The health status and life satisfaction of first-year medical students

Psychological Stress Experienced by First-Year Medical Undergraduates: A Cross-Sectional Study From Eastern India

Background While medical education is vital for producing competent physicians, its rigorous curriculum can harm students' mental well-being. This study focuses on assessing psychological stress in first-year medical students in Eastern India and aims to identify its primary causes. Methods This cross-sectional study involved 125 first-year MBBS students in a tertiary care medical teaching institution in eastern India. They completed the Medical Student Stressor Questionnaire (MSSQ-40) questionnaire to measure stress and provided academic records to be reviewed.  Results Among the 125 students included in the study, male students demonstrated greater academic and interpersonal stress. The findings revealed that a substantial proportion (79%) of the student population experienced high to severe levels of academic stress, followed by 88% who reported moderate to high levels of social-related stress. Furthermore, it was observed that those students who experienced high to severe stress across all six domains tended to perform poorly during the initial half of their academic year. Conclusion The high levels of stress experienced by medical students can have significant implications for their academic performance. However, the nature of our study limits us to only highlight the existence of a correlation between the two. Future studies on the same should be conducted to assess the causal relation between these factors.

A Longitudinal Study Exploring the Role of Mental Health Symptoms and Social Support Regarding Life Satisfaction 18 Months after Initiation of Gender-Affirming Hormone Treatment

While positive changes in mental health have been found following gender-affirming hormone treatment (GAHT), it is unclear how pre-GAHT mental health and social support can influence treatment outcomes. To address this, a retrospective longitudinal design was used in which 137 participants completed measures of social support, anxiety, and depression prior to GAHT (T0) and a measure of life satisfaction 18 months after GAHT (T1). The data showed no significant differences in life satisfaction at T1 based on T0 caseness of anxiety or depression. It was also found that T1 life satisfaction was not predicted by levels of anxiety, depression, or social support at T0. The lack of significant differences in life satisfaction at 18 months post-GAHT based on pre-GAHT mental health, coupled with no evidence for the predictive role social support suggest that these factors are not central to long-term life satisfaction. For many, lower mental wellbeing may be part of the experience of awaiting GAHT and should not be regarded as indicative of longer-term issues. Instead, facilitation of social support connections and mental health support should be offered both concurrently with, and for those awaiting, GAHT.

Students in Turkey During the Early Days of the COVID-19 Pandemic

This study aims to analyse the subjective well-being of university students during the early days of the COVID-19 pandemic process and to examine how students have been affected economically, psychologically and socially. Other subjects included in the scope of the study are the suitability of the physical conditions during the process of online education, the students' motivation, and their expectations towards the future. The study also analyses the connection between these factors and the subjective well-being concepts of happiness and life satisfaction. The study focuses on students of the Faculty of Economics at Marmara University in Turkey. In total, 428 students took part in the survey prepared for the study. Descriptive analyses indicate that students have been negatively affected in terms of psychological and socio-economic factors along with subjective well-being. Ordered probit models show a statistically significant relationship between a major part of these changes and subjective well-being variables.

Stress in Medical Students: PRIMES, an Italian, Multicenter Cross-Sectional Study

Medical students (MSs) are healthcare workers and must also cope with education-related stressors. This study aims to assess factors associated with perceived stress in Italian MSs. A cross-sectional study was conducted in 12 Italian medical schools (MSCs) in November 2018. A questionnaire assessed socio-demographic characteristics, habits, opinions about MSC, and concerns about the future. Stress was assessed with the PSS-10. Descriptive and univariable tests were performed. A linear model was fitted to find associations of the PSS-10 score with characteristics. There were 2513 collected questionnaires. Median PSS-10 score was 18 (IQR 11). Median age was 22 (IQR 4) and 61% of the sample was female. Female gender, being part of a sexual minority, poor financial situation, competitive atmosphere, having hobbies, resting, and sleeping hindered by MSC were characteristics associated with higher PSS-10 scores. Current relationship, good family relationship, and no concerns about the future were protective factors. Being part of sexual minorities had greater effects in students not living away from home, while in the other group it was not having satisfying friendships. Medical students suffer higher levels of stress than the general population, and many MSC stressors are associated. Living away from home modifies risk and protective factors, offering the possibility to tailor group-specific interventions.

The impact of the COVID-19 pandemic on stress, mental health and coping behavior in German University students - a longitudinal study before and after the onset of the pandemic

BACKGROUND

The COVID-19 pandemic has led to massive restrictions in public and private lives, including a shut-down of face-to-face teaching at universities in Germany. We aimed to examine the impact of these changes on perceived stress, mental health and (study-)related health behavior of students in a longitudinal study.

METHODS

For two timepoints - the year before the COVID-19 pandemic (2019, n = 1377) and the year during the COVID-19 pandemic (2020, n = 1867) - we surveyed students of all faculties at one German university for perceptions and preventive behavior regarding the COVID-19 pandemic using standard instruments for stress, anxiety, depression, and behavior and experience patterns.

RESULTS

About 90% of students (n = 1633) in 2020 did not have a known contact infected with SARS-CoV-2, while 180 (9.8%) did have one. Only 10 respondents (0.5%) reported an infection with SARS-CoV-2. Wearing masks and washing hands more often were practiced by ≥80% of students. Taking more care about cleanliness (51.8%) and using disinfectants (39.2%) were practiced much less. A higher percentage of female compared with male students and medical/health science students compared with science, technology, engineering, and mathematics students engaged more frequently in specific or nonspecific preventive measures. More than three quarters (77.1%) of all students rated their general health as (very) good. There were no significant differences in general health, stress, and depression between 2019 and 2020 in the students who responded at both timepoints. The distribution of behavior and experience patterns for this group showed a slight but significant difference from 2019 to 2020, namely decreasing proportions of students with a healthy pattern and a risk pattern for overexertion. Students with different behavior and experience patterns showed marked differences in perceptions and reaction to the COVID-19 pandemic as well as psychosocial stress and symptoms, with higher scores for mental health symptoms and lower scores in preventive behavior regarding risk patterns.

CONCLUSION

Despite massive alterations to students' lives in 2020, there were only moderate consequences for mental health compared with 2019 in the total student group of this German university. However, identifying students at risk would offer opportunities to foster mental health in relevant subgroups.

Predictive factors of quality of life among medical students: results from a multicentric study

Background

Medical students have a worse perception of Quality of Life (QoL) and a high prevalence of psychosocial suffering when compared to the general population. The objective of this study was to investigate associated factors with Quality of Life of Brazilian medical students from an exploratory analysis in a cross-sectional study described in accordance with the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) guidelines.

Methods

This is a cross-sectional and multicenter study with national sample randomized by sex and year of the course. Data were collected between August 2011 and August 2012, using an electronic platform (VERAS platform). Our outcomes included: personal quality of life (QoLp) and quality of life related to medical course activities (QoLmc), both measured using a score ranging from 0 (worst) to 10 (best). Variables as predictors: the World Health Organization Quality of Life Assessment abbreviated version (WHOQOL-BREF); VERAS-Q (a questionnaire created to evaluate the QoL of students in health professions); Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Maslach Burnout Inventory (MBI), Resilience Scale (RS-14), Interpersonal Reactivity Multidimensional Scale (IRMS) and Dundee Ready Education Environment Measure (DREEM).

Results

Our sample is comprised of 1350 (81.8%) medical students. When comparing predictors and both quality of life outcome measures, we found a negative correlation between QoL and the BDI, PSQI and ESS scores. Through a multiple linear regression mode we identified the median of significant predictors to higher QoL. We then run a tree regression model that demonstrated that the VERAS-Q—physical health domain (a domain assessing self-care, self-perception of health, sleep, leisure, physical activity and appearance) was the most important factor predicting QoL. Students with a VERAS-Q-physical health score ≥ 60.9 and a VERAS-Q-time management (address the management of the student's time, free time and whether he can dedicate himself to other activities besides the course) score ≥ 55.7 presented the best QoLmc (score: 8.08–9.63%). Students with a VERAS-Q-physical health score ≥ 79.7 presented the highest QoLp (score 8.93–8.74%).

Conclusion

Physical symptoms, self-perception of health and self-care assessed by the VERAS-Q physical domain had association with both final outcomes. Time management seems to have a protective role for better Quality of Life. These variables should be taken in consideration when designing interventions to improve Quality of Life among medical students.

Prevalence of sleep disorders among medical students of Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia

Background: Sleep disorders are a common medical problem and can affect health and quality of life. There are multiple types of sleep disorders such as obstructive sleep apnea, insomnia, narcolepsy, restless legs/periodic limb movement disorder, circadian rhythm disorders, sleepwalking and nightmares. Medical students appear to be more liable to develop sleep disorders due to their high academic load. Design and Methods: This study seeks to estimate the prevalence of sleep disorders among Umm Al-Qura University medical students and associated risk factors. This cross-sectional study was conducted at the Faculty of Medicine of Umm Al-Qura University in Makkah, Saudi Arabia. A self administrated questionnaire was used to collect the data including socio-demographic data and sleep-50 questionnaire. Four hundred and thirty-eight (438) medical students from the second year to the sixth year were recruited to the study Results: Three hundred and twenty-three participants (73.8%) complained of at least one sleep disorder. The most prevalent sleep disorder among students was narcolepsy at 226 (51.6%). Female students, second year students and students spending significant time watching television or on smartphones were more affected than others with p values of 0.001, 0.005, and 0.004 respectively. Conclusions: Sleep disorders are common among medical students. It is essential to detect and address them before their condition deteriorates.

Energy Poverty and Life Satisfaction: Structural Mechanisms and Their Implications

This paper investigates the distinct mechanisms through which energy poverty is linked to life satisfaction, via health status and one’s satisfaction with one’s own socioeconomic status, using data from the Life in Transition survey. Our sample contains 19,598 individuals from 11 former communist states located in Central and Eastern Europe, and two developed countries for comparison. We estimated a partial least squared–path model and found that both health status and socioeconomic status are relevant mediators. Our results also indicate that gender moderates the relation between health status and life satisfaction. Energy poverty has a low contribution to health status but a larger contribution to satisfaction with socioeconomic status, thus indicating that interventions on energy poverty may not greatly improve the level of health, but can have an influence on how people feel about their life. The contribution of our paper is twofold. On the one side, we continue to consolidate the existing link between energy poverty and self-reported health status with a new focus on the Central and Eastern European countries; on another side, we propose a theoretical framework expansion by including totally novel factors to be analyzed in this context: satisfaction with socioeconomic status, economic environment improvement, and intolerance.

Medicine's Shame Problem

BACKGROUND

Physician mental health is an increasingly discussed topic. Despite the progress made regarding the discussion of physician mental health, these issues remain concerning. In particular, the discussion as to why these issues are so problematic remains limited. Contributors can include bullying, the "hidden curriculum" of medicine, how the medical culture handles errors, and importantly, shame.

OBJECTIVE

This narrative review evaluates the literature on bullying and abuse in medicine, how abuse can exacerbate shame, how the handling of medical errors can exacerbate shame, how shame can negatively affect mental health, and how the medical community and leaders can mitigate these issues.

DISCUSSION

Physician mental health remains an important issue. Job-related stressors, bullying, medicine's hidden curriculum, medical error, traumatic patient encounters, and perfectionism can contribute to physician depression and burnout. Shame may underlie these factors. Shame is a universal emotion that leads to poor self-esteem, depression, eating disorders, abuse, and addiction. However, shame can be addressed and overcome, especially via acknowledgment, vulnerability, and empathy. The medical community can provide some of these techniques by encouraging environments of kindness and respect, giving constructive rather than destructive feedback, providing empathy and support after a medical error, and encouraging mutual learning environments where questions are asked with respect in order to enhance learning. This is opposed to hierarchies and "pimping," where questions are asked with intimidation and disrespect.

CONCLUSIONS

Shame is likely a contributor to physician mental health issues. For shame resilience to occur, it must not be kept secret and mutual support should be provided. By addressing the possible causes behind physician mental health concerns, including shame, more solutions can be proposed.

Study-related behavior patterns of medical students compared to students of science, technology, engineering and mathematics (STEM): a three-year longitudinal study

BACKGROUND

Medical education is perceived as demanding and stressful. Whether this is particularly pronounced in this course of study remains under debate.

METHODS

We used the questionnaire "Work-Related Behavior and Experience Patterns (Arbeitsbezogene Verhaltens- und Erlebensmuster (AVEM))" to assess the development of study-related behavior and experience patterns in medical (n = 584) and STEM students (n = 757) at one German university, with a special emphasis on gender differences, over 3 years of study. Students were surveyed at the beginning of their studies (t0) and again in each consecutive summer semester (t1-t3). Both cross-sectional and longitudinal data were generated and analyzed. Results in the abstract are from the cross-sectional analysis.

RESULTS

Freshman medical students presented with a larger proportion of students with a healthy pattern (58.1%) than STEM students (42.5%). In both groups this proportion decreased to 33.8%/25.1% at t2, with only a minor improvement at t3 (38.1/27.0%). Correspondingly, the proportion of students with a burnout-related risk pattern increased from 8.0% (Med)/13.7% (STEM) to a maximum of 16.9% at t2 in medical students and 27.0% at t3 in STEM students. In both groups female students showed a more unfavorable distribution of patterns and a higher vulnerability, especially in the area of resistance toward stress.

CONCLUSIONS

The unfavorable development of behavior and experience patterns in both student groups demonstrates increasing study related stress and emphasizes the need for prevention and health promotion on an individual and a contextual level.

Effects of Group Fitness Classes on Stress and Quality of Life of Medical Students

Context

Medical school can produce intense psychological distress in its students; however, there is a paucity of research exploring potential means of improving medical students’ well-being.

Objective

To investigate the relationship between physical exercise and stress and quality of life (QOL) in a medical student population.

Methods

This nonrandomized, controlled, 12-week study used a survey research design. First- and second-year osteopathic medical students at the University of New England College of Osteopathic Medicine were recruited to participate in 1 of 3 groups: (1) students participating in 30-minute CXWORX (Les Mills International LTD) group fitness classes; (2) students exercising alone or with up to 2 additional partners regularly (eg, running, weight lifting), henceforth called the health-enhancement group; and (3) students in a control group who did not engage in regular exercise. Participants completed the Perceived Stress Scale survey once every 4 weeks, as well as visual analog scale surveys to assess physical, mental, and emotional QOL weekly during the course of the study. Statistical significance was defined as P<.05.

Results

Sixty-nine participants met the inclusion criteria and completed the study protocol, with 25 in the fitness class group, 29 in the health-enhancement group, and 15 in the control group. Compared with baseline values, the fitness class group demonstrated decreased perceived stress (P=.038) and increased physical QOL (P=.007), mental QOL (P=.046), and emotional QOL (P=.004) after 12 weeks. Participants in the health-enhancement and control groups showed no statistically significant changes between baseline and week 12 for any of these parameters, with the exception of mental QOL, which improved in the health-enhancement group (P=.023).

Conclusion

Participation in regular group fitness classes led to a statistically significant decrease in perceived stress and an increase in physical, mental, and emotional QOL compared with exercising regularly on one's own or not engaging in regular exercise. Attending weekly group fitness classes could be a solution to improving the emotional well-being and stress level of medical students.

Amount of Sleep, Daytime Sleepiness, Hazardous Driving, and Quality of Life of Second Year Medical Students

OBJECTIVE

The authors describe the sleep habits of second year medical students and look for associations between reported sleep duration and depression, burnout, overall quality of life, self-reported academic success, and falling asleep while driving.

METHODS

The authors conducted a cross-sectional descriptive study of two consecutive cohorts of second year medical students at a large public university in the USA. Participants completed an anonymous survey about their sleep habits, daytime sleepiness (Epworth sleepiness scale), burnout (Maslach burnout inventory), depression (PRIME MD), and perceived stress (perceived stress scale). Categorical and continuous variables were compared using chi square tests and t tests, respectively.

RESULTS

Sixty-eight percent of the students responded. Many (34.3%) reported fewer than 7 h of sleep on typical weeknights, including 6.5% who typically sleep less than 6 h. Twenty-five students (8.4%) reported nodding off while driving during the current academic year. Low typical weeknight sleep (fewer than 6 h vs 6-6.9 h vs 7 or more hours) was associated with (1) higher Epworth sleepiness scale scores, (2) nodding off while driving, (3) symptoms of burnout or depression, (4) decreased satisfaction with quality of life, and (5) lower perceived academic success (all p values ≤0.01). Students reporting under 6 h of sleep were four times more likely to nod off while driving than those reporting 7 h or more.

CONCLUSION

Educational, behavioral, and curricular interventions should be explored to help pre-clinical medical students obtain at least 7 h of sleep most on weeknights.

Insomnia and Its Temporal Association with Academic Performance among University Students: A Cross-Sectional Study

INTRODUCTION

Studies show that 9.4% to 38.2% of university students are suffering from insomnia. However, research data in developing countries is limited. Thus, the aim of the study was to assess insomnia and its temporal association with academic performance.

METHODS AND MATERIALS

Institution based cross-sectional study was conducted with 388 students at Debre Berhan University. Data were collected at the nine colleges. Logistic and linear regression analysis was performed for modeling insomnia and academic performance with a p value threshold of 0.05, respectively. Data were entered using EPI-data version 3.1 and analyzed using SPSS version 20.

RESULTS

The prevalence of insomnia was 61.6%. Field of study (p value = 0.01), worshiping frequency (p value = 0.048), marital status (p value = 0.03), and common mental disorder (p value < 0.001) were identified associated factors of insomnia. There was no significant association between insomnia and academic performance (p value = 0.53, β = -0.04). Insomnia explained 1.2% (r² = 0.012) of the difference in academic performance between students.

CONCLUSIONS

Nearly 3 out of 5 students had insomnia. We recommended that universities would endorse sleep quality and mental health illness screening programs for students.

Health-promoting factors in the freshman year of medical school: a longitudinal study

CONTEXT

The freshman year of medical school is a stressful period in the lives of future doctors. Resilience to this stress differs greatly, leading to different health outcomes. Less resilient students, whose health may deteriorate early in their education, are at greater risk for developing stress-related diseases. Early identification of individuals at risk and the provision of tailored health-promoting interventions might prevent this.

OBJECTIVES

This study was designed to investigate: (i) how the health of medical students develops over the freshman year, and (ii) whether certain protective factors can predict general and mental health status after 1 year of medical education.

METHODS

A prospective, longitudinal, observational study was conducted at one medical school. Self-rated general and mental health status before and after the freshman year were used as outcomes. In addition to socio-demographic variables and leisure activities, personality and study-related behaviour and experience were surveyed as potential predictors. Both descriptive techniques and logistic regression analyses were employed to identify predictors for general and mental health separately.

RESULTS

At baseline, 93% of medical students rated their general health and 88% rated their mental health as good. These frequencies declined over the first year to 76% and 84%, respectively. For general health, regular physical activity was the strongest predictor (odds ratio [OR] 4.58). Satisfaction with life (OR 1.18) and balance and mental stability (OR 1.20) emerged as positive predictors, and age (OR 0.85) and striving for perfection (OR 0.76) as negative predictors. Mental health status was predicted by emotional distancing (OR 1.25), experience of social support (OR 0.73), neuroticism (OR 0.89) and age (OR 0.85).

CONCLUSIONS

Self-rated general and mental health declined throughout the first year of medical education. Physical activity proved to be a strong predictor for the maintenance of good general health. This finding may represent a starting point for health-promoting interventions, such as the provision of time slots for physical activity.

Medical Students' Perception of Their Educational Environment and Quality of Life: Is There a Positive Association?

PURPOSE

To assess perceptions of educational environment of students from 22 Brazilian medical schools and to study the association between these perceptions and quality of life (QoL) measures.

METHOD

The authors performed a multicenter study (August 2011 to August 2012), examining students' views both of (1) educational environment using the Dundee Ready Education Environment Measure (DREEM) and (2) QoL using the World Health Organization Quality of Life Assessment, abbreviated version (WHOQOL-BREF). They also examined students' self-assessment of their overall QoL and medical-school-related QoL (MSQoL). The authors classified participants' perceptions into four quartiles according to DREEM total score, overall QoL, and MSQoL.

RESULTS

Of 1,650 randomly selected students, 1,350 (81.8%) completed the study. The mean total DREEM score was 119.4 (standard deviation = 27.1). Higher total DREEM scores were associated with higher overall QoL and MSQoL scores (P < .001 for all comparisons) and younger ages (P < .001). Mean overall QoL scores were higher than MSQoL scores (mean difference, 1.35; 95% confidence interval [CI] 1.28-1.43; P < .001). Multinomial regression models showed significant dose-response patterns: Higher DREEM quartile scores were associated with better QoL. The psychological health domain of WHOQOL-BREF was most closely associated with DREEM scores (odds ratio 4.70; 95% CI = 3.80-5.81).

CONCLUSIONS

The authors observed a positive association between QoL measures and DREEM scores. This association had a dose-response effect, independent of age, sex, and year of medical training, showing that educational environment appears to be an important moderator of medical student QoL.

Stress, Burnout and Coping Strategies in Preclinical Medical Students

It is acknowledged that physicians do not seek the same expert aid for themselves as they would offer their patients. In their preclinical years, medical students appear to espouse comparable behavior. To many, medicine is described as a never-ending path that places the student under heavy stress and burnout from the beginning, leaving him/her vulnerable and with insufficient coping methods. Hence, the objective of this study is to 1) explore the prevalence of stress and burnout among preclinical medical students, and 2) propose solutions to decrease stress and burnout and improve medical education in the preclinical years. A detailed scholarly research strategy using Google Scholar, Scopus, Embase, MEDLINE and PubMed was implemented to highlight key themes that are relevant to preclinical medical students' stress and burnout. Stress varied among different samples of medical students and ranged between 20.9% and 90%. Conversely, burnout ranged between 27% and 75%. Methods that help in reducing the incidence of stress and burnout by promoting strategies that focus on personal engagement, extracurricular activities, positive reinterpretation and expression of emotion, student-led mentorship programs, evaluation systems, career counseling and life coaching should be adopted.

Comparison of physical therapy anatomy performance and anxiety scores in timed and untimed practical tests

Students in health care professional programs face many stressful tests that determine successful completion of their program. Test anxiety during these high stakes examinations can affect working memory and lead to poor outcomes. Methods of decreasing test anxiety include lengthening the time available to complete examinations or evaluating students using untimed examinations. There is currently no consensus in the literature regarding whether untimed examinations provide a benefit to test performance in clinical anatomy. This study aimed to determine the impact of timed versus untimed practical tests on Master of Physical Therapy student anatomy performance and test anxiety. Test anxiety was measured using the State-Trait Anxiety Inventory (STAI). Differences in performance, anxiety scores, and time taken were compared using paired sample Student's t-tests. Eighty-one of the 84 students completed the study and provided feedback. Students performed significantly higher on the untimed test (P = 0.005), with a significant reduction in test anxiety (P < 0.001). Students who were unsuccessful on the timed test showed the greatest improvement on the untimed test ( x¯ = 20.4 ±10%). Eighty-three percent (n = 69) of students preferred the untimed test, 8.4% (n = 7) the timed test, and 8.4% (n = 7) had no preference. Students took on average eight minutes longer on the untimed test. This study found that physical therapy students perform better on untimed tests, which may be related to a reduction in test anxiety. If the intended goal of evaluating health care professional students is to determine fundamental competencies, these factors should be considered when designing future curricula.

Are total, intensity- and domain-specific physical activity levels associated with life satisfaction among university students?

Background

Thorough information about the relationship between physical activity (PA) and life satisfaction is still lacking. Therefore, this study examined the cross-sectional relationships between life satisfaction and meeting the World Health Organization (WHO) moderate to vigorous-intensity PA recommendations, total volume and duration of PA, intensity-specific PA (walking, moderate- and vigorous-intensity), domain-specific PA (work, transport-related, domestic, and leisure-time), and 11 domain and intensity-specific PA types among university students. Additionally, we examined the associations between life satisfaction and gender, age, disposable income, community size, smoking, alcohol intake, body mass index (BMI), and self-rated health.

Methods

The study included a random sample of 1750 university students in Zagreb, Croatia (response rate = 71.7%; 62.4% females; mean age 21.5 ± 1.8 years), using the International Physical Activity Questionnaire — long form and the Satisfaction with Life Scale.

Results

Higher life satisfaction was associated with female gender (β = 0.13; p = <0.001), younger age (β = -0.07; p = 0.024), higher disposable income (β = 0.10; p = 0.001), and better self-rated health (β = 0.30; p = <0.001). No significant association was found between life satisfaction and size of community (p = 0.567), smoking status (p = 0.056), alcohol consumption (p = 0.058), or BMI (p = 0.508). Among all PA variables, only leisure-time vigorous-intensity PA was significantly associated with life satisfaction after adjustments for socio-demographic characteristics, lifestyle and self-rated general health (β = 0.06; p = 0.045).

Conclusions

This study indicated a weak positive relationship between leisure-time vigorous-intensity PA and life satisfaction, whilst no such association was found for other PA variables. These findings underscore the importance of analyzing domain and intensity-specific PA levels in future studies among university students, as drawing conclusions about the relationship between PA and life satisfaction based on total PA levels only may be misleading.

Empathy among medical students: is there a relation with quality of life and burnout?

Background

We aimed to assess medical students' empathy and its associations with gender, stage of medical school, quality of life and burnout.

Method

A cross-sectional, multi-centric (22 medical schools) study that employed online, validated, self-reported questionnaires on empathy (Interpersonal Reactivity Index), quality of life (The World Health Organization Quality of Life Assessment) and burnout (the Maslach Burnout Inventory) in a random sample of medical students.

Results

Out of a total of 1,650 randomly selected students, 1,350 (81.8%) completed all of the questionnaires. Female students exhibited higher dispositional empathic concern and experienced more personal distress than their male counterparts (p<0.05; d≥0.5). There were minor differences in the empathic dispositions of students in different stages of their medical training (p<0.05; f<0.25). Female students had slightly lower scores for physical and psychological quality of life than male students (p<0.05; d<0.5). Female students scored higher on emotional exhaustion and lower on depersonalization than male students (p<0.001; d<0.5). Students in their final stage of medical school had slightly higher scores for emotional exhaustion, depersonalization and personal accomplishment (p<0.05; f<0.25). Gender (β = 0.27; p<0.001) and perspective taking (β = 0.30; p<0.001) were significant predictors of empathic concern scores. Depersonalization was associated with lower empathic concern (β = −0.18) and perspective taking (β = −0.14) (p<0.001). Personal accomplishment was associated with higher perspective taking (β = 0.21; p<0.001) and lower personal distress (β = −0.26; p<0.001) scores.

Conclusions

Female students had higher empathic concern and personal distress dispositions. The differences in the empathy scores of students in different stages of medical school were small. Among all of the studied variables, personal accomplishment held the most important association with decreasing personal distress and was also a predicting variable for perspective taking.

Investigation of health anxiety and its related factors in nursing students

OBJECTIVE

To explore health anxiety in a sample of nursing students to determine the relationships between health anxiety and life satisfaction, personality, and alexithymia.

METHODS

Two thousand and eighty-six nursing students in junior college, which were divided into five groups, were evaluated by questionnaires, including the Life Satisfaction Scales Applicable to College Students, the Chinese version of the Short Health Anxiety Inventory, the Toronto Alexithymia Scale (TAS-20), and the Eysenck Personality Questionnaire.

RESULTS

The mean age, whether the individual was an only child, residence (urban or rural), and were significantly different between the groups. The self-assessment scores were also significantly different between the groups. The Short Health Anxiety Inventory total score and the factor of fearing the likelihood of becoming ill were significantly negatively correlated with the Life Satisfaction Scales Applicable to College Students total score and its two factors, but were significantly positively correlated with psychoticism, neuroticism, and TAS-20 total scores and its scores of the three TAS-20 factors. The negative consequence scale of Short Health Anxiety Inventory was not significantly correlated with externally oriented thinking, but was significantly negatively correlated with extraversion. A hierarchical multiple regression analysis indicted that objective satisfaction, subjective satisfaction, neuroticism, and the three factors of TAS-20 were predictors of health anxiety.

CONCLUSION

Health anxiety was correlated with life satisfaction, personality, and alexithymia in junior college nursing students. Subjective and objective satisfaction, neuroticism, and the identification and expression of emotions may be predictors of health anxiety in nursing students.

What do medical students think about their quality of life? A qualitative study

BACKGROUND

Medical education can affect medical students' physical and mental health as well as their quality of life. The aim of this study was to assess medical students' perceptions of their quality of life and its relationship with medical education.

METHODS

First- to sixth-year students from six Brazilian medical schools were interviewed using focus groups to explore what medical student's lives are like, factors related to increases and decreases of their quality of life during medical school, and how they deal with the difficulties in their training.

RESULTS

Students reported a variety of difficulties and crises during medical school. Factors that were reported to decrease their quality of life included competition, unprepared teachers, excessive activities, and medical school schedules that demanded exclusive dedication. Contact with pain, death and suffering and harsh social realities influence their quality of life, as well as frustrations with the program and insecurity regarding their professional future. The scarcity of time for studying, leisure activities, relationships, and rest was considered the main factor of influence. Among factors that increase quality of life are good teachers, classes with good didactic approaches, active learning methodologies, contact with patients, and efficient time management. Students also reported that meaningful relationships with family members, friends, or teachers increase their quality of life.

CONCLUSION

Quality of teachers, curricula, healthy lifestyles related to eating habits, sleep, and physical activity modify medical students' quality of life. Lack of time due to medical school obligations was a major impact factor. Students affirm their quality of life is influenced by their medical school experiences, but they also reframe their difficulties, herein represented by their poor quality of life, understood as necessary and inherent to the process of becoming doctors.

Sleep disorder among medical students: relationship to their academic performance

BACKGROUND

Medical students are exposed to a significant level of pressure due to academic demands. Their sleep pattern is characterized by insufficient sleep duration, delayed sleep onset, and occurrence of napping episodes during the day.

OBJECTIVE

To examine the prevalence of sleep disorder among medical students and investigate any relationship between sleep disorder and academic performance.

METHODS

This is a cross-sectional self-administered questionnaire-based study. The participants were medical students of the first, second, and third academic years. The Epworth Sleepiness Scale (ESS) was also included to identify sleep disorder and grade point average was recorded for academic performance.

RESULTS

There were 491 responses with a response rate of 55%. The ESS score demonstrated that 36.6% of participants were considered to have abnormal sleep habits, with a statistically significant increase in female students (p = 0.000). Sleeping between 6-10 h per day was associated with normal ESS scores (p = 0.019) as well as the academic grades ≥ 3.75. Abnormal ESS scores were associated with lower academic achievement (p = 0.002).

CONCLUSION

A high prevalence of sleep disorder was found in this group of students, specifically female students. Analysis of the relationship between sleep disorder and academic performance indicates a significant relationship between abnormal ESS scores, total sleeping hours, and academic performance.

The pursuit of medical knowledge and the potential consequences of the hidden curriculum

This study explores how preclinical medical students experience particular elements of their training, specifically their pursuit for medical knowledge and how this may impact their attributes as well as their relations with those outside of the realm of medicine. Ten first-year and 10 second-year students of a US medical school were interviewed regarding their experiences with and perceptions of their medical training. The students reported a cognitive and emotional distance from non-medical students that appears to be accentuated not only by their strenuous academic responsibilities but also elements of the hidden curriculum nested within medical training. Furthermore, students discuss experiencing disapproval, mistrust, and negative judgment toward laypersons thereby suggesting that this distancing may lend to deleterious effects on students’ ability and willingness to connect with others. A Parsonian lens is utilized to examine the notion of a ‘Knowledge Gap’ as well as aspects of the hidden curriculum in medical education and their role in professionalizing medical students.

Sexual function and depressive symptoms among male North American medical students

INTRODUCTION

The role of sexuality as an association of medical student well-being has not been extensively studied.

AIM

We explored the relationship between depressive symptoms, sexuality, and sexual dysfunction in male North American medical students.

MAIN OUTCOME MEASURE

North American medical students were invited to participate in an Internet-based survey. The Center for Epidemiological Studies Depression Scale (CES-D) was utilized to screen for depressive symptoms.

METHODS

Subjects completed an ethnodemographic survey, a sexuality survey, and instruments for the quantification of anxiety, sexuality, and psychosocial function. Descriptive statistics, odds ratios (ORs), and logistic regression were used to analyze our data.

RESULTS

There were 844 male subjects with complete data on the CES-D and the Spielberger State-Trait Anxiety Index. Depressive symptoms (CES-D ≥ 16) were present in 37% of respondents and were more common in subjects with greater levels of anxiety. Subjects who were in sexual relationships and/or had frequent sexual activity were less likely to be depressed compared to other subjects. Erectile dysfunction (ED) was associated with significantly greater likelihood of depressive symptoms (OR 2.90 and 9.27 for depressive symptoms in men with mild or moderate/severe ED relative to men without ED, P < 0.01). After adjusting for ethnodemographic and sexual history factors, ED remained significantly positively associated with depressive symptoms (OR 2.87 and 6.59 for depressive symptoms in men with mild or moderate/severe ED relative to men without ED after adjustment, P ≤ 0.01). Inclusion of data related to psychosocial/relationship factors in the multivariate model eliminated the significant association between ED and depressive symptoms (OR 1.59 and 2.29 for depressive symptoms in men with mild or moderate/severe ED relative to men without ED after adjustment with the Self-Esteem and Relationship quality instrument, P > 0.05), suggesting that psychosocial factors were more strongly associated with depressive symptoms than erectile function.

CONCLUSION

Healthy sexuality and relationships may be protective against depressive symptoms in medical students. Attention to these factors may enhance medical student well-being.

Sexual function and depressive symptoms among female North American medical students

INTRODUCTION

Depression and sexual dysfunction are often comorbid.

AIM

We explored the relationship between sexuality, sexual dysfunction, and depressive symptoms in female medical students in North America.

MAIN OUTCOME MEASURE

Female North American medical students were invited to participate in an internet survey. The CES-D was utilized to screen for depressive symptoms and an abbreviated Spielberger State-Trait Anxiety Index (STAI) was used to quantify anxiety symptoms.

METHODS

Subjects completed an ethnodemographic survey, a sexuality survey, and modified instruments for the quantification of sexual function (the Female Sexual Function Index [FSFI] and the Index of Sexual Life [ISL]). Multivariable logistic regression was used to explore the relationship between sexuality and depressive symptoms.

RESULTS

There were 1,241 female subjects with complete data on CES-D and STAI. Mean age was 25.4 years. Depressive symptoms (CES-D>16) were present in 46% of respondents and were more common in subjects with anxiety symptoms. Subjects who were Caucasian, younger than 28, heterosexual, and in a relationship were least likely to report depressive symptoms. High risk of female sexual dysfunction (HRFSD) was significantly associated with greater likelihood of depressive symptoms (odds ratio [OR] 2.25, P<0.001). After adjusting for ethnodemographic and sexual history factors, HRFSD remained significantly positively associated with depressive symptoms (OR 1.85, P<0.001). Analysis of FSFI and ISL domains indicated that depressive symptoms were most directly associated with worse orgasmic function, interference in sex life from stress and lack of partner, and lower general life satisfaction (P<0.05). Interestingly, greater ISL-sexual satisfaction was associated with greater odds of depressive symptoms (OR 1.40, P=0.01).

CONCLUSION

Depressive symptoms are common in female medical students. HRFSD is associated with depressive symptoms, although the relationship is complex when psychosocial factors are included in the multivariate model. Attention to sexuality factors from student health providers may enhance quality-of-life, academic achievement, and patient care.

Sources of stress and psychological morbidity among undergraduate physiotherapy students

OBJECTIVES

Professional education can be a stressful experience for some individuals, and may impact negatively on emotional well-being and academic performance. Psychological morbidity and associated sources of stress have not been investigated extensively in physiotherapy students. This study explored sources of stress, psychological morbidity and possible associations between these variables in undergraduate physiotherapy students.

DESIGN

A questionnaire-based survey. The Undergraduate Sources of Stress Questionnaire was used to identify sources of stress, and the General Health Questionnaire-12 (GHQ-12) was used to rate the prevalence of psychological morbidity, using a conservative GHQ threshold of 3 to 4 to determine probable 'cases'. Uni- and multivariate tests of correlation were used to analyse the data.

SETTING

An Irish educational institution.

PARTICIPANTS

One hundred and twenty-five physiotherapy undergraduate students.

RESULTS

More than one-quarter of all students (27%) scored above the GHQ threshold, indicating probable psychological morbidity. This is higher than the level of psychological morbidity reported by the general population. Regression analysis showed that academic (beta=0.31, P<0.001) and personal (beta=0.50, P<0.001) sources of stress subscales were significant coefficients, explaining 48% of the variance in psychological morbidity after controlling for part-time employment and hours spent studying. Individual significant items from these subscales were stressful events (beta=0.24, P=0.004), mood (beta=0.43, P< or =0.001) and overall level of stress (beta=0.35, P< or =0.001).

CONCLUSIONS

The results highlighted the emotional vulnerability of a significant proportion of physiotherapy students, with academic and personal issues being the greatest concern. While personal causes of stress such as stressful events and mood are more difficult to control, manipulation of curricular factors may have positive effects on academic sources of stress.

Psychological distress in first year university students: socioeconomic and academic stressors, mastery and social support in young men and women

PURPOSE

Little is known about the role of stressors associated with university life on psychological distress (PD). The aims of this article are to: (1) assess the prevalence of PD among students during their first year of university; (2) study its associations with stressors (socioeconomic and university-related) and protective factors (mastery, social support); and (3) to compare these factors according to gender.

METHODS

Cross-sectional study of a random sample of students aged 18-24 years, in their first year of university in 2005-2006, enrolled in the 6 universities of southeastern France. Standardised questionnaire, by self-administration or telephone interview. Overall, 1,743 students agreed to participate (71.0%).

RESULTS

PD prevalence was estimated at 15.7% (95% CI: 12.9-18.5) among the young men and 33.0% (95% CI: 30.2-35.9) among the young women. Multiple logistic regressions adjusted for social and demographic variables, mode of questionnaire administration, psychiatric history, and recent adverse life events, showed that among men PD was associated with lack of adjustment to the university academic environment (OR = 1.08; 95% CI: 1.00-1.17, P = 0.04), and mastery (OR = 0.73; 95% CI: 0.68-0.79). Among women, the prevalence of PD was associated with medical studies (OR = 2.46; 95% CI: 1.50-4.05), lack of adjustment to the university academic environment (OR = 1.07; 95% CI: 1.03-1.12), mastery (OR = 0.78; 95% CI: 0.75-0.82), and social support (OR = 0.68; 95% CI: 0.54-0.85), with a strong negative statistical interaction between mastery and lack of adjustment.

CONCLUSIONS

This study shows an intermediate prevalence of PD among French first-year university students compared with those observed in university students in other countries. It suggests that PD is related to university-related stressors but failed to find a relation to socioeconomic factors. Risk and protective factors for PD in first-year university students differed somewhat according to gender. However, mastery appeared to have a protective role in both genders. Further research is necessary to confirm these results in other universities and years.

Lower life satisfaction in physicians compared with a general population sample : a 10-year longitudinal, nationwide study of course and predictors

BACKGROUND

There is a strong need for longitudinal and representative studies that focus on doctors' well-being.

METHODS

We conducted a longitudinal and nationwide cohort study (N = 631) of graduating medical students (T1), followed up in their first (T2), fourth (T3) and ninth (T4) postgraduate years. Response rates varied from 62 to 83%; the longitudinal response rate was 41%. We used comparison samples from a general population survey. Predictors of life satisfaction among the doctors were tested by linear regressions and repeated measures statistics.

RESULTS

Doctors of both genders had significantly lower levels of life satisfaction than those in the comparison samples. Life satisfaction was lowest at T1, improved at T2, and stayed at the same level thereafter. Adjusted predictors of life satisfaction at T4 were lower age (P = 0.03), low level of neuroticism personality trait (P = 0.02), being married/cohabiting (P < 0.001), perceived social support (P < 0.001), lower work stress (P = 0.002), negative life events (P = 0.002), and frequency of physical training (P = 0.04). Only one-fifth of the total explained variance (R (2) = 0.34) was due to personality traits, whereas half was explained by married/cohabitant status and perceived social support. Being married/cohabiting, social support and physical training remained significant when mental distress (anxiety and depressive symptoms) was included in an additional multivariate model (R (2) = 0.49). Neuroticism trait (P < 0.001) was a significant predictor in the repeated measures model, but the increase in life satisfaction from T1 to T2 was predicted by lower levels of conscientiousness trait (P = 0.009).

CONCLUSIONS

Norwegian doctors were less satisfied than an educationally age-matched group of the general population. Concurrent situational factors and stress, such as social support and mental distress were of major importance. However, personality clearly predicted life satisfaction over the years.

Psychosocial health risk factors and resources of medical students and physicians: a cross-sectional study

BACKGROUND

Epidemiological data indicate elevated psychosocial health risks for physicians, e. g., burnout, depression, marital disturbances, alcohol and substance abuse, and suicide. The purpose of this study was to identify psychosocial health resources and risk factors in profession-related behaviour and experience patterns of medical students and physicians that may serve as a basis for appropriate health promoting interventions.

METHODS

The questionnaire -Related Behaviour and Experience "Work administered in cross-sectional surveys to students in the first (n = 475) and in the fifth year of studies (n = 355) in required courses at three German universities and to physicians in early professional life in the vicinity of these universities (n = 381).

RESULTS

Scores reflecting a healthy behaviour pattern were less likely in physicians (16.7%) compared to 5th year (26.0%) and 1st year students (35.1%) while scores representing unambitious and resigned patterns were more common among physicians (43.4% vs. 24.4% vs. 41.0% and 27.3% vs. 17.2% vs. 23.3 respectively). Female and male responders differed in the domains professional commitment, resistance to stress and emotional well-being. Female physicians on average scored higher in the dimensions resignation tendencies, satisfaction with life and experience of social support, and lower in career ambition.

CONCLUSION

The results show distinct psychosocial stress patterns among medical students and physicians. Health promotion and prevention of psychosocial symptoms and impairments should be integrated as a required part of the medical curriculum and be considered an important issue during the further training of physicians.

Sintomas depressivos em acadêmicos de medicina da Universidade Federal de Goiás: um estudo de prevalência

INTRODUÇÃO: O presente estudo teve como objetivo investigar a prevalência de sintomas depressivos em alunos de medicina da Universidade Federal de Goiás, comparando com a população em geral e verificando a possibilidade de determinado período do curso atuar como fator de risco. MÉTODO: Estudo transversal, descritivo, de amostra representativa de alunos regularmente matriculados na Faculdade de Medicina da Universidade Federal de Goiás. Foram selecionados 287 alunos do primeiro ao sexto ano através de sorteio aleatório simples. Utilizou-se, para avaliação, o Inventário de Depressão de Beck e um questionário de identificação. RESULTADOS: Na população entrevistada, 26,8% apresentaram sintomas depressivos de acordo com escores do Inventário de Depressão de Beck estabelecidos para este estudo. A prevalência de sintomas depressivos moderados e graves entre os entrevistados foi de 6,9%, enquanto 19,9% apresentaram sintomas leves. Em relação ao sexo, encontrou-se 33,5% de mulheres e 19% de homens com sintomas depressivos. Em relação ao ano em curso, houve maior prevalência entre os alunos do terceiro e do quarto ano. Tristeza, anedonia, baixa auto-estima, perfeccionismo, irritabilidade, desinteresse por pessoas, redução da capacidade de trabalho e cansaço excessivo foram os itens do Inventário de Depressão de Beck mais pontuados. CONCLUSÃO: A prevalência de sintomas depressivos encontrada neste estudo é superior à média encontrada na população em geral, havendo indicativo de que a escola médica possa ser um fator predisponente para tais sintomas.

Improving response rates: introducing an anonymous longitudinal survey research protocol for veterinary medical students

With the Journal of Veterinary Medical Education's recent summer 2005 theme issue on stress, the mental-health concerns of veterinary medical students has been brought to the forefront of the field. Since it is anticipated that research on this topic will continue and that educational institutions may implement changes based upon these results, it is of the utmost importance that this research be of the highest quality. Of particular concern with human-subject inquiries are response rates and confidentiality. In order to accommodate these concerns, an example of a survey research protocol that promotes high response rates and minimizes threats to internal validity influenced by student mistrust in assurances of confidentiality is presented. Specifically, the protocol is designed to ensure anonymity and to preserve the ability to track students longitudinally through the use of anonymous longitudinal identifiers. This protocol was tested with the first-year class of veterinary medical students at Kansas State University in October 2004 and March 2005. The two data collection periods yielded 90% and 76% response rates, respectively. The matching rate of participants, according to the anonymous longitudinal identifiers from Time 1 to Time 2, was 88%.

A multicenter study of burnout, depression, and quality of life in minority and nonminority US medical students

OBJECTIVE

To determine the well-being of minority medical students in a multicenter sample of US medical students.

PARTICIPANTS AND METHODS

All 1098 medical students at 3 medical schools in Minnesota were surveyed in April 2004. Validated instruments were used to assess burnout, depression, and quality of life (QOL). Students were also asked about the prevalence of significant personal life events in the previous 12 months and strategies used to cope with stress.

RESULTS

Although symptoms of depression and overall burnout were similar among minority and nonminority students, minority students were more likely to have a low sense of personal accomplishment (P=.02) and lower QOL In a number of domains (all P< or =.05). These differences persisted on multivariate analysis that controlled for demographic characteristics and recent life events. Minority students were also more likely to have a child (P=.01), originate from outside Minnesota (P<.001), and experience a major personal Illness in the last 12 months (P=.03).

CONCLUSION

As a group, the minority medical students in this survey had a lower sense of personal accomplishment and QOL than nonminority students. Additional studies are needed to provide insight regarding the causes of these inequities and the unique challenges faced by minority medical students. Efforts to improve minority students' well-being, QOL, and learning experience may help prevent attrition among minority medical students and promote diversification in the physician workforce.

Personal life events and medical student burnout: a multicenter study

PURPOSE

Burnout, a marker of professional distress prevalent among residents and physicians, has been speculated to originate in medical school. Little is known about burnout in medical students. The authors sought to identify the prevalence of burnout, variation of its prevalence during medical school, and the impact of personal life events on burnout and other types of student distress.

METHOD

All medical students (n = 1,098) attending the three medical schools in Minnesota were surveyed in spring 2004 using validated instruments to assess burnout, quality of life, depression, and alcohol use. Students were also asked about the prevalence of positive and negative personal life events in the previous 12 months.

RESULTS

A total of 545 medical students (response rate 50%) completed the survey. Burnout was present in 239 (45%) of medical students. While the frequency of a positive depression screen and at-risk alcohol use decreased among more senior students, the frequency of burnout increased (all p < .03). The number of negative personal life events in the last 12 months also correlated with the risk of burnout (p = .0160). Personal life events demonstrated a stronger relationship to burnout than did year in training on multivariate analysis.

CONCLUSIONS

Burnout appears common among U.S. medical students and may increase by year of schooling. Despite the notion that burnout is primarily linked to work-related stress, personal life events also demonstrated a strong relationship to professional burnout. The authors' findings suggest both personal and curricular factors are related to burnout among medical students. Efforts to decrease burnout must address both of these elements.

Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students

PURPOSE

To systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students.

METHOD

Medline and PubMed were searched to identify peer-reviewed English-language studies published between January 1980 and May 2005 reporting on depression, anxiety, and burnout among U.S. and Canadian medical students. Searches used combinations of the Medical Subject Heading terms medical student and depression, depressive disorder major, depressive disorder, professional burnout, mental health, depersonalization, distress, anxiety, or emotional exhaustion. Reference lists of retrieved articles were inspected to identify relevant additional articles. Demographic information, instruments used, prevalence data on student distress, and statistically significant associations were abstracted.

RESULTS

The search identified 40 articles on medical student psychological distress (i.e., depression, anxiety, burnout, and related mental health problems) that met the authors' criteria. No studies of burnout among medical students were identified. The studies suggest a high prevalence of depression and anxiety among medical students, with levels of overall psychological distress consistently higher than in the general population and age-matched peers by the later years of training. Overall, the studies suggest psychological distress may be higher among female students. Limited data were available regarding the causes of student distress and its impact on academic performance, dropout rates, and professional development.

CONCLUSIONS

Medical school is a time of significant psychological distress for physicians-in-training. Currently available information is insufficient to draw firm conclusions on the causes and consequences of student distress. Large, prospective, multicenter studies are needed to identify personal and training-related features that influence depression, anxiety, and burnout among students and explore relationships between distress and competency.

Medical student distress: causes, consequences, and proposed solutions

The goal of medical education is to graduate knowledgeable, skillful, and professional physicians. The medical school curriculum has been developed to accomplish these ambitions; however, some aspects of training may have unintended negative effects on medical students' mental and emotional health that can undermine these values. Studies suggest that mental health worsens after students begin medical school and remains poor throughout training. On a personal level, this distress can contribute to substance abuse, broken relationships, suicide, and attrition from the profession. On a professional level, studies suggest that student distress contributes to cynicism and subsequently may affect students' care of patients, relationship with faculty, and ultimately the culture of the medical profession. In this article, we review the manifestations and causes of student distress, its potential adverse personal and professional consequences, and proposed institutional approaches to decrease student distress.

Prospective cohort study of stress, life satisfaction, self-rated health, insomnia, and suicide death in Japan

The association between many psychosocial factors and risk of suicide was examined. A cohort was conducted over 14 years of follow up among the general population (15,597 people) in Japan. A baseline survey of psychosocial characteristics was conducted by self-administrated questionnaire. The relative risks of occasional emotional stress, difficulty maintaining sleep, and reporting unhealthy as their self-rated health are 3.2 (95% CI: 1.3, 7.6), 2.4 (95% CI: 1.3, 4.3) and 2.6 (95% CI: 1.1, 6.2), respectively. The importance of these observations lie in its potential for improving physician and public awareness of psychosocial factors as an early indication of mental health morbidity.

Depressive mood accompanies hypercholesterolemia in young Japanese adults

Screening of young hypercholesterolemics is important because they are highly susceptible to atherosclerotic diseases. However, in some cases, serum cholesterol level may be elevated temporarily due to stress or other psychological factors. This study examined the effects of mood states on 'persistent' hypercholesterolemia in comparison with 'temporary' hypercholesterolemia among students entering a university. The subjects were 114 untreated first-year students aged 18 to 20 years old. All had been screened positive for hypercholesterolemia (serum total cholesterol > or = 220 mg/dl) upon enrolling in the university. Three months after the screening, they were divided into two groups according to the re-examined serum total cholesterol level; a persistent hypercholesterolemic group (n=41) with >220 mg/dl and a temporary hypercholesterolemic group (n=73) with <220 mg/dl. At that time, they completed the Profile of Mood States (POMS) with tension-anxiety, depression, anger-hostility, vigor, fatigue and confusion scales. The POMS depression scores and the female ratio were higher (both p<0.01) and body mass index was lower (p<0.05) in the persistent hypercholesterolemic subjects than in the temporary hypercholesterolemic subjects; the POMS depression scores were still higher (p<0.05) after controlling for the effects of gender, body mass index, and other POMS scales by multiple logistic regression analysis. Depressive mood appeared to relate to hypercholesterolemia when the university students were screened. Assessment of mood states may be important in screening young hypercholesterolemic patients.

Students' perception of medical school stress and their evaluation of a wellness elective

CONTEXT

Because medical education is known to be demanding and stressful, Case Western Reserve University developed a programme which included a wellness elective which focused on stress reduction and personal wellness.

OBJECTIVES

The purpose of this study was to explore students' perceptions of medical school stress and to assess their perspective on the wellness elective.

SUBJECTS

The essays of 60 medical students enrolled in the wellness elective were used.

METHODS

The essays were analysed using qualitative methodology. Results were validated by questionnaires mailed to the students 2 years later.

RESULTS

It was found that the students felt that: (1) wellness issues should be important for physicians; (2) their own wellbeing had been diminished by the burden of information to be learned in medical school; (3) talking to peers was a useful coping mechanism, and (4) the elective gave permission to engage in wellness activities without additional guilt.

CONCLUSIONS

Based on the students' responses, a wellness elective could be a useful addition to the first- or second-year medical curriculum.

Perfectionism, the imposter phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students

Extensive attention has been paid over the past three decades to the stressors involved in training in the health professions. Although empirical studies have identified demographic subgroups of students most likely to become distressed during training, less research has been carried out to evaluate the impact of students' personality characteristics on their adjustment. Severe perfectionism is one such personality trait that has been shown to increase the risk for anxiety and depressive disorders in other populations. Another set of personality traits linked to increased psychological problems has been labelled the 'impostor phenomenon', which occurs when high achieving individuals chronically question their abilities and fear that others will discover them to be intellectual frauds. Both perfectionism and the impostor phenomenon would seem to be pertinent factors in the adjustment of health professional students; however, these character traits have not been empirically examined in this population. In the present study psychological distress, perfectionism and impostor feelings were assessed in 477 medical, dental, nursing and pharmacy students. Consistent with previous reports, the results showed that a higher than expected percentage of students (27.5%) were currently experiencing psychiatric levels of distress. Strong associations were found between current psychological distress, perfectionism and impostor feelings within each programme and these character traits were stronger predictors of psychological adjustment than most of the demographic variables associated previously with distress in health professional students. Implications for future research, limitations of this study and clinical recommendations are discussed.

The relationships between sleep and measures of health and well-being in college students: a repeated measures approach

The stability of subjective measures of sleep, health, and well-being, as well as the stability of the relationships between sleep and health and well-being were assessed over 3 months. Healthy college students with no consistent sleep complaints completed a 7-day sleep log and battery of surveys related to health and well-being at 3 separate times during the 3 months. Measures of health and well-being were more strongly related to the quality than to the quantity of sleep. Further analyses using the repeated measures results found that participants reported improved sleep and better health, but the affect balance, life satisfaction, and mood states were unchanged across the 3 testing periods. The relationships between the measures of sleep and measures of health and well-being remained constant across the experimental period. Even when working with a non-sleep-disturbed population, healthcare professionals should consider sleep quality as a consistent correlate of daily health and well-being.

American medical students in Israel: stress and coping

Medical students studying abroad have to adapt to a new cultural environment in addition to the usual stresses of medical school. This study explored the perceived stress and coping ability of students of the New York State/American Programme, Sackler School of Medicine, Tel Aviv University, who study medicine in Israel but are expected to return to America to practice. Students were surveyed using the Ways of Coping Checklist (WCCL), Appraisal Dimension Scale (ADS) and two instruments specifically designed for the study. The results supported the view that students having difficulty adapting to their new cultural environment also have difficulty at medical school. This pattern is a negative spiral in which anxiety and depression impair cognitive performance, which leads to academic difficulties and emotional distress. Improvements in student social support and primary prevention were implemented as a result of the study. Limitations of the study are discussed.