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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 7  |  Issue : 2  |  Page : 104-110

Depression, anxiety, stress, and satisfaction of medical students in relation to income and body mass index


1 College of Medicine, Suliman Al Rajhi University, Al Bukairyiah, Saudi Arabia
2 Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Date of Submission02-Sep-2022
Date of Decision19-Oct-2022
Date of Acceptance09-Nov-2022
Date of Web Publication27-Dec-2022

Correspondence Address:
Dr. Thamir Al-Khlaiwi
Associate Professor, Department of Physiology, College of Medicine, King Saud University, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/KKUJHS.KKUJHS_30_22

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  Abstract 

Objectives: The aim of this study was to explore the relationship of students' income and body mass index (BMI) with the level of depression, anxiety, stress, and academic satisfaction. Methods: A cross-sectional study with distribution of online Depression, Anxiety, and Stress Scale questionnaire online to medical students in different universities of Saudi Arabia. In addition, they filled out a predesigned pro forma that contained sociodemographic characteristics and satisfaction status regarding lectures, practical, staff, and examinations. A total of 351 participants completed the study. Students were asked about various academic issues and assessed by a three-point Likert scale (satisfied, undecided, and unsatisfied). Results: The prevalence of depression, anxiety, and stress in students with a father's monthly income of <3000 US Dollars was 72.4% (n = 79), 83.4% (n = 91), and 63.3% (n = 69), respectively. Furthermore, the prevalence of depression, anxiety, and stress in students with a father's monthly income between 3000-5000 US Dollars was 71.5% (n = 73), 74.5% (n = 76), and 48.0% (n = 49) respectively. As for the students with a father's monthly income >5000 US Dollars had a prevalence of 62.1% (n = 87), 71.4% (n = 100), and 48.5% (n = 68) for depression, anxiety, and stress respectively. Hence, it was noted that the prevalence was higher in students with a father's monthly income <3000 US Dollars in all categories (depression P = 0.056 which was marginal, anxiety P = 0.009, and stress P = 0.050).. 46.8% (n = 51) of students with a father's monthly income <3000 US Dollars, 32.4% (n = 33) of students with a father's monthly income between 3000 and 5000 US Dollars, and 30.7% (n = 43) of students with a father's monthly income >5000 showed an extremely severe anxiety score. It showed that the moderate degree of depression with mean total depression score of students with a father's monthly income <3000 was 17.7 ± 11.7. It showed a severe degree of anxiety with a mean total anxiety score of 18.4 ± 11.4, and a moderate degree of stress with a mean total stress score of 19.1 ± 10.4. The prevalence of depression 69.3% (n = 172), anxiety 77.4% (n = 192), and stress 54.8% (n = 136) in students with BMI <25 was higher than in students with BMI ≥25 65.0% (n = 67), 72.8% (n = 75), and 48.5% (n = 50) with no statistically significant difference (P = 0.161, P = 0.433, and 0.572), respectively. It showed that 37.5% (n = 93) of students with BMI <25 were extremely severely anxious while students with BMI ≥25 were 33.0% (n = 34). Conclusions: The prevalence of depression, anxiety, and stress in medical students with low father monthly income was significantly high. The prevalence of severe anxiety in all groups needs more attention from the medical college's higher authorities.

Keywords: Body mass index, financial status, medical students, obesity, psychological status, satisfaction


How to cite this article:
Habib SM, Al-Khlaiwi T. Depression, anxiety, stress, and satisfaction of medical students in relation to income and body mass index. King Khalid Univ J Health Sci 2022;7:104-10

How to cite this URL:
Habib SM, Al-Khlaiwi T. Depression, anxiety, stress, and satisfaction of medical students in relation to income and body mass index. King Khalid Univ J Health Sci [serial online] 2022 [cited 2023 Jan 30];7:104-10. Available from: https://www.kkujhs.org/text.asp?2022/7/2/104/365759


  Introduction Top


There is a tremendous impact of the financial status of people on their achievement, goals, and satisfaction. Most of the stress that people face in their daily lives is mainly because of their financial burdens and the failure to cope with them which has its adverse effects on their overall health. It has been found that humans can be subjected to various psychological disorders more than twice if they are below the level of poverty and subjected to multiple chronic illnesses and subsequently need special health care.[1]

Several factors have been mentioned in the literature which could contribute to the stress facing medical students and has an impact on their mental and health status, which subsequently will affect their academic performance. One cannot deny and ignore factors that apply more pressure upon students such as intensive training, multiple examinations, condensed curriculum, competence, time management, language obstacles, deficiency of social life, language barrier, and insecure future.[2],[3],[4],[5],[6],[7],[8],[9] These factors as well as others might affect their satisfaction toward their academic environments. One possible factor that has been mentioned in the literature but not studied very well includes financial ability and stability.[10],[11] Moreover, several other factors play an important role in the academic life of medical students, but the financial status and its impact on psychological well-being of medical students were not studied appropriately which needs more attention.

One of the major health issues that face health-care providers worldwide and in particular in Saudi Arabia is the increasing rate of obesity with the new lifestyle which reaches astonishing levels.[12],[13] The major problem of obesity in the Middle East is not specific to the elderly, but its impact reaches all society levels. A study by Mehmood et al., 2016, showed a high prevalence of overweight and obesity among students in particular; among them, 21.7% (n = 88) were overweight and 8.4% (n = 34) were obese with no difference between males and females.[14] Moreover, chronic disorders such as hypertension and gallbladder disorders have started to develop among those students.[14] Not only does obesity has its effects on medical students but also on body appearance.[15],[16] Liao et al. observed that 78.8% of medical students were unsatisfied with their appearance which is very high in percentage. In addition, those students tended to develop high anxiety scores.[15]

Mirza et al. found that 55.8% of medical students had depression, 45.9% had anxiety, and 37.7% of students had stress, and their appearance has the highest factor in anxiety.[17] It would be of great importance to assess the association of the father's monthly income and body mass index (BMI) on depression, anxiety, stress, and level of satisfaction in various academic aspects. Therefore, the present study aimed to examine the association between a father's monthly income and BMI on the Depression, Anxiety, and Stress Scale (DASS) and the level of satisfaction of medical students toward various academic-related issues.


  Methods Top


An online form was designed comprising of DASS and the level of satisfaction in correspondence to academic issues. It was conducted in Saudi Arabia, Riyadh, King Saud University, College of Medicine, Department of Physiology, from November 2021 to January 2022. A simple random sampling was used to collect data and distributed through personal efforts and student's affairs to medical students in medical schools of Saudi Arabia (governmental and private). Study variables (father's financial income and BMI of the student) were correlated to DASS as an outcome variable. Furthermore, satisfaction level (outcome variable) was correlated with financial income (father's monthly income <3000 US Dollars, father's monthly income is between 3000 and 5000 US Dollars, and father's monthly income >5000 US dollars according to the student's financial status) and BMI of students. The inclusion criteria were nongraduated medical students currently studying in governmental or private schools in Saudi Arabia. Exclusion criteria were graduated medical students or students studying in dental, applied medical sciences, pharmacy school, and other colleges. In addition, students outside Saudi Arabia were excluded. A sample size of 351 was collected, and it was calculated by using the Steven Thompson Equation. The predesigned pro forma consisted of several sections regarding lectures, practical, evaluation, and teaching staff. These issues were assessed by a three-point Likert scale (satisfied, undecided, and unsatisfied). In addition, the Depression, Anxiety, Stress Scale (DASS) was used to assess psychological status which is a validated and well-known measure. The students were informed there is no obligation to participate. A pilot study was performed to assess the initial response of the students.

Statistical analysis

We used the Statistical Package for Social Sciences (SPSS version 21; IBM Corporation, Armonk, NY, USA). Frequencies, percentages, means, and standard deviations were used to describe categorical and quantitative variables. Pearson's Chi-square test was used to examine the correlation between study variables and outcome. P ≤ 0.05 and 95% confidence intervals were used for the statistical significance and precision of the results to be reported. A t-test was used to compare the mean between the BMI of groups. Analysis of variance was used to compare the three groups of father's monthly income. The correlation ratio (eta) was computed to assess the association between the nominal variables (father's monthly income and BMI) and depression, anxiety, and stress.


  Results Top


As per our plan and aims, a total of 351 complete responses were finally obtained. All incomplete responses which were about 12 were excluded.

The sociodemographic and descriptive variables of the studied population are given in [Table 1]. The final sample size has 109 (31.1%) students with fathers' income <3000 US Dollars, 102 (29.1%) students between 3000 and 5000 US Dollars, and 140 (39.9%) students >5000 US Dollars. Regarding BMI, students <25 represent 248 (70.7%) and students ≥25 represent 103 (29.3%) of the sample. Two hundred and twenty-one (63.0%) students were aged from 20 to 22 years. One hundred and ninety-four (55.3%) students were male students, while 157 (44.7%) were female students.
Table 1: Characteristics of sociodemographic variables of sample size (n=351)

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[Table 2] expresses that students with a father's monthly income of <3000 US Dollars had a prevalence of depression 72.4% (n = 79), anxiety 83.4% (n = 91), and stress 63.3% (n = 69), students' with a father's monthly income between 3000 and 5000 US Dollars had a prevalence of depression 71.5% (n = 73), anxiety 74.5% (n = 76), and stress 48.0% (n = 49), while students with a father's monthly income >5000 US Dollars had a prevalence of depression 62.1% (n = 87), anxiety 71.4% (n = 100), and stress 48.5% (n = 68) with more prevalence in students with fathers' monthly income < 3000 in all categories (depression P = 0.056 which was marginal, anxiety P = 0.009, and stress P = 0.050). Fifty-one (46.8%) students with a father's monthly income <3000 US Dollars, 33 (32.4%) students with a father's monthly income between 3000 and 5000 US Dollars, and 43 (30.7%) students with a father's monthly income of >5000 US Dollars showed an extremely severe anxiety score. The total depression score of students with a father's monthly income <3000 US Dollars was 17.7 ± 11.7, students with a father's monthly income between 3000 and 5000 US Dollars was 17.3 ± 12.2, and students with a father's monthly income >5000 US Dollars was 14.4 ± 11.3 with P = 0.042. The total anxiety score for students with a father's monthly income <3000 was 18.4 ± 11.4, between 3000 and 5000 was 15.4 ± 10.9, and for >5000 US Dollars was 14.8 ± 11.5 with P = 0.035. The total stress score for students with a father's monthly income <3000 US Dollars was 19.1 ± 10.4, between 3000 and 5000 US Dollars was 16.6 ± 10.6, and for >5000 US Dollars was 17.3 ± 10.5 with P = 0.113. [Table 3] shows the association between BMI and DASS. Regarding BMI, the prevalence of depression 69.3% (n = 172), anxiety 77.4% (n = 192), and stress 54.8% (n = 136) in students with BMI <25 was higher than in students with BMI ≥25 (65.0% (n = 67), 72.8% (n = 75), and 48.5% (n = 50) with no statistically significant difference (P = 0.161, P = 0.433, and P = 0.572), respectively. It also showed that 37.5% (n = 93) of students with BMI <25 were extremely severely anxious while students with BMI ≥25 were 33.0% (n = 34). The total mean depression score of students with BMI <25 was 16.6 ± 11.4 and for those ≥25 was 15.7 ± 12.7 with P = 0.536. The total anxiety score for students with BMI <25 was 16.2 ± 11.1 and for ≥25 was 15.8 ± 12.1 with P = 0.783, and the total stress score for students with BMI <25 was 17.2 ± 10.4 and for ≥25 was 17.6 ± 10.6 with P = 0.701.
Table 2: Association of father's monthly income and total prevalence of depression, anxiety, and stress and total mean of depression, anxiety, and stress (n=351)

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Table 3: Association of body mass index and total prevalence of depression, anxiety, and stress and total mean of depression, anxiety, and stress (n=351)

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[Table 4] elaborates the association between the father's monthly income and level of satisfaction with lectures and practical. It showed a higher level of satisfaction of students with a father's monthly income >5000 US Dollars for PBL session with P = 0.021, duration of blocks with P = 0.013, and studying from slides rather than textbooks with P = 0.004. On the other hand, students with father's monthly income <3000 US Dollars had a higher level of satisfaction for the importance of learning skills items with P = 0.001.
Table 4: Association of father's monthly income and level of satisfaction toward lectures and practicals (n=351)

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[Table 5] reveals the association between the father's monthly income (father's income <3000 US Dollars, father's income between 3000 and 5000 US Dollars, and father's income >5000 US Dollars) and the level of satisfaction toward teaching staff and evaluations. It shows more satisfaction of students with a father's monthly income >5000 US Dollars in practical examinations than the other groups with P = 0.006.
Table 5: Association of father's monthly income and level of satisfaction toward teaching staff and evaluation (n=351)

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[Table 6] shows that students with BMI ≥25 are more unsatisfied with all items of lectures and practical than students with BMI <25 even though there were no statistically significant differences between the two groups. [Table 7] shows that students with BMI <25 were more statistically satisfied with the punctuality of the teaching staff (P = 0.002), and their availability during office hours (P = 0.003). Moreover, students with BMI ≥25 were more unsatisfied with all items of teaching staff and evaluations with no statistical difference.
Table 6: Association of body mass index and level of satisfaction toward lectures and practical (n=351)

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Table 7: Association of body mass index and level of satisfaction toward teaching staff and evaluations (n=351)

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The correlation between the father's monthly income and BMI and depression, anxiety, and stress (by eta ratio) was as follows: father's monthly income and depression (−0.127), anxiety (−0.129), and stress (−0.096) showed a high negative correlation with father income (the higher the income, the lesser the prevalence), while BMI and depression (−0.033), anxiety (−0.015), and stress (0.020) showed no correlation.


  Discussion Top


There has been a consensus among scientists regarding the high level of depression, anxiety, and stress among medical students regardless of their sociodemographic characteristics.[18],[19],[20],[21],[22],[23],[24],[25],[26],[27] The present study addresses an important issue of finical status and psychological well-being in medical students' community in the KSA. It was found that students with a father's monthly income of <3000 US Dollars have a high prevalence of depression (72.4%), anxiety (83.4.0%), and stress (63.3%). Our findings revealed that depression and anxiety prevalence was the highest compared to studies conducted in Saudi Arabia by Aboalshamat et al., 2015; Mirza et al., 2021; and Bano et al., 2021.[17],[25],[28] In addition, the results of this study showed that the moderate degree of depression with total mean depression score of students with a father's monthly income <3000 was 17.7 ± 11.7, severe degree of anxiety with a mean total anxiety score was 18.4 ± 11.4, and moderate degree of stress with a mean total stress score was 19.1 ± 10.4. These scores are considered to be high when compared to previous studies.[29],[30],[31],[32] Financial demands on students' families and hence on the students could apply great huge negative effects on their academic performance. In the same regard, the high scores could be due to the impact of the COVID-19 crisis which affected public financial abilities. In addition, the high prevalence of extremely severe anxiety (>30%) in all groups of students has to be taken into consideration. The reasons behind the high level of psychological disorders, whether from teaching staff, curriculum, regulations, or others, have to be understood and treated properly. In addition, the study found a strong negative association between the father's monthly income of the students and depression, anxiety, and stress (the higher the income, the lower the prevalence of psychological disorders). Regarding BMI, the prevalence of depression (69.3%), anxiety (77.4%), and stress (54.8%) in students with BMI <25 was higher than in students with BMI ≥25 with values of 65.0%, 72.8%, and 48.5% for depression, anxiety, and stress, respectively, with no statistically significant difference between the two groups. All the groups were medical students, so they have the same level of education. One possible explanation could be that BMI is affected by the father's monthly income of the students and consequently had the same results. It also showed that 37.5% of students with BMI <25 were extremely severely anxious while students (33.0%) with BMI ≥25 need more attention.

The present study expressed a high level of dissatisfaction among students with BMI ≥25 compared to students with lower BMI regarding lectures, practical, teaching staff, and evaluations. This could not be associated with financial issues because it was not the same situation when the father's monthly income toward teaching issues was compared. It is very difficult to explain the reasons behind the specific satisfaction or unsatisfaction of students toward certain academic issues due to the sample size of the study and the way it was conducted. It would be of great interest to explore the satisfaction level of the students and its correlation to various variables through extensive studies.

Strength and weakness

It is the leading study that examined the association between the income of medical students and DASS and the level of satisfaction with large sample size. It is the leading study that examined the relationship between DASS, level of satisfaction and financial burden with a relatively large sample size. The weakness of this study is its cross sectional design and we could not get full explanations regarding the low satisfaction of students with BMI ≥25 regarding academic issues.


  Conclusions Top


The study revealed a high prevalence of depression, anxiety, and stress prevalence in students with low father monthly income. In addition, the high prevalence of extremely severe anxiety in all groups needs more attention from the medical college's administrators. Students' perspective and satisfaction toward their academic environment has to be taken into consideration and evaluated carefully in order to improve their achievements.

Recommendations

More concern from authorities regarding the financial support of students is needed to lower the level of depression, anxiety, and stress in medical students. Furthermore, expanded studies are of great value to elaborate on the level of satisfaction of the students and to understand the reasons behind their perspectives. Weakness and strength should be evaluated thoroughly in order to construct a very productive and satisfied curriculum.

Ethical approval

The study was approved (E-21–6431) by the College of Medicine Research Center (Institutional Review Board), King Saud University, Riyadh, Saudi Arabia.

Authors contributions

SMH: study hypothesis, study design, data collection, and data analysis.

TMK: study hypothesis, study design, data analysis, and manuscript writing.

All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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