title: Stress, anxiety, and depression among medical students in a multiethnic setting.
abstract: BACKGROUND
  Contemporary literature suggests that medical education might adversely affect students' mental health. Alfaisal University in Riyadh, Saudi Arabia is a developing institution; hence, there has been a concern regarding the mental well-being of the students.
  
  
  OBJECTIVE
  This study was designed to assess the traits of depression, anxiety, and stress among students in relation to potential underlying reasons.
  
  
  METHODS
  All 575 medical students across the 5 years of study participated by filling out the Depression, Anxiety, and Stress Scale-21 (DASS-21) questionnaire anonymously twice. Firstly, 2-3 weeks before a major examination (pre-examination), and secondly, during regular classes (post-examination). Correlation was sought regarding sex, year of scholarship, attendance of a premedical university preparatory program (UPP), housing, and smoking. Subjective comments from students were also obtained.
  
  
  RESULTS
  A total of 76.8% and 74.9% of students participated in pre-and post-examination groups, respectively. The majority were the children of expatriate workers in Saudi Arabia, and included Arabs, South Asians, and North Americans. Prevalence of depression, anxiety, and stress was high (43%, 63%, and 41%, respectively) which reduced (to 30%, 47%, and 30%, respectively) to some extent after examinations. Saudis and those who had attended UPP had higher DASS-21 scores. Smoking and female sex predicted higher levels of "baseline" depression, anxiety, or stress. The students perceived the curriculum and schedule to be the primary causes of their high DASS-21 scores.
  
  
  CONCLUSIONS
  The students had high "baseline" traits of depression, anxiety, and stress, and these were higher if an examination was near, especially among Saudis and those who had attended UPP. Smoking and female sex predicted higher levels of "baseline" depression, anxiety, or stress. Students suggested that study burden and a busy schedule were the major reasons for their high DASS-21 scores.
authors.affiliation: Department of Biochemistry, Alfaisal University, Riyadh, Saudi Arabia.
authors.forename: Bibi
authors.initials: B
authors.lastname: Kulsoom
authors.affiliation: Department of Pharmacology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
authors.forename: Nasir Ali
authors.initials: NA
authors.lastname: Afsar
keywords: DASS; anxiety; depression; examination; medical education; smoking; stress