Original article

Psychological manifestations in students of medicine during the active surveys conducted for Covid-19

0000-0002-9199-501XTayda Ramos Remedios^{1  *}  , 0000-0002-6030-217XThalia Mendivia Ramos²  , 0000-0002-3809-3607Tahys Mendivia Ramos²  , 0000-0002-2777-1695Alexon Hernández Pérez²  , 0000-0001-9241-2042Idania Pérez Salgado² 

¹University of Medical Sciences of Artemisa. Hospital General Commandants Pinares. Artemisa, Cuba.

²University of Medical Sciences of Artemisa. Filial Piti Fajardo. Artemisa, Cuba.

ABSTRACT

Introduction:

Covid-19 has brought about different changes and consequences in society. The healthcare personnel has been one of the most affected groups in the psychological sphere due to the increase of stressful events.

Objective:

to determine the psychological manifestations in students of medicine during the active surveys conducted for Covid-19.

Methods:

a quantitative, observational, descriptive and cross-sectional research was carried out with 59 students of medicine; the students are part of the Municipal Venue of Medical Sciences in San Cristobal, Artemisa province, these students conducted active surveys for Covid-19 during May 2020.

Results:

the vulnerability to stress as symptom was not present in 17 % of the students of medicine. The probable and recognized anxiety was present in 28,8 % and 18,6 respectively. Not present or minimum depression levels prevailed in the 86,4 % of students and only one confirmed suicidal thoughts; 100 % of them had signs of neurotic performance and 54,2 % showed confrontation focused on emotions.

Conclusions:

most of the students of medicine did not manifest psychological disorders or suicidal thoughts.

Key words: SARS-CoV-2; COVID-19; STRESS; ANXIETY; DEPRESSION

INTRODUCTION

Currently, the worldwide faces the so-called first global pandemic in recent history. It started in December 2019 in Wuhan, China, where the first cases of pneumonias caused by a novel coronavirus (SARS-CoV-2) were documented. Due to the rapid spread and global reach, on January 30, 2020, the World Health Organization (WHO) declared a state of international health emergency for this outbreak and on March 11, 2020, Covid-19, a disease caused by SARS-CoV-2, was considered a pandemic.¹

In this regard, Cuba began to implement an action protocol of national scope that contributes to its prevention, control, patient care and protection of both healthcare workers and the population, based on the best existing scientific evidence, where the role of active surveys stands out in primary health care, a cutting-edge element in the prevention of Covid-19.²

Due to the high contagiousness of the virus, the increasing number of confirmed positive cases and the experience of past epidemics and pandemics, it is known that the patients and healthcare personnel involved in their care may suffer from fear, loneliness, sadness, anxiety, depression, stress and post-traumatic stress disorders.³

The psychological well-being of healthcare personnel has been studied and these manifestations have been found in some cases to be a protective factor and, in others, a predisposing condition for triggering psychiatric problems. ⁴

Dealing with the complex health situation worldwide, medical students from the United States and Spain showed their willingness to support medical personnel. ⁵

Cuban students stepped forward to combat this pandemic. In this country, more than 28 000 students carry out active surveys throughout the national territory, in order to detect early possible carriers of SARS-CoV-2, ⁵ since their training includes not only the acquisition of scientific-academic knowledge but also the development of ethical values.

However, they are more prone to develop anxiety, depression, post-traumatic stress and Burnout Syndrome, having repercussions on their health and of their families.^{(4, 5)}

Given that, dealing with Covid-19 imposes important challenges for healthcare professionals and students of medical sciences, along with the care of the population, causing emotional burden on these students and great psychological impact on the population and healthcare personnel, it was decided to conduct this research to determine the psychological manifestations in medical students during Covid-19 active surveys.

METHODS

A quantitative, observational, descriptive and cross-sectional study was carried out in order to determine the psychological manifestations in medical students from the Municipal Venue of Medical Sciences in San Cristobal municipality, Artemisa province, who were carrying out the active surveys for Covid-19 during May 2020.

The target group consisted of 67 medical students, who presented their informed consent to participate and accepted the application of the psychological tests, they were chosen by random sampling (n=59).

The psychological characteristics constituted the variables studied: vulnerability to stress, depression, anxiety, suicidal thoughts, level of psychological functioning and types of coping strategies.

The following tests were applied to assess the psychological characteristics:

• - Stress vulnerability test: it allows assessing the degree of vulnerability to stress or established stress, and to identify aspects linked to the lifestyle of the individual and social support, which may have an impact on his/her, vulnerability.

• - BECK Depression Inventory (BDI): an objective assessment is made of the manifestations of depression and the level of depth and intensity of this. It also identifies the nature of the most important depressive symptoms in patients.

• - Beck Anxiety Inventory (BAI): allows to assess the severity of anxiety symptoms and to reliably distinguish between anxiety and depression. It describes anxiety symptoms related to the physical manifestations of anxiety, according to diagnostic criteria of the 5^th edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM).

• - Beck´s Suicidal Ideation Scale (BSIS): allows identifying suicidal thoughts as not present or identified.

• - Eysenck Personality Test (EPY): allows the assessment of personality and its component factors, level of psychological functioning and temperamental elements.

Data processing was performed with the SPSS program version 17,0 and the results were given in absolute relative percentage frequency, as a summing-up assessment.

For the statistical significance analysis, the Wilcoxon test was applied, using the SPSS 17,.0 program, where p= 0,0001, below the 0,05 significance level.

For the study, the consent of the Medical Committee of Ethics from Camilo Cienfuegos Polyclinic was requested, according to the ethical principles established in the Declaration of Helsinki. In addition, written informed consent was given to each student prior to the study.

RESULTS

A predominance of non-vulnerability to stress was observed in 83 % of the subjects, and only 5 % were extremely vulnerable. Twelve percent (12 %) were classified as moderately vulnerable.

The assessment of anxiety intensity showed the presence of probable and established anxiety in 28,8 % and 18,6 % of the students of medicine, respectively. The rest with more than half of the subjects (52,6 %) did not show anxiety signs or symptoms.

A prevalence of absent or minimal depression was found in 86,4 % of the students and severe depression in 3 % of them.

All students had a neurotic level of functioning; 45,8 % presented coping strategies focused on the disease and 54,2 % focused on emotions.

The Wilcoxon signed ranks test was significant (p= 0,0001) below the significance level of 0,05; which demonstrated the existence of statistical significance in favor of the educational strategy and its effectiveness (Table 1).

Table 1 The relationship between the level of psychological functioning of students of medicine and the type of coping strategies with respect COVID-19. Municipal Medical Science Venue in San Cristobal municipality, Artemisa province. May - 2020. 

p = 0, 0001 Wilcoxon signed-rank test

DISCUSSION

Covid-19, similar to other diseases, constitutes a vital and highly significant event that causes a strong emotional impact and broad social repercussions in those who are exposed to and suffer from it.^3,4

In relation to this disease, there are many psychodynamic qualities that influence, whether affective, traumatic experiences, depression, emotional states and other structural variables, such as temperament, character and personality traits.

Active survey is essential to address Covid-19. Cuba is one of the few countries where this is done from primary health care, which has contributed to control and reduce the catastrophe of epidemiological events that affect the world.⁶

As already noted, university students in the medical sciences have stepped forward to support the fight against Covid-19. From direct prevention in the population and through active survey, they have contributed to the control of this disease, but the psychological impact that this task may have had on them has not been taken into account.

Although there is not much research on medical students specifically, there has been research on medical personnel exposed to similar conditions during this pandemic.

Huang et al., ⁷ studied the mental health of 230 medical personnel in direct care of suspected or confirmed SARS-CoV-2 patients. The researchers found an incidence of anxiety in 23,.1 % and of stress disorders in 27,4 %, figures that do not coincide completely with this study, where stress disorders did not predominate, but there was similarity in the high levels of anxiety found in both researches.

Regarding stress as a relative cause, there is talk of the suppressive effect on the immune system, which may influence the aggravation of the disease. ⁸

Cao et al., ⁹ in their study of 7143 students during the initial phase of the pandemic, found 0,9 % severe anxiety symptoms, 2,7 % moderate and 21,3 % mild. For their part, Lai et al., ¹⁰ studied 1,257 health professionals and reported the presence of depressive symptoms, anxiety and stress reaction in 50,4 %, 44,6 % and 71,5 %, respectively.

These studies coincide, as they all showed high levels of anxiety in each of the samples, but differ from this research in terms of stress reaction and depression which had a non-significant incidence, despite the fact that their workplace was affected by Covid-19 pandemic.

The most common psychopathological disorders in the population are anxiety and depression, the process of this disease is accompanied by fears, anxieties and doubts.

In this sense, Arias et al., ¹¹ found a high degree of stress in 66,5 % of the population studied, as well as mild and high levels of depression in 50,4 %; while Wang and Zhao, ¹² in their evaluation of the psychological impact on university students, found severe anxiety in 557 of them (14,6 %).

The sample studied by the authors, being a young staff who volunteered to deal with COVID-19 pandemic, showed less impact in terms of stress and depression, which differs from the aforementioned studies.

The COVID-19 outbreak had less psychological impact in terms of stress and depression, at least compared to medical personnel and the general population, which could be justified, to an important degree, by the training on the subject of medical students.

The authors think that the evaluation of the harm or threat of the stressful events identified, often considered being beyond the person's own resources to cope with exceptional situations, increases vulnerability to stress of healthcare personnel at risk.

However, the absence of suicidal ideation coincides with that reported by Arias et al., ¹¹ who report that suicidal ideation was absent in 98,47 % of their population.

The predominance of coping strategies focused on emotions is generally associated with non-acute Covid-19, which may suggest that it is a cause of psychological disorder; ⁸ however, the authors consider that the positive associations detected between coping strategies focused on emotions and neurotic functioning suggest that by guiding patients to reduce emotional distress, the levels of stressors would decrease.

CONCLUSIONS

It was concluded that most of the medical students who undertook COVID-19 active survey did not show psychological disorders or suicidal thoughts, only a small percentage showed anxiety, depression and vulnerability to stress, and coping strategies focused predominantly on emotions and neurotic functioning favored the control of negative emotions.

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Received: July 15, 2020; Accepted: November 24, 2020

^*Autor para la correspondencia; [e-mail]

All the authors contributed in equal measure in the conception, design, writing and revision of the final version of the manuscript.

No conflicts of interests are declared.