Psychological disorders and coping strategies among undergraduate medical students during the COVID-19 pandemic in Brazil

Mendes, Tâmaro Chagas; Dias, Ana Catarina Perez

doi:10.1590/1981-5271v46.3-20220061.ING

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Revista Brasileira de Educação Médica

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ORIGINAL ARTICLE • Rev. bras. educ. med. 46 (3) • 2022 • https://doi.org/10.1590/1981-5271v46.3-20220061.ING copy

Psychological disorders and coping strategies among undergraduate medical students during the COVID-19 pandemic in Brazil

Transtornos mentais e estratégias de enfrentamento entre estudantes de medicina durante a pandemia da covid-19 no Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Introduction:

Medical students are commonly considered a vulnerable public to the emergence of mental disorders. In the COVID-19 pandemic context, recent evidence suggests that the COVID-19 crisis may have affected the medical student’s mental health.

Objective:

We aimed to investigate the prevalence of depression, anxiety, and stress symptoms in undergraduate medical students, the associated factors, and the relationship between coping strategies and psychological symptoms during the COVID-19 pandemic period.

Method:

This is a cross-section study with 141 undergraduate medical students from a public medical school in Brazil. The student’s mental health was assessed with the Depression, Anxiety and Stress Scale (DASS-21) and the coping strategies were assessed with the Brief Coping Orientation to Problems Experienced inventory (Brief COPE). Data were collected from December 1, 2020, to February 28, 2021, through the Google Form platform. Descriptive analysis, chi-square, multivariate Poisson regression, and Spearman’s correlation were performed.

Result:

Regarding the students’ mental health, 78 (55.3%; 95%CI: 47.1-63.3) were categorized as having depression symptoms, 71 (50.4%, 95%CI: 42.2-58.5) as having anxiety symptoms, and 86 (61%; 95%CI: 52.8-68.7) as having stress symptoms. About the associated factors, skin color/race had an association with depression and stress, year of the course had an association with stress only, history of psychological/psychiatry treatment had an association with anxiety and stress and self-rated mental health had an association with depression, anxiety, and stress. In relation to the coping strategies, problem-focused strategies had no significant correlations with depression, anxiety, and stress. Emotion-focused strategies had a weak negative correlation with depression only. Avoidance strategies had a moderate positive correlation with depression, anxiety, and stress.

Conclusion:

Overall, our results show high prevalence rates of depression, anxiety, and stress in Brazilian undergraduate medical students and the significant relationship between coping strategies and the presence of psychological impairment during the COVID-19 pandemic.

Keywords:
Medical students; Mental Health; Health Profile; Coping Strategies and COVID-19

	Depression		Anxiety		Stress
Category	n	% (95%CI)	n	% (95%CI)	n	% (95%CI)
Normal-Mild	63	44.7 (36.7-52.9)	70	49.6 (41.5-57.8)	55	39 (31.3-47.2)
Moderate-Extremely severe	78	55.3 (47.1-63.3)	71	50.4 (42.2-58.5)	86	61 (52.8-68.7)
Level
Normal	44	31.2 (24.1-39.3)	61	43.2 (3.35-51.5)	39	27.7 (20.9-35.6)
Mild	19	13.5 (8.8-20.1)	9	6.3 (3.3-11.7)	16	11.3 (7.1-17.6)
Moderate	31	22 (15.9-29.5)	16	11.3 (7.1-17.6)	21	14.9 (9.9-21.7)
Severe	16	11.3 (7.1-17.6)	15	10.6 (6.5-16.8)	31	22 (15.9-29.5)
Extremely severe	31	22 (15.9-29.5)	40	28.3 (21.5-36.3)	34	24.1 (17.8-31.8)

Variables	Depression			Anxiety			Stress
	Normal-Mild	Moderate-Extremely Severe	p	Normal-Mild	Moderate-Extremely Severe	p	Normal-Mild	Moderate-Extremely Severe	p
	N (%)	N (%)		N (%)	N (%)		N (%)	N (%)
Age
18-24	40 (46.5)	46 (53.5)	0.585	44 (51.2)	42 (48.8)	0.652	35 (40.7)	51 (59.3)	0.607
Over 24	23 (41.8)	32 (58.2)	0.585	26 (47.3)	29 (52.7)	0.652	20 (36.4)	35 (63.6)	0.607
Gender
Female	37 (44)	47 (56)	0.854	40 (47.6)	44 (52.4)	0.559	33 (39.3)	51 (60.7)	0.934
Male	26 (45.6)	31 (54.4)	0.854	30 (52.6)	27 (47.4)	0.559	22 (38.6)	35 (61.4)	0.934
Skin color/race
Brown/black	26 (35.6)	47 (64.4)	0.025	31 (42.5)	42 (57.5)	0.077	21 (28.8)	52 (71.2)	0.010
White	37 (54.4)	31 (45.6)	0.025	39 (57.4)	29 (42.6)	0.077	34 (50)	34 (50)	0.010
Family income
≤ 5 MW^a a MW: Minimum Wage per month (BRL $1.100.00 or approximately US$ 197.11).	35 (44.9)	43 (55.1)	0.990	38 (48.7)	40 (51.3)	0.968	29 (37.2)	49 (62.8)	0.663
> 5 to 10 MW	22 (44.9)	27 (55.1)		25 (51)	24 (49)		19 (38.8)	30 (61.2)
>10 MW	6 (42.9)	8 (57.1)		7 (50)	7 (50)		7 (50)	7 (50)
Close person (relative, friend, boyfriend, etc.) with COVID-19
Yes	46 (47.9)	50 (52.1)	0.259	46 (47.9)	50 (52.1)	0.549	38 (39.6)	58 (60.4)	0.838
No	17 (37.8)	28 (62.2)	0.259	24 (53.3)	21 (46.7)	0.549	17 (37.8)	28 (62.2)	0.838
Year at medical school
First years	32 (42.1)	44 (57.9)	0.506	37 (48.7)	39 (51.3)	0.805	23 (30.3)	53 (69.7)	0.021
Final years	31 (47.7)	34 (52.3)	0.506	33 (50.8)	32 (49.2)	0.805	32 (49.2)	33 (50.8)	0.021
Attended classes online
Yes	41 (41.4)	58 (58.6)	0.231	48 (48.5)	51 (51.5)	0.672	35 (35.4)	64 (64.6)	0.172
No	22 (52.4)	20 (47.6)	0.231	22 (52.4)	20 (47.6)	0.672	20 (47.6)	22 (52.4)	0.172
Study routine
Never	6 (24)	19 (76)	0.066	9 (36)	16 (64)	0.266	7 (28)	18 (72)	0.342
Rarely	25 (43.1)	33 (56.9)		32 (55.2)	26 (44.8)		22 (37.9)	36 (62.1)
Occasionally	24 (57.1)	18 (42.9)		19 (45.2)	23 (54.8)		17 (40.5)	25 (59.5)
Frequently	8 (50)	8 (50)		10 (62.5)	6 (37.5)		9 (56.3)	7 (43.8)
Social distancing
Yes	51 (48.6)	54 (51.4)	0.113	52 (49.5)	53 (50.5)	0.961	44 (41.9)	61 (58.1)	0.228
No	12 (33.3)	24 (66.7)	0.113	18 (50)	18 (50)	0.961	11 (30.6)	25 (69.4)	0.228
History of psychological/psychiatric treatment
Yes	28 (38.9)	35 (50.7)	0.158	27 (37.5)	45 (62.5)	0.003	21 (29.2)	51 (70.8)	0.014
No	44 (61.1)	34 (49.3)	0.158	43 (62.3)	26 (37.7)	0.003	34 (49.3)	35 (50.7)	0.014
Self-rated mental health
Worse	33 (35.5)	60 (64.5)	0.001	37 (39.8)	56 (60.2)	0.001	28 (30.1)	65 (69.9)	0.003
Neither worse nor better	26 (70.3)	11 (29.7)		28 (75.7)	9 (24.3)		23 (62.2)	14 (37.8)
Better	4 (36.4)	7 (63.6)		5 (45.5)	6 (54.5)		4 (36.4)	7 (63.6)

Variable	Depression		Anxiety		Stress
Variable	PR^a a PR: Prevalence Ratio (95%CI)	Adj. PR^b b Adj. PR: Adjusted Prevalence Ratio (95%CI)	PR (95%CI)	Adj. PR (95%CI)	PR (95%CI)	Adj. PR (95%CI)
Age	0.55 (0.47-0.63)		0.97 (0.93-1.0)	0.96 (0.92-1.00)	0.96 (0.93-0.99)*	0.96 (0.92-0.99)
Gender
Female	1.02 (0.76-1.40		1.10 (0.79-1.56)		0.98 (0.75-1.30)
Male	1		1		1
Skin color/race
White	1	1	1	1	1	1
Brown/black	1.41 (1.04-1.92)*	1.46 (1.07-2.01)*	1.39 (0.96-1.89)	1.31 (0.93-1.85)	1.42 (1.08-1.87)*	1.43 (1.08-1.89)*
Family income
≤ 5 MW^c c MW: Minimum Wage per month (BRL $1.100,00 or approximately US$ 197,11).	1		1		1
> 5 to 10 MW	1.0 (0.71-1.37)		0.95 (0.66-1.36)		0.97 (0.72-1.29)
> 10 MW	1.03 (0.60 -1.68)		0.97 (0.52-1.66)		0.79 (0.46-1.27)
Close person (relative, friend, boyfriend, etc.) with COVID-19
Yes	1		1		1
No	1.19 (0.87-1.62)		0.89 (0.61-1.27)		1.03 (0.77-1.36)
Year at medical school
First years	1		1		1	1
Final years	0.90 (0.66-1.22)		0.95 (0.68-1.33)		0.72 (055-0.95)*	0.87 (0.64-1.17)
Attended classes online
Yes	1.23 (0.88-1.75)		1.08 (0.75-1.57)		1.23 (0.91-1.68)	1.17 (0.84-1.63)
No	1		1		1	1
Study Routine
Never	1	1	1	1	1	1
Rarely	0.74 (0.51-1.10)	0.78 (0.52-1.16)	0.70 (0.45-1.10)	0.74 (0.47-1.17)	0.86 (0.60-1.24)	0.90 (0.61-1.32)
Occasionally	0.56 (0.36-0.87)*	0.54 (0.34-0.84)**	0.85 (0.54-1.36)	0.76 (0.48-1.22)	0.82 (0.56-1.22)	0.74 (0.49-1.11)
Frequently	0.65 (0.36-1.13)	0.68 (0.37-1.19)	0.58 (0.28-1.11)	0.59 (0.29-1.13)	0.60 (0.34-1.03)	0.60 (0.33-1.05)
Social distancing
Yes	0.77 (0.56-1.07)	0.82 (0.59-1.16)	1.01 (0.69-1.49)		0.83 (0.62-1.12)
No	1	1	1		1
History of psychological/psychiatric treatment
Yes	1.24 (0.91-1.68)	1.30 (0.95-1.77)	1.65 (1.18-2.35)**	1.73 (1.23-2.46)**	1.39 (1.06-1.83)*	1.44 (1.09-1.91)*
No	1	1	1	1	1	1
Self-rated mental health
Worse	1	1	1		1	1
Neither worse nor better	0.46 (0.29-0.69)***	0.48 (0.30-0.74)**	0.40 (0.23-0.64)**	0.43 (0.25-0.69)**	0.54 (0.37-0.76)**	0.58 (0.39-0.83)*
Better	0.98 (0.55-1.61)	0.95 (0.52-1.62)	0.90 (0.47-1.58)	0.92 (0.47-1.64)	0.91 (0.53-1.44)	1.03 (0.60-1.68)

Coping strategies	Overall M (SD)	Depression M (SD)	Anxiety M (SD)	Stress M (SD)
Problem-focused	16.5 (3.69)	16.4 (3.95)	16.8 (3.78)	16.7 (3.95)
Planning	6.09 (1.40)	6.12 (1.49)	6.08 (1.46)	6.17 (1.46)
Active coping	5.66 (1.60)	5.32 (1.67)	5.61 (1.57)	5.53 (1.61)
Instrumental support	4.74 (1.72)	4.92 (1.79)	5.14 (1.80)	5.03 (1.79)
Emotion-focused	25.2 (5.19)	24 (5.43)	24.9 (6.09)	24.7 (5.72)
Acceptance	6.16 (1.55)	5.68 (1.63)	5.70 (1.66)	5.81 (1.63)
Emotional support	5.47 (1.73)	5.35 (1.70)	5.39 (1.84(	5.47 (1.79)
Positive reframing	5.40 (1.95)	5.10 (1.94)	5.58 (1.95)	5.31 (2.02)
Religion	4.95 (2.26)	4.49 (2.16)	4.87 (2.25)	4.69 (2.27)
Humor	3.24 (1.50)	3.43 (1.72)	3.34 (1.67)	3.44 (1.72)
Avoidance	26.5 (6.47)	29.8 (6.16)	29.8 (6.19)	29.3 (6.11)
Self-distraction	6.10 (1.57)	6.01 (1.70)	6.07 (1.68)	6.17 (1.64)
Venting	4.96 (1.62)	5.19 (1.52)	5.32 (1.57)	5.35 (1.58)
Self-blame	4.88 (1.83)	5.85 (1.67)	5.58 (1.74)	5.53 (1.70)
Behavioral Disengagement	4.18 (2.02)	5.17 (1.96)	5.21 (2.03)	4.84 (2.03)
Denial	2.91 (1.63)	3.36 (1.98)	3.44 (1.96	3.30 (1.92)
Substance use	3.50 (2.14)	4.18 (2.34)	4.20 (2.38)	4.09 (2.34)

Coping strategies	Depression r_s (95%CI)	Anxiety r_s (95%CI)	Stress r_s (95%CI)
Problem-focused	-0.08 (-0.24-0.08)	0.05 (-0.11-0.21)	0.05 (-0.11-0.21)
p-value	0.305	0.502	0.526
Emotion-focused	-0.29 (-0.43 - -0.13)	-0.12 (-0.27-0.04)	-0.15 (-0.30-0.01)
p-value	<0.001	0.130	0.068
Avoidance	0.68 (0.58-0.75)	0.56 (0.43-0.66)	0.66 (0.55-0.74)
p-value	<0.001	<0.001	<0.001

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[1] tamaro.mendes@ufvjm.edu.br anacatarina.dias@ufvjm.edu.br