PREVALENCE OF DEPRESSION, ANXIETY AND STRESSAMONG THE UNDERGRADUATE MEDICAL STUDENTS OF PRINCE SATTAM BIN ABDULAZIZ UNIVERSITY, ALKHARJ, SAUDI ARABIA

Sandeep Agrawal, Mohammed Yousef Aleid, Rakan Turki Alotaibi, Mustafa Mohammed Alwusaybie, Othman Mohmmed Almousa, Hosam Monahe Aldalbahi and Saad Mohammed Al-Haqbani ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

The various causes of stressin medical education have been reported to be due to academic demands, examinations, inability to cope, helplessness, increased psychological pressure, and too much work load.(3)High levels of stress may have a negative effect on cognitive functioning and studying of the academic curriculum of a medical student.In many medical schools, the environment itself can cause significant pressure among medical students due to its authoritarian and rigid system which encourages competition rather than cooperation between learners.(4,5) The estimated prevalence of emotional disturbance found in different studies on medical students was higher than that in the general population.In a British study, the prevalence of stress among medical students was found to be 31.2%(6).In comparison, a Swedish study had prevalence of depression as 12.9%, with 2.7% of students who made suicidal attempts.(7) In another study done in Saudi Arabia, the prevalence of depression, anxiety, and stress was found to be 43%, 63%, and 41%, respectively which reduced to 30%, 47%, and 30%, respectively after examinations.(8).
Stress in medical school can lead to mental health problems later in life but students seldom seek help for their problems.( 9)Medical students are a unique group as they are in many ways responsible for the health of the broader population in future and thus one might believe they should be more carefully scrutinized.It is therefore important for medical educators to know the prevalence and predictors of depression, anxiety and stress among students, which can adversely affect their physical, mental and social well-being.Sample size: All male undergraduate medical students studying at the college of medicine in Prince Sattam Bin Abdulaziz University were included in the study.(Therewereno female medical students in the university).Using 'Raosoft software' (11), with a total study population of 200 and a 5% margin of error with 95% confidence interval, the required sample size came out to be 132.

Study Population:-Inclusion Criteria:
All undergraduate medical students who gave verbal informed consent were included in the study.
Exclusion Criteria:-Following were excluded: 1. Students who couldn't be contacted after two attempts.2. Students who did not give their consent.
Study Tools:-1) A standard self-administered questionnaire DASS-21was used in this study to elicit the presence of depression, anxiety and stress in the study population.(10) The Depression Anxiety Stress Scales (DASS)-21 is a 21 item self-report instrument designed to measure the three related negative emotional states of depression, anxiety and stress.It has 7 items each on depression, anxiety and stress.Each item has to be rated by a four-point rating scale.The rating scale is as follows: 0 Did not apply to me at all -NEVER 1. Applied to me to some degree, or some of the time -SOMETIMES 2. Applied to me to a considerable degree, or a good part of time -OFTEN 3. Applied to me very much, or most of the time -ALMOST ALWAYS The final scoring is done by adding 7items (and multiplying by 2) each of depression, anxiety and stress and they subsequently are categorized as normal, mild, moderate, severe and extremely severe according to scoring shown below.The DASS-21 is in public domain and no permission is needed to use it.It has high internal consistency.DASS-21 was translated to Arabic language and then translated back to English for validation and was further validated by three consultant physicians.A semi-open ended and self-prepared questionnaire was used in study for (A) socio demographic details, (B) identifying the factors associated with depression, anxiety and stress.

Dass
The information collected was kept confidential and anonymity is maintained.

Sampling Procedure and Data Collection:-
A written permission was obtained from the Dean of the college of medicine prior to conducting the study.The total number of enrolled medical students was found to be 200.The pilot testing was done in 10 undergraduate medical students 2 students from each academic level but this was not included in the final collected data.The students were personally contacted by the researcher.The standard questionnaire DASS-21and another self-prepared questionnaire was handed over to the respondents for filling up andwere collected in the same visit.The responses were sought in a self-reported, anonymous fashion.Eventually data was collected from 185 medical students out of 200.Five students either did not give their consent or were unavailable during data collection.

Ethical Considerations:-
A written permission was obtained from the dean of college of medicine prior to conducting the study.Verbal informed consent was taken from each respondent before providing the questionnaire for filling up.IRB permission was also taken with IRB No. PSAU-MED-2015-12/14/PI Statistical Analysis:-The information collected on the tools was transferred to a Microsoft Excel Sheet to make a master chart of the whole data.Subsequently analysis of the data was done on the SPSS software version 20.Appropriate statistical testincluding the chi-square testwas applied(categorical data)to find association of various factors with depression, anxiety and stress.p -value less than 0.05 was considered significant.

Results:-
Out of total 200 medical students and the required sample size of 132, data was finally collected from 185 students.
The mean age of the study population was found to be 21.5 years with a standard deviation of 1.5.The majority of the students were single and more than half of them declare themselves as nonsmokers.The socio-demographic details of the study population are shown in Table 1.The overall prevalence of Depression, Anxiety and Stress among the medical students was found to be 39.5%, 56.2% and 37.2% respectively.The results have been shown it Table 2, 3 and 4. It was found in our study that there was an association between the academic year and depression levels.It can be seen from Figure 1that the depression (p=0.048)wasmore prevalent in the early and later academic years and this difference in academic years was found to be significant.It was also seen that stress was significantly low in the 4th year in comparison to other academic years (p=0.033).On being enquired, the students told that spending time with friends, watching television and playing sports were the major de-stressing activities adopted by them.Listening to music, doing meditation and self-medication were some other strategies adopted by them as shown inFigure 3.

Objectives:- Materials and Methods:- Study period: The study was carried out between September 2015 and December 2015. Study Area: University Campus, College of Medicine, Prince Sattam Bin Abdulaziz University. Study Subjects:Male undergraduate medical students. Study design: Cross-sectional study.
Few similar studies have been carried out in Saudi Arabia but none in Alkharj region.So there was need to assess the prevalence of Depression, Anxiety and Stress among the undergraduate medical students studying at Prince Sattam Bin Abdulaziz University of Alkharj.

Table 1 :
-Socio Demographic Details of The Study Population.

Table 2 :
-Prevalance Of Depression among Study Population.

Table 3 :
-Prevalence Of Anxiety among Study Population.

Table 4 :
-Prevalence Of Stress among Study Population.

Table 5 :
-Association Of Depression, Anxiety And Stress With Living With Family.

Table 5 ,
it was found that the students living with their families had lower levels of stress in comparison to students living without their families (p=0.040).

Table 6 :
-Association of Depression, Anxiety And Stress With Smoking.
It was concluded from this cross-sectional study that 1.The prevalence of Depression, Anxiety and Stress among undergraduate medical students was found to be 39.5%, 56.2% and 37.2% respectively.2. Academic stress, academic hours & emotional statewere the major reasons causing stress among undergraduate medical students.3. Spending time with friends, watching television and playing sportswere the major de-stressing activities among undergraduate medical students.