988368

1. Introduction
In the past decade, the problem of studying mental health among students of higher educational institutions has become increasingly popular [1, 2] since symptoms of depression, anxiety, and distress are more common among students than their peers [3-6] as well as the general population [7].
Academic anxiety refers to a group of mental and behavioral responses when a person is worried about potential failure on an exam or similar evaluation condition [8, 9]. Academic stress adversely affects students, their performance, and overall health, causing anxiety and depression, reducing life satisfaction, increasing the risk of developing gastrointestinal diseases [10-12], and decreasing the level of professional training and future success [6]. Students experiencing distress are 2-4 times more likely to use psychoactive substances (drugs, alcohol) and smoke tobacco [13, 14].
High levels of stress adversely impact academic performance [15] and result in having suicidal ideation in the vast majority of medical students [16, 17].This study aims to investigate the medical and psychological status of senior students in medical and pedagogical departments. We hope to propose some recommendations for preventing the maladaptation associated with stressful influences.
2. Materials and Methods
This research is a descriptive and comparative study. We investigated the mental health status of the senior students. From 2018 to 2019, a consecutive sample of 192 fifth-year students was examined using the medico-sociological and psychometric methods. There were 137 medical (first group) and 55 pedagogical (second group) students aged 20-29 years (Mean±SD: 21.8±1.2 years; 142 women and 50 men). They were selected by the convenience sampling method. The inclusion criteria were as follows: studying at one of the medical or pedagogical schools and aged under 30. The exclusion criteria include having a severe physical or mental illness, receiving psychiatric treatment, or any psychotherapy. Participants completed the test for academic stress [18], social phobia inventory [19], Beck depression inventory-II [20], Beck anxiety inventory [21], depression anxiety, and stress scale-21 [22].
Study instruments
Medical and sociological questionnaire
This researcher-made questionnaire investigates socio-demographic information, adaptation problems to the educational process, attitude to the chosen specialty, studying, and living conditions.
Test for academic stress
Shcherbatykh [18] developed a test for academic stress. This questionnaire has recently become a widespread scale in research in Russia. The questionnaire, despite its brevity, is quite comprehensive. It includes responses to a wide range of items. The instrument especially recognizes the contribution of components of academic anxiety, the level of pretest anxiety, paths to reduce academic anxiety, and somatic and psychological symptoms of stress [23].
Social Phobia Inventory (SPIN)
The social phobia inventory (SPIN) [19] is a 17-item self-report inventory for social anxiety symptoms that assesses the clinically significant symptoms of social anxiety disorder. The SPIN has satisfying test-retest reliability, inner consistency, and diverging and concurrent validity. The cut-off point of the SPIN is 19, which identifies persons with and without a social anxiety disorder. The SPIN was sensitive to the improvement of signs across time and displayed varying responses to medication and placebo. The exploratory factor analysis distinguished five dimensions.
Beck Depression Inventory-II (BDI-II)
The Beck depression inventory-II (BDI-II) is a 21-item self-report index generally applied to the dimensions of the appearance and quality of depression among people. The widely used form of the BDI is BDI-II, developed by Beck and his colleagues. Participants can personally answer the BDI-II. It is verified for assessment of 13- to 80-year-old persons. The BDI has excellent test-retest reliability (r=0.93); it also has high inner consistency (α=0.91). This instrument assesses somatic and cognitive signs of depression 20).
Beck Anxiety Inventory (BAI)
The Beck anxiety inventory (BAI) is a 21-item scale that showed high inner consistency (α=0.92) also test-retest reliability across seven days (r81=0.75). The inventory could distinguish the diagnostic samples with anxiety-related disorders such as panic disorder (PD) and generalized anxiety disorder (GAD) from the different samples without anxiety-related disorders such as major depressive disorder (MDD), dysthymic disorder, etc. In addition, the BAI was slightly associated with the revised Hamilton’s anxiety rating scale (r-HARS, r150=0.51) [21].
Depression Anxiety and Stress Scale-21 (DASS-21)
The depression anxiety and stress scale-21 (DASS-21) is a compact self-report of the DASS-42 that measures the negative emotional elements of depression, anxiety, and stress [22]. It has high Cronbach α values of 0.81, 0.89, and 0.78 for the subscales of depression, anxiety, and stress, respectively. It also has excellent internal consistency and parallel reliabilities, and discriminant and converging validities.
The descriptive statistics included the median and interquartile range. We also used the statistical methods of nonparametric statistics like the Chi-square test with Yates’ correction for continuity, the Mann-Whitney test for comparing independent groups, and dominant component factor analysis with varimax rotation.
3. Results
It has been established that women are interested in medical and pedagogical specialties, which make up 3/4 of the study groups. The overwhelming majority of medical and pedagogical students (78.9% and 76.4%, respectively) enterthe course of their free will. At the same time, more than 21% (one in five) of medical and 29% (almost one in three) of pedagogical students entered an institute of higher education on the advice of their relatives.
The study of commitment to career choice (the answer to the question “If it were possible to turn back the clock and you had a choice, would you choose it again, or choose another profession?”) showed that more than half of the pedagogical students (52.7%) and more than a third of the medical ones (35.0%) would choose another profession (χ2=3.943, P=0.047, Odds Ratio [OR]=2.0, 95% CI=1.0-4.0). The probability of disappointment in the profession among pedagogical students is two times higher than that of medical ones.
Among medical students who entered this discipline based on their initiative, only 70.4% would again choose the medical profession, and a third (29.6%) would choose another. Among those who entered “on advice,” 44.8% would choose a medical specialty, and the remaining 55.2% would prefer another proficiency (χ2=5.479, P=0.02, OR=2.9, 95% CI=1.2-7.4). The probability of a voluntary withdrawal is almost three times higher for those who entered not on their initiative than those who made a conscious choice.
Among the pedagogical students who entered based on their initiative, 61.5% would enter again, and 38.5% would choose another profession. Of those who entered “on advice,” only 12.5% would re-enter, and 87.5% would prefer another profession (χ2=9.067, P=0.0035, OR=11.2, 95% CI=2.0-83.3). The probability of a voluntary withdrawal among pedagogical students who did not choose based on their initiative is at least 11 times higher than with a conscious choice of profession. 
The study of gender differences showed that the majority, i.e., 81% of females and only 38.5% of males, entered university on their initiative (χ2=6.751, P=0.01, OR=6.8, 95% CI=1.5-33.5). The numbers indicate that males are over six times more likely not to enter a pedagogical institute on their initiative than females.
The study of students’ assessment of the learning environment (Table 1) shows that the students of pedagogical institute had significantly higher comfort, quality of lectures, reality of expectations, and teaching quality compared to medical students (P=0.000). The differences were in terms of comfort, quality (comprehensibility) of lectures, inconsistency of the textbooks with the curriculum topic, and teaching quality. At the same time, the attitude and the motivation to study were higher among medical students. The lowest score, i.e., 3 points out of 10 according to the median value, was given by medical students to educational materials.



Verifying comparative characteristics for the degree of academic stress factor significance (Table 2) demonstrated that the groups did not differ in most parameters. For medical students, the imperfection of textbooks (lack of them or inconsistency with the curriculum topic) and fear of the future were more significant than for pedagogical students. Also, for pedagogical students, lack of money (with a median score of 6 points, Q25-75 in the range of 3-9 points) was more significant. Students of both groups assessed the degree of “academic load” in the same way: Me=8.0 points, Q25-75 in the range of 6-9-points.




Factor analysis of academic stress factors revealed 2 significant factors among medical students (41.3% of the variance): “high academic load” (29.7%) and “disappointment in the profession” (11.6%). Also, factor analysis revealed 3 factors among pedagogical students (56.4% of the variance): “unwillingness to study” (39%), “domestic conflicts” (9.9%), and “domestic problems” (8.4%). These data indicate that for pedagogical students, the most significant factor was the unwillingness to study due to disappointment in the profession, defective educational materials, and high academic load, as well as problems of interpersonal interaction and conflicts. At the same time, for medical students, a high academic load was significant, and then disappointment in the profession, followed by an unwillingness to study.
The study of comparative characteristics on the severity of symptoms of academic stress (Table 3) showed that among medical students, difficulty focusing, irritability, resentment, low mood, decreased self-esteem, feeling of lack of time, and increased fatigue were more pronounced. 




Pedagogical students who entered the training unwillingly, more than those who chose a profession willingly, perceived academic stress factors: the teachers’ strictness (P=0.015), distance from parents (P=0.025), lack of scholarship (P=0.019), and fear of the future (P=0.042). In addition, they had more pronounced symptoms of academic stress: feelings of helplessness (P=0.016), difficulty focusing (P=0.003), anxiety (P=0.009), feeling of lack of time (P=0.007), palpitation (P=0.004), and laborious breathing (P=0.006).

Factor analysis of the academic stress symptoms demonstrates that they are the same for the students of both groups (Table 4). The most significant differences are fatigue and psychosomatic symptoms.



According to the methods of coping with academic stress, the groups did not differ significantly. Pedagogical students often skipped classes, chatted with friends, used the Internet, and read fiction.
Academic anxiety self-assessment proved to be high in both groups (median of 0.9 points in the medical students and 0.8 in the pedagogical students), and medical students rated it higher. Extremely high academic anxiety (8-10 points) was typical for 75.2% of medical students and 58.2% of pedagogical students (χ2=4.002, P=0.046, OR=2.1, 95% CI=1.0-4.3). The odds ratio showed that medical students were twice as likely to have academic anxiety.
The most significant pretest stress symptoms in both groups were anxiety, fear, sleep-onset insomnia, and a feeling of heart failure. Medical students were significantly more likely to experience feelings of heart failure and frequent urination.
Factor analysis of the pre-examination stress symptoms revealed three significant factors (Table 5).
It is known that psychosomatic symptoms are more significant for medical students, and affective disorders are more significant for their peers from the pedagogical institute. 



Verification of the social phobia prevalence shows that among medical students, symptoms of social phobia are significantly more common (χ2=4.948, P=0.027, OR=2.3, 95% CI=1.1-4.8) than in the pedagogical students: 46% and 27.3% of cases, respectively. The probability of having social phobias in medical students is more than two times higher than in pedagogical students. The clinical level of social phobia (moderate, pronounced, and highly pronounced) was significantly more common in medical students (24.1%) than in peers from the pedagogical institute (7.3%) (χ2=64.093, P=0.014, OR=4.0, 95% CI=1.3-14.3). The probability of diagnosing the clinical level of social phobia among medical students is four times higher than among pedagogical students.
It was found (DASS-21 test) that depression occurred in 41.6% of medical students, significantly more often than in the second group, 23.6%. Anxiety was detected in 44.5% of medical students and 30.9% of pedagogical students (the differences were not statistically significant). The stressors were experienced equally often by students of both groups, 37.9% of medical students and 32.7% of pedagogical students, respectively.
The results of the Beck depression and anxiety inventory (Table 6) confirmed the results of the DASS-21 test and showed that depression in medical students (46% of cases) was recorded more often (χ2=3.954, P=0.047, OR=2.1, 95% CI=1.0-4.3) than among pedagogical students (29.1%). 




The odds ratio indicates that the probability of detecting depression in medical students is at least twice higher than in pedagogical students. Anxiety (according to the BAI) was equally frequent among students of both groups: 14.5% among medical students and 10.9% among pedagogical students.
4. Discussion
The study has revealed negative trends in commitment to the chosen profession among medical and pedagogical students. Moreover, the probability of disappointment in the profession among those who entered not on their initiative is three times higher among medical students and 11 times higher among pedagogical students. Differences in the significance of stress factors for different areas of study have been revealed, too.
The prevalence of extremely high (8-10 points) academic anxiety was more ordinary for medical students (75.2%) than for pedagogical students (58.2%). Among the symptoms of pre-examination stress, psychosomatic symptoms were more significant for medical students, and affective disorders were more significant for their peers from the pedagogical institute.
Depression was at least two times higher among medical students than pedagogical students. They were also more likely to have symptoms of a social phobia than pedagogical students, with a four times higher probability of a diagnosis of clinical level. These results are supported by some studies [24-26] that university students experience high stress and anxiety levels. It was found that most medical students are anxious about having educational anxiety; they also have a greater risk of physical and psychological well-being concerns [24]. According to their educational experience, medical students experience sadness and worry. A pandemic circumstance also may increase such negative feelings. Stress adversely impacts their psychological, emotional, and physical well-being. High pressure may have harmful indications on cognitive capacity and education skills [24].
5. Conclusion
Academic anxiety has widely been observed in medical students. The results indicate that anxiety is higher in medical students. Studying medical science as a competitive situation is more significant for medical students than for pedagogical students. Competitive [27] and academic anxiety adversely affects the performance of individuals like athletes and students. It leads to depression, suicide ideation, and lower function. Because of the high level of academic stressors associated with social phobia, anxiety, depression, and many students with educational and occupational boredom and burnout, developing and implementing psychoeducational programs for medical and pedagogical students is necessary.
On the one hand, the interventions aim to form adaptive ways to overcome anxiety and depression, and stress reduction, which will prevent the development of psychosomatic disorders and addictions. On the other hand, enriching the lifestyles increases social adaptation and success in the future. We conclude that evidence-based treatments for stress reduction improve adaptive emotion regulation [28, 29] and lead to a higher quality of life for university students, especially students of medical sciences.
Ethical Considerations
Compliance with ethical guidelines
All ethical principles were considered in this article. The participants were aware of the aim of the study and its procedure. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished. The research results would be available to them. Written informed consent was obtained from the participants. 
Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit organizations.
Authors' contributions
All authors equally contributed to preparing this article.
Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
We would like to acknowledge the contribution of the participants and thank them for all those who assisted us in conducting the present study.


References