FACTORS ASSOCIATED WITH ANXIETY IN MEDICAL INTERNS AT A PRIVATE UNIVERSITY IN THE CONTEXT OF THE COVID-19 PANDEMIC

ABSTRACT


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Anxiety is de ned as the anticipation of a future threat without compromising the daily activities of the person; when this aspect is compromised, it is considered pathological and is included within anxiety (9) disorders, while major depression is considered a disorder that limits the psychosocial sphere and (10) reduces the quality of life .
The COVID-19 pandemic associated with SARS-CoV-2 has increased and produced changes at the level of the physical and psychological sphere of populations (1,4) belonging or not to the eld of health sciences.
These conditions can be attributed to various factors (11) , among which, at the national level, family economic problems, being a woman, and fear that their medical training will be delayed or deteriorate stand out. ( Internationally, a study in Egypt found that having a previous histor y of psychiatric disorders was statistically associated with depression and anxiety (13) during the pandemic.At the same time in France, it was reported that changes in consumption of alcohol and online learning difficulties were considered statistically signi cant factors.On the other hand, a study conducted in China found that stressors at school, a negative coping style, and stress were predictors of A virtual questionnaire was distributed via institutional email to all medical interns, which was attached to a database in Excel format; later, the data was transferred to the SPSS v26 format for statistical analysis.

Worked using the statistical package SPSS version 26 to
analyze the collected data.
Subsequently, for the inferential statistical analysis, the chi-square test of independence was used.In the case of presenting one or more boxes with expected values

Variables and instruments
They worked with variables such as age, gender, marital status, having children, access to PPE, diagnosis of COVID-19 in the last 12 months, place of medical hospitalization, and for the measurement of anxiety, they worked with the (CAS) questionnaire, the psychometric analyzes con rmed that the scale has a unidimensional structure and solid reliability, omega (17) coefficient ω = 0.93 and validity by factor analysis , which has a cut-off point greater than or equal to at nine points to determine anxiety, in turn, to determine the gradation of depressive symptoms, the Patient Health Questionnaire nine (PHQ-9) instrument was used, which was classi ed as 0 -4 none, 5 -9 mild, 10 -14 moderate, 15-19 moderately severe and 20-27 severe.

Statistical analysis We
For the univariate statistical analysis, the qualitative variables were taken and summarized in absolute and relative frequency tables, and the quantitative variables reported the mean and standard deviation.
To determine the strength and direction of the association, the raw and adjusted prevalence ratio was estimated with their respective 95% con dence intervals, using bivariate and multivariate Poisson regression models, wherein the multivariate model, those independent variables were entered whose coefficients will show statistical signi cance.The cross-sectional study carried out by Zheng et al. which was carried out in a sample of 3 228 nurses in China reported a total incidence of depression of 34,3% and anxiety of 18,1%, respectively.Likewise, it was found that working in areas of high and low risk for COVID-19 is associated with depression.In contrast, our study found a prevalence of anxiety of 22.7% as well as depressive symptoms (Mild, moderate, moderatesevere, and severe) with values of 19.8%, 44.3%, 18.4%, and 6.7%, respectively.The disparity of the data can be attributed to the sample size, level of knowledge, types of exposure areas, number of working hours, and the health center's preventive management.

Ethical issues
through logistic regression analysis, they determined factors associated with anxiety, depression, and stress.Among these the female sex, being in preclinical years (aOR=2.35),not having family economic stability (aOR=2.05)and the fear of damaging medical training of the patient.
Another cross-sectional study conducted by Zheng et (20) al. evaluated the factors associated with depression, anxiety, and stress in a population of nurses, using multivariate logistic regression analysis.Working in an isolation ward or in a fever clinic was an independent risk factor associated with depression, anxiety, and stress.Likewise, having suspected or con rmed patients with COVID-19 in the departments, coming into contact with body uids and having less than 10 years of work were considered independent risk factors with OR values of 1 554 (95% CI: 1.469 and 1.678), respectively.These data may show an overestimation due to the use of the Odds Ratio (OR), due to a prevalence greater than 10% in both depression (15.4%), anxiety (32.6%), and stress (18%).On the other hand, our study, using the prevalence ratio (PR) as a measure of association, determined that severe depression (p<0.039),children (p<0.009), and diagnosis of COVID-19 (p<0.006) were associated statistically with anxiety.
However, at the national level, a study by Huarcaya Victoria et al. used the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety disorder 7 (GAD-7), and Impact of event scale-revised (IES-R) questionnaire, which is already greater than 5-10% in this population.

DISCUSSION
Regression model was performed with variances robust to obtain the crude prevalence ratio with their respective 95% con dence intervals; of the study variables, a statistically signi cant association was found for the variables, depressive symptoms, gender, marital status, children, living with people with risk for severe symptoms of covid, place of medical internment, diagnosis of COVID-19 and access to PPE.Table 2 A Poisson regression model with multiple robust variances was carried out to obtain the ratio adjusted prevalence with their respective 95% con dence intervals with that The variables whose prevalence ratios have a p-value less than 0.05.Finally, the variables severe depressive symptoms, diagnosis of COVID-19 in the last 12 months and access to PPE were those variables that presented statistical signi cance.Table 2 The present study found a relationship for anxiety with the following characteristics, diagnosis of covid 19 in the last 12 months, having children, and presenting severe grading depressive symptoms.
Using the PHQ-9, differences were found between the frequency of moderate to severe depressive symptoms in our results, 69.4%, with those published by García- (18) Iglesias et al. , whose systematic review study conducted on health professionals reviewed a total of 13 articles, found a frequency of 50.7%, this being lower than ours, within the population differences we can identify as probable factors of said difference, the limited access to PPE reported by medical students, coupled with the coexistence of these with relatives at risk of developing severe symptoms from Sars-Cov-2.
The anxiety results in our study were 22.7%, which were lower than those reported by García-Iglesias et al., who reported that the percentage of anxiety in health professionals ranged between 26,5% and 44,6% 14; these differences are probably due to the legal responsibility that the doctor must bear towards his patients, a situation that is not the same with medical students since they do not have any type of responsibility related to the management or treatment Pág.373 (21) since the pandemic (aORr=2,46), were statistically signi cant.
was only carried out in medical interns from a single (22) Our results align with those published by Liu et al. and (23) Nayak et al. , identifying an association by bivariate regression model between anxiety and married marital status.However, when performing the regression model multiple ours nds no association.The loss of association in our study could be because the main anxiety-generating factor is the presence of children, which remains in our multiple regression model.At the same time, it is important to mention that these studies use a logistic regression model whose odds ratios There is an association between the presence of severe depressive symptoms, having children, the diagnosis of covid-19 in the last 12 months with the diagnosis of anxiety in medical interns at the UPSJB during the year 2021.

CONCLUSIONS
f a c u l t y, w h i c h c o u l d a ffe c t t h e m o m e n t o f extrapolating the data to the population of interns in metropolitan Lima and National, non-probabilistic convenience t ype sampling could affec t the representativeness of the sample, which could affect the precision of the statistics that are proposed to be presented as population estimators.

Contribuciones de autoría:
Efraín Cehua participated in the conception and design, collection of results, writing of the article, Approval of the nal version.Juan Carlos Roque participated in the conception and design, analysis and interpretation of data, Approval of the nal version.Joseph Alburqueque participated in the conception and design, collection of results, writing of the article, approval of the nal version.Horus Virú participated in the conception and design, collection of results, writing of the article, approval of the nal version.Catherine Amparo Suárez Egoávil participated in the conception and design, collection of results, writing of the article, approval of the nal version.Israel Armando Guerra Cuyutupac participated in the critical review of the article, approval of the nal version, writing of the article, approval of the Con icts of interest: The authors declare that they have no con ict of interest.

Table 2 .
Bivariate and multiple analysis by Poisson regression model with Robust variances The present study had the approval approved by the ethics committee of the Faculty of Human Medicine of the Universidad San Juan Bautista, with an approval certi cate number 1266.To align with the criteria stipulated in the Declaration of Helsinki, this study provided the participants with informed consent explaining the use of the registered data and the con dentiality measures used to safeguard the privacy and anonymity of the individual.RESULTS