{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:38:43Z","timestamp":1784547523877,"version":"3.55.0"},"reference-count":41,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T00:00:00Z","timestamp":1697587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The ongoing COVID-19 pandemic has posed an array of new challenges for medical students worldwide. Amidst academic rigors, students are confronted with unique stressors, potentially affecting their mental health and substance use. This study aimed to investigate the multifaceted effects of depression, alcohol use, and stress on medical students and discern how these factors have been amplified by the pandemic\u2019s circumstances, and to identify predictors of mental distress during the COVID-19 pandemic period. Materials and Methods: Two online anonymous and cross-sectional surveys were conducted at the University of Medicine and Pharmacy \u201cIuliu Hatieganu\u201d in Romania among medical students in 2018 and in 2022. Data were gathered via online questionnaires distributed through closed student groups on social media platforms, with a total of 1061 participants, to investigate stress, depression, alcohol and drug use, and the impact of the pandemic and online education on mental health, maintaining anonymity and ethical approval. The Medical Student Stress Questionnaire (MSSQ) was employed to measure different aspects of stress, the Beck Depression Inventory (BDI) provided insights into the participants\u2019 depressive symptoms, and for the assessment of alcohol consumption habits, the Alcohol Use Disorders Identification Test (AUDIT) was utilized. Results: Our findings showed a significant decrease in mean depression scores (13.81 vs. 11.56, with p &lt; 0.001) from 2018 to 2022. In 2018, students scored significantly higher in the overall stress-related domains. Additionally, being female, facing financial constraints, and being in pre-clinical years emerged as predictors of heightened academic-related stress and depressive symptoms. Students who had experienced the loss of a family member due to COVID-19 exhibited a statistically significant rise in their average BDI score and current anxiety levels. Conclusions: The pandemic, despite introducing new stressors, may have indirectly fostered an increased focus on students\u2019 mental health, leading to more refined support mechanisms. Specialized interventions, taking into account gender and financial problems, are needed to address the multifaceted challenges faced by medical students. Our study highlights the ongoing need to nurture both the academic and emotional strength of future medical practitioners.<\/jats:p>","DOI":"10.3390\/medicina59101854","type":"journal-article","created":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T02:54:43Z","timestamp":1697684083000},"page":"1854","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Evolving Mental Health Dynamics among Medical Students amid COVID-19: A Comparative Analysis of Stress, Depression, and Alcohol Use among Medical Students"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3691-8871","authenticated-orcid":false,"given":"Codru\u021ba Alina","family":"Popescu","sequence":"first","affiliation":[{"name":"Department of Human Science, University of Medicine and Pharmacy \u201cIuliu Hatieganu\u201d, 400174 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"Tegze\u0219iu","sequence":"additional","affiliation":[{"name":"Counseling Center, University of Medicine and Pharmacy \u201cIuliu Hatieganu\u201d, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soimi\u021ba Mihaela","family":"Suciu","sequence":"additional","affiliation":[{"name":"Department of Physiology, University of Medicine and Pharmacy \u201cIuliu Hatieganu\u201d, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5027-5649","authenticated-orcid":false,"given":"Bogdan Florin","family":"Covaliu","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Public Health and Management, University of Medicine and Pharmacy \u201cIuliu Hatieganu\u201d, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian Mihai","family":"Armean","sequence":"additional","affiliation":[{"name":"Department of Pharmacology Toxicology and Clinical Pharmacology, University of Medicine and Pharmacy \u201cIuliu Hatieganu\u201d, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tudor Adrian","family":"U\u021b\u0103","sequence":"additional","affiliation":[{"name":"Infectious Diseases Hospital, 400348 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru Constantin","family":"S\u00eerbu","sequence":"additional","affiliation":[{"name":"Department of Pharmacology Toxicology and Clinical Pharmacology, University of Medicine and Pharmacy \u201cIuliu Hatieganu\u201d, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,18]]},"reference":[{"key":"ref_1","unstructured":"(2023, September 12). Coronavirus Disease (COVID-19) Pandemic. Available online: https:\/\/www.who.int\/europe\/emergencies\/situations\/covid-19."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1002\/jmv.25678","article-title":"Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle","volume":"92","author":"Lu","year":"2020","journal-title":"J. Med. Virol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1002\/hpm.3008","article-title":"The coronavirus (COVID-19) pandemic\u2019s impact on mental health","volume":"35","author":"Javed","year":"2020","journal-title":"Int. J. Health Plan. Manag."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1080\/17461391.2020.1795273","article-title":"Different levels of physical activity and depression symptoms among older adults from 18 countries: A population-based study from the Survey of Health, Ageing and Retirement in Europe (SHARE)","volume":"21","author":"Marques","year":"2021","journal-title":"Eur. J. Sport Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"113706","DOI":"10.1016\/j.psychres.2021.113706","article-title":"Increased mood disorder symptoms, perceived stress, and alcohol use among college students during the COVID-19 pandemic","volume":"296","author":"Charles","year":"2021","journal-title":"Psychiatry Res."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Oliveira Carvalho, P., H\u00fclsd\u00fcnker, T., and Carson, F. (2021). The impact of the COVID-19 lockdown on European students\u2019 negative emotional symptoms: A systematic review and meta-analysis. Behav. Sci., 12.","DOI":"10.3390\/bs12010003"},{"key":"ref_7","first-page":"245","article-title":"The Effect of Stress during Online Learning on Medical Student\u2019s Learning Achievement in COVID-19 Pandemic","volume":"10","author":"Mahardani","year":"2021","journal-title":"J. Pendidik. Kedokt. Indones. Indones. J. Med Educ."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e259","DOI":"10.1016\/S2468-2667(20)30088-8","article-title":"Alcohol use and misuse during the COVID-19 pandemic: A potential public health crisis?","volume":"5","author":"Clay","year":"2020","journal-title":"Lancet Public Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e2022942","DOI":"10.1001\/jamanetworkopen.2020.22942","article-title":"Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the US","volume":"3","author":"Pollard","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.jad.2020.09.012","article-title":"Alcohol use and mental health status during the first months of COVID-19 pandemic in Australia","volume":"277","author":"Tran","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1111\/j.1360-0443.2010.03351.x","article-title":"Alcohol and depression: Alcohol and depression","volume":"106","author":"Boden","year":"2011","journal-title":"Addiction"},{"key":"ref_12","first-page":"59","article-title":"The psychosocial impact of the COVID-19 pandemic on changes in smoking behavior: Evidence from a nationwide survey in the UK","volume":"6","year":"2020","journal-title":"Tob. Prev. Cessat."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"5","DOI":"10.2478\/amtsb-2021-0022","article-title":"Perceived Stress, Burnout and Anxiety and Fear Related to COVID-19 in Romanian Medical Students\u2014Experience from the State of Emergency in Romania","volume":"26","author":"Armean","year":"2021","journal-title":"Acta Medica Transilv."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"106527","DOI":"10.1016\/j.addbeh.2020.106527","article-title":"Changes in alcohol use as a function of psychological distress and social support following COVID-19 related University closings","volume":"110","author":"Lechner","year":"2020","journal-title":"Addict. Behav."},{"key":"ref_15","unstructured":"Beck, A.T., Steer, R.A., and Brown, G.K. (2012). Inventarul de Depresie Beck, Editura RTS. [2nd ed.]."},{"key":"ref_16","unstructured":"Beck, A.T., Steer, R.A., and Brown, G. (2011). Beck Depression Inventory\u2013II, Psychological Corporation."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/0272-7358(88)90050-5","article-title":"Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation","volume":"8","author":"Beck","year":"1988","journal-title":"Clin. Psychol. Rev."},{"key":"ref_18","first-page":"40","article-title":"Personality Factors Associated with Academic Stress in First Year Medical Students","volume":"6","author":"Bob","year":"2014","journal-title":"Hum. Vet. Med."},{"key":"ref_19","first-page":"231","article-title":"The Development and Validity of the Medical Student Stressor Questionnaire (MSSQ)","volume":"11","author":"Yusoff","year":"2010","journal-title":"ASEAN J. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Yusoff, M.S.B., and Fuad, A. (2010). The Medical Student Stressor Questionnaire (MSSQ) Manual, KKMED Publications.","DOI":"10.1037\/t15334-000"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1111\/j.1360-0443.1993.tb02093.x","article-title":"Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II","volume":"88","author":"Saunders","year":"1993","journal-title":"Addict. Abingdon Engl."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1097\/01.ALC.0000128239.87611.F5","article-title":"Validity of the Alcohol Use Disorders Identification Test in College Students","volume":"28","author":"Kokotailo","year":"2004","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2074","DOI":"10.1001\/jama.1991.03460160052028","article-title":"Substance use among senior medical students. A survey of 23 medical schools","volume":"265","author":"Baldwin","year":"1991","journal-title":"JAMA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1037\/0022-006X.73.2.344","article-title":"Fear of severe acute respiratory syndrome (SARS) among health care workers","volume":"73","author":"Ho","year":"2005","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1007\/s11469-020-00270-8","article-title":"The Fear of COVID-19 Scale: Development and Initial Validation","volume":"20","author":"Ahorsu","year":"2022","journal-title":"Int. J. Ment. Health Addict."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/j.jad.2020.03.183","article-title":"Prevalence of depression among university students in low and middle income countries (LMICs): A systematic review and meta-analysis","volume":"274","author":"Akhtar","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Pokhrel, N.B., Khadayat, R., and Tulachan, P. (2020). Depression, anxiety, and burnout among medical students and residents of a medical school in Nepal: A cross-sectional study. BMC Psychiatry, 20.","DOI":"10.1186\/s12888-020-02645-6"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Al-Shahrani, M.M., Alasmri, B.S., Al-Shahrani, R.M., Al-Moalwi, N.M., Al Qahtani, A.A., and Siddiqui, A.F. (2023). The Prevalence and Associated Factors of Academic Stress among Medical Students of King Khalid University: An Analytical Cross-Sectional Study. Healthcare, 11.","DOI":"10.3390\/healthcare11142029"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"477","DOI":"10.2147\/JMDH.S255781","article-title":"Investigating Stress and Sources of Stress Among Female Health Profession Students in a Saudi University","volume":"13","author":"Alsubaie","year":"2020","journal-title":"J. Multidiscip. Healthc."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Al Houri, H.N., Jomaa, S., Arrouk, D.M.N., Nassif, T., Allah, M.J.A.A., Al Houri, A.N., and Latifeh, Y. (2023). The prevalence of stress among medical students in Syria and its association with social support: A cross-sectional study. BMC Psychiatry, 23.","DOI":"10.1186\/s12888-023-04593-3"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e30629","DOI":"10.1097\/MD.0000000000030629","article-title":"Mental problems and risk factors for depression among medical students during the COVID-19 pandemic: A cross-sectional study","volume":"101","author":"Pattanaseri","year":"2022","journal-title":"Medicine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"208","DOI":"10.4103\/jehp.jehp_1296_20","article-title":"Mental health state in medical students during COVID-19 pandemic","volume":"10","author":"Natalia","year":"2021","journal-title":"J. Educ. Health Promot."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s13033-019-0287-6","article-title":"Prevalence and predictors of depression and anxiety among medical students in Addis Ababa, Ethiopia","volume":"13","author":"Kebede","year":"2019","journal-title":"Int. J. Ment. Health Syst."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Du, C., Zan, M.C.H., Cho, M.J., Fenton, J.I., Hsiao, P.Y., Hsiao, R., Keaver, L., Lai, C.-C., Lee, H., and Ludy, M.-J. (2021). The Effects of Sleep Quality and Resilience on Perceived Stress, Dietary Behaviors, and Alcohol Misuse: A Mediation-Moderation Analysis of Higher Education Students from Asia, Europe, and North America during the COVID-19 Pandemic. Nutrients, 13.","DOI":"10.3390\/nu13020442"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Ammar, A., Brach, M., Trabelsi, K., Chtourou, H., Boukhris, O., Masmoudi, L., Bouaziz, B., Bentlage, E., How, D., and Ahmed, M. (2020). Effects of COVID-19 Home Confinement on Eating Behaviour and Physical Activity: Results of the ECLB-COVID19 International Online Survey. Nutrients, 12.","DOI":"10.3390\/nu12061583"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1177\/0020764020915212","article-title":"The outbreak of COVID-19 coronavirus and its impact on global mental health","volume":"66","author":"Torales","year":"2020","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1002\/hbe2.191","article-title":"COVID-19 and online teaching in higher education: A case study of Peking University","volume":"2","author":"Bao","year":"2020","journal-title":"Hum. Behav. Emerg. Technol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/S2215-0366(20)30168-1","article-title":"Multidisciplinary research priorities for the COVID-19 pandemic: A call for action for mental health science","volume":"7","author":"Holmes","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"ref_39","first-page":"Doc21","article-title":"The impact of COVID-19 pandemic on mental burden and quality of life in medical students\u2014Results of an online survey","volume":"40","author":"Halfmann","year":"2023","journal-title":"GMS J. Med. Educ."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"574812","DOI":"10.3389\/fpsyt.2020.574812","article-title":"#Everything Will Be Fine. Duration of Home Confinement and \u201cAll-or-Nothing\u201d Cognitive Thinking Style as Predictors of Traumatic Distress in Young University Students on a Digital Platform During the COVID-19 Italian Lockdown","volume":"11","author":"Giusti","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_41","unstructured":"United Nation, Department of Economic and Social Affairs (2023, October 14). Transforming Our World: The 2030 Agenda for Sustainable Development. Available online: https:\/\/sdgs.un.org\/2030agenda."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/10\/1854\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:09:22Z","timestamp":1760130562000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/10\/1854"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,18]]},"references-count":41,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["medicina59101854"],"URL":"https:\/\/doi.org\/10.3390\/medicina59101854","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,18]]}}}