The questionnaire was answered by the total 244 medical students and the results are reported in Table 1. Participants’ age range was between 26 and 35 years (28.5%) and most of them (34.0%) were in their fifth year of medical school. A total of 137 (56.0%) respondents stated they were much more tired now than at the beginning of the pandemic.

Out of the 244 interviewees, 61 (25.0%) reported having great sleep deprivation, 69 (28.2%) moderate sleep deprivation, and 54 (22.1%) reported little sleep deprivation. Regarding the interviewees mental health, 221 (90.0%) reported having difficulty concentrating on their daily activities, 21 (8.6%) reported being downcast or depressed throughout the period assessed, while 146 (59.8%) reported experiencing this feeling several times during this period. A total of 31 (12.0%) interviewees reported that, at some point in time, they had wanted to take their own life for not being in contact with the people they loved. In addition, 18 (7.3%) of the interviewees reported being anxious, nervous, impatient, and irritable throughout the period assessed, while 112 (45.0%) reported having experienced this feeling several times during this period and 124 (50.8%) believed that everything they did during the pandemic period was a failure.

Regarding pre-existing conditions, 94 (38.5%) interviewees reported having already been diagnosed with some psychological illness during the period prior to the outbreak of the pandemic. Of the total number of the survey respondents, 68 (27.0%) had been diagnosed with anxiety, 24 (9.8%) with depression, 3 (1.2%) with panic syndrome and 26 (10.6%) with other comorbidities. Out of this group, 89 considered that their condition was aggravated by the COVID-19 pandemic. Regarding psychological assistance, 23 (9.4%) interviewees reported having received psychological support during the period for less than 3 months, 17 (6.9%) between 3 and 6 months and 18 (7.3%) for a period longer than 6 months.

Regarding physical health, 162 (66.4%) of the interviewees reported having gained weight during the period, with 72 (29.5%) respondents reporting having gained between 2 and 5 kg, 54 (22.1%) between 6 and 9 kg and 22 (9.0%) more than 10 kg. Participants were also asked if they had contracted COVID-19 and what physiological consequences they observed with the disease. Out of the respondents who had had COVID-19, 63 reported physiological changes while 36 indicated no changes. A total of 32 interviewees reported loss of smell, 20 retrograde amnesia, 8 obstructive respiratory symptoms and 57 reported other different symptoms. Another point raised with the participants was whether they observed that psychological symptoms self-reflected in the form of physical symptoms, a question to which 160 (65.6%) participants gave a positive answer. Specifically, 34 respondents reported shortness of breath, 28 chest pain, 11 tingling in the upper limbs, and 95 reported other symptoms.

Regarding daily life, participants were also asked how they felt about the news: 27 (11.1%) of them reported that the news always caused panic, 78 (32%) reported that it caused panic often, 107 (43.9%) rarely, and 32 (13.1%) never. In addition, 61 (25.0%) participants reported having cared for someone with mental disorders during the pandemic. At the time of the survey, 111 (45.5%) survey participants had been vaccinated with the first dose of the COVID-19 vaccine, 93 (38.1%) with two doses, 7 (2.9%) with a single dose, and 33 (13.5%) had not yet been vaccinated.

Risk factors for a given condition, as defined by the WHO in 2009, refer to characteristics, conditions or behaviors that increase the likelihood of a person developing certain pathologies. In psychology, we can cite as examples biological, psychological and behavioral factors that increase the likelihood of anxiety or depression in a given population. A detailed example on the subject can be found in the review carried out by Vink et al. (2007) which provides an overview of these factors that cause the development of anxiety and depression in the elderly population.

The occurrence of psychological and psychosocial issues resulting from the pandemic has been widely reported in the literature (Moreno et al., 2020; Talevi et al., 2020), and the occurrence of factors associated with anxiety and depression are important tools for assessing mental health. Lack of sleep is a factor known to be associated with such psychological pathologies (Nutt et al., 2008; Steiger & Pawlowski, 2019). In the population assessed, we could observe a high incidence of this factor, with a total of 75.3% of respondents reporting feeling sleep-deprived to some extent. Leão et al. (2018), when evaluating the occurrence of insomnia in health science students during the period prior to the pandemic, described an occurrence of this factor in 60% of the population showing signs of depression and 44.0% in the healthy population. In addition, these authors also demonstrated the association of this factor with depression and anxiety.

Another result that draws attention is the large number of interviewees who reported difficulty concentrating on daily activities (90.0%). Aquino et al. (2019), when analyzing medical students at a university in Minas Gerais State in Brasil, reported that 89.3% presented a certain periodicity in their concentration difficulty. On the other hand, Bampi et al. (2013), who evaluated medical students at a university in Brasília, reported that only 52.4% of them reported some problem with concentration, while Son et al. (2020), who evaluated students at a university in the United States during the COVID-19 pandemic, observed that 89.0% of them presented some degree of difficulty in concentration. Many of the interviewees also reported feeling down or being depressed throughout the pandemic or often during this period, results that, together, represents up to 67.5% of the students interviewed. Aquino et al. (2019), reports that 63.6% of the medical students evaluated in their study believed they experienced a state of low self-esteem, 82.6% indicated self-critical thinking, and 90.9% reported tiredness or loss of energy. Bampi et al. (2013) reported that 47.6% of their study’s participants who were evaluated considered that they enjoyed life in a kind of unsatisfactory manner or very little, or they did not enjoyed it at all, and that 95.2% of them presented negative feelings (bad mood, despair, anxiety, and depression); 50.0% of them experienced these feelings frequently, very frequently, or always. In the work of Son et al. (2020) the authors indicate that the main factors contributing to depressive thoughts that were observed in their sample were loneliness (33.0%), insecurity or uncertainty (12.0%), helplessness or hopelessness (10.0%), concerns about academic performance (8.0%) and chronic over- thinking (5.0%).

When compared to the results obtained by Bampi et al. (2013), the data of our study suggest that the prevalence of some risk factors for the development of psychological pathologies such as concentration difficulty, lack of sleep disorders and negative feelings increased during the pandemic. However, when we take into account the work of Aquino et al. (2019), an older study, the data suggest a certain stability in the incidence of these factors.

Most respondents diagnosed with psychological pathologies in the pre-pandemic period reported worsening of their clinical condition during the pandemic period. This type of occurrence has been widely reported in the literature (Gobbi et al., 2020; Hao et al., 2020; Robillard et al., 2021). In a very large survey, Gobbi et al. (2020) using an online questionnaire, evaluated 2,734 patients from 12 countries; they also carried out a clinical evaluation of 318 patients from a clinic in the United States. According to these authors, more than half of their psychiatric patients showed a worsening of their condition during the period reviewed. In addition, those authors reported that in the clinical study carried out, more than half of the patients presented new symptoms and required treatment adjustment.

The COVID-19 pandemic has set a series of challenges for treating psychological ill patients. In addition to the physical distancing measures imposed by the authorities, the pandemic lead people to be concerned of leaving their homes to visit a health care facility. Alternatives such as online care can help overcome these obstacles. It is also interesting to note that our study found that approximately 20.0% of respondents had cared for someone with psychological problems during the pandemic.

Regarding weight gain, most interviewees reported having gained weight during the pandemic period. In a survey conducted using an electronic questionnaire in the city of Araçatuba, São Paulo, which included 162 respondents during the period from 2021/11/1 to 2021/11/2, Aro et al. (2021) also reported that, during the pandemic period, most of their study participants gained weight: 45.3% gained between 1 and 5 kg, 16.8% gained between 5 and 10 kg and 4.3% gained more than 10 kg. Adding together those rates yields a total of 66.4% participants who gained weight. These results are in line with the outcome obtained in our study. According to those authors, during the pandemic an increase in food consumption occurred due to the emotional atmosphere and also due to the people’s snacking habit, with a preference for sweets; these are factors that may have contributed to these results. Other data that may help explain this trend come from the work of Verticchio and Verticchio (2020) who interviewed people in the metropolitan region of Belo Horizonte (MG) and observed that 44.0% of them said that the quality of food consumption had worsened and 55% said they were eating more frequently. The authors also observed an increase in the consumption of sweets, soft drinks, alcohol, pasta and bakery items.

Another important point to highlight is the number of people (65.6%) who reported that psychological symptoms reflected in physical symptoms; Jabri et al. (2020) observed an 8.0% increase in cases of stress-associated cardiomyopathy when comparing the pandemic and the pre-pandemic period. In line with such findings, Kir et al. (2021) reported 2 cases of Taktsubo Cardiomyopathy during the COVID-19 pandemic in which both patients reported to have experienced stress levels due to the pandemic. According to those authors, the incidence of stress-related cardiomyopathy has increased as a result of the pandemic in patients who were not infected with SARS-CoV-2. They also suggest that measures should be taken to help the at-risk population (postmenopausal women, patients with psychiatric comorbidities) deal with the ongoing stressors of that period.

As we can see, there have been several reports of students who developed risk factors associated with psychological and psychosocial pathologies. To prevent the occurrence of more severe cases of these pathologies, it is important that this population has access to psychological assistance programs, especially during periods of greater physical distancing, when stressors are more intense. An interesting strategy to be adopted could be the improvement of disciplines and projects that help medical students to cope with their psychosocial and family difficulties, patients deaths, insomnia and anxiety due to the pressure of daily life.

This study provided information about the suffering experienced by medical students living in the triple border region during the COVID-19 pandemic. Although this was a survey study, the results generally indicate that during the COVID-19 pandemic, students reported a worsening of their emotional state which is generally associated with psychological issues; this suggests that there may have been a growth in the incidence of this type of pathology in the group assessed. Future epidemiological studies that assess the development of psychopathologies during the pandemic or that compare the incidence of such pathologies before and after the COVID-19 pandemic may help to better understand the effects of the COVID-19 pandemic on the mental health of this population.