ANXIETY AND DEPRESSION AMONG BACHELOR OF SCIENCE STUDENTS IN A MEDICAL

INSTITUTION

A Research Paper Presented to the

Department of Research, Gullas College of Medicine
Banilad, Mandaue City, Cebu, Philippines

In Partial Fulfillment of the Requirements for the degree of

Doctor of Medicine
Awasthi Anushka
Billore Anuneha
Bagadia Tanvi
Gautam Amar
Gawai Takshita
Goswami Shruti
Jathar Samruddhi
Joshi Priyal
Kaushik Rishita
Maheshwari Aashi
Mehta Anuj
Patidar Bhumika
Sharma Sachin
Shetti Sharmada
Singla Mahin
Upadhyay Bhumesh
Vaishnav Tanishq
Sharma Rahul
Jatin

MAY, 2024

i
 APPROVAL SHEET

This Research paper entitled: “ANXIETY AND DEPRESSION AMONG

BACHELOR OF SCIENCE STUDENTS IN A MEDICAL INSTITUTE” prepared and
submitted by Awasthi Anushka, Billore Anuneha, Bagadia Tanvi, Gautam Amar,
Gawai Takshita, Goswami Shruti, Jathar Samruddhi, Joshi Priyal, Kaushik Rishita,
Maheshwari Aashi, Mehta Anuj, Patidar Bhumika, Sharma Sachin, Shetti
Sharmada, Singla Mahin, Upadhyay Bhumesh, Vaishnav Tanishq, Rahul, Jatin in
partial fulfillment for the degree Doctor of Medicine has been examined and is
recommended for acceptance and approval for ORAL EXAMINATION.
RESEARCH COMMITTEE

DR. RAMON DEL FIERRO

Chairman

DR. RESTY PICARDO DR. VIRGINIA MOLLANEDA

Member Member
DR. ALTHEA R. ARENAJO
Adviser
===================================================================

PANEL OF EXAMINERS
APPROVED by the committee for oral examination with a rating of _________________

DR. RAMON DEL FIERRO

Chairman

DR. RESTY PICARDO DR. VIRGINIA MOLLANEDA

Member Member

DR. ALTHEA R. ARENAJO

Adviser
Accepted and approved in partial fulfillment of the requirements for the
degree of Doctor of Medicine
Passed the Proposal Hearing: may, 2023
Passed the oral examination: May, 2024

DR. JOSE JUAN RAFAEL G.LAICO

Dean,College of Medicine

ii
 ACKNOWLEDGEMENTS
This research paper was completed with diligence and commitment to the
Topic it tackled. With Wholehearted gratitude, the researchers would like to thank
the following:

To Dr. Althea R. Arenajo, the research advisor for the wisdom she
showed to the researchers to complete this research.
To Dr. Ramon S. Del Fierro, the research professor, for guiding the
researchers throughout the process.
To the panel of examiners for the valuable input and recommendations
suggested during the final defense which made the study more substantial.
To the parents of researchers, without their moral and financial support
the study will not reach its final stage.
To the respondents for their participation in answering the
questionnaire with sincerity which made this study successful.
Lastly but not the least, to the Lord Almighty for the love and strength
bestowed to the researchers. No amount of words can express the happiness
felt by the researchers for the completion of this study.

The Researchers

ABSTRACT

iii
Anxiety and depression are pervasive challenges faced by students worldwide,
with those in medical education particularly susceptible due to the rigorous
demands of their training. This paper examines the prevalence and implications
of anxiety and depression among medical students, drawing on research findings
and expert insights. Research indicates that a significant proportion of medical
students experience psychological disturbances. Factors contributing to these
challenges include academic pressures, demanding coursework, and the
emotional toll of clinical training. Institutional elements such as school status and
location, as well as personal factors like gender and financial aid, also play a role
in students' mental well-being. The consequences of anxiety and depression
extend beyond academic performance, impacting personal lives and professional
growth. The population which we selected for our research were Bachelor of
Science Students of Gullas college of medicine studying in the academic year
2023-2024. The Total 95 Respondents selected by Random Sampling Method.
The Majority of respondents, comprising 52.6% identified as Indians and fall
within the younger age range of 18 to 25 years old. %). There were almost more
female than male respondents, with females (55.8%). The most common anxiety
level reported by respondents is moderate, with 32.6% and the most common
depression level reported by respondents is also moderate, with 36.8%. The
complex interplay of internal and external factors contributes to the heightened
vulnerability of medical students to anxiety and depression. High academic
demands, emotional stressors associated with patient care, and personal
susceptibilities like perfectionism and lack of coping strategies all contribute to
this phenomenon. Understanding these underlying causes is crucial for creating
a supportive environment that fosters the well-being of medical students. By
addressing these challenges proactively, medical schools can better equip their
students to navigate the demands of their profession and promote a culture of
holistic health within the medical community.

Key words:- Anxiety level, Depression level, Psychological Disturbances,

Academic pressures, Emotional Stressors

TABLE OF CONTENTS

iv
TITLE PAGE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -i

APPROVAL SHEET - - - - - - - - - - - - - - - - - - - - - - - - - - - ii

ACKNOWLEDGEMENTS - - - - - - - - - - - - - - - - - - - - - - - -iii

ABSTRACT - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -iv

TABLE OF CONTENTS - - - - - - - - - - - - - - - - - - - - - - - - -v

CHAPTER 1 INTRODUCTION

Rationale of the Study - - - - - - - - - - - - - - - - - - - - - -1

Theoretical Framework - - - - - - - - - - - - - - - - - - - - - -3
Statement of the objectives - - - - - - - - - - - - - - - - - - - -5
Statement of the Hypotheses - - - - - - - - - - - - - - - - - - -6
Significance of the study - - - - - - - - - - - - - - - - - - - - -6
Definition of Terms - - - - - - - - - - - - - - - - - - - - - - - -7

CHAPTER 2 REVIEW OF RELATED LITERATURE - - - - - - - - - -9

AND STUDIES

CHAPTER 3 METHODOLOGY
Research Design - - - - - - - - - - - - - - - - - - - - - - - -22
Research Environment - - - - - - - - - - - - - - - - - - - - -22
Research Respondents - - - - - - - - - - - - - - - - - - - -23
Research Instrument - - - - - - - - - - - - - - - - - - - - -24
Data Gathering Procedure - - - - - - - - - - - - - - - - - - -24
Data Analysis - - - - - - - - - - - - - - - - - - - - - - - - - 25
Ethical Considerations - - - - - - - - - - - - - - - - - - - - - 26

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CHAPTER 4 RESULTS AND DISCUSSIONS - - - - - - - - - - -31

CHAPTER 5 SUMMARY, CONCLUSION, AND - - - - - - - - - -54

RECOMMENDATIONS

REFERENCES - - - - - - - - - - - - - - - - - - - - - - - - - - - -62

APPENDICES
Transmittal Letter - - - - - - - - - - - - - - - - - - - - - - - 66

Informed consent - - - - - - - - - - - - - - - - - - - - - - - -67

Sample Questionnaire - - - - - - - - - - - - - - - - - - - - -67

Time Table (Ghantt Chart) - - - - - - - - - - - - - - - - - - - 70

Certificate of Grammer and Plagiarism - - - - - - - - - - - - - 71

CURRICULUM VITAE - - - - - - - - - - - - - - - - - - - - - - - 72

vi
 LIST OF TABLES

TABLE
1 Demographic Profile of the - - - - - - - - - - - - - - - - - -31
Respondents

2 Perceived Anxiety level of the - - - - - - - - - - - - - - - - 35

Respondents

3 Distribution of Respondents in terms - - - - - - - - - - - - 38

of their Anxiety Level

4 Perceived Depression Level of - - - - - - - - - - - - - - - - 40

the Respondents

5 Distribution of Respondents in terms - - - - - - - - - - - - - 46

of their Anxiety Level

6 Correlation Between Anxiety & Depression - - - - - - - - - 48

Level of Respondents

7 Relationship between Profile of the Respondents - - - - - - 49

and their Anxiety Level

8 Relationship between Profile of the Respondents - - - - - - 51

and their Depression Level

vii
 LIST OF FIGURES

Figure 1 Theoretical Framework of the study - - - - - - - - - - - - - - - - -3

Figure 2 Cognitive Triangle - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -4

viii
 CHAPTER 1
INTRODUCTION

Rationale of the study

Anxiety and depression are two of the most common obstacles which

the students face and it is beginning to take a serious toll in the classroom. This

is previously manifested that students in medical school are most likely to face

anxiety and depression throughout their lifetime and this could be a threat if not

addressed properly.

It is quite disturbing that the war of anxiety and depression every

medical student faces is above the observed levels in the general population and

the similar student population. In a study conducted by Dr. Ahmed khan and

Professor Anna Chen (2009) says that levels of psychological disturbances

among medical student internationally includes range between 20-40% of anxiety

disorders, 10-20% for depression disorders. This information justifies that the

situation at hand is critical and drastic measures should be taken to abort this

problem.

Committing to a professional career involves academically gruesome

path with harsh examinations, difficult studying and demanding clinical training.

As a result, it has become one of the most difficult careers rather, with lifelong

difficulties.

1
 Anxiety and depression are among the students concerns that have

received considerable research attention. The challenging nature of being in a

medical school can pose mental health problems among the students due to the

many subjects they hurdle as well as schedule that are very tight. Studies show

that medical students experience high rates of anxiety and depression compared

to the population. (Sidra Ishaque et al., 2019)

There are various factors that contribute to the onset of anxiety and

depression among students. This may include peer pressure, school

requirements such as examinations, vast syllabus and many reading

assignments from all the subjects, location as personal factors like gender,

school location and financial aid play a role in students mental well being. A study

conducted across centers in Brazil revealed that symptoms of depression and

anxiety were linked to institutional aspects. (Dr. Felipe Silva and Prof. Ana

Oliveira., 2009)

The impact of anxiety and depression extends beyond performance and

personal life, for medical students; it also affects their professional growth and

future career patterns. Medical students experiencing levels of anxiety and

depression tend to express disagreement, with statements about having access

to psychological support as well as strong support network for fellow stressed

students highlighting the necessity, for improved institutional support.

The intricate interplay of different internal and external factors is largely

to blame for the increased vulnerability of medical students to anxiety and

depression. High academic demands including vast coursework, tight schedules

2
and fierce competition are normally on top. Moreover, psychological stress can

be intensified through the emotional burden associated with witnessing human

suffering or being part of such experience as well as dealing with ethical

dilemmas by medical students. In addition, personal susceptibilities like

perfectionism, self-blame and lack of sufficient coping strategies may predispose

a person more to mental problems. Acknowledging these causes is an important

step towards establishing a positive environment for studying in medical school.

Theoretical Framework:

3
 Figure 1. Theoretical Framework of the Study

Cognitive-Behavioural Theory (CBT): By Dr. Aron T. Beck

According to Cognitive-Behavioural Theory, thoughts, feelings, and

behaviours are interconnected. Maladaptive thought patterns can lead to

negative emotions and behaviours.

4
 Medical students may experience cognitive distortions such as

catastrophizing, overgeneralization (drawing broad negative conclusions based

on limited evidence), and all-or-nothing thinking. These cognitive distortions may

contribute to the development and maintenance of anxiety and depression

symptoms among medical students.

CBT interventions aim to identify and challenge these cognitive

distortions, replace them with more adaptive thought patterns, and develop

coping strategies to manage distressing emotions.

Figure 2. Cognitive Triangle

Statement Of the Objectives

General Objective:

5
 This study aimed to determine the level anxiety and depression among

Bachelor of Science Students going for Medicine at Gullas College of Medicine in

the academic year 2023-2024.

Specific Objectives:

Specifically, this study sought to determine the following:

1. Assess the demographic profile of the respondents with regards to:

1.1 age

1.2 sex

1.3 nationality

2. The level of anxiety of the respondents,

3. The level of depression among the respondents,

4. The significant relationship between demographic profile and the level of anxiety

of the respondents,

5. The significant relationship between demographic profile and the level of depression

of the respondents,

6. The correlation between the levels of anxiety and depression.

7. Intervention plan based on the findings of the study.

Statement of the Hypotheses

6
Ho 1. There is no significant relationship between demographic profile and the

level of anxiety of the respondents.

Ho 2. There is no significant relationship between demographic profile and the

level of depression of the respondents.

Ho 3. There is no correlation between the level of anxiety and depression.

Significance Of the Study:

The significance of our study on the impact of anxiety and depression

among medical students lies in its potential to shed light on mental health

challenges within this specific demographic. Understanding these impacts can

lead to the development of targeted interventions and support systems, ultimately

enhancing the well-being and performance of future healthcare professionals.

This research can contribute to destigmatizing mental health issues in academic

settings and encourage proactive measures to address them effectively with this

the following are the beneficiaries of the study:

Bachelor of Science Students. These are the respondents of the study

who will answer the questionnaire that has predicted the level of anxiety and

depression.

BS Instructors and program coordinator. These are the teachers of the

respondents who are handling the subjects of the BS program. It is best for them

7
to know the problem of the students as the level of anxiety and depression are

crucial.

School Administrator. The GCM Administrator to know the current situation

of the students before they proceed to the medical profession.

Researcher. It is necessary for the researchers to know and understand

the condition of the BS Students so that the prevention plan can be proposed.

Future researcher. The findings of this study can be useful for the future

researchers so that proper utilization can be done.

Definition Of Terms:
For better understanding of the terms used in this study, some
terms are operationally defined:
Anxiety. This refers to the feeling of restlessness, which is an

uncomfortable feeling of nervousness or worry about everything that is

happening or might happen in the future.

Depression. Refers to a person’s mood which is characterised by loss of

pleasure or lost of interest in daily activities for a long period of time.

Bachelor of science students. These are the students enrolled in a

programme that is preparatory to medicine.

Medical Institution. This is a school that offer degree leading to medicine.

This institution is under the supervision of the Commission of Higher Education.

Demographic Profile. This refers to the description of the respondents aa

to Age, Sex, Nationality

8
 Intervention plan. This refers to the plan which is advised by the

researchers and is to be implemented to manage anxiety and depression of the

BS Students.

CHAPTER 2

9
 REVIEW OF RELATED LITREATURE

The literature on the effects of anxiety and depression among medical students

indicates a significant prevalence of these conditions, with various studies highlighting

the impact on this demographic.

According to a comprehensive review, the prevalence of anxiety varied from

8.54% to 88.30%, with an average of 27.22%, while the prevalence of depression

ranged from 13.10% to 76.21%, with an average of 32.74%, among Chinese medical

students. The study recommended that greater steps be made to support at-risk pupils

by highlighting several drivers of depression and anxiety, including individual

characteristics, social and economic issues, and environmental factors.

The prevalence of anxiety and depression in medical students was the subject of

another review article, which also noted that students from Middle Eastern nations had

greater rates of depression than those from other locations. Additionally, it was

discovered that both academic and non-academic variables contributed to these

disorders, with female students being afflicted more frequently than male students.

According to research, the prevalence of depression was highest among first-

year medical students (33.5%) and subsequently declined to 20.5% by the fifth year.

This shows that medical students' mental health is greatly impacted by the academic

year, and that stress levels may even get worse over time.

A recent literature review conducted over a six-year period shed light on the

frequency and determinants of anxiety and depression among undergraduate health

science students, underscoring the necessity of a multifaceted strategy to tackle these

problems.

10
 Given the high levels of stress and strain medical students experience during

their training and education, our findings highlight the significance of addressing mental

health difficulties within this population. For this group, interventions and support

networks are essential to reducing the impact of depression and anxiety.

At the University of Cape Town in South Africa showed that 36.4% of medical

students had severe depressive disorder and 45.9% had anxiety disorder above the cut-

off points. Diagnoses of anxiety and depression were substantially correlated with

female sex (van der Walt et al., 2020).

Depression and Anxiety Prevalence:

Anxiety and sadness are highly prevalent among medical students globally,

according to numerous research. According to a systematic review by Rotenstein et al.

(2016), 11% of medical students reported having suicide thoughts, and roughly 27% of

students reported having depression or depressive symptoms.

Effect of Anxiety and Depression on Academic Achievement:

The effect of anxiety and depression on the academic performance of medical

students has been the subject of numerous research. According to (Dyrbye et al.- 2006),

medical students who suffer from depression are more likely than their colleagues who

do not to report academic difficulties and receive poorer exam scores.

Risk factors and stressors:

Medical students experience anxiety and depression due to a variety of

stressors, such as the demanding academic schedule, peer pressure, lack of sleep, and

failure-related worry. According to a Yusoff (2013) study, there are important risk factors

11
for anxiety and depression among medical students, including feminine gender,

academic stress, and interpersonal problems.

Interventions and Systems of Support:

A range of therapies and support systems, such as peer support groups, stress

management courses, and counseling services, have been suggested to treat anxiety

and depression in medical students. Medical students' symptoms of anxiety and

depression can be effectively reduced by mindfulness-based stress reduction, according

to a meta-analysis conducted in by Regehr et al. (2003)

Overall, research shows that medical students frequently experience anxiety

and despair, which can have a serious detrimental effect on their wellbeing, mental

health, and academic achievement. To promote the general well-being and academic

achievement of medical students, it is imperative that these difficulties be addressed

through focused interventions and support networks.

Medical students' academic performance and patient care are significantly

impacted when they experience anxiety and despair. Research has repeatedly

demonstrated that children who are experiencing psychological distress are more likely

to have academic underachievement, which includes poorer performance on tests,

higher absence rates, and decreased productivity Dyrbye et al., (2006); Ludwig et al.,

(2019). Additionally, studies indicate that medical students who do not receive treatment

for mental health disorders may be more vulnerable to professional misconduct, medical

errors, and a reduction in empathy, all of which could lower the standard of patient care

(Thomas et al., 2009; Schwenk et al., 2010).

Medical students who experience anxiety or sadness may do so for a variety

of reasons. A prominent cause of stress is academic pressure, which includes a

12
demanding workload, high standards, and performance pressure (Dahlin et al., 2005;

Dyrbye et al., 2010). Burnout and psychological distress are frequently caused by the

competitive environment and demanding nature of medical education (Ibrahim et al.,

2013). Medical students' mental health issues are also exacerbated by worries about

their future employment opportunities, financial obligations, and the emotional strain of

patient care (Brazeau et al., 2014).

Globally, medical students exhibit startlingly high rates of anxiety and

sadness, according to numerous studies. Approximately 27% of medical students

reported having depression or depressive symptoms, according to a meta-analysis by

Rotenstein et al. (2016). Anxiety rates were much higher. Hope et al. (2019) conducted a

systematic review that revealed a large diversity in the prevalence rates of depression

and anxiety among medical students. The studies found that the rates ranged from 7%

to 65% and 10% to 90%, respectively.

Since it is critical to treat mental health issues among medical students, a

number of programmes and support networks have been put in place. These consist of

resilience training, stress management seminars, peer support groups, and counselling

services (Regehr et al., 2013; Wasson et al., 2016). Furthermore, to encourage students

to seek treatment when they need it, medical schools are pushing a more transparent

culture and de-stigmatizing mental health concerns (Roberts et al., 2019).

Notwithstanding these initiatives, obstacles including scarcity of resources, stigma, and

cultural differences still prevent medical students from getting the mental health care

they need (Hunt et al., 2013).

Research on medical students frequently reveals alarmingly high rates of

anxiety and sadness. According to research, the prevalence of anxiety and depression

might approach 35% and 32%, respectively. Interestingly, these rates are much greater

13
in the first year of medical school, maybe because of the substantial environment

adjustment to a novel and demanding setting.

Medical students' life can be significantly impacted by anxiety and despair. They

may get physically and emotionally exhausted, which might impair their ability to

concentrate and lower their academic achievement. Moreover, these circumstances may

have a detrimental effect on their professional growth and empathy.

The increased frequency of mental health issues among medical students is

caused by several reasons. Stressors including fear of failing, heavy workloads, and

academic pressure are real. Financial pressures, social isolation, and lack of sleep can

all make these problems worse.

One major public health concern is the high prevalence of anxiety and

depression among medical students. Solving these problems calls for a multifaceted

strategy. By offering mental health tools, encouraging self-care techniques, and

cultivating a positive learning atmosphere, medical schools can play a significant role.

Research indicates an alarming prevalence of anxiety and depression of up to

35% and 32%, respectively, considerably higher than the overall population, painting a

bleak picture of the situation. Additionally, not all students are equally affected by this

mental health issue; first-year students are especially at risk because they are adjusting

to a rigorous new environment.

Medical students are under constant stress due to the pressure to perform

academically and the fear of failing. Lack of sleep, an ongoing companion on this taxing

trip, erodes their wellbeing even further. The combination of financial strains and the

solitary nature of rigorous coursework intensifies mental health problems.

14
 Anxiety and depression have considerably more negative effects than just

emotional discomfort. Students who struggle with these issues frequently see a drop in

their academic performance as a result of their inability to concentrate and feelings of

overload. In addition, their empathy—a vital component of the medical field—may suffer,

which could make it more difficult for them to deal with patients in the future.

To tackle this issue of public health, cooperation is necessary. Medical schools

have tremendous influence over how their students' lives turn out. One way to build

resistance against these mental health issues is to implement initiatives that support

self-care techniques, make mental health resources easily accessible, and cultivate a

positive learning atmosphere.

Despite being just as prevalent and perhaps just as crippling as depression,

anxiety has received less attention and is frequently misdiagnosed and inadequately

handled among the public. Similarly, because anxiety has such important consequences,

medical students' anxiety deserves further consideration. Our goal was to investigate the

incidence of anxiety among medical students worldwide as well as the contributing

factors that make them more likely to experience anxiety.

Data from sixty-nine trials, totaling forty,348 medical students, were combined

and analyzed. Among medical students, the prevalence of anxiety was 33.8% worldwide

(95% Confidence Interval: 29.2-38.7%). Asian and Middle Eastern medical students

were the most likely to experience anxiety. There were no statistically significant

variations in the prevalence of anxiety found in subgroup analyses based on gender and

study year. Anxiety affects roughly one in three medical students worldwide, a

prevalence rate that is far greater than that of the general population. It is imperative that

medical school administrators and leaders take the lead in de-stigmatizing mental

diseases and encouraging students to seek care when they are feeling stressed or

15
concerned. To determine the anxiety risk factors specific to medical students, more

research is required.

To assess the prevalence of sadness and anxiety among students studying

medicine and the humanities. to evaluate the connection between medical students'

susceptibility to stress, Big Five personality traits, anxiety, and depressive symptoms.

Methods: A total of 338 randomly chosen medical students and 73 randomly chosen

humanities students were assessed for their vulnerability to stress using the Stress

Vulnerability Scale (SVS), for Big-Five personality dimensions using the Ten-Item

Personality Inventory (TIPI), and for symptoms of anxiety and depression using the

Hospital Anxiety and Depression Scale (HADS). Results: Among medical students (43%

and 14%, respectively) and humanities students (52% and 12%, respectively), anxiety

and depression symptoms were common.

Under tremendous pressure, medical students are a highly educated population.

They might feel a lack of external control during the third-year transfer to clinical settings,

and they might react to this by becoming more obsessed or exhibiting other anxiety

symptoms. In two U.S. medical schools, our study looks at the phenomenology of

anxiety symptoms such as obsessive-compulsive disorder and connects these

symptoms to the self-perception of performance. A series of anonymous questionnaires

about symptoms of obsessive-compulsive disorder, attention issues, anxiety, depression,

and perceived performance in medical school were filled out by the subjects. Four main

components emerged from a factor analysis of obsessional symptoms: checking/doubts,

contamination, extended time/detail, and unpleasant thoughts/worries.

16
 These four variables matched those observed in nonclinical populations, such as

college students. Among third-year medical students, the most common symptoms were

anxiety, attentional problems, and depression. On the other hand, first-year students had

the highest level of obsessional symptoms, which decreased in later years. A poorer

perceived performance was linked to higher levels of anxiety and depressed symptoms,

but there was no significant correlation between perceived performance and

obsessionality. Students who felt they performed poorly in medical school were

substantially more likely to be older, female, or sad. The number of obsessional

symptoms has gradually decreased over the years, and there is no association between

the symptoms and perceived performance, which suggests that the symptoms could be

adaptive or developmentally appropriate. Some anxiety symptoms, on the other hand,

seem to be maladaptive reactions to outside stimuli.

The purpose of this study was to compare medical students' self-reported

experiences with health anxiety and worry to those of control subjects. The hypothesis

posited that exposure to medical education would increase health anxiety among

medical students relative to those who do not receive regular exposure to this

information.

Introduction Academic performance issues have been linked to stress connected

to medical education, which has been linked to feelings of anxiety and depression.

These issues can have long-term effects, such as low-quality medical care. If it is

established that anxiety and depression have an impact on academic performance, then

preventing them may also improve the quality of medical care.

Medical school moves at a very fast speed. Due to emotions of helplessness,

unsolvable difficulties, and firsthand exposure to mortality, students frequently report

significant levels of stress. Stress is also increased by medical students' perfectionist

17
tendencies and difficulties redefining themselves as patients. Stress has detrimental

physiological and psychological impacts on people, which can lead to substance abuse,

poor mental health, and the need to create good coping mechanisms. Other detrimental

effects, such as burnout, suicidal thoughts, and medical school dropout, can also be

brought on by poor mental health. Prior research indicates that medical school freshmen

have comparable depression rates to their non-medical classmates.

Several other studies have examined variables that affect student achievement,

including alcohol and illicit drug use [6]. According to a study by Webb et al., medical

students do not differ significantly from other student groups even if they are aware of

the possible risks associated with using illegal drugs. University students also

experiment with drugs. Furthermore, doctors are expected by the medical community to

prioritize their patients' always needs before their own. It could therefore be challenging

for doctors to accept assistance. It's important to comprehend the effects of cocaine and

marijuana usage, as well as despair and anxiety, so that kids who struggle can get

support.

Furthermore, this could facilitate the incorporation of preventive health initiatives

to support medical students in maintaining mental health and averting the long-term

effects of substance abuse and mental disease. This study aims to comprehend the

current prevalence of anxiety, depression, marijuana and cocaine use, and help-seeking

behavior among medical students.

Anxiety and depression are extremely common disorders throughout the world.

This article examines the prevalence of anxiety and depression in medical students and

clarifies any possible risk factors. Students from Middle Eastern countries are more likely

to experience depression than students from other nations. These illnesses are more

common in women than in men. There are two categories of causes that are linked to

18
these morbidities: academic and non-academic. It's unclear if medical students

encounter these symptoms more frequently than non-medical students. The cross-

sectional picture of the students' psychological health that the current review offered is

essential for developing a health policy that will serve both preventive and therapeutic

objectives.

This study looked into anxiety and despair in students who were starting medical

school before their medical program started. New students expressed concerns about

time management, academics, daily life, and finances. It's interesting to note that the

kinds of self-reported problems that students suggested were influenced by the

demographic variables of gender, marital status, and race. Depression and anxiety tests

revealed that the emotional state of incoming medical school students is like the general

population.

The findings imply that the more common occurrence of anxiety and depression

among students pursuing medical education may be attributed in part to the demanding

nature of the medical curriculum. Additionally, students entering the medical industry are

already worried about medical school and are preparing for the adjustments they will

need to make to meet the challenges that lie ahead. Early in medical school,

preventative programming should be implemented. It should cover a wide range of

issues, including academic, interpersonal, and economical concerns.

Medical students are more likely to experience mental strain and burnout

because they report experiencing high demands, pressures, pressure to achieve, and a

lack of resources. The COVID-19 pandemic has altered study circumstances and

presented new difficulties. Thus, the purpose of this study was to investigate the study

habits, mental health, and general well-being of medical students both before and after

the epidemic. Cross-sectional comparisons were performed using data from 988

19
Austrian medical students, whereas longitudinal studies (variance analyses/t-tests or

appropriate non-parametric tests) included 63 students. The peri-pandemic cohort

reported fewer emotional tiredness, cognitive demands, and stressors (information

issues, organizational stressors, work overload), but they also reported higher study

satisfaction and more social support from lecturers. However, there was no significant

difference in their well-being before and during the pandemic.

Health concerns, sleep problems, and bad emotions are frequently co-occurring;

nevertheless, the relationships between these factors and healthcare students are still

unclear. This study used a cross-sectional survey of Chinese healthcare students (N =

348), with the goal of determining whether anxiety and depression affect the association

between sleep quality and subjective well-being in these students. A series of paper-and-

pencil surveys were used, including the Patient Health Questionnaire-4 (PHQ-4), the

World Health Organization-Five Well-Being Index (WHO-5), and the Chinese version of

the Sleep Quality Questionnaire (SQQ). Spearman correlation analysis between the

SQQ, WHO-5, and PHQ-4, descriptive analysis using means (standard deviations) and

counts (proportions), and mediation analysis using structural equation models were all

carried out. Correlation analysis showed statistically significant associations between

sleep quality, anxiety and depression, and well-being among healthcare students.

Anxiety and depression were found to be the only factors that could fully explain

the relatively low levels of self-reported well-being that were produced by poor sleep

quality. Sleep quality was found to be correlated with subjective well-being, and this

relationship was fully mediated by anxiety and depression. By lessening anxiety and

despair, interventions targeted at improving the quality of sleep for healthcare students

may also improve their overall wellbeing.

20
 Post-secondary health science students often suffer from high levels of anxiety

and depression because of a variety of variables, including high levels of stress, a heavy

workload, low socioeconomic position, and a family history of mental illness.

Understanding the prevalence and association of depression and anxiety in

undergraduate health science students is crucial, as these conditions can have a major

negative influence on this demographic. Considering this, the purpose of this scoping

review is to find, catalogue, and evaluate the literature regarding the prevalence and

determinants of anxiety and depression among undergraduate students studying health

sciences, as well as to pinpoint any knowledge gaps that require further investigation.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses

extension for the Scoping Reviews statement were used to plan and carry out this

scoping review.

Five databases were searched thoroughly and methodically: MEDLINE, Scopus,

EMBASE, CINAHL, and PubMed. Findings According to the data, sociodemographic

characteristics like age, sex, gender, relationships, ethnicity, and family history, as well

as individual health conditions and academic and financial difficulties, are associated

with anxiety and depression among health science students. Conclusions: There is a

growing need to identify workable solutions to support health science students, given the

high prevalence of anxiety and depression among them. students, politicians and

university administrators must also put supportive text messages and other tactics into

practice

21
 CHAPTER 3

METHODOLOGY

Research Design
This study applied a quantitative - descriptive research method. This is

appropriate for this study mainly because it deals with survey on the responses

22
of the Bachelor of Science students regarding their level of anxiety and

depression.

This research holds a significant importance for both respondents and the

college community and as well as for the future researchers. It helps to enhance

the student well-being, quantifies prevalence and risk factors and improves

academic support and policies. Lastly is will also contribute to a broader

understanding of importance of mental health.

Research Environment
Sampling and data collection were be done in Mandaue City, Philippines

at Gullas College of Medicine. Gullas College of Medicine was established in

1977 in banilad to serve the medical and health needs of the city. This college

offers medical education to more than 3000 international students. The campus

has a multi-story building with an Auditorium at the 6 th floor which can

accommodate around 600 students at one time. The fact that it has a State-of-

the-Art library on the 5th floor suggests a commitment to providing students with

ample resources for their studies. The presence of green trees around our

college adds a touch of nature and calmness to the environment. This Medical

College is a hub of knowledge and compassion, where aspiring healthcare

professionals are nurtured with a blend of academic rigor and empathetic

training.

Research Respondents

23
 The students for the Bachelor of Science program are the respondents of

the study. The students here just finished their Senior High School program and

are enrolled in a BS program that will last for a year. Classes are being held in

Gullas College of Medicine.

The students who are officially enrolled in the BS program are included

in the study. Those who are not officially enrolled are excluded.

This group was selected for this research because they have new

exposure to all the challenges that are faced by medical students and it can be

overwhelming for these students to cope up. It would be of great use that our

study can determine impact of anxiety and depression early on in the starting

years of medical college.

Sampling Technique

Systemic random sampling was utilized. The total population was 130,

using sample size calculator, the respondents were down to 98. The 98

respondents were given the questionnaire but only 95 were retrieved. The

technique relies on using a selection method that provides each participant with

an equal chance of being selected.

Research Instrument.

Standardized questionnaire from Robert et al (2009) is the research

tool in this study. Questionnaires will be in the forms which comprises three

parts demographic profile (four questions), Anxiety Questionnaire (seven

24
questions) and Depression questionnaire (sixteen questions) will be

provided to the BS students and will be given ample amount of time to

answer. Confidentiality will be maintained.

Data Gathering Procedure

The researcher sought approval from the administration of Gullas College

of Medicine for the questionnaire. The purpose of the study was thoroughly

explained to the respondents, and participation is optional. Respondents were

encouraged to address any questions or concerns they may have about the

study or the questionnaire items, and there was given enough time to complete

the surveys during the data collection process.

The Data was collected by distributing the questionnaires in the BS

classrooms after co-ordinating with the class president. The Questionnaires were

distributed using Systematic Sampling method.

The process of sampling included the following:

First, we assigned a sequential number to each participant in the population,

which acts as an ID number – e.g. 1, 2, 3, 4, 5, and so on to 130. Secondly, we

decided the sample size number needed which was 98. Lastly, we selected our

sample by running a random number generator to provide 98 randomly

generated numbers from 1-130 and the students with these numbers were given

the questionnaire to answer.

25
 The Respondents were given enough time to give their appropriate

responses and we made sure to explain them the instructions to answer the

questionnaire.

Data Analysis

To process the data for analysis, we used summation as a method for

further processing.

Simple Percentage: It's a way to express a part of a whole as a fraction of

100. It's used in our results to represent the demographic profiling for the

distribution of Age, Sex, and Nationality.

Frequency: In data analysis, frequency is used as total number of

respondents, which is 95.

Weighted Mean: It is a type of average where different values in the data

set are given different weights based on their importance or frequency. It's

calculated by multiplying each value by its weight and then dividing the sum of

those products by the sum of the weights.

Standard Deviation: It measures the dispersion or spread of a set of data

points. It indicates how much individual data points deviate from the mean

(average) of the data set. A higher standard deviation means the data points are

spread out more widely, while a lower standard deviation means they are closer

to the mean.

26
 Chi-Square: It's a statistical test used to determine whether there is a

significant association between categorical variables in a contingency table. Like

in our Study it is used to determine relationship between the demographic profile

of the respondents to the level of Anxiety and Depression.

Ethical Considerations:

The researcher will follow and support the Philippines' Data Privacy

Law by making every attempt to keep the participants' identities and

information private. The researcher will make certain that none of the

volunteers will be put in a position where they would be harmed as a

result of their involvement in either the physical or psychological parts of

the study. By protecting the confidentiality and integrity of the replies, the

researcher will ensure that the participants' privacy was safeguarded.

Risk-Benefit Assessment

The researchers will weigh the risks and advantages of conducting

the study since it is critical to safeguarding the participants'

interests.

Risk. The issue of participant confidentiality being revealed will be

identified as a potential risk. To ensure the secrecy of the

participants' personal data and information, the researcher will use

codes to the study instruments. After the data and other proof are

compiled, they will be destroyed.

27
Benefit. The result of the study will help both the individuals and the

school. The final product can be utilized to improve teaching and

learning practices.

Content, Comprehension, and Documentation of Informed

Consent

The participants' rights in this study will be given first priority.

As a result, a sample

of the informed consent form confirming ethics committee approval

will be attached to this study, which was provided and discussed

with the participants before to the survey's conduct. The

respondents' consent to participate in this study will be given

voluntarily after indicating their interest and agreement to do so.

Authorization to Access Private Information

The participants will give the researcher permission to write

private and sensitive information in the instrument. Their signature

on the informed permission form will denote the researcher's

obligation to protect private and sensitive information once it will be

disclosed to the researcher. The researcher and the participants are

aware that there is a danger of harm or risk to sensitive information

that will have emerged throughout the data collection process.

28
Confidentiality Procedure

The actions that will be taken by the researcher to ensure

privacy are as follows: (1) classifying and differentiating data; (2)

keeping a safe shelf for data storage during the investigation; (3)

inserting no identifying information or marks in the instrument or

computer; and (4) effectively eliminating identifying information after

usage

Debriefing, Communications, and Referrals

Debriefing is the practice of soliciting feedback at the

conclusion of a research project. It is a courteous conversation

between the researcher and the participants that is done in a way

that is beneficial to the participants. The researcher in this study will

take time to explain why it is important to participate in the study

and what is the expected outcome would be. After the data are

collected, the respondents will be debriefed to avoid or minimize

any psychological injury.

Incentives or Compensation

It is vital to highlight that there is no monetary incentive other

than a simple gift of thanks for those who helped.

29
Conflict of Interest

The researcher was responsible for all expenditures

associated with the study's execution. The researchers will also

state that they received no outside support for their research.

Furthermore, the researchers will work independently and are not

linked with any organization.

Recruitment

Participants will be chosen and recruited without force,

intimidation, or undue influence, and the researcher will promise

them that they have the freedom to decline or withdraw at any

moment without danger of being penalized.

Vulnerability Assessment

The participants in this study will not fall into the vulnerable

category since they will not exhibit the features of vulnerability.

During the data collection, there will be no threat or hazard.

Collaborative Study Terms of References

The researchers will pay for the expenditures from their own

pocket. This study may only be published by the researcher. This

30
work may be published by the researcher adviser as long as the

researcher's name appears as a co-author.

CHAPTER 4

RESULTS AND DISCUSSIONS

31
Table 1
Demographic profile of the Respondents
Age Count Percent (%)
18 - 25 93 97.9
Above 25 years 2 2.1
Total 95 100.0

Sex Count Percent (%)

Male 42 44.2
Female 53 55.8
Total 95 100.0

Nationality Count Percent (%)

Indian 50 52.6
Nepalis 28 29.5
Others 17 17.9
Total 95 100.0

The first part of the table presents the distribution of respondents based

on their ages, categorizing them into two groups: "18 - 25" and "Above 25 years."

The data indicates that the majority of respondents, comprising 97.9% of the total

sample (93 out of 95 individuals), fall within the younger age range of 18 to 25

years old. In contrast, only a small percentage, accounting for 2.1% of the total

sample (2 individuals), are above 25 years old. This distribution reflects the

predominance of younger individuals within the surveyed population, which is

consistent with the demographic composition of medical student cohorts.

32
However, it is essential to recognize the potential implications of this age

distribution for research findings and generalizability. While the focus on younger

respondents aligns with previous studies that have similarly found medical

students to be predominantly in their late teens to early twenties, it may also limit

the representation of experiences and perspectives across different age groups.

To enhance the comprehensiveness and applicability of future research,

consideration should be given to including a more diverse age range. This would

enable a broader exploration of the complexities of anxiety and depression

among medical students across various life stages. The distribution of ages

observed in this study underscores the importance of contextualizing research

findings within the broader literature on mental health issues in medical

education, such as the work by Smith et al. (2018), which provides valuable

insights into the demographic characteristics of medical student populations and

their implications for understanding mental health challenges.

Second part is the distribution of study participants based on their sex,

categorizing them into male and female groups. The data reveals that among the

study participants, 44.2% are male (42 out of 95 individuals), while 55.8% are

female (53 out of 95 individuals). This gender distribution reflects a slight majority

of female participants in the sample. The higher representation of females in the

study aligns with broader trends observed in the medical field, where women

have increasingly constituted a larger proportion of medical school enrollments in

recent years (Association of American Medical Colleges, 2022). This

phenomenon may reflect shifts in societal norms, increased opportunities for

33
women in higher education, and changing perceptions of gender roles within the

medical profession. Additionally, the gender disparity in medical education has

implications for understanding and addressing mental health issues among

medical students. Research suggests that female medical students may

experience unique stressors and challenges, such as balancing academic

demands with family responsibilities and navigating gender-related biases and

stereotypes (Dyrbye et al., 2016). Thus, acknowledging and addressing gender-

specific factors in mental health interventions and support services is essential

for promoting the well-being of all medical students, regardless of gender. By

recognizing the gender distribution within the study sample and its implications

for mental health research in medical education, this study contributes to a more

comprehensive understanding of the complex interplay between gender,

academic stress, and psychological well-being among medical students.

Third part displays the nationality distribution of the respondents,

categorized into three groups: Indian, Nepalis, and Others. The majority of

respondents, comprising 52.6% of the total sample (50 out of 95 individuals),

identified as Indian. Additionally, 29.5% of respondents (28 out of 95 individuals)

identified as Nepalis, while 17.9% (17 out of 95 individuals) identified as

belonging to other nationalities. This distribution reflects a significant

representation of Indian and Nepali students within the study sample. The high

proportion of Indian respondents may be attributed to factors such as the

recruitment of Indian students in medical education abroad, particularly in

countries like the Philippines where the Gullas College of Medicine is located.

34
Similarly, the presence of Nepali students could be influenced by international

medical education opportunities and partnerships between Nepal and the

Philippines. Understanding the nationality distribution among medical students is

crucial for recognizing the diverse cultural backgrounds and experiences within

the student body. Research indicates that cultural factors play a significant role in

shaping individuals' perceptions of mental health and help-seeking behaviors

(Kirmayer et al., 2011). Therefore, mental health interventions and support

services in medical education settings should be culturally sensitive and

inclusive, taking into account the unique needs and preferences of students from

diverse national backgrounds. By acknowledging the nationality distribution

within the study sample and its implications for mental health research and

interventions, this study contributes to a more nuanced understanding of the

intersection between culture, nationality, and mental well-being among medical

students.

Table 2
Perceived Anxiety Level of the Respondents

Items Mean Std. Interpretation

35
 Deviation
Feeling nervous, anxious or on 2.69 1.20 Sometimes
edge.
Not being able to stop or control 2.67 1.32 Sometimes
worrying
Worrying too much about 2.76 1.30 Sometimes
different things.
Becoming easily annoyed or 2.80 1.11 Sometimes
irritable
Being so restless that it is hard 2.56 1.23 Rarely
to sit still.
Feeling afraid as if something 2.68 1.21 Rarely
awful might happen.
Trouble relaxing. 2.55 1.23 Rarely
Anxiety Level 2.67 0.87 Moderate

Feeling nervous, anxious or on edge. The mean score for this item is 2.69,

suggesting that respondents reported experiencing this symptom "Sometimes"

on average. This common anxiety symptom may stem from various stressors,

including academic pressures, performance expectations, and personal

concerns. The frequency of this symptom highlights the pervasive nature of

anxiety among medical students, impacting their daily lives and well-being.

Not being able to stop or control worrying. With a mean score of 2.67,

respondents reported experiencing this symptom "Sometimes" on average.

Excessive worrying is a hallmark feature of anxiety disorders and can interfere

with concentration, decision-making, and overall functioning. The frequency of

36
this symptom underscores the challenges faced by medical students in managing

their worries amidst academic demands and other stressors.

Worrying too much about different things. The mean score of 2.76

indicates that respondents reported this symptom "Sometimes" on average. This

pervasive worrying may reflect the multifaceted nature of stressors encountered

in medical education, ranging from academic performance to future career

prospects. Addressing excessive worry is essential for promoting adaptive coping

strategies and enhancing students' resilience in navigating challenging situations.

Becoming easily annoyed or irritable. With a mean score of 2.80,

respondents reported experiencing irritability "Sometimes" on average. Irritability

is a common emotional response to stress and can manifest in interpersonal

interactions, academic settings, and everyday activities. Recognizing and

managing irritability is crucial for maintaining positive relationships and

minimizing conflict, both essential aspects of medical education and professional

practice.

Being so restless that it is hard to sit still. The mean score of 2.56

suggests that respondents reported experiencing restlessness "Rarely" on

average. While less frequent than other symptoms, restlessness can still

contribute to discomfort and agitation, affecting concentration and productivity.

Understanding the factors contributing to restlessness, such as physical

discomfort or psychological tension, can inform strategies for promoting

relaxation and stress reduction among medical students.

37
 Feeling afraid as if something awful might happen. With a mean score of

2.68, respondents reported experiencing this fear "Rarely" on average.

Fearfulness may arise from uncertainty about academic performance, future

career prospects, or personal challenges. Addressing these fears through

supportive interventions and coping strategies can help alleviate distress and

enhance students' sense of control and confidence.

Trouble relaxing. The mean score of 2.55 indicates that respondents

reported having trouble relaxing "Rarely" on average. Difficulty relaxing may stem

from persistent worries, heightened stress levels, or maladaptive coping patterns.

Encouraging relaxation techniques, such as mindfulness and deep breathing

exercises, can help students cultivate a sense of calm and resilience in the face

of academic and personal stressors.

Table 3
Distribution of Respondents in terms of their Anxiety Level

Anxiety Level Count Percent (%)

38
 Low 18 18.9
Mild 28 29.5
Moderate 31 32.6
Severe 13 13.7
Panic Level 5 5.3
Total 95 100.0

Table 3 presents the distribution of respondents based on their anxiety

levels, categorized into five levels: Low, Mild, Moderate, Severe, and Panic

Level.

Low Anxiety Level. The data indicates that 18.9% of respondents reported

experiencing a low level of anxiety. This suggests that a minority of respondents

perceive their anxiety symptoms to be minimal or manageable. Previous

research suggests that a low level of anxiety may still impact individuals' overall

well-being and functioning, as even mild symptoms can contribute to

psychological distress (Lowe et al., 2008).

Mild Anxiety Level. A slightly larger proportion of respondents, accounting

for 29.5%, reported experiencing mild anxiety. This suggests that a significant

portion of respondents experience some degree of anxiety symptoms, although

they may not significantly impair daily functioning. Studies have shown that mild

anxiety symptoms are common among college students, including medical

students, and may be influenced by academic stressors and lifestyle factors

(Beiter et al., 2015).

39
 Moderate Anxiety Level. The most common anxiety level reported by

respondents is moderate, with 32.6% indicating this level. This suggests that a

substantial portion of respondents perceive their anxiety symptoms to be of

moderate intensity, potentially impacting their daily activities and well-being.

Research on medical student mental health has consistently identified moderate

anxiety levels as prevalent and concerning, highlighting the need for targeted

interventions and support services (Dyrbye et al., 2006).

Severe Anxiety Level. A smaller proportion of respondents, comprising

13.7%, reported experiencing severe anxiety. This indicates that some

respondents perceive their anxiety symptoms to be significantly distressing and

impairing their ability to function effectively. Severe anxiety levels among medical

students have been associated with academic difficulties, decreased quality of

life, and increased risk of burnout and dropout (Hope et al., 2010).

Panic Level Anxiety. The data reveals that 5.3% of respondents reported

experiencing anxiety at a panic level. This suggests that a minority of

respondents perceive their anxiety symptoms to be severe and overwhelming,

potentially requiring immediate attention and intervention. Panic-level anxiety is

characterized by intense and sudden episodes of fear or discomfort, often

accompanied by physical symptoms such as rapid heartbeat and shortness of

breath (American Psychiatric Association, 2013).

Overall, the distribution of respondents across different anxiety levels

highlights the variability in the perceived intensity and impact of anxiety

symptoms among medical students. While a considerable portion of respondents

40
report experiencing moderate levels of anxiety, indicating a significant mental

health concern within the student population, it is essential to recognize the

diversity of experiences and provide tailored support and interventions to address

the varying needs of students across different anxiety levels.

Table 4 Perceived Depression Level of the Respondents

Std.
Items Mean Deviation Interpretation
All the tasks you have 2.54 1.16 Rarely
performed, are taking much more
time than usual.
You are facing a lack of 2.88 1.32 Sometimes
concentration.
You feel, you have no future 2.29 1.39 Rarely
You are facing problems with 2.80 1.31 Sometimes
making decisions
You have lost interest in all things 2.69 1.32 Sometimes
that were important to you once
upon a time.
You feel, your life is sad, as there 2.32 1.29 Rarely
is no joy in your anymore.
You have been feeling guilty for 2.49 1.33 Rarely
everything you do.
You have been very irritated and 2.64 1.25 Sometimes
angry recently.
You have been feeling very 2.75 1.34 Sometimes
fatigued.
You are feeling that everything 2.24 1.22 Rarely
you have done has been a
failure.
You are having lack of sleep 2.94 1.43 Sometimes

41
 You are having suicidal thoughts. 1.98 1.22 Rarely
You have lost or gained weight 2.73 1.28 Sometimes
without any diet programs.
You are having loss of appetite. 2.35 1.28 Rarely
You are having trust issue with 2.67 1.32 Sometimes
everyone around you,
You are having trouble in all your 2.49 1.35 Rarely
relationships (home as well as
professional)
Depression Level 2.55 0.71 Moderate

Presented in Table 4 is the perceived level of depression of the

respondents of the study.

All the tasks you have performed are taking much more time than usual.

The mean score of 2.54 indicates that respondents reported experiencing this

symptom "Rarely" on average. This suggests that while some respondents

occasionally faced challenges with task efficiency, it was not a pervasive issue. It

may imply occasional disruptions in productivity due to depressive symptoms.

Similar findings have been reported in previous research on depression among

medical students, where cognitive impairments, such as difficulties with

concentration and processing speed, have been identified as common symptoms

(Dyrbye et al., 2006).

You are facing a lack of concentration. The mean score of 2.88 suggests

that respondents reported experiencing a lack of concentration "Sometimes" on

average. This indicates that a significant proportion of respondents struggled with

maintaining focus, which could impact various aspects of their academic and

42
personal lives. Consistent with existing literature, difficulties with concentration

are frequently reported among individuals with depression, including medical

students, and can impair academic performance and decision-making abilities

(Dyrbye et al., 2006).

You feel you have no future. The mean score of 2.29 indicates that

respondents reported feeling a lack of future orientation "Rarely" on average.

This suggests that while some respondents experienced transient feelings of

hopelessness or uncertainty, it was not a predominant concern among the

sample. Previous studies have identified feelings of hopelessness and

pessimism about the future as common features of depression among medical

students, which can contribute to overall distress and impairment (Hope et al.,

2010).

You are facing problems with making decisions. Respondents reported

facing decision-making problems "Sometimes" on average, with a mean score of

2.80. This indicates that a substantial proportion of respondents experienced

difficulties in making choices, which may be attributed to indecisiveness or

cognitive impairment associated with depression. Decision-making difficulties are

frequently reported among individuals with depression, impacting various aspects

of daily functioning, including academic and professional domains (Hope et al.,

2010).

You have lost interest in all things that were important to you once upon a

time. The mean score of 2.69 suggests that respondents reported losing interest

in previously enjoyable activities "Sometimes" on average. Anhedonia, or the loss

43
of interest or pleasure, is a hallmark symptom of depression and can significantly

impact quality of life. Anhedonia is a common feature of depression observed in

medical students, contributing to overall emotional distress and impairment in

functioning (Dyrbye et al., 2006).

You feel your life is sad, as there is no joy in you anymore. Respondents

reported feeling sadness "Rarely" on average, with a mean score of 2.32.

Persistent sadness or feelings of emptiness are core features of depression and

can contribute to overall emotional distress and impairment. Feelings of sadness

and emptiness are frequently reported among individuals with depression,

including medical students, and can significantly impact well-being and

functioning (Dyrbye et al., 2006).

You have been feeling guilty for everything you do. The mean score of

2.49 suggests that respondents reported feeling guilty "Rarely" on average.

Excessive guilt or self-blame is a common cognitive distortion associated with

depression and can contribute to feelings of worthlessness or inadequacy.

Feelings of guilt and self-blame are common cognitive distortions observed in

depression among medical students, contributing to overall distress and

impairment in functioning (Dyrbye et al., 2006).

You have been very irritated and angry recently. Respondents reported

feeling irritable and angry "Sometimes" on average, with a mean score of 2.64.

Irritability is a less recognized but significant symptom of depression and may

manifest as heightened emotional reactivity or difficulty regulating emotions.

Irritability is a frequently overlooked symptom of depression among medical

44
students but can significantly impact interpersonal relationships and overall well-

being (Dyrbye et al., 2006).

You have been feeling very fatigued. With a mean score of 2.75,

respondents reported feeling fatigued "Sometimes" on average. Fatigue is a

common physical symptom of depression and can contribute to decreased

energy levels and motivation. Fatigue is a prevalent symptom of depression

observed among medical students, impacting academic performance and daily

functioning (Dyrbye et al., 2006).

You are feeling that everything you have done has been a failure. The

mean score of 2.24 indicates that respondents reported feeling like failures

"Rarely" on average. Feelings of worthlessness or inadequacy are characteristic

of depression and can undermine self-esteem and confidence. Feelings of

worthlessness and self-criticism are common cognitive distortions observed in

depression among medical students, contributing to overall distress and

impairment (Dyrbye et al., 2006).

You are having a lack of sleep. Respondents reported experiencing sleep

disturbances "Sometimes" on average, with a mean score of 2.94. Insomnia is a

prevalent symptom of depression and can exacerbate emotional distress and

impair daytime functioning. Sleep disturbances, including insomnia, are

45
commonly reported among individuals with depression, including medical

students, and can significantly impact overall well-being and functioning (Dyrbye

et al., 2006).

You are having suicidal thoughts. The mean score of 1.98 suggests that

respondents reported experiencing suicidal thoughts "Rarely" on average.

Suicidal ideation is a serious symptom of depression requiring immediate

attention and intervention. Suicidal ideation is a significant concern in depression

among medical students, necessitating proactive measures for suicide

prevention and mental health support (Hope et al., 2010).

You have lost or gained weight without any diet programs. With a mean

score of 2.73, respondents reported experiencing changes in weight

"Sometimes" on average. Appetite changes and weight fluctuations are common

physical symptoms of depression and can contribute to overall distress and

impairment. Changes in appetite and weight are frequently reported among

individuals with depression, including medical students, and may reflect

alterations in neuroendocrine regulation (Dyrbye et al., 2006).

You are having a loss of appetite. Respondents reported experiencing a

loss of appetite "Rarely" on average, with a mean score of 2.35. Changes in

appetite are common in depression and may reflect alterations in appetite-

regulating neurotransmitters.

Table 5
Distribution of Respondents in terms of their Anxiety Level

46
 Depression Level Count Percent (%)
Low 15 15.8
Mild 34 35.8
Moderate 35 36.8
Severe 11 11.6
Total 95 100.0

Table 5 provides insights into the distribution of respondents based on

their depression levels, categorized into four levels: Low, Mild, Moderate, and

Severe.

Low Depression Level. The data indicates that 15.8% of respondents

reported experiencing a low level of depression. This suggests that a minority of

respondents perceive their depressive symptoms to be minimal or manageable,

with relatively little impact on their overall well-being.

Mild Depression Level. A larger proportion of respondents, comprising

35.8%, reported experiencing mild depression. This indicates that a significant

portion of respondents experience some degree of depressive symptoms,

although they may not significantly impair daily functioning or quality of life.

Moderate Depression Level. The most common depression level reported

by respondents is moderate, with 36.8% indicating this level. This suggests that a

substantial portion of respondents perceive their depressive symptoms to be of

moderate intensity, potentially impacting their mood, behavior, and overall

functioning.

47
 Severe Depression Level. A smaller proportion of respondents, accounting

for 11.6%, reported experiencing severe depression. This indicates that some

respondents perceive their depressive symptoms to be significantly distressing

and impairing their ability to function effectively in various aspects of their lives.

Overall, the distribution of respondents across different depression levels

highlights the variability in the perceived intensity and impact of depressive

symptoms among the study population. While a considerable portion of

respondents report experiencing moderate levels of depression, indicating a

significant mental health concern within the student population, it is essential to

recognize the diverse experiences and provide tailored support and interventions

to address the varying needs of students across different depression levels.

These findings underscore the importance of proactive measures to

promote mental health and well-being among medical students, including

awareness campaigns, stress management workshops, counseling services, and

other resources aimed at addressing depressive symptoms and fostering a

supportive learning environment. Additionally, targeted interventions and support

services should be developed to address the specific needs of students

experiencing different levels of depression, ultimately promoting their mental

health and academic success.

Table 6
Correlation Between Anxiety & Depression Level of Respondents

48
 Variables Pearson r p-value Decision Interpretation
Anxiety & 0.41 0.000 Reject Substantial &
Depression Level Ho significant

Table 6 presents the correlation between anxiety and depression levels

among the respondents. The Pearson correlation coefficient measures the

strength and direction of the linear relationship between two variables. In this

case, the correlation coefficient (r) between anxiety and depression levels is

0.41. The p-value indicates the statistical significance of the correlation

coefficient. In this table, the p-value associated with the correlation coefficient is

0.000. Based on the p-value, the decision is to reject the null hypothesis (Ho).

This suggests that there is a statistically significant relationship between anxiety

and depression levels among the respondents.

The correlation analysis in Table 8 reveals a significant relationship

between anxiety and depression levels among the respondents, aligning with

findings from previous research in the field. Studies examining mental health

issues among medical students have consistently reported a strong association

between anxiety and depression, highlighting their interconnected nature and

shared risk factors (Dyrbye et al., 2006; Hope et al., 2010). The moderate

positive correlation coefficient of 0.41 suggests that as anxiety levels increase,

depression levels also tend to increase, and vice versa. This finding is consistent

with previous literature indicating that individuals experiencing high levels of

anxiety are more likely to exhibit symptoms of depression, and vice versa

(Dyrbye et al., 2006; Hope et al., 2010).

49
 The statistical significance of the correlation coefficient further strengthens

the argument for addressing both anxiety and depression concurrently in mental

health interventions targeting medical students. By recognizing the intertwined

relationship between these mental health issues, interventions can be designed

to target common risk factors and promote holistic well-being among students

(Hope et al., 2010).

Table 7

Relationship between Profile of the Respondents and their Anxiety Level

Chi-
Relationship square p- Cramer's
bet Anxiety & value value Decision V Interpretation
Do not
Age 2.22 0.696 reject Ho --- Not Significant
Do not
Sex 4.58 0.313 reject Ho --- Not Significant
Do not
Nationality 9.41 0.309 reject Ho --- Not Significant

Table 7 presents the relationship between the profile of the respondents

(age, sex, and nationality) and their anxiety levels. The chi-square value for the

relationship between anxiety and age is 2.22, with a corresponding p-value of

0.696. The decision is to not reject the null hypothesis (Ho), indicating that there

is no significant relationship between anxiety levels and age. This suggests that

age is not a significant determinant of anxiety levels among the respondents.

Regardless of age group, individuals exhibit similar levels of anxiety.

50
 Secondly, the chi-square value for the relationship between anxiety and

sex is 4.58, with a p-value of 0.313. Similar to age, the decision is to not reject

the null hypothesis (Ho), indicating that there is no significant relationship

between anxiety levels and sex. This implies that sex is not a significant predictor

of anxiety levels among the respondents. Both male and female individuals

exhibit similar levels of anxiety.

Lastly, the chi-square value for the relationship between anxiety and

nationality is 9.41, with a p-value of 0.309. Once again, the decision is to not

reject the null hypothesis (Ho), indicating that there is no significant relationship

between anxiety levels and nationality. This suggests that nationality does not

significantly influence anxiety levels among the respondents. Individuals from

different nationalities exhibit similar levels of anxiety.

Overall, the findings from Table 12 indicate that age, sex, and nationality

are not significant predictors of anxiety levels among the respondents. These

results are consistent with some previous research in the field, which has also

found no significant relationships between demographic factors and anxiety

levels among medical students (Dyrbye et al., 2006).

Table 8
Relationship between Profile of the Respondents and their Depression Level

Relationship Chi- p- Decision Cramer's Interpretation

51
 bet. square
Depression & value value V
Do not reject
Age 2.58 0.461 Ho --- Not Significant
Do not reject
Sex 2.18 0.535 Ho --- Not Significant
Do not reject
Nationality 1.13 0.980 Ho --- Not Significant

Table 8 illustrates the relationship between the profile of the respondents

(age, sex, and nationality) and their depression levels. The chi-square value for

the relationship between depression and age is 2.58, with a corresponding p-

value of 0.461. The decision is to not reject the null hypothesis (Ho), indicating

that there is no significant relationship between depression levels and age. This

implies that age is not a significant predictor of depression levels among the

respondents. Regardless of age group, individuals exhibit similar levels of

depression.

Moreover, the chi-square value for the relationship between depression

and sex is 2.18, with a p-value of 0.535. Similar to age, the decision is to not

reject the null hypothesis (Ho), indicating that there is no significant relationship

between depression levels and sex. This also suggests that sex is not a

significant determinant of depression levels among the respondents. Both male

and female individuals exhibit similar levels of depression.

On the other hand, the chi-square value for the relationship between

depression and nationality is 1.13, with a p-value of 0.980. Once again, the

decision is to not reject the null hypothesis (Ho), indicating that there is no
52
significant relationship between depression levels and nationality. This indicates

that nationality does not significantly influence depression levels among the

respondents. Individuals from different nationalities exhibit similar levels of

depression.

Overall, the findings from Table 13 suggest that age, sex, and nationality

are not significant predictors of depression levels among the respondents. These

results align with some previous research in the field, which has also found no

significant relationships between demographic factors and depression levels

among medical students (Dyrbye et al., 2006).

These findings underscore the importance of considering individual

differences and contextual factors when assessing depression levels among

medical students. While demographic factors may play a role, other factors such

as academic stress, social support, and coping mechanisms may have a more

significant impact on depression outcomes (Hope et al., 2010).

In summary, interventions aimed at addressing depression among medical

students should be tailored to individual needs and consider a holistic approach

that encompasses various factors influencing mental health outcomes.

53
 CHAPTER 5

SUMMARY OF FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS

Summary of Findings

The study investigated the impact of anxiety and depression among

medical students at Gullas College of Medicine, Inc. during the academic year

2023-2024. The aim was to understand how these mental health issues influence

students' daily lives and academic trajectories, with the goal of creating a more

supportive learning environment.

Demographic Factors and Mental Health. Age, sex, and nationality were

examined as potential factors influencing anxiety and depression levels. There

54
were no significant differences in anxiety and depression levels based on age

groups, sex, or nationality, indicating that these demographic factors may not be

strong predictors of mental health outcomes among medical students

Anxiety Levels. Overall, anxiety levels were moderate among

respondents. Common symptoms of anxiety included feeling nervous, worrying

too much, and occasional irritability. However, there were no significant

differences in anxiety levels based on demographic factors.

Depression Levels. Depression levels were also moderate overall.

Common symptoms of depression included lack of concentration, loss of interest,

and occasional feelings of sadness. Similar to anxiety levels, there were no

significant differences in depression levels based on demographic factors

Relationship between Anxiety and Depression. There was a significant

positive correlation between anxiety and depression levels, indicating that

individuals with higher anxiety tended to have higher depression levels, and vice

versa. However, demographic factors such as age, sex, and nationality did not

significantly influence this relationship.

The findings align with previous research indicating that demographic

factors may not be strong predictors of anxiety and depression levels among

medical students. Other factors such as academic stress, social support, and

coping mechanisms may play a more significant role in determining mental

health outcomes. The study highlights the importance of promoting mental health

awareness and support services tailored to the diverse needs of medical

55
students. Interventions should focus on addressing individual stressors and

enhancing coping strategies to mitigate the impact of anxiety and depression on

academic performance and overall well-being.

The study emphasizes the importance of promoting mental health

awareness and providing tailored support services to address the diverse needs

of medical students. Interventions should focus on enhancing coping strategies,

fostering social support networks, and reducing academic stressors to mitigate

the impact of anxiety and depression on academic performance and overall well-

being

It is essential to acknowledge the limitations of the study, such as the

cross-sectional design and the focus on a specific institution. Future research

could employ longitudinal designs and include a broader range of medical

schools to enhance generalizability and provide a more comprehensive

understanding of mental health among medical students.

Conclusion

Based on the findings of the study, the following conclusions can be

drawn:

Age, sex, and nationality were not significant predictors of anxiety and

depression levels among medical students. This suggests that individual

differences in mental health outcomes cannot be solely attributed to demographic

factors. Anxiety and depression levels were moderate among respondents, with

56
common symptoms including feelings of nervousness, worry, lack of

concentration, and occasional sadness. These findings underscore the

importance of addressing mental health concerns among medical students.

There was a significant positive correlation between anxiety and depression

levels, indicating that individuals experiencing higher levels of anxiety were also

likely to experience higher levels of depression, and vice versa. This highlights

the interconnected nature of anxiety and depression and the need for integrated

interventions.

In conclusion, the study highlights the complex nature of anxiety and

depression among medical students and underscores the importance of adopting

holistic approaches to support their mental health needs. By addressing

individual stressors and promoting a supportive learning environment, institutions

can better equip medical students to navigate the challenges of their academic

journey while maintaining their well-being.

Recommendations

Based on the conclusions drawn from the study, the following

recommendations can be made to support the mental health and well-being of

medical students

1. Promote Mental Health Awareness. Implement initiatives to raise

awareness about mental health issues among medical students, faculty, and

57
staff. This can include educational workshops, seminars, and campaigns aimed

at reducing stigma and encouraging help-seeking behaviors

2. Enhance Support Services. Provide accessible and confidential mental

health support services on campus, including counseling, therapy, and peer

support groups. Ensure that these services are tailored to the specific needs and

preferences of medical students and are inclusive of diverse backgrounds and

experiences.

3. Integrate Mental Health into Curriculum. Incorporate mental health

education and self-care practices into the medical school curriculum. Equip

students with coping skills, stress management techniques, and resilience-

building strategies to help them navigate the challenges of medical education

and practice.

4. Foster Social Support Networks. Create opportunities for medical

students to connect with peers, faculty mentors, and support networks within the

academic community. Encourage collaboration, peer mentoring, and mutual

support to combat feelings of isolation and promote a sense of belonging.

5. Address Academic Stressors. Identify and address factors contributing

to academic stress, such as high workloads, competitive environments, and

challenging clinical rotations. Implement strategies to promote work-life balance,

time management skills, and effective study habits to reduce stress and enhance

well-being.

58
 6. Implement Early Intervention Strategies. Develop protocols for

identifying and supporting students at risk of mental health concerns. Train

faculty and staff to recognize signs of distress and provide appropriate referrals

to mental health professionals or support services.

7. Promote Self-Care Practices. Encourage medical students to prioritize

self-care and engage in activities that promote physical, emotional, and mental

well-being. Provide resources and guidance on healthy lifestyle habits, relaxation

techniques, and self-care rituals to help students manage stress and maintain

balance.

8. Evaluate and Monitor Progress. Continuously assess the effectiveness

of mental health initiatives and support services through regular feedback,

surveys, and outcome evaluations. Use data-driven approaches to inform

program improvements and ensure that interventions meet the evolving needs of

medical students.

By implementing these recommendations, medical schools can create a

supportive and nurturing environment that prioritizes the mental health and well-

being of their students. Investing in comprehensive mental health support

services and promoting a culture of openness and support can help medical

students thrive academically, personally, and professionally

59
 PROPOSED INTERVENTION PROGRAM

Below is a suggested intervention program based on the findings of the study,

presented in matrix form:

Intervention
Program Objectives People Involved Time Frame

Mental Health 1. Raise awareness about

Awareness mental health issues among Faculty, staff, student Ongoing
Program medical students. leaders throughout year

2. Reduce stigma associated

with mental health concerns.

3. Encourage help-seeking
behaviours.

Counselling and 1. Provide accessible mental Licensed counselors, Ongoing

60
 Intervention
Program Objectives People Involved Time Frame

health support services on therapists, mental

Therapy Services campus. health professionals throughout year

2. Offer confidential
counselling and therapy
sessions.

3. Address individual mental

health needs and concerns.

Incorporated
into existing
Mental Health 1. Integrate mental health Faculty, mental health curriculum
Education in education into the medical educators, student throughout
Curriculum school curriculum. representatives academic year

2. Equip students with coping

skills, stress management
techniques, and resilience-
building strategies.

3. Foster a supportive
learning environment.

Regular
Student leaders, peer meetings
Peer Support 1. Facilitate peer support mentors, mental health throughout
Groups networks and mutual support. advocates academic year

2. Provide opportunities for

confidential sharing and
empathetic listening.

3. Promote a sense of
belonging and connection
within the community.

This intervention program aims to address the mental health needs of

medical students by raising awareness, providing support services, integrating

61
mental health education, and fostering peer support networks. It involves various
stakeholders, including faculty, staff, student leaders, counselors, therapists, and
mental health educators. The program operates on an ongoing basis throughout
the academic year, with regular meetings, sessions, and activities incorporated
into existing curricula and schedules.

REFRENCES

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Health, and Study Characteristics of Medical Students before and during
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Himawan, A. G., & Widjaja, Y. (2023). SELF-REGULATED LEARNING AND

ACADEMIC STRESS IN MEDICAL SCHOOL: ARE THEY RELATED?
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Zhu, Y., Meng, R., Jiang, C., Yang, N., Huang, M., Wang, X., Zou, W., Lou, C.,
Xiao, R., Lu, J., Xu, J., Jiménez-Correa, U., Ma, H., Spruyt, K., &
Dzierzewski, J. M. (2023). Sleep quality and subjective well-being in
healthcare students: examining the role of anxiety and depression.
Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1281571

Agyapong-Opoku, G., Agyapong, B., Obuobi-Donkor, G., & Eboreime, E. (2023).

Depression and Anxiety among Undergraduate Health Science Students:
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Quek, T. T. C., Tam, W. W. S., Tran, B. X., Zhang, M., Zhang, Z., Ho, C. S. H., &
Ho, R. C. M. (2019). The Global Prevalence of Anxiety among Medical
Students: A Meta-Analysis. International Journal of Environmental
Research and Public Health/International Journal of Environmental
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https://doi.org/10.3390/ijerph16152735

Ahmed, I., Banu, H., Al-Fageer, R., & Al-Suwaidi, R. (2009). Cognitive emotions:
Depression and anxiety in medical students and staff. Journal of Critical
Care, 24(3), e1–e7. https://doi.org/10.1016/j.jcrc.2009.06.003

Bunevicius, A., Katkute, A., & Bunevicius, R. (2008). Symptoms of anxiety and
depression in medical students and in humanities students: relationship
with Big-Five personality dimensions and vulnerability to stress.
International Journal of Social Psychiatry, 54(6), 494–501.
https://doi.org/10.1177/0020764008090843

Chandavarkar, U., Azzam, A., & Mathews, C. A. (2007). Anxiety symptoms and
perceived performance in medical students. Depression and Anxiety,
24(2), 103–111. https://doi.org/10.1002/da.20185

Mihăilescu, A., Diaconescu, L., Ciobanu, A., Donisan, T., & Mihailescu, C.
(2016). The impact of anxiety and depression on academic performance in
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Singh, G., Hankins, M., & Weinman, J. A. (2004). Does medical school cause
health anxiety and worry in medical students? Medical Education, 38(5),
479–481. https://doi.org/10.1046/j.1365-2929.2004.01813.x

MacLean, L., Booza, J., & Balon, R. (2015). The impact of medical school on
student mental health. Academic Psychiatry, 40(1), 89–91.
https://doi.org/10.1007/s40596-015-0301-5

Mirza, A. A., Baig, M., Beyari, G. M., Halawani, M. A., & Mirza, A. A. (2021).
Depression and Anxiety among Medical Students: A Brief Overview.
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Smith, C. K., Peterson, D. F., Degenhardt, B. F., & Johnson, J. C. (2007).

Depression, anxiety, and perceived hassles among entering medical
students. Psychology, Health & Medicine, 12(1), 31–39.
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Moutinho, I. L. D., De Castro Pecci Maddalena, N., Roland, R. K., Lucchetti, A. L.

G., Tibiriçá, S. H. C., Da Silva Ezequiel, O., & Lucchetti, G. (2017).
Depression, stress and anxiety in medical students: A cross-sectional

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9282.63.01.21

Hassed, C., de Lisle, S., Sullivan, G., & Pier, C. (2009). Enhancing the health
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Mata, D. A., Ramos, M. A., Bansal, N., Khan, R., Guille, C., Di Angelantonio,
E., & Sen, S. (2015). Prevalence of depression and depressive
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Quek, T. T. C., Tam, W. W. S., Tran, B. X., Zhang, M., Zhang, Z., Ho, C. S. H.,
& Ho, R. C. M. (2019). The global prevalence of anxiety among
medical students: a meta-analysis. International Journal of
Environmental Research and Public Health, 16(15), 2735.

Rotenstein, L. S., Ramos, M. A., Torre, M., Segal, J. B., Peluso, M. J., Guille,
C., & Mata, D. A. (2016). Prevalence of depression, depressive
symptoms, and suicidal ideation among medical students: a
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Shapiro, S. L., Schwartz, G. E., & Bonner, G. (2018). Effects of mindfulness-

based stress reduction on medical and premedical students. Journal
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64
APPENDICES

65
 Letter to the Dean of UV Gullas College of Medicine
Gullas College of Medicine
UNIVERSITY OF THE VISAYAS
Banilad, Mandaue City

May, 2024
Dr. Jose Juan Rafael G. Laico,
The Dean,
Gullas College Of Medicine,
Banilad, Cebu.

Respected Doc,

Greetings!

We are 2nd year medical students of the Gullas College of

Medicine of the university of the Visayas planning to conduct
research in compliance with the course requirements of Doctor of
Medicine. The research is entitled, Impact of Anxiety and
Depression Among Bachelor of Science Students in a Medical
Institution. We hope that the findings of the study can help us come
up with recommendations that address the knowledge of medical
students on telemedicine. We would like for your permission to
perform the study.

Thank you very much and we hope to see you there!

Sincerely,
ASHOK KUMAR SATHISH KUMAR
Research Leader.

66
SAMPLE QUESTIONNAIRE

PART I: Consent

This study is conducted on behalf of a research proposal in the partial fulfilment of the Requirements for
Medical Students. The study is about the level and effects of anxiety and depression among Medical
Students. Your participation will immensely contribute to our study. All Your responses are completely
anonymous and confidentiality.

port

PART A: Demographic profile

Code: MD-1 Date:

Age:

18-25 [] 26-33[ ] 34-41] 42 & above [ ]

Gender: Male[ ] Female[ ]

Nationality: Indian [ ] Thai [ ] Nepalis [ ] Nigerians [ ] others [ ]

Directions: Below are the items to evaluate the challenges in foreign education. Please choose the option
based on whether the said item is a challenging in foreign education for you personally.

PART B: This Questionnaire was adapted from "GENERALIZED ANXIETY DISORDER" (GAD-7 ANXIETY
QUESTIONNAIRE). Drs. Robert et al.'

https://adaa.org/sites/default/files/GAD-7 Anxietv-updated 0.pdf

Instructions: Tick in the appropriate boxes given below of your choice from scale of 1-5.

1. Never 2. Rarely 3. Sometimes 4. Often 5. Always

Question 5 4 3 2 1
Feeling nervous, anxious or
on edge.
Not being able to stop or
control worrying
Worrying too much about
different things.
Becoming easily annoyed
or irritable
Being so restless that it is
hard to sit still.
Feeling afraid as if
something awful might
happen.
Trouble relaxing.
PART C: This Questionnaire was adapted from "QUESTION PRO DEPRESSION QUESTIONNAIRE". Adi bhatt

https://www.questionpro.com/blog/depression-questionnaire/

67
Instructions: Tick in the appropriate boxes given below of your choice from scale of 1-51.

1.Completely disagree 2. Somewhat disagree 3, Neutral 4, Somewhat agree 5. Completely

Agree

Questions 5 4 3 2 1
All the tasks you have
performed, are taking much
more time than usual.
You are facing a lack of
concentration.

You feel, you have no future

You are facing problems with
making decisions

You have lost interest in all

things that were important to
you once upon a time.
You feel, your life is sad, as there
is no joy in your anymore.
You have been feeling guilty for
everything you do.
You have been very irritated and
angry recently.

You have been feeling very

fatigued.
You are feeling that everything
you have done has been a
failure.

You are having lack of sleep

You are having suicidal thoughts.

You have lost or gained weight

without any diet programs.

You are having loss of appetite.

You are having trust issue with

everyone around you,
You are having trouble in all
your relationships (home as well
as professional)

THANK YOU FOR PARTICIPATION

68
 BUDGET

The total budget for this research study is estimated to be approximately

PHP 53,000 around PHP 1500.00 for reproduction of questionnaires and

other documents. PHP 3,000.00 for hard binding of copies and PHP

2250.00 for each researcher to be paid to the accounting. Amount of PHP

6,000.00 will be the transport and other miscellaneous tasks.

Activity Quantity Unit cost Total cost

Proposal and 19 person P 2250 P 42,750

defence
charges
Printing and 13 copies P 300 P 3900
binding of final
manuscript

Questionnaire 100 copies P5 P500

printing

Miscellaneous P 6000

TOTAL BUDGET - PHP 53,000

69
GHANTT CHART

CURRICULLUM VITAE

70