Disparities of Depression and Anxiety among Medical Students

ABSTRACT

The current study sought to assess the gender differences in relation to anxiety and depression among medical students. This cross-sectional study took a sample consisted (N=240) of medical students (males: n=104 and females: n=136) with a mean age of 22.9 years (SD=2.13). For assessment, Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were used. Data was stored and analyzed in SPSS version 2.1. Findings demonstrated that 32.4% students scored at the minimal range of depression, while 30.3% scored at mild depression level, 23.4% were at moderate level of depression, and 13.9% students scored at severe depression level. Approximately, 27.4% students scored at minimal range of anxiety, students with mild anxiety were 33.6%, and 20.3% students were at moderate anxiety level, while 18.7% students scored at severe level of anxiety. By applying independent sample t-test to determine gender differences, results demonstrated no significant gender differences in depression (p> .05). However, a significant difference was found for anxiety where male students exhibited higher levels of anxiety than females (p< .05). Moreover, depression and anxiety were significantly higher among hostelite students than day-scholars (p<.05). It was concluded that a marked number of medical students had clinically significant symptoms of depression and anxiety. The frequency was higher among hostelite students than day-scholars, and male students experienced more anxiety than female students. The study findings highlighted gender and residential presentation of the students as a risk factor of depression and anxiety among the medical students.

Keywords : anxiety, depression, medical students, mental health

*Corresponding author: [email protected]

Published: 28-06-2024

1. INTRODUCTION

Depression and anxiety are the most common mental health conditions globally (Bellos et al., 2013). According to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), persistent feelings of sadness (depressed mood), loss of interest or pleasure, diminished energy, and lack of concentration are the main symptoms of depression (American Psychiatric Association, 2013). While uncertainty, excessive worry, fear arising from anticipation, muscle tension, restlessness, irritability, increased heart rate, rapid breathing, sweating, and difficulty in concentration and sleep are the leading symptoms of anxiety (American Psychiatric Association, 2013).

Depression and anxiety are common mental health concerns affecting medical students worldwide. The demands and stressful situations encountered during medical education and training create a unique environment that significantly impacts the mental well-being of students. The academic workload, including exams, coursework, and long study hours, are linked to increased stress levels among medical students. Balancing multiple roles, such as studying, personal life, and clinical commitments, may lead towards psychological distress, depression, and symptoms associated with anxiety (Dyrbye et al., 2006). Moreover, high levels of perfectionism, characterized by unrealistic expectations and fear of failure, have been correlated with higher rates of depression and anxiety among medical students (Hu et al., 2019). However, effective coping strategies, such as emotional regulation, problem-solving, and seeking social support, may mitigate the negative impact of stressors on the mental well-being of medical students (Mosley et al., 2019). Strong support systems, including friends, family, and peers, may serve as protective factors against depression and anxiety among medical students (Houkes et al., 2011).

The ratio of mental health issues is rapidly increasing in Pakistan. Furthermore, the occurrence of depression and anxiety among Pakistani medical students has been a growing concern in recent years. Ihsan et al., 2025) found the marked prevalence of depressive symptoms among Peshawar medical students, including a lack of interest in activities (35%), sleep disturbances (35%), feelings of hopelessness (32.5%), fatigue (37.5%), and difficulty concentrating (30%). Additionally, a concerning portion (25%) reported thoughts of self-harm as well. Khan et al., 2024) reported that about 40.65% of nursing students were found to have anxiety and depressive symptoms. Jamali et al., 2024) revealed that over 59.1% of their study participants experienced anxiety, with female medical students having a higher prevalence rate than male students. The prevalence of depression among medical students was nearly 77.3% with increasing prevalence among females at 84.2% than males at 72%.

Moreover, Gul et al., 2024) found the prevalence of mixed depression and anxiety symptoms among medical students at about 19.4% with 26.2% borderline cases. However, no significant gender differences were observed. Several other studies have highlighted that the medical students are more vulnerable to develop mental health problems as compared to the general population (Rab et al., 2008; Rizvi et al., 2015).

Understanding the ratio of depression and anxiety among Pakistani medical students is crucial for several reasons. Firstly, medical education is known for its rigorous and demanding nature, which exposes students to high levels of stress. The transition from a regular undergraduate student to a medical student involves a significant increase in workload, academic pressure, and competition. This may lead to the development of mental health issues, that is, depression and anxiety. Research conducted in other countries indicated that medical students have a higher risk to experience psychological distress as compared to students in other fields (Rotenstein et al., 2016). Secondly, depression and anxiety among medical students may have severe consequences. These mental health issues could adversely affect the academic performance of medical students, increase absenteeism, decrease productivity, and even lead towards substance abuse or suicidal ideation (Pacheco et al., 2017). Furthermore, there is a need for the latest update on the occurrence and gender differences in relation to depression and anxiety among Pakistani medical students to address their mental health-related issues. By identifying the extent of the problem, healthcare institutions and policymakers may develop appropriate interventions, support systems, and policies to promote the well-being of medical students, as well as enhance their academic performance. Hence, the current study explored the frequency of depression and anxiety and gender differences among medical students in Pakistan.

Hypotheses

There is likely to be a marked frequency of depression and anxiety among medical students.
There are likely gender differences in depression and anxiety among medical students.
Hostelite students are likely to have more depression and anxiety than day-scholars.

Results

In this study, a total of 240 medical students participated. Findings demonstrated that the mean score of BDI was 22.31 with 2.10 standard deviation. Whereas, the mean score of BAI was 24.10 with a standard deviation of 3.21. The percentage of students who scored at the minimal range of depression was 32.4%, while 30.3% scored at mild depression level, 23.4% were at moderate depression level, and 13.9% students scored at severe level of depression. The percentage of students who scored at the minimal range of anxiety was 27.4%, students with mild anxiety were 33.6%, and 20.3% students were at moderate anxiety level, while 18.7% students scored at severe level of anxiety. The social demographic variables are mentioned in Table

Table 1 Social Demographic Variables (N = 240)

Baseline Characteristic	N	%
Gender
Male	104	43
Female	136	57
Family Background
Rural	139	58
Urban	101	42
Family System
Nuclear	169	70
Joint	71	30
Residential Status
Hostelite	135	56
Day-scholar	105	44
Use of any Illicit Drug
Yes	0	0
No	240	100
History of Psychiatric Illness
Yes	19	8
No	221	92

By applying independent sample t-test for gender differences, results showed no significant gender differences in depression (p>.05). However, a significant difference was found for anxiety where male students exhibited higher levels of anxiety than female students (p<.05) (see Table 2).

Table 1 Mean Comparison between Male and Female Students on Depression and Anxiety Scales (N=240)

Variable	Male		Female		t (238)	p	Cohen's d
Variable	M	SD	M	SD	t (238)	p	Cohen's d
Depression	23.35	3.43	24.22	3.34	10.20	.124	0.633
Anxiety	26.40	4.21	21.61	3.10	4.79	.012	4.132

Independent sample t-test was further performed to evaluate the residential status differences. It was found that depression and anxiety were significantly higher among hostelite students than day-scholars (p<.05) (see Table 3).

Table 1 Mean Comparison between Hostelite and Day-scholars on Depression and Anxiety Scales (N=240)

Variable	Hostelite		Day-scholar		t(238)	p	Cohen's d
Variable	M	SD	M	SD	t(238)	p	Cohen's d
Depression	25.32	4.31	20.22	3.54	6.33	.011	1.595
Anxiety	24.43	3.14	19.91	2.12	1.51	.013	1.234

Discussion

The current study found a marked number of students with depressive and anxiety symptoms. Several researches have been carried out all over the world to evaluate the occurrences of depression and anxiety among medical students. A survey on university students suggests that nearly 19.5% of students have depression, while 43.7% have clinically significant anxiety (Rab et al., 2008). The prevalence of depression was recorded at 40.9% in another study on medical students, whereas the prevalence of anxiety symptoms was found at 74.2% (Rizvi et al., 2015). The symptoms associated with depression and anxiety were present in 45.5% of university students (Hashmi et al., 2014). Whereas, Ali et al. (2014) found a greater prevalence of depression and anxiety symptoms (73.8%) among university students and male students were found to be 1.85 times more depressed than female students. Khan et al. (2006) conducted a study on medical students in Pakistan, and the prevalence of significant depression and anxiety symptoms was at 47.4% and 56.1%, respectively. However, all these figures cannot be generalized to the whole population. This is because these figures were taken from the studies conducted on small samples, ranging from 66 to as high as 715.

The current study observed a significant gender difference for anxiety where male students exhibited higher levels of anxiety than female students. It is essential to note that there is limited research specifically analyzing the causal factors of high prevalence of anxiety among male medical students than females. However, it is widely acknowledged that medical students, in general, experience higher levels of anxiety as compared to the general population. Based on existing literature, there are some common factors that contribute to higher anxiety rates among male medical students. These include societal expectations; traditional gender roles and societal expectations in our culture may cause the higher prevalence of anxiety among male medical students. Males are often associated with certain attributes, such as strength, independence, and resilience, which may create internal pressures to uphold these expectations even in the face of stressors. This may result in higher levels of anxiety as male medical students may be less comfortable seeking help or expressing emotions due to social norms and expectations (Eisler et al., 2019). Male medical students, similar to their female counterparts, face the challenge of balancing work and personal life together. However, familial responsibilities may further exacerbate the stress experienced by male students. For instance, they may have to support their family financially while simultaneously perceived to excel academically. This may lead towards increased anxiety and stress levels (Bennett et al., 2021; Hossain et al., 2023). Moreover, there is stigma surrounding mental health; in general, men may face greater stigma when it comes to seeking help for mental health issues including anxiety. Male medical students may experience similar barriers to seeking support due to the perception that asking for help or experiencing anxiety is a sign of weakness or vulnerability (Chatmon, 2020).

When comparing the residential or scholastic status, the results showed that depression and anxiety were significantly higher among hostelite students than day-scholars. There are several factors that may contribute to hostelite students experiencing more symptoms of depression and anxiety as compared to day-scholars. However, the circumstances of every individual vary, and not all hostelite students necessarily experience higher levels of depression and anxiety. Living away from home could lead towards decreased emotional support, which has been found to be a contributing factor of depression and anxiety (Mansoor & Ali, 2015). Students living in hostels often face additional stressors, such as adjusting in a new environment and managing daily tasks without familial guidance. Moreover, they may experience higher levels of academic pressure due to increased competition and the absence of parental supervision (Minchekar & Mangore, 2019; Moradi, 2008). Furthermore, hostel life can sometimes be socially isolating, as students are away from their usual social networks and may struggle to make new connections. Feelings of loneliness and social isolation have been linked to increased level of depression and anxiety (Ebesutani et al., 2015; Moeller & Seehuus, 2019).

Limitations and Suggestions

The current study was based on a small sample selected from one medical college only. There is a need to conduct large scale studies in order to figure out the prevalence and gender differences of depression and anxiety among Pakistani medical students. Furthermore, there is a need to identify several other factors contributing to the development of depression and anxiety among medical students. Moreover, it should also be explored why residing in the college dormitories is a contributing factor to self-reported depression and anxiety among students. Further studies are required to develop tailored interventions in order to address their mental health concerns.

Implications

The findings of the study can be used to understand the risk or contributing factors of anxiety and depression. In addition, these findings can be beneficial to develop interventions targeting specific stressors, enhance coping mechanisms, and provide accessible mental health resources. Educational institutions have a crucial role in promoting the mental health of medical students. For instance, awareness campaigns and workshops on stress management, self-care, and seeking help for mental health concerns, as highlighted by current findings, may help reduce the stigma associated with seeking support. Additionally, incorporating mental health education into the curriculum could provide students with the necessary knowledge and skills to prioritize their mental well-being.

Conclusion

The findings of the study highlighted that anxiety and depression are prevalent among medical students. The risk of developing clinically significant symptoms of depression and anxiety may vary across gender and residential presentation. Male students experience more anxiety than female students and the frequency of depression and anxiety is higher among hostelite students than day-scholars.

CONFLICT OF INTEREST

The author of the manuscript has no financial or non-financial conflict of interest in the subject matter or materials discussed in this manuscript

DATA AVAILABILITY STATEMENT

The data associated with this study will be provided by the corresponding author upon request.

FUNDING DETAILS

No funding has been received for this research.

REFERENCES

Ali, A., Rao, M. H., Ali, S., Ahmed, T., Safi, M., Malik, A., & Husan, B. (2014). Prevalence of anxiety and depression and their associated risk factors among engineering students in Karachi, Pakistan. International Journal of Emerging Technology and Advanced Engineering, 4(9), 52–55.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(DSM-5-TR). https://www.psychiatry.org/psychiatrists/practice/dsm

Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893–897. https://doi.org/10.1037/0022-006X.56.6.893

Beck, A. T., Steer, R. A., & Carbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77–100. https://doi.org/10.1016/0272-7358(88)90050-5

Bellos, S., Skapinakis, P., Rai, D., Zitko, P., Araya, R., Lewis, G., Lionis, C., & Mavreas, V. (2013). Cross-cultural patterns of the association between varying levels of alcohol consumption and the common mental disorders of depression and anxiety: Secondary analysis of the WHO Collaborative Study on Psychological Problems in General Health Care. Drug And Alcohol Dependence, 133(3), 825–831. https://doi.org/10.1016/j.drugalcdep.2013.08.030

Bennett, D., McCarty, C., & Carter, S. (2021). Grit, financial stress, and academic success for FGCS. Journal of Instructional Pedagogies, 26, 1–26.

Chatmon, B. N. (2020). Males and mental health stigma. American Journal of Men's Health, 14(4), 1–3. https://doi.org/10.1177/1557988320949322

Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Academic Medicine, 81(4), 354–373.

Ebesutani, C., Fierstein, M., Viana, A. G., Trent, L., Young, J., & Sprung, M. (2015). The role of loneliness in the relationship between anxiety and depression in clinical and school‐based youth. Psychology in the Schools, 52(3), 223–234. https://doi.org/10.1002/pits.21818

Eisler, R. M., Skidmore, J. R., & Ward, C. H. (2019). Masculine gender-role stress: Predictor of anger, anxiety, and health-risk behaviors. Journal of Personality Assessment, 52(1), 133–141. https://doi.org/10.1207/s15327752jpa5201_12

Ferrari, A. J., Charlson, F. J., Norman, R. E., Patten, S. B., Freedman, G., Murray, C. J., Vos, T., & Whiteford, H. A. (2013). Burden of depressive disorders by country, sex, age, and year: Findings from the global burden of disease study 2010. PLoS Medicine, 10(11), Article e1001547. https://doi.org/10.1371/journal.pmed.1001547

Gul, N., Ali, A., Rizwanullah, Khayam, Khan, M. S., Gul, F., Gul, A., Shehriyar, Ali, K., & Haseeb, S. O. (2024). Prioritizing mental health: A cross-sectional investigation of depression prevalence and risk factors among medical students in Peshawar, Pakistan. International Journal of Medical Students, 12(1), 22–28. https://doi.org/10.5195/ijms.2024.2173

Hashmi, A. M., Aftab, M. A., Naqvi, S. H., Sajjad, W., Mohsin, M., & Khawaja, I. S. (2014). Anxiety and depression in Pakistani medical students: A multicenter study. Health Med, 8(7), 813–820.

Hossain, M. K., Mahfuz, T., Latif, S., & Hossain, M. E. (2023). Determinants of financial stress among university students and its impact on their performance. Journal of Applied Research in Higher Education, 15(1), 226–237. https://doi.org/10.1108/JARHE-02-2021-0082

Houkes, I., Winants, Y., Twellaar, M., & Verdonk, P. (2011). Development of burnout over time and the causal order of the three dimensions of burnout among male and female GPs. A three-wave panel study. BMC Public Health, 11, Article e240. https://doi.org/10.1186/1471-2458-11-240

Hu, K. S., Chibnall, J. T., & Slavin, S. J. (2019). Maladaptive perfectionism, impostorism, and cognitive distortions: Threats to the mental health of pre-clinical medical students. Academic Psychiatry, 43, 381–385. https://doi.org/10.1007/s40596-019-01031-z

Ihsan, A. H., Khan, M. M., Ullah, M., Khan, Q. A., & Khan, S. U. (2025). Prevalence and risk factors of depression among university students in Peshawar. Indus Journal of Bioscience Research, 3(1), 827–834. https://doi.org/10.70749/ijbr.v3i1.599

Jamali, Y. A., Khan, J. A., Jamali, I. A., Shah, H., & Kumari, R. (2024). Depression, anxiety and stress among undergraduate students of Shah Abdul Latif University, Khairpur: Depression, anxiety and stress among students. Pakistan Journal of Health Sciences, 5(4), 99–104. https://doi.org/10.54393/pjhs.v5i04.1384

Khan, D. A., Khan, M. T., Masih, A. G., Siddiqui, D. A., Parvez, A., Ali, F. M., & Bibi, A. (2024). Anxiety, depressive symptoms and socio-demographic factors associated with self-esteem among male nursing students: Self-Esteem among male nursing students. Pakistan Journal of Health Sciences, 5(1), 15–20. https://doi.org/10.54393/pjhs.v5i01.1249

Khan, M. S., Mahmood, S., Badshah, A., Ali, S. U., & Jamal, Y. (2006). Prevalence of depression, anxiety and their associated factors among medical students in Karachi, Pakistan. Journal-Pakistan Medical Association, 56(12), 583–586.

Mansoor, U. L., & Ali, M. A. M. H. (2015, December 7–8). Impact of hostel students' satisfaction on their academic performance in Sri Lankan universities [Paper presentation]. 5th International Symposium, Oluvil, Sri Lanka. http://ir.lib.seu.ac.lk/handle/123456789/1318

Minchekar, V. S., & Mangore, N. D. (2019). Home emotional and social adjustment and mental health among hostel students. Think India Journal, 22(38), 31–36.

Moeller, R. W., & Seehuus, M. (2019). Loneliness as a mediator for college students' social skills and experiences of depression and anxiety. Journal of Adolescence, 73, 1–13. https://doi.org/10.1016/j.adolescence.2019.03.006

Moradi, G. (2008). Correlation between social capital and mental health among hostel students of Tehran and shiraz universities. Social Welfare Quarterly, 8(30), 143–170.

Mosley, T. H. Jr., Perrin, S. G., Neral, S. M., Dubbert, P. M., Grothues, C. A., & Pinto, B. M. (2019). Stress, coping, and well-being among third-year medical students. Academic Medicine, 69(9), 765–777.

Pacheco, J. P., Giacomin, H. T., Tam, W. W., Ribeiro, T. B., Arab, C., Bezerra, I. M., & Pinasco, G. C. (2017). Mental health problems among medical students in Brazil: A systematic review and meta-analysis. Brazilian Journal of Psychiatry, 39, 369–378. https://doi.org/10.1590/1516-4446-2017-2223

Rab, F., Mamdou, R., & Nasir, S. (2008). Rates of depression and anxiety among female medical students in Pakistan. EMHJ-Eastern Mediterranean Health Journal, 14(1), 126–133.

Rizvi, F., Qureshi, A., Rajput, A. M., & Afzal, M. (2015). Prevalence of depression, anxiety and stress (by DASS scoring system) among medical students in Islamabad, Pakistan. British Journal of Medicine and Medical Research, 8(1), 69–75.

Rotenstein, L. S., Ramos, M. A., Torre, M., Segal, J. B., Peluso, M. J., Guille, C., Sen, S., & Mata, D. A. (2016). Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: A systematic review and meta-analysis. JAMA, 316(21), 2214–2236. https://doi.org/10.1001/jama.2016.17324