Depression, stress, anxiety and burnout among undergraduate and postgraduate medical trainees in Saudi Arabia over two decades: A systematic review

Figures & data

Figure 1. PRISMA chart for retrieval of included articles.

Figure 2. Trends of severe depression among medical students in Saudi Arabia, by year of publication.

Figure 3. Trends of severe depression among undergraduate medical students, by academic level and by year of publication.

Table 1. Prevalence of anxiety among medical trainees in Saudi Arabia from the studies conducted from 2000 to 2020.

Author’s name	Year of publication	City/region	Study population	Sample size	Response rate	Tool for measuring anxiety	Cut-off points used for levels of anxiety	Overall prevalence of anxiety levels	Prevalence of anxiety by sex	Prevalence of anxiety by academic level	Prevalence of anxiety by specialty
Al-Khani et al.	2019	Qasseem	Medical students	206	46%	Depression Anxiety Stress Scales-21 (DASS-21)	Not reported	Mild to moderate = 27.4% Severe to extremely severe = 25.3%	Not reported	Not reported	NA
Alaqeel et al.	2017	Riyadh	Medical students	270	Not reported	DASS-21	Not reported	Mild = 7.1% Moderate = 26.1% Severe = 13.4% Extremely severe = 14.2%	Not reported	Not reported	NA
Alshamlan, AlShamlan et al.	2020	Dammam	Clinical year medical students (4th, 5th and 6th year)	523	95%	General Anxiety Disorder tool (GAD-7)	Minimal: GAD-7 ≤ 4 Mild: 5 ≤ GAD-7 ≤ 9 Moderate:10 ≤ GAD-7 ≤ 14 Severe: 15 ≤ GAD-7	Minimal = 41.5% Mild = 26.8% Moderate = 17.4% Severe = 14.3% Any anxiety: GAD-7 > 10) = 31.7%	Any anxiety: Male = 22.8% Female = 39.2%	Any anxiety: Fourth year = 40.2% Fifth year = 25.3% Sixth year = 29.7%	NA
Ibrahim N, Al-Kharboush, et al.	2013	Jeddah	Female medical students	450	Not reported	Hospital Anxiety and Depression Scale (HADS)	None: HADS ≤ 7 Borderline: 8 ≤HADS ≤ 10 Morbid: 11 ≤ HADS	Normal = 31.8% Borderline = 33.3% Morbid = 34.9%	NA	Morbid anxiety: Second year = 33.3% Third year = 29.7% Fourth year = 39% Fifth year = 33.8% Sixth year = 39.2%	NA
Ibrahim, NK, Battarjee, et al.	2013	Jeddah	Medical students (second year to internship)	597	Not reported	HADS	None: HADS ≤ 7 Borderline: 8 ≤HADS ≤ 10 Morbid: 11 ≤ HADS	No anxiety = 32.9% Borderline = 31.1% Morbid = 36.1%	Not reported	NA	NA
Inam	2007	Qasseem	Medical students (premedical, 1st, 2nd and 3rd years)	302	Male = 68.7% Female = 99%	The Aga Khan University Anxiety and Depression Scale (AKUADS)	A cut-off score of 19 was used to classify the student to have anxiety and depression	Overall anxiety and depression: 50%	Overall anxiety and depression: Male = 44.4% Female = 60.6%	Anxiety and depression total: Premedical = 48.7% First year = 72.5% Second year = 29.1% Third year = 54.9%	NA
Kulsoom and Afsar	2015	Riyadh	Medical students	442	76.8% (pre-examination survey) and 74.9% (post-examination survey)	DASS-21	Normal: DASS < 8 Mild: 8 ≤ DASS ≤ 9 Moderate: 10 ≤ DASS ≤ 14 Severe: 15 ≤ DASS ≤ 19 Extremely severe: 20 ≤ DASS	Pre-exam: Normal or mild anxiety = 37% Moderate or severe anxiety = 63% Post-exam: Normal or mild anxiety = 53% Moderate or severe anxiety = 47%	Not reported	Not reported	NA
Lateef Junaid et al.	2020	Al-Majmaah	Medical students	247	90%	Beck Anxiety Inventory (BAI)	Minimal: BAI score ≤ 7 Mild: 8 ≤ BAI score ≤ 15 Moderate: 16 ≤ BAI score ≤ 25 Severe: 26 ≤ BAI score Overall anxiety: 16 ≤ BAI score	Minimal = 33% Mild = 27% Moderate = 24% Severe = 16% Overall = 40%	Moderate to severe: Male = 34.9% Female = 49.4%	Moderate to severe anxiety: Second year = 27.3% Third year = 46.9% Fourth year = 54.2% Fifth year = 42.6% Sixth year = 38.2%	NA

Note: NA: not applicable.

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Data availability statement

All data generated or analysed during this systematic review are included in this published article and its supplementary files.