ. Médica Super. 2020, 34, 6–7. [Google Scholar]
  43. Thompson, G.; McBride, R.B.; Hosford, C.C.; Halaas, G. Resilience among Medical Students: The Role of Coping Style and Social Support. Teach. Learn. Med. 2016, 28, 174–182. [Google Scholar] [CrossRef]
  44. Fredrick, J.W.; Luebbe, A.M.; Mancini, K.J.; Burns, G.L.; Epstein, J.N.; Garner, A.A.; Jarrett, M.A.; Becker, S.P. Family environment moderates the relation of sluggish cognitive tempo to attention-deficit/hyperactivity disorder inattention and depression. J. Clin. Psychol. 2019, 75, 221–237. [Google Scholar] [CrossRef] [Green Version]
  45. de Souza, K.C.; Mendes, T.B.; Gomes, T.H.S.; da Silva, A.A.; Nali, L.H.D.S.; Bachi, A.L.L.; Rossi, F.E.; Gil, S.; França, C.N.; Neves, L.M. Medical Students Show Lower Physical Activity Levels and Higher Anxiety than Physical Education Students: A Cross-Sectional Study during the COVID-19 Pandemic. Front. Psychiatry 2021, 12, 804967. [Google Scholar] [CrossRef]
  46. Chootong, R.; Sono, S.; Choomalee, K.; Wiwattanaworaset, P.; Phusawat, N.; Wanghirankul, N.; Laojaroensuk, P.; Thongkhundum, P.; Saetang, R.; Euanontat, S.; et al. The association between physical activity and prevalence of anxiety and depression in medical students during COVID-19 pandemic: A cross-sectional study. Ann. Med. Surg. 2022, 75, 103408. [Google Scholar] [CrossRef] [PubMed]
  47. Stanford, F.C.; Durkin, M.W.; Stallworth, J.R.; Blair, S.N. Comparison of physical activity levels in physicians and medical students with the general adult population of the United States. Phys. Sportsmed. 2013, 41, 86–92. [Google Scholar] [CrossRef] [PubMed]
  48. Grasdalsmoen, M.; Eriksen, H.R.; Lønning, K.J.; Sivertsen, B. Physical exercise, mental health problems, and suicide attempts in university students. BMC Psychiatry. 2020, 20, 175. [Google Scholar] [CrossRef] [PubMed]
  49. Mikkelsen, K.; Stojanovska, L.; Polenakovic, M.; Bosevski, M.; Apostolopoulos, V. Exercise and mental health. Maturitas 2017, 106, 48–56. [Google Scholar] [CrossRef] [PubMed]
  50. Wipfli, B.; Landers, D.; Nagoshi, C.; Ringenbach, S. An examination of serotonin and psychological variables in the relationship between exercise and mental health. Scand. J. Med. Sci. Sport. 2011, 21, 474–481. [Google Scholar] [CrossRef] [PubMed]
  51. Santander-Hernández, F.M.; Ichiro-Peralta, C.; Guevara-Morales, M.A.; Díaz-Vélez, C.; Valladares-Garrido, M.J. Smartphone overuse, depression & anxiety in medical students during the COVID-19 pandemic. PLoS ONE 2022, 17, e0273575. [Google Scholar]
Table
Table 1. Socio-educational characteristics of medical students from Lambayeque, Peru.
Table 1. Socio-educational characteristics of medical students from Lambayeque, Peru.
Characteristicsn (%)
Type of university
Public240 (49.8)
Private242 (50.2)
Age in years (categorized)
16 to 20192 (39.8)
>20290 (60.2)
Sex
Female230 (47.7)
Male252 (52.3)
Socioeconomic level
Low65 (13.5)
Medium416 (86.3)
High1 (0.2)
Living conditions
With family43 (8.9)
Alone439 (91.1)
Family problems
No171 (35.5)
Yes311 (64.5)
Physical activity
No322 (66.8)
Yes160 (33.2)
Depression
Normal376 (78.0)
Mild100 (20.7)
Moderate5 (1.0)
Severe1 (0.2)
Anxiety
Normal184 (38.2)
Mild152 (31.5)
Moderate96 (19.9)
Severe50 (10.4)
Table
Table 2. Factors associated with depression and anxiety in medical students in Lambayeque, Peru.
Table 2. Factors associated with depression and anxiety in medical students in Lambayeque, Peru.
VariablesDepressionp *Anxietyp *
No (n = 376)Yes (n = 106)No (n = 184)Yes (n = 298)
n (%)n (%)n (%)n (%)
Type of university <0.001 <0.001
Public205 (85.4)35 (14.6) 114 (47.5)126 (52.5)
Private171 (70.7)71 (29.3) 70 (28.9)172 (71.1)
Age in years (categorized) 0.783 0.011
16 to 20151 (78.7)41 (21.4) 60 (31.3)132 (68.8)
> 20225 (77.6)65 (22.4) 124 (42.8)166 (57.2)
Sex 0.035 0.005
Female189 (82.2)41 (17.8) 73157 (68.3)
Male187 (74.2)65 (25.8) 111 (44.1)141 (56.0)
Socioeconomic level 0.163 0.263
Low45 (69.2)20 (30.8) 21 (32.3)44 (67.7)
Medium330 (79.3)86 (20.7) 162 (38.9)254 (61.1)
High1 (100.0)0 (0.0) 1 (100.0)0 (0.0)
Living conditions 0.343 0.642
With family36 (83.7)7 (16.3) 15 (34.9)28 (65.1)
Alone340 (77.5)99 (22.6) 169 (38.5)270 (61.5)
Family problems 0.215 0.019
No128 (74.9)43 (25.2) 113 (53.6)98 (46.5)
Yes248 (79.7)63 (20.3) 71 (41.5)100 (58.5)
Physical activity 0.002 0.001
No238 (73.9)84 (26.1) 139 (43.2)183 (56.8)
Yes138 (86.3)22 (13.8) 45 (28.1)115 (71.9)
* p-values calculated with the Chi-Square test of independence.
Table
Table 3. Analysis of factors associated with depression and anxiety in medical students in Lambayeque, Peru.
Table 3. Analysis of factors associated with depression and anxiety in medical students in Lambayeque, Peru.
CharacteristicsSimple Regression
DepressionAnxiety
PR95% CIp *PR95% CIp *
Type of university
PublicRef. Ref.
Private2.011.40–2.89<0.0011.351.17–1.56<0.001
Age in years (categorized)
16 to 20Ref. Ref.
> 201.050.74–1.480.7830.830.73–0.960.011
Sex
FemaleRef. Ref.
Male1.451.02–2.050.0350.820.71–0.940.006
Socioeconomic level
LowRef. Ref.
Medium0.670.45–1.010.0680.900.75–1.080.306
High
Living conditions
With familyRef. Ref.
Alone1.390.69–2.790.3430.940.75–1.190.642
Family problems
NoRef. Ref.
Yes0.810.57–1.130.2151.261.04–1.530.019
Physical activity
NoRef. Ref.
Yes0.530.34–0.810.0021.261.10–1.450.001
* p-values obtained with Generalized Linear Models (GLM), Poisson family, log-link function, and robust variance.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Piscoya-Tenorio, J.L.; Heredia-Rioja, W.V.; Morocho-Alburqueque, N.; Zeña-Ñañez, S.; Hernández-Yépez, P.J.; Díaz-Vélez, C.; Failoc-Rojas, V.E.; Valladares-Garrido, M.J. Prevalence and Factors Associated with Anxiety and Depression in Peruvian Medical Students. Int. J. Environ. Res. Public Health 2023, 20, 2907. https://doi.org/10.3390/ijerph20042907

AMA Style

Piscoya-Tenorio JL, Heredia-Rioja WV, Morocho-Alburqueque N, Zeña-Ñañez S, Hernández-Yépez PJ, Díaz-Vélez C, Failoc-Rojas VE, Valladares-Garrido MJ. Prevalence and Factors Associated with Anxiety and Depression in Peruvian Medical Students. International Journal of Environmental Research and Public Health. 2023; 20(4):2907. https://doi.org/10.3390/ijerph20042907

Chicago/Turabian Style

Piscoya-Tenorio, Jorge L., Walter V. Heredia-Rioja, Noelia Morocho-Alburqueque, Sandra Zeña-Ñañez, Palmer J. Hernández-Yépez, Cristian Díaz-Vélez, Virgilo E. Failoc-Rojas, and Mario J. Valladares-Garrido. 2023. "Prevalence and Factors Associated with Anxiety and Depression in Peruvian Medical Students" International Journal of Environmental Research and Public Health 20, no. 4: 2907. https://doi.org/10.3390/ijerph20042907

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop