Sexual harassment exposure and impaired mental health in medical students. The MESSIAEN national study

Examining medical students' experience of gender-based discrimination and sexual harassment from clinical teachers at a UK medical school

PURPOSE OF THE ARTICLE

To quantify the prevalence and characterise the nature of gender-based discrimination (GBD) and sexual harassment (SH) arising from clinical teachers towards medical students at one UK medical school.

MATERIALS AND METHODS

A mixed quantitative and qualitative survey of medical students. Chi-squared analysis and logistic regression was performed on quantitative data, while an inductive thematic analysis of qualitative data was undertaken. These findings were compared to look for common patterns.

RESULTS

Females were significantly more likely to report experiencing both GBD (χ2 = 38.61, p < 0.0001) and SH (χ2 = 19.53, p < 0.0001) than males (OR = 10.45 (CI 4.84 - 22.56, p < 0.0001)). These behaviours were more likely to be reported in specific surgical placements than medical placements (χ2 = 15.06, p < 0.001 and χ2 = 5.90, p < 0.05). Perpetrators were more commonly male, and more commonly consultants. Exposure to GBD or SH was significantly more likely to affect the choice of specialty in females compared to males (χ2 = 11.17, p < 0.001). Students noted a casual use of sexist language, inappropriate sexual advances, and gender-based microaggressions which create a pervasive discrepancy in educational opportunities between genders. Participants reported that concerns regarding anonymity, questioning the severity of the incident, and an ingrained medical hierarchy prevented students reporting these incidents.

CONCLUSIONS

The rate of GBD and SH from clinical teachers to medical students remains high, affecting female students more than male students. This study highlights key areas that must be improved to achieve a more equitable teaching experience in UK medical schools. Developing robust reporting and support systems is an important step in eradicating these behaviours.

Gender-based violence among healthcare students: Prevalence, description and associated factors

OBJECTIVES

The aims of the current study were 1) to provide the prevalence of five types of gender-based violence (GBV) among male and female healthcare students; 2) to describe perpetrators' status, where the GBV occurred, and psychological and behavioural impacts of the GBV; and 3) to identify factors associated with GBV.

DESIGN

A cross-sectional study was conducted among voluntary healthcare students in France.

SETTING

Health Campus at Rouen and nursing schools in Normandy, France.

PARTICIPANTS

Volunteer healthcare students of 18 years and over.

DATA COLLECTED

Five types of GBV were recorded: GBV1: damage to a person's image due to a sexual connotation on social networks, GBV2: sexist remarks and behaviour, GBV3: comments with sexual connotations, GBV4: sexual assaults and GBV5: rape or attempted rape. Perpetrators' status, where the GBV occurred, psychological and behavioural impacts of GBV were also recorded.

RESULTS

One thousand one hundred and fifty-two students were included. The mean age was 20.8 years (SD = 2.26), 82.6% of students were women (0.4% non-binary). Since the beginning of their healthcare study, 41.2% of students CI 95% [39.7-42.6] were victim of at least one type of GBV: 15.8% among men CI 95% [13.2-18.4] and 46.0% CI 95% [44.4-47.6] among women (p < 0.001). The perpetrators were student peers, regardless of the type of GBV, healthcare workers for the GB2 and GBV3, and patients except for GBV5. The main consequences of GBV on health was psychological and eating related. After multivariate analysis, being a woman, LGBTQ+ (Lesbian, Gay, Bi, Trans, Queer and other), a nurse, a physiotherapist student, having a job, living with roommates and year of study were risk factors for GBV.

CONCLUSION

GBV is so common at healthcare universities and could have such severe consequences for students that more work is needed to generate a culture change and ensure safe learning environments.

Effects of chronic workplace harassment on mental health and alcohol misuse: a long-term follow-up

BACKGROUND

Research on the impacts of exposure to workplace harassment (WH) is largely cross-sectional, and existing prospective studies generally are between two and five years of follow-up, with the longest US study being 10 years. However, the effects of exposure to WH may persist longer, particularly if exposure has been chronic. This study fills this gap by examining effects of prior exposure to chronic sexual and generalized WH on psychological distress and alcohol misuse over an approximately 25 year study period.

METHODS

Individuals originally recruited from a university-employed sample in the United States were surveyed at 8 time points from 1996-2007 and again in 2020-2021. A series of hybrid path analyses were tested on a sample of 2352 individuals, regressing recent outcomes on latent classes of harassment derived from earlier survey waves, controlling baseline outcomes and demographics. Model fit was assessed using a variety of fit statistics, and standardized regression coefficients were used to assess significance of individual pathways.

RESULTS

Prior exposure to chronic sexual harassment had significant direct associations with psychological distress, alcohol misuse, and recent stressors at follow-up. Prior exposure to chronic generalized harassment had significant direct associations with lower income and alcohol misuse. Both forms of WH were significantly indirectly associated with psychological distress through recent stressors at follow-up.

CONCLUSIONS

Exposure to chronic WH is associated with long-term effects on psychological distress and alcohol misuse in a sample representing a wide variety of job types and racial/ethnic identities. Enforcement of anti-sexual harassment law and policies and enactment of policies and laws to prevent generalized harassment/workplace bullying are imperative for the protection of worker health.

Mental health in medical, dental and pharmacy students: A cross-sectional study

Background

The mental health of health students is considered a public health issue which increased dramatically with the COVID 19’s pandemic. Few studies have assessed the prevalence of depression in medical, pharmacy, and dental students. Our goal was to assess mental health in health students from the same university and identify the associated factors.

Methods

An online survey was sent to the health students of the University of Paris in 3 specialties (medicine, pharmacy, and dentistry). We used the Hospitalization Anxiety and Depression scale, the Composite International Diagnostic Interview-Short Form and the Maslach Burnout Inventory (with 2 versions: the Human Services Survey for clinical students and residents and the Student survey for the others). The presence of suicidal ideation, humiliation, sexual harassment, and sexual aggression over twelve-months was also measured. We performed multivariable logistic regression analyses to identify the associated factors of Major Depressive Episodes (MDE).

Findings

1925 students answered the survey. The overall prevalence of 7-day anxiety and depressive symptoms, MDE, suicidal ideation, humiliation, sexual harassment, and sexual aggression were 55%, 23%, 26%, 19%, 19%, 22%, and 5.5%, respectively. Burnout was present in 42% of nonclinical students and 65% of clinical students and residents. Multivariable logistic regression identified several associated factors of MDE: moderate (OR = 1.49,CI95[1.17-1.90]) or major (OR = 2.32,CI95[1.68-3.20]) subjective financial difficulties, humiliation (OR = 1.71,CI95[1.28-2.28]), sexual abuse (OR = 1.65,CI95[1.04-2.60]), and sexual harassment (OR = 1.60,CI95[1.19-2.16]).

Interpretation

This is one of the largest studies comparing dental, pharmacy and medical students from the same university. We found elevated prevalences of psychiatric symptoms with variation depending on specialty.

Sexual Harassment and Mental Health of Female Healthcare Workers in a Tertiary Care Hospital in Riyadh, Saudi Arabia

Background In this study, we aimed to estimate the prevalence and identify the correlates of sexual harassment among female healthcare workers in a tertiary care hospital in Riyadh, Saudi Arabia. Methodology A cross-sectional study was conducted among 432 female healthcare workers in both Arabic and English languages. The questionnaire consisted of five sections which included the sociodemographic characteristics, a sexual harassment survey, the Kessler distress scale, social support, and the Rosenberg self-esteem scale. Unadjusted odds ratios with 95% confidence intervals were calculated to identify the significant factors associated with harassment. Results Sexual harassment was reported by 15.5% of the participants, with verbal harassment being the most commonly reported (66%), followed by physical harassment (34%). Around three-fourths of harassment acts took place during the daytime, and 18% of the participants preferred to keep quiet about it. Moderate distress [2.38 (1.17, 4.84)] and severe distress [2.31 (1.09, 4.90)], feeling hopeless [2.86 (1.47, 5.57)] and feeling depressed [3.70 (1.62, 8.48)] were significantly associated with sexual harassment. Low self-esteem items, such as "I don't have good qualities" [4.78 (2.0, 11.43)], "don't have much to be proud of" [2.10 (1.22, 3.63)], "wish that I have more respect for myself" [2.30 (1.36, 3.90)], and "inclined to feel that I am a failure" [2.27 (1.24, 4.16)] were significantly associated with sexual harassment. Conclusions It is important for all employees to know about their rights and report all types of harassment acts. Counseling sexually harassed victims should focus on improving the self-esteem and mental distress of these women. Prevention of harassment against female healthcare workers can improve their mental health as well as their quality of work.

Mental health and working conditions among French medical students: A nationwide study

BACKGROUND

Medical students' mental health is a public health problem that has worsened with COVID 19's pandemic. There is a lack of French data. The principal aim was to assess French medical students' mental health.

METHODS

An online cross-sectional survey was performed between May 27 and June 27, 2021. An anonymous questionnaire was sent via academic email addresses by medical faculties and secondly on social media. We assessed 7-day anxiety and depressive symptoms were evaluated with the Hospitalization Anxiety and Depression scale, 12-month major depressive episode (MDE) with the Composite International Diagnostic Interview- Short Form, burnout with the Maslach Burnout Inventory, 12-month suicidal ideation, humiliation, sexual harassment, and sexual aggression during their curriculum. Multivariable logistic regression was performed to identify main MDE associated factors.

OUTCOMES

11,754 participants (response rate: 15.3%) were included. Prevalence of 7-day anxiety symptoms, 7-day depressive symptoms, 12-month MDE, and 12-month suicidal thoughts were 52%, 18%, 25%, and 19% respectively. Burnout syndrome concerned 67% of clinical students and residents and 39% of preclinical students. Prevalence of humiliation, sexual harassment, and sexual abuse during their curriculum were 23%, 25%, and 4%, respectively. Having important (OR = 1.44, IC 95 [1.31-1.58], p < 0.001) or very important financial issues (OR = 2.47, IC 95 [2.15-2.85], p < 0.001), experienced humiliation (OR = 1.63, IC 95 [1.46-1.81], p < 0.001), sexual harassment (OR = 1.43, IC 95 [1.28-1.59], p < 0.001) and sexual abuse (OR = 1.52, IC 95 [1.24-1.85], p < 0.001) were associated with an increased risk of MDE.

INTERPRETATION

This is the largest study on French medical students' mental health. These results point to very particular conditions in French students environment that need to be addressed to improve their mental health.

Work environment and mental health in nurse assistants, nurses and health executives: results from the AMADEUS study

AIM

To explore work environment and mental health in nurse assistants, nurses and health executives in a national large-scale study.

BACKGROUND

We have data for physicians but not for other healthcare workers categories.

METHODS

6935 participants were recruited between 2021 May and June by professional mailings and professional networks.

RESULTS

All professional categories reported high rates of high psychological demand (>90%), low social support (>60%) burnout (50 to 60%), exposure to potentially morally injurious events (>40%) depression (approximately 30%). Surgery nurses reported the highest exposure to potentially morally injurious events. Major depression was identified in approximately 30% of participants in all categories but less than 10% reported consuming antidepressants. 31 to 49% of participants reported sleep disorders and 16 to 21% reported consuming regularly hypnotics. Physicians reported high hazardous drinking behavior and nurse assistant high smoking rates.

CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT

Our results suggest that preventing burnout and depression in healthcare workers is a priority. To reach this goal, nursing managers could develop some interventions to reduce psychological demand and increase personal accomplishment and social support between colleagues, prevent sustained bullying at the workplace and health risk behaviors. These interventions should be further developed and evaluated.

Is sexual harassment and psychological abuse among medical students a fatality? A 2-year study in the Paris Descartes School of Medicine

INTRODUCTION

An observatory of sexual harassment and psychological abuse was set up at one of France's largest schools of medicine to both quantify and reduce sexual harassment or psychological abuse of medical students.

METHODS

Over a 2-year period, we described the evolution of sexual harassment and psychological abuse and explored for associated factors. Moreover, a qualitative analysis using an inductive approach was performed from students' verbatim.

RESULTS

2795 responses were collected. Sexual harassment was reported in 7% and psychological abuse in 15%, at baseline, and decreased after the observatory was set up. Women had higher odds of being a victim of sexual harassment. Older students reported less often psychological abuse and being a witness of sexual harassment. Surgery departments were associated with up to 5.7-fold increased odds of sexual harassment. Surgery and pediatrics departments were associated with a 2-fold increased odds of psychological abuse. Qualitative analysis revealed four categories: humiliation, the feeling of inferiority, sexual harassment, and manifestations of violence.

CONCLUSION

During clerkships, factors associated with higher odds of sexual harassment and psychological abuse were female gender, younger age, and departments of surgery. Setting up such an observatory may contribute to reduce this burden and provide a useful tool to raise awareness.