الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Psychological troubles, including depression, anxiety and stress, are frequent and well-documented among medical students all over the world. ADHD persists into adulthood in approximately 75% of individuals with childhood onset, maintaining similar characteristics. Although symptoms in adults appear to be less severe, they may cause the same degree of impairment having a significant impact on the relationships, careers, and even the personal safety.
We conducted a two- phase study. First phase included a cross sectional study to screen the high school graduates, accepted for enrollment at Alexandria faculty of medicine, as regard depression, stress and anxiety as well as adult ADHD. Second phase included a single blinded randomized controlled trial included 325 distressed first year medical students who were eligible for enrollment in phase two: implementation of fighting against distress program versus waiting list control group for mildly to moderately depressed, stressed &/or anxious first year medical students in accordance to depression, anxiety & stress score (DASS 21) in addition to positive ADHD in accordance to adult self-report scale (ASRS) screener.
Outcome measures of phase two were psychological status (pre- and post- intervention) as denoted by scores of DASS 21 and ASRS in addition to students’ academic performance as denoted by grades of first semester exams (Records of students’ grades at the end of first semester 2016/2017). This study is registered and approved by Alexandria Faculty of Medicine research ethics committee.
More than a half of screened students 779 (57.8%) were girls. The majority of them (92.3%) aged 18 years old with only 7.7% of them were19 years. Nearly two thirds of students (63%) were from outside Alexandria and only 37% of students were from Alexandria. Regarding the place of living in Alexandria, 55.1% of them live with their family, nearly two fifths (42.5%) were residing the student university hostel and a minority live alone or with his/her relatives. The vast majority of studied students (93.5%) were graduated from governmental secondary schools. only 6.6% of medical students learned in private schools. One eighth (12.6%) of enrolled students suffered from severe or profound stress and 29.1% of them had mild to moderate stress. Nearly 20% of studied students were severely anxious and 29.3% had mild to moderate anxiety. Female students were significantly more anxious than males as P>0.001. According to DASS 21, nearly half of enrolled students had a certain level of depression ranged from mild to profound. Severe and profound depression was diagnosed among 14.3% of students and 34.9% had either mild or moderate depression. Screening of enrolled students for ADHD using ASRS showed that nearly one fifth (21.8%) had symptoms highly suggestive and another fifth (20.3%) was border line.
A total of 325 mild/ moderate depressed, anxious &/or distressed students, who were eligible for enrollment in the study, were randomized. Sixty students of the intervention group attended all the sessions of the program & sixty six of the waiting list control group completed the (DASS 21) questionnaire at the end of first semester. Among students in the intervention group, there was statistical significant evidence that the depression level improved (p=0.001) as well as stress level (p=0.001). About control group, there was significant deterioration in the depression level (p=0.004) and stress level (p=0.004). Anxiety level showed significant deterioration in intervention group (p=0.003) but more deterioration in control group (p<0.001). There was statistical significant evidence (p=0.001) that the intervention group achieved better grades in first semester exams compared to the control group (p<0.001).
Finally, our study proved that fighting against distress program improved depression and stress scores as well as academic performance in the intervention group compared to the control group, anxiety level deteriorated in both groups but was better in intervention group.