{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:02:41Z","timestamp":1792886561415,"version":"4.5.0"},"update-to":[{"DOI":"10.12688\/f1000research.52051.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T00:00:00Z","timestamp":1621814400000}}],"reference-count":25,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T00:00:00Z","timestamp":1621814400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>\n                    <ns3:bold>Background:<\/ns3:bold>\n                    Emotional distress is a major impact of COVID-19 among not only the general public but also healthcare workers including medical students. This study aimed at describing self-reported changes in emotional reactions associated with COVID-19 among medical students in Jordan and to assessing the potential effect of social media utilization on emotional distress among this group.\n                  <\/ns3:p>\n                  <ns3:p>\n                    <ns3:bold>Methods:<\/ns3:bold>\n                    A cross-sectional design was utilized to collect data early on during the outbreak in Jordan. All medical students in Jordan were eligible to complete an online questionnaire assessing self-reported emotional reactions to COVID-19 that covered four main domains: negative emotion (anxiety, worry, depression, panic, loneliness, and nervousness), positive emotion (happiness, joy, and excitement), sleep disorders (insomnia, shallow sleep, nightmares, and insufficient sleep), and aggression (verbal argument and physical fighting). The frequency of social media utilization as a main source of COVID-19 information was also assessed.\n                  <\/ns3:p>\n                  <ns3:p>\n                    <ns3:bold>Results:<\/ns3:bold>\n                    59.9% of participants were females, 64.9% were enrolled at the two major medical schools in Jordan, and 59.6% were in the pre-clinical stage (years). A significant proportion of participants self-reported increased negative emotional levels of anxiety (49.2%), worry (72.4%), depression (23.1%), panic (22.6%), and nervousness (38.2%) and decreased positive emotional levels of happiness (44.8%), joy (47.3%), and feelings of excitement (45.1%). Self-reported sleep disorders were not as common (less than 15% for any of the four items), while arguing with others was at 26.7%. Significant differences by gender and academic year were detected. Almost half of participants reported using social media as a main source of COVID-19 information \u201cmost\/all-the-times\u201d with a significant effect of such on reducing emotional distress.\n                  <\/ns3:p>\n                  <ns3:p>\n                    <ns3:bold>Conclusion:<\/ns3:bold>\n                    The results suggest a potential effect of COVID-19 on the emotional distress of medical students. Addressing and mitigating such effects is crucial. The potential buffering effect of social media should be further investigated.\n                  <\/ns3:p>","DOI":"10.12688\/f1000research.52051.2","type":"journal-article","created":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T05:20:07Z","timestamp":1621833607000},"page":"297","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Medical students\u2019 relative immunity, or lack thereof, against COVID-19 emotional distress and psychological challenges; a descriptive study from Jordan"],"prefix":"10.12688","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4504-4472","authenticated-orcid":false,"given":"Khalid","family":"Kheirallah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Bloukh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wasim","family":"Khasawneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jomana","family":"Alsulaiman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adi","family":"Khassawneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4713-8536","authenticated-orcid":false,"given":"Abdel-Hameed","family":"Al-Mistarehi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Alqudah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3814-4865","authenticated-orcid":false,"given":"Lina","family":"Elsalem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir","family":"Al Bashir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan H.","family":"Awad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tariq","family":"Al-Shatanawi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2878-1107","authenticated-orcid":false,"given":"Tareq","family":"Saleh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2021,5,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"687-691","DOI":"10.1016\/j.jiph.2020.01.005","article-title":"Middle East Respiratory Syndrome-Corona Virus (MERS-CoV) associated stress among medical students at a university teaching hospital in Saudi Arabia.","volume":"13","author":"A Al-Rabiaah","year":"2020","journal-title":"J Infect 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Educ."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/10-297\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/10-297\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/10-297\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T06:00:10Z","timestamp":1621836010000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/10-297\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,24]]},"references-count":25,"URL":"https:\/\/doi.org\/10.12688\/f1000research.52051.2","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.56594.r85933","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.56594.r85935","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,24]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/10-297\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.55277.r83589, Nedal Alnawaiseh, Department of Public Health, School of Medicine, University of Mutah, Al-Karak, Jordan, 22 Apr 2021, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/10-297\/v1#referee-response-83589","order":0,"name":"referee-response-83589","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>khalid kheirallah<\/b>; \n<i>Posted: 29 Apr 2021<\/i>; The authors much appreciate your valuable feedback and thank you for the approval of this manuscript to be considered for publication at F1000Research. Below please note our response in line with your feedback.&nbsp;  This study addressed a critical point, mental health, which is considered a taboo within conservative societies. The authors addressed this issue and clearly clarified its limitation in the manuscript.  \n<b>Thank you for this positive feedback and added value of the paper.&nbsp;<\/b>  &nbsp; I found it really interesting to cover a spectrum of indicators that assess, or screen, for potential mental health problems among medical students. The question is, then, how could this reflect on the population? Any suggestions?  \n<b>This study addressed such spectrum in order to fine-tune needs of this valuable population. As indicated in our submission, one can simply identify the major mental ill-health concerns as being self-identified among participants by gender and by year level. Top problems could be further explored using future research as indicated in the study. We never aimed to diagnose mental ill-health but rather point to the potential problem among this group. If 10% of self-reported issues are considered high-risk, then this could further identify where interventions could be considered and where the research focus should be. <\/b> \n<b>As for the population, the results reflect an image that reflects on the general population. Our focus then should also consider the general public and other subpopulations.&nbsp;&nbsp;<\/b>   Also, medical students are more likely to seek mental health problems if they have access to a clinic. But this is not the norm in conservative societies like Jordan. It may be considered a limitation if the authors did not assess access to mental health professional services. On the same point, how will the screening&nbsp;tools for the positive&nbsp;and negative domains investigated reflect&nbsp;the true problem given that self-reported mental health depression, for example, may be overestimating the actual values. Any thoughts&nbsp;on what the authors expect the true need for mental health advising and counseling among this population?&nbsp;  \n<b>It is a major limitation that we did not consider seeking medical help. But this is an issue that was suggested by reviewers&nbsp;of the questionnaire to exclude as it will not be an accurate measure for this taboo-related issue.&nbsp;<\/b> \n<b>As stated earlier, we expect that our screening self-reported results address provide 10% of self-reported issues be an actual estimate then we have an idea about the impact of mental health issues among medical students.&nbsp;<\/b>   The mental health status of medical students is biased by multiple factors that were not addressed in the study. How will the authors&nbsp;direct future research considering such biases?&nbsp;For example, academic achievement&nbsp;and substance use.&nbsp;  \n<b>The top 5 mental health issues identified in the manuscript could be further investigated and explored using fine-tuned questionnaires that consider other potential confounders. This is not added to the manuscript and will be part of the recommendations.&nbsp;<\/b>   On the same page of future research, will next research question encounters worry? Depression? Anxiety? Or what domain?&nbsp;  \n<b>Apparently this research pointed to the top 5 mental health issues (for each gender and year level). These could further be explored using follow-up studies. This was indicated in the study.&nbsp;<\/b>   It seems that gender is playing a major role in defining mental health of medical students. Why didn't the authors&nbsp;do a regression analysis to identify the role of gender? This may be due to the fact that the tools used limit further statistical tests? Any other thoughts?&nbsp;  \n<b>While a regression is a good fit for this paper, we wanted to only shed the light on the major mental health issues and point out to the policy makers of the major ones to be considered in the medical curriculum and medical services provided to students. We did not feel that adding a regression model for a self-reported mental health issue is a good fit as it may not reflect validity of self-reported depression, for example. Future research utilizing&nbsp;standardized&nbsp;screening tools may use advanced statistical analyses and have more variables relevant to mental health.&nbsp;<\/b>","URL":"https:\/\/f1000research.com\/articles\/10-297\/v2#referee-comment-6634","order":1,"name":"referee-comment-6634","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.55277.r83591, Tariq Kewan, Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH, USA, 29 Apr 2021, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/10-297\/v1#referee-response-83591","order":2,"name":"referee-response-83591","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>khalid kheirallah<\/b>; \n<i>Posted: 29 Apr 2021<\/i>; \n<b>We appreciate your opinion and feedback. Kindly note our response in line with the provided comments.&nbsp;&nbsp;<\/b> In this article Kheirallah and colleagues studied the impact of COVID-19 pandemic on the medical student emotional distress using a self reported questionnaire. In addition Authors analyzed the impacts of social media utilization as a source of information on the the emotional factors, below are some comments to consider:&nbsp;  The authors used a self reported cross sectional design to analyze the outcomes, however targeted population size and response rates were not reported. It is also worth to mention the response rate by each different university.   \n<b>Thank you for this comment. We have updated the manuscript to state that the total population of medical students is 10,000. Out of the sample selected for this survey, a total of 3,000 as already stated, the response rate was added to the results section (46.8%). <\/b>  &nbsp;  Can the authors explain why they considered&nbsp;response rate of 20% to be sufficient, please cite a paper.&nbsp;   \n<b>Thank you for this comment. We have a previous experience with this population and a response rate was less than 30%. Being conservative, we have decided that a 20% is suitable. A reference is already inserted for which we had a 20% response rate. <\/b>   How the authors guaranteed that each participant will respond one time only?   \n<b>Thank you for this valuable note. We have no guarantee that each student will fill the questionnaire only once. But we have no reason to believe that medical students will fill more than one time. <\/b>   Can you provide the time period of the study?   \n<b>Thank you for this comment. The study stated, under methods, that this survey was conducted between March 17 and 20, 2020. <\/b>   Authors need to provide the questionnaire used in the study to be published as a supplementary with the article.&nbsp;   \n<b>Thank you for this note. We have now updated the supplementary materials to include the questionnaire. <\/b>   The definition of different symptoms reported was not specified. For example what is the difference between anxiety and panic or worry and anxiety?&nbsp;This also will raise the question regarding participant understanding of the questions. Did the authors provide explanations for the participant to ensure understanding. Can the authors provide specific definition for each&nbsp;symptoms \/ disorder they reported, for example what is the dentition of insomnia?   \n<b>Thank you for this note. We have defined each term as self-reported. It was meant to screen and prioritize potential mental health issues using self-reported responses. This was stated as part of the limitations. <\/b>   Results are conflicting.&nbsp;In table 2 , 72.2% of all participant reported worry but at the same time 44.8% reported increased happiness. This will raise the concern of appropriate understanding of the participants.&nbsp;   \n<b>Thank you for this note. The potential overlap is possible given the way the study was conducted. It may be true that students are worried about their educational process at the early stages of the pandemic, still feel happy being able to spend more time with their families. This issue needs further investigation using qualitative study design as positive and negative emotions are possible given the circumstances of uncertainties. <\/b> \n<b>Qualitative investigations of the study results was suggested and recommended as part of the study\u2019s future directions in multiple locations.<\/b>   Authors concluded that social media use may have a buffering effect on emotional distress which is wrong. This conclusion cant be made based on the study design provided. Authors just described the differences in the prevalence of different symptoms \/ diseases between three different groups based on the use of social media as a source of information. Other variables \/ confounders were not taken into consideration and this conclusion is not appropriate.&nbsp;   \n<b>Thank you for this note. Social media utilization has been suggested to \u201cmoderate\u201d the relationship between multiple variables and mental health issues. As such, our results of potential differences in mental health variables by social media utilization <i>may <\/i>suggest a buffering effect. Future studies, including follow-up designs are then needed to investigate this relationship. This is what was suggested in the conclusion of the study. As such, the effect of social media utilization may, or may not, be a factor in the buffering suggested. The conclusion, as such, has been worded to reflect this. Edits were made. <\/b>","URL":"https:\/\/f1000research.com\/articles\/10-297\/v2#referee-comment-6635","order":3,"name":"referee-comment-6635","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.55277.r83592, Walid Alali, Department of Epidemiology and Biostatistics, Faculty of Public Health, Kuwait University, Safat, Kuwait, 07 May 2021, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/10-297\/v1#referee-response-83592","order":4,"name":"referee-response-83592","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}