Medical students are at high risk of developing depressive symptoms rather than their age- matched group as medical education is stressful and medical students have psychological and academic stressors.

The stress that the medical students experience was thought to be associated with depressive symptoms and decrease the quality of life, deteriorating academic achievements, and clinical practice [27].

The present research revealed that, the prevalence of depressive symptoms among medical Students of Assiut University was 55.5%, and this finding is nearly similar to a study among Assiut University medical students in the academic year 2003–2004 (55.3%) (4) and a study conducted among medical students at the academic year 2015 in Alexandria University 57.9% [3].

However, prevalence of depressive symptoms in our study is lower than that reported by a study among Egyptian medical students in 2016 at Fayoum University which found prevalence of depressive symptoms 60.8% [6].

Prevalence of depressive symptoms in our study is higher than the study among Al-Azhar University medical students (42.9%) [8], and among study conducted at Alexandria University 2020 between medical students of 4th, 5th, and 6th academic years, which found prevalence of depressive symptoms about 45.0% [28].

In the present study, the multivariable regression revealed that, younger age of the students was significant associated with more depressive symptoms (OR = 0.797; p < 0.001). This is consistent with Elsway et al. that reported prevalence of moderate and severe depression decreased with the increase in the students’ age. This can be explained by the fact that with their advance in age, they became more mature [28].

However, a study conducted among medical Students in Sudan International University [10], and study among medical students in India [22] found no statistically significant difference between age and the presence of depressive symptoms.

Regarding gender, our study found statistically significant higher depressive symptoms among females than males (58.9% vs 51.2% respectively). This is consistent with other studies in reporting higher levels of depressive symptoms among females [3, 8, 29,30,31].

Higher prevalence of depressive symptoms among females may be due to that female complain more about the high load of the curriculum, they are more likely to report stress, females are more liable to over complaint about physical and psychological symptoms [3].

Regarding academic year, our study revealed that, there was high depressive symptoms among students of the first three years (academic years) (58.3%) vs (52.6%) among students of clinical years but was of no significant association and this is in accordance with a study among medical students in Khartoum University [32]. This is consistent with a study among medical students et al.-Azhar University which showed that the level of depressive symptoms increases among students in the second and third years of the medical course than clinical years.

The decrease in depressive symptoms with advance of academic years can be explained also by either their advance in age; a gradual adaptation to the academic environment and that the stress of new study environment and taking more responsibility for their learning [28].

Regarding scholastic achievement, the present research revealed statistically significant higher depressive symptoms among pass/failed students (74.3%) compared to (53.1%) among excellent, very good and good students. This is in consistent with Sarokhani et al.’s study which reported a low prevalence rate of depressive symptoms among students with moderate and high performance in examination [33].

As regards living with family during study, there was higher depressive symptoms among students who live in apartment alone or with a friend (60.1%) compared to (54.5%) among students who live with their families.

However, many studies revealed that living away from their families during study period is associated with more depression as reported in a study among medical students in Saudia Arabia showed that, 88% of participants who lived alone had depressive symptoms [34].

Another study conducted et al.-Azhar University found that, students who live away from their family (in and outside the University residence) were found to have had a significant high prevalence of depressive symptoms. This can be explained by the fact that students who live away from their families are in need of family support [8].

As regards parental education and occupation, our study revealed that there was no significant association between them and presence of depressive symptoms among medical students. However, Ibrahim et al. conducted a study in 2012 among Assiut University undergraduate students including medical students, and he found a highly significant association between parental education, occupation, and presence of depressive symptoms (4). This may be attributed that, sampled students are of different socio-economic classes.

The current study revealed that, depressive symptoms were higher among students with lower socioeconomic status. This is consistent with a study performed among Assiut University students including medical students [4]. Also, a study among medical students from South Korea [35]. However, in India Hakim et al.’s study, it was revealed that there was no significant association between socio-economic status and presence of depressive symptoms [36].

The present research revealed significant association between depressive symptoms and the presence of chronic medical condition (OR = 3.174; P = 0.024), this is in accordance with a study in New-Delhi [37] and another study performed among first year medical students in Menoufiya University [5]. However, Elsawy WIH et al. reported no statistically significant difference between presence of chronic medical illness and presence of depressive symptoms [28].

Family history of mental illness other than depression had a significant association with the presence of depressive symptoms, and this is consistent with a study in Portugal [2], study among medical students in Sudan [10], and Elsawy et al.’s study [28]. However, a study among medical students at Qassim University, Saudia [38] showed no significant association between them.

Moreover, family history of depression was significantly associated with higher depressive symptoms, this is in accordance with a study among medical students at an institution in Karnataka [39] and a study among medical students at a private medical college in south India [40].

The present research revealed that, lower life satisfaction score was associated with the presence of depressive symptoms (OR = 0.908; p < 0.001), this is consistent with a study among medical students at Irish medical university, Bahrain [41].

Regarding stress, the present research revealed that drive- and desire-related stressors (DRS) followed by social-related stressors (SRS) and teaching- and learning-related stressors (TLRS) were the major stressors faced by students and depressive symptoms were significantly less in the absence of medical stressors assessed by MSSQ. In multivariable regression, students with higher medical stress score were three times more liable to have depressive symptoms (OR = 3.596, P < 0.001).

This is consistent with a study performed among medical students in University of Putra in Malaysia [42], a study conducted among undergraduate medical Students in a Teaching Medical Institution of South India [43] and study conducted among female Health Profession Students in a Saudi University [44].

Our study revealed an inverse relationship between sense of control and depressive symptoms (a low sense of control was related with the presence of depressive symptoms), (OR = 2.323; p < 0.001). This agreed with a study carried out among students from six UK universities that found depressive symptoms were related with lower perceived control with an OR of 1.6 [24].

Study limitations

Students’ schedules to find convenient time for data collection without disruption of educational process and to be away from exams take time from us for coordination and appointments. Risk of missing severely depressed because of absenteeism. The study depends on self-reported data that is subjected to reporting bias (over reporting/recall bias).

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