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

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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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“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
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
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 55
“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
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
“&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
“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
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
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
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
“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 36
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
“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
“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
“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 38
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
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
“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 46
“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 41
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 38
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
“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
“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
Poor sleep quality, excessive daytime sleepiness and association with mental health in college students
Ramos, J. N., 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 33
“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
“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 32
“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
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
“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 31
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
“…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
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
“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
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
“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 25
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 29
“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
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 32
“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
“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., Wang, X., Zhang, M., Yu, L., He, J., Wu, S., Yan, J., Zheng, Y., Zhou, Y., & Chen, Y. (2024) · Journal of Advanced Research · doi:10.1016/j.jare.2024.05.030 · Cited by 28
“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
“…& 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
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
“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
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
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

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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