ABSTRACT
Introduction: The COVID-19 pandemic has completely changed the experience of higher education with potentially negative consequences for students' wellbeing. Objective(s): To compare medicine/dentistry students' depression/ anxiety/stress levels before versus during the pandemic and to analyse the role of COVID-19-related stressors in their psychological distress. Method(s): Students from the Faculty of Medicine University of Coimbra answered socio-demographic and personality questionnaires and the Depression, Anxiety and Stress Scale/DASS before (academic years 2016-2017-2018-2019 - SAMPLE1;n=1000) and during (September-December 2020 and January-March 2021 - SAMPLE2;n=650) the COVID-19 pandemic. Mean age (21.12+/-3.75), personality traits scores, and gender proportions (75% girls) did not significantly differ between samples. SAMPLE2 also filled in the Fear of COVID-19 Scale and a new version of the Inventory of Sources of Stress During Medical Education/ISSDME, containing a COVID-19 -related dimension (restrictions on training and on socializing with friends/colleagues). Result(s): SAMPLE2 presented significantly higher mean scores of depression (3.89+/-3.55vs.3.33+/-3.34), anxiety (3.27+/-4.08vs.2.86+/-3.29), stress (7.07+/-5.72vs.6.18+/-4.59) and total DASS (12.28+/-10.55vs.13.65+/-11.13) than SAMPLE1 (all p<.05). Fear of COVID-19 was a significant predictor of DASS score (adjusted R2=2.9%, p<.001). COVID-19-related stressors continued explaining significant increments of DASS variance after controlling for each of the ISSDME dimensions: Course demands (R2 Change=1.8%), Human demands (2.5%), Lifestyle (2.3%), Academic competition (5.5%), and Academic adjustment (5.2%) (all p<.001). Conclusion(s): This study adds to the evidence of the negative impact of COVID-19 on students and emphasizes its pernicious role on medical students' psychological distress, which is already higher due to the individual and academic stressors to which they are more exposed.