Prevalence and Predictors of Depression Among First-Year Medical Students in the Kurdistan Region of Iraq: A Cross-Sectional Study

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Despite increasing concern, limited evidence exists on the prevalence and predictors of depression among first-year medical students in the Kurdistan Region of Iraq. Methods A cross-sectional study was conducted between November 2024 and January 2025 using an online self-administered questionnaire. A total of 435 first-year medical students participated. Depression was assessed using the Beck Depression Inventory-II (BDI-II). Sociodemographic, lifestyle, and psychosocial characteristics were collected. Data were analyzed with SPSS version 27, and ordinal logistic regression was applied to identify predictors of depression severity. Results Overall, 59.2% of students reported some level of depression, with 24.1% experiencing moderate symptoms and 23.9% severe depression. Male students had significantly higher odds of severe depression compared with females (OR = 1.49, 95% CI: 1.02–2.17, p = 0.038). Energy drink consumption showed a protective association (OR = 0.66, 95% CI: 0.45–0.98, p = 0.039). Exercise showed a non-significant protective trend, while socioeconomic status, academic performance, sleep, social support, and life events were not significantly associated with depression severity. Conclusion Depression is highly prevalent among first-year medical students in the Kurdistan Region, with nearly half of cases falling within the moderate-to-severe range. Male gender emerged as a key risk factor, while some lifestyle behaviors showed protective effects. These findings highlight the urgent need for targeted interventions, preventive strategies, and institutional support during the early stages of medical education. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Biological sciences/Psychology Social science/Psychology Health sciences/Risk factors Depression Medical students First-year Kurdistan Region Predictors Cross-sectional study Figures Figure 1 Introduction Students in the field of medicine frequently experience the debilitating mental health condition known as depression, which adversely affects productivity, overall life satisfaction, and future career prospects. The transition into the demanding environment of medical school can be particularly overwhelming, as students struggle with an extensive syllabus, practical sessions, and new social dynamics. Numerous studies indicate a heightened prevalence of depression and anxiety within this population [ 1 , 2 ]. In both the Kurdistan region and Iraq generally, concerning rates of depression and anxiety among students have prompted research into the underlying factors contributing to this issue. Al-Kadhimi et al. (2017) reported that 28% of students at the University of Baghdad experienced clinically significant depression, which was linked to educational and psychosocial stressors [ 3 ]. Similarly, Rasheed & Hussein (2019) found that 52.1% of students in Erbil exhibited depressive symptoms, with a higher prevalence among males [ 4 ]. Research at Duhok University revealed that 70.7% of students suffered from generalized anxiety disorder, a condition that often coexists with depressive symptoms [ 5 ]. Additionally, findings from Sulaimaniyah suggest that most patients with major depressive disorders exhibit moderate symptoms and a high resistance to medication [ 6 ]. First-year medical students are at a greater risk of depression compared to students in other years. For instance, a study in Nepal revealed that 44% of first-year students reported experiencing depression [ 7 ]. A study conducted in South India supports this observation, indicating that levels of depression, anxiety, and stress significantly increased during the first half of medical training, especially among students with maladaptive coping styles [ 8 ]. These studies demonstrate that depression is a widespread issue transcending borders, impacting medical students due to academic, personal, and social pressures. However, there is a significant lack of information specifically concerning first-year medical students in the Kurdistan Region of Iraq. This transitional period is particularly sensitive and represents a critical time for intervention. Therefore, the current study aims to determine the prevalence and contributing factors of depression among first-year medical students in the region. Methodology Study Design and Setting An online self-administered questionnaire was developed and implemented as part of a descriptive cross-sectional study conducted from November 23, 2024, to January 15, 2025. The questionnaire was distributed through various sociotechnical platforms, including Facebook, WhatsApp, and Telegram, as well as through collaborative systems in both public and private institutions within the Kurdistan Region. Study Population The target population comprised first-year medical students aged 17 and older. Participants who did not provide verbal consent were excluded from the study. Additionally, students who were not first-year medical students or who submitted ambiguous or incomplete responses were also excluded. Sample Size and Sampling A total of 435 responses were considered and thoroughly analyzed for the study. This was a convenient sampling exercise, allowing any interested individual with access to the survey link to participate. Study Instrument Depression was assessed using the Beck Depression Inventory-II (BDI-II), a self-administered scale consisting of 21 items that have been pre-validated for reliability. Each item is scored on a scale from 0 to 3, resulting in an overall score ranging from 0 to 63. The cutoffs, as established by previous study [ 9 ], are as follows: 0–13 = Minimal depression 14–19: mild depression 20–28 = Moderate depression 29–63 = Severe depression In addition to collecting sociodemographic data (such as age, gender, state of residence, marital status, and socioeconomic status), various lifestyle and psychosocial factors were assessed. These included sleep patterns, exercise habits, energy drink consumption, family history of mental illness, levels of social support, and experiences of significant life events. Pilot Testing and Reliability A small group of students completed the questionnaires to streamline the data collection instrument. No significant alterations were necessary. The BDI-II demonstrated a high level of internal reliability, with a Cronbach’s alpha of 0.85. Data Collection Procedure Informed consent was obtained through an online survey platform before participants could take part in the study. Participants were limited to a single submission, and responses were collected anonymously. Data analysis Spreadsheet software was used to transfer the information to Microsoft Excel, and the information was analyzed with SPSS version 27. A summary of the participants' demographic and depression level data was captured using descriptive statistics. The independent predictors for the data were estimated using ordinal logistic regression, and the odds ratio (OR) with accompanying 95 percent confidence intervals (CI) was calculated. The p-value that was less than 0.05 was statistically significant. Ethical Approval This study received ethical approval from the Research Ethics Committee, Faculty of General Medicine, Koya University (Meeting code: 3, Paper code: 12, Date: 24/10/2024). Written informed consent was obtained from all participants before data collection. Confidentiality and anonymity were maintained throughout the research process, and participation was entirely voluntary, with the option to withdraw at any stage without penalty. All methods were carried out in accordance with relevant guidelines and regulations, including the ethical standards outlined in the Declaration of Helsinki. Results Sociodemographic characteristics The data for the figures can be found in Table 1, which covers the sociodemographic of the participants. Of the first-year medical students, 252 were males and 183 were females. Most of the respondents were students with rural living (51.3%) as opposed to urban (48.7%). Most of the participants were single (94.9%), while 5.1% were married. In terms of students’ socioeconomic status, more than half of the participants came from a middle socioeconomic background (54.7%). Many of the students were in the age range of 17 to 18 years (71.7%), and the minority of the students were in the range of 21 to 22 years (1.6%), with no participants being older than 23 years. Table 1. Sociodemographic characteristics of first-year medical students in the Kurdistan Region (n = 435) Variable Category Frequency Percentage Gender Male 252 57.9% Female 183 42.1% Residence Rural 223 51.3% Urban 212 48.7% Marital Status Single 413 94.9% Married 22 5.1% Socioeconomic Status Low 110 25.3% Middle 238 54.7% High 87 20.0% Age Group (years) 17–18 312 71.7% 19–20 116 26.7% 21–22 7 1.6% 23–24 0 0.0% Lifestyle and Psychosocial Traits The distribution of hours spent sleeping was rather predictable as captured in Table 2, making it unsurprising that 34.7% of people claimed they slept for 4 to 5 hours, 31.5% for 6 to 7 hours, and 33.8% for 8 to 9 hours. Not reporting any more than 10 hours of sleep was in line with this data. Regular exercise was only practiced by 40.7% of people, with 59.3% not participating in any form of exercise. Just 27.8% of students stated that they used energy drinks, with the majority, 72.2%, saying they did not. The prevalence of a positive family history of a mental illness was also considerably low, at 16.8%. The rest of the psychosocial data was somewhat positive, as 68.3% of students had favorable social support, with the remaining 31.7% having low social support. Around 56.6% of people had not gone through any significant life events compared with 43.4% who had. Table 2. Lifestyle and psychosocial characteristics of first-year medical students in the Kurdistan Region (n = 435) Variable Category Frequency Percentage Sleep hours 4–5 hours 151 34.7% 6–7 hours 137 31.5% 8–9 hours 147 33.8% 10+ hours 0 0.0% Exercise Yes 177 40.7% No 258 59.3% Energy drink use Yes 121 27.8% No 314 72.2% Family history of mental illness Yes 73 16.8% No 362 83.2% Social support Good 297 68.3% Poor 138 31.7% Life events Yes 189 43.4% No 246 56.6% Prevalence of depression Figure 1 illustrates the distribution of depression severity for this population. Out of 435 students, 178 (40.8%) had minimal depression, 49 (11.2%) had mild depression, 105 (24.1%) had moderate depression, and 104 (23.9%) had severe depression. This figure shows that a large portion, 59.2% of students, experienced depression to some extent, with close to half of this number reporting symptoms of moderate to severe depression. Factors associated with depression severity Depression severity results of the ordinal logistic regression approach were presented in Table 3. Being male was found to be a significant predictor of depression severity, with males having 1.49 higher odds of reporting more severe depression as compared to females (OR = 1.488, 95% CI: 1.023–2.166, p = 0.038). Odds of depression severity were found to be higher when the respondents did not use energy drinks (OR = 0.660, 95% CI: 0.445–0.978, p = 0.039). Protective trends were shown with exercise (OR = 0.727, p = 0.079), even though it was not a significant finding. Age also demonstrated a weak correlation (OR = 1.254, p = 0.089), suggesting older students still carry more risk of more severe depression. Other factors—residence, social class, school achievements, a personal or family history of mental disease, accessible emotional support, and the impact of life changes—were not found to have significant association with depression severity. Table 3. Ordinal logistic regression analysis of factors associated with depression severity among first-year medical students in the Kurdistan Region (n = 435) Variable OR Lower 95% CI Upper 95% CI P-value Age 1.254 0.966 1.626 0.089 Gender (Male) 1.488 1.023 2.166 0.038 Sleep hours 0.932 0.841 1.032 0.176 Residence (Urban) 1.115 0.785 1.584 0.542 Socioeconomic status (Low) 1.066 0.631 1.800 0.813 Socioeconomic status (Middle) 1.323 0.836 2.092 0.232 Academic performance (Good) 1.097 0.735 1.636 0.651 Academic performance (Poor) 0.817 0.496 1.346 0.428 Exercise (Yes) 0.727 0.510 1.038 0.079 Energy drink use (Yes) 0.660 0.445 0.978 0.039 Family history (Yes) 0.943 0.592 1.502 0.806 Social support (Poor) 1.123 0.772 1.634 0.545 Life events (Yes) 1.080 0.758 1.538 0.670 Discussion Main findings This study evaluated the extent, intensity, and predictors of depression among the first-year medical students in the Kurdistan Region of Iraq. The results indicate considerable depressive symptomatology, as almost sixty percent of students (59.2%) registered some measure of depression. Alarmingly, almost half of these cases were classified as having moderate to severe depression, indicating considerable distress in this population. Prevalence of depression The prevalence of depression found in this study (59.2% overall, with nearly half in the moderate-to-severe range) is in line with growing evidence from Iraq and the Kurdistan Region. In Erbil, Rasheed and Hussein (2019) reported depression in 52.1% of medical students, with males more affected than females—a finding that mirrors our results and highlights a potentially context-specific gender pattern. Similarly, in Baghdad, Al-Kadhimi et al. (2017) [3] observed depressive symptoms in 28% of medical students, while a more recent Baghdad study using PHQ-9 indicated that 57.9% of students were in the mild-to-moderate range, confirming the widespread burden of psychological distress in Iraqi cohorts [10]. Data from Duhok further reinforce this trend, where 70.7% of medical students were diagnosed with generalized anxiety disorder, with severity associated with female gender, urban residence, and poor academic performance [5]. Together, these Iraqi findings are consistent with our high prevalence estimates, though methodological differences (e.g., use of BDI-II vs PHQ-9 vs GAD-7) may explain variations in reported rates. Our findings also align with international studies documenting high levels of distress during early medical training. In Nepal, Shah et al. (2021) [7] found that 44% of first-year medical students reported depressive symptoms, while in South India, Mallaram et al. (2024) [8] observed a significant rise in depression, anxiety, and stress within the first six months of study. A German study reported high rates of psychological burden among medical students, particularly during the preclinical years, where up to 53% of participants reported moderate-to-severe depressive symptoms [11]. Similarly, a multicenter study in China found that 47.3% of medical students reported depression, with academic stress and low social support identified as key predictors [12]. These rates are slightly lower than ours, but they reflect the same vulnerability of students during the transition to medical education. Comparable evidence is also available from the Middle East and Asia. A cross-sectional study in Saudi Arabia reported that 46% of medical students experienced depressive symptoms, with lifestyle and academic pressures as primary contributors [13]. This previously proved in a review, depression is significantly more common among medical students than in the general population, affecting about one-third worldwide. Symptoms often worsen during medical school and are linked with anxiety, burnout, and suicidal thoughts. Contributing factors include heavy workloads, stressful clinical environments, competitive grading, and personality traits like perfectionism, while stigma and confidentiality concerns hinder help-seeking. Protective factors such as social support, exercise, and resilience can reduce risk. The authors recommend that medical schools adopt integrated strategies—such as well-being curricula, peer support, pass/fail grading, and stigma reduction—to promote mental health and create a healthier learning culture [14]. While a lower rate has been found in South Asia, a study reported that 19% of medical students were depressed, with the highest prevalence among first-year students (25%), followed by final-year (20%) and third-year students (12%) [15]. The underreporting of depression in South Asia (19%) may stem from the social and economic differences between the region and Kurdistan, Iraq. Students in the region face political instability, insufficient finances, a lack of mental health support, and unpredictable job markets, which brings on added burdens. This growth in stress absolutely elevates the chances of depression. In South Asia, students face enormous pressure, yet more fundamental economic struggles and security problems might be less severe. There are sociocultural factors inhibiting the reporting of depression. Students in certain places may minimize the severity of the illness due to stigma, which could be a weaker explanation for the underreported cases. A more recent systematic review and meta-analysis of medical students’ mental health concluded that depressive symptoms are prevalent across diverse educational systems, with pooled estimates around 19.4% [16], though rates often exceed 22% in Indonesia [17]. Compared to these external figures, our results fall at the higher end, suggesting either a greater psychological toll in the Kurdistan Region or fewer protective resources available to students. Taken together, both internal and external studies confirm that depression among medical students is widespread, with consistently high prevalence during the early years of training. Our study shares important similarities with Iraqi and regional findings, particularly the high proportion of students with clinically significant symptoms and the unexpected higher severity among males. Differences with some international studies—such as the stronger role of socioeconomic and academic predictors in other contexts or slightly lower prevalence rates in Western and East Asian settings—likely reflect cultural, institutional, and methodological factors. Nevertheless, the overarching picture is clear: first-year medical training is a critical period of vulnerability globally, and in the Kurdistan Region, the burden appears particularly severe, strengthening the call for context-sensitive preventive strategies and early intervention. Differences within gender The current study shows how male students reported more depression severity than female students. This is unusual given that many studies worldwide, including in South Asia, argue that the depression is more pronounced and frequent in women due to sociocultural constructs, gender expectations, and role in society. That said, studies in Iraq remain inconclusive. For instance, Rasheed & Hussein (2019) [4] also reported that males in Erbil have greater depression levels. This shows that cultural contexts may impact the gendered pattern of distress reporting and suggests that male students in the Kurdistan Region might be enduring more significant pressures, such as financial and academic expectations. Lifestyles and psychosocial issues Perhaps the most notable finding was the association between energy drink consumption and lower odds of depression severity. While this may reflect the temporarily stimulating effects of caffeine and related ingredients, it raises questions about sustainability and whether such use constitutes a healthy coping strategy. Previous studies have linked high energy drink consumption to increased depression, anxiety, sleep disturbances, and risky behaviors [18], suggesting that the protective association observed here should be interpreted with caution. One possible explanation is that students who consume energy drinks may also engage in other adaptive coping mechanisms, whereas non-consumers may represent a more vulnerable subgroup. Further research is needed to clarify this complex relationship. Although not statistically significant, exercise demonstrated a protective trend, with students who exercised regularly showing lower odds of depression. This finding is not consistent with international literature that highlights the benefits of physical activity for stress reduction and mood regulation [19]. In contrast, sleep duration and social support were not significantly associated with depression severity in this study, despite being well-established predictors of mental health in other contexts [20,21]. This discrepancy may be due to limitations in measurement, sample size, or cultural influences that shaped how these factors were reported or experienced. Academic and socioeconomic factors The study found no significant association between depression severity and either academic performance or socioeconomic status. This aligns with another study in India [8], while there is another study that reported that a higher depression level can delay academic progression [22]. This indicates that the immediate pressures of adapting to medical school, particularly during the first year, may overshadow the impact of these background factors. In other words, structural characteristics such as socioeconomic position or academic standing may exert less influence compared with the intense psychological and academic demands inherent in the early stages of medical training. These findings carry important implications for medical schools and policymakers in the Kurdistan Region. Strengthening the mental health components of medical education, embedding awareness and coping strategies into the curriculum, and improving access to counseling services are essential. Interventions should not only focus on alleviating existing depressive symptoms but also emphasize building resilience, reducing stigma, and fostering supportive academic environments that protect students’ long-term mental health and professional development. Strengths This study had several strengths. First, depression was assessed using the Beck Depression Inventory-II (BDI-II), a validated and widely used instrument for measuring depressive symptoms. Second, the sample size was relatively large (n = 435), enhancing the generalizability of the findings to first-year medical students in the region. Third, by focusing specifically on students without a reported history of mental illness, the study was able to examine depression within a population that is particularly vulnerable during their initial exposure to the stresses of medical education. Despite these strengths, some limitations must be acknowledged. The use of a self-report instrument introduces the possibility of recall or response bias. The cross-sectional design prevents determination of causality or identification of predictive factors over time, highlighting the need for longitudinal research. The online survey format and convenience sampling may have produced selection bias, as participation was likely skewed toward students with internet access or a greater interest in mental health issues. Additionally, several predictors (e.g., energy drink consumption, social support) were assessed using single-item measures, which may oversimplify complex constructs. Finally, cultural stigma surrounding mental illness in the region may have contributed to underreporting of depressive symptoms. Conclusion In summary, the medical students in the Kurdistan Region showed a high prevalence of depression, with almost 60% of first-year students reporting depressive symptoms and an alarming prevalence of almost 50% experiencing moderate to severe depression. Being a male student was identified as a risk, and while protective factors such as energy drink consumption should also be investigated, this study found prevalence data lacking. This study highlights the need for medical schools to implement mental health first aid programs, as well as screening and preventive measures, to protect the students' mental well-being. Declarations Relevant to SDGs This study aligns with SDG 3 (Good Health and Well-being), SDG 4 (Quality Education), and SDG 10 (Reduced Inequalities) by addressing academic burnout, promoting mental health, and highlighting the impact of socioeconomic disparities on student achievement. Ethical consideration This study received ethical approval from the Research Ethics Committee, Faculty of General Medicine, Koya University (Meeting code: 3, Paper code: 12, Date: 24/10/2024). Written informed consent was obtained from all participants before data collection. Confidentiality and anonymity were maintained throughout the research process, and participation was entirely voluntary, with the option to withdraw at any stage without penalty. Conflict of interest There is no conflict of interest. Data availability The data is available on request. Funding source The fund has not been received for this paper. Author contribution This paper is research solo. 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13:48:36","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":84581,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7754717/v1/28d6f43596a2ae7d1b510a1f.html"},{"id":100689424,"identity":"02e5a76d-f47d-47e4-997d-a1378bae3f43","added_by":"auto","created_at":"2026-01-20 13:42:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":120443,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLevel of depression among participants\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7754717/v1/a9fc99f4365f495761822dc5.png"},{"id":105565749,"identity":"d1f74c7c-6996-461c-a569-eb8a6efef9f7","added_by":"auto","created_at":"2026-03-27 12:54:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1250531,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7754717/v1/b25e76b3-d57c-42bd-a806-eee10f7e6db8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Predictors of Depression Among First-Year Medical Students in the Kurdistan Region of Iraq: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eStudents in the field of medicine frequently experience the debilitating mental health condition known as depression, which adversely affects productivity, overall life satisfaction, and future career prospects. The transition into the demanding environment of medical school can be particularly overwhelming, as students struggle with an extensive syllabus, practical sessions, and new social dynamics. Numerous studies indicate a heightened prevalence of depression and anxiety within this population [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn both the Kurdistan region and Iraq generally, concerning rates of depression and anxiety among students have prompted research into the underlying factors contributing to this issue. Al-Kadhimi et al. (2017) reported that 28% of students at the University of Baghdad experienced clinically significant depression, which was linked to educational and psychosocial stressors [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Similarly, Rasheed \u0026amp; Hussein (2019) found that 52.1% of students in Erbil exhibited depressive symptoms, with a higher prevalence among males [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Research at Duhok University revealed that 70.7% of students suffered from generalized anxiety disorder, a condition that often coexists with depressive symptoms [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Additionally, findings from Sulaimaniyah suggest that most patients with major depressive disorders exhibit moderate symptoms and a high resistance to medication [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFirst-year medical students are at a greater risk of depression compared to students in other years. For instance, a study in Nepal revealed that 44% of first-year students reported experiencing depression [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A study conducted in South India supports this observation, indicating that levels of depression, anxiety, and stress significantly increased during the first half of medical training, especially among students with maladaptive coping styles [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese studies demonstrate that depression is a widespread issue transcending borders, impacting medical students due to academic, personal, and social pressures. However, there is a significant lack of information specifically concerning first-year medical students in the Kurdistan Region of Iraq. This transitional period is particularly sensitive and represents a critical time for intervention. Therefore, the current study aims to determine the prevalence and contributing factors of depression among first-year medical students in the region.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eAn online self-administered questionnaire was developed and implemented as part of a descriptive cross-sectional study conducted from November 23, 2024, to January 15, 2025. The questionnaire was distributed through various sociotechnical platforms, including Facebook, WhatsApp, and Telegram, as well as through collaborative systems in both public and private institutions within the Kurdistan Region.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe target population comprised first-year medical students aged 17 and older. Participants who did not provide verbal consent were excluded from the study. Additionally, students who were not first-year medical students or who submitted ambiguous or incomplete responses were also excluded.\u003c/p\u003e\n\u003ch3\u003eSample Size and Sampling\u003c/h3\u003e\n\u003cp\u003eA total of 435 responses were considered and thoroughly analyzed for the study. This was a convenient sampling exercise, allowing any interested individual with access to the survey link to participate.\u003c/p\u003e\n\u003ch3\u003eStudy Instrument\u003c/h3\u003e\n\u003cp\u003eDepression was assessed using the Beck Depression Inventory-II (BDI-II), a self-administered scale consisting of 21 items that have been pre-validated for reliability. Each item is scored on a scale from 0 to 3, resulting in an overall score ranging from 0 to 63. The cutoffs, as established by previous study [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], are as follows:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e0\u0026ndash;13\u0026thinsp;=\u0026thinsp;Minimal depression\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e14\u0026ndash;19: mild depression\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e20\u0026ndash;28\u0026thinsp;=\u0026thinsp;Moderate depression\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e29\u0026ndash;63\u0026thinsp;=\u0026thinsp;Severe depression\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eIn addition to collecting sociodemographic data (such as age, gender, state of residence, marital status, and socioeconomic status), various lifestyle and psychosocial factors were assessed. These included sleep patterns, exercise habits, energy drink consumption, family history of mental illness, levels of social support, and experiences of significant life events.\u003c/p\u003e\n\u003ch3\u003ePilot Testing and Reliability\u003c/h3\u003e\n\u003cp\u003eA small group of students completed the questionnaires to streamline the data collection instrument. No significant alterations were necessary. The BDI-II demonstrated a high level of internal reliability, with a Cronbach\u0026rsquo;s alpha of 0.85.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Procedure\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eInformed consent\u003c/strong\u003e \u003cp\u003ewas obtained through an online survey platform before participants could take part in the study. Participants were limited to a single submission, and responses were collected anonymously.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eSpreadsheet software was used to transfer the information to Microsoft Excel, and the information was analyzed with SPSS version 27. A summary of the participants' demographic and depression level data was captured using descriptive statistics. The independent predictors for the data were estimated using ordinal logistic regression, and the odds ratio (OR) with accompanying 95 percent confidence intervals (CI) was calculated. The p-value that was less than 0.05 was statistically significant.\u003c/p\u003e \u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received ethical approval from the Research Ethics Committee, Faculty of General Medicine, Koya University (Meeting code: 3, Paper code: 12, Date: 24/10/2024). Written informed consent was obtained from all participants before data collection. Confidentiality and anonymity were maintained throughout the research process, and participation was entirely voluntary, with the option to withdraw at any stage without penalty. All methods were carried out in accordance with relevant guidelines and regulations, including the ethical standards outlined in the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Results ","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data for the figures can be found in Table 1, which covers the sociodemographic of the participants. Of the first-year medical students, 252 were males and 183 were females. Most of the respondents were students with rural living (51.3%) as opposed to urban (48.7%). Most of the participants were single (94.9%), while 5.1% were married. In terms of students\u0026rsquo; socioeconomic status, more than half of the participants came from a middle socioeconomic background (54.7%). Many of the students were in the age range of 17 to 18 years (71.7%), and the minority of the students were in the range of 21 to 22 years (1.6%), with no participants being older than 23 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Sociodemographic characteristics of first-year medical students in the Kurdistan Region (n = 435)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e94.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocioeconomic Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Group (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17\u0026ndash;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e71.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19\u0026ndash;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21\u0026ndash;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23\u0026ndash;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eLifestyle and Psychosocial Traits\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe distribution of hours spent sleeping was rather predictable as captured in Table 2, making it unsurprising that 34.7% of people claimed they slept for 4 to 5 hours, 31.5% for 6 to 7 hours, and 33.8% for 8 to 9 hours. Not reporting any more than 10 hours of sleep was in line with this data. Regular exercise was only practiced by 40.7% of people, with 59.3% not participating in any form of exercise. Just 27.8% of students stated that they used energy drinks, with the majority, 72.2%, saying they did not. The prevalence of a positive family history of a mental illness was also considerably low, at 16.8%.\u003c/p\u003e\n\u003cp\u003eThe rest of the psychosocial data was somewhat positive, as 68.3% of students had favorable social support, with the remaining 31.7% having low social support. Around 56.6% of people had not gone through any significant life events compared with 43.4% who had.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Lifestyle and psychosocial characteristics of first-year medical students in the Kurdistan Region (n = 435)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep hours\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u0026ndash;5 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u0026ndash;7 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u0026ndash;9 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10+ hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExercise\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnergy drink use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e72.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily history of mental illness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e362\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e83.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e68.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLife events\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of depression\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 1 illustrates the distribution of depression severity for this population. Out of 435 students, 178 (40.8%) had minimal depression, 49 (11.2%) had mild depression, 105 (24.1%) had moderate depression, and 104 (23.9%) had severe depression. This figure shows that a large portion, 59.2% of students, experienced depression to some extent, with close to half of this number reporting symptoms of moderate to severe depression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with depression severity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepression severity results of the ordinal logistic regression approach were presented in Table 3. Being male was found to be a significant predictor of depression severity, with males having 1.49 higher odds of reporting more severe depression as compared to females (OR = 1.488, 95% CI: 1.023\u0026ndash;2.166, p = 0.038). Odds of depression severity were found to be higher when the respondents did not use energy drinks (OR = 0.660, 95% CI: 0.445\u0026ndash;0.978, p = 0.039). Protective trends were shown with exercise (OR = 0.727, p = 0.079), even though it was not a significant finding. Age also demonstrated a weak correlation (OR = 1.254, p = 0.089), suggesting older students still carry more risk of more severe depression. Other factors\u0026mdash;residence, social class, school achievements, a personal or family history of mental disease, accessible emotional support, and the impact of life changes\u0026mdash;were not found to have significant association with depression severity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Ordinal logistic regression analysis of factors associated with depression severity among first-year medical students in the Kurdistan Region (n = 435)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower 95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper 95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.966\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.626\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender (Male)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep hours\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence (Urban)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.542\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocioeconomic status (Low)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.813\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocioeconomic status (Middle)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.836\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.232\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcademic performance (Good)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.735\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.636\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.651\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcademic performance (Poor)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.496\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.428\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExercise (Yes)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.727\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnergy drink use (Yes)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.660\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.445\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily history (Yes)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.943\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.806\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial support (Poor)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.772\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.634\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.545\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLife events (Yes)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.758\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.670\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion ","content":"\u003cp\u003e\u003cstrong\u003eMain findings\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study evaluated the extent, intensity, and predictors of depression among the first-year medical students in the Kurdistan Region of Iraq. The results indicate considerable depressive symptomatology, as almost sixty percent of students (59.2%) registered some measure of depression. Alarmingly, almost half of these cases were classified as having moderate to severe depression, indicating considerable distress in this population.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of depression\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of depression found in this study (59.2% overall, with nearly half in the moderate-to-severe range) is in line with growing evidence from Iraq and the Kurdistan Region. In Erbil, Rasheed and Hussein (2019) reported depression in 52.1% of medical students, with males more affected than females\u0026mdash;a finding that mirrors our results and highlights a potentially context-specific gender pattern. Similarly, in Baghdad, Al-Kadhimi et al. (2017) [3] observed depressive symptoms in 28% of medical students, while a more recent Baghdad study using PHQ-9 indicated that 57.9% of students were in the mild-to-moderate range, confirming the widespread burden of psychological distress in Iraqi cohorts [10]. Data from Duhok further reinforce this trend, where 70.7% of medical students were diagnosed with generalized anxiety disorder, with severity associated with female gender, urban residence, and poor academic performance [5]. Together, these Iraqi findings are consistent with our high prevalence estimates, though methodological differences (e.g., use of BDI-II vs PHQ-9 vs GAD-7) may explain variations in reported rates.\u003c/p\u003e\n\u003cp\u003eOur findings also align with international studies documenting high levels of distress during early medical training. In Nepal, Shah et al. (2021) [7] found that 44% of first-year medical students reported depressive symptoms, while in South India, Mallaram et al. (2024) [8] observed a significant rise in depression, anxiety, and stress within the first six months of study. A German study reported high rates of psychological burden among medical students, particularly during the preclinical years, where up to 53% of participants reported moderate-to-severe depressive symptoms [11]. Similarly, a multicenter study in China found that 47.3% of medical students reported depression, with academic stress and low social support identified as key predictors [12]. These rates are slightly lower than ours, but they reflect the same vulnerability of students during the transition to medical education.\u003c/p\u003e\n\u003cp\u003eComparable evidence is also available from the Middle East and Asia. A cross-sectional study in Saudi Arabia reported that 46% of medical students experienced depressive symptoms, with lifestyle and academic pressures as primary contributors [13]. This previously proved in a review, depression is significantly more common among medical students than in the general population, affecting about one-third worldwide. Symptoms often worsen during medical school and are linked with anxiety, burnout, and suicidal thoughts. Contributing factors include heavy workloads, stressful clinical environments, competitive grading, and personality traits like perfectionism, while stigma and confidentiality concerns hinder help-seeking. Protective factors such as social support, exercise, and resilience can reduce risk. The authors recommend that medical schools adopt integrated strategies\u0026mdash;such as well-being curricula, peer support, pass/fail grading, and stigma reduction\u0026mdash;to promote mental health and create a healthier learning culture [14]. While a lower rate has been found in South Asia, a study reported that 19% of medical students were depressed, with the highest prevalence among first-year students (25%), followed by final-year (20%) and third-year students (12%) [15]. The underreporting of depression in South Asia (19%) may stem from the social and economic differences between the region and Kurdistan, Iraq. Students in the region face political instability, insufficient finances, a lack of mental health support, and unpredictable job markets, which brings on added burdens. This growth in stress absolutely elevates the chances of depression. In South Asia, students face enormous pressure, yet more fundamental economic struggles and security problems might be less severe. There are sociocultural factors inhibiting the reporting of depression. Students in certain places may minimize the severity of the illness due to stigma, which could be a weaker explanation for the underreported cases.\u003c/p\u003e\n\u003cp\u003eA more recent systematic review and meta-analysis of medical students\u0026rsquo; mental health concluded that depressive symptoms are prevalent across diverse educational systems, with pooled estimates around 19.4% [16], though rates often exceed 22% in Indonesia [17]. Compared to these external figures, our results fall at the higher end, suggesting either a greater psychological toll in the Kurdistan Region or fewer protective resources available to students.\u003c/p\u003e\n\u003cp\u003eTaken together, both internal and external studies confirm that depression among medical students is widespread, with consistently high prevalence during the early years of training. Our study shares important similarities with Iraqi and regional findings, particularly the high proportion of students with clinically significant symptoms and the unexpected higher severity among males. Differences with some international studies\u0026mdash;such as the stronger role of socioeconomic and academic predictors in other contexts or slightly lower prevalence rates in Western and East Asian settings\u0026mdash;likely reflect cultural, institutional, and methodological factors. Nevertheless, the overarching picture is clear: first-year medical training is a critical period of vulnerability globally, and in the Kurdistan Region, the burden appears particularly severe, strengthening the call for context-sensitive preventive strategies and early intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDifferences within gender\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current study shows how male students reported more depression severity than female students. This is unusual given that many studies worldwide, including in South Asia, argue that the depression is more pronounced and frequent in women due to sociocultural constructs, gender expectations, and role in society. That said, studies in Iraq remain inconclusive. For instance, Rasheed \u0026amp; Hussein (2019) [4] also reported that males in Erbil have greater depression levels. This shows that cultural contexts may impact the gendered pattern of distress reporting and suggests that male students in the Kurdistan Region might be enduring more significant pressures, such as financial and academic expectations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLifestyles and psychosocial issues\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePerhaps the most notable finding was the association between energy drink consumption and lower odds of depression severity. While this may reflect the temporarily stimulating effects of caffeine and related ingredients, it raises questions about sustainability and whether such use constitutes a healthy coping strategy. Previous studies have linked high energy drink consumption to increased depression, anxiety, sleep disturbances, and risky behaviors [18], suggesting that the protective association observed here should be interpreted with caution. One possible explanation is that students who consume energy drinks may also engage in other adaptive coping mechanisms, whereas non-consumers may represent a more vulnerable subgroup. Further research is needed to clarify this complex relationship.\u003c/p\u003e\n\u003cp\u003eAlthough not statistically significant, exercise demonstrated a protective trend, with students who exercised regularly showing lower odds of depression. This finding is not consistent with international literature that highlights the benefits of physical activity for stress reduction and mood regulation [19]. In contrast, sleep duration and social support were not significantly associated with depression severity in this study, despite being well-established predictors of mental health in other contexts [20,21]. This discrepancy may be due to limitations in measurement, sample size, or cultural influences that shaped how these factors were reported or experienced.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcademic and socioeconomic factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study found no significant association between depression severity and either academic performance or socioeconomic status. This aligns with another study in India [8], while there is another study that reported that a higher depression level can delay academic progression [22]. This indicates that the immediate pressures of adapting to medical school, particularly during the first year, may overshadow the impact of these background factors. In other words, structural characteristics such as socioeconomic position or academic standing may exert less influence compared with the intense psychological and academic demands inherent in the early stages of medical training.\u003c/p\u003e\n\u003cp\u003eThese findings carry important implications for medical schools and policymakers in the Kurdistan Region. Strengthening the mental health components of medical education, embedding awareness and coping strategies into the curriculum, and improving access to counseling services are essential. Interventions should not only focus on alleviating existing depressive symptoms but also emphasize building resilience, reducing stigma, and fostering supportive academic environments that protect students\u0026rsquo; long-term mental health and professional development.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study had several strengths. First, depression was assessed using the Beck Depression Inventory-II (BDI-II), a validated and widely used instrument for measuring depressive symptoms. Second, the sample size was relatively large (n = 435), enhancing the generalizability of the findings to first-year medical students in the region. Third, by focusing specifically on students without a reported history of mental illness, the study was able to examine depression within a population that is particularly vulnerable during their initial exposure to the stresses of medical education.\u003c/p\u003e\n\u003cp\u003eDespite these strengths, some limitations must be acknowledged. The use of a self-report instrument introduces the possibility of recall or response bias. The cross-sectional design prevents determination of causality or identification of predictive factors over time, highlighting the need for longitudinal research. The online survey format and convenience sampling may have produced selection bias, as participation was likely skewed toward students with internet access or a greater interest in mental health issues. Additionally, several predictors (e.g., energy drink consumption, social support) were assessed using single-item measures, which may oversimplify complex constructs. Finally, cultural stigma surrounding mental illness in the region may have contributed to underreporting of depressive symptoms.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, the medical students in the Kurdistan Region showed a high prevalence of depression, with almost 60% of first-year students reporting depressive symptoms and an alarming prevalence of almost 50% experiencing moderate to severe depression. Being a male student was identified as a risk, and while protective factors such as energy drink consumption should also be investigated, this study found prevalence data lacking. This study highlights the need for medical schools to implement mental health first aid programs, as well as screening and preventive measures, to protect the students\u0026apos; mental well-being.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eRelevant to SDGs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study aligns with SDG 3 (Good Health and Well-being), SDG 4 (Quality Education), and SDG 10 (Reduced Inequalities) by addressing academic burnout, promoting mental health, and highlighting the impact of socioeconomic disparities on student achievement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received ethical approval from the Research Ethics Committee, Faculty of General Medicine, Koya University (Meeting code: 3, Paper code: 12, Date: 24/10/2024). Written informed consent was obtained from all participants before data collection. Confidentiality and anonymity were maintained throughout the research process, and participation was entirely voluntary, with the option to withdraw at any stage without penalty.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data is available on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe fund has not been received for this paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis paper is research solo.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent of publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI hereby give my consent for the publication of the manuscript of the above title. I confirm that the work is original, not under consideration elsewhere, and approved by all author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany thanks for all the participants for their response.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNair, M. et al. Mental health trends among medical students. \u003cem\u003eProc. Bayl. Univ. Med. Cent.\u003c/em\u003e \u003cb\u003e36\u003c/b\u003e (3), 408\u0026ndash;410 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRich, A., Viney, R., Silkens, M., Griffin, A. \u0026amp; Medisauskaite, A. The experiences of students with mental health difficulties at medical school: a qualitative interview study. \u003cem\u003eMed. Educ. Online\u003c/em\u003e. \u003cb\u003e29\u003c/b\u003e (1), 2366557 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Kadhimi, F. 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Sleep duration and mental health in young adults. \u003cem\u003eSleep. Med.\u003c/em\u003e \u003cb\u003e115\u003c/b\u003e, 30\u0026ndash;38 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWickramaratne, P. J. et al. Social connectedness as a determinant of mental health: A scoping review. Pan X. \u003cem\u003eeditor PLOS ONE\u003c/em\u003e. \u003cb\u003e17\u003c/b\u003e (10), e0275004 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWagner, F. et al. The relationship between depression symptoms and academic performance among first-year undergraduate students at a South African university: a cross-sectional study. \u003cem\u003eBMC Public. Health\u003c/em\u003e. \u003cb\u003e22\u003c/b\u003e (1), 2067 (2022).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Depression, Medical students, First-year, Kurdistan Region, Predictors, Cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-7754717/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7754717/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDepression is a common mental health issue among medical students worldwide, particularly during the first year of training, when students face academic, social, and psychological pressures. Despite increasing concern, limited evidence exists on the prevalence and predictors of depression among first-year medical students in the Kurdistan Region of Iraq.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA cross-sectional study was conducted between November 2024 and January 2025 using an online self-administered questionnaire. A total of 435 first-year medical students participated. Depression was assessed using the Beck Depression Inventory-II (BDI-II). Sociodemographic, lifestyle, and psychosocial characteristics were collected. Data were analyzed with SPSS version 27, and ordinal logistic regression was applied to identify predictors of depression severity.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOverall, 59.2% of students reported some level of depression, with 24.1% experiencing moderate symptoms and 23.9% severe depression. Male students had significantly higher odds of severe depression compared with females (OR\u0026thinsp;=\u0026thinsp;1.49, 95% CI: 1.02\u0026ndash;2.17, p\u0026thinsp;=\u0026thinsp;0.038). Energy drink consumption showed a protective association (OR\u0026thinsp;=\u0026thinsp;0.66, 95% CI: 0.45\u0026ndash;0.98, p\u0026thinsp;=\u0026thinsp;0.039). Exercise showed a non-significant protective trend, while socioeconomic status, academic performance, sleep, social support, and life events were not significantly associated with depression severity.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDepression is highly prevalent among first-year medical students in the Kurdistan Region, with nearly half of cases falling within the moderate-to-severe range. Male gender emerged as a key risk factor, while some lifestyle behaviors showed protective effects. These findings highlight the urgent need for targeted interventions, preventive strategies, and institutional support during the early stages of medical education.\u003c/p\u003e","manuscriptTitle":"Prevalence and Predictors of Depression Among First-Year Medical Students in the Kurdistan Region of Iraq: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-20 11:27:34","doi":"10.21203/rs.3.rs-7754717/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"51ac9f38-be24-4d0f-b89a-0a6666eecaf6","owner":[],"postedDate":"January 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":61319441,"name":"Health sciences/Diseases"},{"id":61319442,"name":"Health sciences/Health care"},{"id":61319443,"name":"Health sciences/Medical research"},{"id":61319444,"name":"Biological sciences/Psychology"},{"id":61319445,"name":"Social science/Psychology"},{"id":61319446,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-03-26T05:09:45+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-20 11:27:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7754717","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7754717","identity":"rs-7754717","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}