Medical students are particularly vulnerable to mental health concerns as a result of burden of their academic life and their job description requirements which increase their vulnerability to depression and anxiety. Hence the current pandemic adverse event may increase such negative feelings [7, 8, 20].
The findings of this study revealed a considerable negative impact on mental health in the studied group in which majority of the participants were experiencing increased stress and anxiety due to COVID-19 pandemic and lockdown.
In this study, according to DASS, those with clinically significant depression were 75.2%. The sum of clinically significant anxiety was 56.4%. Those with clinically significant stress were 52.9% (Table 3). The result of this study was in accordance with the results of a study held in Saudi Arabia where the majority of medical students (73%) were found to be stressed [1]. Our results were higher than the finding of a study held in India by Vala et al. [15] who used the same psychometric tool and found that depression, anxiety and stress were 15.6, 17.2, 10.8%, respectively. Yet, only 1st year medical students were assessed in the last study. Also, our results are higher than survey held in China among college students as all in which the overall incidence of anxiety was 26.60%. Depressive emotions were detected in 21.16% of the students [5]. Another Chinese study found that deteriorated mental health status among Chinese students [4]. Wang et al. [16, 17] found that in total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; those who reported moderate to severe anxiety symptoms was 28.8%; while 8.1% of the respondents showed reported moderate to severe stress levels. This difference may be due to involvement of large sample among all college students not only medical students.
Regarding IES, the result of this study showed that 9.6% had the probability for PTSD while, 44.7% had high PTSD high enough to suppress immunity (Table 3), where females were significantly higher than male (Table 4). This was in line with a study done by Torun and Torun [14] in Turkey also, found that the average scores given to IES-R in women were also higher (p = 0.02).
Regarding association between different variables and psychological impact of COVID-19, the multivariate regression analysis of the significant univariate factors revealed that IES, depression, anxiety and stress are significantly related to gender, history of road accident and personal history of psychiatric disorders (Table 6). Studied variables such as being a female, student status, physical symptoms and poor self-rated health status were found to be significantly associated with a greater levels of stress, anxiety, and depression (p < 0.05) as a psychological impact of COVID-19. However, precise health information about treatment and local outbreak situation, particular precautionary measures were associated with and lower levels of stress, anxiety, and depression (p < 0.05) [16]. Also, the results of multivariate analysis in a study by Chang et al. [5], reported that those who live in rural areas, and reporting negative information regarding the epidemic were more likely to have anxiety. Yet, factors related to likeliness of depression were female gender, residence in suburbs, a drinking history, and excessive negative information concerning the epidemic.
Results of correlation analysis of psychological impact of COVID-19 assessed from Changzhi Medical College in China; indicated that economic effects, and effects on daily routine, and hanging in academic activities, were positively correlated with anxiety symptoms (p < 0.001). However, social support was negatively correlated with the level of anxiety (p < 0.001) [4]. Cao et al. [4] reported that living with parents was associated with significantly lower rates of severe anxiety in students, while living in rural areas, not having a steady income and recognizing somebody has the infection increased the risk of severe anxiety. These results concerning different studied variables may broaden the scope on the multifactorial nature of the psychological resilience which may affect psychological impact of different life stressors like the period of COVID-19.