|Year : 2018 | Volume
| Issue : 1 | Page : 48-51
Psychiatric morbidity among medical students: An Egyptian study
Samir Abolmagd1, Ashraf Adel1, Dina El Tabei1, Hisham Salah2, Maha Emadeldin2, Mohamed A Khalil1
1 Department of Psychiatry, Faculty of Medicine, Cairo University, Cairo, Egypt
2 Department of Psychiatry, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
|Date of Submission||03-Dec-2017|
|Date of Acceptance||17-Dec-2017|
|Date of Web Publication||29-Jan-2018|
Mohamed A Khalil
Department of Psychiatry, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, 12311
Source of Support: None, Conflict of Interest: None
Background Medical education is perceived as being stressful, with negative effects on students’ mental health. Therefore, the aim of this study was to assess psychiatric morbidity among final year medical students from the Faculty of Medicine, Cairo University.
Participants and methods A total of 200 students were randomly chosen during attendance of their psychiatry round. Both male and female students were included in the study, and students with major medical diseases were excluded. All participants signed an informed written consent. Participants were subject to clinical assessment using the semistructured interview of Present State Examination (PSE). Data were transferred to the statistical package of social science version 20 for quantitative data analysis.
Results Overall, 61% of the students were males and 39% were females, and the age of both male and female students ranged from 21 to 31 years old, with a mean value of 23.21±1.09 years. None of the students in the sample were diagnosed as having any of the psychotic disorders. Overall, 83 and 44% of students in the sample had subclinical mood and anxiety symptoms, respectively.
Conclusion Most students had anxiety and depressive symptoms not mounting to a diagnosis, and a substantial proportion of medical students had an ongoing psychiatric condition.
Keywords: medical students, psychiatric morbidity, Egyptian
|How to cite this article:|
Abolmagd S, Adel A, El Tabei D, Salah H, Emadeldin M, Khalil MA. Psychiatric morbidity among medical students: An Egyptian study. Egypt J Psychiatr 2018;39:48-51
|How to cite this URL:|
Abolmagd S, Adel A, El Tabei D, Salah H, Emadeldin M, Khalil MA. Psychiatric morbidity among medical students: An Egyptian study. Egypt J Psychiatr [serial online] 2018 [cited 2018 Apr 25];39:48-51. Available from: http://new.ejpsy.eg.net/text.asp?2018/39/1/48/224010
| Introduction|| |
Medical education is perceived as being stressful. It is characterized by many psychological changes in students. Medical students encounter multiple anxieties in transformation from insecure student to young knowledgeable physician. There is a growing concern about stress in medical training. It was observed that medical students experience a high incidence of personal distress during their undergraduate course. High levels of stress may have a negative effect on mastery of the academic curriculum. Stress, health, and emotional problems increase during the period of undergraduate medical education. This can lead to mental distress and has a negative effect on cognitive functioning and learning (Dahlin et al., 2005).
The estimated prevalence of emotional disturbance was found in different studies to be higher in medical students than in general population. In three British universities, the prevalence of stress was 31.2%, whereas in a Malaysian medical school, it was 41.9%, and in a Thai medical school 61.4%. So, it is important for medical educators to know the prevalence and causes of student distress, which not only affects students’ health but also their academic achievement at different time points during their education (Abdulghany, 2008).
In addition to learning technical skills, responding to patient problems, and interacting with other healthcare professionals, these students may be experiencing additional stressors while adapting to new ways of teaching and learning in medicine (Elzubeir et al., 2010).
The reporting of significantly higher relationship, academic, and environmental stressors among Egyptian students relative to Saudi students may be explained by larger numbers of students within crammed classrooms and the lower socioeconomic status of their families, which indicates that medical students from wealthier Arab countries and families may be protected from at least some academic environment and financial stressors (El-Gilany et al., 2008).
Depressive and anxiety symptoms are highly prevalent among medical students. Several studies revealed that medical students are susceptible to high rates of morbidity during their undergraduate years (Dyrbye et al., 2007; Dahlin and Runeson, 2007), and this can be related to impairment in the development of professional, academic, and social skills (Facundes and Ludermir, 2005). In addition, this comorbidity is associated with an increased risk of suicide, evaluated by attempted and completed suicides (Wallin and Runeson, 2003).
Medical students are more prone to depression than their nonmedical peers. Although the rate of depression among students entering medical school is similar to that among other people of similar ages; the prevalence increases disproportionately over the course of medical school (Rosal et al., 1997). A number of tests that must be passed frequently lead to anxiety (Sherina et al., 2003).
In Egypt, a study on psychiatric morbidity among university students showed that anxiety states were diagnosed in 36% of the total sample, and females were twice more prone to anxiety disorders than males, with a ratio of 2 : 1 (Okasha, 2005).
Medical students experience substantial anxiety from the beginning of the training process (Daly and Willcock, 2002; Kiessling et al., 2004). Although some degree of stress is a normal part of medical training and can be a motivator for some individuals, not all students find stress constructive. For many individuals, stress arouses feelings of fear, incompetence, uselessness, anger, and guilt and can be associated with both psychological (Tyseen et al., 2001) and physical morbidities (Park and Adler, 2003). Students use various coping mechanisms to process stress that vary by year in training and source of stress (Stern et al., 1993). The specific coping strategies that students use may determine the effect of stress on psychological and physical health (Park and Adler, 2003) and may determine whether stress has a positive or negative influence (Moffat et al., 2004).
| Participants and methods|| |
A total of 200 students were randomly chosen during attendance of their psychiatry round. Both males and females were included in the study, and students with major medical diseases were excluded. A written informed consent was taken from students after discussing with them the aim of the study. The research was ethically approved by the ethical and scientific committee, Psychiatry Department, Faculty of Medicine, Cairo University. All participants were clinically assessed by using a semistructured interview of Present State Examination (PSE-10 Short English-Arabic version, Sabri, 2009), which is useful for clinicians and researchers in screening individuals with psychiatric disorders and those who present with subclinical morbidity. It is a semistructured interview that is widely used as a screening instrument in studies of psychiatric epidemiology. Analysis of the answers to different questions, in which clinical judgment plays a role, allows the data to be transformed into a series of symptom and syndrome scores that were according to Diagnostic and Statistical Manual of Mental Disorders IV criteria classified into disorders. Data were collected and then transferred to the statistical package of social science version 20 (SPSS v.20; SPSS Inc., Chicago, Illinois, USA) for quantitative data analysis.
| Results|| |
In the sample, male students comprised 61% and female 39%. Their age ranged from 21 to 31 years, with a mean of 23.21±1.09 years. Of the students, 85.5% were single, 13% were engaged, and 1.5% of them were married. Most (95%) did not use medication, whereas 5% used medication occasionally. Overall, 11% of the students in the sample smoked from 11 to 20 cigarettes per day, 10% smoked from 1 to 10 cigarettes, 6% smoked more than 20 cigarettes per day, whereas 73% of students in the sample did not smoke yet. Overall, 91.5% of students in the sample had no family history of psychiatric disorders, whereas 8.5% had a positive family history of psychiatric disorders (1.5% of them had similar conditions).
Regarding anxiety disorders, 23% of students had anxiety symptoms not mounting to a diagnosis (subclinical symptoms), 28% were diagnosed as having generalized anxiety disorder, 8% were diagnosed as having obsessive-compulsive disorder, followed by 5.5, 2, and 1% of them having social phobia, panic disorder, and specific phobia, respectively. However, 3% of students in the sample had conversion disorder, whereas 1% had somatization disorder.
Regarding mood disorders, 15.5% of students had depressive symptoms not mounting to a diagnosis (subclinical symptoms), 8% were diagnosed as having major depressive disorder, 5.5% were diagnosed as having bipolar I disorder, and 3% were diagnosed as having dysthymia.
Finally, none of the students were diagnosed as having any of the psychotic disorders screened for (schizophrenia, schizoaffective disorder, delusional disorder, brief psychotic disorder, and shared psychotic disorder) ([Table 1] and [Table 2]).
| Discussion|| |
Depressive and anxiety symptoms are highly prevalent among medical students. Several studies revealed that medical students are susceptible to high rates of morbidity during their undergraduate years (Dahlin and Runeson, 2007; Dyrbye et al., 2007), and this can be related to impairment in the development of professional, academic, and social skills (Facundes and Ludermir, 2005).
In this study, we assessed the different psychiatric morbidities among medical students during attendance of their psychiatry round. It was found that 23% of students had anxiety symptoms not mounting to a diagnosis (subclinical symptoms), 28% were diagnosed as having generalized anxiety disorder, 8% were diagnosed as having obsessive-compulsive disorder followed by 5.5, 2, and 1% of them having social phobia, panic disorder, and specific phobia, respectively. However, 3% of students in the sample had conversion disorder, whereas 1% had somatization disorder. However, these results were compared with those of a study carried out on a sample of Egyptian university students presenting to the psychiatric outpatient clinic at Cairo University Students Hospital, where 35% of the students were presenting with anxiety symptoms not mounting to a diagnosis, 23% were diagnosed as having generalized anxiety, 4% were diagnosed as having obsessive-compulsive disorder followed by 5 and 8% of them presenting with panic disorder and phobias, respectively; moreover, 3% of the students had conversion disorder, whereas 6% had somatization disorder (Abou El Enien, 2010). Our findings regarding anxiety (mounting to a diagnosis) were comparable to the findings of earlier studies of psychiatric morbidity among university students in Egypt which showed that anxiety states were diagnosed in 36% of the study sample (Okasha et al., 1977).
Regarding mood symptoms in the present study, 15.5% of students had depressive symptoms not mounting to a diagnosis (subclinical symptoms), 8% were diagnosed as having major depressive disorder, 5.5% were diagnosed as having bipolar I disorder, and finally 3%, were diagnosed as having dysthymia. These results were matched with those of a study carried out on a sample of Egyptian university students presenting to the psychiatric outpatient clinic at Cairo University Students Hospital, where 17% of the students were presenting with depressive symptoms not mounting to a diagnosis, 11% were diagnosed as having major depressive disorder, 3% diagnosed as having bipolar I disorder, and finally, 21% were diagnosed as having dysthymia (Abou El Enien, 2010). The higher prevalence of anxiety and depression among medical students may indicate that students’ coping strategies and personal health deteriorate as they enter medical school (Somers et al., 2006).
Nimesh and Mohan (2006) concluded that the prevalence of depressive symptoms among medical students in most of the studies was higher than the general population within a range of 15–17%, as reported from data of Western countries.
None of the students in the sample were diagnosed as having any of the psychotic disorders screened for (schizophrenia, schizoaffective disorder, delusional disorder, brief psychotic disorder, and shared psychotic disorder); however, this did not agree with the findings of Abou El Enien (2010), who found that 7% of the sample had the diagnosis of brief psychotic disorder, 4% had the diagnosis of schizophrenia, and 1% had the diagnosis of a shared psychotic disorder. This difference could be explained by the fact that this sample was recruited from the Psychiatric Outpatient Clinic at Cairo University Students’ Hospital, whereas our sample was recruited from students attending the psychiatry round (i.e. functioning students).
The overall prevalence rates of psychiatric morbidities (65%) in this research are comparable to the longitudinal study conducted in the University of Sydney, in which the target was all 117 students attending their final year of university, where 70% met the criteria for psychiatric morbidity (Willcock et al., 2004).
The reasons for such high levels of psychiatric morbidity and burnout among medical students are likely to be complex and to reflect both the environment in which young doctors work and personal characteristics as well. It is possible that the repeated high scores of psychological distress were reflecting certain trait-like characteristics which were stable in students over time.
In conclusion, a substantial proportion of medical students had ongoing psychiatric conditions. Individual as well as organizational interventions should be targeted for comprehensive stress management programs for medical students. These programs should emphasize on study skills, time management, healthy lifestyles, and effective coping strategies.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Abdulghany H (2008). Stress and depression among medical students − a cross-sectional study. Pak J Med Sci 24:12–17.
Abou El Enien S (2010). Study of the risk factors for psychological suffering among a sample of university students in Egypt, Cairo University [MSc Thesis].
Dahlin M, Runeson B (2007). Burnout and psychiatric morbidity among medical students entering clinical training: a three year prospective questionnaire and interviewbased study. BMC Med Educ 7:6.
Dahlin M, Joneborg N, Runeson B (2005). Stress and depression among medical students: a cross-sectional study. Med Educ 39:594–604.
Daly M, Willcock S (2002). Examining stress and responses to stress in medical students and new medical graduates. Med J Aust 177(Suppl):S14–S15.
Dyrbye L, Thomas M, Eacker A, Harper W, Massie F, Power D et al.
(2007). Race, ethnicity, and medical student well-being in the United States. Arch Intern Med 167:2103–2109.
El-Gilany AH, Amr M, Hammad S (2008). Perceived stress among male medical students in Egypt and Saudi Arabia: effects of socio-demographic factors. Ann Saudi Med 28:442–448.
Elzubeir MA, Elzubeir KE, Magzoub ME (2010). Stress and coping strategies among Arab medical students: towards a research agenda. Educ Health (Abingdon) 23:355.
Facundes V, Ludermir A (2005). Common mental disorders among health care students. Rev Bras Psiquiatr 27:194–200.
Kiessling C, Schubert B, Scheffner D, Burger W (2004). First year medical students’ perceptions of stress and support: a comparison between reformed and traditional track curricula. Med Educ 38:504–509.
Moffat K, McConnachie A, Ross S, Morrison J (2004). First year medical student stress and coping in a problem-based learning medical curriculum. Med Educ 38:482–491.
Nimesh G, Mohan I (2006). Regional health forum WHO South-East Asia region. 5:1.
Okasha A (2005). Mental health in Egypt. Isr J Psychiatry Relat Sci 42:116–125.
Okasha A, Kamel M, Sadek A, Lotaif Z (1977). Psychiatric morbidity among university students in Egypt. Br J Psychiatry 131:149–154.
Park C, Adler N (2003). Coping style as a predictor of health and well-beingacross the first year of medical school. Health Psychol 22:627–631.
Rosal M, Ockene I, Ockene J (1997). A longitudinal study of students’ depression at one medical school. Acad Med 72:542–546.
Sabri N (2009). Inter-rater reliability of the short Arabic form of the present state examination (PSE-10). Egypt J Psychiatry 29:45–54.
Sherina M, Lekhraj R, Nadarajan K (2003). Prevalence of emotional disorders among medical students in a Malaysian University. Asia Pac Fam Med 2:213–217.
Somers J, Goldner E, Waraich P (2006). Prevalence and incidence studies of anxiety disorders: a systematic review of the literature. Can J Psychiatry 51:100–103.
Stern M, Norman S, Komm C (1993). Medical students’ differential use of coping strategies as a function of stressor type, year of training, and gender. Behav Med 18:173–180.
Tyseen R, Vaglum P, Gronvold NT, Bkeberg O (2001). Factors in medical school that predict postgraduate mental health problems in need of treatment. A nation wide and longitudinal study. Med Edu 35:110–120.
Wallin U, Runeson B (2003). Attitudes towards suicide and suicidal patients among medical students. Eur Psychiatry 18:329–333.
Willcock S, Daly M, Tennant C, Allard B (2004). Burnout and psychiatric morbidity in new medical graduates. Med J Malaysia 181:357–360.
[Table 1], [Table 2]