INTRODUCTION

Around the world, university medical education is considered one of the most demanding academic and emotional training programs. This has tarnished the mental health of medical students with the high prevalence of anxiety and depression¹.

Clark and Beck define anxiety as a complex response system that overestimates a situation as potentially lethal for the individual². The World Health Organization (WHO) estimates that more than 260 million people suffer from this pathology³. In Peru, around 44.64% of university students study anxiety⁴. The prevalence of anxiety in medical students around the world has a wide range of variability, from 37.2% in Brazil⁵, 58.5% in Mexico⁶, to 75.4% in Peru⁷. On the other hand, the WHO characterizes depression as sadness, loss of interest or pleasure, guilt or lack of self-esteem, sleep or appetite disorders, feelings of tiredness, and lack of concentration; approximately 300 million people worldwide suffer from it⁸. When comparing the prevalence of depression among Peruvian university students, those of health sciences are the first with 54.9%⁹. The prevalence of depression in medical students is different around the world, in Malaysia, it is 11%¹⁰; in Brazil it is 41%¹¹, while in Peru, it is 32.5%¹².

Due to the high prevalence of these pathologies, their association was studied at the University of Rochester, New York, concluding that adolescents with a negative anxiety response style longitudinally have a greater probability of presenting with depressive symptoms, and it increases in these the association between anxiety and depression¹³. Due to the high prevalence of anxiety and depression, and the probable association between both pathologies in medical university students around the world, it has been considered to carry out the present study to determine the association between anxiety and depression in medical students of the Ricardo Palma University during the academic cycle 2021-II.

METHODOLOGY

RESULTADOS

In the sample, a predominance of the female sex was found at 59.09%. Likewise, it was reported that 30% of the students were of low socioeconomic level, 40.91% of medium socioeconomic level, and 29.09% of high socioeconomic level. 39.09% of the students took pre-clinical courses, 52.73% took clinical courses, and 8.18% attended medical internships.

Table 1shows that, regarding anxiety, 33.64% was moderate and 32.73% severe; that is to say: anxiety was moderate or severe in 66.37%. Regarding depression: moderate in 19.09% and severe in 13.64%; that is to say: depression was moderate or severe in 33.73%.

Table 2shows that of the students who suffered from depression, 65.45% were female, 47.27% were of low socioeconomic status and 52.73% had clinical courses.

Table 3shows that of the students who suffered from anxiety, 59.57% were female, 72.34% were of low and medium socioeconomic status, and 55 .32% had clinical courses.

InTable 4, in relation to the bivariate analysis, the probability of suffering from depression in the group of students who suffer from anxiety was 4.5 times with respect to the group of students who do not suffer from anxiety (PR=4.51; CI95 % 1.21 - 16.79, p=0.025). And the probability of suffering from depression in the group of students with a low socioeconomic level was 2.29 times compared to the group of students with a high socioeconomic level (PR=2.29; CI95% 1.37 - 3.8; p=0.002). . Regarding the multivariate analysis, the probability of depression in those who suffer from anxiety is 4.52 times compared to those who do not suffer from anxiety. This was statistically significant (p: 0.038). In addition, the probability of depression in those with a low socioeconomic level is 2.02 times that of those with a high socioeconomic level. This was statistically significant (p: 0.004).

DISCUSSION

In the present study carried out on the medical students of the Ricardo Palma University during the period 2021-II, the prevalence of anxiety was 85.46% and depression was 50%.

With regard to anxiety, studies conducted before the pandemic, that is, up to 2019, show a lower prevalence of anxiety, Mexico with 58.5%⁶, Colombia with 26.5% for trait anxiety¹⁵, Brazil with 37.2%⁵and in Peru, a multicenter study of three universities, from the coast, mountains and jungle, showed anxiety of 10.5%¹⁶. On the contrary, studies carried out during the pandemic to date show a prevalence of anxiety in Spain of 24.71% for Anxiety state (anxiety state) and 21.53 for Anxiety trail (anxiety trait)¹⁷, in the United States 30.6%¹⁸, in Peru a thesis carried out in Piura found that 64.7% of medical students suffer from anxiety¹⁹, and a study carried out a year earlier at the same university in the present sample found a prevalence of anxiety of 75.4%²⁰. The high prevalence of anxiety in medical students at Ricardo Palma University in the period 2021-II is not different from that in medical students in the post-COVID-19 era around the world.

In relation to depression, the studies carried out in the pre-pandemic era found the following prevalences, in Mexico 26.8%⁶, in Colombia 30.15%¹⁵, in Brazil 27.6% were reported from the first to the sixth year of studies²¹. In comparison, a multicenter study in Peru revealed a prevalence of depression of 3.9%¹⁶. And the studies carried out during the pandemic to date show a prevalence of depression in Spain of 41%¹⁷, in the United States of 24.3%¹⁸, in Mexico a longitudinal study described that the prevalence of depression increased from 19.84% to 40.08% between April and December 2020²². In Peru, a study conducted at the same university in the sample a year earlier found 78.8% depression²⁰. Great variability in the prevalence of depression is observed in medical students around the world both before the COVID-19 pandemic and during it.

When performing the chi-square test, a p-value (p: 0.038) was obtained, which shows a significant association between anxiety and depression in the medical students of Ricardo Palma University in the period 2021-II. This result is similar to the study by Ivana Damásio et al., where Brazilian medical students from different academic semesters were surveyed, obtaining a significant association between anxiety and depression⁵. Similarly, a cross-sectional study conducted on Chinese medical students in 2020 determined that there was a significant positive correlation between anxiety and depression²³. Similarly, the Spanish multicenter cross-sectional study conducted in 43 different medical schools in 2021 showed a statistically significant association between Anxiety Trail (anxiety trait) and depression¹⁷.

Likewise, depression is associated with a history of mental illness²⁴, a history of psychiatric disorder²⁵and the presence of a mental illness²⁶. Similarly, anxiety is statistically associated with a history of mental illness²⁷and psychiatric disorder²⁵.

The literature indicates that the female sex and the presence of depression have a statistically significant association; This statement is supported by publications from Brazil²¹, the United States²⁸, and Saudi Arabia²⁴. The present study determined that the female sex had a 31% greater probability of suffering from depression but without a statistically significant association. Similar occurred in other Peruvian studies, the first carried out in Huánuco in 2020, with a sample that included medical students from the first to the fifth academic year; this showed that the female sex was a risk factor of 1.03 times more to have depression, but without significant association²⁹. The second also carried out in 2020, was a multicenter study, where medical students from the first to the sixth year were evaluated in the cities of Lima, Cusco and Ucayali, as a representation of the Peruvian coast, mountains and jungle. This publication also demonstrated that there was no significant association between sex and depression in their sample¹⁶.

Likewise, a Mexican study in 2020, which compared first and last-year medical students with students from other careers except those in the health area, showed that female medical students had a higher probability of suffering from depression, but this was not statistically significant⁶. This lack of statistically significant association between the female sex and depression in medical students has been suggested that may be due to the contribution that medical training gives to gender equality in the area of health⁶.

In this study, the significant association between low socioeconomic status and depression was determined. Similar occurred in Egypt (2020); it was shown that being dissatisfied with your socioeconomic level is associated with depression²⁶. In turn, Çelik et al. supported that poor economic status is associated with depression³⁰.

In the present study, no statistically significant association was found between pre-clinical courses, clinical courses and medical internships with depression. A similar occurred with the 2020 Peruvian study that took as a sample three universities from the coast, mountains, and jungle; it did not find a statistically significant association between year of study and major depression¹⁶. Similarly, a Brazilian study from 2017 showed no significant association between the academic semester (pre-clinical, clinical, and internship) and depression⁵.

Similarly, various publications indicate that depression may be associated with pre-clinical courses or the first 3 years of study, such as the United States study that took 40 medical schools as a population, which showed a significant association between depression and pre-clinical courses¹⁸. Likewise, a Peruvian study from 2020 showed that depression was statistically associated with the first year of studies²⁹.

The results are diverse. Thus a Mexican study carried out in 2020, which compared medical students in their first and last year of medicine with students from other careers except those in the health area, showed an association between depression and their last year of medicine⁶.

CONCLUSIONS

The findings of this study show a high prevalence of anxiety and depression among medical students at Ricardo Palma University. Likewise, according to the bivariate analysis, there is a statistically significant association between anxiety and depression, and between low socioeconomic status and depression. For this reason, it is recommended that students receive psychological support during their university career, and include mental health courses in the undergraduate curriculum that provide effective and efficient tools to prevent and combat these pathologies.