Prevalence of mental health disorders and associated factors among premedical students preparing for medical entrance exams: A cross- sectional study in Pakistan

Purpose In low- and middle-income countries like Pakistan, premedical students preparing for competitive medical entrance examinations experience increasing academic, emotional, and societal pressures that affect their mental health. This study aims to assess the burden of depression, anxiety, and stress and determine associated factors within this population, with our research question being: What is the prevalence of mental health problems (stress, anxiety, and depression), and what are the associated factors contributing to mental health outcomes among premedical students in Pakistan? Methods A cross-sectional study was conducted among premedical students aged 18 and above in Pakistan who appeared for the Medical and Dental College Admission Test. Results A total of 743 premedical students participated in the study (69.4% female; mean age 20.06 ± 1.37 years). Prevalence of mental health symptoms, including depression, anxiety, and stress, was 75.2%, 77.1%, and 65.3% respectively. Extremely severe levels of depression, anxiety, and stress were observed in 25%, 13.6%, and 12.7%. Female gender was significantly associated with increased odds of severe anxiety (OR 2.27, 95% CI 1.56–3.29, p<0.001) but decreased odds of being in higher categories of depression (Normal vs Mild+: OR 0.48, 95% CI 0.35–0.65, p<0.001; Mild vs Moderate+: OR 0.49, 95% CI 0.37–0.66, p<0.001) and stress (Normal vs Mild+: OR 0.47, 95% CI 0.36–0.60, p<0.001; Mild vs Moderate+: OR 0.47, 95% CI 0.36–0.60, p<0.001; Moderate vs Severe+: OR 0.44, 95% CI 0.34–0.57, p<0.001). Conclusions Mental health symptoms were highly prevalent among premedical students, with anxiety, depression, and stress affecting a substantial majority. These findings underscore the urgent need for policy-level interventions to support the mental health of MDCAT aspirants.