Changes in Depression, Anxiety, and Stress Levels during a Religious Period: A Prospective Cohort Study

Objective: There is conflicting evidence suggesting an association between Ramadan and mental health. Aim: This study aims to assess changes in depression, anxiety, and stress levels during Ramadan among university students from Saudi Arabia and to measure the magnitude of change in these levels according to gender. Methods: This study is a prospective cohort study. Data was collected using a structured questionnaire that measured demographic data of the students, and levels of depression, anxiety, and stress utilizing the short form of the Depression Anxiety Stress Scales questionnaire (DASS 21). The assessments were performed starting from the month of Shaban (the month that precedes Ramadan), and the second wave of data collection was initiated beginning the second week of Ramadan until the end of the month. Differences in the proportion of students who are categorized as normal or having abnormal degrees of depression and anxiety between Shaban and Ramadan were tested using either the Chi-square test or Fisher's exact test. Results: A total of 321 students completed the assessment during Shaban and Ramadan. More than half of the students were male (54.2%), with a mean age of 22. A statistically significant difference in levels of anxiety, depression, and stress between the assessment periods was detected (p < 0.001). The proportion of students classified as normal increased during Ramadan across all measured conditions in comparison to during Shaban. The reduction in the number of students classified as having anxiety, depression, and stress between the assessment periods remained statistically significant across both genders. Nonetheless, degrees of change appear to be higher among male students than among female students. Conclusion: This study identified a reduction in levels of depression, anxiety, and stress among students during the month of Ramadan, as well as gender variation concerning levels of change. The results support the significance of considering social, religious, and spiritual aspects when designing interventions to address individuals' mental health.