1. Mood & Stress Shakhawan Salih. Shanyar Kadir. Shkar Dilshad

2. Introduction A mood is an emotional state. Moods differ from emotions in that they are less specific, less intense, and less likely to be triggered by a particular stimulus or event. Moods generally have either a positive or negative valence. In other words, people typically speak of being in a good mood or a bad mood.

3. Introduction Stress is a feeling of strain and pressure. Symptoms may include a sense of: Being overwhelmed Feelings of anxiety Overall irritability Insecurity Nervousness Social withdrawal Loss of appetite Depression Others

4. Introduction Two groups of mood disorders are broadly recognized: 1) Depressive disorders A) Major depressive disorder (MDD) B) Dysthymia C) Double depression 2) Bipolar disorders A) Bipolar I & II B) Cyclothymia

5. Introduction Objectives: To identify the level of stress among different stages of the medical school To identify any gender differences related to stress To identify if mood & stress are affected by studying or exam marks and vice versa.

6. Methodology Study Design Cross-sectional study (survey) Questionnaire Sociodemographic (7) Mood and Stress Questions (48)

7. Methodology Study Population and Sample Population = Students of Sulaymaniyah Medical School Sample = All 6 Stages, Random Sampling, Evey 4 th Student Data Collection Took 3 days First 4 stages in a single day 5 th and 6 th stages within 2 days

8. Methodology Data Processing 162 complete questionnaires (9 ignored because incomplete) Entered into IBM SPSS v21 Frequency tables for socio-demographic data and statistical measures of distribution for age, height, and weight Chi-Squared and Fisher’s Exact tests used to find associations If 20.0% or more of data cells in contingency table had expected count below 5, Fisher’s exact was used p value of less than 0.05 taken as significant

9. Results (sociodemographic data) FrequencyPercent Gender Male7747.5 % Female8552.5 % Stage 12616.0 % 22716.7 % 32716.7 % 42616.0 % 52716.7 % 62917.9 % Socioeconomic status Moderate12879.0 % High (Rich)3219.8 % NR21.2 % Residence Village31.9 % City15796.9 % NR21.2 %

10. Results Does your stress increase when you have a family problem? TotalP-value (X 2 ) Never or not at all Some of the time or mildly Often or moderately Always or severely Student Gender Female Count 416303585 0.021 % 4.7%18.8%35.3%41.2%100.0% Male Count 723321577 % 9.1%29.9%41.6%19.5%100.0% Total Count 11396250162 % 6.8%24.1%38.3%30.9%100.0%

11. Results Does other people’s pain (accidents, death,…etc) affect your mood? TotalP-value (X 2 ) Never or not at all Some of the time or mildly Often or moderately Always or severely Student Gender Female Count 819332585 0.030 % 9.4%22.4%38.8%29.4%100.0% Male Count 1821231375 % 24.0%28.0%30.7%17.3%100.0% Total Count 26405638160 % 16.3%25.0%35.0%23.8%100.0%

12. Results Do you feel nauseous or get reflux when stressed? TotalP-value (X 2 ) Never or not at all Some of the time or mildly Often or moderately Always or severely Student Gender Female Count 2325171883 0.002 % 27.7%30.1%20.5%21.7%100.0% Male Count 362111371 % 50.7%29.6%15.5%4.2%100.0% Total Count 59462821154 % 38.3%29.9%18.2%13.6%100.0%

13. Results Do you get more stressed out while studying for the examinations? TotalP-value (X 2 ) Never or not at all Some of the time or mildly Often or moderately Always or severely Student Gender Female Count 610283983 0.000 % 7.2%12.0%33.7%47.0%100.0% Male Count 632241476 % 7.9%42.1%31.6%18.4%100.0% Total Count 12425253159 % 7.5%26.4%32.7%33.3%100.0%

14. Results Do you get sleep-deprived during examination times? TotalP-value (X 2 ) Never or not at all Some of the time or mildly Often or moderately Always or severely Student Gender Female Count 1525172683 0.003 % 18.1%30.1%20.5%31.3%100.0% Male Count 262716776 % 34.2%35.5%21.1%9.2%100.0% Total Count 415233 159 % 25.8%32.7%20.8% 100.0%

15. Results Do your exam marks affect your mood? TotalP-value (X 2 ) Never or not at all Some of the time or mildly Often or moderately Always or severely Student Gender Female Count 826193285 0.017 % 9.4%30.6%22.4%37.6%100.0% Male Count 1732111777 % 22.1%41.6%14.3%22.1%100.0% Total Count 25583049162 % 15.4%35.8%18.5%30.2%100.0%

16. Results Do you have a tendency to addictions or substance abuse when under stress? Total P-value (Fisher’s Exact) Never or not at all Some of the time or mildly Often or moderately Always or severely Student Gender Female Count 8021285 0.000 % 94.1%2.4%1.2%2.4%100.0% Male Count 48157676 % 63.2%19.7%9.2%7.9%100.0% Total Count 1281788161 % 79.5%10.6%5.0% 100.0%

17. Does your mood affect your relationship with your friends? Total P-value (Fisher’s Exact) Never or not at all Some of the time or mildly Often or moderately Always or severely College Stage 1 Count 1276126 0.016 % 46.2%26.9%23.1%3.8%100.0% 2 Count 1346326 % 50.0%15.4%23.1%11.5%100.0% 3 Count 51110127 % 18.5%40.7%37.0%3.7%100.0% 4 Count 895426 % 30.8%34.6%19.2%15.4%100.0% 5 Count 1483227 % 51.9%29.6%11.1%7.4%100.0% 6 Count 7184029 % 24.1%62.1%13.8%0.0%100.0% Total Count 59573411161 % 36.6%35.4%21.1%6.8%100.0%

18. Does hanging out with friends make your mood better?Total P-value (Fisher’s Exact) Never or not at all Some of the time or mildly Often or moderately Always or severely College Stage 1 Count 458926 0.006 % 15.4%19.2%30.8%34.6%100.0% 2 Count 3741327 % 11.1%25.9%14.8%48.1%100.0% 3 Count 3671127 % 11.1%22.2%25.9%40.7%100.0% 4 Count 0814325 % 0.0%32.0%56.0%12.0%100.0% 5 Count 21012327 % 7.4%37.0%44.4%11.1%100.0% 6 Count 0149629 % 0.0%48.3%31.0%20.7%100.0% Total Count 12505445161 % 7.5%31.1%33.5%28.0%100.0%

19. Do you think about committing suicide to get rid of stress? Total P-value (Fisher’s Exact) Never or not at all Some of the time or mildly Often or moderately Always or severely College Stage 1 Count 1563125 0.043 % 60.0%24.0%12.0%4.0%100.0% 2 Count 1444224 % 58.3%16.7% 8.3%100.0% 3 Count 2240127 % 81.5%14.8%0.0%3.7%100.0% 4 Count 1871026 % 69.2%26.9%3.8%0.0%100.0% 5 Count 2500126 % 96.2%0.0% 3.8%100.0% 6 Count 2260129 % 75.9%20.7%0.0%3.4%100.0% Total Count 1162786157 % 73.9%17.2%5.1%3.8%100.0%

20. Results Do you have an increased sensitivity to pain? Total P-value (Fisher’s Exact) Never or not at all Some of the time or mildly Often or moderately Always or severely Socioeconomic Status Moderate Count 6439177127 0.018 % 50.4%30.7%13.4%5.5%100.0% High (Rich) Count 10181332 % 31.3%56.3%3.1%9.4%100.0% Total Count 74571810159 % 46.5%35.8%11.3%6.3%100.0%

21. Results Do you lack stamina or tire easily? TotalP-value (X 2 ) Never or not at all Some of the time or mildly Often or moderately Always or severely Socioeconomic Status Moderate Count 28563011125 0.038 % 22.4%44.8%24.0%8.8%100.0% High (Rich) Count 13162132 % 40.6%50.0%6.3%3.1%100.0% Total Count 41723212157 % 26.1%45.9%20.4%7.6%100.0%

22. Conclusions Females more prone to stress Affected more by family problems Affected more by other people’s pain More likely to get nausea and reflux under stress Get more stress out while studying for exams Get more sleep-deprived by exams Affected more by exam marks Males A higher tendency for addictions

23. Conclusions By Stage Mood gets better when hanging out with friends (increases with stage) Suicidal ideation higher among the first two stages By SES High SES: increased sensitivity to pain Low SES: lack stamina and tire more easily

24. Recommendations Classes to the medical students About risk factors for stress How to deal with stress How to detect serious suicidal ideations in others