Anxiety and Depressive Symptoms Among Early‐Year Medical Students in Pakistan: Prevalence, Associated Factors, and Mental Health Service Implications—A Multicenter Cross‐Sectional Study
Abstract
ABSTRACT Background Anxiety and depressive symptoms are common among medical students, but multicenter evidence from the early years of training in Pakistan is limited. We estimated symptom prevalence and examined sociodemographic, behavioral, academic, and psychosocial correlates of symptom severity. Methods We conducted a multicenter cross‐sectional survey from January to June 2024 among 1630 of 1800 invited first‐ and second‐year students at 9 medical colleges in Islamabad (response rate, 90.6%). Symptoms were assessed with the Patient Health Questionnaire‐9 (PHQ‐9) and Generalized Anxiety Disorder‐7 (GAD‐7). Because the proportional‐odds assumptions were not supported and sparse upper‐severity categories caused separation, adjusted associations were estimated using bias‐reduced multinomial logistic regression with minimal symptoms as the reference outcome. Results Anxiety symptoms (GAD‐7 ≥ 5) were present in 756/1630 students (46.4%; 95% CI, 44.0%–48.8%), and depressive symptoms (PHQ‐9 ≥ 5) in 942/1630 (57.8%; 95% CI, 55.4%–60.2%). Peer pressure was associated with moderate versus minimal anxiety (aOR, 6.42; 95% CI, 3.59–11.49), severe versus minimal anxiety (aOR, 37.23; 95% CI, 3.54–391.86), moderate versus minimal depressive symptoms (aOR, 4.07; 95% CI, 2.69–6.18), and moderately severe/severe versus minimal depressive symptoms (aOR, 10.79; 95% CI, 3.79–30.73). Sleeping 7–8 h per night was associated with lower odds of severe anxiety (aOR, 0.11; 95% CI, 0.02–0.59) and moderate depressive symptoms (aOR, 0.22; 95% CI, 0.12–0.38). Severe‐category estimates were imprecise because only 20 students had severe anxiety and 34 had moderately severe/severe depressive symptoms. Conclusion Anxiety and depressive symptoms were common among early‐year medical students. Peer pressure, harassment, sleep, academic stage, and support were associated with symptom severity, but the cross‐sectional design precludes causal inference. Medical colleges should evaluate confidential student‐support and referral pathways.