{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T10:47:41Z","timestamp":1785494861461,"version":"3.56.0"},"reference-count":62,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T00:00:00Z","timestamp":1687737600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Objective<\/jats:title><jats:p>To identify sociodemographic and educational factors associated with mental health disorders in Peruvian medical students in clinical years.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>Cross-sectional study. We surveyed students from 24 Peruvian medical schools. We defined negative perception of educational environment as having a Dundee Ready Educational Environment Measure score below 100 points; we defined anxiety and depression as having more than 4 points on the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 scales, respectively. Poisson regression with robust variance was used to assess the association between negative perception of educational environment and mental health alterations.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>Among the 808 participants, the prevalence of anxiety and depression symptoms was 77.6% and 67.3%, respectively. Negative perception of the educational environment was 31.6%. The factors associated with anxiety were being male (PR = 0.95, 95% CI:0.91\u20130.98), previous medical condition (Prevalence ratios PR = 1.10, 95% CI:1.05\u20131.16), previous diagnosis of coronavirus disease 2019 (PR = 0.93, 95% CI: 0.93\u20130.94), being from highlands (PR = 1.11, 95% CI: 1.05\u20131.16), studying at a national university (PR = 0.90, 95% CI: 0.88\u20130.92), and negative perception of the educational environment (PR = 1.04, 95% CI: 1.03\u20131.05), while factors associated with depression were being male (PR = 0.94, 95% CI: 0.93\u20130.95), previous medical condition (PR = 1.12, 95% CI: 1.08\u20131.17), type of university (national) (PR = 0.95, 95% CI: 0.95\u20130.96), and negative perception of the educational environment (PR = 1.11, 95% CI: 1.07\u20131.16).<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>We found evidence that during the COVID-19 pandemic anxiety and depression are prevalent among Peruvian medical students. Sociodemographic factors and negative perception of educational environment were associated with the presence of these conditions.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0286338","type":"journal-article","created":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T17:22:55Z","timestamp":1687800175000},"page":"e0286338","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Sociodemographic and educational factors associated with mental health disorders in medical students of clinical years: A multicenter study in Peru"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5338-076X","authenticated-orcid":true,"given":"J. 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Accessed October 13, 2022. https:\/\/covid19.minsa.gob.pe\/sala_situacional.asp."},{"issue":"5","key":"pone.0286338.ref004","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.edumed.2019.07.001","article-title":"El ambiente educativo en los contextos de formaci\u00f3n m\u00e9dica","volume":"20","author":"JV Lafuente Sanchez","year":"2019","journal-title":"Educ M\u00e9dica"},{"issue":"1","key":"pone.0286338.ref005","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1186\/s12909-019-1839-9","article-title":"Improving students\u2019 learning environment by DREEM: an educational experiment in an Iranian medical sciences university (2011\u20132016)","volume":"19","author":"H Bakhshialiabad","year":"2019","journal-title":"BMC Med Educ"},{"issue":"1","key":"pone.0286338.ref006","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1186\/s12909-021-02837-y","article-title":"Medical student wellness in the United States during the COVID-19 pandemic: a nationwide survey","volume":"21","author":"L Nikolis","year":"2021","journal-title":"BMC Med Educ"},{"issue":"18","key":"pone.0286338.ref007","doi-asserted-by":"crossref","first-page":"9897","DOI":"10.3390\/ijerph18189897","article-title":"The Impact of COVID-19 Pandemic on Italian University Students\u2019 Mental Health: Changes across the Waves","volume":"18","author":"M Di Consiglio","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0286338.ref008","article-title":"Prevalence and Associated Factors of Complains on Depression, Anxiety, and Stress in University Students: An Extensive Population-Based Survey in China","volume":"13","author":"Y Yu","year":"2022","journal-title":"Front Psychol"},{"issue":"2","key":"pone.0286338.ref009","doi-asserted-by":"crossref","first-page":"e559","DOI":"10.1002\/hsr2.559","article-title":"Prevalence of anxiety, depression, and stress among students of Jahangirnagar University in Bangladesh","volume":"5","author":"MdM Hossain","year":"2022","journal-title":"Health Sci Rep"},{"key":"pone.0286338.ref010","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.nedt.2018.01.009","article-title":"Prevalence of depression among nursing students: A systematic review and meta-analysis","volume":"63","author":"YJ Tung","year":"2018","journal-title":"Nurse Educ Today"},{"issue":"Supplement_4","key":"pone.0286338.ref011","doi-asserted-by":"crossref","first-page":"ckz186.555","DOI":"10.1093\/eurpub\/ckz186.555","article-title":"Depression, anxiety stress and associated factors among university students in France","volume":"29","author":"K Herrmann","year":"2019","journal-title":"Eur J Public Health"},{"key":"pone.0286338.ref012","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2022.1004902","article-title":"A cross-sectional study to assess the level of satisfaction with virtual education in Peruvian medical students","volume":"10","author":"P Grados-Espinoza","year":"2022","journal-title":"Front Public Health"},{"issue":"1","key":"pone.0286338.ref013","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1186\/s12909-021-02625-8","article-title":"Measuring the educational environment in a Sri Lankan medical school following curricular revision","volume":"21","author":"A Ellawala","year":"2021","journal-title":"BMC Med Educ"},{"issue":"2","key":"pone.0286338.ref014","doi-asserted-by":"crossref","first-page":"171","DOI":"10.15381\/anales.v82i2.19602","article-title":"Ense\u00f1anza del dominio sistema de salud y modelo de atenci\u00f3n en las facultades de medicina humana de universidades peruanas, 2020","volume":"82","author":"PJ Hern\u00e1ndez-Y\u00e9pez","year":"2021","journal-title":"An Fac Med"},{"issue":"2","key":"pone.0286338.ref015","doi-asserted-by":"crossref","first-page":"99","DOI":"10.15381\/anales.v61i2.4320","article-title":"Situaci\u00f3n del Profesional M\u00e9dico Cirujano a Ocho A\u00f1os de Iniciada la Reforma de la Salud y la Seguridad Social","volume":"61","author":"C Lip","year":"2000","journal-title":"An Fac Med"},{"issue":"1","key":"pone.0286338.ref016","first-page":"5","article-title":"Educaci\u00f3n m\u00e9dica en Per\u00fa","volume":"23","author":"A Berm\u00fadez-Garc\u00eda","year":"2020","journal-title":"FEM Rev Fund Educ M\u00e9dica"},{"issue":"1","key":"pone.0286338.ref017","first-page":"123","article-title":"Online mixted sampling: An application in hidden populations","volume":"8","author":"F Baltar","year":"2012","journal-title":"Intang Cap"},{"key":"pone.0286338.ref018","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/1477-7525-8-8","article-title":"Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool","volume":"8","author":"J Garc\u00eda-Campayo","year":"2010","journal-title":"Health Qual Life Outcomes"},{"issue":"10","key":"pone.0286338.ref019","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"RL Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"issue":"1","key":"pone.0286338.ref020","article-title":"Propiedades psicom\u00e9tricas del GAD-7, GAD-2 y GAD-Mini en universitarios peruanos","volume":"10","author":"RA Franco-Jimenez","year":"2022","journal-title":"Prop\u00f3sitos Represent"},{"issue":"4","key":"pone.0286338.ref021","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1097\/00006842-200107000-00021","article-title":"Validation and utility of the patient health questionnaire in diagnosing mental disorders in 1003 general hospital Spanish inpatients","volume":"63","author":"C Diez-Quevedo","year":"2001","journal-title":"Psychosom Med"},{"issue":"2","key":"pone.0286338.ref022","doi-asserted-by":"crossref","first-page":"72","DOI":"10.20453\/rnp.v83i2.3749","article-title":"Propiedades psicom\u00e9tricas del Patient Health Questionnaire (PHQ-9) en estudiantes de medicina en Lima, Per\u00fa","volume":"83","author":"J Huarcaya-Victoria","year":"2020","journal-title":"Rev Neuropsiquiatr"},{"issue":"2","key":"pone.0286338.ref023","doi-asserted-by":"crossref","first-page":"255","DOI":"10.17843\/rpmesp.2017.342.2642","article-title":"An\u00e1lisis psicom\u00e9trico de un cuestionario para medir el ambiente educativo en una muestra de estudiantes de medicina en Per\u00fa","volume":"34","author":"O Flores-Flores","year":"2017","journal-title":"Rev Peru Med Exp Salud Publica"},{"key":"pone.0286338.ref024","volume":"33","author":"U Guerrero","year":"2018","journal-title":"Validaci\u00f3n y adaptaci\u00f3n cultural del Dundee Ready Education Environment Measure (DREEM) en estudiantes de medicina peruanos"},{"issue":"Extra 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Psychol"},{"key":"pone.0286338.ref028","doi-asserted-by":"crossref","first-page":"859107","DOI":"10.3389\/fpubh.2022.859107","article-title":"Somatic Symptoms, Anxiety, and Depression Among College Students in the Czech Republic and Slovakia: A Cross-Sectional Study","volume":"10","author":"B Gavurova","year":"2022","journal-title":"Front Public Health"},{"key":"pone.0286338.ref029","doi-asserted-by":"crossref","first-page":"113108","DOI":"10.1016\/j.psychres.2020.113108","article-title":"Psychological effects of the COVID-19 outbreak and lockdown among students and workers of a Spanish university","volume":"290","author":"P Odriozola-Gonz\u00e1lez","year":"2020","journal-title":"Psychiatry Res"},{"issue":"1","key":"pone.0286338.ref030","doi-asserted-by":"crossref","first-page":"95","DOI":"10.4269\/ajtmh.20-1302","article-title":"Predictive Factors for Impaired Mental Health among Medical Students during the Early Stage of the COVID-19 Pandemic in Morocco","volume":"104","author":"H Essangri","year":"2021","journal-title":"Am J Trop Med Hyg"},{"issue":"4","key":"pone.0286338.ref031","first-page":"568","article-title":"Nivel de ansiedad de estudiantes de medicina de primer a\u00f1o de una universidad privada del Per\u00fa en tiempos de Covid-19","volume":"20","author":"MM Saravia-Bartra","year":"2020","journal-title":"Rev Fac Med Humana"},{"key":"pone.0286338.ref032","unstructured":"Gonzales Neyra JR. Nivel de depresi\u00f3n, ansiedad y estr\u00e9s en j\u00f3venes universitarios asociados a confinamiento social\u2014Arequipa 2020. Univ Cat\u00f3lica St Mar\u00eda. Published online August 19, 2020. Accessed February 24, 2022. https:\/\/tesis.ucsm.edu.pe\/repositorio\/handle\/UCSM\/10219."},{"key":"pone.0286338.ref033","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1186\/s12888-023-04638-7","article-title":"Comorbid anxiety and depressive symptoms and the related factors among international medical students in China during COVID-19 pandemic: a cross-sectional study","volume":"23","author":"L Yuan","year":"2023","journal-title":"BMC Psychiatry"},{"issue":"3","key":"pone.0286338.ref034","first-page":"51","article-title":"Vitamin D Deficiency and Depression in Thai Medical Students During COVID-19 Pandemic: a Cross-Sectional Study","volume":"32","author":"K. Anuroj","year":"2022","journal-title":"East Asian Arch Psychiatry Off J Hong Kong Coll Psychiatr Dong Ya Jing Shen Ke Xue Zhi Xianggang Jing Shen Ke Yi Xue Yuan Qi Kan"},{"key":"pone.0286338.ref035","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1186\/s12888-021-03107-3","article-title":"Depressive symptoms among Peruvian adult residents amidst a National Lockdown during the COVID-19 pandemic","volume":"21","author":"DA Antiporta","year":"2021","journal-title":"BMC Psychiatry"},{"key":"pone.0286338.ref036","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.profnurs.2022.06.013","article-title":"Race, gender, and ethnicity differences of nursing students\u2019 experiences during the COVID-19 pandemic","volume":"42","author":"T Kippenbrock","year":"2022","journal-title":"J Prof Nurs"},{"key":"pone.0286338.ref037","doi-asserted-by":"crossref","first-page":"i5320","DOI":"10.1136\/bmj.i5320","article-title":"Women have higher rates of mental disorders than men, NHS survey finds","volume":"354","author":"A. Gulland","year":"2016","journal-title":"BMJ"},{"issue":"5","key":"pone.0286338.ref038","first-page":"201","article-title":"Gender differences in depression. Epidemiological findings from the European DEPRES I and II studies","volume":"252","author":"J Angst","year":"2002","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"key":"pone.0286338.ref039","doi-asserted-by":"crossref","first-page":"110236","DOI":"10.1016\/j.pnpbp.2020.110236","article-title":"Younger people are more vulnerable to stress, anxiety and depression during COVID-19 pandemic: A global cross-sectional survey","volume":"109","author":"P Varma","year":"2021","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"},{"key":"pone.0286338.ref040","article-title":"A Hypothesis of Gender Differences in Self-Reporting Symptom of Depression: Implications to Solve Under-Diagnosis and Under-Treatment of Depression in Males","volume":"12","author":"P Shi","year":"2021","journal-title":"Front Psychiatry"},{"issue":"8948","key":"pone.0286338.ref041","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/S0140-6736(95)90622-3","article-title":"Prevention of male suicides: lessons from Gotland study","volume":"345","author":"W Rutz","year":"1995","journal-title":"Lancet Lond Engl"},{"issue":"5","key":"pone.0286338.ref042","doi-asserted-by":"crossref","first-page":"e0252481","DOI":"10.1371\/journal.pone.0252481","article-title":"Depression, anxiety, and the COVID-19 pandemic: Severity of symptoms and associated factors among university students after the end of the movement lockdown","volume":"16","author":"LSC Woon","year":"2021","journal-title":"PLoS ONE"},{"key":"pone.0286338.ref043","unstructured":"Chronic Illness and Mental Health: Recognizing and Treating Depression. National Institute of Mental Health (NIMH). Accessed October 12, 2022. https:\/\/www.nimh.nih.gov\/health\/publications\/chronic-illness-mental-health."},{"issue":"10","key":"pone.0286338.ref044","doi-asserted-by":"crossref","first-page":"e2025591","DOI":"10.1001\/jamanetworkopen.2020.25591","article-title":"Factors Associated With Mental Health Disorders Among University Students in France Confined During the COVID-19 Pandemic","volume":"3","author":"M Wathelet","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"5","key":"pone.0286338.ref045","article-title":"The association between COVID-19 diagnosis or having symptoms and anxiety among Canadians: A repeated cross-sectional study","volume":"34","author":"Elton-Marshall Nigatu","year":"2021","journal-title":"Anxiety Stress Coping"},{"issue":"23","key":"pone.0286338.ref046","first-page":"1285","article-title":"COVID-19 y salud mental","volume":"13","author":"A Rodr\u00edguez-Quiroga","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"pone.0286338.ref047","unstructured":"INEI\u2014Salud Reproductiva, Pobreza y Condiciones de Vida en el Per\u00fa. Accessed October 12, 2022. http:\/\/proyectos.inei.gob.pe\/web\/biblioineipub\/bancopub\/est\/lib0078\/S04-2.htm."},{"issue":"2","key":"pone.0286338.ref048","first-page":"14","article-title":"Pol\u00edticas P\u00fablicas y Educaci\u00f3n Rural en la Sierra del Per\u00fa: Identificando el Problema (1 Parte)\u2014La Calidad del Sistema Educativo Peruano en el \u00c1rea Rural Andina y Su Incidencia en los Ecosistemas de Monta\u00f1a","author":"AG Villar","year":"2017","journal-title":"Rev Glaciares Ecosistemas Mont"},{"issue":"2","key":"pone.0286338.ref049","first-page":"292","article-title":"Percepci\u00f3n de conocimientos y actitudes frente a COVID-19 en un grupo de ciudadanos de la zona urbana de Hu\u00e1nuco","volume":"21","author":"MR Aquino","year":"2021","journal-title":"Rev Fac Med Humana"},{"issue":"1","key":"pone.0286338.ref050","doi-asserted-by":"crossref","first-page":"70","DOI":"10.17843\/rpmesp.2022.391.9702","article-title":"Conocimientos, actitudes y percepci\u00f3n sobre el rol de los medios de comunicaci\u00f3n respecto a la COVID-19 en estudiantes de Medicina de una universidad peruana","volume":"39","author":"JL Paredes","year":"2022","journal-title":"Rev Peru Med Exp Salud Publica"},{"issue":"5","key":"pone.0286338.ref051","first-page":"445","article-title":"AMEE Medical Education Guide No. 23 (Part 2): Curriculum, environment, climate, quality and change in medical education\u2013a unifying perspective","volume":"23","author":"JM Genn","year":"2001","journal-title":"Med Teach"},{"issue":"4","key":"pone.0286338.ref052","first-page":"411","article-title":"Educational environment and psychological distress of medical students: The role of a deep learning approach","volume":"10","author":"MSB Yusoff","year":"2015","journal-title":"J Taibah Univ Med Sci"},{"issue":"2","key":"pone.0286338.ref053","doi-asserted-by":"crossref","first-page":"e231","DOI":"10.18295\/squmj.2021.21.02.011","article-title":"Epidemiology of Burnout and Its Association with Academic Performance Among Medical Students at Hail University, Saudi Arabia","volume":"21","author":"AH Aljadani","year":"2021","journal-title":"Sultan Qaboos Univ Med J"},{"issue":"1","key":"pone.0286338.ref054","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s10459-012-9354-3","article-title":"How motivation affects academic performance: a structural equation modelling analysis","volume":"18","author":"RA Kusurkar","year":"2013","journal-title":"Adv Health Sci Educ Theory Pract"},{"issue":"2(B)","key":"pone.0286338.ref055","first-page":"672","article-title":"Medical students\u2019 perceptions of their educational environment in an integrated curriculum in Saudi Arabia","volume":"71","author":"T Altamimi","year":"2021","journal-title":"JPMA J Pak Med Assoc"},{"key":"pone.0286338.ref056","article-title":"A rapid appraisal of educational environment of an evolving medical school in northern India","volume":"1","author":"S Naik","year":"2017","journal-title":"Int J Med Sci Public Health"},{"issue":"1","key":"pone.0286338.ref057","first-page":"27","article-title":"Percepci\u00f3n de los estudiantes de medicina del ambiente educativo en una facultad con curr\u00edculo tradicional (UCH-Chile) y otra con curr\u00edculo basado en problemas (UNC-Argentina)","volume":"14","author":"G D\u00edaz-V\u00e9liz","year":"2011","journal-title":"Educ M\u00e9dica"},{"issue":"4","key":"pone.0286338.ref058","first-page":"513","article-title":"Impact of the flipped classroom strategy in the learning environment in surgery: A comparison with the lectures","volume":"35","author":"LC Dom\u00ednguez","year":"2015","journal-title":"Biom\u00e9dica"},{"issue":"2","key":"pone.0286338.ref059","article-title":"Desaf\u00edos de la educaci\u00f3n superior en el Per\u00fa durante la pandemia por la covid-19","volume":"13","author":"P Vilela","year":"2021","journal-title":"Desde El 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