Effect of military conflict on mental health: a cross-sectional study among the medical students at Khartoum governmental universities, Sudan, 2023

Abstract

Objectives: This study aimed at better understanding the challenges imposed by Sudan 2023 military conflict on medical education through surveying students about their view of the current faced challenges and their future and academic plans. It as well investigated the effect of the war on their mental health status in terms of anxiety, depression and post-traumatic stress disorder (PTSD) and their associated factors.

Design: A multicentric observational cross-sectional design was adopted.

Setting and participants: Medical students of all Khartoum state governmental medical universities were invited to participate in an online survey.

Primary and secondary outcomes measures: Primary: prevalence of anxiety, depression and post-traumatic stress disorders (PTSDs) among medical students. Secondary: the associated factors that could impact these disorders, current status of medical education and students' future career intentions.

Results: Of the 612 included students, 64.38% were females and 96.90% were single, with a median age of 21 years. Approximately 68% reported their schools had plans to continue education. The prevalence rates of 58.3%, 51.5% and 27.1% were found for depression, anxiety and PTSD, respectively. Increase in increased age (β=0.18, 95% CI: 0.04 to 0.32) and female gender (β=-2.3, 95% CI: -2.9 to -1.6) were linked to higher anxiety risk. Weekly conflict news checks (β=-0.89, 95% CI: -1.7 to -0.09) and religious habits (β=-1.3, 95% CI: -1.9 to -0.63) reduced anxiety. Age was associated with higher depression risk (β=0.14, 95% CI: 0.02 to 0.27), while internet stability (β=-1.3, 95% CI: -2.2 to -0.37), religious habits (β=-1.2, 95% CI: -1.8 to -0.53) and online education or reading (β=-1.0, 95% CI: -1.7 to -0.36) reduced it. Male gender lowered PTSD risk (β=-4.5, 95% CI: -7.2 to -1.7). Above-average pre-conflict financial status (β=3.3, 95% CI: 0.04 to 6.6), financial damage (β=3.6, 95% CI: 0.93 to 6.2), physical abuse (β=8.5, 95% CI: 3.1 to 14) and family member death (β=6.2, 95% CI: 0.38 to 12) were associated with higher PTSD risk.

Conclusion: Medical education is currently disrupted in Sudan due to war, with most of the universities having no clear plan to ease the situation. Medical students suffer from depression and anxiety, among other psychological stresses, with many of them considering transferring or dropping out from medical schools; the majority intend to leave Sudan after graduation.

Keywords: Anxiety disorders; Depression & mood disorders; Education, Medical.

Figure 1. The prevalence of depression, anxiety and post-traumatic stress disorder among medical students of governmental universities.