Moderate and severe symptoms of anxiety and depression are increased among female medical students during the COVID-19 pandemic




COVID-19; Mental Health; Anxiety; Student, Medical; Depression.


Background: Emotional disorders in medical students are expected and deserve more attention, especially during the COVID-19 Pandemic. Objective: Evaluate anxiety and depression disorders among medical students during the COVID-19 Pandemic. Methods:  A cross-sectional study at a private medical college in Brazil, two months after stay-at-home order and postponed classes due to the COVID-19 Pandemic. A survey among medical students was conducted in May 2020, using questionnaires regarding social and demographic status, the GAD-7 for symptoms of anxiety, and the PHQ-9 for symptoms of depression. Results: A total of 340 of 347 (97.98%) medical students participated. The average GAD-7 score was 9.18 (±4.75), and the average PHQ-9 score was 12.72 (±6.62). The results indicate a significant positive relationship between GAD-7 and females (F=5.816 P=.016). Using a cut-off score of 10 for GAD-7, 157 (46.17%) students were identified with moderate or severe anxiety symptoms. For the PHQ-9 score, using a cut-off of 10 219 (64.41%), students were recognized with moderate or severe symptoms of depression; the results indicate a significant positive relationship between the PHQ-9 and females (F=5.640 P=.018). Conclusion: The analysis demonstrated a significantly higher prevalence of moderate and severe anxiety    and depression symptoms among female medical students during the COVID-19 Pandemic.


Ahmed, I., Banu, H., Al-Fageer, R., & Al-Suwaidi, R. (2009). Cognitive emotions: Depression and anxiety in medical students and staff. Journal of Critical Care, 24(3), e1–e7.

Baldassin, S., Alves, T. C. D. T. F., De Andrade, A. G., & Nogueira Martins, L. A. (2008). The characteristics of depressive symptoms in medical students during medical education and training: A cross-sectional study. BMC Medical Education.

Beard, C., & Björgvinsson, T. (2014). Beyond generalized anxiety disorder: Psychometric properties of the GAD-7 in a heterogeneous psychiatric sample. Journal of Anxiety Disorders.

Bendtsen, M., Müssener, U., Linderoth, C., & Thomas, K. (2020). A Mobile Health Intervention for Mental Health Promotion Among University Students: Randomized Controlled Trial. JMIR MHealth and UHealth, 8(3), e17208.

Cullen, W., Gulati, G., & Kelly, B. D. (2020). Mental health in the COVID-19 Pandemic. QJM: An International Journal of Medicine, 113(5), 311–312.

Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Academic Medicine, 81(4), 354–373.

Inoue, T., Tanaka, T., Nakagawa, S., Nakato, Y., Kameyama, R., Boku, S., … Koyama, T. (2012). Utility and limitations of PHQ-9 in a clinic specializing in psychiatric care. BMC Psychiatry.

Iqbal, S., Gupta, S., & Venkatarao, E. (2015). Stress, anxiety & depression among medical undergraduate students & their socio-demographic correlates. Indian Journal of Medical Research, Supplement, 141(Mar2015), 354–357.

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001a). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine.

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001b). The PHQ-9. Journal of General Internal Medicine, 16(9), 606–613.

Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317–325.

Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., & Hu, S. (2020). Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network Open, 3(3), e203976.

Manea, L., Gilbody, S., & McMillan, D. (2012). Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. Canadian Medical Association Journal, 184(3), E191–E196.

Moutinho, I. L. D., Maddalena, N. de C. P., Roland, R. K., Lucchetti, A. L. G., Tibiriçá, S. H. C., Ezequiel, O. da S., & Lucchetti, G. (2017). Depression, stress and anxiety in medical students: A cross-sectional comparison between students from different semesters. Revista Da Associação Médica Brasileira, 63(1), 21–28.

Pappa, S., Ntella, V., Giannakas, T., Giannakoulis, V. G., Papoutsi, E., & Katsaounou, P. (2020). Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 Pandemic: A systematic review and meta-analysis. Brain, Behavior, and Immunity.

Puthran, R., Zhang, M. W. B., Tam, W. W., & Ho, R. C. (2016). Prevalence of depression amongst medical students: a meta-analysis. Medical Education, 50(4), 456–468.

Rosenthal, J. M., & Okie, S. (2005). White Coat, Mood Indigo — Depression in Medical School. New England Journal of Medicine, 353(11), 1085–1088.

Sahu, P. (2020). Closure of Universities Due to Coronavirus Disease 2019 (COVID-19): Impact on Education and Mental Health of Students and Academic Staff. Cureus, 2019(4), 4–9.

Santos, I. S., Tavares, B. F., Munhoz, T. N., Almeida, L. S. P. de, Silva, N. T. B. da, Tams, B. D., & Matijasevich, A. (2013). Sensibilidade e especificidade do Patient Health Questionnaire-9 (PHQ-9) entre adultos da população geral. Cadernos de Saúde Pública, 29(8), 1533–1543.

Sousa, T. V., Viveiros, V., Chai, M. V., Vicente, F. L., Jesus, G., Carnot, M. J., … Ferreira, P. L. (2015). Reliability and validity of the Portuguese version of the Generalized Anxiety Disorder (GAD-7) scale. Health and Quality of Life Outcomes.

Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine.

Thomas, K., & Bendtsen, M. (2019). Mental Health Promotion Among University Students Using Text Messaging: Protocol for a Randomized Controlled Trial of a Mobile Phone–Based Intervention. JMIR Research Protocols, 8(8), e12396.

WHO. (2020). WHO Characterizes COVID-19 as A Pandemic. World Health Organization. Retrieved from




How to Cite

SARTORÃO FILHO, C. I. .; RODRIGUES, W. C. de L. V. .; CASTRO , R. B. de .; MARÇAL, A. A. .; PAVELQUEIRES, S. .; TAKANO, L. .; OLIVEIRA, W. L. de .; SARTORÃO NETO, C. I. . Moderate and severe symptoms of anxiety and depression are increased among female medical students during the COVID-19 pandemic. Research, Society and Development, [S. l.], v. 10, n. 6, p. e34610615406, 2021. DOI: 10.33448/rsd-v10i6.15406. Disponível em: Acesso em: 22 oct. 2021.



Health Sciences