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Psychological impact of self-quarantine on malaysian dental students during COVID-19 pandemic

1 Department of Pediatric Dentistry, Penang International Dental College, Butterworth, Penang, Malaysia
2 UG Dental Student, Penang International Dental College, Butterworth, Penang, Malaysia

Date of Submission19-Jan-2021
Date of Decision30-Mar-2021
Date of Acceptance14-Apr-2021

Correspondence Address:
Fawaz Shamim Siddiqui,
Department of Pediatric Dentistry, Penang International Dental College, Level 18, NB Tower, Jalan Bagan Luar, 12000, Butterworth, Penang
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_34_21


Background: Pandemics harm mental health by inducing stressors such as frustration, boredom, financial loss, self-isolation, fear of infection, and stigmatization. Students are vulnerable and at risk of ill effects of these stressors. Aim: The objective of this study was to determine the mental health status and associated social risk factors among dental students in Malaysia during the coronavirus disease 2019 pandemic. Materials and Methods: This was an online cross-sectional study done using the Depression Anxiety Stress Scale-21 questionnaire. The study was carried among the undergraduate dental students in Malaysia, during the period of compulsory self-quarantine. The prevalence of depression, anxiety, and stress (DAS) and their median scores were computed and analyzed with sociodemographic factors using Mann–Whitney U test, Kruskal–Wallis test, odds ratio, and Chi-square test. Results: The prevalence of DAS was 33.5%, 28.7%, and 7.3%, respectively, with no gender differences. Depression increased with increasing age (P = 0.043) and year of study (P = 0.015). The prevalence of depression was the highest in the students of Indian ethnicity (44%; P = 0. 018). Students from public universities reported a higher prevalence of anxiety (34%; P = 0.019) and stress scores (P = 0.013). A family's financial crisis increased the risk of DAS (P < 0.05). Being quarantined with family increased the odds of anxiety by 2.8 times (P < 0.05). Conclusion: Students were found to be vulnerable to the negative psychological impact of self-quarantine as measured by their mental health status. The study also identified demographic and social risk factors contributing toward this vulnerability.

Keywords: Anxiety, dental, depression, psychological, stress

How to cite this URL:
Siddiqui FS, Qian GY. Psychological impact of self-quarantine on malaysian dental students during COVID-19 pandemic. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2022 Dec 6]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=321277

  Introduction Top

On January 30, 2020, the World Health Organization (WHO) had declared the 2019-nCoV (novel coronavirus) outbreak as a Public Health Emergency of International Concern.[1] By this time, the coronavirus disease 2019 (COVID-19) had already spread to all the five WHO regions. The Malaysia government in the bid to mitigate the spread of the virus in the population took a timely decision to impose self-quarantine through enforcing the Movement Control Order (MCO) on the March 18, 2020.[2] This order instructed the general population to self-quarantine themselves and specifically prohibited mass movements and gatherings of people across the country including at places of recreation, worships, sports, and social and cultural activities. The MCO of 14 days eventually got extended multiple times owing to the increasing number of infectious cases in the country. Because the period of MCO was tied directly to the number of cases, there was an element of uncertainty about the period of lockdown.

Being in quarantine has been reported to cause negative psychological effects such as stress symptoms, confusion, anger, anxiety, feeling of helplessness, boredom, loneliness, and depression.[3],[4] The closure of educational institutions indefinitely affected students' educational activities and their psychosocial health.[5] The hustle-bustle of academic life shifted from synchronous to asynchronous online learning activities. This was reported as a cause of frustration in the previous epidemics.[6]

A position paper on multidisciplinary research priorities for the COVID-19 pandemic placed immediate priority on collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups and their mitigation.[7]

We hypothesized that the disruption of social and academic activities of dental students would make them vulnerable to the negative impact of self-isolation. With an online flexible teaching schedule with less active supervision and no clinical activities, students may be overwhelmed with the amount of leisure time at their disposal. With limited movement within living spaces and limited activities to do, students would feel bored, frustrated, and hopeless. We also hypothesized that general circumstances such as economic loss to the family, disruption of academics, fear of infection will affect the mental health of the student while being with family during quarantine will support them.

Therefore, the objective of this study was to determine the mental health status of undergraduate dental students in Malaysia during the compulsory self-quarantine period. The study also investigated possible social risk factors affecting mental well-being.

  Materials and Methods Top

This study was approved and conducted in accordance with the moral-ethical codes laid down by the Institutional Review Board (Approval ref. no. PIDC/IRB/FRP/1/20).

Study design and sample size

A cross-sectional study design was used to conduct the research using an online survey approach. The study population was dental students (year 1 to year 5) studying in private and public universities in Malaysia. The sample size calculation was done using the prevalence of depression, anxiety, and stress (DAS) as 30%.[8] The estimated minimum sample size of 323 respondents was obtained with a 95% confidence level and 5% confidence interval. Given the poor response rate to online data collection methods, we doubled the minimum estimated sample size to 646 responses. A combination of cluster and convenience sampling methods was used to draw the samples. Each university was considered as a cluster and through their respective dental deans; all their undergraduate dental students were invited to participate in the study.

Google Forms online survey platform was used to conduct the study. The Google Form contained an informed consent and a self-administered questionnaire. Those students who consented and were willing to participate in the study completed the form and submitted it. While those who were not undergraduate students or did not consent to the study or submitted an incomplete Google form were excluded from the study. The duration of data collection was 2 weeks.

Data collection tool

The self-administered Google form with structured close-ended questions (except for one open-ended one) was used to collect the demographic details and to administer the Depression Anxiety Stress Scale-21 (DASS-21) questionnaire [Appendix 1].

DASS-21 questionnaire measured three scales, namely DAS using 21 questions.[9] Each of these three scales had 7 items each. A five-point Likert scale was used to rate the severity/frequency of these items experienced by the respondents over the past week. The total score of each scale was computed by adding up the individual scores of all the items in that scale and multiplying it by a factor of 2. The cutoff scores used to define the severity of the three scales were taken from the Malaysian adolescent mental health survey.[10]

Statistical analysis

Statistical analysis was performed using IBM Corp. released 2011, IBM SPSS Statistics for Windows, version 20.0. Armonk, NY: IBM Corp. Since the data obtained were in ordinal and categorical measurements, descriptive statistics using median and proportions were used to summarize the data. To test the relationship between the variables inferential statistics were used. For the ordinal data, Median Test for K-Independent samples (when comparing two groups) and Independent Sample Mann–Whitney U-test (when comparing >2 groups) were used. Moreover, for categorical data, odds ratio (OR) and Chi-square tests (for contingency tables) were used. A variable having an OR of value >1 was considered as a contributory factor and a value lower than 1 was considered protective in nature. The confidence level was set at two tails and 5% for statistical significance.

  Results Top

The study was conducted from the 55th day of MCO to the 77th day. From a total of 13 (six government and seven private) universities in Malaysia, 12 participated in the study. A total of 762 students completed the online questionnaire, out of which 655 were included for the analysis after applying the exclusion criteria and data cleaning. The estimated response rate was 20%, which fulfilled our sample size requirement. The mean age of the respondents was 22.45 years. Among them, 82% were in the age group of 21–24 years. Of the total 655 respondents, 79% were females and 21% males. The majority of students were of Malay ethnicity (53%) followed by Chinese (33%) and lastly Indians (15%). The student participation from private and public universities was 56% and 44%, respectively. The least participation came from 1st year students (11%), followed by 2nd year students (19%), 4th year students (23%), 5th year students (22%), and most came from 3rd year students (25%).

The reliability statistics of the completed DASS-21 questionnaire showed a coefficient of reliability and consistency Cronbach's alpha as 0.895 (N of items = 3), which was considered as having good internal consistency and amenable to inferential statistics.

The prevalence of DAS in the study population (n = 655) was found to be 33.5%, 28.7%, and 7.3%, respectively. Among those who had depression (n = 220), 55.9% had mild severity, 43.2% had moderate severity, while the rest 0.9% had of severe nature. The severity distribution of 188 respondents who had anxiety traits was: Mild = 34%, moderate = 46.8%, severe = 16.4%, and extremely severe = 2.6%. Of those who were found to be stressed (n = 48), 79.1% had mild severity and the rest 20.8% had moderate severity.

[Table 1] depicts the prevalence and the median scores of DAS in the different variables in the study. It can be observed that according to the cutoff scores for assessing the severity of DAS, all the variables had a median score in the normal category. However, differences were noted in the prevalence and the median scores within the groups. These differences were investigated for significance using the statistical tests mentioned in the material and methods section.
Table 1: Demographic variables of the study population and their respective median score from Depression Anxiety Stress Scale-21

Click here to view

From [Table 1], it is evident that there were no statistical gender differences in DAS. Although female respondents had a higher prevalence of DAS, they had the same median score as the males. The prevalence of DAS increased with age, with a statistically significant change in the median scores of depressions. Comparison of the ethnicities showed that Chinese ethnic groups had statistically least prevalence of DAS and lowest median scores of DAS. The median score of depression was significantly higher in students of the fourth year and least in the students of the 1st year. The DAS prevalence and median scores of students attending public universities were found to be higher and had significantly higher anxiety and stress scores as compared to students from private universities.

[Table 2] shows the odds of respondent's social circumstances in the prevalence of DAS. It was found that all four social circumstances were contributory to the presence of DAS. The family's financial crisis significantly increased the risk of DAS. Being quarantined with family put the respondents at 2.8 times the odds of anxiety as compared to those quarantined away from home with friends or alone.
Table 2: Odds ratio of the variable enquiring into the respondent's social circumstances (n=655)

Click here to view

For the open-ended question on what activities the students did more than usual in their extra leisure free time during the MCO, a varied response was reported. The responses were categorized into two thematic categories, namely productive activities and nonproductive activities. Under the productive activity's students reported that they had started an online business, pursued spiritual development, participated in webinars/online courses, worked part-time, took up new hobbies such as cooking/painting/baking, leisure reading, exercising, chatting with family and friends, and spent more time studying. Under the unproductive activity's students reported binge-watching TV, surfing the Internet and social media, watching YouTube, playing online and video games, and loitering around the house.

  Discussion Top

The uniqueness of the COVID-19 pandemic was the lack of any prior knowledge about its route of transmission, pathognomonic signs/symptoms, and more so its clinical management. In these circumstances, self-quarantine was an appropriate measure to slow down the spread of the virus till the public health systems prepared to mitigate it.

This study found the prevalence of DAS between the 55th day and 77th day of MCO as 33.5%, 28.7%, and 7.3%. Although the median score of the study population for all three markers was within the normal limits, there was a group of respondents who reported severe to extremely severe symptoms. The prevalence in this group was 1% for depression, 19% for anxiety, and 21% for stress. Our finding when compared to the global prevalence of three markers during this pandemic showed comparable results for all the markers except for stress. In a meta-analysis and systematic review, Salari et al. reported the prevalence of DAS as 33.7%, 31.9%, and 29.6% in the adult population, respectively.[8] The lower prevalence of stress in our study could be attributed to the relief experienced by the students from the break-in their daily grind of activities like getting up early, rushing to university, no academic stress due to flexibility in scheduling and learning, no stress from case scheduling and probably having more time to spend on leisure activities. From our study, we also noted students utilized their extra free time wisely and spent it on productive activities which could have relieved their stress.

This study found no significant gender difference in the prevalence of the markers even though female respondents had a slightly higher prevalence. This finding was in agreement with the studies published recently which stated a higher prevalence of DAS in women in the general population during the pandemic.[11],[12],[13] However, among health science students, our findings were in disagreement with Fata Nahas et al., who reported that male students had higher scores for depression.[14]

In the present study, the prevalence of the DAS increased with increasing age group and the median scores also increased significantly. This finding was confirmed when it was noted that the prevalence of depression also increased with the year of study and the median scores significantly increased from year 1 to year 5. This finding was not in agreement with a study conducted in Iran in the prepandemic period.[15] Our result could be attributed to a feeling of hopelessness due to uncertainty about graduating on time. The fear of increasing backlog of clinical work to be completed and availability of the cases to complete the competency test in time was found to trigger an ill effect on the mental health of the students.[16]

One common variable affecting the mental health of the students was their ethnicity. Students of Chinese ethnicity had a significantly lower prevalence of all three markers and significantly lower median scores as compared to Malay and Indian ethnic groups. The Indian ethnic group showed the highest prevalence and median score. This trend in ethnic differences was similar to the technical report published by the Psychiatrist group, Ministry of Health, Malaysia.[17] The trend could be explained by the virtue of the difference in cultural up-bring and economic wellbeing of the communities. In the Chinese culture, children are exposed to high academic stress early in life, and they therefore gradually develop coping mechanisms.[18] It is also likely that students of Malay and Indian ethnicity were more expressive about their emotions as compared to students of Chinese ethnicity.

This study also found that the students of public universities had not the only higher prevalence of anxiety and stress but also significantly higher anxiety and stress scores. The odds of students in public universities having anxiety and stress compared to students in private universities were 1.5 and 1.4, respectively. While there was no available comparative literature on this from Malaysia, a study at the Georgia Institute of technology found similar results.[19] This could be attributed to the socioeconomic differences. Students in public universities may be under financial pressure to complete the course on time since most of them are supported by various scholarships.

Students who were worried about the delay in the academic session had higher odds of having DAS. Delay in the academic session had been reported to affect future employment prospects.[20]

Another common variable which affected the mental well-being of the students was the financial health of the family. This study found that 40.1% (n = 655) of students reported that their family was facing a financial crisis during this pandemic. Moreover, the odds of these students having DAS were 1.896, 1.659, and 2.021, respectively. This would be interpreted as an economic crisis that affected the mental status of the students. Dentistry in Malaysia is expensive and parents rely on bank loans/scholarships to pay the tuition fee. Family financial crises could have been due to voluntary salary deduction, loss of job, going on unpaid leaves, and dying business activities. Our results were similar to other studies which reported family financial health is correlated to the prevalence of depression in students.[21],[22]

In the present study, we found that the odds of anxiety in students quarantined with their family were 2.823 as compared to those quarantined away from the family. Our finding was in disagreement with a study conducted among students of a medical university in China, where the authors found that during the COVID-19 pandemic, staying with parents had a protective effect on the anxiety of the students.[23] Our finding could be explained by the fact that since the students were spending more time with their parents, parental supervision, and parental control of their activities would have increased. Furthermore, increased parental expectations of studying and helping around the household chores could have affected the anxiety level.

An important finding of the present was that the students engaged in a variety of activities in their free time which could have influenced their mental health. Being an online entrepreneur emerged as an interesting finding. Students were perhaps aware of financial challenges and economic consequences caused by the pandemic.[24] Other reported activities such as religious practices and exercise were similar to those reported in the literature.[25]

The finding of this study is novel because no such study has been performed in Malaysia. Since simple random sampling could not be performed due to the nonfeasibility of obtaining a complete list of the student sample population, a convenience sampling technique was used. Due to the self-reporting nature of the DAS, the prevalence may be under-reported. These limitations were addressed by ensuring the minimum estimated sample size was reached and the DASS-21 questionnaire met the reliability and validity coefficient.

  Conclusion Top

The study population showed the symptoms of the psychological impact of self-quarantine during COVID-19. Demographic and social risk factors identified were as follows: Students of Malay and Indian ethnicity; of increasing age group; in the higher year of study; enrolled in public universities; facing a family financial crisis and those quarantined with family.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  Appendix 1: Questionnaire used in the study Top

Psychological Impact of Self-quarantineon Malaysian Dental StudentsduringCOVID 19 Pandemic

Dear student,

Thank you for participating in this survey.

COVID 19 has impacted everyone's life. The KKM (MoH, Malaysia) reports that during self-isolation, a person may experience increased stress and anxiety levels. The objective of this survey is to determine if our dental students are facing any psychological effects of the COVID 19 pandemic. This knowledge will help the educational institutions and the government to direct the appropriate psycho-social support to the students. This survey does not ask for any details which can identify you, even your email. If you wish, you can share your email at the end of survey to receive the report of your response. This study is approved by Institutional Review Board (Ref. no. PIDC/IRB/FRP/1/20).

For any inquiries, please do not hesitate to contact me.

Dr. Fawaz Siddiqui (Assistant Professor, Penang International Dental College) Email: [email protected]

* Required

  1. I hereby give my consent to complete this questionnaire. *

  2. Mark only one oval.

    Agree Skip to question 2


    Skip to question 2

    1. What is your gender? *

    Mark only one oval.



    2. How old are you? *

    Mark only one oval.

    18 years and below

    19-20 years

    21-22 years

    23-24 years

    25 years and above

  3. 3. What is your ethnicity? *

  4. Mark only one oval.

    18 years and below

    19-20 years

    21-22 years

    23-24 years

    25 years and above

  5. 3. What is your ethnicity? *

  6. Mark only one oval.



    Indian (includes other ethnic groups of Tamil and Sikh races)

    Orang Asli (including Negrito / Senoi / Proto-Malay)

    Kadazandusun (including other ethnic groups from Sabah)

    Iban (including other ethnic groups from Sarawak)

    Mixed ethnicity

  7. 4. Which University / College do you attend? *

  8. Mark only one oval.

    Universiti Malaya (UM)

    Universiti Sains Malaysia (USM)

    Universiti Kebangsaan Malaysia (UKM)

    Universiti Teknologi MARA (UiTM)

    Universiti Islam Antarabangsa Malaysia (IIUM)

    Universiti Sains Islam Malaysia (USIM)

    AIMST University

    Penang International Dental College (PIDC)

    MAHSA University College

    International Medical University (IMU)

    Melaka-Manipal Medical College(MMMC)

    SEGi University

    Lincoln University College (LUC)

  9. 5. Which dental program are you enrolled in? *

  10. Mark only one oval.

    First-Year BDS

    Second-Year BDS

    Third-Year BDS

    Fourth-Year BDS

    Fifth-Year BDS

    Dental Technology Program (BDT)

    Graduated Awaiting Posting (GAP)

    Master/Doctor Dental Program

  11. 6. Where are you living during the MCO lockdown? *

  12. Mark only one oval.

    At home with family

    At home all alone

    Away from home with friends

    Away from home all alone

  13. 7. How worried are you that your academic year may be delayed due to COVID 19pandemic? *

  14. Mark only one oval.

  15. 8. Is your family facing any financial problems due to COVID 19 pandemic, which isworrying you? *

  16. Mark only one oval.




  17. 9. Has any of your family member, relative or acquaintance tested positive forCOVID 19 infection? *

  18. Mark only one oval.



  19. 10. Excluding time spent on daily chores like eating, sleeping, bathing, cleaning,laundry etc, how are you spending the extra time at hand during the period ofMCO? (You can select more than 1 option) *

  20. Check all that apply.

    Leisure reading more

    Learning new skills (e.g. cooking / painting / computer) .

    Binge watching TV

    Surfing social media more

    Playing online / video games more

    Loitering around the house more

    Studying more

    Exercising more

    Chatting with family and friends more

    Praying more


  21. 1. I found it hard to wind down *

  22. Mark only one oval.

  23. 2. I was aware of dryness of my mouth *

  24. Mark only one oval.

  25. 3. I couldn't seem to experience any positive feeling at all *

  26. Mark only one oval.

  27. 4. I experienced breathing difficulty (eg, excessively rapid breathing,breathlessnessin the absence of physical exertion) *

  28. Mark only one oval.

  29. 5. I found it difficult to work up the initiative to do things *

  30. Mark only one oval.

  31. 6. I tended to over-react to situations *

  32. Mark only one oval.

  33. 7. I experienced trembling (eg, in the hands) *

  34. Mark only one oval.

  35. 8. I felt that I was using a lot of nervous energy *

  36. Mark only one oval.

  37. 9. I was worried about situations in which I might panic and make a fool of myself *

  38. Mark only one oval.

  39. 10. I felt that I had nothing to look forward to *

  40. Mark only one oval.

  41. 11. I found myself getting agitated *

  42. Mark only one oval

  43. 12. I found it difficult to relax *

  44. Mark only one oval.

  45. 13. I felt down-hearted and blue *

  46. Mark only one oval.

  47. 14. I was intolerant of anything that kept me from getting on with what I was doing *

  48. Mark only one oval.

  49. 15. I felt I was close to panic *

  50. Mark only one oval.

  51. 16. I was unable to become enthusiastic about anything *

  52. Mark only one oval.

  53. 17. I felt I wasn't worth much as a person *

  54. Mark only one oval.

  55. 18. I felt that I was rather touchy *

  56. Mark only one oval.

  57. 19. I was aware of the action of my heart in the absence of physical exertion (eg,sense of heart rate increase, heart missing a beat) *

  58. Mark only one oval.

  59. 20. I felt scared without any good reason *

  60. Mark only one oval.

  61. 21. I felt that life was meaningless *

  62. Mark only one oval.

  63. If you would like to receive the report of your DASS survey, please provide youremail in the space provided below.

  References Top

World Health Organization. Rolling Updates on Coronavirus Disease (COVID-19). Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen. [Last accessed on 2020 Jun 12; Last updated on 2020 Apr 15].  Back to cited text no. 1
Prime Minister's Office of Malaysia. The Prime Minister's Special Message on COVID-19, March 16, 2020. Available from: https://www.pmo.gov.my/2020/03/perutusan-khas-yab-perdana-menteri-mengenai-covid-19-16-mac-2020. [Last accessed on 2020 Jun 12].  Back to cited text no. 2
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020;395:912-20.  Back to cited text no. 3
Kementerian Kesihatan Malaysia. Guidelines COVID-19 Management in Malaysia No. 5/2020-Annexure 33 (September 18, 2020). Available from: http://covid-19.moh.gov.my/garis-panduan/garis-panduan-kkm. [Last accessed on 2020 Sep 18].  Back to cited text no. 4
YOUNGMiNDS. Coronavirus: Impact on Young People with Mental Health Needs (March, 2020). Available from: https://youngminds.org.uk/media/3708/coronavirus-report_march2020.pdf. [Last accessed on 2020 Aug 12].  Back to cited text no. 5
Clark J. Fear of SARS thwarts medical education in Toronto. BMJ 2003;326:784.  Back to cited text no. 6
Holmes EA, O'Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, et al. Multidisciplinary research priorities for the COVID-19 pandemic: A call for action for mental health science. Lancet Psychiatry 2020;7:547-60.  Back to cited text no. 7
Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis. Global Health 2020;16:57.  Back to cited text no. 8
Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. Sydney: Psychology Foundation; 1995.  Back to cited text no. 9
Ministry of Health Malaysia. National Health and Morbidity Survey 2017. Malaysia: Adolescent Mental Health (DASS-21); 2017, Available from: http://iku.moh.gov.my/images/IKU/Document/REPORT/NHMS2017/MHSReportNHMS2017.pdf. [Last accessed on 2020 Aug 18].  Back to cited text no. 10
Hyland P, Shevlin M, McBride O, Murphy J, Karatzias T, Bentall RP, et al. Anxiety and depression in the Republic of Ireland during the COVID-19 pandemic. Acta Psychiatr Scand 2020;142:249-56.  Back to cited text no. 11
Zhou SJ, Zhang LG, Wang LL, Guo ZC, Wang JQ, Chen JC, et al. Prevalence and socio-demographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19. Eur Child Adolesc Psychiatry 2020;29:749-58.  Back to cited text no. 12
Moghanibashi-Mansourieh A. Assessing the anxiety level of Iranian general population during COVID-19 outbreak. Asian J Psychiatr 2020;51:102076.  Back to cited text no. 13
Fata Nahas ARM, Elkalmi RM, Al-Shami AM, Elsayed TM. Prevalence of depression among health sciences students: Findings from a public university in Malaysia. J Pharm Bioallied Sci 2019;11:170-5.  Back to cited text no. 14
Jowkar Z, Masoumi M, Mahmoodian H. Psychological stress and stressors among clinical dental students at Shiraz School of Dentistry, Iran. Adv Med Educ Pract 2020;11:113-20.  Back to cited text no. 15
Grubic N, Badovinac S, Johri AM. Student mental health amid the COVID-19 pandemic: A call for further research and immediate solutions. Int J Soc Psychiatry 2020;66:517-18.  Back to cited text no. 16
Ministry of Health, Malaysia. Malaysian Mental Healthcare Performance: Technical Report; 2016. Available from: https://www.moh.gov.my/moh/resources/Penerbitan/Laporan/Umum/Mental%20Healthcare%20Performance%20Report%202016.pdf. [Last accessed on 2020 Aug 18].  Back to cited text no. 17
Zhao X, Selman RL, Haste H. Academic stress in Chinese schools and a proposed preventive intervention program. Cogent Educ 2015;2:1000477.  Back to cited text no. 18
Georgia Institute of Technology. “Who has better mental health: Public or private college students? Mental health culture at top-ranked campuses.” ScienceDaily. ScienceDaily, 1 June 2017. Available from: http://www.sciencedaily.com/releases/2017/06/170601124124.htm [Last accessed on 2020 Aug 18].  Back to cited text no. 19
Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020;395:470-73.  Back to cited text no. 20
Moeini B, Bashirian S, Soltanian AR, Ghaleiha A, Taheri M. Prevalence of depression and its associated sociodemographic factors among Iranian female adolescents in secondary schools. BMC Psychol 2019;7:25.  Back to cited text no. 21
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  [Table 1], [Table 2]


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