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

Exploring the impact of depression, anxiety, stress, academic engagement, and dropout intention on medical students' academic performance: A prospective study

BACKGROUND

Depression, anxiety, and stress (DAS) have been linked to poor academic outcomes. This study explores the relationships among DAS, academic engagement, dropout intentions, and academic performance - measured by Grade Point Average (GPA) - in medical students. It aims to understand how these factors relate to each other and predict academic performance.

METHODS

Data were collected from 351 medical students (74.9 % female) through an online survey. The average age was 20.2 years. Psychometric instruments measured DAS, academic engagement, and dropout intentions. Structural equation modeling was used to test the relationships between these variables and their prediction of GPA.

RESULTS

DAS was negatively associated with academic engagement β̂=-0.501p<0.001 and positively associated with dropout intentions β̂=0.340p<0.001. Academic engagement positively predicted GPA β̂=0.298p<0.001 and negatively associated with dropout intentions β̂=-0.367p<0.001. DAS had a nonsignificant direct effect on GPA β̂=-0.008p=0.912. However, the indirect effect of DAS - via academic engagement - on GPA and dropout intention was statistically significant.

LIMITATIONS

The study's limitations include the use of a convenience sample and the collection of all variables, except GPA, at the same time point, which may affect the generalizability of the results.

CONCLUSIONS

The study supports the important role of DAS in its association with academic engagement and dropout intentions, which can predict GPA. Addressing DAS could enhance academic engagement and reduce dropout rates, leading to better academic performance.

Mental health in midwifery students: A French nationwide survey

BACKGROUND

Poor mental health in health students is a major public health issue, impacting personal quality of life and functioning, curriculum and care quality to patients.

PROBLEM

Few studies to date have examined mental health in midwifery students.

AIM

To evaluate the midwifery students'mental health.

METHODS

An online cross-sectional survey was performed between 02/11/2023 and 11/12/2023. Anonymous questionnaires were sent to midwife students via academic emails by all midwife faculties in France. We assessed the prevalence of current depressive symptoms, current generalised anxiety symptoms, burnout for students in internship, 12-month major depressive disorder and 12-month suicidal ideation, humiliation, sexual harassment, and sexual aggression during their curriculum with specific questions. Multivariate logistic regression was performed to identify the main factors associated with major depressive disorder and suicidal ideation.

FINDINGS

Among midwifery students, 1920 (response rate: 51.9 %) were included. The prevalences of current depressive symptoms, anxiety symptoms, burnout, 12-month major depressive disorder, and 12-month suicidal ideation were 62 %, 47 %, 44 %, 13 % and 14 %, respectively. Humiliation, sexual harassment and sexual aggression were reported by 19 %, 1.8 % and 0.7 %, respectively. In multivariable analyses, having important financial difficulties and sexual violence were associated with higher rates of major depressive episodes and suicidal ideation.

DISCUSSION

>1 in 10 students suffered from 12-month depression and/or suicidal ideation, and almost half of them expressed various distressing symptoms.

CONCLUSION

These alarming results highlighted the need for interventions to improve mental health in midwifery students, including safer conditions of education and living.

Prevalence of Depression and Generalized Anxiety Among LGBTQ+ Medical Students in Thailand

This study evaluated the prevalence and associated factors of depression and generalized anxiety among LGBTQ+ in five medical schools in Thailand. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess major depressive disorder (MDD) and generalized anxiety disorder (GAD), respectively, and multivariable logistic regression was employed to identify associated factors. Of 1,322 students, 412 (31.16%) identified as LGBTQ+. The prevalence for MDD and GAD among LGBTQ+ students were 32.77% and 17.23%, respectively. Significant associated factors for both MDD and GAD were a history of psychiatric illness (AOR for MDD = 2.32, p = .020; AOR for GAD = 3.67, p < .001), educational problems (AOR for MDD = 6.62, p < .001; AOR for GAD = 5.12, p < .001), and dissatisfaction with gender identity or sexual orientation (AOR for MDD = 1.92, p = .019; AOR for GAD = 2.47, p = .005). Additional factors associated with MDD were preclinical years (AOR = 2.30, p = .023), financial struggles (AOR = 2.05, p = .021), and inadequate peer support (AOR = 2.57, p = .044). In conclusion, nearly one-third and one-fifth of Thai LGBTQ+ medical students suffer from MDD and GAD, respectively. Our findings suggest that Thai medical schools should promote LGBTQ+ inclusivity to enhance students' identity satisfaction. Peer support groups should be encouraged, especially for preclinical LGBTQ+ students who face educational and financial challenges.

Use of service and treatment adequacy in medical students and residents suffering from depression in France: A nationwide study

Depression was already a public health issue before the Covid-19 pandemic. Use of service and treatment adequacy in medical students was poorly known. A 2021 French national study found the prevalence of 12-month major depressive disorder (MDD) was 25 % in medical school students and residents (MSSR). The main objective of our study was to measure the prevalence of service use and adequate treatment (therapy and/or recommended pharmacotherapy) and their associated factors. A national online survey was conducted in 2021. The Composite International Diagnostic Interview Short-Form questionnaire was used to assess MDD; 12-months service use and pharmacotherapy were assessed. Univariate and multivariate logistic regressions were performed between students' demographic characteristics, use of services, and treatment adequacy. Among included MSSR who experienced MDD in the last 12 months, only 32 % received adequate treatment, including 20 % with recommended pharmacotherapy. Being more advanced in medical studies and being treated both by a general practitioner and a psychiatrist were associated with receiving recommended pharmacotherapy. To our knowledge, our study is the largest to assess use of service and treatment adequacy in MSSR. Given the low percentage of depressed students receiving recommended treatment, it seems important to develop new interventions to better detect and treat MDD in MSSR.

Global prevalence of anxiety and depression among medical students during the COVID-19 pandemic: a systematic review and meta-analysis

PURPOSE

As future physicians, medical students have experienced tremendous pressure during the ongoing COVID-19 pandemic, which is associated with a high risk of depression and anxiety. We aimed to investigate an overview of the prevalence of anxiety and depression among medical students in various countries during the global COVID-19 pandemic, and discuss associated stressors.

METHODS

We systematically searched CINAHL, EMBASE, MEDLINE, PubMed, and Web of Science for relevant articles from December 1, 2019 to March 15, 2023. We performed meta-analysis using a random-effects model with REML method to calculate the pooled prevalence of anxiety and depression. Begg's and Egger's tests were used to identify the potential risk of publication bias. Meta-regression was used to explore potential sources of heterogeneity.

RESULTS

We identified 130 studies reporting anxiety and depression among 132,068 medical students during the COVID-19 pandemic. Eight screening tools were identified for anxiety and six for depression. The pooled prevalence of mental health outcomes for anxiety and depression was 45% (95% confidence interval [CI], 40%-49%) and 48% (95% CI, 43%-52%), respectively. The pooled prevalence of mental health outcomes for moderate and severe anxiety and moderate and severe depression was 28% (95% CI, 24%-32%) and 30% (95% CI, 26%-35%), respectively. There was high heterogeneity between studies, with I2 ranging from 99.58%-99.66%. Continent and survey date were included in the meta-regression model. The results of meta-regression revealed that medical students in Asia had a lower prevalence of anxiety, and depression than those in other regions. The survey date (from February to June, 2020) showed a significantly positive correlation with the prevalence of anxiety and depression.

CONCLUSIONS

We demonstrated the global prevalence of anxiety and depression among medical students during the COVID-19 pandemic. The data highlight that medical students worldwide are at high risk of experiencing anxiety and depression. The reported stressors can be categorized into personal, academic, environmental and cultural, and pandemic factors. Schools and institutions should ensure optimal alternative learning environments for uninterrupted provision of medical education. The appropriate authorities should prioritize the provision of adequate protection for medical students and establish policies to promote new methods of training and education during a disaster, such as via distance learning.

Associations between humiliation, shame, self-harm and suicidality among adolescents and young adults: A systematic review

BACKGROUND

Suicide is the second leading cause of death among young people worldwide. Research indicates that negative social contexts involving familial and peer relationships have far-reaching influences on levels of suicidality in later life. While previous systematic reviews have focused on evaluating associations between negative life events such as abuse and bullying in childhood and subsequent suicidality, this systematic review examines the prevalence of, and association between the processes of humiliation and shame in later self-harm, suicidal ideation, and suicide among adolescents and young adults.

METHODS

A systematic literature search of databases including MEDLINE, Web of Science Core Collection, CINAHL, PsycINFO, and Embase was conducted to identify potential studies. ProQuest was searched to identify relevant grey literature research. A combination of MESH terms and keywords was used. All original quantitative studies published in English that examined the prevalence, or association between humiliation or shame and suicidal behaviours and/or death by suicide were included. Studies were assessed for methodological quality using Joanna Briggs Institute critical appraisal tools. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) [CRD42022289843].

RESULTS

Narrative synthesis was performed. A total of 33 studies reporting the prevalence of, or association between humiliation (n = 10) or shame (n = 23) and suicidal thoughts/behaviours were included. The prevalence of humiliation among those with any suicidality ranged from 18% to 28.1%, excluding an outlier (67.1%), with two studies presenting a significant association between humiliation and self-harm in their fully adjusted analyses. The studies that outlined humiliation and suicidal thinking (intent/suicide plan) had no association after adjustment for confounders. For shame, half of the studies found an association in adjusted models (n = 10), and this was evident for both suicidal ideation and self-harm.

CONCLUSION

To our knowledge, this is the first study to attempt a systematic review on this topic. The dearth of research in this field of enquiry is reflective of unique challenges associated with assessments of humiliation and shame in various clinical settings amongst adolescent and young adult populations. Nonetheless, given the importance and relevance of the psychological imprint of humiliation in youth morbidity and mortality in the field of mental health, it is timely to attempt such a systematic review. In light of the associated role of humiliation and shame in self-harm and suicidality among young people, we recommend that these processes need to be explored further via prospective studies and assessed as part of a comprehensive bio-psycho-social assessment when focusing on life stressors for adolescent and young adults presenting with suicidality to emergency departments and mental health services.

The consumption of psychoactive substances among French physicians: how do they perceive the creation of a dedicated healthcare system?

Introduction

Substance use among physicians can have negative impacts on their health, quality of life, and patient care. While Physician Health Programs (PHPs) have proven effective, many physicians with substance use disorders (SUDs) still face obstacles in seeking help. Our study explores the expectations, attitudes, and experiences of French physicians regarding the implementation of a specialized healthcare system (SHS) for addiction, and their opinions on the factors that could improve the effectiveness of such a service, with a focus on substance use disorders (SUDs).

Methods

We conducted a web-based survey from April 15 to July 15, 2021, which included questions about sociodemographic characteristics, substance use, and attitudes toward a specialized healthcare system (SHS) for physicians with SUDs.

Results

Of the 1,093 respondents (62.5% female), 921 consumed alcohol (84.2%), and 336 (36.4%) were categorized as hazardous drinkers (AUDIT-C ≥ 4 for women and ≥ 5 for men). The mean AUDIT-C score was 3.5 (±1.7 SD), with a range from 1 to 12. Factors associated with hazardous alcohol consumption included coffee consumption [OR 1.53 (1.11-2.12)], psychotropic drug use [OR 1.61 (1.14-2.26)], cannabis use [OR 2.96 (1.58-5.55)], and other drug use [OR 5.25 (1.92-14.35)]. On the other hand, having children was associated with non-hazardous alcohol consumption [OR 0.62 (0.46-0.83)]. Only 27 physicians (2.9%) had consulted a specialist in addiction medicine, while 520 (56.4%) expressed interest in such a consultation. The main barriers to accessing a dedicated consultation were denial (16.3%), physician self-medication (14.3%), fear of judgment (12.8%), and confidentiality concerns (10.2%).

Conclusion

A specialized consultation with trained professionals in a neutral location can improve access to care for healthcare workers and maintain patient confidentiality and anonymity. Prevention and awareness can reduce addiction stigma and help peers in need. The improvement of healthcare workers' addiction culture and detection of addictive behavior in peers depends on academic addiction medicine.

Mental health first aid training among healthcare French students: a qualitative study

Background

Healthcare students are a population more at risk for mental health issues, especially anxiety, depression, and suicidal thoughts. The health faculty of Université Paris Cité in France, Paris has implemented a Mental Health First Aid (MHFA) course aiming to improve students' mental health literacy, self-care and peer-support and to decrease stigma about mental illness. We conducted a qualitative study exploring the lived experience of this MHFA training course among healthcare students so to better assess its implementation within this specific context and population.

Methods

This qualitative study used the five-stage inductive process to analyze the structure of lived experience (IPSE) approach. All the healthcare students that had completed the 2-day MHFA training were approached to participate. Data was collected through individual semi-structured interviews and inclusion continued until data saturation was reached. Data analysis was based on an inductive, descriptive, and structuring procedure to determine the structure of lived experience characterized by the central axes of experience.

Results

Twenty students were included. Data analysis produced a common structure of lived experience based on three central axes of experience, (1) a personal experience, (2) a student experience and (3) a professional experience. The participants all experienced this course intertwined within these 3 axes. Their motivation to take the course was personal -being of feeling concerned by the topic-, was study-oriented - to learn and revise psychiatry- and was professional - so to develop both practical and soft skills. In their personal experience, participants reported a transformative experience and some interventions with friends and family, while both in their student and professional experience, they felt frustrated with both the content and the form of the course.

Conclusion

The results reported similar outcomes reported in the literature about skills, knowledge, and awareness; but mostly produce original avenues about how to better adapt such course to this specific population so to better address students' expectations and mental health issues. This MHFA course -with an adapted content addressing eating disorders, self-mutilations and sexual and gender-based violence - could be part of the early curriculum of healthcare students. The latter could then benefit from a level 2/advanced MHFA course years later specifically tailored for healthcare professionals.

Understanding students' motivations for participating in a mindfulness course: a qualitative analysis of medical students' views

OBJECTIVES

Improving medical students' wellbeing and empowerment through curricular activities is a topic of interest worldwide. Mindfulness-based interventions (MBIs) are increasingly implemented in medical education often as part of elective courses. To better understand training outcomes and adjust curriculum to students' needs, we will explore why will medical students participate in meditation-based education?

METHODS

We analyzed 29 transcripts from the first session of an 8-week MBSR program offered to medical students in French. Transcripts were coded and analyzed using a qualitative content thematic analysis and the constant comparison method.

RESULTS

Analyses resulted in three themes describing students' motivation: (1) Medical education and the physician's role, i.e. improving interpersonal skills, acquiring skills oriented toward a more integrative medicine, being more productive in a highly competitive context. (2) Caring for my health i.e. aiming at stress reduction, emotion regulation, and improving self-compassion. (3) A quest for meaning, i.e. optimizing meaning of care, and meaning of life.

CONCLUSION

The results highlight the congruence between the perceived motivations and the evidence on the effect of mindfulness on self-care, the development of humanistic medical skills, and the meaning of care. Some findings raise the issue of the limits of using mindfulness to enhance one's productivity. Notably, participants articulated the need for self-care as in mindfulness training, with the ability to care for others.

The prevalence and risk factors of mental problems in medical students during COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

This meta-analysis and systematic review aimed to evaluate the global prevalence and risk factors of mental problems (i.e., depression, anxiety, stress, sleep disorder, posttraumatic stress disorder (PTSD), burnout, psychological distress, and suicidal ideation) among medical students during the COVID-19 pandemic.

METHOD

We searched PubMed, Embase, Web of Science, psycARTICLES, PsycINFO, CNKI, and Wan Fang for studies on the prevalence of mental problems among medical students from January 1, 2020, to April 1, 2022. The pooled prevalence was calculated by random-effect models. We performed a narrative review to identify the risk factors.

RESULTS

The meta-analysis included 201 studies (N = 198,000). The prevalence of depression (41 %, 95 % CI, 37-45 %,), anxiety (38 %,95 % CI, 34 %-42 %), stress (34 %, 95 % CI, 27 %-42 %), sleep disorder (52 %, 95 % CI, 44 %-60 %), psychological distress (58 %, 95 % CI, 51 %-65 %), PTSD (34 %, 95 % CI, 22 %-46 %), suicidal ideation (15 %, 95 % CI, 11 %-18 %) and burnout (38 %, 95 % CI, 25 %-50 %) was high. The major risk factors were being female, being junior or preclinical students, exposure to COVID-19, academic stress, psychiatric or physical disorders history, economic trouble, fear of education impairment, online learning trouble, fear of infection, loneliness, low physical activity, low social support, problematic internet or smartphone use, and young age.

LIMITATIONS

Most studies were cross-sectional. Few studies provided a reasonable response rate, suggesting potential selection bias.

CONCLUSIONS

The study demonstrated a high prevalence and risk factors for mental problems during COVID-19, calling for mental health services. Our findings are valuable for college and health authorities to identify high-risk students and provide targeted intervention.

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.

Association of depression symptoms and sleep quality with state-trait anxiety in medical university students in Anhui Province, China: a mediation analysis

BACKGROUND

The prevalence of depression symptoms among medical students is particularly high, and it has increased during the COVID-19 epidemic. Sleep quality and state-trait anxiety are risk factors for depression, but no study has yet investigated the mediating role of state-trait anxiety in the relationship between poor sleep quality and depression symptoms in medical students. This study aims to investigate the relationship among depression symptoms, sleep quality and state-trait anxiety in medical university students in Anhui Province.

METHODS

This was a cross-sectional survey of 1227 students' online questionnaires collected from four medical universities in Anhui Province using a convenience sampling method. We measured respondents' sleep quality, state-trait anxiety, and depression symptoms using three scales: the Pittsburgh Sleep Quality Index (PSQI), the State-Trait Anxiety Inventory (STAI) and the Self-rating Depression Scale (SDS). We analysed the mediating role of STAI scores on the association between PSQI scores and SDS scores through the Sobel-Goodman Mediation Test while controlling for covariates. P < 0.05 was considered statistically significant.

RESULTS

A total of 74.33% (912) and 41.40% (518) of the respondents reported suffering from poor sleep quality and depression symptoms. Sleep quality, state-trait anxiety, and depression symptoms were positively associated with each other (β = 0.381 ~ 0.775, P < 0.001). State-trait anxiety partially mediated the association between sleep quality and depression symptoms (Sobel test Z = 15.090, P < 0.001), and this mediating variable accounted for 83.79% of the association when adjusting for potential confounders. Subgroup analysis further revealed that STAI scores partially mediated the association between PSQI scores and SDS scores in females and rural students and fully mediated the association between PSQI scores and SDS scores in males and urban students.

CONCLUSIONS

This study found that sleep quality and state-trait anxiety have a significant predictive effect on depression symptoms. State-trait anxiety mediated the relationship between sleep quality and depression symptoms, with a more complex mechanism observed among rural and female medical students. Multiple pathways of intervention should be adopted, such as encouraging students to self-adjust, providing professional psychological intervention and timely monitoring, enriching extracurricular activities, and making changes in policies regarding long shifts and working hours.

Mental Health and Physical Activity of Female Higher Education Students during the COVID-19 Pandemic: A Comparative Cross-Sectional Study from Lithuania

During emerging adulthood (EA), higher education medical students undergo a higher risk of anxiety and depression compared to the general population. The aim of this comparative cross-sectional study was to compare the proportions of three mental disorders, namely anxiety, depression and somatisation in terms of their symptoms and self-reported physical activity (PA) levels across the cohorts of biomedical and non-biomedical female students as well as to assess the association between the mental health outcomes and PA use. Between September 2021 and January 2022, a total of 1231 female higher education students aged between 18 and 29 years old were recruited for the study. Severe symptoms of anxiety and depression, as well as unexplained somatic complaints, were suffered by 51.9%, 11% and 23% of female students, respectively. Non-biomedical female students, compared to medicine and health sciences students, were more vulnerable due to the increased prevalence of negative mental health outcomes. The relationship between increased sports activity as a potential trigger for mental well-being and decreased severity of depressive symptoms was identified in the cohorts of both biomedical (adjusted odd ratio (OR_adj) 0.4; 95% confidence interval (CI): 0.1-1.0) and non-biomedical (OR_adj 0.4; 95% CI: 0.2-0.9) female students. The current research highlights the importance of increasing sports activity by involving students in regular physical exercise of specific types for decreasing the severity of depressive symptoms in student-aged female populations.

Détresse et résilience des étudiants en médecine de Paris Saclay lors de la première vague de la pandémie de COVID-19

Les étudiants en médecine sont exposés à des risques psychosociaux responsables d’un plus haut niveau d’anxiété, de dépression, de syndrome d’épuisement professionnel que la population française de même âge. Lors de la première vague de la pandémie COVID-19 en France, un certain nombre d’entre eux se sont mobilisés pour venir en aide aux hôpitaux débordés. Au travers de cette expérience, ils ont rapporté une détresse psychologique modérée, laquelle était nuancée par différentes capacités de résilience. Cette étude explore les ressources et les difficultés d’étudiants en médecine de l’université Paris-Saclay (France) engagés lors de la première vague dans les services hospitaliers. Si l’exposition à la mort et les conditions de soins dégradés ont pu impacter leurs motivations à étudier, l’expérience a également permis à certains d’entre eux d’acquérir des compétences complémentaires, de participer à l’effort collectif, d’éviter le confinement généralisé et d’aider les autres soignants. La prise en compte de ces facteurs de résilience au regard des difficultés rencontrées (exacerbées par la crise sanitaire, mais qui existaient déjà avant cette dernière) permet de nourrir la réflexion sur l’amélioration de la qualité de vie des étudiants en médecine dans le système universitaire médical français.