INTRODUCTION
The coronavirus pandemic has increased mental health distress among health professionals.1, 2 Residents, pre-pandemic, already had elevated rates of depression, burnout, and suicide.3 However, there are no studies quantifying the effects of the COVID-19 pandemic on the mental health of medical students in the USA. Our purpose was to conduct a multi-institution survey to assess mental health among US medical students.
METHODS
An online questionnaire was distributed to students enrolled in all 16 allopathic medical institutions located in Washington and New York states between June 17 and July 17, 2020. The questionnaire emphasized questions focused on individual mental health during the first months of the COVID-19 pandemic, between March and April 2020. We assessed for depressive (Patient Health Questionnaire, PHQ-8) and anxiety (Generalized Anxiety Disorder, GAD-7) symptoms, in addition to asking about self-rated mental health compared to before the pandemic on a scale of 0 to 100%. The PHQ-8 was scored as none (0–4), mild (5–9), moderate (10–14), moderately severe (15–19), and severe (20–24), while the GAD-7 was scored using none (0–4), mild (5–9), moderate (10–14), and severe (15 or greater). The linear covariance between depression and anxiety was analyzed using Microsoft Excel and reported as Pearson’s correlation coefficient (R). This study was approved by the Weill Cornell Medicine Institutional Review Board (IRB# 20-04021790) and follows STROBE guidelines for cross-sectional studies.
RESULTS
A total 1139 completed the survey (Washington: 174, 14%; New York: 1065, 86%; Table 1). Our response rate was 12%. Students who reported symptoms of COVID-19 or who reported a close contact (family member, friend, or romantic partner) with symptoms constituted 40% (n=457) of all participants. Approximately 7% (n=80) reported a COVID-19-related death of at least one close contact. Most participants (n=718, 70%) rated their mental health as worse than baseline following the initial months of the COVID-19 pandemic. One-fifth of respondents (n=202, 20%) reported experiencing improved mental health in the initial months of the COVID-19 pandemic.
Table 1.
Sample Demographics
| n(%) | |
|---|---|
| No. of respondents | 1139 |
| Class year | |
| Year 1 | 363 (32) |
| Year 2 | 311 (27) |
| Year 3 | 298 (26) |
| Year 4 | 87 (8) |
| Graduate studies or research year | 62 (5) |
| Time off/other | 17 (2) |
| Gender | |
| Woman | 830 (66) |
| Man | 385 (31) |
| Trans | 4 (0.3) |
| Gender queer/non-conforming | 19 (2) |
| Non-binary | 7 (0.1) |
| From a group traditionally underrepresented in medicine* | 321 (26) |
| Specialty of interest | |
| Anesthesiology | 38 (3) |
| Dermatology | 15 (1) |
| Emergency medicine | 98 (9) |
| Family medicine | 62 (5) |
| Internal medicine | 199 (17) |
| Neurological surgery | 12 (1) |
| Neurology | 34 (3) |
| Obstetrics and gynecology | 63 (6) |
| Orthopedic surgery | 33 (3) |
| Otolaryngology | 23 (2) |
| Pathology | 8 (1) |
| Pediatrics | 100 (9) |
| Physical medicine and rehabilitation | 14 (1) |
| Plastic surgery | 8 (1) |
| Psychiatry | 55 (5) |
| Radiation oncology | 7 (1) |
| Radiology | 16 (1) |
| Surgery | 57 (5) |
| Thoracic surgery | 4 (0) |
| Undecided | 275 (24) |
| Urology | 15 (1) |
| Vascular surgery | 2 (0) |
*Based on the definition by the Association of American Medical Colleges4
Depressive and anxiety symptoms were common (Table 2). The majority (61%) of respondents reported experiencing some depressive symptoms, 371 (37%) were mild, 151 (15%) were moderate, 65 (6%) had moderately severe, and 34 (3%) had severe with 250 (24%) meeting criteria for major depression. Similarly, most respondents (58%) reported some symptoms of anxiety: 385 (38%) mild, 130 (13%) moderate, and 68 (7%) severe with 198 (20%) meeting criteria for an anxiety disorder. There was significant correlation between the PHQ-8 and the GAD-7 scores among participants (R=0.7, P<.001).
Table 2.
Mental Health Questionnaires Scores
| Question | n(%) |
|---|---|
| Patient Health Questionnaire-8 | 1013 |
| None | 394 (39) |
| Mild | 371 (37) |
| Moderate | 151 (15) |
| Moderately severe | 64 (6) |
| Severe | 34 (3) |
| Questions | |
| Reduced interest | 605 (60) |
| Feeling down | 635 (63) |
| Sleep alterations | 577 (79) |
| Feeling tired | 625 (86) |
| Changes in appetite | 483 (64) |
| Feelings of guilt | 386 (53) |
| Difficulty concentrating | 540 (74) |
| Feeling slow or restless | 136 (19) |
| General Anxiety Disorder Questionnaire-7 | 1011 |
| None | 429 (42) |
| Mild | 385 (38) |
| Moderate | 130 (13) |
| Severe | 68 (7) |
| Questions | |
| Feeling nervous | 818 (81) |
| Non-stop worrying | 559 (55) |
| Worrying about different things | 682 (68) |
| Trouble relaxing | 684 (68) |
| Feeling restless | 324 (32) |
| Easily annoyed or irritated | 668 (66) |
| Afraid of awful things happening | 504 (50) |
DISCUSSION
We found that over two-thirds of medical students who completed our survey believed their mental health had deteriorated following the start of the COVID-19 pandemic, with most students reporting one or more symptoms of depression and anxiety. This suggests that mental health disorders may have been higher during the pandemic than previously reported.5 The results of the survey suggest a higher prevalence of major depressive disorder or symptoms of depression among US medical students than previously reported.5 This is particularly concerning as this group has previously shown higher prevalence of depression compared to the general population.6 Anxiety is common among medical students; previous studies have found that it is diagnosed up to eight times more frequently than in the general US population.6 In our study, nearly one out of five US medical students had moderate to severe anxiety symptoms. Our findings also highlight that medical students experienced depression and anxiety symptoms at a similar rate as frontline workers during the COVID-19 pandemic despite not necessarily being exposed to in-person patient care.7 Our study has several limitations. First, our response rate was low. Second, we solicited participation from the most afflicted areas during the study period. Third, baseline PHQ-8 and GAD-7 scores were not obtained, and policy changes affecting daily life continued well beyond the date of data collection. Our study raises concern about mental health issues as medical students become residents and enter the workforce. More research and support for medical student and resident mental health is needed, particularly in the wake of the COVID-19 pandemic.
Acknowledgements
The authors would like to thank the medical students who participated in this study and the continued effort of individuals across the country in prioritizing the well-being of medical trainees. Thank you to Peter M. Marzuk, MD and Jessica A. Gold, MD for their comments on this project.
Funding
Briana Christophers was supported by a Medical Scientist Training Program grant from the National Institute of General Medical Sciences of the National Institutes of Health under award number T32GM007739 to the Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD–PhD Program.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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