Global prevalence of anxiety and depression among medical students during the COVID-19 pandemic: a systematic review and meta-analysis

Abstract

Purpose: As future physicians, medical students have experienced tremendous pressure during the ongoing COVID-19 pandemic, which is associated with a high risk of depression and anxiety. We aimed to investigate an overview of the prevalence of anxiety and depression among medical students in various countries during the global COVID-19 pandemic, and discuss associated stressors.

Methods: We systematically searched CINAHL, EMBASE, MEDLINE, PubMed, and Web of Science for relevant articles from December 1, 2019 to March 15, 2023. We performed meta-analysis using a random-effects model with REML method to calculate the pooled prevalence of anxiety and depression. Begg's and Egger's tests were used to identify the potential risk of publication bias. Meta-regression was used to explore potential sources of heterogeneity.

Results: We identified 130 studies reporting anxiety and depression among 132,068 medical students during the COVID-19 pandemic. Eight screening tools were identified for anxiety and six for depression. The pooled prevalence of mental health outcomes for anxiety and depression was 45% (95% confidence interval [CI], 40%-49%) and 48% (95% CI, 43%-52%), respectively. The pooled prevalence of mental health outcomes for moderate and severe anxiety and moderate and severe depression was 28% (95% CI, 24%-32%) and 30% (95% CI, 26%-35%), respectively. There was high heterogeneity between studies, with I² ranging from 99.58%-99.66%. Continent and survey date were included in the meta-regression model. The results of meta-regression revealed that medical students in Asia had a lower prevalence of anxiety, and depression than those in other regions. The survey date (from February to June, 2020) showed a significantly positive correlation with the prevalence of anxiety and depression.

Conclusions: We demonstrated the global prevalence of anxiety and depression among medical students during the COVID-19 pandemic. The data highlight that medical students worldwide are at high risk of experiencing anxiety and depression. The reported stressors can be categorized into personal, academic, environmental and cultural, and pandemic factors. Schools and institutions should ensure optimal alternative learning environments for uninterrupted provision of medical education. The appropriate authorities should prioritize the provision of adequate protection for medical students and establish policies to promote new methods of training and education during a disaster, such as via distance learning.

Keywords: Anxiety; COVID-19; Depression; Medical students; Prevalence.

Fig. 1

Flow chart for selection of reviewed articles. *Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). **If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71

Fig. 2

Pooled prevalence of anxiety and depression among medical students during COVID-19 pandemic. a Pooled prevalence of anxiety among medical students during COVID-19 pandemic. b Pooled prevalence of anxiety (moderate and severe) among medical students during COVID-19 pandemic

Fig. 3

Sensitivity analysis of anxiety and depression for individual studies on the summary effect. a Sensitivity analysis of anxiety for individual studies on the summary effect. b Sensitivity analysis of anxiety (moderate and severe) for individual studies on the summary effect. c Sensitivity analysis of depression for individual studies on the summary effect. d Sensitivity analysis of depression (moderate and severe) for individual studies on the summary effect

Fig. 4

Funnel plot of anxiety and depression among medical students during COVID-19 pandemic. a Funnel plot of anxiety among medical students during COVID-19 pandemic. b Funnel plot of anxiety (moderate and severe) among medical students during COVID-19 pandemic. c Funnel plot of depression among medical students during COVID-19 pandemic. d Funnel plot of depression (moderate and severe) among medical students during COVID-19 pandemic