ASSOCIATION BETWEEN ANXIETY AND DEPRESSION IN MEDICAL STUDENTS AT THE RICARDO PALMA UNIVERSITY DURING THE YEAR 2021

Introduction : The mental health of medical students around the world has been aﬀected by the presence of anxiety and depression. According to the World Health Organization, more than 260 million people suﬀer from anxiety and approximately 300 million people suﬀer from depression. Objective: To determine the association between anxiety and depression in medical students at Ricardo Palma University during the 2021-II academic year. Methods: Observational, analytical, cross-sectional and quantitative study. From a population of 2046 medical students from the �rst to the seventh year of studies, the size of the sample obtained was 110 students. The data obtained was collected through Google Forms. Results: Of the medical students, 85.46% manifested some degree of anxiety and 50% manifested some degree of depression. These pathologies occurred more frequently in the female sex, low socioeconomic level and in those who had clinical courses. A statistically signi�cant association was found between anxiety and depression (p: 0.038), and between low socioeconomic status and depression (p: 0.004). No statistically signi�cant association was found between female sex and depression, nor between pre-clinical courses and depression. Conclusions: High prevalences of anxiety and depression were found in medical students at the Ricardo Palma University. In addition, a statistically signi�cant association between anxiety and depression was evidenced (p: 0.038). For this reason, it is recommended to implement a psychological accompaniment throughout the medical university career.

Due to the high prevalence of these pathologies, their association was studied at the University of Rochester, New York, concluding that adolescents with a negative anxiety response style longitudinally have a greater probability of presenting with depressive symptoms, and it increases in these the association between (13) anxiety and depression .Due to the high prevalence of anxiety and depression, and the probable association between both pathologies in medical university students around the world, it has been considered to carry out the present study to determine the association between anxiety and depression in medical students of the Ricardo Palma University during the academic cycle 2021-II.

Design and study area
Obser vational, analytical, cross-sectional and quantitative study in medical students from the rst Around the world, university medical education is considered one of the most demanding academic and emotional training programs.This has tarnished the mental health of medical students with the high (1) prevalence of anxiety and depression .

METHODS
Clark and Beck de ne anxiety as a complex response system that overestimates a situation as potentially ( 2 ) lethal for the individual .The World Health Organization (WHO) estimates that more than 260 (3) million people suffer from this pathology .In Peru, (4) around 44.64% of university students study anxiety .
The prevalence of anxiety in medical students around the world has a wide range of variability, from 37.2% in is 32.5% .
to the seventh year of study at Ricardo Palma University during the 2021-II academic cycle, who met the following inclusion criteria: being older 18 years old and sign the informed consent.Students who answered the questionnaire completely were excluded.

Population and sample
Of the total number of medical students (2046), a sample of 110 students was obtained by using a calculator provided by IINIB, according to the Analytical Transversal design.Through strati ed probabilistic sampling, it was determined that from the sample obtained, 42 students had to take pre-clinical courses, 58 students had to take clinical courses, and 10 students had to be in the medical internship.
The Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) were applied to medical students between November and December 2021.Data were obtained through a data collection form in Google Forms virtual survey format, in addition, the following sociodemographic data were obtained: age, sex, university study cycle, and socioeconomic level.

Variables and instruments
The anxiety variable was measured using the Beck Anxiety Inventory (BAI), which has four scales: no anxiety (0-7 points), mild anxiety (8-15 points), moderate anxiety (16-25 points), and severe anxiety (26-63 points); with a Cronbach's alpha coefficient of 0.88.To measure the depression variable, the Beck Depression Inventory (BDI) was used, which has four scales: the subject does not suffer from depression (0-13 points), the subject suffers from mild depression (14-19 points), the subject suffers from a moderate depression (20-28 points), the subject suffers from severe depression (29-63 points); with a Cronbach's alpha coefficient of 0.889.

Statistical analysis
A descriptive analysis was performed using absolute frequency tables and percentages; Likewise, two bivariate analyzes and a multivariate analysis were carried out.In the latter, crude and adjusted prevalence ratios (PR) were shown, performed with a con dence interval > 95% (95% CI) and a signi cance level of p ≤0.05.The data were stored and processed in a database in Excel and STATA version 16.

INTRODUCTION
Pág. 736 In the sample, a predominance of the female sex was

Ethical Aspects
For the present investigation, approval was obtained Saudi Arabia .The present study determined that the female sex had a 31% greater probability of suffering from depression but without a statistically signi cant association.Similar occurred in other Peruvian studies, the rst carried out in Huánuco in 2020, with a sample that included medical students from the rst to the fth academic year; this showed that the female sex was a risk factor of 1.03 times more to have depression, but without signi cant association .The second also carried out in 2020, was a multicenter study, where medical students from the rst to the sixth year were evaluated in the cities of Lima, Cusco and Ucayali, as a representation of the Peruvian coast, mountains and jungle.This publication also demonstrated that there was no signi cant association between sex and (16) depression in their sample .
different academic semesters were surveyed, obtaining a signi cant association between anxiety and ( 5 ) depression .Similarly, a cross-sectional study conducted on Chinese medical students in 2020 determined that there was a signi cant positive ( 2 3 ) correlation between anxiety and depression .
Similarly, the Spanish multicenter cross-sectional study conducted in 43 different medical schools in 2021 showed a statistically signi cant association between (17) Anxiety Trail (anxiety trait) and depression .
Likewise, a Mexican study in 2020, which compared rst and last-year medical students with students from other careers except those in the health area, showed that female medical students had a higher probability of suffering from depression, but this was not (6) statistically signi cant .This lack of statistically signi cant association between the female sex and depression in medical students has been suggested that may be due to the contribution that medical (6) training gives to gender equality in the area of health .
In this study, the signi cant association between low

DISCUSSION
With regard to anxiety, studies conducted before the pandemic, that is, up to 2019, show a lower prevalence (6) of anxiety, Mexico with 58.5% , Colombia with 26.5% for trait anxiety , Brazil with 37.2% and in Peru, a multicenter study of three universities, from the coast, (16) mountains and jungle, showed anxiety of 10.5% .found a prevalence of anxiety of 75.4% .The high prevalence of anxiety in medical students at Ricardo Palma University in the period 2021-II is not different from that in medical students in the post-COVID-19 era around the world.
In relation to depression, the studies carried out in the pre-pandemic era found the following prevalences, in (6) (15) Mexico 26.8% , in Colombia 30.15% , in Brazil 27.6% were reported from the rst to the sixth year of studies (21) .In comparison, a multicenter study in Peru revealed a (16) prevalence of depression of 3.9% .And the studies carried out during the pandemic to date show a with the rst year of studies .
The results are diverse.Thus a Mexican study carried out in 2020, which compared medical students in their rst and last year of medicine with students from other careers except those in the health area, showed an association between depression and their last year of (6) medicine .

CONCLUSIONS
The ndings of this study show a high prevalence of anxiety and depression among medical students at Ricardo Palma University.Likewise, according to the bivariate analysis, there is a statistically signi cant association between anxiety and depression, and between low socioeconomic status and depression.For this reason, it is recommended that students receive psychological support during their university career, a n d i n c l u d e m e n t a l h e a l t h c o u r s e s i n t h e undergraduate curriculum that provide effective and efficient tools to prevent and combat these pathologies.
Similarly, various publications indicate that depression may be associated with pre-clinical courses or the rst 3 years of study, such as the United States study that took 40 medical schools as a population, which showed a signi cant association between depression and pre-socioeconomic status and depression was determined.Similar occurred in Egypt (2020); it was shown that being dissatis ed with your socioeconomic level is (26) associated with depression .In turn, Çelik et al. supported that poor economic status is associated with (30) depression .
In the present study, no statistically signi cant association was found between pre-clinical courses, clinical courses and medical internships with depression.A similar occurred with the 2020 Peruvian study that took as a sample three universities from the coast, mountains, and jungle; it did not nd a statistically signi cant association between year of (16) study and major depression .Similarly, a Brazilian study from 2017 showed no signi cant association between the academic semester (pre-clinical, clinical, and internship) and depression .
from the Research Ethics Committee of the Faculty of Human Medicine of the Ricardo Palma University, as stated in the PG record.136-021 (approved December 5, 2021).The ethical principles of biomedical research in (14) human beings of the Declaration of Helsinki 2013 , informed consent was obtained from each participant, keeping their anonymity, as well as the con dentiality of the data.En la muestra se encontró predominio del sexo Pág.737 found at 59.09%.Likewise, it was reported that 30% of the students were of low socioeconomic level, 40.91% of medium socioeconomic level, and 29.09% of high moderate in 19.09% and severe in 13.64%; that is to say: depression was moderate or severe in 33.73%.

Table 1 .
Prevalence of anxiety and depression in medical students at the Ricardo PalmaUniversity in the period 2021-II.

Table 2 .
Factors related to Depression.

Table 3 .
Factors related to Anxiety.

Table 4 .
Bivariate and multivariate analysis associated with depression.
publications from Brazil , the United States , and On the contrary, studies carried out during the pandemic to date show a prevalence of anxiety in Spain of 24.71% for Anxiety state (anxiety state) and 21.53 for Anxiety trail