{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T07:55:31Z","timestamp":1791186931589,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anxiety and depressive symptoms are common among medical students, but multicenter evidence from the early years of training in Pakistan is limited. We estimated symptom prevalence and examined sociodemographic, behavioral, academic, and psychosocial correlates of symptom severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter cross\u2010sectional survey from January to June 2024 among 1630 of 1800 invited first\u2010 and second\u2010year students at 9 medical colleges in Islamabad (response rate, 90.6%). Symptoms were assessed with the Patient Health Questionnaire\u20109 (PHQ\u20109) and Generalized Anxiety Disorder\u20107 (GAD\u20107). Because the proportional\u2010odds assumptions were not supported and sparse upper\u2010severity categories caused separation, adjusted associations were estimated using bias\u2010reduced multinomial logistic regression with minimal symptoms as the reference outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Anxiety symptoms (GAD\u20107\u2009\u2265\u20095) were present in 756\/1630 students (46.4%; 95% CI, 44.0%\u201348.8%), and depressive symptoms (PHQ\u20109\u2009\u2265\u20095) in 942\/1630 (57.8%; 95% CI, 55.4%\u201360.2%). Peer pressure was associated with moderate versus minimal anxiety (aOR, 6.42; 95% CI, 3.59\u201311.49), severe versus minimal anxiety (aOR, 37.23; 95% CI, 3.54\u2013391.86), moderate versus minimal depressive symptoms (aOR, 4.07; 95% CI, 2.69\u20136.18), and moderately severe\/severe versus minimal depressive symptoms (aOR, 10.79; 95% CI, 3.79\u201330.73). Sleeping 7\u20138\u2009h per night was associated with lower odds of severe anxiety (aOR, 0.11; 95% CI, 0.02\u20130.59) and moderate depressive symptoms (aOR, 0.22; 95% CI, 0.12\u20130.38). Severe\u2010category estimates were imprecise because only 20 students had severe anxiety and 34 had moderately severe\/severe depressive symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Anxiety and depressive symptoms were common among early\u2010year medical students. Peer pressure, harassment, sleep, academic stage, and support were associated with symptom severity, but the cross\u2010sectional design precludes causal inference. Medical colleges should evaluate confidential student\u2010support and referral pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.73250","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T08:12:35Z","timestamp":1789805555000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anxiety and Depressive Symptoms Among Early\u2010Year Medical Students in Pakistan: Prevalence, Associated Factors, and Mental Health Service Implications\u2014A Multicenter Cross\u2010Sectional Study"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5931-6204","authenticated-orcid":false,"given":"Farah","family":"Rashid","sequence":"first","affiliation":[{"name":"Department of Community Medicine\/Public Health, NUST School of Health Sciences National University of Sciences and Technology (NUST) Islamabad Pakistan"},{"name":"Health Services Academy Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iffat","family":"Noor","sequence":"additional","affiliation":[{"name":"Department of Community Medicine\/Public Health, NUST School of Health Sciences National University of Sciences and Technology (NUST) Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wajeha","family":"Najeeb","sequence":"additional","affiliation":[{"name":"Department of Community Medicine\/Public Health CMH Kharian Medical College Kharian Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadiya Rashed","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Islamabad Medical &amp; Dental College Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafiz Muhammad","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Community Medicine\/Public Health, NUST School of Health Sciences National University of Sciences and Technology (NUST) Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9084-2185","authenticated-orcid":false,"given":"Abid","family":"Malik","sequence":"additional","affiliation":[{"name":"Department of Public Mental Health Health Services Academy Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2066-4467","authenticated-orcid":false,"given":"Atif","family":"Rahman","sequence":"additional","affiliation":[{"name":"Department of Primary Care and Mental Health, Institute of Population Health University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-020-01532-x"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001888-200604000-00009"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.17324"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16152735"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2923.2001.00726.x"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajme.2016.01.005"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.5195\/ijms.2024.2664"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjment-2024-301528"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(00)00205-6"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0276894"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13033-024-00646-6"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31612-X"},{"key":"e_1_2_14_14_1","volume-title":"Guidance on Community Mental Health Services: Promoting Person\u2010Centred and Rights\u2010Based Approaches","author":"World Health Organization","year":"2021"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.847460"},{"key":"e_1_2_14_16_1","volume-title":"Stress: Appraisal and Coping","author":"Lazarus R. 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