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Good Mental Health Status of Medical Students: Is There A Role for Physical Activity?

Authors:
  • ESI-MC&PGIMSR, Rajajinagar, Bangalore, India.

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Background: Mental health problems are more commonly seen in youth, more so in medical students. Physical activity though known to improve mental health is difficult to follow among medical students. Aims & Objectives: This study aimed to in vestigate self-reported levels of anxiety and depression and compare these with self-reported physical activity among medical students in an institution of India. Material & Methods: A Cross sectional study was done among 430 medical students and interns of a medical college of rural Karnataka, India. Hospital Anxiety and Depression Scale (HADS) and International Physical Activity Questionnaire (IP AQ) were administered to assess mental health status and physical activity levels respectively. Results: The prevalence of anxiety (65.1%), depression (39.5%) and anxiety with depression (34.4%) was high among medical students. Only 18.1% of students were highly active while 35.9% were inactive when physical activity levels were measured. Students who were highly active and minimally active in physical activity showed lower levels of depression and anxiety compared to low physical activity group. lConclusion: Mental health problems are high and physical activity levels are low among medical undergraduate students. Engagement in physical activity can be an important contributory factor in positive mental health of future doctors. © 2015 Journal of Krishna Institute of Medical Sciences University.
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ORIGINAL ARTICLE
Abstract:
Keywords: Anxiety, Depression, Physical activity,
Medical students
Introduction:
Mental health disturbances, including nonclinical
depression, anxiety traits, feelings of sadness, or
Background: Mental health problems are more
commonly seen in youth, more so in medical students.
Physical activity though known to improve mental
health is difficult to follow among medical students.
Aims & Objectives: This study aimed to investigate
self-reported levels of anxiety and depression and
compare these with self-reported physical activity
among medical students in an institution of India.
Material & Methods: A Cross sectional study was done
among 430 medical students and interns of a medical
college of rural Karnataka, India. Hospital Anxiety and
Depression Scale (HADS) and International Physical
Activity Questionnaire (IPAQ) were administered to
assess mental health status and physical activity levels
respectively. Results: The prevalence of anxiety
(65.1%), depression (39.5%) and anxiety with depres-
sion (34.4%) was high among medical students. Only
18.1% of students were highly active while 35.9%
were inactive when physical activity levels were
measured. Students who were highly active and
minimally active in physical activity showed lower
levels of depression and anxiety compared to low
physical activity group. Conclusion: Mental health
problems are high and physical activity levels are low
among medical undergraduate students. Engagement
in physical activity can be an important contributory
factor in positive mental health of future doctors.
Good Mental Health Status of Medical Students: Is There A Role for Physical
Activity?
1* 2 3 3
Deepthi R , Ashakiran S , Thota Venkat Akhilesh , Mohan Reddy
1Department of Community Medicine, ESIC-MC & PGIMSR, Rajajinagar, Bangalore-560010
2
(Karnataka) India, Department of Biochemistry, Saptagiri Institute of Medical Sciences &
3
Research Centre, Bangalore-560010 (Karnataka) India, Department of Psychiatry, Sri Devaraj
Urs Medical College, Kolar-563101(Karnataka) India
temporary mood disorders are associated with
morbidity and mortality in the adolescent and
youth population [1-4]. The prevalence of mental
health disturbances among children and
adolescents remain significantly high [1-4] and
were almost similar to that of adult population [5].
The prevalence of depression among adolescents
in South East Asian region has been found to be 15
20% mainly due to inability to cope with intense
emotions, aggressiveness, isolation from family,
inability to keep one’s disappointments in
perspective and academic stress. Research has
consistently shown that doctors with healthy
personal lifestyle and habits are more likely to
impart healthy behaviours to their patients [6].
Physical activity is proven to improve mental
health among normal individuals and in people
suffering from mental illness [7]. The positive
association between physical activity, mental
health and treatment of mental health problems,
has been demonstrated in various studies [7, 8].
Studies have demonstrated that physical activity
has a beneficial effect on mild to moderate
depression [9, 10] and public health
recommendations for aerobic physical activity
have been found to be an effective treatment for
mild to moderate depressive disorder [11].
Research on the effect of physical activity on
anxiety has been studied in a systematic review
which showed a positive association with low
physical activity [12]. This has led to the
ISSN 2231-4261
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promotion of physical activity, within health
policy and practice, for the improvement of both
physical and mental health in the general
population.
In medical field, amount of study students must
undergo is vast and its education process is
characterized by many psychological changes
among them. This is evidenced by high prevalence
of mental disorders among medical students as
observed in various studies [13-16]. Some studies
have identified that anxiety and depression are
common problems, with students likely to suffer
mental health problems because of concerns
regarding their studies [16]. One study has
reported that 60% of undergraduate students had
elevated levels of anxiety and depression [17].
Though Medical Council of India has laid down
regulations that it is mandatory that all medical
colleges should have facilities for sports and
recreation, its utilization is doubtful. As a
consequence of the findings from this limited
amount of research among medical students in
India, this study aimed to investigate self reported
levels of anxiety and depression and compare
these with self-reported physical activity among
medical students in a medical college. Since
presence of examinations and term of study may
also have effect on mental health status, this study
also aims at assessing the association of
examinations in the next 2 months and academic
term of study of the student with anxiety,
depression and physical activity levels.
Material and Methods:
It was a cross sectional study done among medical
students and interns of a medical college of rural
Karnataka, India. Institutional ethical committee
clearance was obtained from Sri Devraj Urs
Medical College, Kolar. Study duration was one
year from May 2011 to April 2012. All 600
students were requested to participate, of which
430 students consented to participate in the study.
Questionnaire containing general information,
Hospital Anxiety and Depression Scale (HADS)
and International Physical Activity Questionnaire
(IPAQ) was administered to all the students after
taking informed written consent. Students were
asked not to write their name to maintain
confidentiality and promote getting correct
information. General information including age,
gender, are they facing exams in the next two
months was collected.
Mental state was measured using Hospital
Anxiety and Depression Scale (HADS) [18]
having a 14-item self-report questionnaire with
seven questions relating to anxiety and seven
questions relating to depression. Scoring was
based on a 4-point likert scale (0-3) with a
maximum score for each subscale being 21. For
both subscales, scores of 0–7 indicated the
absence of clinical symptoms of anxiety and
depression; scores of 8–10 indicated mild
symptoms, 11–14 moderate symptoms and 15–21
severe symptoms. The scale was originally
designed to detect elevated levels of anxiety and
depression amongst patients in non-psychiatric
hospital clinics, and therefore was thought
suitable to be use with any population who did not
have a clinically defined psychiatric disorder. This
scale was observed to have good psychometric
properties in terms of factor structure, inter-
correlation and internal consistency [19].
Physical activity was measured using International
Physical Activity Questionnaire (IPAQ). The IPAQ
[20] was an instrument designed primarily for
population surveillance of physical activity among
adults [21]. The validity and reliability of the
instrument was established in various studies [22]
Questions on time spent included physical
activities done at work, house and yard, to get from
place to place, and spare time for recreation,
exercise or sport in the last 7 days. Activities were
classified as vigorous and moderate physical
activities [20]. The total duration of physical
activity, per week, was calculated to the nearest
minute, metabolic equivalents (MET) were
Deepthi R et. al.
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calculated. Students with 5 or more days of any
combination of walking, moderate-intensity or
vigorous intensity activities achieving a minimum
of at least 600 MET-min/week were classified as
“minimally active”. Students with 7 or more days
of any combination of walking, moderate-
intensity or vigorous intensity activities achieving
a minimum of at least 3000 MET-minutes/week
were classified as “highly active” category or
health enhancing physical activity (HEPA).
Students with less than 5 days of any combination
of walking, moderate-intensity or vigorous
intensity activities or having less than 600 MET-
min/week were classified as “inactive”.
Data Analysis:
Proportions of students with various levels of
anxiety, depression and physical activity profile
were calculated. Association between mental
status and fitness was assessed using chi square
test. Odds ratios with their confidence intervals
were calculated. Pearson's correlation and co
association of anxiety and depression scores were
found out. Correlation between anxiety scores and
depression scores was done with the academic
term of study subjects.
Results:
Anxiety and Depression:
For depression, the mean score was 6.85 (S.D. =
3.8). This fell within the normal range of depressive
classification. (Table 1) The mean anxiety score for
the student cohort was 8.99 (S.D. = 4.2). This fell
within the mild symptom range. Considering the
percentage of students who fell within the different
severity band ratings of anxiety and depression,
34.9% of students were considered normal on the
anxiety subscale and 60.5% on the depression
subscale. Only 9.3% of students were considered to
have severe anxiety, with 4.2% falling into severity
range for depression. Prevalence of anxiety among
females was 70.8% as compared to males which
was 57.8% and this difference was found to be
2
statistically significant (c=9.13, df=2,p=0.005).
Prevalence of depression among males (40.1%)
and females (39.1%) were similar.
Overall combined prevalence of anxiety and
depression among students was 34.42%.
Prevalence among males (34.8%) and females
(34.2%) were observed to be similar. Co presence
of depression and anxiety among males and
females were significantly more compared to
presence of just depression or anxiety or being
2
normal (c=115.3, df=2,p=0.000) .
Males N (%)
Females N (%)
Total N (%)
Depression
Normal
112 (59.9)
148 (60.9)
260 (60.5)
Mild
44 (23.5)
62 (25.5)
106 (24.7)
Moderate
21 (11.2)
25 (10.3)
46 (10.7)
Severe
10 (5.3)
8 (3.3)
18 (4.2)
Anxiety
Normal
79 (42.2)
71 (29.2)
150 (34.9)
Mild
44 (23.5)
82 (33.7)
126 (29.3)
Moderate
42 (22.5)
72 (29.6)
114 (26.5)
Severe
22 (11.8)
18 (7.4)
40 (9.3)
Total
187 (100)
243 (100)
430 (100)
Table 1: Proportion of Anxiety and Depression among Medical Students
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Physical Activity:
Table 2 shows physical activity levels among
medical students. Considering the percentage of
students who fall within the different grades of
physical activity, 18.1% of students were highly
active, 46% were minimally active and 35.9%
were inactive. As shown in table 2 more females
were physically inactive (41.6%) compared to that
of males (28.3%) and this difference was
2
statistically significant (c=34.6, df=2,p=0.000).
Table 3 shows association of anxiety, depression
and physical activity levels between males and
females. Anxiety was 1.22 times more associated
with females than compared to males. Males were
1.8 times more physically active than compared to
females.
Association between physical activity and
mental health:
Table 4 shows that students engaging in some
physical activity were significantly less depressed
(34.1%) as compared to students who were
physically inactive (49.4%). Anxiety among
physically inactive students was 66.9%, which is
slightly higher as compared to students who were
physically active (64.1%). Students engaging in
physical activity were significantly less likely to
be suffering from both depression and anxiety
(31.2%) as compared to students who were
physically inactive (40.3%).
Table 5 shows the association of anxiety,
depression and physical activity with appearing
for exams in the next two months. Anxiety was
more commonly observed among students
appearing for exams (OR = 1.59) compared to
those who did not. Figure 1 shows the correlation
between different variables. Anxiety and
depression scores significantly decreased with
increase in the term of studies of students. As the
depression scores increased anxiety scores also
increased significantly.
Physical Activity
Males N (%)
Females N (%)
Highly Active
57 (30.5)
21 (8.6)
Minimally active
77 (41.2)
121 (49.8)
Inactive
53 (28.3)
101 (41.6)
Total
187 (100)
243 (100)
Table 2: Physical Activity Levels among Medical Students
Mental status
Males
(N=187)
Females
(N= 243)
p
value
OR (CI)
Depression
75 (40.1)
95 (39.1)
0.83
0.97 (0.77 - 1.23)
Anxiety
108 (57.8)
172 (70.8)
0.005
1.22 (1.05 -1.42)
Depression & anxiety
65 (34.8)
83 (34.2)
0.896
0.98 (0.76 - 1.28)
Physically Active
134 (71.7)
142 (58.4)
0.005
1.8 (1.19 – 2.70)
Table 3: Association of Gender with Anxiety, Depression and
Physical Activity among Students
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Mental status
Physically Active
(N=276)
Physically Inactive
(N= 154)
p
value
OR(CI)
Depression
94 (34.1)
76 (49.4)
0.002
1.89 (1.26 - 2.82)
Anxiety
177 (64.1)
103 (66.9)
0.56
1.13 (0.75 - 1.71)
Depression & anxiety
86 (31.2)
62 (40.3)
0.057
1.49 (0.99 - 2.25)
Table 4: Association of Physical Activity Levels with Anxiety and Depression
among Students
Table 5: Association of Proximity of Exams with Anxiety, Depression and
Physical Activity among Students
Variables
Exams in 2 months
(N=209)
No Exams
(N= 221)
P
value
OR (CI)
Depression
91 (43.5)
79 (35.7)
0.098
1.14 (0.98 - 1.32)
Anxiety
153 (73.2)
127 (57.5)
0.001
1.59 (1.21 - 2.08)
Depression & anxiety
80 (38.3)
68 (30.8)
0.1
1.12 (0.98 -1.29)
Physically Active
139 (62.9)
137 (65.6)
0.57
1.12 (0.76 – 1.67)
Fig 1a: Correlation between Variables Associated with Anxiety and Depression Scores.
R=0.64, p < 0.01
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Discussion:
The prevalence of anxiety (65.1%), depression
(39.5%) and anxiety with depression (34.4%) was
high among medical undergraduate students. It is
distributing to note that 9.3% of students reported
to have severe anxiety and 4.2% severe
depression. Only 18.1% of students were highly
physically active while 35.9% were inactive.
Tyson et al reported a much lower prevalence of
depression (10%) and a similar prevalence of
anxiety (60%) among medical students [23].
Previous studies which have looked at the mental
health of students have concluded that they are at
an increased risk of anxiety and depression [16,
17]. Prevalence of anxiety was more among
students appearing for exams in two months as
compared to those who did not. Though the goal of
medical education is to graduate knowledgeable,
skilful and professional physicians, somehow
medical training has some unintentional negative
effects on medical students mental and emotional
health. Studies state that student's distress
contributes to pessimism and subsequently may
affect care to patients, relationship with faculty
and finally success in their future carrier as
physician [24]. Hence the issue of potential
mental health problems in medical students is one
which needs to be proactively and continually
monitored by academic institutions.
Anxiety has been significantly observed more
commonly among females (70.2%), as compared
to males. The prevalence of depression has been
similar among males and females. The present
results are in line with previous studies, [13, 24,
25] who have reported more mental health
disorders among female medical students. This
may be due to increase in negative psychological
functioning during adolescence; females seem to
report more psychological complaints than males.
More anxiety among females can be attributed to
the fact that females have a lower threshold for
tolerating stress and also in evaluating and
Fig 1b: Correlation between Variables Associated with Term of Studies and Depression Scores.
R=-0.20, p < 0.01
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reporting experiences as problematic. The
differences may therefore partly result from
gender differences in self-reporting styles [26].
Totally, the results highlight the need to provide
support for female medical students especially, as
they seem to be more vulnerable to psychological
problems.
Students engaged in some physical activity have
shown significantly lower levels of depression
(34.1%) than the students have been inactive
(49.4%). Students engaged with some physical
activity also have shown lower levels of anxiety
and anxiety with depression than the inactive
group. There are various studies where both
anxiety and depression were significantly
associated with low physical activity [27, 28, 29].
There has been a negative correlation between
amounts of physical activity and self-reported
anxiety and depression scores as reported by
Tyson et al [23] Hassmen et al have suggested that
greater amounts of physical activity is associated
with a reduction in depression [30]. As cause
effect relationship cannot be established in this
study, it is difficult to say that higher levels of
depression are due to a lack of physical activity. It
may be the case as suggested in other studies [31,
32] that the more depressed an individual
becomes, the less likely he is to engage in physical
activity. There are only few studies which have
explored the relationship between mental health
status and physical activity among medical
students who were not primarily identified as
having any mental health problems.
The significant increase in anxiety levels among
students appearing for exams in the next two
months has been observed than those who don't.
This study supports the findings of previous
studies; in that majority of the medical students
experience some level of anxiety during exams
[33, 34] Hashmat et al have also reported
significant lack of physical activity among exam
going students [34]. There has been a negative
correlation observed between the term of studies,
anxiety scores and depression scores. This may be
due to the behavioural adjustment made by
medical students to meet the needs of the course
over period of time. This study does not give
causal association between physical activity and
mental health as it is a cross sectional study. A
longitudinal cohort study for five years on fresh
students will help in exploring the same.
In summary prevalence of anxiety, depression and
co presence of anxiety and depression is high
among medical students. Physical activity levels
are low among medical students. Anxiety levels
are significantly higher among females compared
to males. Males are significantly more physically
active compared to females. Depression is
significantly associated with physical inactivity.
Anxiety has been significantly higher among
students who are appearing for exams in the next
two months. Anxiety and depression scores are
decreased as the term of study of students
increased.
Finally, our findings contribute to the growing
body of literature demonstrating a positive
association between low physical activity and
depression and anxiety among medical students.
Furthermore, qualitative research into the
perceptions of the role of physical activity in the
lives of students for the maintenance of good
mental health may also shed light on this
relationship.
Conclusion:
It should be of interest to the students wishing to
maintain and promote their mental health while at
medical college, and also for universities wishing
to safeguard their students emotional well-being
through the promotion of physical activity.
Fostering good mental wellbeing and preventing
mental health problems among medical students
plays a crucial role in medical education and
health improvement.
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Acknowledgements:
We thank all students of SDUMC, Kolar for their humble and enthusiastic participation in the
research.
References:
1. Grunbaum JA, Kann L, Kinchen SA, et al. Youth risk
behavior surveillance—United States, 2001. MMWR
Surveill Summ 2002; 51:1-64.
2. Shaffer D, Fisher P, Dulcan MK, et al. The NIMH
Diagnostic Interview Schedule for Children Version
2.3 (DISC 2.3), description, acceptability, prevalence
rates, and performance in the MECA Study: Methods
for the Epidemiology of Child and Adolescent Mental
Disorders Study. J Am Acad Child Adolesc Psychiatry
1996; 35(7):865-877.
3. Shaffer D, Gould MS, Fisher P, et al. Psychiatric
diagnosis in child and adolescent suicide. Arch Gen
Psychiatry 1996; 53(4): 339-348.
4. Shatin D, Drinkard CR. Ambulatory use of
psychotropics by employer-insured children and
adolescents in a national managed care organization.
Ambul Pediatr 2002; 2:111-119.
5. Merikangas KR, Nakamura EF, Kessler RC.
Epidemiology of mental disorders in children and
adolescents. Dialogues Clin Neurosci 2009;
11(1):7–20.
6. Oberg EB, Frank E. Physicians' health practices
strongly influence patient health practices. J R Coll
Physicians 2009; 39(4): 290-291.
7. Saxena S, Ommeren VM, Tang K, Armstrong T. Mental
health benefits of physical activity. Journal of Mental
Health 2005; 14(5): 445-451.
8. Stathopoulou G, Powers MB, Berry AC, Smits JAJ, Otto
MW. Exercise Interventions for Mental Health: A
Quantitative and Qualitative Review. Clinical
Psychology: Science and Practice 2006; 13 (2): 179-193.
9. Craft L. Exercise and clinical depression: examining
two psychological mechanisms. Psychology of Sport
and Exercise 2005; 6 (2):151-171.
10. Faulkner G, Biddle SJH. Exercise and depression:
considering variability and contextuality. Journal of
Sport & Exercise Psychology 2004; 26(1):3-18.
11. Dunn M, Trivedi J, Kampert C, Clark H. Chambliss.
Exercise treatment for depression Efficacy and dose
response. American Journal of Preventive Medicine
2005; 28(1):1-8.
12. Hamer M, Taylor A, Steptoe A. The effect of acute
aerobic exercise on stress related blood pressure
responses: a systematic review and meta-analysis.
Biological Psychology 2005; 71(2): 183-190.
13. Dahlin M, Joneborg N, Runeson B. Stress and
depression among medical students: A cross sectional
study. Med Educ 2005; 39(6): 594 -604.
14. Seyedfatimi N, Tafreshi M, Hagani H. Experienced
stressors and coping strategies among Iranian nursing
students.BMC Nursing 2007; 6:11.
15. Aktenkin M, KaramanT, Yesim YS, Erdem S ,Erengin
H, Akaydin M. Anxiety, depression and stressful life
events among medical students: a prospective study in
Antalya, Turkey. Med Educ 2001; 35(1):12-17.
16. Wardle J, Steptoe A, Gulis G, et al. Depression
perceived control, and life satisfaction in university
students from central-Eastern and western Europe.
International Journal of Behavioural Medicine 2004;
11 (1): 27-36.
17. Inam SN, Saqib A, Alam E. Prevalence of anxiety and
depression among medical students of a private
university. Journal of the Pakistani Medical
Association 2003; 53(2):44-47.
18. Zigmond A, Snaith RP. The Hospital Anxiety and
Depression Scale. Acta Psychiatrica Scandinavia
1983; 67: 361-370.
19. Mykletun A, Stordal E, Dahl A. Hospital Anxiety and
Depression (HAD) Scale: factor structure, item
analyses and internal consistency in a large population.
British Journal of Psychiatry 2001; 179: 540-544.
20. Thirlaway K, Benton D. Participation in physical
activity and cardiovascular fitness have different
effects on mental health and mood. Journal of
Psychosomatic Research 1992; 36(7): 657-665.
21. Booth ML. Assessment of Physical Activity: An
International Perspective. Research Quarterly for
Exercise and Sport 2000; 71(2):114-120.
22. Craig CL. International physical activity
questionnaire: 12-country reliability and validity. Med
Sci Sports Exerc 2003; 35(8): 1381-1395.
23. Tyson P, Wilson K, Crone D, Brailsford R, Laws K.
Physical Activity and Mental Health in a Student
Population. Journal of Mental Health 2010; 19(6):
492-499.
24. Sreeramareddy CT, Shankar PR, Binu VS,
Mukhopadhay C, Ray B, Menezes RG. Psychological
morbidity, sources of stress and coping strategies
Deepthi R et. al.
Journal of Krishna Institute of Medical Sciences University 63
ÓÓ
JKIMSU, Vol. 4, No. 1, Jan-Mar 2015
among undergraduate medical students of Nepal. BMC
Medical Education 2007; 7(26):1-8.
25. Mostafa SR, Bassiouny A, Shafei M, Tarhony AH.
Levels and predictors of stress among medical students
in Alexandria. Bull Alex Fa Med 2006; 42(4):1-8.
26. Dyrbye LN, Thomas MR, Shanfelt TD. Medical
student distress: causes, consequences and proposed
solutions. Mayo Clinic Proc 2005; 80(12): 1613-1622.
27. Heyerdahl S, Kvernmo S, Wichstrom L. Self-reported
behavioural/ emotional problems in Norwegian
adolescents from multiethnic areas. European Child &
Adolescent Psychiatry 2004; 13(2): 64-72.
28. Ahmadi J, Samavat F, Sayyad M, Ghanizadeh A.
Various types of exercise and scores on the Beck
Depression Inventory. Psychological Reports 2002;
90(3):821-822.
29. Toskovic N. Alterations in selected measures of mood
with a single bout of dynamic Taekwondo exercise in
*Author for Correspondence: th nd
Dr. Deepthi R, No – 620 G, 'Raghava' 35 Cross, Rajajinagar 2 Block, Bangalore,
Karnataka, India -560010. Cell: 0919731885405 Email: drdeepthikiran@gmail.com
college-age students. Perceptual and Motor Skills
2001; 92(3): 1031-1038.
30. Hassmen P, Koivula N, Uutela A. Physical exercise and
psychological well being: a population study in
Finland. Preventative Medicine 2000; 30(1): 17-25.
31. Ussher M, Stanbury L, Cheeseman V, Faulkner G.
Physical Activity Preferences and percieved Barriers to
Activity Among Persons with Severe Mental Illness in
the United Kingdom. Psychiatric Services 2007; 58(3):
405-408.
32. Paluska SA, Schwenk TL. Physical activity and mental
health: current concepts. Sports Medicine 2000; 29(3):
167-180.
33. Siapanish R. Stress among Medical students in a Thai
Medical School. Med Teach 2003; 25(5): 502-506.
34. HashmatS, Hashmat M, Amanullah F, Aziz S. Factors
causing exam anxiety in medical students. J Pak Med
Assoc 2008; 58(4): 167-170.
Deepthi R et. al.
... Calculated sample size was 148 using a formulae 4PQ/d 2 , taking P as 40.3%, prevalence of anxiety and depression among physically inactive medical students from previous study. 13 All students who had given consent from these batches were included except those who were physically challenged were excluded. Data was collected using selfadministrated questionnaire. ...
... 16 Another study done by Deepthi showed that only 35.9% of medical students were inactive. 13 The present study also shows that more than half of medical female students 52 (70.3%) were physically inactive compared with their male students and this difference was statistically significant. The similar results were obtained from a study done by Deepthi which showed that 41.6% of female students were physically inactive when compared to their male counterpart which comprised of 28.3%. ...
... The similar results were obtained from a study done by Deepthi which showed that 41.6% of female students were physically inactive when compared to their male counterpart which comprised of 28.3%. 13 Another study done by Satheesha showed higher percentage of medical students involved in physical activity about 81% of males and 71% of females taking part in physical activity. 17 The present study also shows a statistically significant difference between level of physical activity and anxiety and depressive symptoms. ...
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Background: World Health Organization (WHO) defines physical activity as “any bodily movement produced by skeletal muscles that requires energy expenditure. Since medical education is considered stressful due to voluminous academics, it leaves little time for the students to relax and recreate. Hence the present study had been undertaken with an aim to study various trends of physical activity, health status and academic performance among medical students and to find out any association between physical activity and health status, academic performance of medical students.Methods: A cross-sectional study had been undertaken among 2nd and 3rd year MBBS students of our medical college. Physical activity was assessed using GPAQ version 2 questionnaire and mental status of students was measured using hospital anxiety and depression scale. Height, weight, and BMI, of each student along with demographic details were collected. The total percentage of any one of the internal marks of each student was taken for assessing the academic performance.Results: Out of total 150 medical students it was found that 44% of medical students were physically inactive and 40.7% of them were highly active. Majority of female students 70.3% were physically inactive and overweight and obesity were higher among them when compared with male students. But anxiety and depressive symptoms were higher among male students. There was statistically significant difference in association between level of physical activity and mental health. The academic performance also increased with increase in physical activity.Conclusions: Physical activity and mental health are related proportionally and it bears a positive influence on the education of the youth. The regular physical activity improves the mental status and academic performance among students.
... Author also suggested that the engagement in physical activity can be an important contributory factor in positive mental health of future doctors. 20 Exercise has neuroprotective effects as it regularises the brain-derived neurotrophic factor (BDNF) responsible for neurogenesis and improvement in cognitive function. [21][22][23] Animal studies have shown that increased physical activity causes changes in different neurotransmitters (serotonin and endorphins). ...
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Background: Bipolar disorder is one of the common chronic serious mental illness affecting 7 billion people in the world associated with significant morbidity which goes unrecognized. After extensive literature search, it was found that there is paucity of studies from the Indian setting that have addressed the issue of bipolar disorder.Methods: The present study was carried out to screen for bipolar disorder among medical undergraduate students and its correlates. Due to non-availability of many studies from India, the proportion of 50% was taken as prevalence to calculate the sample size. With 95% confidence interval and 8% absolute error, a sample size of 126 was calculated using Epi Info. Study tools used were a semi structured questionnaire on socio-demographic profile of participants, Global Physical Activity Questionnaire (GPAQ) and Mood Disorder Questionnaire (MDQ). MDQ is a self-reporting screening instrument for bipolar disorder having a Cronbach’s alpha coefficient of 0.83. Data was analyzed using chi-square test with p value <0.05 considered statistically significant.Results: The study included 87.3% males and 12.7% females with mean age 21.26±1.23 years. Out of 126 participants, 17 (13.5%) were screened positive for bipolar disorder. Factors found to have statistically significant association with bipolar disorder were number of siblings, type of family, migration status of family, living in hostel, body mass index and physical activity of the participant. Conclusions: The results suggest that medical students constitute a vulnerable group and there are certain risk factors other than academic stressors which predispose a medical student to mental illness.
... 11 Deepthi R et al. have shown that engagement in PA may be an essential contributing element in high-quality intellectual health of medical students and hence promotion of PA is essential for good mental wellbeing and treating mental health problems among medical students. 12 Robert A et al. concluded that PA is mandatory for prevention of mental illness among medical students, by introducing PA in medical student's curriculum to assist the students in improving their mental as well as physical health. 5 Over ninety percent of mental health problems are anxiety and depression and co-morbidity which one make it clear and revise sentence is common. ...
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... In general, it can be stated that vigorous activity brings larger improvements of MS, with a decrease of NMS and an increase of PMS, although these improvements are not similar in all the dimensions of MSs and neither the differences of MS among the levels of PA are always significant. (Arruza et al., 2007;Beedie et al., 2008;Bonet et al., 2017;Cervelló et al., 2014;Deepthi et al., 2015;Leon-Prados et al., 2012;Noce et al., 2016;Reed and Ones, 2006). Based on what was previously stated, the present research intends to analyze and describe the possible relations of the different levels of PA with the positive and negative feelings of the MS and gender. ...
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Introduction: Physical inactivity has been identified as the fourth leading risk factor for global mortality Medical students play an important role in promoting health education to the patients starting with their clinical training years. Objectives: The study was conducted to assess the patterns of physical activity among the medical students and to assess the perceived barriers of physical activity among them. Methodology: A cross sectional study was conducted among students of a medical college those students available at the time of interview were included in the study. The study was conducted from 19/10/2019 to 2/12/19. A batch of interns who were posted to community medicine department, were trained with the Global Physical Activity Questionnaire and were asked to collect the data from other medical students. Results: Out of the 250 students interviewed, 46% of them were males and 54% of them were females. Around 76% of the male students and 85% of the female students does not fulfil the WHO recommendations on moderate physical activity on health. Based on MET minutes/week ≥ 67% of the students are inactive/low active, 33% are active. Conclusion: Majority of medical students have not met the recommended WHO criteria for physical activity among students.
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Associations between exercise and mental well-being have been documented repeatedly over the last two decades. More recently, there has been application of exercise interventions to clinical populations diagnosed with depression, anxiety, and eating disorders with evidence of substantial benefit. Nonetheless, attention to the efficacy of exercise interventions in clinical settings has been notably absent in the psychosocial treatment literature, as have been calls for the integration of these methods within the clinical practice of psychologists. In this article, we provide a quantitative and qualitative review of these efficacy studies in clinical samples and discuss the potential mechanism of action of exercise interventions, with attention to both biological and psychosocial processes. The meta-analysis of 11 treatment outcome studies of individuals with depression yielded a very large combined effect size for the advantage of exercise over control conditions: g = 1.39 (95% CI: .89–1.88), corresponding to a d = 1.42 (95% CI: .92–1.93). Based on these findings, we encourage clinicians to consider the role of adjunctive exercise interventions in their clinical practice and we discuss issues concerning this integration.
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Objective To assess psychological changes in medical students in Antalya, Turkey during their undergraduate education. The first-year follow-up outcomes are presented in this article.DesignAll first-year undergraduate students were given a detailed, self-report questionnaire and another in the second year. They were asked to complete the General Health Questionnaire (GHQ), the Spielberger State–Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI).SettingThe Faculties of Medicine, Economics and Physical Education (PE) of the Akdeniz University, Antalya, Turkey.ParticipantsAll first-year undergraduate students in the Faculties of Medicine, Economics and PE who were registered in 1996.ResultsThe findings showed that psychological test scores on the GHQ, the STAI and the BDI rose significantly in medical students between the first and second years. Using the GHQ, with different cut-off scores, the percentage of students scoring above the thresholds was higher in medical students in year 2, compared with economics and PE students. In addition, the scores for some stressful life events of medical students showed a significant rise from year 1 to year 2. Multiple regression analyses indicated that some stressful life events related to social activities were associated with the psychological test scores for medical students.Conclusion The results indicate that there is a decrease in the psychological health of first-year medical students. Some inadequacies in the social activities of the students might play a role in this type of disturbance.
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This study was designed to investigate and to compare the acute alterations in selected measures of mood profile in novice Taekwondo practitioners while evaluating whether dynamic Taekwondo practice was an appropriate exercise modality for enhancing six psychological state dimensions: Vigor, Anxiety, Depression, Anger, Fatigue, and Confusion. 20 male and female college-age students enrolled in Taekwondo activity class and an additional 20 students enrolled in the lecture-control class (ages 18 to 21 years) completed the Profile of Mood States (POMS) inventory prior to and immediately following one 75-min. session of dynamic Taekwondo or lecture. To examine the exercise effect, a series of 2 X 2 analysis of covariance were performed on mean posttest scores, using pretest scores as the covariate. Analysis indicated that Tackwondo participants reported a significant improvement (p < .007) with respect to the control group in scores on Tension, Depression, Anger, Fatigue, Confusion, and Vigor. Also, Total Mood Disturbance significantly improved after the dynamic Taekwondo session. The selected affective benefits of an acute Taekwondo exercise in this study were independent of sex. Unlike the exercising subjects, the control subjects reported no such benefits and, indeed, increased their scores for negative mood states. These results suggest that a dynamic version of Taekwondo achieves the necessary activity parameters that begin to induce positive mood state changes and that extensive Tackwondo skill is not necessary to elicit some beneficial change in affect, This study also supports the findings of several earlier studies indicating that acute exercise may elicit positive changes in affective states and that prolonged exercise is not necessary to produce immediate beneficial alterations of mood.
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Background: The age, sex, and ethnic distribution of adolescents who commit suicide is significantly different from that of the general population. The present study was designed to examine psychiatric risk factors and the relationship between them and demographic variables.Methods: A case-control, psychologic autopsy study of 120 of 170 consecutive subjects (age, <20 years) who committed suicide and 147 community age-, sex-, and ethnic-matched control subjects who had lived in the Greater New York (NY) area.Results: By using parent informants only, 59% of subjects who committed suicide and 23% of control subjects who met DSM-III criteria for a psychiatric diagnosis, 49% and 26%, respectively, had had symptoms for more than 3 years, and 46% and 29%, respectively, had had previous contact with a mental health professional. Best-estimate rates, based on multiple informants for these parameters, for suicides only, were 91%, 52%, and 46%, respectively. Previous attempts and mood disorder were major risk factors for both sexes; substance and/or alcohol abuse was a risk factor for males only. Mood disorder was more common in females, substance and/or alcohol abuse occurred exclusively in males (62% of 18-to 19-year-old suicides). The prevalence of a psychiatric diagnosis and, in particular, substance and/or alcohol abuse increased with age.Conclusion: A limited range of diagnoses—most commonly a mood disorder alone or in combination with conduct disorder and/or substance abuse—characterizes most suicides among teenagers.
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Background: Public health discussions of physical activity have tended to focus on physical health benefits rather than mental health benefits. Aim: This article provides a commentary on the potential benefits of physical activity on mental health. Method: This article reviews the documented association between mental disorders and lack of regular physical activity. Results and conclusion: While highlighting the need to build a much stronger evidence basis, the article summarizes key literature that describes physical activity as an intervention that may be helpful for the promotion of mental health and wellbeing, the prevention and treatment of common mental disorders, and as a strategy in psychosocial rehabilitation for persons with severe mental disorders. The article discusses various interventions and settings for promoting physical activity and highlights that mental health professionals are an underused resource for the promotion of physical activity. Declaration of interest: None.