A total 182 medical students were included in the current study. As shown in Figure 1, the prevalence of depressive and anxiety symptoms in all study students were 44.0% and 30.8%, respectively. Figure 2 shows depressive symptoms were significantly higher in the first-year compared with fifth-year students (52.9% versus 35.8%, p=0.020). Anxiety symptoms were also higher in the first-year compared with fifth-year students (35.6% versus 26.3%), but the difference did not reach statistical significance (p=0.176). Approximately 25.3% of the students had both depressive and anxiety symptoms, which was again significantly higher in the first-year compared with fifth-year students (32.2% versus 18.9%, p=0.040). Approximately 49.5% of the students had either depressive or anxiety symptoms, without significant difference between students of the two academic years (56.3% versus 43.2%, p=0.076).
Table 1 shows the sociodemographic and academic characteristics by the academic year of the students. Compared with fifth year students, first-year students had significantly younger age (19.1±1.1 versus 23.1±0.6 years, p<0.001), significantly better grade point average (GPA) (83.9% versus 43.2% for GPA 4.50 to 5.00, p<0.001), significantly more frequent successful academic years (97.7% versus 90.5%, p=0.042), significantly more frequent within-family living status (94.3% versus 88.4%, 0.037), and significantly more frequent sedentary (not active) lifestyle (29.9% versus 15.2%, p=0.009). There were no significant differences between students of the two academic years in gender (54.9% males), use of psychological therapy (20.9%), adequate sleeping duration (57.1% 7-9 hours), single social status (97.8%), and current smoking (17.0%).
Table 2 shows the responses to COVID-19 pandemic related questions by the academic year of students. Approximately one-fifth of the study students were always (9.9%) or most of the time (9.3%) feeling worried about acquiring COVID-19, without significant differences between students of the two academic years (p=0.517). Almost half of the study students were always (15.9%) or most of the time (33.5%) feeling worried or anxious about their academic performance during COVID-19 pandemic, with significantly higher worry level in the first-year compare with fifth year students (63.2% versus 36.8%, p<0.001). Approximately 30% of the study students were always (8.8%) or most of the time (22.0%) feeling sad, depressed or anxious during COVID-19 pandemic, without significant differences between students of the two academic years (p=0.648). Approximately 11.2% of the study students were diagnosed with COVID-19, with significantly less frequent infection rate in the first-year compare with fifth year students (2.4% versus 19.1%, p<0.001). Half of the study students had at least one of their relatives diagnosed with COVID-19, without significant differences between students of the two academic years (p=0.764).
Table 3 shows the univariate and multivariate logistic regression analysis of potential predictors of depressive and anxiety symptoms. In addition to academic years, only the variables that were significantly (or almost significantly) associated with depressive or anxiety symptoms in univariate analysis were shown. First-year student had double odds of having depressive symptoms compared with fifth year students in univariate analysis (odds ratio [OR] 2.01, 95% confidence interval [CI] 1.11-3.65, p=0.021) but not in multivariate analysis. Independent risk factors of depressive symptoms included having concomitant anxiety (OR=9.57, 95% CI 3.59-25.49, p<0.001), being worried about acquiring COVID-19 infection (OR=5.60, 95% CI 1.74-17.97, p=0.004), being worried about academic performance (OR=4.33, 95% CI 1.80-10.39, p=0.001), and feeling sad, depressed or anxious (OR=7.75, 95% CI 2.88-20.85, p<0.001). Academic year was not a significant predictor of anxiety in either univariate or multivariate analysis. Independent risk factors of anxiety included having lower GPA (OR=2.70, 95% CI 1.03-7.08, p=0.044) and having concomitant depressive symptoms (OR=13.91, 95% CI 6.08-31.81, p<0.001).