Frequency of anxiety, depression and the coping methods adopted

by medical students of Sheikh Zayed Medical College,

Rahim Yar Khan

Submitted by

Batch C

4th year MBBS (2018-2019)

Department of Community Medicine

Sheikh Zayed Medical College ,Rahim Yar Khan

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We acknowledge the efforts of Professor Dr. Hafiz Muhammad Yar
and Dr. Ghulam Mustafa in accomplishment of this task.

STUDENT PROFILE

Name of student:___________________________________________

Father’s name:______________________________________________

Class Roll no. :_______________________________________________

University roll no. :___________________________________________

Signature:__________________________________________________

Batch:_____________________________________________________

Signature of supervisor:____________

Dr. Ghulam Mustafa

Associate Professor Community Medicine.

Sheikh Zayed Medical College, Rahim Yar Khan

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 STUDENTS OF BATCH C

Sr. No. Names of students Roll # Sr. No. Names of students Roll #

1 Syeda Maham Bukhari 437 14 Hamza Ehsan 524

2 Sara Iqbal 438 15 Ameer Hamza 527

3 Sidra Aziz 439 16 Muhammad Kashif Razzaq 528

4 Sadaf Munir 440 17 Muhammad Asif 529

5 Rakhshanda Batool 441 18 Muhammad Mudassir Jamal 531

6 Sarah Afzal 442 19 Muhammad Waqas Mehdi 532

7 Umaira Kausar 444 20 Muhammad Nazim 534

8 Gull Zeba Bukhari 446 21 Arslan Ahmad 535

9 Sana Mariam 448 22 Muhammad Roshaan 536

10 Mahrukh Raza 450 23 Muhammad Irfan 542

11 Mahnoor Alam Siddique 455 24 Muhammad Kamran 548

12 Hina Baloch 456 25 Saad Shair 549

13 Aima Nasir 464

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 CONTENTS

Sr. no Topics Page no.

1 Abstract 7

2 Introduction 9

3 Objectives 27

4 Methodology 29

5 Results 32

6 Discussion 57

7 Conclusion 62

8 References 64

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ABSTRACT

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 ABSTRACT

Background: Anxiety and depression are two of the most common mental ailments
nowadays present in medical students due to the raising academic pressure faced by
them. So they find different ways to combat with this mental issue. The aim is to
determine the level of anxiety and depression and the coping abilities and the methods
adopted by students to alleviate their anxiety and depression. Objectives: To assess
the frequency, sex wise distribution of anxiety and depression and coping methods
adopted by medical students of Sheikh Zayed Medical College,. Methodology: Study
design: Cross-sectional study. Duration and setting in this study was from 19th April to
19th may 2019 at Sheikh Zayed Medical College Rahim Yar Khan. This study was
conducted by students of fourth year batch C under the supervision of batch teacher
Dr. Ghulam Mustafa. 170 out of 650 medical students were selected by convenient
sampling technique, equal number of students were selected from first year to final
year. A questionnaire was distributed to the students and data was collected by asking
them to fill it. The performa used was The Hospital Anxiety and Depression Scale,
used to assess anxiety and depression. The data was analyzed using SPSS Version
17. Results: The study showed 88 (51.8%) female and 82 (48.2%) male students. The
mean age of students was 21.03±1.7 years. The mean anxiety score was 8.82±3.9
and mean depression score was 6.16±3.7. Mean value of depression among female
students was 6.77±4.0 and among male students was 5.5±3.2. Mean anxiety value
among female students was 9.73±3.7 and in male students it was 7.84±3.8. methods
adopted had mean values as: social (60.6%) , religious (58.6%), behavioral (45.25%),
pharmacological (5.73%), psychiatric (8.8%) and addiction (7.65). Conclusion: This
study concluded that more than half students had borderline to abnormal anxiety level
while almost one third of them had borderline to abnormal depression status, anxiety
and depression is more in female students than in male students. They cope their
anxiety and depression mainly through social, religious and then behavioral means
while few of the students through pharmacological and psychiatric means.

Keywords : Anxiety, depression, coping methods, medical students.

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INTRODUCTION

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 INTRODUCTION
Anxiety
Anxiety is an emotion characterized by an unpleasant state of inner turmoil, often
accompanied by nervous behavior such as pacing back and forth, somatic complaints,
and rumination[1]. It is the subjectively unpleasant feelings of dread over anticipated
events, such as the feeling of imminent death[2]. Anxiety is not the same as fear,
which is a response to a real or perceived immediate threat , whereas anxiety involves
the expectation of future threat [3]. Anxiety is a feeling of uneasiness and worry,
usually generalized and unfocused as an overreaction to a situation that is only
subjectively see as menacing [4]. It is often accompanied by muscular tension,
restlessness, fatigue and problem in concentration, anxiety can be appropriate but
when experienced the individual may suffer from an anxiety disorder [3].
Anxiety disorders occur when a person regularly feels disproportionate levels of
distress, worry, or fear over an emotional trigger.
Common symptoms and signs of anxiety disorder can include:
• restlessness or feeling edgy.
• becoming tired easily, fatigue.
• trouble concentrating, that may also appear as memory or attention
problems.
• feeling as if the mind is going "blank".
• Irritability.
• muscle tension.
• headaches.
• Sleep problems (trouble falling or staying asleep or having sleep that is not
restful).
Anxiety that is associated with specific (specific or simple phobia) or social fears
(social phobia) may also result in avoidance of certain situations or an elevation of
symptoms to trigger a panic attack. Panic attacks are sudden episodes of intense fear
and/or physical discomfort that reach a peak within minutes. Specific signs
and symptoms of panic attack include both physical and emotional symptoms such as:
• palpitations (feelings of rapid and/or irregular heartbeats);

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 • chest pain, chest tightness or other discomfort, feeling like one is having
a heart attack;
• shortness of breath or trouble breathing;
• sweating of the palms;
• nausea or other stomach upset;
• trembling or shaking;
• feeling dizzy, unsteady, lightheaded, or faint;
• derealization (feelings of unreality) or depersonalization (feeling detached
from oneself);
• fear of losing control or going insane;
• numbness or tingling sensations;
• chills or hot flashes;
• feeling like one is choking;
• a sense of impending doom;
• Feeling like one is dying [5].

Reason of anxiety among people : Anxiety or Anxiety disorders have a complicated

network of causes, including:
• Environmental factors: Elements in the environment around an individual can
increase anxiety. Stress from a personal relationship, job, school, or financial
predicament can contribute greatly to anxiety disorders. Even low oxygen levels in
high-altitude areas can add to anxiety symptoms.
• Genetics: People who have family members with an anxiety disorder are more
likely to have one themselves [6][7][8][9].
• Twin Studies: Estimates of genetic influence on anxiety, based on studies of twins,
range from 25–40% depending on the specific type and age-group under study.
For example, genetic differences account for about 43% of variance in panic
disorder and 28% in generalized anxiety disorder [11]. Longitudinal twin studies
have shown the moderate stability of anxiety from childhood through to adulthood
is mainly influenced by stability in genetic influence [12][13]. When investigating
how anxiety is passed on from parents to children, it is important to account for
sharing of genes as well as environments, for example using the intergenerational
children-of-twins design [14].

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• Poor coping skills: e.g., rigidity/inflexible problem solving, denial, avoidance,
impulsivity, extreme self-expectation, negative thoughts, affective instability, and
inability to focus on problems are associated with anxiety. Anxiety is also linked
and perpetuated by the person's own pessimistic outcome expectancy and how
they cope with feedback negativity [16]. Temperament (e.g., neuroticism) and
attitudes (e.g. pessimism) have been found to be risk factors for anxiety [15][17].
• Cognitive distortions: such as over generalizing, catastrophizing, mind reading,
emotional reasoning, binocular trick, and mental filter can result in anxiety. For
example, an over generalized belief that something bad "always" happens may
lead someone to have excessive fears of even minimally risky situations and to
avoid benign social situations due to anticipatory anxiety of embarrassment. In
addition, those who have high anxiety can also create future stressful life events
[18].
• Medical factors: Other medical conditions can lead to an anxiety disorder, such as
the side effects of medication, symptoms of a disease, or stress from a serious
underlying medical condition that may not directly trigger the changes seen in
anxiety disorder but might be causing significant lifestyle adjustments, pain, or
restricted movement.
• Brain chemistry: Stressful or traumatic experiences and genetic factors can alter
brain structure and function to react more vigorously to triggers that would not
previously have caused anxiety. Psychologists and neurologists define many
anxiety and mood disorders as disruptions to hormones and electrical signals in
the brain.
• Use of or withdrawal from an illicit substance: The stress of day-to-day living
combined with any of the above might serve as key contributors to an anxiety
disorder.
Sometimes, stressful events occur as the result of a third party, such as an
employer or partner, but anxious feelings might emerge from people telling
themselves the worst will happen. An anxiety disorder may develop without any
external stimuli whatsoever. Disproportionate anxiety can result from a
combination of one or more of the above causes. For example, a person may
respond to stress at work by drinking more alcohol or taking illicit substances,
increasing anxiety levels and the risk of further complications [6][7][8][9].

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Reasons of anxiety among medical students: College students have a lot to worry
about but medical students have it even worse. Not only do you have to worry
about class, the pressures of residency, and getting enough sleep, but you also have
to worry about being accepted to a good medical program. In fact, according to a study
reported by Anxiety.org, after only the first two months of medical school, 26% of the
students admitted to suffering from anxiety disorders. Another 15% reported that they
had depression and close to 10% were suffering from stress related disorders.
In addition, the Journal of the American Medical Association found that one out of
every 10 medical students has reported that they have had suicidal thoughts.
Approximately 30% of those in medical school have symptoms of depression. Many
say it is about the lack of sleep or getting good grades but others claim it is more about
being away from home, too much competition, or a heavy workload. Others say that
they are having trouble with other college related issues such as tuition expenses, not
fitting in with peers, or how to keep up with the rest of the class [19].

Depression
Depression (major depressive disorder) is a common and serious medical illness that
negatively affects how you feel the way you think and how you act. Fortunately, it is
also treatable. Depression causes feelings of sadness and/or a loss of interest in
activities once enjoyed. It can lead to a variety of emotional and physical problems
and can decrease a person’s ability to function at work and at home [20][21][22].
OR
Depression (major depressive disorder or clinical depression) is a common but serious
mood disorder. It causes severe symptoms that affect how you feel, think, and handle
daily activities, such as sleeping, eating, or working. To be diagnosed with depression,
the symptoms must be present for at least two weeks [23].
Depression seems to be more common among women than men. Symptoms include
lack of joy and reduced interest in things that used to bring a person happiness. Life
events, such as bereavement, produce mood changes that can usually be
distinguished from the features of depression. The causes of depression are not fully
understood but are likely to be a complex combination of genetic, biological,
environmental, and psychosocial factors [24][25][26][27].
Depression symptoms can vary from mild to severe and can include:
o Feeling sad or having a depressed mood
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 o Loss of interest or pleasure in activities once enjoyed
o Changes in appetite — weight loss or gain unrelated to dieting
o Trouble sleeping or sleeping too much
o Loss of energy or increased fatigue
o Increase in purposeless physical activity (e.g., hand-wringing or pacing) or
slowed movements and speech (actions observable by others)
o Feeling worthless or guilty
o Difficulty thinking, concentrating or making decisions
o Thoughts of death or suicide
Symptoms must last at least two weeks for a diagnosis of depression. Also, medical
conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic
symptoms of depression so it is important to rule out general medical causes.

Prevalence of depression: Depression affects an estimated one in 15 adults (6.7%)

in any given year. And one in six people (16.6%) will experience depression at some
time in their life. Depression can strike at any time, but on average, first appears during
the late teens to mid-20s. Women are more likely than men to experience depression.
Some studies show that one-third of women will experience a major depressive
episode in their lifetime [20][21][22].
According to the Centers for Disease Control and Prevention (CDC), 7.6 percent of
people over the age of 12 have depression in any 2-week period. This is substantial
and shows the scale of the issue. According to the World Health Organization (WHO),
depression is the most common illness worldwide and the leading cause of disability.
They estimate that 350 million people are affected by depression, globally
[24][25][26][27].

Types of depression: Some forms of depression are slightly different, or they may
develop under unique circumstances, such as:
• Persistent depressive disorder: (also called dysthymia) is a depressed mood
that lasts for at least two years. A person diagnosed with persistent depressive
disorder may have episodes of major depression along with periods of less
severe symptoms, but symptoms must last for two years to be considered
persistent depressive disorder.

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 • Postpartum depression: is much more serious than the “baby blues” (relatively
mild depressive and anxiety symptoms that typically clear within two weeks
after delivery) that many women experience after giving birth. Women with
postpartum depression experience full-blown major depression during
pregnancy or after delivery (postpartum depression). The feelings of extreme
sadness, anxiety, and exhaustion that accompany postpartum depression may
make it difficult for these new mothers to complete daily care activities for
themselves and/or for their babies.
• Psychotic depression: occurs when a person has severe depression plus some
form of psychosis, such as having disturbing false fixed beliefs (delusions) or
hearing or seeing upsetting things that others cannot hear or see
(hallucinations). The psychotic symptoms typically have a depressive “theme,”
such as delusions of guilt, poverty, or illness.
• Seasonal affective disorder: is characterized by the onset of depression during
the winter months, when there is less natural sunlight. This depression
generally lifts during spring and summer. Winter depression, typically
accompanied by social withdrawal, increased sleep, and weight gain,
predictably returns every year in seasonal affective disorder.
• Bipolar disorder: is different from depression, but it is included in this list is
because someone with bipolar disorder experiences episodes of extremely low
moods that meet the criteria for major depression (called “bipolar depression”).
But a person with bipolar disorder also experiences extreme high – euphoric or
irritable – moods called “mania” or a less severe form called “hypomania.”
Examples of other types of depressive disorders newly added to the diagnostic
classification of DSM-5 include disruptive mood dysregulation disorder (diagnosed in
children and adolescents) and premenstrual dysphoric disorder (PMDD) [23].

Reasons of depression among people: Some types of depression run in families,

indicating an inheritable biological vulnerability to depression. This seems to be the
case, especially with bipolar disorder. Not everybody with the genetic makeup that
causes vulnerability to bipolar disorder will develop the illness. Apparently, additional
factors, like a stressful environment, are involved in its onset.
An external event such as a serious loss, chronic illness, difficult relationship,
exposure to abuse, neglect or community violence, financial problem, or any negative
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life events or unwelcome changes in life patterns can trigger a depressive episode and
chronic exposure to such negative factors can result in persistent depression. People
exposed to numerous and/or severe stressors as young children may develop
changes in their brain structure that may make them prone to developing depression
during adulthood.
Very often, a combination of genetic, psychological, and environmental factors is
involved in the onset of a depressive disorder. Stressors that contribute to the
development of depression sometimes affect some groups more than others. For
example, minority groups who more often feel impacted by discrimination are
disproportionately represented. Socioeconomically disadvantaged groups have higher
rates of depression compared to their advantaged counterparts. Immigrants to the
United States may be more vulnerable to developing depression, particularly when
isolated by language.
Regardless of ethnicity, men appear to be particularly sensitive to the depressive
effects of unemployment, divorce, low socioeconomic status, and having few good
ways to cope with stress. Women who have been the victim of physical, emotional, or
sexual abuse, either as a child or perpetrated by a romantic partner are vulnerable to
developing a depressive disorder, as well. Men who engage in sex with other men
seem to be particularly vulnerable to depression when they have no domestic partner,
do not identify themselves as homosexual, or have been the victim of multiple
episodes of antigay violence. However, it seems that men and women have similar
risk factors for depression for the most part.
Different neuropsychiatric illnesses seem to be associated with an overabundance or
a lack of some of these neurochemicals in certain parts of the brain. For example, a
lack of dopamine at the base of the brain causes Parkinson's disease. There appears
to be a relation between Alzheimer's dementia and lower acetylcholine levels in the
brain. The addictive disorders are under the influence of the neurochemical dopamine.
That is to say, drugs of abuse and alcohol work by releasing dopamine in the brain.
The dopamine causes euphoria, which is a pleasant sensation. Repeated use of drugs
or alcohol, however, desensitizes the dopamine system, which means that the system
gets used to the effects of drugs and alcohol. Therefore, a person needs more drugs
or alcohol to achieve the same high feeling (builds up tolerance to the substance).
Thus, the addicted person takes more substance but feels less and less high and
increasingly depressed. There are also some drugs whose effects can include
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depression (these include alcohol, narcotics, and marijuana) and those for whom
depression can be a symptom of withdrawal from the substance
(including caffeine, cocaine, or amphetamines).
Certain medications used for a variety of medical conditions are more likely than others
to cause depression as a side effect. Specifically, some medications that treat high
blood pressure, cancer, seizures, extreme pain, and to achieve contraception can
result in depression. Even some psychiatric medications, like some sleep aids and
medications to treat alcoholism and anxiety, can contribute to the development of
depression.
Many mental health conditions or developmental disabilities are associated with
depression, as well. Individuals with anxiety, attention deficit hyperactivity
disorder (ADHD), substance abuse, and developmental disabilities may be more
vulnerable to developing depression.
Schizophrenia is associated with an imbalance of dopamine (too much) and serotonin
(poorly regulated) in certain areas of the brain. Finally, the depressive disorders
appear to be associated with altered brain serotonin and nor epinephrine systems.
Both of these neurochemicals may be lower in depressed people. Please note that
depression is "associated with" instead of "caused by" abnormalities of these
neurochemicals because we really don't know whether low levels of neurochemicals
in the brain cause depression or whether depression causes low levels of
neurochemicals in the brain.
Psychological factors also contribute to a person's vulnerability to depression. Thus,
persistent deprivation in infancy, physical or sexual abuse, exposure to community
violence, clusters of certain personality traits, and inadequate ways of coping
(maladaptive coping mechanisms) all can increase the frequency and severity of
depressive disorders, with or without inherited vulnerability.
The presence of maternal-fetal stress is another risk factor for depression. It seems
that maternal stress during pregnancy can increase the chance that the child will be
prone to depression as an adult, particularly if there is a genetic vulnerability.
Researchers believe that the mother's circulating stress hormones can influence the
development of the fetus' brain during pregnancy. This altered fetal brain development
occurs in ways that predispose the child to the risk of depression as an adult. Further
research is still necessary to clarify how this happens. Again, this situation shows the

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complex interaction between genetic vulnerability and environmental stress, in this
case, the stress of the mother on the fetus [28][29][30].

Reasons of depression among medical students:

About as many as one-third of medical students have some form of depression. Being
a medical student and eventually working in the medical industry is rewarding, but the
journey there can be a depressing one, and here are a few reasons why.
It’s Competitive: Many industries have an intense amount of competition, but medical
school is especially competitive. Everyone is trying hard to achieve the highest grades
possible in order to eventually get to the best career possible, and it can be
overwhelming. This fierce competition can lead to you feeling down about yourself and
feeling like you’ll never ace that test, match where you’d like, or perhaps that the
specialty you’ve chosen isn’t the right one after all. Just remember that you will
accomplish your goals and your confidence and abilities have gotten you this far, and
it will feel sweet when your goals come to fruition.
There’s a Lot of Work: Any school is going to have its load of work, but medical school
requires extra-long hours of studying and work. This not only can make you feel
stressed, but you may also not have enough time to unwind, which causes your
emotions to be pent up and for you to feel overwhelmed constantly.
Not Enough Time to Seek Treatment: Because all your time is devoted to school, you
may not have enough time to treat your depression, much less get to a diagnosis. This
can create a vicious cycle, where your performance lessens because you don’t have
enough time to improve your mental well-being, and your lessened performance
makes you more depressed in turn.
There is a Stigma Against Treating Depression: Because of the competitiveness of
medical school, you may believe that if you have depression or are feeling depressed
that you’re weak and not worthy of medical school. This is not the case. Doctors need
help too, and just because you hit a bump in the road in school, it doesn’t mean that
you should quit. The best thing for people to do is to try to treat their problems, instead
of bottling them all up, or allowing them to prevent them from reaching their goals [31].

Outcomes of anxiety and depression in medical students

Physical effects: People with anxiety can experience a range of physical and
psychological symptoms. The most common include: feeling nervous, tense, or fearful,
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restlessness, a rapid heart rate, panic attacks in severe cases, sweating, shaking,
fatigue, weakness, dizziness, difficulty concentrating, sleep problems, nausea,
digestive issues, feeling too cold or too hot, chest pain.
Systemic effects: During periods of anxiety, a person's breathing may become rapid
and shallow, which is called hyperventilation [32].
Long-term anxiety may not be good for the cardiovascular system and heart health.
Some studies suggest that anxiety increases the risk of heart diseases in otherwise
healthy people.[34] Medical experts have associated excessive weight gain with many
health issues, including diabetes and heart disease. Being underweight can harm the
heart, affect fertility, and cause fatigue. Depression may also be an independent risk
factor for heart health problems. According to research published in 2015, one in five
people with heart failure or coronary artery disease have depression [35]. People with
depression may experience unexplained aches or pains, including joint or muscle
pain, breast tenderness, and headaches.
In the short-term, anxiety boosts the immune system's responses. However,
prolonged anxiety can have the opposite effect. People with chronic anxiety disorders
may be more likely to get the common cold, the flu, and other types of infection [32].
People with depression are more likely to have inflammatory conditions or
autoimmune disorders, such as irritable bowel syndrome (IBS), type 2 diabetes,
and arthritis [35].
As a result, a person with anxiety may experience nausea, diarrhea, and a feeling that
the stomach is churning. They may also lose their appetite. Some research suggests
that stress and depression are linked to several digestive diseases, including irritable
bowel syndrome (IBS) [32].
Mental effect: Medical student depression was linked to substance abuse, suicide and
impaired professional function interpersonal skills, professionalism, physical and
mental health. The relationship between the development of depression and the
greater future risk of recurrence of depressive episodes and long-term morbidity is
consensual [33].
Any type of mental illness can have a negative impact on the cognitive development
and learning, and has a very high cost to individual and society, including medical
school dropout, suicide, deterioration in relationships, marital problems and impaired
ability to work effectively [34].

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People with depression may experience insomnia or trouble sleeping. This condition
can leave them feeling exhausted, making it difficult to manage both physical and
mental health [35].
Effects on education/professionalism: Medical students with small coping reservoir or
few positive inputs are at greater risk of distress, including burnout. An examination of
burnout literature reveals that it is prevalent in medical students (28–45%), and
depression and burnout seem to be closely linked [33]. Symptoms of depression
include: tiredness and lack of energy, so even small tasks take extra effort, angry
outbursts, irritability or frustration, even over small matters, trouble thinking,
concentrating, making decisions and remembering things [36].
Behavioral effects: Students depressed throughout the course show increased
perception of relationship problems, cynicism, and decreased satisfaction with
academic activities. This sacrificial behavior has been described to potentiate a vicious
cycle that impairs professional function, interpersonal skills , professionalism, and
physical and mental health. Despite the persistence of depression being low these is
a crucial group of students who continuously experience depression [33].
Examples of complications associated with depression include: alcohol or drug
misuse, Anxiety, panic disorder or social phobia, family conflicts, relationship
difficulties, and work or school problems, social isolation, suicidal feelings, suicide
attempts or suicide, self-mutilation, such as cutting, premature death from medical
conditions [36].

Treatment of Depression and Anxiety among Medical students

Depression Treatment
Therapy, Medication, and Lifestyle Changes That Can Treat Depression: When you’re
depressed, it can feel like you’ll never get out from under a dark shadow. However,
even the most severe depression is treatable. So, if your depression is keeping you
from living the life you want to, don’t hesitate to seek help. Learning about your
depression treatment options will help you decide which approach is right for you.
From therapy to medication to healthy lifestyle changes, there are many effective
treatments that can help you overcome depression, feel happy and hopeful again, and
reclaim your life.
Lifestyle changes: An essential part. Lifestyle changes are simple but powerful tools
in the treatment of depression. Sometimes they might be all you need. Even if you
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need other treatment as well, making the right lifestyle changes can help lift
depression faster—and prevent it from coming back.
Exercise: Regular exercise can be as effective at treating depression as
medication. Not only does exercise boost serotonin, endorphins, and other feel-good
brain chemicals, it triggers the growth of new brain cells and connections, just like
antidepressants do. Best of all, you don’t have to train for a marathon in order to reap
the benefits. Even a half-hour daily walk can make a big difference. For maximum
results, aim for 30 to 60 minutes of aerobic activity on most days.
Social support: Strong social networks reduce isolation, a key risk factor for
depression. Keep in regular contact with friends and family, or consider joining a class
or group. Volunteering is a wonderful way to get social support and help others while
also helping yourself.
Nutrition: Eating well is important for both your physical and mental health. Eating
small, well-balanced meals throughout the day will help you keep your energy up and
minimize mood swings. While you may be drawn to sugary foods for the quick boost
they provide, complex carbohydrates are a better choice. They’ll get you going without
the all-too-soon sugar crash.
Sleep: Sleep has a strong effect on mood. When you don’t get enough sleep, your
depression symptoms will be worse. Sleep deprivation exacerbates irritability,
moodiness, sadness, and fatigue. Make sure you’re getting enough sleep each night.
Very few people do well on less than seven hours a night. Aim for somewhere between
seven to nine hours each night.
Stress reduction: Make changes in your life to help manage and reduce stress. Too
much stress exacerbates depression and puts you at risk for future depression. Take
the aspects of your life that stress you out, such as work overload or unsupportive
relationships, and find ways to minimize their impact [37].
Psychotherapy: Psychotherapy (or talk therapy) has an excellent track record of
helping people with depressive disorder. While some psychotherapies have been
researched more than others, many types can be helpful and effective. A good
relationship with a therapist can help improve outcomes.
For most people, psychotherapy and medications give better results together than
either alone, but this is something to review with your mental health care provider.
Further, many clinicians are trained in more than one kind of psychotherapy, so ask

20
your clinician what kind of psychotherapy they practice and how it can help you. A few
examples include:
• Cognitive behavioral therapy (CBT) has a strong research base to show it helps
with symptoms of depression. This therapy helps assess and change negative
thinking patterns associated with depression. The goal of this structured
therapy is to recognize negative thoughts and to teach coping strategies. CBT
is often time-limited and may be limited to 8–16 sessions in some instances.

• Interpersonal therapy (IPT) focuses on improving problems in personal

relationships and other changes in life that may be contributing to depressive
disorder. Therapists teach individuals to evaluate their interactions and to
improve how they relate to others. IPT is often time-limited like CBT.

• Psychodynamic therapy is a therapeutic approach rooted in recognizing and

understanding negative patterns of behavior and feelings that are rooted in past
experiences and working to resolve them. Looking at a person’s unconscious
processes is another component of this psychotherapy. It can be done in short-
term or longer-term modes

Medication
For some people, antidepressants may help reduce or control symptoms.
Antidepressants often take 2-4 weeks to begin having an effect and up to 12 weeks to
reach full effect. Most people will have to try various doses or medications to find what
works for them. Here are some antidepressants commonly used to treat depression:
Selective serotonin reuptake inhibitors (SSRIs): act on serotonin, a brain chemical.
They are the most common medications prescribed for depression.
• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Citalopram (Celexa)
• Escitalopram (Lexapro)

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Serotonin and norepinephrine reuptake inhibitors (SNRIs) are the second most
common antidepressants. These medications increase serotonin and norepinephrine.
• Venlafazine (Effexor)
• Desvenlafazine (Pristiq)
• Duloxetine (Cymbalta)
Norepinephrine-dopamine reuptake inhibitors (NDRIs) increase dopamine and
norepinephrine. Bupropion (Wellbutrin) is a popular NDRI medication, which causes
fewer (and different) side effects than other antidepressants. For some people,
bupropion causes anxiety symptoms, but for others it is an effective treatment for
anxiety.
Mirtazapine (Remeron) targets specific serotonin and norepinephrine receptors in the
brain, thus indirectly increasing the activity of several brain circuits. Mirtazapine is used
less often than newer antidepressants (SSRIs, SNRIs and bupropion) because it is
associated with more weight gain, sedation and sleepiness. However, it appears to be
less likely to result in insomnia, sexual side effects and nausea than the SSRIs and
SNRIs.
• Bupropion (Wellbutrin)
• Mirtazapine (Remeron)
Second-generation antipsychotics (SGAs), or “atypical antipsychotics,” treat
schizophrenia, acute mania, bipolar disorder and bipolar mania and other mental
illnesses. SGAs can be used for treatment-resistant depression.
• Aripiprazole (Abilify)
• Quetiapine (Seroquel)
Tricyclic antidepressants (TCAs) are older medications, seldom used today as initial
treatment for depression. They work similarly to SNRIs but have more side effects.
They are sometimes used when other antidepressants have not worked. TCAs may
also ease chronic pain.
• Amitriptyline (Elavil)
• Desipramine (Norpramin)
• Doxepin (Sinequan)
• Imipramine (Tofranil)
• Nortriptyline (Pamelor, Avantyl)
• Protriptyline (Vivactil)

22
 Monoamine oxidase inhibitors (MAOIs) are less used today because newer, more
effective medications with fewer side effects have been found. These medications
can never be used in combination with SSRIs. MAOIs can sometimes be effective for
people who do not respond to other medications.
• Phenelzine (Nardil)
• Isocarboxazid (Marplan)
• Tranylcypromine Sulfate (Parnate)
• Selegiline patch (Emsam) [36].
Mind-body connections: Integrative medicine practitioners believe the mind and body
must be in harmony for you to stay healthy. Examples of mind-body techniques that
may be helpful for depression include:
• Acupuncture
• Relaxation techniques such as yoga or tai chi
• Meditation
• Guided imagery
• Massage therapy
• Music or art therapy
• Spirituality
• Aerobic exercise
Relying solely on these therapies is generally not enough to treat depression. They
may be helpful when used in addition to medication and psychotherapy [39].
Management of Anxiety:-
Anxiety is highly treatable, and doctors usually recommend a combination of some of
the following:
• medication
• therapy
• support groups
• lifestyle changes involving physical activity and meditation
Self-treatment
In some cases, a person can manage anxiety at home without clinical supervision.
However, this may be limited to shorter and less severe periods of anxiety.
Doctors recommend several exercises and techniques to cope with brief or focused
bouts of anxiety, including:

23
• Stress management: Limit potential triggers by managing stress levels. Keep an eye
on pressures and deadlines, organize daunting tasks in to-do lists, and take enough
time off from professional or educational obligations.
• Relaxation techniques: Certain measures can help reduce signs of anxiety, including
deep-breathing exercises, long baths, meditation, yoga, and resting in the dark.
• Exercises to replace negative thoughts with positive ones: Write down a list of any
negative thoughts, and make another list of positive thoughts to replace them.
Picturing yourself successfully facing and conquering a specific fear can also provide
benefits if the anxiety symptoms link to a specific stressor.
• Support network: Talk to a person who is supportive, such as a family member or
friend. Avoid storing up and suppressing anxious feelings as this can worsen anxiety
disorders.
• Exercise: Physical exertion and an active lifestyle can improve self-image and trigger
the release of chemicals in the brain that stimulate positive emotions.

Counseling and therapy

Standard treatment for anxiety involves psychological counseling and therapy.
This might include psychotherapy, such as cognitive behavioral therapy (CBT) or a
combination of therapy and counseling.
CBT aims to recognize and alter the harmful thought patterns that can trigger an
anxiety disorder and troublesome feelings, limit distorted thinking, and change the
scale and intensity of reactions to stressors.
This helps people manage the way their body and mind react to certain triggers.
Psychotherapy is another treatment that involves talking with a trained mental
health professional and working to the root of an anxiety disorder.
Sessions might explore the triggers of anxiety and possible coping mechanisms.
Medications
Several types of medication can support the treatment of an anxiety disorder. Other
medicines might help control some of the physical and mental symptoms. These
include:
Tricyclics: This is a class of drugs that have demonstrated helpful effects on most
anxiety disorders other than obsessive-compulsive disorder (OCD). These drugs are
known to cause side effects, such as drowsiness, dizziness, and weight gain. Two
examples of tricyclics are imipramine and clomipramine.
24
 Benzodiazepines: These are only available on prescription, but they can be highly
addictive and would rarely be a first-line medication. These drugs tend not to cause
many side effects, except for drowsiness and possible dependency. Diazepam, or
Valium, is an example of a common benzodiazepine for people with anxiety.
Anti-depressants: While people most commonly use anti-depressants to manage
depression, they also feature in the treatment of many anxiety
disorders. Serotonin reuptake inhibitors (SSRI) are one option, and they have fewer
side effects than older anti-depressants. They are still likely to cause nausea and
sexual dysfunction at the outset of treatment. Some types include fluoxetine and
citalopram.
Other medications that can reduce anxiety include:
• beta-blockers
• monoamine oxidase inhibitors (MAOIs)
• buspirone
Stopping some medications, especially anti-depressants, can cause withdrawal
symptoms, including brain zaps. These are painful jolts in the head that feel like shocks
of electricity.
An individual planning to adjust their approach to treating anxiety disorders after a long
period of taking anti-depressants should consult their doctor about how best to move
away from medications.
If severe, adverse, or unexpected effects occur after taking any prescribed
medications, be sure to update a physician.

Prevention
Although anxious feelings will always be present in daily life, there are ways to reduce
the risk of a full-blown anxiety disorder. Taking the following steps will help keep
anxious emotions in check and prevent the development of a disorder, including:
• Consume less caffeine, tea, soda, and chocolate.
• Check with a doctor or pharmacist before using over-the-counter (OTC) or herbal
remedies for chemicals that might make anxiety worse.
• Keep up a balanced, nutritious diet.
• Regular sleep patterns can be helpful.
Avoid alcohol, cannabis, and other recreational drugs [40].

25
OBJECTIVES

26
 OBJECTIVES

The objectives of this study were to:

1. Assess the frequency of anxiety and depression among medical students of

Sheikh Zayed Medical College, Rahim Yar Khan.
2. Assess sex wise frequency of anxiety and depression among medical students
of Sheikh Zayed Medical College, Rahim Yar Khan.
3. Assess the social, behavioral, religious, pharmacological, psychiatric and
addiction as coping methods of anxiety and depression among medical
students of Sheikh Zayed Medical College, Rahim Yar Khan.

27
METHODOLOGY

28
 METHODOLOGY

Study design: This was a cross-sectional study.

Study settings: Conducted across students of Sheikh Zayed Medical College Rahim
Yar Khan.

Study subjects: First year to final year MBBS students.

Sample size: A total of 170 students were included in the study.

Sampling techniques: Convenient sampling technique was used.

Duration of study: From 19th April to 19th May 2019.

Inclusion criteria: Students present at the time of distribution of questionnaire and

were willing to participate in study.

Exclusion Criteria: Students not willing to participate in study and those who are
outside.

Data collection method: Students were briefed about the purpose of research and
assured of confidentiality and informed consent was taken. Data was collected on
management options among medical students coping with anxiety and depression.
Hospital anxiety and depression scale (HADS) [41][42] was used for assessing anxiety
and depression. Demographic features of students were also noted such as age, sex,
residence, and year of study. After an in-depth literature review, a questionnaire was
designed as a tool for data collection. Confidentiality and anonymity were ensured.

Data analysis: Data was entered and analysed with SPSS-2017. Frequency of
anxiety and depression and these categories were presented as percentage. The
categories of anxiety and depression were based on scale such as:

1-7: Normal

8-10: border line

11-21: abnormal

Mean+- SD of anxiety and depression score was also calculated. Frequency of

different coping options taken by students were presented that are categorized as:

29
Social, behavioural, religious, pharmaceutical, addiction and psychiatric. Class wise
and sex wise distribution was conducted.

Independent sample t- Test was applied for comparing the anxiety and depression
score among boys and girls students, rural and urban, day scholar and hostilities. Chi-
square test was also applied to compare the sex wise, age wise and residence wise
anxiety and depression.

Ethical approach was brought from institutional review board.

30
RESULTS

31
 RESULTS

This study was conducted to assess the anxiety and depression among medical
students and management options used by students to cope these conditions

Table I: Class wise distribution of study subjects

Class Frequency Percentage

30 17.6
1st year

34 20.0
2nd year

39 22.9
3rd year

39 22.9
4th year

28 16.5
5th year

170 100.0
Total

Table I shows that Out of 170, 17.6% were of first year 20% were of second year
22.9% were of third year 22.9% were of fourth year 16.5% were of final year.

32
Table II: Sex wise distribution of study subjects

Sex Frequency Percent

82 48.2
Male

88 51.8
Female

170 100.0
Total

Table II shows that Out of 170 study subjects 48.2% were males while 51.8% were
females.

33
Table III: Hostelite and day scholars among study subjects

Students Residence Frequency Percent

Hostelite 157 92.4

Day scholar 13 7.6

Total 170 100.0

Table III shows that out of 170 study subjects 92.4% were hostelite while 7.6% were
day scholars.

34
Table IV: Residence wise distribution among study subjects

Residence Frequency Percentage

Rural 53 31.2

Urban 117 68.8

Total 170 100.0

Table IV: shows that out of 170 study subjects 31.2% were from rural areas while
68.8% were

from urban areas.

35
Table V: Category wise frequency of anxiety among study subjects

Anxiety categories
Frequency Percent
Normal (0-7)
72 42.4

Borderline (8-10)
37 21.8

Abnormal (11-21)
61 35.9

Total
170 100.0

Table V shows that out of 170 study subjects,42.4% were in normal range, 21.8%
were in borderline range 35.9% were in abnormal range.

36
Table VI: category wise frequency of depression among study subjects

Depression category
Frequency Percent
Normal (0-7)
114 67.1

Borderline (8-10) 37 21.8

Abnormal (11-21) 19 11.2

Total 170 100.0

Table VI shows that out of 170 subjects 67.1% were in normal range, 21.8 were
in borderline range 11.2% were in abnormal range.

37
Figure I: Graph shows different categories of coping methods adopted by
medical students to overcome their anxiety and depression.

PHARMACOLOGICAL 5.73

ADDICTION 7.65

PSYCHIATRIC 8.8

BEHAVIORAL 45.25

RELIGIOUS 58.6

SOCIAL 60.6

0 10 20 30 40 50 60 70

percenages

Figure I shows different categories of coping methods which include social 60.6%,
religious 58.6%, behavioral 45.25%, psychiatric 8.8%, addiction 7.65%,
pharmacological 5.7%.

38
Table VII: Distribution of social coping methods among study subjects

Do you want to be alone

Frequency Percent
Yes 102 60

No 68 40

Total 170 100

Do you want to talk with someone close

Yes 134 78.8

No 36 21.2

Total 170 100.0

Do you want to spend time with friend and family

Yes 137 80.6

No 33 19.4

Total 170 100.0

Did you involve in wrongdoing due to it

Yes 39 22.9

No 131 77.1

Total 170 100.0

Table VIII shows that among study subject 60% want to be alone, 78.8% talk with
Someone, 80.6% spend time with friends and family, 22.9% involve in wrongdoing.

39
Table VIII: Distribution of behavioral coping methods among study subjects

Do you become talkative

Frequency Percent
Yes 65 38.2

No 105 61.8

Total 170 100.0

Do you eat more or less than usual

Yes 99 58.2

No 71 41.8

Total 170 100.0

Do you like to watch TV dramas News or movies

Yes 113 66.5

No 57 33.5

Total 170 100.0

Do you make lame jokes

Yes 67 39.4

No 103 60.6

Total
170 100.0

Table VIII : shows that among study subjects 38.2% become talkative, 58.2% eat
more or less than usual 66.5 like to watch TV dramas, News or movies, 39.4% make
lame jokes.

40
Table IX: Distribution of behavioral coping methods among study subjects.

Do you want to sleep more than usual

Frequency Percent
Yes 122 71.8
No 48 28.2
Total 170 100.0

Do you listen songs continuously

Yes 76 44.7
No 94 55.3

Total 170 100.0

Do you want to go for walk or outing

Yes 112 65.9

No 58 34.1
Total 170 100.0
Did you want to weep

Yes 108 63.5

No 62 36.5
Total 170 100.0

Table IX shows that among study subjects 71.8% sleep more than usual, 44.7%
listen song, 63.5% Go for walk or outing, 63.5% want to weep.

41
Table X: Distribution of behavioral coping methods among study subjects

Did you want to beat others

Frequency Percent
Yes 59 34.7
No 111 65.3
Total 170 100.0
Did you want to hurt yourself

Yes 37 21.8
No 133 78.2
Total 170 100.0
Did you want to break things

Yes 54 31.8
No 116 68.2
Total 170 100.0
Did you want to end your life or attempt suicide

Yes 11 6.5
No 159 93.5
Total 170 100.0

Table X shows that among study subjects,34.7% want to beat others,21.8% hurt
themselves 31.8% break things,16.5% end their lives or attempt suicide.

42
Table XI: Distribution of religious coping methods among study subjects

Do you offer prayer or nawafil

Frequency Percent
Yes 121 71.2

No 49 28.8

Total 170 100.0

Do you recite Holy Quran

Yes 91 53.5

No 79 46.5

Total 170 100.0

Do you prefer listening naat

Yes 87 51.2

No 83 48.8

Total 170 100.0

Table XI shows that among study subject 71.2% offer prayer,53.5% recite Holy
Quran 51.2% prefer listening naat.

43
Table XII: Distribution of addiction coping methods in study subjects

Did you smoke

Frequency Percent
yes 22 12.9

No 148 87.1

Total 170 100.0

Did you use alcohol or any other reliever

Yes 4 2.4

No 166 97.6

Total 170 100.0

Table XII shows that among study subject 12.9% smoke , 2.4% use alcohol or any
other reliever

44
Table XIII: Distribution of pharmacological coping options among study
subjects

Do you take any medicine for it

Frequency Percent
Yes 17 10.0
No 153 90.0
Total 170 100.0
If yes, then

self medication 10 5.9

Consultation 7 4.1
No 153 90.0
Total 170 100.0
Do you take medication during stressful condition like viva of Prof

Yes 22 12.9
No 148 87.1
Total 170 100.0
If yes then which medicine

Inderal 14 8.2
Relaxin 3 1.8
Benzodiazepine 4 2.4
Any Other Drug 1 .6
No 148 87
Total 170 100.0

Table XIII shows that among study subjects 10% take medicine and among them
5.9% self medicate 4.1% tconsultation.Among study subjects 12.9% take medication
during stressful condition of prof and among them 8.2% use Inderal, 1.8% use
Relaxin, 2.4% use benzodiazepines, 0.6% use other drugs.

45
 Table XIV: Distribution of consultation coping methods among study subjects

Do you consult psychiatrist for counseling

Frequency Percent
Yes 15 8.8

No 155 91.2

Total 170 100.0

Table XIV shows that among study subject 8.8% consult a psychiatrist while others
do not.

46
Table XV: Descriptive statistics of age, anxiety and depression.

Age in Depression Anxiety

Characteristics years score score

Mean 21.03 6.16 8.82

Std. Error of Mean .130 .287 .300

Median 21.00 6.00 9.00

Mode 22 3 5

Std. Deviation 1.701 3.738 3.910

Variance 2.893 13.973 15.286

Minimum 17 0 1

Maximum 25 18 19

Table XV shows that the study subjects having mean age 21.03±1.7 have
depression score 6.16±3.7 and anxiety score 8.82±3.9

47
 Table XVI: Descriptive statistics of the depression and anxiety among males
and females

Scores
Std. Std. Error
Sex
N Mean Deviation Mean P value

Depression Male 82 5.51 3.252 .359

score
Female
88 6.77 4.065 .433
0.02

Anxiety score Male 82 7.84 3.828 .423

Female
88 9.73 3.784 .403
0.001

Table XVI shows that mean value of depression among males was 5.51±3.2, and
among females was 6.77±4.0 (p=0.02). While mean value of anxiety among males
was 7.84±3.8 and among that of females was 9.73±3.7 (p=0.001).

48
Table XVII: Descriptive statistics of depression and anxiety score among
hostelites and day scholars

Group Residenc Std. Std. Error P value

Statistics e N Mean Deviation Mean

Depression Hostelite 157 6.01 3.743 .299

score
Day .065
13 8.00 3.266 .906
scholar

Anxiety Hostelite 157 8.76 3.850 .307

score
Day .491
13 9.54 4.684 1.299
scholar

Table XVII shows that mean value of depression score among hostelites was
6.01±3.7 and among day scholars was 8±3.2 (p=0.065) And mean value of anxiety
among hostelites was 8.76±3.8 and among that of day scholars was 9.54 ±4.6
(p=0.491).

49
Table XVIII: Descriptive statistics of depression category in males and females
in study subjects

Sex
Depression category

Borderline (8- Abnormal (11-

Normal (0-7) 10) 21) Total

Male 60 (73.2%) 17 (20.7%) 5 (6.1%) 82 (100%)

Female
54 (61.4%) 20 (22.7%) 14 (15.9%) 88 (100%)

Total 114 (67.1%) 37 (21.8%) 19 (11.2%) 170(100%)

Table XVIII shows that among males 73.2% were in normal category, 20.7% were in
borderline category 6.1% were in abnormal category while among females 61.4%
were in normal category, 22.7% were in Borderline category and 15.9% were in
abnormal category

50
Table XIX: Descriptive statistics of anxiety category among males and females
in study subjects

Anxiety category
Sex

Normal (0-7) borderline (8-10) Abnormal(11-21) Total

Male
45 (54.9%) 15 (18.3%) 22 (26.8%) 82 (100%)

Femal
27 (30.7%) 22 (25.0%) 39 (44.3%) 88 (100%)

Total 72 (42.4%) 37 (21.8%) 61 (35.9%) 170 (100%)

Table XIX shows that among males 54.9% were in normal category,18.3% were in
borderline category 26.8% were in abnormal category while among females 30.7%
were in normal category, 25.0% were in Borderline category and 44.3% were in
abnormal category.

51
Table XX: Descriptive statistics of depression category among hostelites and
day scholars in study subjects

Depression category Total

Residence Normal (0-7) Borderline (8-10) Abnormal (11-21)

Hostelite 109 (69.4%) 31 (19.7%) 17 (10.8%) 157(100%)

Day scholar
5(38.5%) 6(46.2%) 2 (15.4%) 13(100%)

Total 114 (67.1%) 37 (21.8%) 19 (11.2%) 170(100%)

Table XIX shows that among hostelites 69.4% were in normal category, 19.7% were
in borderline category 10.8% were in abnormal category while among day scholar
38.5% were in normal category, 46.2% were in Borderline category and 15.4% were
in abnormal category.

52
 Table XXI: Descriptive statistics of anxiety category among hostelites and day
scholars in study subjects

Anxiety category

Residence Normal (0-7) Borderline(8-12) Abnormal 11-21 Total

Hostelite 68(43.3%) 33(21.0%) 56(35.7%) 157(100%)

Day scholar 4(30.8%) 4(30.8%) 5(38.5%) 13(100%)

Total 72(42.4%) 37(21.8%) 61(35.9%) 170(100%)

Table XXI shows that among hostelites 43.3% were in normal category, 21.0% were
in borderline category 35.7% were in abnormal category while among day scholar
30.8% were in normal category, 30.8% were in Borderline category and 38.5 were in
abnormal category.

53
 Table XXII: Descriptive statistics of depression category among different
Professionals

Depression category

MBBS year Normal (0-7) Borderline (8-10) Abnormal (11-21) Total

1st year 20 (66.7%) 7 (23.3%) 3 (10.0%) 30 (100%)

2nd year 18 (52.9%) 10 (29.4%) 6 (17.6%) 34 (100%)

3rd year 30 (76.9%) 5 (12.8%) 4 (10.3%) 39 (100%)

4th year 29 (74.4%) 7(17.9%) 3 (7.7%) 39 (100%)

5th year 17 (60.7%) 8(28.6%) 3 (10.7%) 28 (100%)

Total 170
114 (67.1%) 37 (21.8%) 19 (11.2%)
(100%)

Table XXII shows depression category: 23.3%,29.4%, 12.8%, 17.9% and 21,8%
are borderline in 1st, 2nd, 3rd, 4th and 5th year respectively and 10%, 17.6%, 10.3%,
7,7%, 10,7% and 11,2% are abnormal in 1st, 2nd, 3rd, 4th and 5th year respectively

54
Table XXIII: Descriptive statistics of Anxiety category among different
Professionals

Anxiety category Total

MBBS year Normal (0-7) Borderline (8-10) Abnormal (11-21)

1st Year 14 (46.7%) 8 (26.7%) 8 (26.7%) 30 (100%)

2nd Year 8 (23.5%) 9 (26.5%) 17 (50.0%) 34 (100%)

3rd year 14 (35.9%) 12 (30.8%) 13 (33.3%) 39 (100%)

4th year 24 (61.5%) 4 (10.3%) 11 (28.2%) 39 (100%)

5th year 12 (42.9%) 4 (14.3%) 12 (42.9%) 28 (100%)

Total 72 (42.4%) 37 (21.8%) 61 (35.9%) 170 (100%)

Table XXIII shows that among 1st year 26.7% were in borderline category, 26.7%
were in abnormal category while among 2nd year 26.5% were in Borderline category,
and 50.0% were in abnormal category. While among 3rd year 30.8% were in
Borderline category, 33.3% were in abnormal category. While among 4th year 10.3%
were in Borderline category, 28.2% were in abnormal category. While among 5th
year 14.3% were in Borderline category, 42.9% were in abnormal category.

55
DISCUSSION

56
 DISCUSSION

This study was conducted to assess the anxiety and depression among medical
students and management options used by students to cope these conditions. This
study shows that the study subjects having mean age 21.03±1.7 have depression
score 6.16±3.7 and anxiety score 8.82±3.9.

This show that Out of 170, 30 (17.6%) were of first year 34 (20%) were of second year
39 (22.9%) were of third year 39 (22.9%) were of fourth year 28 (16.5%) were of final
year. This study shows that Out of 170 study subjects 82 (48.2%) were males while
88 (51.8%) were females. This study shows that out of 170 study subjects 157 (92.4%)
were hostelite while 13 (7.6%) were day scholars.

This study shows that out of 170 study subjects 53 (31.2%) were from rural areas while
117 (68.8%) were from urban areas. This study shows that out of 170 study subjects,
72 (42.4%) were in normal range, 37 (21.8%) were in borderline range 61 (35.9%)
were in abnormal range. This study shows that out of 170 subjects 114 (67.1%) were
in normal range, 37 (21.8) were in borderline range19 (11.2%) were in abnormal
range. This study shows that among study subjects 102 (60%) want to be alone, 134
(78.8%) want to talk with someone, 137 (80.6%) want to spend time with friends and
family, while 39 (22.9%) involve in wrongdoing. This study shows that among study
subjects 65 (38.2%) become talkative, 99 (58.2%) eat more or less than usual 113
(66.5%) like to watch TV dramas, News or movies, 67 (39.4) make lame jokes.

This study shows that among study subjects 122 (71.8%) sleep more than usual, 76
(44.7%) listen song, 108 (63.5%) Go for walk or outing, 108 (63.5) want to weep.

This study shows that among study subjects, 59 (34.7%) want to beat others, 37
(21.8%) want to hurt themselves 54 (31.8%) want to break things, 11 (6.5%) want to
end their lives or attempt suicide.

This study shows that among study subject 121 (71.2%) offer prayer, 91 (53.5%) recite
Holy Quran, 87 (51.2%) prefer listening naat.

This study shows that among study subject 22 (12.9%) smoke, 4 (2.4%) use alcohol
or any other reliever.

57
This study shows that among study subjects 17 (10%) take medicine and among them
10 (5.9%) self-medicate 7 (4.1%) take consultation. Among study subjects 22 (12.9%)
take medication during stressful condition of prof and among them 14 (8.2%) use
Inderal, 3 (1.8%) use Relaxin, 4 (2.4%) use benzodiazepines, 1 (0.6%) use other
drugs.

This study shows that among study subject 15 (8.8%) consult a psychiatrist while
others do not. A previous study has shown that active coping strategies, such as
positive framing, talking to family and friends, leisure activities, and exercising, can
reduce the level of perceived stress among college students [43].

This study shows that mean value of depression among males was 5.51±3.2, and
among females was 6.77 ±4.0 (p=0.02) While mean value of anxiety among males
was 7.84 ±3.8 and among that of females was 9.73 ±3.7 (p=0.001)

Table XVII shows that mean value of depression score among hostelites was 6.01
±3.7 and among day scholars was 8 ±3.2 (p=0.065) and mean value of anxiety among
hostelites was 8.76 ±3.8 and among that of day scholars was 9.54 ±4.6 (p=0.491).

This study shows that among males 60 (73.2%) were in normal category, 17 (20.7%)
were in borderline category 5 (6.1%) were in abnormal category while among females
54 (61.4%) were in normal category, 20 (22.7%) were in Borderline category and 14
(15.9%) were in abnormal category.

However in a previous prospective, longitudinal observational study which was

conducted at the Medical School of the University of Minho, Portugal, showed almost
same depression with prevalence ranged from 21.5 to 12.7% (academic years
2009/2010 and 2012/2013) [44].

Around 37% of Canadian medical students meet the criteria for burnout, according to
a Canadian Federation of Medical Students (CFMS) survey sent to medical students
across the country. (Preliminary data have been shared at conferences; publication
expected in 2018.) In research published last year by the Journal of the American
Medical Association, based on an international survey, 27% of medical students
reported symptoms of depression [45].

This study shows that among males 45 (54.9%) were in normal category, 15 (18.3%)
were in borderline category 22 (26.8%) were in abnormal category while among

58
females 27 (30.7%) were in normal category, 22 (25.0%) were in Borderline category
and 39(44.3%) were in abnormal category.

The students reported good quality of life (68%) but presented anxiety (27%),
depression (20%) and impaired social functioning. Fifty-one percent of the students
acknowledged academic needs and 25% psychological needs. Only a portion of the
students with anxiety and depression or bad quality of life used the institutional
support. Female gender, perceived psychological needs and anxiety symptoms were
associated to the use of the Mental Health Service. Satisfaction with mentoring
relationships and positive changes were associated to Mentoring attendance [46].

This study shows that among hostelites 109 (69.4%) were in normal category, 31
(19.7%) were in borderline category 17 (10.8%) were in abnormal category while
among day scholar 5 (38.5%) were in normal category, 6 (46.2%) were in Borderline
category and 2 (15.4%) were in abnormal category

This study shows that among hostelites 68 (43.3%) were in normal category, 33
(21.0%) were in borderline category 56 (35.7%) were in abnormal category while
among day scholar 4 (30.8%) were in normal category, 4(30.8%) were in Borderline
category and 5(38.5%) were in abnormal category.

A previous study with aims to evaluate the prevalence of burnout, depressive

symptoms, and anxiety symptoms and attitudes toward substance use in medical
students as well as their evolution during the 4 years of medical school, conducted at
American University of Beirut Medical Center (AUBMC) between September and
December 2016, which included in total, 176 out of 412 eligible medical students
responded. The survey was anonymous and administered via e-mail link to an
electronic form. The study included general socio-demographic questions and
standardized validated tools to measure depressive symptomatology (PHQ-9),
burnout (Burnout Measure), anxiety (GAD-7), alcohol use (AUDIT), and substance
abuse (DAST-10) as well as questions pertaining to attitudes toward recreational
substance use .this study showed that overall, 23.8% of medical students reported
depressive symptomatology, with 14.5% having suicidal ideations. Forty-three percent
were found to have burnout. Those who screened positive for burnout were more likely
to be males, to be living away from their parents, and to have experienced a stressful
life event during the last year. With the exception of burnout, there was no significant

59
difference in the prevalence of depression or anxiety among the 4 years of medical
school. There was a significant difference in alcohol use, illicit substance use, and
marijuana use during the four medical school years [47].

This study shows that among 1st year 20 (66.7%) were in normal category,7 (23.3%)
were in borderline category 3 (10.0%) were in abnormal category while among 2nd
year 18 (52.9%) were in normal category,10 (29.4%) were in Borderline category and
6 (17.6%) were in abnormal category. While among 3rd year 30 (76.9%) were in
normal category,5 (12.8%) were in Borderline category and 4 (10.3%) were in
abnormal category. While among 4th year 29 (74.4%) were in normal category,7
(17.9%) were in Borderline category and 3 (7.7%) were in abnormal category. While
among 5th year 17 (60.7%) were in normal category,8 (28.6%) were in Borderline
category and 3 (10.7%) were in abnormal category.

This study shows that among 1st year 14 (46.7%) were in normal category, 8 (26.7%)
were in borderline category 8 (26.7%) were in abnormal category while among 2nd
year 8 (23.5%) were in normal category, 9 (26.5%) were in Borderline category and
17 (50.0%) were in abnormal category .while among 3rd year 14 (35.9%) were in
normal category,12(30.8%) were in Borderline category and 13 (33.3%) were in
abnormal category. while among 4th year 24 .(61.5%) were in normal category,
4(10.3%) were in Borderline category and 11 (28.2%) were in abnormal category.
while among 5th year 12 (42.9%) were in normal category, 4(14.3%) were in Borderline
category and 12 (42.9%) were in abnormal category.

60
CONCLUSION

61
 CONCLUSION

This study showed that majority of the medical student had borderline to abnormal
anxiety and about one third of them were borderline to abnormal depression scores.
Majority of medical students used social, behavioral and religious while few of them
used pharmacological and psychiatric options to cope with anxiety and depression.
Depression and anxiety scores among females were significantly higher than males.
It is suggested that appropriate interventions may be started at medical colleges to
control anxiety and depression among medical students.

62
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