Introduction
Coronavirus disease (COVID-2019) pandemic has caused a worldwide increase of hospitalization from pneumonia and multiorgan failure (1). During such a difficult time, there was an increased risk of many mental disorders such as Obsessive-compulsive disorder (OCD) and anxiety among health care workers (2).
OCD is one of the common mental disorders that people have worldwide and can have a life-time prevalence of 1.1-3.3%. OCD can have a wide range of symptoms and can take many forms which might make diagnosis difficult. OCS usually develops during adolescence and late teens and the median age is usually around 20 years of age, which makes university students more susceptible to develop it. Unfortunately, undergraduate medical students have particular risk due to the nature of their curriculum that allows less time for leisure and due to the way they are taught to be more perfect and precise to the degree of obsess a little more; all these risk factors and others make medical students more prone to OCD than the general population (3-5). They are also more prone to have general anxiety disorder (GAD) and burnout from the aforementioned stressors that cause conflicts in work-life balance (6). COVID-19 adds up to their stressors by disrupting their pre-clinical and clinical training and by forcing them to adapt to the new social environment. This caused medical students to have 61% and 70% higher for anxiety and depression, respectively (7). A systematic review with meta-analysis found that anxiety prevalence was about 28% among medical students during COVID-19 (8). (7, 8)
Particularly in Syria, mental health has already been neglected for decades, and education has been significantly injured as many facilities were destroyed during the destruction of the Syrian social structure (18). There was a destruction of the health facilities and the economy deteriorated to the extent that poverty reached more than 80% which os probably worse now during COVID (2).
To study medicine in Syria through the public system which has the majority of medical students and considered the highest prestigious, students have to pass year 12 of school with high grades. Then they have to enter a preparatory school for one year. This year along with year 12 allow students to enter medical schools across Syria as their average marks are the determinant factors. Subsequently, students must do at least 2 years of pre-clinical learning and 2 years of clinical working. Finally, they must do one year of internship that has rotation and can graduate by doing the national medical exam, so undergraduate medical school is at least 6 years in total. Medical students in this study were categorized according to these groups.
Therefore, this study aims to assess the prevalence of anxiety and OCD among medical students in Syria, during the COVID-19 pandemic after 10 years of war.