Prevalence and predictors of anxiety and depression in medical students from low- and middle-income countries

Abstract

Background & Objective: Medical students in low- and middle-income countries (LMICs) encounter high academic demands and complex psychosocial stressors, increasing their vulnerability to mental health disorders. Anxiety and depression are particularly prevalent, yet evidence on their burden and predictors across LMICs remain fragmented.  This systematic review synthesizes the prevalence, predictors, and risk factors of anxiety and depression among undergraduate medical students in LMICs. Methodology: We conducted a systematic search of PubMed, Scopus, Google Scholar, and other sources for studies published in English between January 2020 to January 2025. Cross-sectional observational studies reporting prevalence of anxiety and/or depression among undergraduate medical students in LMICs were included. Risk of bias was assessed using JBI for cross-sectional studies and ROBIS for systematic reviews. Results: A total of 1,437 records were identified, of which 20 studies met the inclusion criteria, encompassing 69,871 medical students from diverse regions including Africa, South Asia, Southeast Asia, and the Middle East. The pooled prevalence of anxiety was 52.5% (±11.6), and depression was 40.6% (±6.3). Female students consistently showed higher vulnerability to anxiety and depression, and clinical-year students were more prone to depressive symptoms. Lifestyle factors such as high screen use increased risk, whereas physical activity was protective. Overweight status was associated with increased likelihood of depression (OR = 2.58). Comorbidity between anxiety, depression, and stress was common. Barriers to help-seeking, cultural stigma, academic stress, and insufficient institutional support were frequently reported. Conclusion: Anxiety and depression are highly prevalent among medical students in LMICs, influenced by academic, social, and lifestyle factors. Context-specific interventions, including mental health services, stress management, and anti-stigma initiatives, are essential to protect the well-being of future healthcare professionals.