Published: 2021-05-26

Assessment of depression among medical students during COVID-19 in a southern state of India

Jilu Anna Mathew, Evin Siby, Arun George Alex, Gouri Krishna B. S., Merlin Moni, Vishal Marwaha


Background: The COVID-19 lockdown has caused increased psychological disturbances among the student community. Medical students are susceptible to mental stressors and thus more likely to be affected by the pandemic. The aim of the study was to determine the prevalence of depression, anxiety and stress in medical students during the COVID-19 lockdown in Kerala along with the associated socio-demographic factors.

Methods: A web-based cross-sectional study was conducted among medical students during COVID-19 lockdown in a southern state of India. Collected data included socio-demographic details and depression, anxiety and stress scale-21 (DASS-21). Chi square test was used to determine the association of depression, anxiety and stress with the socio-demographic factors.

Results: A total of 760 students were invited to partake in this study. 702 satisfied the inclusion criteria and completed the evaluation, giving a response rate of 92.4%. Among the participants 67.4% were female and 32.6% were males. Prevalence of depression, anxiety and stress among medical students were 55.1%, 33.2% and 29.4% respectively. It was found that both male and female students experienced the same levels of depression (p=0.533) during the pandemic. Students studying in private self-financing medical colleges experienced more anxiety compared to students at government medical college (p=0.008) during the pandemic. It was also observed that prevalence of depression (58.4%) was highest among first year medical students.

Conclusions: The study revealed that depression, anxiety and stress were prevalent in majority of medical students during the pandemic.


COVID-19, DASS-21, Depression, Anxiety, Medical students

Full Text:



Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-3.

Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91(1):157-60.

Cheng HY, Jian SW, Liu DP, Ng TC, Huang WT, Lin HH, et al. Contact tracing assessment of COVID-19 transmission dynamics in Taiwan and risk at different exposure periods before and after symptom onset. JAMA Intern Med. 2020;180(9):1156-63.

Fauci AS, Lane HC, Redfield RR. Covid-19- Navigating the Uncharted. N Engl J Med. 2020;382(13):1268–9.

Menon JC, Rakesh PS, John D, Thachathodiyl R, Banerjee A. What was right about Kerala’s response to the COVID-19 pandemic. BMJ Glob Heal. 2020;5(7):1-5.

Sahay RR, Yadav PD, Gupta N, Shete AM, Radhakrishnan C, Mohan G, et al. Experiential learnings from the Nipah virus outbreaks in Kerala towards containment of infectious public health emergencies in India. Epidemiol Infect. 2020.

Suryanarayana MH, Agrawal A, Prabhu KS. Inequality-adjusted Human Development Index: States in India. Indian J Human Develop. 2016;10(2):157-75.

Kumar B, Shah MAA, Kumari R, Kumar A, Kumar J, Tahir A. Depression, anxiety, and stress among final-year medical students. Cureus. 2019;11(3):4257.

Zung WW. Psychosomatics official. J Aca Psychosomat Med. 1971;8(6).

Wong TW, Gao Y, Tam WWS. Anxiety among university students during the SARS epidemic in Hong Kong. Stress Heal. 2007;23(1):31-5.

Wheaton MG, Abramowitz JS, Berman NC, Fabricant LE, Olatunji BO. Psychological predictors of anxiety in response to the H1N1 (swine flu) pandemic. Cognit Ther Res. 2012;36(3):210-8.

Xiao H, Shu W, Li M, Li Z, Tao F, Wu X, et al. Social distancing among medical students during the 2019 coronavirus disease pandemic in china: Disease awareness, anxiety disorder, depression, and behavioral activities. Int J Environ Res Public Health. 2020;17(14):1-13.

Islam M, Sujan SH, Tasnim R, Sikder T, Potenza M, Van OJ. Psychological responses during the COVID-19 outbreak among university students in Bangladesh. PLoS One. 2020;15(12):1-28.

Vala N, Vachhani M, Sorani A. Study of anxiety, stress, and depression level among medical students during COVID-19 pandemic phase in Jamnagar city. Natl J Physiol Pharm Pharmacol. 2020;10(0):1.

Pandey U, Corbett G, Mohan S, Reagu S, Kumar S, Farrell T, et al. Anxiety, depression and behavioural changes in junior doctors and medical students associated with the coronavirus pandemic: a cross-sectional survey. J Obstet Gynecol India. 2020;71:33-7.

Nisha SN, Francis YM, Balaji K, Raghunath G, Kumaresan M. A survey on anxiety and depression level among South Indian medical students during the COVID 19 pandemic. Int J Res Pharm Sci. 2020;11(1):779-86.

Pattanshetti V, Pattanshetti S. The impact of COVID-19 on medical education in India. J Sci Soc. 2020;47(1):1-2.

Choi B, Jegatheeswaran L, Minocha A, Alhilani M, Nakhoul M, Mutengesa E. The impact of the COVID-19 pandemic on final year medical students in the United Kingdom: a national survey. BMC Med Educ. 2020;20(1):206.

Supe AN. A study of stress in medical students at Seth G. S. medical college. J Postgrad Med. 1998;44(1):1-6.

Bakioğlu F, Korkmaz O, Ercan H. Fear of COVID-19 and positivity: mediating role of intolerance of uncertainty, depression, anxiety, and stress. Int J Ment Health Addict. 2020;1-14.

Martínez-Hernáez A, Carceller-Maicas N, DiGiacomo SM, Ariste S. Social support and gender differences in coping with depression among emerging adults: a mixed-methods study. Child Adolesc Psychiatry Ment Health. 2016;10:2.

Zhao JL, Jiang WT, Wang X, Cai ZD, Liu ZH, Liu GR. Exercise, brain plasticity, and depression. CNS Neurosci Ther. 2020;26(9):885-95.

Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335-43.

Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21). Constr validity Norm data a large non-clinical sample Br J Clin Psychol. 2005;5(1):1-8.

Rehman U, Shahnawaz MG, Khan NH, Kharshiing KD, Khursheed M, Gupta K, et al. Depression, anxiety and stress among indians in times of Covid-19 lockdown. Community Ment Health J. 2020:1-7.

Falade J, Oyebanji AH, Babatola AO, Falade OO, Olumuyiwa TO. Prevalence and correlates of psychiatric morbidity, comorbid anxiety and depression among medical students in public and private tertiary institutions in a nigerian state: a cross-sectional analytical study. Pan Afr Med J. 2020;37(53):1-15.

Nakhostin-Ansari A, Sherafati A, Aghajani F, Khonji MS, Aghajani R, Shahmansouri N. Depression and anxiety among iranian medical students during COVID-19 pandemic. Iran J Psychiatry. 2020;15(3):228-35.