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Research ArticleOriginal Articles
Open Access

Depression, anxiety and stress among medical and non-medical students in Saudi Arabia: An epidemiological comparative cross-sectional study

Ahmad A. Mirza, Waleed A. Milaat, Iman K. Ramadan, Mukhtiar Baig, Soha A. Elmorsy, Ghada M. Beyari, Mohammed A. Halawani, Ruqayyah A. Azab, Meshari T. Zahrani and Nora K. Khayat
Neurosciences Journal April 2021, 26 (2) 141-151; DOI: https://doi.org/10.17712/nsj.2021.2.20200127
Ahmad A. Mirza
From the Department of Otolaryngology, Head and Neck Surgery (Mirza), Faculty of Medicine in Rabigh, from the Department of Community Medicine (Milaat, Ramadan), from the Department of Clinical Biochemistry/Medical Education (Baig), Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, from the Department of Epidemiology and Statistics (Elmorsy), King Abdullah Medical City, Makkah, from the Faculty of Medicine (Beyari, Halawanim, Azab, Zahrani, Khayat) Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia, from the Department of Community Medicine (Ramadan), Faculty of Medicine, Alazhar University, and from the Department of Pharmacology (Elmorsy), Faculty of Medicine, Cairo University, Cairo, Egypt
MBBS, MSc
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  • For correspondence: [email protected]
Waleed A. Milaat
From the Department of Otolaryngology, Head and Neck Surgery (Mirza), Faculty of Medicine in Rabigh, from the Department of Community Medicine (Milaat, Ramadan), from the Department of Clinical Biochemistry/Medical Education (Baig), Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, from the Department of Epidemiology and Statistics (Elmorsy), King Abdullah Medical City, Makkah, from the Faculty of Medicine (Beyari, Halawanim, Azab, Zahrani, Khayat) Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia, from the Department of Community Medicine (Ramadan), Faculty of Medicine, Alazhar University, and from the Department of Pharmacology (Elmorsy), Faculty of Medicine, Cairo University, Cairo, Egypt
MD, PhD
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Iman K. Ramadan
From the Department of Otolaryngology, Head and Neck Surgery (Mirza), Faculty of Medicine in Rabigh, from the Department of Community Medicine (Milaat, Ramadan), from the Department of Clinical Biochemistry/Medical Education (Baig), Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, from the Department of Epidemiology and Statistics (Elmorsy), King Abdullah Medical City, Makkah, from the Faculty of Medicine (Beyari, Halawanim, Azab, Zahrani, Khayat) Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia, from the Department of Community Medicine (Ramadan), Faculty of Medicine, Alazhar University, and from the Department of Pharmacology (Elmorsy), Faculty of Medicine, Cairo University, Cairo, Egypt
MBBS, PhD
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Mukhtiar Baig
From the Department of Otolaryngology, Head and Neck Surgery (Mirza), Faculty of Medicine in Rabigh, from the Department of Community Medicine (Milaat, Ramadan), from the Department of Clinical Biochemistry/Medical Education (Baig), Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, from the Department of Epidemiology and Statistics (Elmorsy), King Abdullah Medical City, Makkah, from the Faculty of Medicine (Beyari, Halawanim, Azab, Zahrani, Khayat) Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia, from the Department of Community Medicine (Ramadan), Faculty of Medicine, Alazhar University, and from the Department of Pharmacology (Elmorsy), Faculty of Medicine, Cairo University, Cairo, Egypt
PhD, MHPE
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Soha A. Elmorsy
From the Department of Otolaryngology, Head and Neck Surgery (Mirza), Faculty of Medicine in Rabigh, from the Department of Community Medicine (Milaat, Ramadan), from the Department of Clinical Biochemistry/Medical Education (Baig), Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, from the Department of Epidemiology and Statistics (Elmorsy), King Abdullah Medical City, Makkah, from the Faculty of Medicine (Beyari, Halawanim, Azab, Zahrani, Khayat) Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia, from the Department of Community Medicine (Ramadan), Faculty of Medicine, Alazhar University, and from the Department of Pharmacology (Elmorsy), Faculty of Medicine, Cairo University, Cairo, Egypt
MD, PhD
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Ghada M. Beyari
From the Department of Otolaryngology, Head and Neck Surgery (Mirza), Faculty of Medicine in Rabigh, from the Department of Community Medicine (Milaat, Ramadan), from the Department of Clinical Biochemistry/Medical Education (Baig), Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, from the Department of Epidemiology and Statistics (Elmorsy), King Abdullah Medical City, Makkah, from the Faculty of Medicine (Beyari, Halawanim, Azab, Zahrani, Khayat) Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia, from the Department of Community Medicine (Ramadan), Faculty of Medicine, Alazhar University, and from the Department of Pharmacology (Elmorsy), Faculty of Medicine, Cairo University, Cairo, Egypt
MBBS
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Mohammed A. Halawani
From the Department of Otolaryngology, Head and Neck Surgery (Mirza), Faculty of Medicine in Rabigh, from the Department of Community Medicine (Milaat, Ramadan), from the Department of Clinical Biochemistry/Medical Education (Baig), Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, from the Department of Epidemiology and Statistics (Elmorsy), King Abdullah Medical City, Makkah, from the Faculty of Medicine (Beyari, Halawanim, Azab, Zahrani, Khayat) Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia, from the Department of Community Medicine (Ramadan), Faculty of Medicine, Alazhar University, and from the Department of Pharmacology (Elmorsy), Faculty of Medicine, Cairo University, Cairo, Egypt
MBBS
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Ruqayyah A. Azab
From the Department of Otolaryngology, Head and Neck Surgery (Mirza), Faculty of Medicine in Rabigh, from the Department of Community Medicine (Milaat, Ramadan), from the Department of Clinical Biochemistry/Medical Education (Baig), Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, from the Department of Epidemiology and Statistics (Elmorsy), King Abdullah Medical City, Makkah, from the Faculty of Medicine (Beyari, Halawanim, Azab, Zahrani, Khayat) Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia, from the Department of Community Medicine (Ramadan), Faculty of Medicine, Alazhar University, and from the Department of Pharmacology (Elmorsy), Faculty of Medicine, Cairo University, Cairo, Egypt
Medical student
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Meshari T. Zahrani
From the Department of Otolaryngology, Head and Neck Surgery (Mirza), Faculty of Medicine in Rabigh, from the Department of Community Medicine (Milaat, Ramadan), from the Department of Clinical Biochemistry/Medical Education (Baig), Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, from the Department of Epidemiology and Statistics (Elmorsy), King Abdullah Medical City, Makkah, from the Faculty of Medicine (Beyari, Halawanim, Azab, Zahrani, Khayat) Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia, from the Department of Community Medicine (Ramadan), Faculty of Medicine, Alazhar University, and from the Department of Pharmacology (Elmorsy), Faculty of Medicine, Cairo University, Cairo, Egypt
Medical student
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Nora K. Khayat
From the Department of Otolaryngology, Head and Neck Surgery (Mirza), Faculty of Medicine in Rabigh, from the Department of Community Medicine (Milaat, Ramadan), from the Department of Clinical Biochemistry/Medical Education (Baig), Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, from the Department of Epidemiology and Statistics (Elmorsy), King Abdullah Medical City, Makkah, from the Faculty of Medicine (Beyari, Halawanim, Azab, Zahrani, Khayat) Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia, from the Department of Community Medicine (Ramadan), Faculty of Medicine, Alazhar University, and from the Department of Pharmacology (Elmorsy), Faculty of Medicine, Cairo University, Cairo, Egypt
Medical student
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Article Figures & Data

Figures

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  • Figure 1
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    Figure 1

    - Bar chart demonstrating the prevalence of depression, anxiety and stress disorders (DASD) among medical and non-medical students

  • Figure 2
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    Figure 2

    - Pie chart illustrating a)the depression severity in medical versus non-medical students, b) the anxiety severity in medical versus non-medical students, C) the stress severity in medical versus non-medical students.

Tables

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    Table 1

    - Socio-demographic characteristics and academic profile of the study participants.

    Medical Students n=231Non-medical Students n=234 n (%)Total n=465
    Socio-demographic characteristics
    Age (mean, SD)21.67 (1.56)21.23 (2.34)21.46 (2.00)
    Gender
    Male106 (45.89)92 (39.32)198 (42.58)
    Female125 (54.11)142 (60.68)267 (57.42)
    Marital status
    Not married224 (96.97)202 (86.32)426 (91.61)
    Married7 (3.03)32 (13.68)39 (8.39)
    Hometown*
    Urban224 (96.97)210 (91.30)234 (94.14)
    Rural/Countryside7 (3.03)20 (8.70)27 (5.86)
    Father’s educational level*
    Illiterate2 (0.87)8 (3.46)10 (2.17)
    Primary-intermediate28 (12.17)53 (22.94)81 (17.57)
    Secondary62 (26.96)70 (30.30)132 (28.63)
    University+138 (60.00)100 (43.29)238 (51.63)
    Mother’s educational level*
    Illiterate9 (3.90)30 (12.99)39 (8.44)
    Primary-intermediate29 (12.55)52 (22.51)81 (17.53)
    Secondary45 (19.48)59 (25.54)104 (22.51)
    University+148 (64.07)90 (38.96)238 (51.52)
    Residence place during the time of the study*
    Students’ residence facility9 (3.90)15 (6.55)24 (5.22)
    Living with family222 (96.10)214 (93.45)436 (94.78)
    Family monthly income (in Saudi Riyals)*
    <50006 (3.55)27 (17.53)33 (10.22)
    5000-1000032 (18.93)42 (27.27)74 (22.91)
    >10000-2000074 (43.79)62 (40.26)136 (42.11)
    >2000057 (33.73)23 (14.94)80 (24.77)
    Academic profile
    Number of registered weekly hours (mean, SD)*25.64 (9.35)16.28 (4.39)20.79 (8.60)
    Academic level
    Junior89 (38.53)168 (78.50)257 (57.75)
    Senior142 (61.47)46 (21.50)188 (42.25)
    Did you match with the first choice in admission?*
    Yes197 (86.40)140 (61.50)337 (74.07)
    No31 (13.60)87 (38.50)118 (25.93)
    Failure in learning module(s)*
    No217 (94.76)156 (67.24)373 (80.91)
    Yes12 (5.24)76 (32.76)88 (19.09)
    GPA (mean, SD)*3.39 (0.44)3.05 (0.63)3.23 (0.56)
    Daily studying hours after school*
    <1 hour21 (9.09)78 (33.91)99 (21.48)
    1-2 hours86 (37.23)83 (36.09)169 (36.66)
    >2-4 hours90 (38.96)41 (17.83)131 (28.42)
    >4 hours34 (14.72)28 (12.17)62 (13.45)

    *The variable has missing values

      • View popup
      Table 2

      - Depression, anxiety and stress disorders among medical and non-medical students

      CategoryMedical studentsNon-medical studentsP-value‡
      Depression
      Prevalence129 (55.84%)122 (52.14%)0.423
      Mean of score (SD)12.94 (11.29)11.24 (9.72)0.082§
      Normal102 (44.16)112 (47.86)
      Mild29 (12.55)31 (13.25)0.142
      Moderate50 (21.65)48 (20.51)
      Severe20 (8.66)28 (11.97)
      Extremely severe30 (12.99)15 (6.41)
      Anxiety
      Prevalence106 (45.89%)141 (60.26%)0.002*
      Mean (SD)8.46 (9.07)11.09 (9.79)0.003*§
      Normal126 (54.11)93 (39.74)
      Mild20 (8.66)23 (9.83)0.024*
      Moderate39 (16.88)44 (18.80)
      Severe16 (6.93)26 (11.11)
      Extremely severe31 (13.42)48 (20.51)
      Stress
      Prevalence87 (37.66%)89 (38.03%)0.934
      Mean (SD)13.74 (11.69)12.09 (10.23)0.105§
      Normal144 (62.34)145 (61.97)
      Mild18 (7.79)24 (10.26)0.007*
      Moderate26 (11.26)33 (14.10)
      Severe17 (7.36)25 (10.68)
      Extremely severe26 (11.26)7 (2.99)

      *Statically significant at p<0.05. ‡Chi-squared test unless mentioned otherwise. §Student’s t-test.

        • View popup
        Table 3

        - Univariate and multivariate logistic regression analysis of different factors on depression among medical and non-medical students.

        VariablesORP value95% CIaORP value95% CI
        ULLLLLUL
        Study field
        MedicineRefRef
        Education0.860.420.601.241.070.840.552.07
        Energy beverages†1.430.01*1.081.891.610.051.012.58
        Gender
        MaleRefRef
        Female1.89<0.001*1.302.742.130.02*1.153.93
        Family conflicts at home‡2.10<0.001*1.453.041.830.04*1.023.26
        Psychiatric condition
        NoRefRef
        Yes7.43<0.001*2.5821.4110.660.03*1.3286.38
        Time from home to university§1.53<0.001*1.191.961.500.04*1.022.19
        Academic level
        JuniorRefRef
        Senior1.290.190.881.882.530.01*1.294.95

        OR - Odds ratio, aOR - adjusted odds ratio, CI - confidence interval, UL - Upper limit, LL - Lower limit. *statistically significant. †Ordinal variable (1: Never, 2: Occasionally, 3: Once daily, and 4: >2 times daily). ‡Ordinal variable (1: Composed/Stable, 2: Minor conflicts, and 3: Major conflicts). §Ordinal variable (1: less than 15 minutes, 2: 15 – 30 minutes, 3: more than 30 – 60 minutes, and 4: more than 60 minutes).

          • View popup
          Table 4

          - Univariate and multivariate logistic regression analysis of different factors on anxiety among medical and non-medical students.

          CategoryORP-value95% CIaORP-value95% CI
          LLULLLUL
          Study field
          MedicineRefRef
          Education1.790.002*1.242.582.070.02*1.153.71
          Hobbies and leisure†1.000.990.821.221.400.04*1.021.93
          Gender
          MaleRefRef
          Female2.13<0.001*1.463.091.970.03*1.073.61
          Family conflicts at home‡2.21<0.001*1.533.201.950.02*1.123.40
          Energy beverages§1.660.001*1.242.211.770.02*1.102.84
          Time from home to university¶1.74<0.001*1.352.241.680.01*1.142.47

          OR - Odds ratio, aOR - adjusted odds ratio, CI - confidence interval, UL - Upper limit, LL - Lower limit, *statistically significant, †Ordinal variable (1: None, 2: Rarely, 3: Occasionally, and 4: Regularly). ‡Ordinal variable (1: Composed/Stable, 2: Minor conflicts, and 3: Major conflicts). §Ordinal variable (1: Never, 2: Occasionally, 3: Once daily, and 4: ≥2 times daily). ¶Ordinal variable (1: less than 15 minutes, 2: 15 – 30 minutes, 3: more than 30 – 60 minutes, and 4: more than 60 minutes)

            • View popup
            Table 5

            - Univariate and multivariate logistic regression analysis of different factors on stress among medical and non-medical students.

            CategoryORP-value95% CIaORP-value95% CI
            LLULLLUL
            Study field
            MedicineRefRef
            Education1.020.930.701.480.980.950.571.70
            Family conflicts at home†3.07<0.001*2.124.432.69<0.001*1.674.33
            Psychiatric condition
            NoRefRef
            Yes7.67<0.001*3.2717.985.210.002*1.7915.14
            Daily studying hours after school‡1.320.006*1.091.621.370.02*1.041.79
            Smart device use for entertainment§1.50<0.001*1.241.821.480.002*1.151.91
            Parent status
            Divorced or deadRefRef
            Alive & married1.580.001*1.192.100.430.008*0.230.81
            Failure in learning module(s)
            NoRefRef
            Yes0.890.530.611.292.070.04*1.024.19

            OR - Odds ratio, aOR - adjusted odds ratio, CI - confidence interval, UL - Upper limit, LL - Lower limit, *statistically significant, †Ordinal variable (1: Composed/Stable, 2: Minor conflicts, and 3: Major conflicts), ‡Ordinal variable (1: less than 1 hour, 2: 1-2 hours, 3: more than 2-4 hours, and 4: more than 4 hours), §Ordinal variable (1: less than 2 hours daily, 2: 2-4 hours daily, 3: more than 4-6 hours daily, and 4: more than 6 hours daily)

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            Depression, anxiety and stress among medical and non-medical students in Saudi Arabia: An epidemiological comparative cross-sectional study
            Ahmad A. Mirza, Waleed A. Milaat, Iman K. Ramadan, Mukhtiar Baig, Soha A. Elmorsy, Ghada M. Beyari, Mohammed A. Halawani, Ruqayyah A. Azab, Meshari T. Zahrani, Nora K. Khayat
            Neurosciences Journal Apr 2021, 26 (2) 141-151; DOI: 10.17712/nsj.2021.2.20200127

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            Depression, anxiety and stress among medical and non-medical students in Saudi Arabia: An epidemiological comparative cross-sectional study
            Ahmad A. Mirza, Waleed A. Milaat, Iman K. Ramadan, Mukhtiar Baig, Soha A. Elmorsy, Ghada M. Beyari, Mohammed A. Halawani, Ruqayyah A. Azab, Meshari T. Zahrani, Nora K. Khayat
            Neurosciences Journal Apr 2021, 26 (2) 141-151; DOI: 10.17712/nsj.2021.2.20200127
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