Studies have shown that the strain skilled by medical students is way larger than that skilled by different university students. during this study, we have a tendency to aim to grasp the ensuing mental state problems that square measure skilled by medical students, significantly in Asia, via a scientific review of the present literature.
Methods
Initial searches on MEDLINE, Embase and SpringerLink came up with a complete of one,033 distinctive articles. Studies not specializing in medical students alone, not mentioning mental state problems or not containing prevalence values were excluded.
Results
We enclosed fourteen articles in our analysis. ADs had a prevalence of seven.04% (100/1,420). Depression was prevailing in eleven.0% (1,115/10,147) of scholars. a complete of twelve.9% (54/420) and twelve.9% (41/319) of male and feminine medical students severally were screened for depression. hostel stayers.
Conclusions
We found that mental state problems have an effect on a big proportion of medical students and that they square measure additional prevailing in sure subpopulations of medical students. additional analysis ought to be done relating to this issue. With such data, it's hoped that applicable interventions is designed to enhance the mental state of medical students.
Keywords: mental state problems, medical students, graduate school, Asia, prevalence, general review
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Introduction
One of the most functions of medical colleges is to coach physicians to satisfy the tending desires of current and future national populations (1,2). this is often typically achieved through arduous coaching course of study and programmes during which high levels of motivation, intelligence and stamina square measure expected. In fact, the entire expanse of skilled data and skills nonheritable by medical students is larger than that of scholars from different majors (3,4). this is often exacerbated by the actual fact that people aged between 18–24 years elderly square measure significantly in danger of developing mental disorders like major emotional disturbance (MDD), anxiety disorders (ADs) and psychiatrical comorbidity (5-7). As a consequence, stress levels and therefore the extent of emotional disturbances amongst medical students is high (8-10). Studies have conjointly shown that mental state issues square measure higher amongst university students as compared to their peers (11-13). additional analysis ought to be done relating to this issue. With such data, it's hoped that applicable interventions is designed to enhance the mental state of medical students.
Within Asia, there square measure varied medical education systems (21). at the start having adopted their ancient education systems from their previous Western colonial leaders like the uk, the US, European nation and France, there are important medical education reforms inside Asian countries thus on prepare physicians to satisfy the distinctive cultural and tending desires of native communities inside the continent (22,23). As such, the present state of medical education in Asia differs in sure areas compared to Western medical education. Thus, the various curricula place separate demands and expectations upon medical students. this might probably lead to distinct incidence and prevalence statistics of mental state problems amongst medical students in Asian medical colleges.
Objective
Two previous systematic reviews through with papers from the u. s. of America (USA), and therefore the uk (UK) and different communicative countries severally, showed that North yankee and different medical students square measure additional depressed and anxious than their peers. but there's a scarcity of analysis synthesis focusing entirely on Asian medical students (8,24). Consequently, the target of this study is to perform a scientific review of papers that have studied mental state problems amongst Asian medical colleges thus on determine the prevalence of mental state issues amongst medical students inside Asia. we have a tendency to hope that the synthesised data obtained will bring around lightweight the severity of mental state problems inside Asian universities, and consequently lead to psychological interventions inside universities thus on improve the mental state of medical students.
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Methods
Identification of studies
Our study targeted on the incidence and prevalence of mental state problems in Asian medical colleges.A total of one,033 distinctive records were obtained and their titles and abstracts were reviewed so as to exclude tangential studies; articles in English and with sufficiently elaborate English abstracts were enclosed, articles not associated with graduate school or medical students were excluded. probably relevant abstracts were assessed and relevant articles were downloaded and their entire texts assessed. The references cited by every probably relevant paper and papers instructed by databases, like Elsevier, were conjointly assessed for relevance; ninety four probably relevant abstracts were assessed and forty seven full text articles downloaded (Figure 1).
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Figure 1
PRISMATM diagram of the choice of studies for the systematic review.
Internet behaviour
Abramovitch et al., 2000 (37) Israel 1st Year Medical Students in Tel Aviv-Jaffa University, Israel 25.8±2.3037 seventy one one hundred Mean age: twenty five.8 (23–27); sex magnitude relation (m/f) (69.6/30.4); faith (Jewish:other eighty nine.2:10.8) 27.9%, 10.4% United Nations agency drank over ten drinks/week nineteen.7%, 40.0% of whom preserved over ten cigarettes/day metallic element
Chan et al., 2007 (38) Singapore Medical students from the Yong lavatory sculptor faculty of medication, National University of Singapore 17–25 909 eighty fifth (909/1,069) Males hour, females four-hundredth seven.7% (more than four drinks a week) one.5% NA
37.7%, total: 62.4% NA NA
Khan et al., 2006 (28) city, Asian nation Agha Khan University twenty one.3±1.88 Agha Khan University Anxiety and Depression Scale (AKUADS) 142 Over ninetieth metallic element twenty one.8% NA
Rodrigo et al., 2011 (40) Democratic Socialist Republic of Sri Lanka Medical Students, University of capital of Sri Lanka, Democratic Socialist Republic of Sri Lanka twenty two.7 503 Unclear Males: forty eight.7%, females: fifty one.3% metallic element metallic element twenty seven.6%. 40.6%: viewing on-line creative activity, 6%: used the net to attack someone or a bunch. 4.4%: concerned in on-line dishonorable money activities. 14%: overuse thirty four.6%: had been told by parents/teachers/peers that their net use was an excessive amount of. 6%: believed that they have skilled facilitate to beat
Shaikh et al., 2004 (41) Asian nation collegian medical students of all 5 years in a very medical school in city 17–25 twenty one 264 half a mile (264/300) fifty two.3% 138 were males, 47.7% 126 were females. 136 day students (51.5%), 128 (48.5%) were hostellites. Those on college’s money help were forty one.3% NA 6.44% NA
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Table 5Reference (first author) Study location Study population age bracket of subjects (Y) Assessment tool Sample size Response rate Subject characteristics Prevalence of body dysmorphic disorder
Liao et al., 2010 (34) China hand year medical students from Central South University (Hunan Province, Changsha City) 16–21 Cross-sectional, descriptive survey design; BSQ, SMAQ, DCQ, BDDQ 487 students ninety seven.4% (487/500) 306 females (62.8%) and 181 males (37.2%) 1.3%
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Table 6
Prevalence of self-destructive thoughts in medical students
Reference (first author) Study location Study population age bracket of subjects (Y) Sample size Response rate Subject characteristics Prevalence of self-destructive mentation
Ahmed et al, 2009 (30) Dubai, UAE Students of Dubai Medical school for ladies (DMCG) Unclear a hundred sixty five 100% feminine medical students three-d of depressed patients (0.858% of total study population)
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Depression
Data on depression was found in 9/30 studies, with a pooled prevalence of eleven.0% (1,115/10,147) of scholars. Students were screened for depression victimisation seven completely different tools (Table 1). The 9 studies were from East Asia, South Asia and therefore the Near East (28-36).
Two studies classified depression supported gender, showing no vital distinction between the prevalence for male and feminine students, 12.9% (54/420) and twelve.9% (41/319) for male and feminine medical students severally.
The odds of presymptomatic students having being screened for depression was one.63 times higher compared to clinical students.Home staying medical students had a one.33 times higher odds to be depressed compared to hostel-stayers, with 12.1% (29/239) of home stayers being depressed compared to nine.2% (37/402) of hostel stayers.19 Unclear metallic element twenty nine.4%
Taha et al., 2012 (33) Asian country Male presymptomatic (from 1st to fourth year) Medical Students, school of medication, University of Dammam, Asian country 15–30 (20.21±1.46) valid Arabic version of “Influence of finding out on Students’ Health” (ISSH) form 363 male medical students eighty five.4% (363/425) 169 (37.1%) students don't study in their own town. 21.5% share rooms with different medical students. Majority of scholars (70.2%) digest their folks thirty-nine.4%
Yang et al., 2014 (35) China 1st to fifth year medical undergraduates in Huazhong University of Science and Technology, China one7–24 Symptoms listing ninety (SCL-90) 1,137 98.9% (1,137/1,150) 624 males, 513 females; fifty nine pre-clinical students (671/1,137) 2.02% (36)
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Table 4
Prevalence of header mechanisms in medical students
Reference Study location Study population age bracket of subjects (Y) Sample size Response rate (%) Subject characteristics Prevalence of alcohol consumption addiction = over twenty one drinks/week Prevalence of butt use
Included studies
Thirty studies written in English and revealed between Gregorian calendar month 2000 until Gregorian calendar month 2015, rumored primary knowledge on the incidence and prevalence of mental disorders (according to numerous diagnostic criteria, like the motion Depression Inventory or motion Anxiety Inventory) from a population or sub-population of medical students in Asian countries (25,26). Out of those thirty studies, fourteen were enclosed within the final qualitative synthesis.
Data extraction
Once a study was enclosed, the info relevant to the study-level variables (first author, year of publication, country of study, diagnostic criteria) were noted. The studies were then given points in keeping with the Joanna-Briggs Institute Prevalence assessment Tool for rate-related variables (27). 2 freelance authors (ANC and AAS) assessed all the chosen papers employed in this analysis and disagreements were resolved by accord. Studies were enclosed for (qualitative synthesis) if there was a accord between the 2 authors if the quantity of points (‘Yes’) were quite half dozen out of ten points.
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Results
Fourteen full text articles, with 13,111 participants, were enclosed during this study. This systematic review targeted on depression, anxiety, common brick mechanisms, body dysmorphic disorders and its associated uptake disorders, and unsafe ideations among medical students. The assessment tools employed in every study square measure compiled in Table one.
Table 1
Tools wont to assess student’s mental state
Assessment tool Abbreviation range of studies
Depression
Aga Khan University Anxiety and Depression Scale AKUADS one (28)
Beck depression Inventory BDI three (29-31)
Hospital Anxiety and Depression Scale HADS one (32)
Influence of finding out on Students' Health ISSH one (33)
Self-Rating Depression Scale SDS one (34)
Symptoms list ninety SCL-90 one (35)
Zung Depression Scale ZDS one (36)
Anxiety
Aga Khan University Anxiety and Depression Scale AKUADS one (28)
Beck Anxiety Inventory Bai two (30,31)
Hospital Anxiety and Depression Scale HADS one (32)
Influence of finding out on Students’ Health ISSH one (33)
Symptoms list ninety SCL-90 one (35)
Body Dysmorphic Disorder (1 study with multiple tools)
Body form form BSQ one (34)
Swansea Muscularity Attitudes form SMAQ one (34)
Dysmorphic Concern form DCQ one (34)
Body Dysmorphic Disorder form BDDQ one (34)
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Nine studies (Table 2) evaluated depression among medical students, with associate degree mixture prevalence of eleven.0%. ADs had associate degree mixture prevalence of seven.04%, supported knowledge from six studies (Table 3). brick mechanisms within the type of alcohol use, butt smoking and problematic web behaviors were mentioned in three, four and one study severally (Table 4). One study and its 2-year follow-up enclosed body dysmorphic disorder and disordered uptake attitudes among medical students, however the prevalence for each of those problems was low, I Chronicles and a pair of severally (Table 5). The prevalence of unsafe ideations was rumored in one study, with third-dimensional of medical students having such ideations (Table 6); none of the scholars were rumored to possess tried suicide within the study.
Table 2
Prevalence of depression in medical students
Reference Study location Study population age bracket Assessment tool Sample size Response rate (%) Subject characteristics Prevalence of depression
Ahmed et al., 2009 (30) port, UAE Students of port Medical school for ladies (DMCG) Unclear BDI a hundred sixty five 100 percent feminine medical students twenty eight.6%
Basnet et al., 2012 (36) Kingdom of Nepal B. P. Koirala Institute of Health Sciences twenty one.18±1.65; range, 18–26 y Zung depression scale ninety four ninety four (94/100) fifty seven were males and thirty seven females twenty nine.78%
El-Gilany et al., 2008 (32) Kingdom of Saudi Arabia, Egypt school of drugs in Al-Hassa, King Faisal University, Kingdom of Saudi Arabia Mean age: twenty one.0±1.9 y Hospital Anxiety and Depression Scale (HAD) 284 eighty one.6% (284/348) All males sixteen.20%
Khan et al., 2006 (28) urban center, Asian nation title Khan University. All medical students WHO had spent quite half dozen months within the establishment and failed to have any physical health problem twenty one.3±1.88 y Depression that was outlined as a bring to an end score nineteen or higher than on title Khan University Anxiety and Depression Scale (AKUADS) 142 Over ninetieth fifty nine were females. Most of the scholars were from middle class seventieth
Liao et al., 2010 (34) China hand year medical students from Central South University (Hunan Province, Changsha City) 16–21 y Cross-sectional, descriptive survey design; SDS 487 students ninety seven.4 (487/500) 306 females (62.8%) and 181 males (37.2%) 5.6%
Lupo et al., 2011 (31) Israel Medical students from urban center University 18–37 (24.6±3.2) y Cross-sectional study. BDI 119 Unclear Na twenty five.20%
Roh et al., 2009 (29) national capital, South Korea Medical Students attending all forty one medical colleges in South Korea 18–26 y Cross-sectional study; form enclosed BDI seven,357 students fifty two.2% (7357/14095) Na nine.4% (689 students)
Taha et al., 2012 (33) Kingdom of Saudi Arabia Male presymptomatic (from initial to fourth year) Medical Students, school of drugs, University of Dammam, Kingdom of Saudi Arabia 15–30 (20.21±1.46) y valid Arabic version of “Influence of finding out on Students’ Health” (ISSH) form 363 male medical students eighty five.4% (363/425) 169 (37.1%) students don't study in their own town. 21.5% share rooms with different medical students. Majority of scholars (70.2%) brook their folks thirty one.10%
Yang et al., 2014 (35) China initial to fifth year medical undergraduates in Huazhong University of Science and Technology, China one7–24 y Symptoms list ninety (SCL-90) 1,137 98.9%1,137/1,150) 624 males, 513 females; fifty nine pre-clinical students (671/1,137) 3.17% (36)
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Table 3
Prevalence of hysteria in medical students
Reference (first author) Study location Study population age bracket of subjects (Y) Assessment tool Sample size Response rate (%) Subject characteristics Prevalence of hysteria
Ahmed et al., 2009 (30) port, UAE Students of port Medical school for ladies (DMCG) Unclear Bai a hundred sixty five 100 percent feminine medical students twenty eight.7%BAI
Anxiety Data on ADs was found in six studies with a pooled prevalence of seven.04% (100/1,420) (28,30-33,35). 5 completely different tools were wont to assess anxiety. there have been no vital variations in prevalence between genders for anxiety.
Coping mechanisms Alcohol use was current in thirty eight.7% (849/2,196) of scholars and cigaret smoking, was current in five.5% (76/1,386) of scholars within the enclosed studies (28,37-39,41). One study in Vietnam compared the distinction in alcohol use between male and feminine students (39). Male students had a a pair of.02 times higher odds to consume alcohol compared to feminine students. There was no vital distinction in genders among students UN agency smoke-cured cigarettes. Problematic net behavior was noted in twenty seven.3% (139/503) of scholars during a study exhausted country (40). The behaviors ranged from on-line porn, deceitful money transactions, cyber attacks and overuse of net. a complete of forty.6% of those students admitted to viewing and downloading on-line porn, 6 June 1944 had used it for cyber attacks and four.4% had been concerned in some variety of on-line deceitful activity. a complete of 6 June 1944 of those students believed that they required skilled facilitate to beat their behaviors. Body dysmorphic disorders A study done by among initial year medical students from Central South University (Hunan Province, Changsha City) in 2006 victimisation the Body form form (BSQ), Dysmorphic Concern form (DCQ) and Body Dysmorphic Disorder form (BDDQ) (34). One third of scholars showed a priority with some facet of their physical look, measured by the BDDQ, but solely five students out of 486, screened positive for body dysmorphic disorder; wherever they spent a major portion of your time daily pre-occupied with the looks of a piece. A third of the sample was involved with some facet of their physical look (as measured by BDDQ)—this finding is markedly not up to rates reported in alternative studies though the inclusion of weight-related considerations with their look screened positive for BDD in our study. the foremost vital correlates of dysmorphic concern for males were scores on the SIAS (anxiety) (
Anxiety
While the pooled prevalence of hysteria was seven.04%, there was a study in China with a prevalence of two.02% (35). the remainder of the studies from the center East and South Asia had prevalences from fifteen.5–70% (28-30,32). Like depression, this low prevalence in China was related to medical students having additional data compared to their different undergrad contemporaries in addition as faculties being additional ready to deal with students’ psychological state problems by partaking psychological counselors to assist students.
Suicidal intellection
The study on unsafe ideations noted that students within the UAE, whereas they did have concepts of suicide, failed to try suicide thanks to spiritual reasons. A study in Scandinavian nation showed a two.8% suicide try rate among medical students (45). it's so relevant to notice that Asian students’ religions may preclude them from working on these unsafe ideations.
Strengths
One of giantst} strengths of this study would be the actual fact that the sample size was large covering a complete of thirteen,111 participants from numerous regions in Asia, from East to South Asia and also the Near East. This range of participants is comparative to the previous systematic reviews exhausted different regions. what is more the study focussed on newer studies revealed once 2000, so being additional applicable for current medical students.
Limitations
We noted sure limitations to our systematic review. Firstly, thanks to the shortage of enough knowledge inside this literature, we have a tendency to were unable to perform a quantitative meta-analysis of the varied risk factors that may make a case for the psychological state problems amongst medical students. excluding that, there have been sure limitations to the scales utilized by the varied studies enclosed inside our systematic review. whereas the Beck’s Depression and Anxiety indexes area unit valid tools for creating the designation of depression and anxiety, sure studies used completely different cut-off values for designation these psychological state problems, so this may lead to differing prevalences seen within the completely different studies. but the BDI was utilized in solely 3 studies and also the Baic in two, thus reducing the extent of this limitation.
In addition to time period and anxiety scores, the info for the prevalence of body dysmorphic disorder and feeding disorders can be restricted by the self-reporting nature of the tools, like the BDDQ, so resulting in either AN over- or under-estimation of the particular incidence of such disorders and thus additional studies ought to be done to seek out out additional concerning however medical students area unit suffering from these problems.
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Conclusions
Mental health problems have an effect on a major proportion of medical students in Asia. whereas the prevalence of depression and anxiety area unit under world values, the high levels of motivation, intelligence and stamina expected of medical students may end up in undesirable personal and skilled consequences which might cause ultimate medico impairment. Studies have shown that medical students’ data in psychological state problems in addition as schools’ support through psychological intervention ends up in these lower prevalence rates compared to undergrad students. additional analysis ought to be done relating to this issue. With such data, it's hoped that applicable interventions will be designed to enhance the psychological state of medical students.
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