Stress in Study: Assessing Depression Differences Among Medical and Non- Medical Students

Stress in Study: Assessing Depression Differences Among Medical and Non- Medical Students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Stress in Study: Assessing Depression Differences Among Medical and Non- Medical Students Taimoor Asghar, Ali Hassan, Ifrah Sahar, Muhammad Tahir, Bilal Shahid, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7508873/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Background University students experience significant academic stress, which may contribute to depressive symptoms. Evidence comparing depression levels between medical and non-medical students in South Asia remains limited. This study examined differences in depressive symptoms and assessed the psychometric properties of the PHQ-9 and DASS-21 scales in a large student sample. Methods A cross-sectional survey was conducted among 602 students (Medical: n = 424; Non-Medical: n = 178) using the Patient Health Questionnaire-9 (PHQ-9) and the Depression, Anxiety, and Stress Scales-21 (DASS-21). Analyses included descriptive statistics, reliability (Cronbach’s α), confirmatory factor analysis (CFA), item response theory (IRT), and symptom network analysis, conducted in R. Results Median PHQ-9 scores were slightly higher among non-medical students (10.0, Q1–Q3 = 7.0–14.0) compared to medical students (9.0, Q1–Q3 = 5.0–13.0). Internal consistency was high for PHQ-9 (α = 0.82), DASS-Depression (α = 0.88), DASS-Anxiety (α = 0.85), and DASS-Stress (α = 0.86). CFA supported the three-factor DASS-21 model with good fit (CFI = 0.95, TLI = 0.95, RMSEA = 0.052, SRMR = 0.031). IRT analyses showed strongest discrimination for self-worth, concentration, down, and appetite items, while interest contributed the least. Symptom network analysis identified self-worth, concentration, and meaninglessness as central nodes, with somatic items (sleep, appetite, energy) bridging across domains. Conclusions Non-medical students reported slightly higher depressive symptoms compared to medical students, though both groups showed substantial burden. The PHQ-9 and DASS-21 demonstrated excellent reliability and construct validity. Interventions should target central symptoms, such as self-worth and concentration difficulties, to enhance mental health support in university populations. depression medical students non-medical students PHQ-9 DASS-21 confirmatory factor analysis item response theory symptom network analysis reliability Full Text Additional Declarations No competing interests reported. Supplementary Files DepressionOrignal.xlsx RationaleforStatisticalandPsychometricMethods.docx networkcentralityindices.csv suppreliabilitydetails.csv suppcorrelationsPHQ9vsDASS.csv IRTlocaldependence.csv CFAWLSMVfitindices.csv IRTitemfitSX2.csv ReliabilityOmega.csv sessionInfo.txt SFig1totalshistograms4k600dpi.tiff SFig2PHQ9severitybygroup4k600dpi.tiff SFig3CFAloadingsbars4k600dpi.tiff SFig4networkcentralitybars4k600dpi.tiff SFig5IRTtracecurvesfaceted4k600dpi.tiff 3.Questionairre.docx fullpipelinePHQ9DASS21.r Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 04 May, 2026 Reviews received at journal 30 Apr, 2026 Reviews received at journal 19 Apr, 2026 Reviewers agreed at journal 10 Apr, 2026 Reviewers agreed at journal 02 Apr, 2026 Reviewers invited by journal 09 Sep, 2025 Editor assigned by journal 09 Sep, 2025 Editor invited by journal 09 Sep, 2025 Submission checks completed at journal 04 Sep, 2025 First submitted to journal 04 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7508873","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":515090167,"identity":"321b1cc9-8885-457c-86ed-452536d5da1d","order_by":0,"name":"Taimoor 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Students","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"depression, medical students, non-medical students, PHQ-9, DASS-21, confirmatory factor analysis, item response theory, symptom network analysis, reliability","lastPublishedDoi":"10.21203/rs.3.rs-7508873/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7508873/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003cbr\u003e\nUniversity students experience significant academic stress, which may contribute to depressive symptoms. Evidence comparing depression levels between medical and non-medical students in South Asia remains limited. This study examined differences in depressive symptoms and assessed the psychometric properties of the PHQ-9 and DASS-21 scales in a large student sample.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003cbr\u003e\nA cross-sectional survey was conducted among 602 students (Medical: n = 424; Non-Medical: n = 178) using the Patient Health Questionnaire-9 (PHQ-9) and the Depression, Anxiety, and Stress Scales-21 (DASS-21). Analyses included descriptive statistics, reliability (Cronbach’s α), confirmatory factor analysis (CFA), item response theory (IRT), and symptom network analysis, conducted in R.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003cbr\u003e\nMedian PHQ-9 scores were slightly higher among non-medical students (10.0, Q1–Q3 = 7.0–14.0) compared to medical students (9.0, Q1–Q3 = 5.0–13.0). Internal consistency was high for PHQ-9 (α = 0.82), DASS-Depression (α = 0.88), DASS-Anxiety (α = 0.85), and DASS-Stress (α = 0.86). CFA supported the three-factor DASS-21 model with good fit (CFI = 0.95, TLI = 0.95, RMSEA = 0.052, SRMR = 0.031). IRT analyses showed strongest discrimination for self-worth, concentration, down, and appetite items, while interest contributed the least. Symptom network analysis identified self-worth, concentration, and meaninglessness as central nodes, with somatic items (sleep, appetite, energy) bridging across domains.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003cbr\u003e\nNon-medical students reported slightly higher depressive symptoms compared to medical students, though both groups showed substantial burden. The PHQ-9 and DASS-21 demonstrated excellent reliability and construct validity. Interventions should target central symptoms, such as self-worth and concentration difficulties, to enhance mental health support in university populations.\u003c/p\u003e","manuscriptTitle":"Stress in Study: Assessing Depression Differences Among Medical and Non- Medical Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-16 09:08:03","doi":"10.21203/rs.3.rs-7508873/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-04T16:58:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T08:04:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-19T05:23:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"168828779308483676573526282493748526189","date":"2026-04-10T15:38:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"134972337997719982706760340325362403998","date":"2026-04-02T16:47:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-09T12:56:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-09T12:55:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-09T12:48:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-04T22:02:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-09-04T21:59:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"19603fea-fd61-46c6-b2dc-f34612f32929","owner":[],"postedDate":"September 16th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-04T16:58:10+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T17:09:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-16 09:08:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7508873","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7508873","identity":"rs-7508873","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}