Effects of the COVID-19 Pandemic on Anxiety and Depression among Medical Interns.

Abstract

Introduction: The demanding nature of emergency medicine (EM), requiring immediate responses to emergencies, and presents significant challenges, particularly for new trainess specialty. Our goal was to evaluate levels of anxiety and depression among EM intern doctors, with focus on the impact of the COVID-19 pandemic.

Methods: We conducted this study at Istanbul University-Cerrahpasa, Department of Emergency Medicine, from December 29, 2019-May 2, 2021. In Türkiye, the six year medical education program has the first three years preclinical, the fourth and fifth years comprised of clerkships, and the sixth year is internship training. In this final year, these intern doctors rotate through various departments, including an 8-week EM internship. A total of 203 medical interns participated in the study, 50.2% male. We assessed participants using the State-Trait Anxiety Inventory (STAI 1-2) and the Beck Depression Inventory, both prior to starting their EM internship and upon completion. Intern doctors were divided into two groups: 51 who completed their internship before the COVID-19 pandemic (December 29, 2019-March 11, 2020) and 152 during the pandemic (March 11, 2020-May 2, 2021). We compared pre- and post-internship scores within each group and between the two cohorts.

Results: Anxiety scores (STAI-1) increased significantly in both groups during the internship. In the pre-COVID-19 group, median STAI-1 scores rose from 47 (IQR: 38-53) to 51 (IQR: 45-56) (p<0.001), and in the COVID-19 group, from 41 (IQR: 35-48) to 47 (IQR: 42-52) (p<0.001). However, depression scores (BDI) showed a significant increase only in the pre-COVID-19 group: from 9 (IQR: 2-14) to 26 (IQR: 15-32) (p<0.001). In contrast, the COVID-19 group's depression scores remained relatively stable, increasing only from 7 (IQR: 2-13) to 8 (IQR: 3-16) (p=0.345).There were no significant differences between the groups in trait anxiety (STAI-2) scores (p=0.221) or pre-internship BDI scores (p=0.408). However, post-internship BDI scores were significantly lower in the COVID-19 group compared to the pre-COVID-19 group (median: 8 vs. 26; p<0.001).

Conclusion: The EM internship was associated with an increase in anxiety levels among intern doctors. Depression scores did not show a significant increase in the COVID-19 group, whereas depression scores significantly increased in the pre-COVID-19 group by the end of the internship. These findings suggest that, while anxiety increased across both groups, depression levels were more stable in the COVID-19 group, with lower post-internship scores compared to those in the pre-COVID-19 group.