Major depressive disorder in Mexican medical students and associated factors: A focus on current and past abuse experiences

Coping with the Stress through Individual and Contextual Resilient Factors in Primary School Settings

Children face school stress as students through all educational stages. A negative association between resilience and stress has been demonstrated by many authors, but most of these studies have been carried out in higher educational stages. So, the aim of the present study is, on the one hand, to find out the level of stress of primary school children and also the types of stressful situations in school settings, and on the other hand, to analyze the effect of individual and contextually resilient factors on their level of school stress. The study involved 427 children between 6 and 12 years of age, who were administered the IECI school stress scale and the RES-PRIM Resilience questionnaire for children. Descriptive analyses, correlations, and regression analyses were performed on the data. Results showed an average level of school stress, with the most stressful situations being: participating in too many activities, concentration problems, and nervousness when being asked by the teacher in class. Predictive analysis showed that part of the school stress could be explained by both individual factors (self-esteem, introspection, future purpose, and social skills) and resilient contextual factors (teacher support, parental support, and peer support). It is concluded that it is necessary to pay more attention to the transitions between different educational stages with programs that reinforce academic information and encourage the development of individual resilient skills, stressing the importance of the role of teachers, peers, and parents as support groups.

Depression and associated factors in medical students in Acapulco during the COVID-19 pandemic: A cross-sectional study

BACKGROUND

Depression is common in medical students and the Mexican state of Guerrero has the highest rates of depression in the country. Acapulco, the seat of the state medical school, is a tourist destination that experienced early high rates of COVID-19. The COVID-19 pandemic closed all schools in Mexico, obliging a shift from face-to-face to virtual education. In this new context, medical students faced challenges of online teaching including inadequate connectivity and access technologies. Prolonged isolation during the pandemic may have had additional mental health implications.

AIM

Assess depression prevalence and its associated factors affecting medical students in Acapulco, Mexico during the COVID-19 pandemic.

METHODS

A cross-sectional survey of students of the Faculty of Medicine of the Universidad Autónoma de Guerrero, in November 2020. After informed consent, students completed a self-administered questionnaire collating socio-demographic, academic and clinical variables, major life events and changes in mood. The Beck inventory provided an assessment of depression. Bivariate and multivariate analyses relied on the Mantel-Haenszel procedure to identify factors associated with depression. We estimated the odds ratio (OR) and 95% confidence intervals.

RESULTS

33.8% (435/1288) of student questionnaires showed evidence of depression in the two weeks prior to the study, with 39.9% (326/817) of young women affected. Factors associated with depression included female sex (OR 1.95; 95%CI 1.48-2.60), age 18-20 years (OR 1.36; 95%CI 1.05-1.77), perceived academic performance (OR 2.97; 95%CI 2.16-4.08), perceived economic hardship (OR 2.18; 95%CI 1.57-3.02), and a family history of depression (OR 1.85; 95%CI 10.35-2.54). Covid-19 specific factors included a life event during the pandemic (OR 1.99; 95%CI 1.54-2.59), connectivity problems during virtual classes and difficulties accessing teaching materials (OR 1.75; 95%CI 1.33-2.30).

CONCLUSIONS

The high risk of depression in medical students during the COVID-19 pandemic was associated with perceived academic performance and technical barriers to distance learning, in addition to known individual and family factors. This evidence may be useful for the improvement of programs on prevention and control of depression in university students.

Prevalence and Factors Associated with Anxiety and Depression in Peruvian Medical Students

During medical training, students are exposed to stressors that deteriorate mental health. This study determined depression and anxiety prevalence and their associated factors in students from four medical schools in northern Peru. A cross-sectional study was conducted among medical students from Lambayeque, Peru. The Goldberg Anxiety and Zung Depression tests were applied. The dependent variables were depression and anxiety, and their association with covariates (age, sex, type of university, socioeconomic level, experience, family problem, and physical activity) was evaluated. Prevalence ratios were calculated using generalized linear models. Of 482 students, the prevalence of anxiety was 61.8% and depression was 22.0%. A severe level of anxiety was observed in 6.2% in the group between 16 and 20 years old. It was observed that private university students had higher frequencies of having depression (PR = 2.01) and anxiety (PR = 1.35); males had a lower risk of anxiety (PR = 0.82), but higher risk of depression compared to females (PR = 1.45). Performing physical activity decreased the prevalence of depression (PR = 0.53); however, it increased the frequency of anxiety (PR = 1.26). Having family problems increased the prevalence of anxiety (PR = 1.26). Medical students from private universities experienced higher rates of depression and anxiety. Depression and anxiety were associated with gender and physical activity. These findings highlight the importance of mental health promotion due to its link with quality of life and academic performance.

Uso de ansiolíticos e antidepressivos entre estudantes de medicina de uma universidade

Objetivou-se identificar o uso de medicamento ansiolítico e/ou antidepressivo e associá-lo às características dos estudantes de medicina de uma universidade. Trata-se de um estudo com 449 estudantes de medicina no interior do estado de São Paulo. O uso de medicamento antidepressivo e/ou ansiolítico era feito por 24,3% dos estudantes, sendo a maior parte do sexo feminino e cursando os dois primeiros anos da faculdade. Não houve associação entre o uso de medicamento e os fatores como: idade, renda, morar com a família, horas de sono, relação com docentes e ter pai e mãe vivos. Observou-se maior chance de fazer terapia entre os estudantes que usavam medicamento (β=1,12, OR=3,07, p<0,001) e uma menor chance de realizar exercício físico (β=-0,051, OR=0,60, p=0,03). Estratégias para o manejo da depressão e da ansiedade devem ser incentivadas e ações para reduzir o estresse durante o curso devem fazer parte de um programa de apoio das universidades. 

Advances and challenges in the detection of academic stress and anxiety in the classroom: A literature review and recommendations

In recent years, stress and anxiety have been identified as two of the leading causes of academic underachievement and dropout. However, there is little work on the detection of stress and anxiety in academic settings and/or its impact on the performance of undergraduate students. Moreover, there is a gap in the literature in terms of identifying any computing, information technologies, or technological platforms that help educational institutions to identify students with mental health problems. This paper aims to systematically review the literature to identify the advances, limitations, challenges, and possible lines of research for detecting academic stress and anxiety in the classroom. Forty-four recent articles on the topic of detecting stress and anxiety in academic settings were analyzed. The results show that the main tools used for detecting anxiety and stress are psychological instruments such as self-questionnaires. The second most used method is acquiring and analyzing biological signals and biomarkers using commercial measurement instruments. Data analysis is mainly performed using descriptive statistical tools and pattern recognition techniques. Specifically, physiological signals are combined with classification algorithms. The results of this method for detecting anxiety and academic stress in students are encouraging. Using physiological signals reduces some of the limitations of psychological instruments, such as response time and self-report bias. Finally, the main challenge in the detection of academic anxiety and stress is to bring detection systems into the classroom. Doing so, requires the use of non-invasive sensors and wearable systems to reduce the intrinsic stress caused by instrumentation.

Prevalence and Correlates of Likely Major Depressive Disorder among Medical Students in Alberta, Canada

BACKGROUND

Medical students are exposed to multiple factors during their academic and clinical studies that contribute to depression.

AIMS

This study aims to examine the prevalence and correlates of likely major depressive disorder (MDD) among medical students.

METHODS

This study utilized a descriptive cross-sectional design. Data were collected through a self-administered online survey, which included questions on sociodemographic characteristics and likely MDD using the PHQ-9. Data were analyzed using a descriptive, Chi-square test and logistic regression model.

RESULTS

There were 246 medical students who participated in the survey. The majority were females, 155 (65.1%); Caucasian, 158 (66.4%); and in a relationship, 168 (70.5%). The prevalence of likely MDD was 29.1%. Respondents who did not feel supported and respondents who were neutral about their social support, friends, and family, were 11 and 4 times more likely to experience MDD than those who felt well supported (OR = 11.14; 95% CI: 1.14-108.80) and (OR = 4.65; 95% CI: 1.10-19.56), respectively.

CONCLUSIONS

This study suggests a high prevalence of likely MDD among medical students who do not feel they have sufficient social support from friends and family. Social adjustments, including talking to friends and family and participating in leisure activities, could reduce the level of depression among medical students.

Association Between Socio-Affective Symptoms and Glutathione and CD4 and CD8 Lymphocytes in College Students

Background: The prevalence of anxiety and depression in young students is associated with biosocial factors and scholastic stress. However, few studies have evaluated emotional-affective symptoms that are related to the immune system and antioxidant parameters in young individuals without diagnoses of affective disorders. Aim: This study aims to assess the relationship between emotional-affective symptoms and glutathione concentrations and CD4 and CD8 lymphocyte counts in college students. Methods: College students (n = 177) completed standardized psychometric instruments, including the Perceived Stress Scale, Hamilton Anxiety Scale, Beck Depression Inventory, Familiar Social and Friends Support Scale, and Rosenberg Scale. Blood samples were biochemically analyzed. Analyses of variance were conducted between four groups according to symptom severity. Results: A considerable prevalence of stress, anxiety, and depression symptoms was observed and negatively correlated with self-esteem and socio-familiar support. Perceived stress was sexually dimorphic. Although biochemical parameters were within reference ranges, glutathione, CD4, and CD8 tended to be lower in participants with anxiety and depression symptoms, which may be of predictive value. Conclusion: The relationship between antioxidant/immune parameters and socio-affective scores is latent in undiagnosed college students who might develop affective disorders. The findings suggest that during the initial development of affective disorders, stress management strategies should be implemented to help college students cope with the academic load and monitor negative changes in their physiological state.

Medical Students' Experience of Harassment and Its Impact on Quality of Life: a Scoping Review

OBJECTIVES

Medical students' experiences of harassment and its influence on quality of life were examined.

DESIGN

A set of databases were employed in this review, and using ATLAS.ti, a set of emergent themes were identified.

RESULTS

The initial search identified 4580 potential articles for review. The inclusion and exclusion criteria reduced the list to 48 articles. Two predominant emergent themes were categorised as 'Antecedents' of 'harassment' and 'Consequences' on quality of life.

CONCLUSIONS

Harassment likely has an adverse impact on quality of life, although more empirical research is required to establish more definitive links between the two variables.

Medical Students' Experience of Harassment and Its Impact on Quality of Life: a Scoping Review

OBJECTIVES

Medical students' experiences of harassment and its influence on quality of life were examined.

DESIGN

A set of databases were employed in this review, and using ATLAS.ti, a set of emergent themes were identified.

RESULTS

The initial search identified 4580 potential articles for review. The inclusion and exclusion criteria reduced the list to 48 articles. Two predominant emergent themes were categorised as 'Antecedents' of 'harassment' and 'Consequences' on quality of life.

CONCLUSIONS

Harassment likely has an adverse impact on quality of life, although more empirical research is required to establish more definitive links between the two variables.

Perceived quality of life among Brazilian medical students: initial findings from a follow-up study

This study evaluates Brazilians medical students' Quality of Life and verified associated factors, according to graduation medical cycles: basic (two first years), theoretical-practical (third and fourth years) and clinical (fifth and sixth years). Data were obtained from QualiMed study, conducted at Medical School of Federal University of Minas Gerais, Brazil, using WHOQOL-Bref. Analyses were performed using ANOVA and multiple logistic regressions. A total of 1470 medical students participated and were more satisfied than dissatisfied with their quality of life. Psychological Domain obtained the worst assessment (60.64) and Environment Domain the best one (68.14). The perception of quality of life improved over the course, being worse in the basic cycle and better in the clinical cycle, statistically different for all domains (p-value<0.05). Most variables were negatively associated with quality of life, indicating that their absence reduces the chances of a better perception. Absence of regular physical activity and having depression symptoms were negatively associated with all WHOQOL-Bref Domains. Individual, behavioral and psychological aspects negatively impact the quality of life of evaluated students. Psychological support strategies, encouraging resilience and carrying out physical activities are recommended to improve quality of life, mainly in first years of medical school.

Effectiveness of behavioral activation for depression treatment in medical students: Study protocol for a quasi-experimental design

INTRODUCTION

Depression is a frequent mood disorder among medical students that can lead to multiple negative consequences at individual and social level (such as academic achievement and interpersonal conflicts) as well as patient care performance. Therefore, the need of depression decreasing treatments in medical students is important. This study is designed to evaluate the effectiveness of the Behavioral Activation Treatment for Depression in a sample of Mexican medical students.

METHODS

This study will be performed under a quasi-experimental design to verify the effectiveness of the Behavioral Activation Treatment for Depression to reduce depressive symptoms in medical students from two public universities in northwestern Mexico. The participants will be assessed with the Center for Epidemiologic Studies Depression Scale, the Depression Anxiety Stress Scales, the Pittsburgh Sleep Quality Index, and the Plutchik Suicide Risk Scale. In addition to the psychometric assessment, there will be an electroencephalogram evaluation using the EMOTIV (v 1.1) device.

RESULTS

A pre-post intervention of 10 Behavioral Activation Treatment for Depression sessions will be implemented. The results of the effectiveness of the Behavioral Activation Treatment for Depression will be analyzed in five measures at pre-post intervention and two follow-ups of 3 and 6 months.

CONCLUSIONS

This study looks for evidence regarding the efficacy and feasibility of the Behavioral Activation Treatment for Depression in a sample of medical students from two public universities in Mexico with high levels of depression along with stress and anxiety.

Depression in Mexican medical students: A path model analysis

Background

Depression is a mental health disorder present in medical students that foster cumulative disadvantages throughout life and that may compromise patient care. Yet, in Mexico there is a dearth of research concerning prediction models for depression in this population.

Methods

The aim of this cross-sectional study was to develop and test a path model analysis of depression in 103 freshmen Mexican medical students ages 18–23 years old selected non-randomly. Anxiety, emotion dysregulation, and coping skills were used as factors influencing depression. Mexican self-report scales were used as assessment measures.

Results

Main results showed that anxiety and emotion dysregulation had a significant direct influence on depression. Emotion dysregulation had a significant direct effect on coping skills and anxiety, while anxiety had a significant direct effect on problem drinking and alcohol problems. Fit indexes obtained indicate an excellent adjustment to data. R square indicates that 53.7% of the variance in depression can be explained by this model.

Limitations

The results are exploratory rather than confirmatory. The sample size was not large enough and the research focused on only Mexican freshmen medical students. Other factors associated to depression in medical students were not considered.

Conclusions

The current research provides unique findings in terms of a model of depression in Mexican medical students through which it is possible to design and implement interventions that decrease depression, thus positively affecting their well-being, their future careers as medical doctors and their abilities to serve the society adequately, especially in the context of Latin American cities.

Social Violence Increases the Risk of Suicidal Ideation Among Undergraduate Medical Students

BACKGROUND

Depression is highly prevalent worldwide, and may have fatal consequences. Violence is associated to psychopathology and has exponentially increased in some areas of Mexico. Healthcare professionals are vulnerable to increased anxiety, depression, suicide and lately, to violence by organized crime. The aim of the study was to determine the prevalence of anxiety/depression/suicidal ideation and the weight of social violence as a risk factor.

METHODS

Cross sectional study in three generations of undergraduate medical students at entry to internship year in our institution. All students voluntarily agreed to participate. All of them answered Beck and HAM-A. Two generations also responded Plutchik suicidal risk inventory. Sex, type of university and degree of violence in their geographic areas were also recorded. Prevalence rates were calculated for each outcome. χ² tests and odds ratio (OR) for bivariate analysis, and Mantel-Hanezel to adjust according to level of violence.

RESULTS

All of the eligible students responded the anxiety and inventories (n = 8,858), and 6,451 also responded the suicide risk test. Overall, 37.2% displayed severe anxiety, 14.9% moderate/severe depression and 8.5% suicidal ideation. Female sex and private university increased the risk for anxiety and depression. High violence, severe anxiety or depression increased the risk for suicidal ideation. Adjusted by violence zone, female sex, being single and the coexistence of depression were associated with a higher risk for suicidal ideation.

CONCLUSIONS

Anxiety, depression and suicidal ideation are highly prevalent among premedical interns in Mexico. Living in highly violent areas significantly increases the risk for anxiety/depression/suicidal ideation.

Disease-discordant twin structural MRI studies on affective disorders

Magnetic resonance imaging (MRI) studies have identified neural structures implicated in the pathophysiology of mood disorders, especially bipolar disorder (BD) and major depressive disorder (MDD). However, the role of genetic and environmental influences on such brain deficits is still unclear. In this context, the present review summarizes the current evidence from structural MRI and Diffusion Tensor Imaging (DTI) studies on twin samples concordant or discordant for BD or MDD, with the aim of clarifying the role of genetic and environmental risk factors on brain alterations. Although the results showed a complex interplay between gene and environment in affective disorders, the evidence seem to underline that both genetic and environmental risk factors have an impact on brain areas and vulnerability to MDD and BD. However, the precise mechanism of action and the interaction between these factors still needs to be unveiled. Therefore, future larger studies on concordant or discordant twins should be encouraged, because this population provides a unique opportunity to probe separately genetic and environmental markers of disease vulnerability.

Depressive symptoms and quality of life among Chinese medical postgraduates: a national cross-sectional study

High workloads and heavy academic pressure can have significant implications for the risk for depression and poor quality of life (QoL). This study aimed to investigate QoL and depressive symptoms in medical students undergoing postgraduate neurology specialty training in China. The survey covered demographic characteristics, the 8-itemMedical Outcomes Study Short-Formquestionnaire (SF-8), and the 2-itemPrimary Care Evaluation of Mental Disorders depression screening tool. Logistic regression analysis was used to investigate the determinants of QoL and depressive symptoms. Participants were 1,814 postgraduates from 249 hospitals in 27 Chinese provinces. The mean SF-8 physical and mental component summary scores were 78.17 (standard deviation [SD] 15.20) and 68.33 (SD 17.15), respectively. One-third of respondents had depressive symptoms, and those without depressive symptoms had significantly higher QoL scores. The multivariate regression analysis showed that factors independently associated with depressive symptoms were being in the second year of study, a lower household income, and less sleep  time. Although QoL among our sample of Chinese medical students undergoing postgraduate neurology specialty training was favorable relative to other comparable populations, one-third of respondents had depressive symptoms. Accurate measures should be taken to change this situation.

Relationship between family history of alcohol problems and different clusters of depressive symptoms

Objectives:

Major depressive disorder (MDD) is a multifactorial syndrome with significant interactions between genetic and environmental factors. This study specifically investigates the association between family history of alcohol problems (FHAP) and family history of depression (FHD), and how these relate to different clusters of depressive symptoms.

Methods:

Correlations between FHAP and FHD and different clusters of the Beck Depression Inventory (BDI) were studied. We sampled 333 employees from a general hospital who had been receiving a psychiatric consultation between 2005 and 2012. Analysis of variance (ANOVA) and Analysis of covariance (ANCOVA) models were conducted to explore these correlations.

Results:

There was a significant positive correlation between FHAP and BDI affective score. This result remained significant even after the adjustment for other variables considered as important factors for MDD, such as gender, age, marital status, education, ethnic group and FHD. More specifically, FHAP was correlated with dissatisfaction and episodes of crying among the affective symptoms. FHAP showed no statistical difference in any of the other clusters score or in the BDI total score. Moreover, as expected, we found a correlation between FHD and BDI total score and Somatic and Cognitive clusters.

Conclusion:

FHAP should be routinely investigated in individuals presenting with depressive symptoms. This is especially important in cases presenting with dissatisfaction and episodes of crying in patients who do not endorse criteria for MDD. Due to study limitations, the findings require replication by neurobiological, epidemiological and clinical studies.

Verbal Abuse Related to Self-Esteem Damage and Unjust Blame Harms Mental Health and Social Interaction in College Population

Verbal abuse is an emotional abuse intended to inflict intense humiliation-denigration-fear as perceived by exposed person. Network-based approaches have been applied to explore the integrative-segregated patterns of associations among the psychological features and external stimuli for diverse populations; few studies reported for verbal abuse effects in college population. Self-reporting measurements acquired form 5,616 college students were used for network analyses. Escalating cascades of verbal abuse from differential sources (parents, peers, or supervisors; network 1) and directed associations among verbal abuse severity-psychopathology-social interaction (network 2) were estimated using the directed acyclic graphs. Principal connectors of verbal abuse–psychopathology–social interaction were shown using the graph theory metrics calculated from the intra-individual covariance networks (network 3). Directed propagating patterns of verbal abuse phenomena differed by source (network 1). Severe peer-related verbal abuse affected psychomotor changes and influenced irritability (network 2). Verbal abuse of self-esteem damage and unjust blame served as connectors in the verbal abuse-psychopathology-social interaction; influence of smartphone overuse-related distress was stronger in cases with more severe verbal abuse (network 3). Verbal abuse that damages self-esteem and conveys unjust blame harms mental health and social interaction for college population.