Salud Mental

Factors associated with the presence of depression, anxiety, and substance use in health students from 10 Latin American countries during the COVID-19 pandemic


Rosa Elena Ulloa Flores
Ricardo Díaz Sánchez
Helena Estefanía Mora Noriega
Luisa Fernanda Sánchez Musi
Rogelio Apiquian Guitart
Daniela Michelle Olvera Green
Francisco Rafael De la Peña Olvera
Marcos Francisco Rosetti Sciutto
Lino Palacios Cruz
Pablo Mayer Villa
Juan David Palacio Ortiz


Introduction. Health science students represented a particularly vulnerable group during the pandemic. Studies in various regions have found a high prevalence of psychopathology, associated with the presence of stressors such as contact with patients, isolation, and financial difficulties.
Objective. To determine the stressors for and frequency of depression, anxiety and substance use in Latin American health science students during the COVID-19 pandemic.

Method. A questionnaire-based, cross-sectional study was conducted to measure the presence of stressors and determine anxiety and depression symptoms through the PHQ-9 and the GAD-7 scales, and substance use in 777 students from ten countries, from June 2020 to January 2021.

Results. The most frequent stressors were having a loved one diagnosed with COVID-19 and being diagnosed with another illness. A total of 54.1% of the sample had depression, and 46.2% had anxiety according to the rating scales cut-off points, while 24.8% reported substance use. Reading or listening to news about the pandemic was the main stressor associated with the presence of psychopathology.

Discussion and conclusion. Latin American health science students displayed high frequencies of psychopathology associated with various stressors. It is therefore important to monitor the mental health of this population to prevent low academic performance.

Depression, anxiety, COVID-19, pandemic, health science students


Abbasi, M. S., Ahmed, N., Sajjad, B., Alshahrani, A., Saeed, S., Sarfaraz, S., Alhamdan, R. S., Vohra, F., & Abduljabbar, T. (2020). E-Learning perception and satisfaction among health sciences students amid the COVID-19 pandemic. Work, 67(3), 549-556. doi: 10.3233/WOR-203308

Agranatti, A., Longarini, A., Lopez Arancio M., Olaciregui Plot A., Viola, M.B., Santamarina, N.C. y Zubimend, M. (2021). Prevalencia de síntomas de ansiedad, depresión y estrés en estudiantes de medicina durante el aislamiento social, preventivo y obligatorio por la COVID-19. Revista Argentina de Medicina, 9(4), 301-311.

Alkureishi, M. L., Jaishankar, D., Dave, S., Tatineni, S., Zhu, M., Chretien, K. C., Woodruff, J. N., Pincavage, A., Lee, W. W., & Medical Student Well-being Being Research Consortium. (2022). Impact of the Early Phase of the COVID-19 Pandemic on Medical Student Well-Being: a Multisite Survey. Journal of General Internal Medicine, 37(9), 2156-2164. doi: 10.1007/s11606-022-07497-2

Allgaier, A. K., Pietsch, K., Frühe, B., Sigl-Glöckner, J., & Schulte-Körne, G. (2012). Screeningfordepressioninadolescents: validityofthepatienthealthquestionnaireinpediatriccare. Depression and Anxiety, 29(10), 906-913. doi: 10.1002/da.21971

Auerbach, R. P., Alonso, J., Axinn, W. G., Cuijpers, P., Ebert, D. D., Green, J. G., Hwang, I., Kessler, R. C., Liu, H., Mortier, P., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., Andrade, L. H., Benjet, C., Caldas-de-Almeida, J. M., Demyttenaere, K., ... Bruffaerts, R. (2016). Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychological Medicine, 46(14), 2955-2970. doi: 10.1017/S0033291716001665

Borghero, F., Martínez, V., Zitko, P., Vöhringer, P. A., Cavada, G., & Rojas, G. (2018). Tamizaje de episodio depresivo en adolescentes. Validación del instrumento PHQ-9. Revista Médica de Chile, 146(4), 479-486. doi: 10.4067/s0034-98872018000400479

Bryant-Genevier, J., Rao, C. Y., Lopes-Cardozo, B., Kone, A., Rose, C., Thomas, I., Orquiola, D., Lynfield, R., Shah, D., Freeman, L., Becker, S., Williams, A., Gould, D. W., Tiesman, H., Lloyd, G., Hill, L., & Byrkit, R. (2021). Symptoms of Depression, Anxiety, Post-Traumatic Stress Disorder, and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers During the COVID-19 Pandemic - United States, March-April 2021. MMWR. Morbidity and Mortality Weekly Report, 70(48), 1680-1685. doi: 10.15585/mmwr.mm7048a6

Cao, W., Fang, Z., Hou, G., Han, M., Xu, X., Dong, J., & Zheng, J. (2020). The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research, 287, 112934. doi: 10.1016/j.psychres.2020.112934

Christophers, B., Nieblas-Bedolla, E., Gordon-Elliott, J. S., Kang, Y., Holcomb, K., & Frey, M. K. (2021). Mental Health of US Medical Students During the COVID-19 Pandemic. Journal of General Internal Medicine, 36(10), 3295-3297.

Conway, C. C., Rutter, L. A., & Brown, T. A. (2016). Chronic environmental stress and the temporal course of depression and panic disorder: A trait-state-occasion modeling approach. Journal of Abnormal Psychology, 125(1), 53-63. doi: 10.1037/abn0000122

Corrales-Reyes, I., Villegas-Maestre, J., Carranza-Esteban, R., & Mamani-Benito, O. (2022). Depresión, ansiedad y estrés en estudiantes cubanos de Estomatología durante el rebrote de la COVID-19. Revista Cubana de Medicina Militar, 51(1), e02201720. Retrieved from

COVID-19 Mental Disorders Collaborators. (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet, 398(10312), 1700-1712. doi: 10.1016/S0140-6736(21)02143-7

Czernik, G., Giménez, S., Mora, M., & Almirón, L. (2006). Variables sociodemográficas y síntomas de depresión en estudiantes universitarios de Medicina de Corrientes, Argentina. Alcmeon, Revista Argentina de Clínica Neuropsiquiátrica, 13(2), 64-73.

Duan, L., Shao, X., Wang, Y., Huang, Y., Miao, J., Yang, X., & Zhu, G. (2020). An investigation of mental health status of children and adolescents in china during the outbreak of COVID-19. Journal of Affective Disorders, 275, 112-118.

Dudovskiy, J. (2022). The Ultimate Guide to Writing a Dissertation in Business Studies: A Step-by-Step Assistance (6th ed.). Retrieved from (accessed 13 June 2022).

Ekström, S., Andersson, N., Lövquist, A., Lauber, A., Georgelis, A., Kull, I., Melén E., & Bergström, A. (2022). COVID-19 among young adults in Sweden: self-reported long-term symptoms and associated factors. Scandinavian Journal of Public Health, 50(1), 85-93. doi: 10.1177/14034948211025425

Fernandez, M. D. S., Vieira, I. S., Silva, N. R. J. da, Cardoso, T. de A., Bielavski, C. H., Rakovski, C., & Silva, A. E. R. (2021). Anxiety symptoms and alcohol abuse during the COVID-19 pandemic: A cross-sectional study with Brazilian dental undergraduate students. Journal of Dental Education, 85(11), 1739-1748. doi: 10.1002/jdd.12742

Frank, V., Doshi, A., Demirjian, N. L., Fields, B. K. K., Song, C., Lei, X., Reddy, S., Desai, B., Harvey, D. C., Cen, S., & Gholamrezanezhad, A. (2022). Educational, psychosocial, and clinical impact of SARS-CoV-2 (COVID-19) pandemic on medical students in the United States. World Journal of Virology, 11(3), 150-169. doi: 10.5501/wjv.v11.i3.150

García-Campayo, J., Zamorano, E., Ruiz, M. A., Pardo, A., Pérez-Páramo, M., López-Gómez, V., Freire, O., & Rejas, J. (2010). Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool. Health and Quality of Life Outcomes, 8, 8. doi: 10.1186/1477-7525-8-8

Gilbody, S., Richards, D., Brealey, S., & Hewitt, C. (2007). Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): adiagnostic meta-analysis. Journal of General Internal Medicine, 22(11), 1596-1602. doi: 10.1007/s11606-007-0333-y

Granados-Cosme, J. A., Gómez-Landeros, O., Islas-Ramírez, M. I., Maldonado-Pérez, G., Martínez-Mendoza, H. F., & Pineda Torres, A. M. (2020). Depresión, ansiedad y conducta suicida en la formación médica en una universidad en México. Investigación en Educación Médica, 9(35), 65-74.

Guavita. M., & Sanabria, P. (2006). Prevalencia de sintomatología depresiva en una población estudiantil de la facultad de medicina de la Universidad Militar Nueva Granada, Bogotá Colombia. Revista de la Facultad de Medicina de la Universidad Nacional de Colombia, 54(2), 76-87.

Guldager, J. D., Jervelund, S., & Berg-Beckhoff, G. (2021). Academic stress in Danish medical and health science students during the COVID-19 lock-down. Danish Medical Journal, 68(7), A11200805

Guse, J., Weegen, A. S., Heinen, I., & Bergelt, C. (2021). Mental burden and perception of the study situation among undergraduate students during the COVID-19 pandemic: a cross-sectional study and comparison of dental and medical students. BMJ Open, 11(12), e054728. doi: 10.1136/bmjopen-2021-054728

Halperin, S. J., Henderson, M. N., Prenner, S., & Grauer, J. N. (2021). Prevalence of Anxiety and Depression Among Medical Students During the Covid-19 Pandemic: A Cross-Sectional Study. Journal of Medical Education and Curricular Development, 8, 2382120521991150. doi: 10.1177/2382120521991150

Herrera, G. (2021). Riesgo de ansiedad, estrés y depresión en los estudiantes de enfermería de una Universidad privada de Bogotá durante la pandemia por SARS COV-2 [Trabajo de investigación para optar el título de Enfermera]. Repositorio Universidad de ciencias aplicadas y ambientales u.d.c.a. Retrieved from

International Monetary Fund. (2022). Chapter 1 - Global prospects and policies. In World Economic Outlook (April). Retrieved from

Jia, Q., Qu, Y., Sun, H., Huo, H., Yin, H., & You, D. (2022). Mental Health Among Medical Students During COVID-19: A Systematic Review and Meta-Analysis. Frontiers in Psychology, 13, 846789. doi: 10.3389/fpsyg.2022.846789

Lasheras, I., Gracia-García, P., Lipnicki, D. M., Bueno-Notivol, J., López-Antón, R., de la Cámara, C., Lobo, A., & Santabárbara, J. (2020). Prevalence of Anxiety in Medical Students during the COVID-19 Pandemic: A Rapid Systematic Review with Meta-Analysis. International Journal of Environmental Research and Public Health, 17(18), 6603. doi: 10.3390/ijerph17186603

Liu, J., Zhu, Q., Fan, W., Makamure, J., Zheng, C., & Wang, J. (2020). Online Mental Health Survey in a Medical College in China During the COVID-19 Outbreak. Frontiers in Psychiatry, 11, 459.

Ma, Z., Zhao, J., Li, Y., Chen, D., Wang, T., Zhang, Z., Chen, Z., Yu, Q., Jiang, J., Fan, F., & Liu, X. (2020). Mental health problems and correlates among 746 217 college students during the coronavirus disease 2019 outbreak in China. Epidemiology and Psychiatric Sciences, 29, e181. doi: 10.1017/S2045796020000931

Merz, E. L., Malcarne, V. L., Roesch, S. C., Riley, N., & Sadler, G. R. (2011). A multigroup confirmatory factor analysis of the Patient Health Questionnaire-9 among English- and Spanish-speaking Latinas. Cultural Diversity and Ethnic Minority Psychology, 17(3), 309-316. doi: 10.1037/a0023883

Natarajan, J., & Joseph, M. A. (2022). Impact of emergency remote teaching on nursing students’ engagement, social presence, and satisfaction during the COVID-19 pandemic. Nursing Forum, 57(1), 42-48. doi: 10.1111/nuf.12649

Racine, N., McArthur, B. A., Cooke, J. E., Eirich, R., Zhu, J., & Madigan, S. (2021). Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatrics, 175(11), 1142-1150. doi: 10.1001/jamapediatrics.2021.2482

Ravens-Sieberer, U., Kaman, A., Erhart, M., Devine, J., Schlack, R., & Otto, C. (2021). Impact of the COVID-19 pandemic on quality of life and mental health in children and adolescents in Germany. European Child & Adolescent Psychiatry, 31(6), 879-889.

Rodrigues, I. L., Nunes, T. P., Cortez, C. S., & Lourenço, A. M. (2022). E-Learning Impact on Veterinary Medical Student’s Mental Health during the COVID-19 Pandemic. Journal of Veterinary Medical Education, e20210052. doi: 10.3138/jvme-2021-0052

Ruvalcaba, K. A., González, L. P., & Jiménez, J. M. (2021). Depresión y ansiedad en estudiantes de Medicina durante el confinamiento por la pandemia de COVID-19. Investigación en Educación Médica, 10(39), 52-59. doi: 10.22201/fm.20075057e.2021.39.21342

Sandoval, K. D., Morote-Jayacc, P. V., Moreno-Molina, M., & Taype-Rondan, A. (2021). Depresión, estrés y ansiedad en estudiantes de Medicina humana de Ayacucho (Perú) en el contexto de la pandemia por COVID-19. Revista Colombiana de Psiquiatría. doi: 10.1016/j.rcp.2021.10.005

Sartorao Filho, C. I., Rodrigues, W. C. de L. V., Beauchamp de Castro, R., Marcal, A. A., Pavelqueires, S., Takano, L., de Oliveira, W. L., & Sartorao Neto, C. I. (2020). Impact of covid-19 pandemic on mental health of medical students:a cross-sectional study using GAD-7 and PHQ-9 questionnaires. MedRxiv. doi: 10.1101/2020.06.24.20138925

Shankar, P. R., Chan, M. H., Wong, P. S., & Venkateswaran, S. P. (2022). Mental health of students of biomedical sciences during the COVID-19 pandemic: a scoping review. Medicine and Pharmacy Reports, 95(2), 131-143. doi: 10.15386/mpr-2139

Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. doi: 10.1001/archinte.166.10.1092

Spitzer, R.L., Kroenke, K., & Williams, J. B. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ Primary Care Study. JAMA, 282(18), 1737-1744. doi: 10.1001/jama.282.18.1737

Weisberg, R. B. (2009). Overview of generalized anxiety disorder: epidemiology, world presentation, and course. The Journal of Clinical Psychiatry, 70(Suppl 2), 4-9. Retrieved from