Pre-exam anxiety during COVID-19: A cross-sectional study of medical and paramedical students in the Arab community

Pre-exam anxiety is a condition that affects students before their exams, and significantly affects their academic performance, physical, and mental state. Medical and paramedical students are more likely to experience exam-related stress and anxiety. Here we aimed to evaluate the prevalence of exam anxiety and its associated risk factors among undergraduate Arab medical and paramedical students. We performed a multi-center cross-sectional study in 6 Arab countries: Egypt, Syria, Iraq, Palestine, Algeria, and Libya from March to April 2021. We used Epi Info version 7.2 software to calculate the sample size. An online questionnaire including The Depression, Anxiety, and Stress Scale-21 Items (DASS-21) was used to measure exam-related anxiety. A total of 18,979 participants filled out the questionnaire, 71.3% of them were females. The majority of the study participants were between the ages of 20 to 21 years 42.4% (n = 8055). On the DASS, 38.8% of participants experienced severe symptoms of depression, 47.6% of them experienced severe symptoms of anxiety, and 30.2% experienced severe symptoms of stress. Of the 3 subscales of the DASS, Females had a significantly higher risk than males of developing Depression, Anxiety, and Stress (B = 2.454, P < .001), (B = 4.256, P < .001), (B = 3.516, P < .001) respectively. Participants aged 22 years or more were less susceptible to test-related depression (B = -0.907, P < .001) and anxiety (B = -0.958, P < .001). Students who spend 13 to 18 hours a week studying, were considerably more likely to have lower scores on all DASS subscales than those who study more than 18 hours per week, depression (B = -0.983, P < .001), Anxiety (B = -1.334, P < .001) and stress (B = -1.693, P < .001). The prevalence of exam-related anxiety, stress, and depression is high among medical and paramedical students in the Arab region. Medical educators should be aware of the impacts of this comorbidity and should work on implementing new and effective strategies to help students cope with psychological changes during exams. This paper gives a clearer insight into the level of exam anxiety and its predictors, which will enable the responsible authorities to intervene, based on the findings.