Psychological Impact of Covid-19 Pandemic on Mental Health Among Medical Students in Malaysia
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Abstract
Introduction: The Coronavirus disease-2019 impacted the governments and public health systems worldwide, with the psychological impact including an increase in the level of stress, anxiety and depression. We determine the prevalence of depression, anxiety and stress using the Depression Anxiety Stress Scales (DASS-21), and to determine the psychological impact of COVID-19 pandemic amongst medical students in Sarawak, Malaysia using the revised Impact of Event Scale (IES-R). Methods: We analysed 355 medical student’s data obtained from an online survey. All the undergraduate medical students were the sample population. IBM SPSS version 22.0 was used for data analysis. A p-value of £.05 was considered statistically significant. Results: Analysis indicated that three-fourths of the students had no mental health issues. More than one-tenth of the students were moderately depressed (12.4%) and 4.3% severely depressed. A similar pattern of prevalence of anxiety was noted with 10% reported moderate anxiety, and 6.8% had severe anxiety. 15.8% of the students had mild stress, 4.2% moderately stressed, and 2% severely stressed. A hierarchical multiple linear regression analysis showed that hyperarousal appeared to be a predictor of depression (β=.466, p<.001), anxiety (β=.481, p<.001) and stress β=.508, p<.001). Along with hyperarousal, intrusion (β=.148, p<.05) predicts stress among the students. Conclusion: Our analysis revealed that hyperarousal symptoms related to the global pandemic of COVID-19 led to significant mental health issues among students. Therefore, urgent strategies to support the students’ psychosocial wellbeing and self-care and to strengthen their coping skills and resilience need to be implemented.
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Grupe DW, Nitschke JB. Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nat Rev Neurosci. 2013 Jul;14(7):488–501.
Shigemura J, Ursano RJ, Morganstein JC, Kurosawa M, Benedek DM. Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: Mental health consequences and target populations. Psychiatry Clin Neurosci. 2020;74(4):281–2.
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. New England Journal of Medicine [Internet]. 2020 Feb 20 [cited 2020 Jun 13];382(8):727–33. Available from: https://doi. org/10.1056/NEJMoa2001017
Lipsitch M, Swerdlow DL, Finelli L. Defining the Epidemiology of Covid-19 — Studies Needed. New England Journal of Medicine [Internet]. 2020 Mar 26 [cited 2020 Jun 13];382(13):1194–6. doi:10.1056/NEJMp2002125
WHO. WHO Director-General’s opening remarks at the media briefing on COVID-19 [Internet]. 2020 [cited 2020 Apr 18]. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19 11-march-2020
WHO. China national experts share COVID-19 experiences with international community [Internet]. 2020 [cited 2020 Apr 15]. Available from: https://www.who.int/china/news/detail/12-03-2020-china-national-experts-share-covid-19-experiences-with-international-community
Prime Minister’s Office of Malaysia. Restriction of Movement Order, 2020 [Internet]. Prime Minister’s Office of Malaysia. 2020 [cited 2020 Apr 15]. Available from: https://www.pmo.gov.my/2020/03/movement-control-order/
Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research [Internet]. 2020 Mar 20 [cited
Apr 13];112934. Available from: http://www.sciencedirect.com/science/article/pii/S0165178120305400
Xiao C. A Novel Approach of Consultation on 2019 Novel Coronavirus (COVID-19)-Related Psychological and Mental Problems: Structured Letter Therapy. Psychiatry Investig [Internet]. 2020 Feb 25 [cited 2020 Apr 14];17(2):175–6. Available from: http://www.psychiatryinvestigation.org/journal/view.php?doi=10.30773/pi.2020.0047
CDC. Coronavirus Disease 2019 (COVID-19) [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2020 Sep 15]. Available from: https://www.cdc.gov/coronavirus/2019- ncov/prevent-getting-sick/social-distancing.html
Xiang Y-T, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet Psychiatry [Internet]. 2020 Mar 1 [cited 2020 Apr 15];7(3):228–9. Available from: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30046-8/abstract
Van Droogenbroeck F, Spruyt B, Keppens G. Gender differences in mental health problems among adolescents and the role of social support: results from the Belgian health interview surveys 2008 and 2013. BMC Psychiatry [Internet]. 2018 Jan 10 [cited 2020 Apr 15];18(1):6. Available from: https://doi.org/10.1186/s12888-018-1591-4
Kvrgic S, Harhaji S, Mijatovic Jovanovic V, Ac Nikolic E, Radic I, Ccntovic S, et al. Gender Differences in Mental Health among Adult Population in Vojvodina, Serbia. Iran J Public Health [Internet]. 2013 Aug [cited 2020 Apr 16];42(8):833–41. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441914/
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet [Internet]. 2020 Feb 15 [cited 2020 Apr 18];395(10223):507–13. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30211-7/abstract
Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine [Internet]. 2020 Apr 30 [cited 2020 May 7];382(18):1708–20. doi:10.1056/NEJMoa2002032
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 15;395(10223):497–506.
McCabe D. The Impact of Event Scale - Revised (IES-R). try this:Best Practices in Nursing Care to Older Adults [Internet]. 2019;(19):1–3. Available from: https://consultgeri.org/try-this/general-assessment/issue-19.pdf
Creamer M, Bell R, Failla S. Psychometric properties of the Impact of Event Scale—Revised. Behaviour Research and Therapy [Internet]. 2003 Dec 1 [cited 2020 May 11];41(12):1489–96. Available from: http://www.sciencedirect.com/science/article/pii/S0005796703002274
Beck JG, Grant DM, Read JP, Clapp JD, Coffey SF, Miller LM, et al. The Impact of Event Scale – Revised: Psychometric properties in a sample of motor vehicle accident survivors. J Anxiety Disord [Internet]. 2008 [cited 2020 May 8];22(2):187–98. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2259224/
Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales [Internet]. 2nd ed. Sydney, Australia: Psychology Foundation of Australia; 1995 [cited 2020 Apr 16]. Available from: https://trove.nla.gov.au/version/38629420
Musa R, Fadzil MA, Zain Z. Translation, validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales (DASS). Asean Journal of Psychiatry. 2007;8(2):82– 9.
Musa R, Aidid EM. Psychometric Properties of the Depression Anxiety Stress Scale 21-item (DASS-21) Malay Version among a Big Sample Population of Non-Malays in Malaysia. Malaysian Journal of Psychiatry [Internet]. 2020 Mar 23 [cited 2020 Jun 12];29(1). Available from: https://www.mjpsychiatry.org/index.php/mjp/article/view/525
Shamsuddin K, Fadzil F, Ismail WSW, Shah SA, Omar K, Muhammad NA, et al. Correlates of depression, anxiety and stress among Malaysian university students. Asian Journal of Psychiatry [Internet]. 2013 Aug 1 [cited 2020 Jun 12];6(4):318–23. Available from: http://www.sciencedirect.com/ science/article/pii/S1876201813000592
IBM Corp. IBM SPSS Statistics for Windows, Version 20.0. IBM Corp [Internet]. 2013 [cited 2019 Mar 12]; Available from: https://www.researchgate.net/publication/281345377_IBM_SPSS_statistics_for_windows_version_200
Garson GD. Testing Statistical Assumptions. 1st ed. North Carolina State University: Statistical Associates Publishing, USA; 2012. 53 p.
Garson GD. Multiple Regression. 1st ed. Asheboro, NC: Statistical Associates Publishers; 2014. 32 p.
Laerd. How to perform a Multiple Regression Analysis in SPSS Statistics | Laerd Statistics [Internet]. 2019 [cited 2020 Feb 23]. Available from: https://statistics.laerd.com/spss-tutorials/multiple-regression-using-spss-statistics.php
Sharma A. Understanding Mahalanobis Distance And Its Use Cases [Internet]. Analytics India Magazine. 2018 [cited 2019 Jun 10]. Available from: https://www.analyticsindiamag.com/understanding-mahalanobis-distance-and-its-use-cases/
Gray JB, Woodall WH. The Maximum Size of Standardized and Internally Studentized Residuals in Regression Analysis. The American Statistician [Internet]. 1994 [cited 2020 Feb 11];48(2):111–3. Available from: https://www.jstor.org/stable/2684258
Frost J. How to Interpret Adjusted R-Squared and Predicted R-Squared in Regression Analysis [Internet]. Statistics By Jim. 2017 [cited 2020 Feb 11]. Available from: http://statisticsbyjim.com/regression/interpret-adjusted-r-squared-predicted-r-squared-regression/
Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry [Internet]. 2002 Feb [cited 2020 May 21];1(1):16–20. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/
Arumugam T. Higher Education students to receive one-off RM200 each [Internet]. NST Online. 2020 [cited 2020 May 21]. Available from: https://www.nst.com.my/news/nation/2020/03/578700/higher-education-students-receive-one-rm200-each
Rafidi R. Special needs students face hurdles in e-learning. News Strait Times Online [Internet]. 2020 May 6 [cited 2020 May 21];1. Available from: https://www.nst.com.my/education/2020/05/590453/special-needs-students-face-hurdles-e-learning
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. International Journal of Environmental Research and Public Health [Internet]. 2020 Jan [cited 2020 Apr 15];17(5):1729. Available from: https://www. mdpi.com/1660-4601/17/5/1729
Amr M, El Gilany AH, El-Hawary A. Does Gender Predict Medical Students’ Stress in Mansoura, Egypt? Taylot & Francis Online [Internet]. 2009 Dec 9 [cited 2020 May 20];13(1). Available from: https://www.tandfonline.com/doi/abs/10.3402/meo.v13i.4481
Doheny K. COVID-19 & Household Spread: How Likely? [Internet]. WebMD. [cited 2020 Sep 11]. Available from: https://www.webmd.com/lung/news/20200430/covid-19-household-spread-how-likely
Scher CD, McCreary DR, Asmundson GJG, Resick PA. The structure of post-traumatic stress disorder symptoms in three female trauma samples: A comparison of interview and self-report measures. Journal of Anxiety Disorders [Internet]. 2008 Oct [cited 2020 May 20];22(7):1137–45. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0887618507002101
Stordal E, Bjartveit Kruger M, Dahl NH, Kruger O, Mykletun A, Dahl AA. Depression in relation to age and gender in the general population: the Nord- Trondelag Health Study (HUNT). Acta Psychiatr Scand. 2001 Sep;104(3):210–6.
Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin. 2017 Aug;143(8):783–822.
Pérez LG, Abrams MP, López-Martínez AE, Asmundson GJG. Trauma exposure and health: the role of depressive and hyperarousal symptoms. J Trauma Stress. 2012 Dec;25(6):641–8.
Taylor S. The Psychology of Pandemics: Preparing for the Next Global Outbreak of Infectious Disease. [Internet]. 1st ed. Newcastle upon Tyne: Cambridge Scholars Publishing, UK; 2019 [cited 2020 May 22]. 188 p. Available from: http://link. springer.com/10.1007/978-3-030-15346-5
Lenze EJ, Wetherell JL. A lifespan view of anxiety disorders. Dialogues Clin Neurosci. 2011 Dec;13(4):381–99.
Rudolph KD, Hammen C. Age and gender as determinants of stress exposure, generation, and reactions in youngsters: a transactional perspective. Child Dev. 1999 Jun;70(3):660–77.
Stephenson KL, Valentiner DP, Kumpula MJ, Orcutt HK. Anxiety Sensitivity and Posttrauma Stress Symptoms in Female Undergraduates Following a Campus Shooting. J Trauma Stress [Internet]. 2009 Dec [cited 2020 May 22];22(6):489–96. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2798915/
Thakur A, Creedon J, Zeanah CH. Trauma- and Stressor-Related Disorders Among Children and Adolescents. Focus (Am Psychiatr Publ) [Internet]. 2016 Jan [cited 2020 May 22];14(1):34–45. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6524445/
Blunt J. Hyperarousal: the Critical Determinant of Post-Trauma Sequelae [Master’s Thesis]. [Australia]: The University of Adelaide; 2016.