Prevalence of psychological stress, depression and anxiety among medical students in Egypt

Fawzy, Mohamed; Hamed, Sherifa A.

doi:10.1016/j.psychres.2017.05.027

Cited by 455Healthcare professionals’ stress and burnoutStudent Stress and CopingCOVID-19 and Mental Health

Prevalence of psychological stress, depression and anxiety among medical students in Egypt

Fawzy, Mohamed, Hamed, Sherifa A.·2017·Psychiatry Research

DOI 10.1016/j.psychres.2017.05.027

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Abstract

Poor psychological health in medical students has been reported nationwide. This study estimated the prevalence of depression, anxiety and stress symptoms among medical students who were enrolled in a public university in Upper Egypt and determine the association of these morbidities with the students' basic socio-demographic variables. This cross-sectional study included 700 students. A self-administered, questionnaire for the socio-demographic characteristics, Depression Anxiety Stress Scale (DASS 21) and Pittsburgh Sleep Quality Index (PSQI) questionnaire were used for assessment. High frequencies of depression (65%), anxiety (73%) and stress (59.9%) were reported. Stress scores were significantly higher than depression and anxiety (P=0.001). 55.7% were poor sleepers. In univarate analysis, females, those living in the University campus/students' residence facility, in the preclinical years and with lower academic achievement had higher scores of DASS and PSQI compared to their comparative partners. Significant correlations were reported between stress with depression, anxiety and PQSI scores (P=0.0001). In multivariate analysis, stress scores were significantly associated with female sex, depression and anxiety scores. We conclude that depression, anxiety and stress symptoms are common in medical students of Assiut University relative to other schools and female gender was significantly correlated with these findings.

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Previous studies identified that being enrolled in a health-related program of study was a risk factor for psychological distress.
“This is contrary to previous studies [56,57], which identified that being enrolled in a health-related program of study was a risk factor for psychological distress.”
From The Prevalence of Depression, Anxiety and Stress and Their Associated Factors in College Students. (2020) · cites this paper as [57]
College students have experienced high levels of stress, with reported stress and anxiety among students in China (74.3%), Saudi Arabia (63.5%), Bangladesh (61%), and Egypt (59.9%).
“Furthermore, previous research showed that college students had experienced high levels of stress. Studies have also reported some levels of stress and anxiety among students in China (74.3%), Saudi Arabia (63.5%), Bangladesh (61%), and Egypt (59.9%) [21–24].”
From Efficacy of a web application for stress management among Iranian college students during COVID-19 outbreak: a study protocol for randomized controlled trials (2020) · cites this paper as [24]

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Determinants of sleep quality in college students: A literature review
Wang, F., & Bíró, É. (2020) · EXPLORE · doi:10.1016/j.explore.2020.11.003 · Cited by 314 · see citing works
The link between stress, well-being, and psychological flexibility during an Acceptance and Commitment Therapy self-help intervention
Wersebe, H., Lieb, R., Meyer, A. H., Hofer, P., & Gloster, A. T. (2018) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2017.09.002 · Cited by 250 · see citing works
“Also it has been associated with a range of adverse health outcomes, such as anxiety and depression (Fawzy & Hamed, 2017; Herr et al., 2017; Melchior et al., 2007; Tennant, 2001), coronary disease (e.g. Li, Zhang, Loerbroks, Angerer, & Siegrist, 2014), and sleep problems (e.g. Faber & Schlarb,…”
A cross-sectional survey on sleep quality, mental health, and academic performance among medical students in Saudi Arabia
Al-Khani, A. M., Sarhandi, M. I., Zaghloul, M. S., Ewid, M., & Saquib, N. (2019) · BMC Research Notes · doi:10.1186/s13104-019-4713-2 · Cited by 221 · see citing works
Depression and Anxiety Among Medical Students: A Brief Overview
Mirza, A. A., Baig, M., Beyari, G. M., Halawani, M. A., & Mirza, A. A. (2021) · Advances in Medical Education and Practice · doi:10.2147/amep.s302897 · Cited by 216 · see citing works
Mental Health, Social and Emotional Well-Being, and Perceived Burdens of University Students During COVID-19 Pandemic Lockdown in Germany
Kohls, E., Baldofski, S., Moeller, R., Klemm, S.-L., & Rummel‐Kluge, C. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.643957 · Cited by 220 · see citing works
Prevalence and Predictors of Depression, Anxiety, and Stress among Youth at the Time of COVID-19: An Online Cross-Sectional Multicountry Study
Omari, O. A., Sabei, S. D. A., Rawajfah, O. A., Sharour, L. M. A., Aljohani, K. A., Alomari, K., Shkman, L., Dameery, K. A., Saifan, A. R., Zubidi, B. A., et al. (2020) · Depression Research and Treatment · doi:10.1155/2020/8887727 · Cited by 205 · see citing works
“Young females have higher levels of DAS [37, 38].”
Background
Perceived stress, reasons for and sources of stress among medical students at Rabigh Medical College, King Abdulaziz University, Jeddah, Saudi Arabia
Gazzaz, Z. J., Baig, M., Alhendi, B. S. M. A., Suliman, M. M. O. A., Alhendi, A. S. A., Al-Grad, M. S. H., & Qurayshah, M. A. A. (2018) · BMC Medical Education · doi:10.1186/s12909-018-1133-2 · Cited by 165 · see citing works
“Several studies conducted in Arab countries, such as Egypt (60%) [15], Sudan (50%) [8], Lebanon (62%) [3], and few studies in Saudi Arabia (72%) [16], (53%) [17], and (63%) [18], showed high levels of stress among medical students.”
Background
Sleep quality in medical students: a comprehensive meta-analysis of observational studies
Rao, W., Li, W., Qi, H., Hong, L., Chen, C., Li, C.-Y., Ng, C. H., Ungvari, G. S., & Xiang, Y. (2020) · Sleep And Breathing · doi:10.1007/s11325-020-02020-5 · Cited by 164 · see citing works
Stress, Anxiety and Depression among a Cohort of Health Sciences Undergraduate Students: The Prevalence and Risk Factors
Fauzi, M. F., Anuar, T. S., Teh, L. K., Lim, W. F., James, R. J., Ahmad, R., Mohamed, M. B., Bakar, S. H. A., Yusof, F. Z. M., & Salleh, M. Z. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18063269 · Cited by 167 · see citing works
Sleep disruption in medicine students and its relationship with impaired academic performance: A systematic review and meta-analysis.
Seoane, H. A., Moschetto, L., Orliacq, F., Orliacq, J., Serrano, E., Cazenave, M. I., Vigo, D. E., & Perez-Lloret, S. (2020) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2020.101333 · Cited by 150 · see citing works
Associations Between Academic Stress and Depressive Symptoms Mediated by Anxiety Symptoms and Hopelessness Among Chinese College Students
Zhang, C., Shi, L., Tian, T., Zhou, Z., Peng, X., Shen, Y., Li, Y., & Ou, J. (2022) · Psychology Research and Behavior Management · doi:10.2147/prbm.s353778 · Cited by 175 · see citing works
“Anxiety symptoms are closely related to school performance, exams, assignments, ranking, test scores, teacher-student relationships, and other related topics.(15,16) Moreover, a large body of research has demonstrated that anxiety symptoms and depressive symptoms are closely related among college students.”
Background
Escala de Depressão, Ansiedade e Estresse: propriedades psicométricas e prevalência das afetividades
Martins, B. G., da Silva, W. R., Marôco, J. P., & Campos, J. Á. D. B. (2019) · Jornal Brasileiro de Psiquiatria · doi:10.1590/0047-2085000000222 · Cited by 235 · see citing works
Prevalence and predictors of depression and anxiety among medical students in Addis Ababa, Ethiopia
Kebede, M. A., Anbessie, B., & Ayano, G. (2019) · International Journal of Mental Health Systems · doi:10.1186/s13033-019-0287-6 · Cited by 119 · see citing works
Perceived Academic Stress and Depression: The Mediation Role of Mobile Phone Addiction and Sleep Quality
Zhang, X., Gao, F., Kang, Z., Zhou, H., Zhang, J., Li, J., Yan, J. H., Wang, J., Liu, H., Wu, Q., et al. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.760387 · Cited by 134 · see citing works
Buffering Academic Stress during the COVID-19 Pandemic Related Social Isolation: Grit and Growth Mindset as Protective Factors against the Impact of Loneliness
Mosanya, M. (2020) · International Journal of Applied Positive Psychology · doi:10.1007/s41042-020-00043-7 · Cited by 127 · see citing works
“The risk of mental health disorders, including psychological distress, is, in general, high among university students (Farrer et al. 2016; Fawzy and Hamed 2017) and might increase with a lack of social support for international students (Cao et al. 2020; Wang et al. 2020).”
Background
Prevalence of sleep problems among medical students: a systematic review and meta-analysis
Jahrami, H., Dewald‐Kaufmann, J., Faris, M. E., Al-Ansari, A. M., Taha, M. H., & AlAnsari, N. (2019) · Journal of Public Health · doi:10.1007/s10389-019-01064-6 · Cited by 108 · see citing works
A systematic review and meta-analysis of studies exploring prevalence of non-specific anxiety in undergraduate university students
Ahmed, I., Hazell, C. M., Edwards, B., Glazebrook, C., & Davies, E. B. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04645-8 · Cited by 130 · see citing works
“Three studies reported a significant negative relationship between age and anxiety score [71, 73, 120], with one reporting a significant positive relationship [65].”
BackgroundInfluential
The Worldwide Prevalence of Sleep Problems Among Medical Students by Problem, Country, and COVID-19 Status: a Systematic Review, Meta-analysis, and Meta-regression of 109 Studies Involving 59427 Participants
Bin-Jabr, M. A., Alalawi, I. S., Alzahrani, R. A., Albalawi, O. S., Hamzah, R. H., Ibrahim, Y. S., Buali, F., Husni, M., BaHammam, A. S., Vitiello, M. V., et al. (2023) · Current Sleep Medicine Reports · doi:10.1007/s40675-023-00258-5 · Cited by 115 · see citing works
“The most obvious consequence of insufficient sleep is decreased alertness and focus [58, 81].”
Depression, anxiety, and stress and their association with Khat use: A cross-sectional study among Jazan University students, Saudi Arabia
Al Bahhawi, T., Albasheer, O. B., Makeen, A. M., Arishi, A., Hakami, O., Maashi, S., Al-Khairat, H. K., Alganmy, O., Sahal, Y., Sharif, A., et al. (2018) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s182744 · Cited by 94 · see citing works
“3 In addition, similar to findings reported previously, 30,34 excess caffeine consumption was associated with higher rates of anxiety symptoms.”
Depression, anxiety and stress among medical and non-medical students in Saudi Arabia: An epidemiological comparative cross-sectional study
Mirza, A. A., Milaat, W. A., Ramadan, I. K., Baig, M., Elmorsy, S. A., Beyari, G. M., Halawani, M. A., Azab, R. A., Zahrani, M. T., & Khayat, N. K. (2021) · Neurosciences · doi:10.17712/nsj.2021.2.20200127 · Cited by 87 · see citing works
Prevalence of anxiety, depression, and suicidal ideation symptoms among university students: a systematic review
Paula, W. D., Breguez, G. S., Machado, E. L., & Meireles, A. L. (2020) · Brazilian Journal of Health Review · doi:10.34119/bjhrv3n4-119 · Cited by 85 · see citing works
“The studies of Fawzy and Hamed (2017) and Iqbal et al. (2015) reported the highest prevalence of anxiety in Egypt and India (73.0% and 66.9%, respectively) (Fawzy, & Hamed, 2017; Iqbal, Gupta, & Venkatarao, 2015), whereas the lowest rates were reported in France and Pakistan (7.6% and 13.2%,…”
ResultInfluential
The prevalence risk of anxiety and its associated factors among university students in Malaysia: a national cross-sectional study
Mohamad, N. E., Sidik, S. M., Akhtari‐Zavare, M., & Gani, N. A. (2021) · BMC Public Health · doi:10.1186/s12889-021-10440-5 · Cited by 84 · see citing works
Irrational beliefs, depression, anxiety, and stress among university students in Hong Kong
Chan, H. W. Q., & Sun, C. F. R. (2020) · Journal of American College Health · doi:10.1080/07448481.2019.1710516 · Cited by 80 · see citing works
“Students face many challenges from academic, social, and personal issues, which may cause stress for students.(1,2) Not all students respond negatively to academic stress; some may find that stress can inspire them to work hard to achieve their goals.”
BackgroundResult
Prevalence and factors associated with depressive and anxiety symptoms among Palestinian medical students
Shawahna, R., Hattab, S., Alshafei, R. S., & Tabouni, M. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02658-1 · Cited by 79 · see citing works
Time to think: Subjective sleep quality, trait anxiety and university start time.
Norbury, R., & Evans, S. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.11.054 · Cited by 74 · see citing works
“Two independent studies in medical students (Fawzy and Hamed, 2017; Kalyani et al., 2017) reported high prevalence of moderate to severe anxiety (70% and 40%, respectively) which correlated with sleep quality.”
Background
Sleep Quality among Medical Students at King Abdulaziz University: A Cross-sectional Study
Jambi, S. K., Nk, I., Fatani, A. N., Badawi, F. A., Andijani, R. A., Mansouri, Y. M., & Ainousa, A. M. (2017) · Journal of Community Medicine & Health Education · doi:10.4172/2161-0711.1000561 · Cited by 73 · see citing works
“This finding coincides with results from Virginia [28], Ethiopia [28,29] and Egypt [21].”
BackgroundResultInfluential
Association between orthorexia nervosa, eating attitudes and anxiety among medical students in Lebanese universities: results of a cross-sectional study
Farchakh, Y., Hallit, S. R., & Soufia, M. (2019) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-019-00724-6 · Cited by 72 · see citing works
“According to a study conducted among Egyptian medical students, anxiety symptoms are more common in medical students relative to other schools with female gender significantly correlated with these findings [23].”
Values, acceptance, and belongingess in graduate school: Perspectives from underrepresented minority students
Miller, A. N., & Orsillo, S. M. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.01.002 · Cited by 73 · see citing works
Short-Term Effects of a Multidimensional Stress Prevention Program on Quality of Life, Well-Being and Psychological Resources. A Randomized Controlled Trial
Recabarren, R. E., Gaillard, C., Guillod, M., & Martin-Söelch, C. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00088 · Cited by 66 · see citing works
“In particular, higher prevalence of psychological distress was reported in medical students in Germany (3–5), the US (6), and Egypt (7).”
Background
Kesejahteraan psikologis dan tingkat stres pada mahasiswa tingkat akhir
Aulia, S., & Panjaitan, R. U. (2019) · Jurnal Keperawatan Jiwa · doi:10.26714/jkj.7.2.2019.127-134 · Cited by 65 · see citing works
Effectiveness of an online positive psychology intervention among Tunisian healthcare students on mental health and study engagement during the Covid‐19 pandemic
Krifa, I., Hallez, Q., van Zyl, L. E., Braham, A., Sahli, J., Ben Nasr, S., & Shankland, R. (2022) · Applied Psychology: Health and Well-Being · doi:10.1111/aphw.12332 · Cited by 58 · see citing works
Effect of childhood adversity experiences, psychological distress, and resilience on depressive symptoms among Indonesian university students
Kaloeti, D. V. S., Rahmandani, A., Sakti, H., Salma, S., Suparno, S., & Hanafi, S. P. (2018) · International Journal of Adolescence and Youth · doi:10.1080/02673843.2018.1485584 · Cited by 61 · see citing works
“Such issues currently were reported in India (Deb et al., 2016; Kumar, Kavitha, Kulkarni, Siddalingappa, & Manjunath, 2016), Egypt (Fawzy & Hamed, 2017), Malaysia (Shamsuddin et al., 2013), Turkey (Sart, Borkan, Erkman, & Serbest, 2016), America (Beiter et al., 2015; Eck et al., 2014), Brazil…”
Cognitive, emotional, physical, and behavioral stress-related symptoms and coping strategies among university students during the third wave of COVID-19 pandemic
Attia, M., Ibrahim, F., Elsady, M. A.-E., Khorkhash, M. K., Rizk, M. A., Shah, J., & Amer, S. A. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.933981 · Cited by 78 · see citing works
The Prevalence and Associated Factors of Academic Stress among Medical Students of King Khalid University: An Analytical Cross-Sectional Study
Alshahrani, M., Alasmri, B. S., Al-Shahrani, R. M., Almoalwi, N., Qahtani, A. A. A., & Siddiqui, A. F. (2023) · Healthcare · doi:10.3390/healthcare11142029 · Cited by 58 · see citing works
“9%, and the female sex was significantly associated with this finding [19].”
Background
Effects of aerobic exercise, traditional Chinese exercises, and meditation on depressive symptoms of college student
Song, J., Liu, Z., Huang, J., Wu, J., & Tao, J. (2021) · Medicine · doi:10.1097/md.0000000000023819 · Cited by 58 · see citing works
Factors Associated with Self-Esteem, Resilience, Mental Health, and Psychological Self-Care Among University Students in Northern Thailand
Auttama, N., Seangpraw, K., Ong-Artborirak, P., & Tonchoy, P. (2021) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s308076 · Cited by 56 · see citing works
Perceived stress and anxiety among medical students at Helwan University: A cross-sectional study
Ebrahim, O. S., Sayed, H. A. E., Rabei, S., & Hegazy, N. (2024) · Journal of Public Health Research · doi:10.1177/22799036241227891 · Cited by 67 · see citing works
“16,17 To the best of our knowledge, little is known about the levels of stress and anxiety among Helwan Medical Students, a newly borne institution, located at “Ain Helwan” which is 30 km south of Cairo.”
Background
Only Children Were Associated with Anxiety and Depressive Symptoms among College Students in China
Cheng, S., Jia, C.-X., & Wang, Y. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17114035 · Cited by 57 · see citing works
Risk indicators of depression among medical, dental, nursing, pharmacology, and other medical science students in Saudi Arabia
Hamasha, A. A., Kareem, Y. M., Alghamdi, M. S., al-Garni, M. S. A.-G. M. S., AlAhedib, K., & Alharbi, F. A. (2019) · International Review of Psychiatry · doi:10.1080/09540261.2019.1584095 · Cited by 52 · see citing works
“These results are comparable with that of other studies (AlFaris et al., 2016; Fawzy & Hamed 2017; Ibrahim et al., 2013; Inam, 2007; Kronfol et al., 2018).”
BackgroundResult
Predictors of sleep quality in medical students during COVID-19 confinement
Saguem, B. N., Nakhli, J., Romdhane, I., & Nasr, S. B. (2022) · L'Encéphale · doi:10.1016/j.encep.2021.03.001 · Cited by 52 · see citing works
Depression and Anxiety among Undergraduate Health Science Students: A Scoping Review of the Literature
Agyapong-Opoku, G., Agyapong, B., Obuobi-Donkor, G., & Eboreime, E. (2023) · Behavioral Sciences · doi:10.3390/bs13121002 · Cited by 59 · see citing works
“Anxiety symptoms are common among health sciences students, with a signiﬁcant proportion of undergraduate medical students being anxious [49,89].”
BackgroundInfluential
Association of ADHD symptoms, depression and suicidal behaviors with anxiety in Chinese medical college students
Shen, Y., Zhang, Y., Chan, B. S. M., Meng, F., Yang, T., Luo, X., & Huang, C. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02555-7 · Cited by 48 · see citing works
Insomnia May Mediate the Relationship Between Stress and Anxiety: A Cross-Sectional Study in University Students
Manzar, M. D., Mohammed, S., Pandi-Perumal, S. R., & BaHammam, A. S. (2021) · Nature and Science of Sleep · doi:10.2147/nss.s278988 · Cited by 48 · see citing works
“Stress and anxiety are major psychiatric health issues, both of which are highly prevalent in the university students’ populations and most often coexist.(2) Studies using animal models of stress have shown that stress is involved in increasing or initiating anxiety.”
Background
Latent class analysis of depression and anxiety among medical students during COVID-19 epidemic
Liu, Z., Liu, R., Zhang, Y., Zhang, R., Liang, L., Wang, Y., Wei, Y., Zhu, R., & Wang, F. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03459-w · Cited by 47 · see citing works
“The poor mental health group had a higher probability of scoring on all other factors except suicidal ideation, which can partly be attributed to the stressful training experience [44], such as the long length of schooling, academic pressure, and the stress of clinical practice [45].”
Background
Stress, Anxiety, and Depression in Pre-Clinical Medical Students: Prevalence and Association with Sleep Disorders
Alrashed, F. A., Alsubiheen, A. M., Alshammari, H., Mazi, S. I., Al‐Saud, S. A., Alayoubi, S., Kachanathu, S. J., Albarrati, A., Aldaihan, M. M., Ahmad, T., et al. (2022) · Sustainability · doi:10.3390/su141811320 · Cited by 53 · see citing works
“As reported in a recent study from Egypt [13], students enrolled in the preclinical years had higher PSQI scores than those enrolled in the clinical years.”
Prevalence and correlates of depression, anxiety and stress among undergraduate pharmacy students in Nigeria
Aluh, D. O., Abba, A., & Afosi, A. B. (2020) · Pharmacy Education · doi:10.46542/pe.2020.201.236248 · Cited by 44 · see citing works
“Studies have been carried out among medical (Fawzy & Hamed, 2017; Tanaja, Sachdeva, & Dwivedi, 2018; Kebede, Anbessie, & Ayano, 2019; Yousif et al., 2019), nursing (Cheung et al., 2016) and pharmacy students (Gonçalves & Figueiredo-braga, 2018; Sabourin, Prater, & Mason, 2018).”
Mental health literacy and help-seeking behaviour among Egyptian undergraduates: a cross-sectional national study
Baklola, M. I., Terra, M., Taha, A., Elnemr, M., Yaseen, M., Maher, A., Buzaid, A. H., Alenazi, R., Mohamed, S. A. O., Abdel-Hady, D., et al. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05620-7 · Cited by 49 · see citing works
“In Egyptian universities, an alarming 37% of undergraduate students meet the diagnostic criteria for moderate depression, suggesting the significant impact of life-stage and academic stressors in this population [11].”
Background
Transdiagnostic internet intervention for Indonesian university students with depression and anxiety: evaluation of feasibility and acceptability
Rahmadiana, M., Karyotaki, E., Schulte, M., Ebert, D. D., Passchier, J., Cuijpers, P., Berger, T., van Ballegooijen, W., Wimbarti, S., & Riper, H. (2021) · JMIR Mental Health · doi:10.2196/20036 · Cited by 44 · see citing works
“University students may experience common mental health disorders such as depression and anxiety [1-3].”
Sleep Quality and Mental Health Among Medical Students: A Cross-Sectional Study
Vidović, S., Rakić, N., Kraštek, S., Pešikan, A., Degmečić, D., Zibar, L., Labak, I., Heffer, M., & Pogorelić, Z. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14072274 · Cited by 43 · see citing works
Mental health and online learning among medical students during the COVID-19 pandemic: a Saudi national study
Aljhani, S., AlAteeq, D. A., Alwabili, A., & Alamro, A. (2021) · The Journal of Mental Health Training Education and Practice · doi:10.1108/jmhtep-04-2021-0037 · Cited by 44 · see citing works
Prevalence of common mental disorders among medical students in China: a systematic review and meta-analysis
Wang, J., Liu, M., Bai, J., Chen, Y., Xia, J., Liang, B., Wei, R., Lin, J., Wu, J., & Xiong, P. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1116616 · Cited by 52 · see citing works
“Chinese databases to (1) systematically assess the comprehensive prevalence of common mental distresses (including depression, anxiety, suicide attempt, suicide ideation, and suicide plan) among medical students in China; (2) conduct subgroup analysis; and (3) explore the sources of heterogeneity among studies.”
BackgroundMethodInfluential
Depressive symptoms among first-year Chinese undergraduates: The roles of socio-demographics, coping style, and social support
Tang, W., & Dai, Q. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.09.027 · Cited by 44 · see citing works
Mental Health and Well-Being of University Students in Okinawa
Ratanasiripong, P., China, T., & Toyama, S. (2018) · Education Research International · doi:10.1155/2018/4231836 · Cited by 41 · see citing works
“&e universal and increasingly competitive nature of higher education has exacerbated common academic stressors which contribute to mental health issues among university students [1, 2].”
Background
Symptoms of Depression, Anxiety, and Stress and Prevalence of Major Depression and Its Predictors in Female University Students
Blanco, V., Salmerón, M., Otero, P., & Vázquez, F. L. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18115845 · Cited by 41 · see citing works
“They were lower than those of Fawzy and Hamed [5] for Egyptian medical students.”
BackgroundResultInfluential
Regulatory emotional self-efficacy and psychological distress among medical students: multiple mediating roles of interpersonal adaptation and self-acceptance
Zhang, X., Yue, H., Sun, J., Liu, M., Li, C., & Bao, H. (2022) · BMC Medical Education · doi:10.1186/s12909-022-03338-2 · Cited by 40 · see citing works
Professional identity and mental health of rural-oriented tuition-waived medical students in Anhui Province, China
Wang, L., Yang, Y., Zhu, J., Xie, H., Jiang, C., Zhang, C., Li, J., & Huang, F. (2019) · BMC Medical Education · doi:10.1186/s12909-019-1603-1 · Cited by 40 · see citing works
Association of depression symptoms and sleep quality with state-trait anxiety in medical university students in Anhui Province, China: a mediation analysis
Chen, J., Tuersun, Y., Yang, J., Xiong, M., Wang, Y., Rao, X., & Jiang, S. (2022) · BMC Medical Education · doi:10.1186/s12909-022-03683-2 · Cited by 37 · see citing works
Magnitude and correlates of sleep quality among undergraduate medical students in Ethiopia: cross –sectional study
Wondie, T., Molla, A., Mulat, H., Damene, W., Bekele, M., Madoro, D., & Yohannes, K. (2021) · Sleep Science and Practice · doi:10.1186/s41606-021-00058-2 · Cited by 41 · see citing works
“Prevalence of psychological stress, depression and anxiety among medical students in Egypt.”
Result
Antibiotics exposure attenuates chronic unpredictable mild stress-induced anxiety-like and depression-like behavior
Meng, C., Feng, S., Hao, Z., Dong, C., & Liu, H. (2021) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2021.105620 · Cited by 37 · see citing works
Prevalence of depressive symptoms and associated psychosocial risk factors among French University students: the moderating and mediating effects of resilience
Kokou-Kpolou, C. K., Jumageldinov, A., Park, S., Nieuviarts, N., Noorishad, P.-G., & Cénat, J. M. (2021) · Psychiatric Quarterly · doi:10.1007/s11126-020-09812-8 · Cited by 36 · see citing works
“This results aligned with several past studies summarized by meta-analytic studies [2, 21] and with recent studies [15, 22, 49], including the study by Herrmann et al.”
Smoking and nicotine dependence in relation to depression, anxiety, and stress in Egyptian adults: A cross-sectional study
Elsary, A. Y., & El-Sherbiny, N. A. (2022) · Journal of Family and Community Medicine · doi:10.4103/jfcm.jfcm_290_21 · Cited by 36 · see citing works
“8%).[21] However, the present findings were in line with the findings of an Egyptian study; which showed that 65%, 73%, and 59.”
Result
Prevalence of depression among Chinese medical students: A systematic review and meta-analysis
Jin, T., Sun, Y., Wang, H., Qiu, F., & Wang, X. (2022) · Psychology, Health & Medicine · doi:10.1080/13548506.2021.1950785 · Cited by 34 · see citing works
“This coincides with previous studies on the correlation between mental disorders and somatic symptoms (Fawzy & Hamed, 2017; Lew Figure 3.”
Result
Different Areas of Chronic Stress and Their Associations with Depression
Hussenoeder, F. S., Conrad, I., Pabst, A., Luppa, M., Stein, J., Engel, C., Zachariae, S., Zeynalova, S., Yahiaoui‐Doktor, M., Glaesmer, H., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19148773 · Cited by 34 · see citing works
The Prevalence and Associated Factors of Depression, Anxiety and Stress of First Year Undergraduate Students in a Public Higher Learning Institution in Malaysia
Hamzah, N. S. A., Farid, N. D. N., Yahya, A., Chin, C., Su, T. T., Rampal, S., & Dahlui, M. (2019) · Journal of Child and Family Studies · doi:10.1007/s10826-019-01537-y · Cited by 38 · see citing works
Mental health of Turkish medical students during the COVID-19 pandemic
Çimen, İ. D., Alvur, T. M., Coşkun, B., & Şükür, N. E. Ö. (2021) · International Journal of Social Psychiatry · doi:10.1177/00207640211066734 · Cited by 37 · see citing works
“Studies (Bore et al., 2016; Fawzy & Hamed, 2017; Moutinho et al., 2017) before the pandemic show similar results.”
Result
Relationship Between Physical Activity Levels and Psychological Well-Being Among Male University Students in South East, Nigeria: A Cross-Sectional Study
Ugwueze, F. C., Agbaje, O. S., Umoke, P. C. I., & Ozoemena, E. L. (2021) · American Journal of Men s Health · doi:10.1177/15579883211008337 · Cited by 40 · see citing works
“The results could be attributed to academic demands and stress, financial difficulties and other school environment-related factors (Fawzy & Hamed, 2017; Hiester et al., 2009), personal, political and socioeconomic alienation of youth in Nigeria (Ifeagwazi et al., 2015).”
Background
An investigation on information quality, media richness, and social media fatigue during the disruptions of COVID-19 pandemic
Xiao, H., Zhang, Z., & Zhang, L. (2021) · Current Psychology · doi:10.1007/s12144-021-02253-x · Cited by 34 · see citing works
Application of a classroom-based positive psychology education course for Chinese medical students to increase their psychological well-being: a pilot study
Zhang, X., Zhang, B.-S., & Wang, M. (2020) · BMC Medical Education · doi:10.1186/s12909-020-02232-z · Cited by 33 · see citing works
Prevalence of Sleep Problems Among Chinese Medical Students: A Systematic Review and Meta-Analysis
Sun, Y., Wang, H., Jin, T., Qiu, F., & Wang, X. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.753419 · Cited by 36 · see citing works
“The exclusion criteria are: (1) Intervention studies, case reports and cases comments, (2) Lack of data to calculate the prevalence of sleep problems, (3) Abstracts with no full text, (4) Studies that reported results include Chinese medical students, but without a subgroup analysis of that, (5) Studies investigating…”
BackgroundMethod
Depression and its correlation with social support and health-promoting lifestyles among Chinese university students: a cross-sectional study
Tang, Z., Feng, S., & Lin, J. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-044236 · Cited by 38 · see citing works
“11 However, it was lower than the 65% reported in Egypt 61 and 66.8% in Liaoning province, China.”
BackgroundInfluential
Depression among medical students in Alexandria, Egypt
Elsawy, W., Sherif, A. A. R., Attia, M., & El-Nimr, N. (2020) · African Health Sciences · doi:10.4314/ahs.v20i3.47 · Cited by 31 · see citing works
Poor sleep quality, excessive daytime sleepiness and association with mental health in college students
Ramos, J., Muraro, A. P., Nogueira, P. S., Ferreira, M. G., & Rodrigues, P. R. M. (2021) · Annals of Human Biology · doi:10.1080/03014460.2021.1983019 · Cited by 27 · see citing works
“Fawzy and Hamed (2017), when assessing college students at Assiut University’s medical school in Egypt, found a positive correlation of total PSQI score with depression, anxiety, and stress scores.”
Mental health and wellbeing among Egyptian medical students: a cross-sectional study
El‐Gabry, D. A., Okasha, T. A., Shaker, N. M., Elserafy, D., Mohamed, M. Y., Aziz, K. A., Bhugra, D., Molodynski, A., & Elkhatib, H. (2022) · Middle East Current Psychiatry · doi:10.1186/s43045-022-00193-1 · Cited by 30 · see citing works
“However, a number of individual investigations have been carried out in different cities across Egypt [21, 39, 40].”
Background
Factors influencing stress and resilience among Egyptian medical students: a multi-centric cross-sectional study
Mohammed, H. E., Bady, Z. A. M., Abdelhamid, Z. G., Elawfi, B., AboElfarh, H. E., Elboraay, T., & Abdel-Salam, D. M. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05820-1 · Cited by 29 · see citing works
“Despite a global prevalence of 34%, stress was prevalent in 59.9% of Assiut University students in Upper Egypt [22].”
BackgroundResultInfluential
The Association Between Dietary Zinc Intake and Health Status, Including Mental Health and Sleep Quality, Among Iranian Female Students
Hajianfar, H., Mollaghasemi, N., Tavakoly, R., Campbell, M. S., Mohtashamrad, M., & Arab, A. (2020) · Biological Trace Element Research · doi:10.1007/s12011-020-02316-3 · Cited by 29 · see citing works
Traditional Chinese Medicine Body Constitutions and Psychological Determinants of Depression among University Students in Malaysia: A Pilot Study
Yap, S. Y., Foo, C. N., Lim, Y. M., Ng, F. L., Sidik, S. M., Tang, P. Y., Singh, J. K. N., & Pheh, K. S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18105366 · Cited by 28 · see citing works
“Previous studies among undergraduate students have shown that psychological stress is significantly associated with depression [49,50].”
Background
Predictors of Anxiety, Depression, and Stress among Female University Nursing Students during the COVID-19 Pandemic: A Cross-Sectional Study in Saudi Arabia
Albikawi, Z. F. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12111887 · Cited by 29 · see citing works
The Relationship between Religion, Spirituality, Psychological Well-Being, Psychological Resilience, Life Satisfaction of Medical Students in the Gaziantep, Turkey
Akbayram, H. T., & Keten, H. S. (2024) · Journal of Religion and Health · doi:10.1007/s10943-024-02027-2 · Cited by 28 · see citing works
“…induced by different factors, such as information-overload due to the medical curriculum, long study hours, lack of leisure or rest time, challenging exams, competition with peers, fear of academic failure, family expectations, changes in lifestyle, and financial difficulties (Fawzy & Hamed, 2017).”
Background
Investigating Stress and Sources of Stress Among Female Health Profession Students in a Saudi University
Al-Qahtani, M. F., & Alsubaie, A. S. R. (2020) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s255781 · Cited by 27 · see citing works
Quality of Sleep and Its Correlates among Yemeni Medical Students: A Cross-Sectional Study
Attal, B., Bezdan, M., & Abdulqader, A. (2021) · Sleep Disorders · doi:10.1155/2021/8887870 · Cited by 26 · see citing works
“The association between stress and psychological disorders on the one hand and sleep disorders on the other has been documented among the medical students [16, 36, 37].”
Background
Sintomas de ansiedade e depressão entre estudantes de medicina: estudo de prevalência e fatores associados
Sacramento, B. O., dos Anjos, T. L., Barbosa, A. G. L., Tavares, C. F., & Dias, J. P. (2021) · Revista Brasileira de Educação Médica · doi:10.1590/1981-5271v45.1-20200394 · Cited by 26 · see citing works
A Study on Sleeping Pattern among Undergraduate Medical Students of a Tertiary Care Teaching Hospital of Kolkata
Basu, M., Saha, S. K., Majumder, S., Chatterjee, S., & Misra, R. (2019) · International Journal of Medicine and Public Health · doi:10.5530/ijmedph.2019.4.26 · Cited by 26 · see citing works
“As per the expert panel report published in Sleep Health-The Journal of the National Sleep Foundation 2015, in younger adults (18-25): Sleep range is 7-9 hr.”
Method
PTSD Coach Online-Arabic: A Randomized Controlled Pilot Trial to Examine Feasibility, Acceptability, and Preliminary Effectiveness.
Miller-Graff, L. E., Ellis, K., & Hosny, N. (2020) · Journal of Traumatic Stress · doi:10.1002/jts.22621 · Cited by 16 · see citing works
Promoting University Students’ Mental Health through an Online Multicomponent Intervention during the COVID-19 Pandemic
Theurel, A., Witt, A., & Shankland, R. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191610442 · Cited by 25 · see citing works
“The negative consequences of these stressors affect not only their physical and emotional health but also their academic performance, leading to increased dropout rates, poor life satisfaction, and self-confidence, and, in some cases, suicidal thoughts [14,15].”
Background
Prevalence of depression, anxiety and burnout in medical students at the University of Namibia
Mhata, N. T., Ntlantsana, V., Tomita, A. M., Mwambene, K., & Saloojee, S. (2023) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v29i0.2044 · Cited by 32 · see citing works
The chain mediating role of psychological resilience and neuroticism between intolerance of uncertainty and perceived stress among medical university students in Southwest China
Xu, X., Yan, X., Zhang, Q., Xu, C., & Li, M. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05345-z · Cited by 24 · see citing works
“As the successors of medical workers, medical university students have been reported experiencing a higher level of stress compared with their peers, such as the stress of schooling, academic pressure and the stress of clinical practice [3].”
Background
Association between Sleep Quality and Physical Activity in Physical Education Students in Chile in the Pandemic Context: A Cross-Sectional Study
Merellano-Navarro, E., Bustamante-Ara, N. E., Russell‐Guzmán, J., Lagos-Hernández, R., Uribe, N., & Godoy-Cumillaf, A. E. R. (2022) · Healthcare · doi:10.3390/healthcare10101930 · Cited by 24 · see citing works
“On the other hand, evidence shows that women tend to have longer sleep latency and shorter sleep duration [59].”
Background
Associations between specific dietary patterns, gut microbiome composition, and incident subthreshold depression in Chinese young adults
Jiang, X.-M., Wang, X.-T., Zhang, M., Yu, L., He, J., Wu, S., Yan, J.-L., Zheng, Y.-J., Zhou, Y.-Y., & Chen, Y.-J. (2024) · Journal of Advanced Research · doi:10.1016/j.jare.2024.05.030 · Cited by 23 · see citing works
“PSQI [40], developed by Buysse et al., is a self-report tool assessing sleep quality over a one-month period.”
Method
Weight-Related Status and Associated Predictors with Psychological Well-being among First-Year University Students in Bangladesh: A Pilot Study
Islam, M. S., Akter, R., Sikder, M. T., & Griffiths, M. D. (2020) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-020-00243-x · Cited by 23 · see citing works
“…& Nawaza 2018), Malaysia (37.2%; Shamsuddin et al. 2013), Saudi Arabia (53.6%; Al Bahhawi et al. 2018), Jordan (24.6%; Hamaideh 2018), Turkey (21.8%; Arslan et al. 2009), Egypt (65%; Fawzy & Hamed 2017), and the USA (23%; Beiter et al. 2015) but less than in Hong Kong (68.5%; Lun et al. 2018).”
Influential
Symptoms of anxiety and depression among medical students: study of prevalence and associated factors
Sacramento, B. O., dos Anjos, T. L., Barbosa, A. G. L., Tavares, C. F., & Dias, J. P. (2021) · Revista Brasileira de Educação Médica · doi:10.1590/1981-5271v45.1-20200394.ing · Cited by 23 · see citing works
Mediating Effect of Sleep Disorder Between Low Mental Health Literacy and Depressive Symptoms Among Medical Students: The Roles of Gender and Grade
Hu, J., Wang, J., Li, D., Huang, X., Xue, Y., Jia, L., Zhang, Z., Wan, Y., Song, X., Wang, R., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.818295 · Cited by 23 · see citing works
“the new environment, individuals have to deal with the problems, challenges and needs in daily life (40).”
Background
Effects of duration and intensity of psychological stressors on mental health outcomes
Malykhin, N. V., Serrano, J., Pietrasik, W., & Hegadoren, K. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.05.012 · Cited by 21 · see citing works
Contribution of researchers in the Arab region to peer-reviewed literature on mental health and well-being of university students
Sweileh, W. M. (2021) · International Journal of Mental Health Systems · doi:10.1186/s13033-021-00477-9 · Cited by 21 · see citing works
Efficacy of a web application for stress management among Iranian college students during COVID-19 outbreak: a study protocol for randomized controlled trials
Khademian, F., Aslani, A., Ravangard, R., Bastani, P., Nami, M., & Jafari, P. (2020) · Trials · doi:10.1186/s13063-020-04949-0 · Cited by 20 · see citing works

Depression, anxiety and stress among first year medical students in an Egyptian public university
Abdallah, A. R., & Gabr, H. M. (2014) · International Research Journal of Medicine and Medical Sciences · Cited by 111 · see citing works
The prevalence of depression, anxiety, and stress among a sample of first-year medical students
Hammouda, S. M., Shafie, T. M. E., & Shennawy, E. E. (2020) · Egyptian Journal of Psychiatry · doi:10.4103/ejpsy.ejpsy_3_20 · Cited by 3 · see citing works
The Prevalence of Psychological Stress, Anxiety, and Depression among Medical Students During Their Study Period in Palestine
Asherah, A. A. (2025) · Journal of Sexual Medicine & Research · doi:10.47363/jsmr/2025(4)137
Assessment of Prevalence and Factors Associated with Depression, Anxiety and Stress among Medical Students
Siva Keerthika, S., Biradar, S. M., Kamble, V. S., & Shrinivas Reddy, B. (2023) · Indian Journal of Public Health Research & Development · doi:10.37506/ijphrd.v14i3.19421
Prevalence and associated factors of stress, anxiety and depression among medical Fayoum University students
Wahed, W. Y. A., & Hassan, S. K. (2016) · Alexandria Journal of Medicine · doi:10.1016/j.ajme.2016.01.005 · Cited by 405 · see citing works

Authors: Fawzy, M., & Hamed, S. A.
Affiliations: Assiut University Hospitals (EG)
Corresponding author: Hamed, Sherifa A.
ORCID: Hamed, Sherifa A.
Venue: Psychiatry Research
Publisher: Elsevier BV
Published: 2017-09
Volume: 255
Pages: 186-194
ISSN: 0165-1781 (ISSN-L)
DOI: 10.1016/j.psychres.2017.05.027
OpenAlex: W2615784653
Cited by: 455
References: 83
Citations by year: 2026: 30 · 2025: 52 · 2024: 60 · 2023: 74 · 2022: 68 · 2021: 81 · 2020: 46 · 2019: 28 · 2018: 13 · 2017: 2
FWCI: 39.29
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Psychiatry Research (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
Social Sciences › Psychology › Developmental and Educational Psychology › Student Stress and Coping
Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Keywords: psychological stress, depression, anxiety, medical students, sleep quality, prevalence, sociodemographic factors, sex differences, academic performance, Assiut University
MeSH terms: Adolescent, Adult, Anxiety, Cross-Sectional Studies, Depression, Egypt, Female, Humans, Male, Mental Health, Surveys and Questionnaires, Stress, Psychological, Students, Medical, Prevalence, Young Adult

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Prevalence of psychological stress, depression and anxiety among medical students in Egypt

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