Psychological distress among medical students in conflicts: a cross-sectional study from Syria

Background: Medical education can be a time of great psychological distress for students. The ongoing Syrian conflict represents an additional factor potentially contributing to poor mental health among medical students. Studies revealed high levels of psychological distress among Syrians. We aimed to investigate the prevalence and risk factors of depression, anxiety and stress among medical students at Damascus University during this period of war. Methods: A cross-sectional study was conducted using the Depression, Anxiety and Stress Scale (DASS-21) in addition to questions about demographic and financial characteristics, and questions about the effects of the ongoing war on the participants' lives. Results: 350 students were included. Prevalence of depression, anxiety and stress was 60.6%, 35.1%, and 52.6%, respectively. Depression was more likely in females and those with "intermediate" or "insufficient" personal income. Anxiety was more likely in females and those with "insufficient" personal income while less likely in fifth-and sixth-year compared to second-year students. Stress was lower in fifth-year compared to second-year students and higher in "insufficient" personal income compared to "sufficient" personal income. Conclusions: We concluded that Syrian medical students suffer from high rates of psychological distress. Females, second-year students, and those with "insufficient" personal income were the most affected. Students' perception of their own financial status, rather than the financial status per se was related to psychological distress. There was no evidence of a direct relationship between the ongoing conflict and psychological distress. Further investigations of causes and consequences of poor mental health in Syrian medical students are essential.