The Association Between Online Education and Mental Health Among Medical Students During the COVID-19 Pandemic: A...

This study aimed to examine associations between mental health symptoms and several pandemic-related experiences specifically online education, social isolation, financial concerns, and health anxieties among medical students during the coronavirus disease-2019 (COVID-19) pandemic. Due to the cross-sectional design and the absence of a pre-pandemic or contemporaneous in-person comparison group, causal relationships cannot be established, and the associations of online education cannot be isolated from the broader pandemic context.

This cross-sectional study was conducted at Tehran University of Medical Sciences during the COVID-19 pandemic. The sampling frame comprised all basic sciences and physiopathology medical students (N = 1247). A simple random sample of 400 students was drawn; 330 completed the online questionnaire (response rate: 82.5%). The questionnaire included the Patient Health Questionnaire (PHQ-9), Perceived Stress Scale (PSS-10), and researcher-developed items on pandemic-related experiences. Data were analyzed using SPSS-24. Potential selection and non-response biases are discussed in the limitations.

330 medical students participated in the study, of whom 137 (41.5%) were female and 193 (58.5%) were male. Clinical screening revealed that 26.5% of participants had minimal or no symptoms, while 46.8% had mild depression, 17.3% had moderate depression, and 9.4% had severe depression. For analytical comparison, when combining minimal and mild severities, 73.3% presented with minimal/mild depression. Additionally, 4.2% had mild stress, 91.5% had moderate stress, and 4.2% had severe anxiety.

Several factors, including a history of psychiatric illness, lack of private study space, fear of social isolation, health-related anxiety, dissatisfaction with virtual classes, poor internet access, and financial concerns, were significantly associated with depression and/or perceived stress among medical students during the COVID-19 pandemic. Given the cross-sectional design and the absence of multivariable adjustment, these findings should be interpreted strictly as descriptive, unadjusted associations rather than independent predictors. The results highlight exploratory areas that may warrant further confirmatory investigation.