The prevalence and impact of depression among medical students: a nationwide cross-sectional study in South Korea

Prevalence and correlates of depressive symptoms among undergraduate health science students at the University of Parakou, Benin

OBJECTIVES

Research on psychological distress in African students is scarce. This study aimed at exploring the epidemiology (prevalence and correlates) of depressive symptoms among undergraduate health sciences students at the University of Parakou (Benin).

METHODS

We conducted a cross-sectional survey from June to July 2022 at the University of Parakou, the second-largest university in the Republic of Benin. Depressive symptoms were assessed using the Patient Health Questionnaire depression scale (PHQ-9). Information on several independent factors was collected and their associations with depressive symptoms were investigated using logistic regression models.

RESULTS

Data from 560 students were analyzed (mean age: 21.3± 2.3 years, 60 % were male, and 50.4 % were registered in the first year of study). The overall prevalence of depressive symptoms was 39.1 % [95 % CI: 35.2 %-43.1 %]. Moderate and severe depressive symptoms were observed in 15.3 % and 1.8 % of participants, respectively. In the multivariable model, being aged 21-23 (adjusted Odds Ratio=1.8, p-value: 0.007), a female (aOR=1.5, p-value: 0.050), a medical student (aOR=2.9, p-value: <0.001), a public health student (aOR=3.6, p-value: <0.001), belonging to households with higher incomes (aOR= 2.4, p<0.001), and experiencing stress (aOR=1.5, p-value: 0.048) independently increased the probability of having depressive symptoms. However, having support from close relatives (aOR= 0.5, p-value: 0.026) was associated with a lower probability of depressive symptoms.

CONCLUSIONS

Our findings revealed a high prevalence of depressive symptoms among undergraduate health science students. Given the correlates identified, actions to promote coping skills in stress and encourage more parental support may be real avenues likely to help reduce the frequency and consequences of depressive symptoms.

Moderated moderation modelling of subjective social status, pocket money and depressive symptoms of university students in Ghana

Introduction

Although the relationship between subjective social status and depression in university students has been well-established, this association could be seen as a spurious one. Previous studies have shown that key variables like financial resources and age could play key roles in explaining the variances in social status and mental health outcomes. In this research, we assessed the complex interrelationships between subjective social status, financial resources at their disposal and depressive symptoms among university students within their young and middle adulthood stages.

Methods

A cross-sectional survey was conducted in a university in Ghana to sample 1134 university students through accidental sampling. The McArthur Scale and WHO-5 Well-being measure were used for the data collection.

Results

The results revealed that higher levels of subjective social status were associated with lower levels of depression. It was further found that the interaction between students' pocket money and age played unique roles in the relationship between subjective social status and depression.

Conclusion

The study findings call on stakeholders in education to explore funding opportunities and to examine ways of empowering parents (financially) to adequately support the students. Health educationists and promoters, including psychologists, school counsellors and parents could compliment these efforts by helping to train and empower students through self-regulation or management skills to help improve their well-being. Continuous efforts are required to improve the financial status and mental health of students.

Factors associated with academic performance among medical students at a medical school in South Korea: A retrospective cohort study

Longitudinal research has provided systematic empirical data on the short- and long-term outcomes of admissions policies, curricular innovations, and complex decisions on students' academic progress. This study aimed to investigate the academic performance of medical students and related factors using cohort database collected from a medical school. The study participants included 134 medical students who graduated from Chonnam National University Medical School in 2022. The medical school's cohort database was used to collect data on demographics, admission, academic performance, extracurricular activities, and performance on the National Korean Medical Licensing Examination (KMLE). Participating in club activities had a significant association with medical students' academic advancement delay or leave of absence during the entire course of medical school (P = 0.007). Logistic regression analysis indicated that the nationwide clinical knowledge mock examination during the fourth year of medical school was significantly associated with passing the KMLE (adjusted odds ratio 1.12, 95% confidence interval 1.02-1.22; P = 0.014). Extracurricular school activities (a non-cognitive student attribute) and a wide range of cognitive student attributes captured from the cohort database were associated with medical students' academic performance. In conclusion, this study can reinforce a strong emphasis on the inclusion of cognitive and non-cognitive information in medical school curricula and assessments in order to improve medical education programs and future postgraduate performance.

Depression among medical students in Tunisia: Prevalence and associated factors

BACKGROUND

Medical school is known for its lengthy process, which is both physically and emotionally draining. Students' mental balance would shrink as they progress in their medical training. A systematic review and meta-analysis reported that the prevalence of depressive symptoms among medical students remained relatively constant at 27.2%.

AIM

To assess the prevalence of depressive symptoms among Tunisian medical students and evaluate its associated factors.

METHODS

This is a descriptive cross-sectional study that was carried out in the second semester of the academic year 2017/2018, between April 2018 and July 2018 among 1138 medical students. Data were collected using a socio-demographic questionnaire and the Beck Depression Inventory-II (BDI-II).

RESULTS

Sixty-four percent (n = 728) of the participants had depressive symptoms, of which 266 (23.4%) met the criteria for mild, 271 (23.8%) for moderate, and 191 (16.8%) for severe depressive symptoms. Female gender, low socio-economic level, smoking habits and history of mental disorder, performing leisure and physical activities, satisfaction toward a career choice, and happiness perception were the main prognostic factors for depression among medical students. Although academic grades may not be considered a prognostic factor, final-year students appeared to be less depressive than their colleagues.

CONCLUSION

These findings give insight into mental health issues and comorbidities among Tunisian medical students. It is a hopeful request for decision-makers and academic authorities to set serious measures and draw effective interventions to minimize the currency of psychological distress among this subpopulation.

Prevalence of common mental disorders among medical students in China: a systematic review and meta-analysis

Background

The prevalence of mental distress is common for medical students in China due to factors such as the long duration of schooling, stressful doctor-patient relationship, numerous patient population, and limited medical resources. However, previous studies have failed to provide a comprehensive prevalence of these mental disorders in this population. This meta-analysis aimed to estimate the prevalence of common mental disorders (CMDs), including depression, anxiety, and suicidal behaviors, among medical students in China.

Methods

We conducted a systematic search for empirical studies on the prevalence of depression, anxiety, suicide attempt, suicide ideation, and suicide plan in Chinese medical students published from January 2000 to December 2020. All data were collected pre-COVID-19. The prevalence and heterogeneity estimations were computed by using a random-effects model and univariate meta-regression analyses.

Results

A total of 197 studies conducted in 23 provinces in China were included in the final meta-analysis. The prevalence data of depression, anxiety, suicide attempt, suicide ideation, and suicide plan were extracted from 129, 80, 21, 53, and 14 studies, respectively. The overall pooled crude prevalence for depression was 29% [38,309/132,343; 95% confidence interval (CI): 26%-32%]; anxiety, 18% (19,479/105,397; 95% CI: 15%-20%); suicide ideation, 13% (15,546/119,069; 95% CI: 11%-15%); suicide attempt, 3% (1,730/69,786; 95% CI: 1%-4%); and suicide plan, 4% (1,188/27,025; 95% CI: 3%-6%).

Conclusion

This meta-analysis demonstrated the high prevalence of CMDs among Chinese medical students. Further research is needed to identify targeted strategies to improve the mental health of this population.

Comparison of depression, anxiety, and stress between public and private university medical students

Context

Depression, anxiety, and stress are common among medical students because of hectic and heavy studies.

Aim

This study was carried out to determine the magnitude of the Depression, Anxiety, and Stress Scale (DASS) among undergraduate medical students and its relationship with its causative factors in public and private universities.

Setting and Design

The study tool was DASS (Depression, Anxiety, Stress Scale-21) which was distributed through the Department of Physiology, College of Medicine, King Saud University, adopting a multistage cluster sampling method for an observational study design.

Subjects and Data

Data from undergraduate medical students (N = 337) was collected from public and private medical colleges in Saudi Arabia.

Statistical Analysis

Independent t-tests and analysis of covariance were applied to analyze the data.

Results

There was a significant difference in depression with a higher mean score in private versus public medical students (8.38±5.93 vs 6.34±5.46, p=0.001), anxiety (9.49±5.12 vs 7.91±5.00, p=0.005), and stress (9.11±5.11 vs 7.93±5.02, p=0.035). There was a significant difference in the level of anxiety between second- and third-years students (p =0.01).

Conclusion

Private medical university students have significantly higher depression, anxiety, and stress levels compared to public universities. More studies are needed to explore the causes of this psychological impact.

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

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The effect of COVID-19 home quarantine on the psychological state of pharmacy students: a cross-sectional study

Background

Psychological morbidity has been documented in medical and pharmaceutical undergraduate students in different countries around the world. In this study, we examined the impact of coronavirus disease 2019 (COVID-19) home quarantine on the depressive psychological aspects of last-grade pharmacy students.

Methods

A cross-sectional study was conducted by the Department of Clinical Pharmacy, Faculty of Pharmacy, Deraya University, Egypt. Two hundred and sixty-eight last-grade pharmacy students were included in this study, and they completed a self-administered, pre-designed, anonymous questionnaire. The main outcome measures were the Hamilton Depression Rating Scale (HRS) and Patient Health Questionnaire-9 (PHQ-9), which were measured to screen for the symptoms of psychological depression and determine the degree of depression severity between the beginning and the end of the COVID-19 home quarantine period. Data entry and analysis were done using the Statistical Package for Social Science (SPSS) software version 26. Descriptive statistics were employed for analyses of the data, and categorical variables were described by frequencies and percentages. Bivariate and multivariable analyses were performed to examine relations between demographic data and psychological scales. The study protocol was approved by the Faculty of Pharmacy, Minia University Ethical Committee.

Results

A total of 268 students participated in this study (102 males and 166 females). The mean ± SD score of baseline HRS and HRS at the end of the study was 6.3 ± 4.45, 7.95 ± 5.36, respectively, with the presence of a statistically significant difference between the two scores (p < 0.001). The mean ± SD score of baseline PHQ-9 and PHQ-9 at the end of the study was 4.35 ± 3.45, 5.37 ± 4.14, respectively, with the presence of a statistically significant difference between the two scores (p < 0.001). The results showed that the COVID-19 home quarantine period led to a depressive psychological effect on the students in this study.

Conclusions

Students’ psychological depression causes morbidity and, in some cases, mortality. Psychological depressive problems were significantly associated with the COVID-19 home quarantine period, which calls for early intervention to solve it. Student counselling services must be more accessible and affordable to overcome this problem.

Depressive symptoms and its correlates among medical students in Upper Egypt

Background

Medical students are at high risk of developing depressive symptoms rather than their age-matched group as medical education is stressful and medical students have psychological and academic stressors. The study aimed to estimate the prevalence of depressive symptoms and the most important correlates associated with it among Assiut University Medical Students in the academic year 2019–2020. It is a cross sectional study conducted among 766 medical students at Assiut University in the academic year 2019–2020, screening for depressive symptoms was by patient health questionnaire-9 (PHQ-9).

Results

The mean age of students was 21.27 ± 1.9, 55.5% of them have depressive symptoms. Female students had statistically significantly higher percent of depressive symptoms compared with males (58.9% vs 51.2%), there was statistically significant lower mean socio-economic score among students having depressive symptoms compared to students with no depressive symptoms (5.73 ± 2.46 and 6.22 ± 2.5 respectively). Students having depressive symptoms had higher mean scores of stresses. The multivariable regression revealed that younger age of the students (OR = 0.797; p < 0.001), having a chronic disease (OR = 3.174; P = 0.024), lower life satisfaction score (OR = 0.908; p < 0.001), students with higher medical stress score (OR = 3.596, P < 0.001), and high sense of control score (OR = 2.323; p < 0.001) were the significant correlates of depressive symptoms among medical students.

Conclusions

Female gender, low socio-economic status, having chronic disease, presence of family history of either mental illness or depressive symptoms, low satisfaction with life, higher total medical stressors, and low sense of control were the most important correlates of depressive symptoms among medical students.

Ego-resiliency moderates the risk of depression and social anxiety symptoms on suicidal ideation in medical students

BACKGROUND

Little is known about the role of protective factors in suicidal ideation among medical students. This study aimed to examine the association between suicidal ideation and protective (self-esteem/ego-resiliency/social support) and risk (depression/social anxiety) factors.

METHODS

Data on sociodemographic factors, depression, social anxiety, self-esteem, ego-resiliency, social support, and current suicidal ideation were collected from 408 medical students. A logistic regression model was constructed to identify the independent impact of potential influencing factors on suicidal ideation. Potential moderating effects were also explored.

RESULTS

Thirty-eight participants (9.3%) reported experiencing suicidal ideation. Younger age, higher levels of depression, social anxiety, and lower levels of self-esteem, ego-resiliency, and social support were found to be significantly correlated with suicidal ideation. In the final model, higher levels of depression and social anxiety were associated with an increased risk of suicidal ideation, while higher levels of self-esteem and social support were associated with a decreased risk of suicidal ideation. Although the independent effect was not significant, the interactions of ego-resiliency with both depression and social anxiety on suicidal ideation were significant. Higher levels of ego-resiliency acted as a buffer against suicidal ideation among those with higher levels of depression or social anxiety.

CONCLUSIONS

In addition to risk factors, this study revealed the underlying protective and moderating factors of suicidal ideation among medical students. Mental health programs focusing on enhancing ego-resiliency, self-esteem, and social support may contribute to suicide prevention in medical students.

Effect of cognitive behavioral therapy program on mental health status among medical student in Palestine during COVID pandemic

BACKGROUND

The COVID-19 pandemic had a profound psychological influence on everyone in society, and the impact it had on students, particularly medical students, cannot be underestimated. The main purpose of this study is to (1) determine the prevalence of mental disorders among medical students and their associated factors, and (2) examine the effectiveness of cognitive behavior therapy on mental health problems among medical students.

METHODS

Between March and May 2021, we conducted a randomized controlled study on two phases among medical students at An-Najah National University. Data were collected using an online questionnaire and the Arabic version of the 12-item General Health Questionnaire (GHQ-12). We also used the MEDAS tool to assess their Mediterranean Diet (MD) adherence. In the second phase, sixty-six students were recruited and assigned randomly to control and intervention groups. Intervention impact was assessed using 12-item General Health Questionnaire at two-time points; baseline, and 8 weeks post-intervention. The interventional model used was cognitive behavioral therapy, and the control group received no treatment.

RESULTS

A total of 329 students were included in the analysis of the first phase of the study. Approximately 28% of students had mental health problems. We found a significant relationship between good mental health status with a higher level of physical activity level, longer sleeping hours, and shorter entertainment time (p < 0.05). In the second phase of the study, a total of 91 students were included. Overall, using the CBT program showed a significant improvement in the outcome measures. At 8 weeks post-intervention, students had lower scores on total GHQ-12, depression, anxiety, and social dysfunction.

CONCLUSION

These findings propose that adequate attention must be paid to the mental health of medical students and that CBT programs can be used for the management of mental health problems among medical students.

Distant education in Moroccan medical schools following COVID-19 outbreak at the early phase of lockdown: Were the students really engaged?

The Coronavirus pandemic outbreak has induced many urgent adaptation measures in Morocco including medical education that had to abruptly adopt an exclusive distant education approach, without former sufficient preparation. The present study aimed to assess medical students’ engagement in their acutely implemented distant learning and to identify factors that could be associated to the students’ studying engagement levels. Medical students from 1st to 5th years of medical studies, enrolled in all Moroccan public medical faculties were invited to fill-in an anonymous online questionnaire.

3174 medical students took part in the study, with a mean age of 20.4 +/- 1.8 years old, and 65.4% of them were women. 90% of the participants reported moderate to drastic change of their sleeping habits and 65% suffered depression symptoms. 20.7% of students didn't engage at all in their learning, 26% studied for less than one hour daily, and only 53.3% studied for one hour or more daily. Only 46.4% of the participants had access to multimedia studying resources and only 20.9% were offered online interactive sessions with their teachers. 41.8% of the participants were unsatisfied from their distant learning experience. Lower studying engagement rates were significantly associated with older age, male gender, change of sleeping patterns, depression symptoms, and also with lack of access to multimedia studying resources and poor general satisfaction from the distant learning experience.

Distant Education needs to include more interactive activities and more multimedia studying resources to engage students more efficiently in their self-regulated learning.

Impact of COVID-19 on Lifestyle, Personal Attitudes, and Mental Health Among Korean Medical Students: Network Analysis of Associated Patterns

The current COVID-19 pandemic have affected our daily lifestyle, pressed us with fear of infection, and thereby changed life satisfaction and mental health. The current study investigated influencing cascade of changes during the COVID-19 among the lifestyle, personal attitudes, and life (dis)satisfaction for medical students, using network-based approaches. This cross-sectional survey used self-reports of 454 medical students during June and July of 2020. Depressive mood, anxiety, and intention to drop out of school were observed in 11.9, 18.5, and 38.3% of medical students, respectively. Directed acyclic graph that estimated directional propagation of the COVID-19 in medical students' daily lives initiated from the perception of unexpected event, propagated to nervous and stressed feeling, trouble relaxing, feeling like a failure, and were followed by trouble concentrating, feeling loss of control for situation, and fear of infecting colleagues. These six features were also principal mediators within the intra-individual covariance networks comprised of changed lifestyle, personal attitude, and mental health at COVID-19 pandemic. Psychosocial supports targeting nervousness, trouble relaxing and concentrating, fear of spreading infection to colleagues, feelings of a failure or loss of situational control are required for better mental health of medical students during the COVID-19 pandemic.

Prevalence of Depressive Symptoms and Associated Psychosocial Risk Factors among French University Students: the Moderating and Mediating Effects of Resilience

University students constitute a higher risk population for mental health problems, especially for depression. Given the lack of literature addressing such issues in France, this study estimated the prevalence rates of depression, its sociodemographic correlates in French university students [FUS], and examined whether resilience resources moderated and mediated the relationship between perceived stress and depressive symptoms. Participants (N = 1435, Mage = 20.5) completed the Beck Depression Inventory (BDI-II), the Perceived Stress Scale, the Brief Resilience Scale, and a sociodemographic questionnaire. Descriptive, multiple logistic regressions, and mediation analyses were used. With respect to the BDI-II's cutoff scores, 20.3% (95% CI: 18.3 to 22.4%) and 22.8% (95% CI: 20.7 to 25.0%) were positive to moderate and severe depression, respectively. Gender and education attainment appeared to be moderate risk factors when accounting for cumulative effect of perceived stress and resilience. Resilience buffered and partially mediated the perceived stress-depression relationship. In conclusion, the prevalence of depression was higher in FUS, as reported in previous studies. The amount of academic and daily stress explained this prevalence. University students with low resilience level were more at risk. Interventions aiming to improve resilience skills could help to mitigate the negative effects of stress and to promote mental health in this population.

Symptoms of Depression, Anxiety, and Stress and Prevalence of Major Depression and Its Predictors in Female University Students

Depression, anxiety and stress are increasingly concerning phenomena in our society, with serious consequences on physical and mental health. The repercussions may be particularly devastating in particular population subgroups, such as female university students. The purpose of this study was to determine the levels of depression, anxiety, and stress and the prevalence of depression and associated factors, in Spanish university women. A cross-sectional study was conducted with a random sample of 871 students from the Santiago de Compostela University (mean age 20.7 years, SD = 2.8). Information was collected on sociodemographic and academic characteristics; symptoms of depression, anxiety, and stress; diagnosis of major depression; optimism, resilience, social support, life engagement, and five personality domains, using validated instruments. Of the participants, 18.1%, 22.8% and 13.5% presented with severe/very severe levels of depression, anxiety and stress, respectively. A total of 12.9% had major depression. Higher life engagement was associated with lower risk of depression (OR = 0.92, 95% CI 0.87–0.98), while higher levels of neuroticism (OR = 1.20, 95% CI, 1.12–1.28) and openness to experience (OR = 1.08, 95% CI, 1.02–1.14) were associated with greater risk. These findings reveal an alarming percentage of female university students who experience major depression and severe/very severe stress.

Depression in Belgian first-year university students: A longitudinal study of self-definition, interpersonal relatedness, mentalizing, and integration

Despite evidence of increasing prevalence of depression in university students, few studies investigated how depression evolves over the first months at university. We investigate severity of depression among first-year university students during their first semester at university, and whether it was associated with impairments in personality, mentalizing (or reflective functioning), and social and academic integration. Participants in this two-wave prospective study were 377 Belgian first-year students in 2018 and 2019. Results showed that maladaptive interpersonal relatedness and self-definition at the start of the first semester (T1) were prospectively associated with increases in the prevalence and severity of depression at the end of the semester (T2). Uncertainty, but not certainty, with regard to mentalizing was positively associated with severity of depression at T2 and mediated the association between personality dimensions and severity of depression. The implications of these findings for depression prevention and intervention strategies in first-year university students are discussed.

Depression and Perceived Social Support in Asian American Medical Students

PURPOSE

Recent data reported that 21.5% of medical students in the United States of America (USA) are Asian American (AA). With the growing focus on developing medical school wellness programs, authors conducted a systematic, nationwide survey to assess prevalence of depression among AA medical students with a focus on disaggregating the AA population.

METHODS

A survey tool comprised of PHQ-9 and depression history, and questions on social support were emailed to members of the Asian Pacific American Medical Students Association enrolled in a USA medical school during the 2016-2017 academic year. Participants were grouped as East Asian American (EAA), Southeast Asian American (SEAA), and South Asian American (SAA). We evaluated associations between depression and regional ethnicity, depression history, and perceived support.

RESULTS

A total of 457 AA medical students were surveyed. SAA medical students were more likely to endorse symptoms of depression than EAA students. Students who identified as female were more likely to endorse symptoms of depression than their male-identifying counterparts. There was no significant relationship between students' perception of the support they received and their depressive symptoms.

CONCLUSION

Medical school administration should be aware of the unique needs of the heterogeneous population that comprises AA medical students. SAA students and those who identify as female are more likely to endorse symptoms of depression than their AA counterparts. Further research must be done to evaluate the factors that influence the mental health needs of AA medical students.

The Psychological Effect of COVID-19 on Home-Quarantined Nursing Students in China

Coronavirus disease 2019 (COVID-19) has significantly caused socioeconomic impacts. However, little is known about the psychological effect of COVID-19 on home-quarantined nursing students. The present study aimed to identify the prevalence and major determinants of anxiety, depression and post-traumatic stress symptoms (PTSS) in Chinese nursing students during the COVID-19 pandemic quarantine period. An online survey was conducted on a sample of 6,348 home-quarantined nursing students. Mental health status was assessed by the Generalized Anxiety Disorder 7-Item Scale (GAD-7), the Patient Health Questionnaire 9-Item Scale (PHQ-9) and the Post Traumatic Stress Disorder Check List-Civilian version (PCL-C), respectively. Logistic regression analyses were performed to identify risk factors of anxiety, depression and PTSS. The overall prevalence of anxiety was 34.97%, and the rates of "mild," "moderate," and "severe" anxiety were 26.24, 7.04, and 1.69%, respectively. Depression was detected in 40.22% of the nursing students, and the prevalence of "mild," "moderate," "moderately severe," and "severe" depression was 27.87, 7.18, 4.08, and 1.09%, respectively. The overall prevalence of PTSS was 14.97%, with the prevalence of "mild" and "moderate-to-severe" PTSS reported at 7.04 and 7.93%, respectively. Male gender and insufficient social support were common risk factors for anxiety, depression and PTSS. In conclusion, about one-third, two-fifths, and one-seventh of Chinese nursing students had anxiety, depression and PTSS during the period of home quarantine, respectively. Timely and appropriate psychological interventions for nursing students should be implemented to reduce the psychological harm caused by COVID-19 pandemic.

Depression and Anxiety Among Medical Students: A Brief Overview

Depression and anxiety are highly prevalent conditions worldwide. This article reviews the extent of depression and anxiety among medical students and elucidates associated potential risk factors. In comparison to other countries, students from Middle East countries have a higher prevalence of depression. Females suffer from these conditions more commonly than males. Factors associated with these morbidities can be divided into academic and non-academic factors. There is an inconclusiveness of whether medical students experience these symptoms more commonly than their counterparts. The present review provided a cross-sectional picture of the students' psychological well-being, which is crucial to formulate a health policy for preventive and therapeutic purposes.

Association between nutritional level, menstrual-related symptoms, and mental health in female medical students

Objective

Research suggests that medical students as well as women are at greater risk of depression compared to the general population and men. This suggests that female medical students are crucial targets requiring specific monitoring for mental health disorder prevention and intervention. However, little is known regarding the risk factors for poor mental health among this population. Therefore, we investigated whether menstrual symptoms and nutritional status are associated with psychological distress in Japanese female medical students.

Methods

This cross-sectional study assessed 326 female medical students who attended a school medical check-up, which included blood sampling in 2018. The levels of psychological distress were evaluated using the Japanese General Health Questionnaire (J-GHQ)-30. We defined high GHQ scores as GHQ-30 ≥7. We checked dysmenorrhea levels and assessed menstrual symptoms according to the presence of premenstrual syndrome (PMS). Dysmenorrhea was evaluated according to quartiles of the sum of the Menstrual Distress Questionnaire (MDQ). PMS was assessed using the Premenstrual Symptoms Questionnaire (PSQ). We evaluated levels of serum albumin, hemoglobin, ferritin, and lipid metabolite as nutritional factors. A multivariate logistic regression analysis was used to identify the association between menstrual-related symptoms or nutritional factors and the levels of psychological distress.

Results

A total of 45 female medical students (15%) experienced psychological distress. Serum albumin levels were associated with psychological distress, while lipid metabolite levels were not. The intensity of dysmenorrhea and the presence of PMS were associated with psychological distress, independent of nutritional status.

Conclusion

Both menstrual symptoms and nutrition markers were associated with the levels of psychological distress in Japanese female medical students. School doctors and nurses can help improve the mental health of young female medical students by encouraging a healthy diet and checking for the presence of menstrual symptoms.

Prevalence and factors associated with depressive and anxiety symptoms among Palestinian medical students

BACKGROUND

Co-existence of depression and anxiety can be associated with severe detrimental consequences to the physical, mental and social wellbeing of the affected populations. This study was conducted to determine prevalence of depressive and anxiety symptoms among Palestinian medical students and to investigate associations between sociodemographic factors of the students with depressive and anxiety symptoms.

METHODS

This study was conducted in a cross-sectional observational design using a questionnaire in the period between September 2018 and April 2019 in a major university in the West Bank of Palestine. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II) and anxiety symptoms were assessed using the Beck Anxiety Inventory (BAI). The questionnaire also collected the sociodemographic characteristics of the students. Reliability of the questionnaire was tested using the test re-test method. A total of 425 medical students were invited to participate in the study.

RESULTS

Of those invited, 286 students completed the questionnaire, giving a response rate of 67.3%. More than half (56.6%) of the students had minimal depression, 20.3% had mild depression, 14.0% had moderate depression, 9.1% had severe depression, 23.4% had no anxiety, 29.7% had mild to moderate anxiety, 25.5% had moderate to severe anxiety, and 21.3% had severe anxiety. Multiple linear regression analysis showed that academic stage (p-value < 0.01), Grade Point Average (p-value < 0.01), mental health status (p-value < 0.001), ever attempted suicide (p-value < 0.05), and religious commitment (p-value < 0.01) were predictors of BDI-II scores. Multiple linear regression analysis showed that academic stage (p-value < 0.05) and mental health status (p-value < 0.001) were predictors of BAI scores.

CONCLUSIONS

Depressive and anxiety symptoms were prevalent among Palestinian medical students in a major university in the West Bank of Palestine. Interventions might be designed to improve self-rated mental health of medical students in their academic years, ameliorate study conditions, and provision of counseling services to improve spirituality might be effective in reducing symptoms of depression and anxiety among medical students in Palestine. Future studies are still needed to investigate if these interventions could be useful in reducing depressive and anxiety symptoms among Palestinian medical students.

The relationship between students' perception of the educational environment and their subjective happiness

BACKGROUND

Happiness, a subjective judgment about one's quality of life, is influenced by environmental factors and should be considered as an important goal of medical education, which should support each learner's development as a person as well as a professional. However, although several studies have reported on the correlation between Dundee Ready Educational Environment Measure (DREEM) scores and students' academic achievement, few have investigated the relationship between DREEM scores and students' subjective happiness. This study examined different perceptions of the educational environment between phases of the curriculum and determined which DREEM subscales affect the overall level of happiness.

METHODS

We used the Korean version of the DREEM questionnaire and a single item measure of happiness on a scale of 0 to 10. First we analyzed student perceptions of the educational environment according to their demographic characteristics using independent sample t-tests and one-way analysis of variance. A multiple regression analysis was performed to reveal which subscales affect the overall level of happiness while controlling for grade point average (GPA) and other demographic characteristics.

RESULTS

The subjects were 239 medical school students across all stages of the curriculum. The students' overall perception was more positive for the educational environment during Phase 3 (clerkship) than Phase 1 (pre-medical). Among the DREEM subscales, this difference was especially prominent in Students' Perception of Learning and Students' Academic Self-Perceptions. In contrast, no difference in the subjective perception of happiness was found between phases. The effect of GPA on happiness became insignificant under the control of other variables, but the influence of the Students' Social Self-Perceptions (SSSP) subscale remained significant.

CONCLUSIONS

The students' overall perception of the educational environment was more positive during the clerkship period than in the pre-medical period. Based on our finding that the SSSP correlates significantly with subjective happiness, we suggest that institutions promote not only students' academic development but also their happiness by fostering an appropriate educational environment.

Quality of Life (QoL) among medical students in Saudi Arabia: a study using the WHOQOL-BREF instrument

BACKGROUND

Poor Quality of Life (QoL) among medical students is associated with an unhealthy lifestyle, psychological distress, and academic failure, which could affect their care for patients in the future. This study aimed to evaluate the reliability and validity of the Arabic WHOQOL-BREF tool among Saudi medical students and to assess the effect of gender, educational level, and academic performance on their QoL.

METHODS

This was a cross-sectional study among medical students of King Abdulaziz University in February 2016, using the Arabic version of the WHOQOL-BREF instrument.

RESULTS

Six-hundred-thirty medical students were included, where females constituted (51.1%). Cronbach's α coefficient for the overall domains of WHOQOL-BREF was 0.86. Students' self-reported QoL mean score was 3.99 ± 0.95, and their mean score for the overall satisfaction with health was 3.66 ± 1.06. The environmental domain had the highest mean score (67.81 ± 17.39). High achievers showed lower psychological health, while poor academic performance was associated with better psychological health and social relationship QoL scores (P < 0.013 and P < 0.014, respectively).

CONCLUSIONS

The WHOQOL-BREF is valid and reliable for assessing QoL among Saudi medical students. Although gender and academic year had no impact on the students' QoL, better-performing students reported lower psychological health and social relationships scores.

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

BACKGROUND

Major depressive disorder (MDD) is highly prevalent among medical students (MS). Abuse experiences, as well as stress, are among the factors associated with MDD. However, their association with MDD in MS has been scarcely addressed.

METHODS

A cross-sectional study design was used to evaluate the association between MDD and possible risk factors, focusing on current and past abuse experiences inside and outside the academic setting in a large representative MS sample (n = 1,068) using self-report instruments to assess MDD (PHQ-9) and perceived academic stress levels during exam season.

RESULTS

Depressive symptom severity directly correlates with levels of perceived academic stress. The prevalence of MDD was 16.2%. A history of emotional abuse during childhood or adolescence, as well as most types of current abuse were associated with MDD. Multiple logistic regression analysis showed that current emotional abuse outside school had the strongest association with MDD in MS, followed by a personal history of depression and suicide attempt, a family history of depression, and perceived academic stress levels.

LIMITATIONS

Cross-sectional design, participants represent a specific population, and other variables that could be associated with MDD: comorbid psychiatric disorders, current antidepressant treatment and protective factors (resilience and health-promoting coping strategies) were not evaluated.

CONCLUSIONS

MDD is strongly associated with several risk factors that include most types of current and past abuse experiences. Timely identification of individuals at-risk will be critical to establish preventive strategies to limit the impact of MDD in MS and offer prompt therapeutic alternatives when needed.

The role of empathy and psychological need satisfaction in pharmacy students' burnout and well-being

BACKGROUND

The purpose of this study was to examine the relationship between Korean pharmacy students' empathy and psychological need satisfaction and their levels of burnout and psychological well-being, using structural equation modeling.

METHODS

The participants were 452 pharmacy students from five South Korean universities. The Jefferson Scale of Empathy (Health Professions Students version), the Activity-Feeling States Scale, and the Maslach Burnout Inventory-Student Survey were used to assess empathy, psychological need satisfaction, and burnout, respectively. Psychological well-being was measured with the Mood Rating Scale, Self-Esteem Scale, and Satisfaction With Life Scale. The fits of the measurement and structural regression (SR) models with data on the four variables were evaluated using the Tucker-Lewis index (TLI), incremental fit index (IFI), comparative fit index (CFI), and root mean-square error of approximation (RMSEA) using AMOS 18.0.

RESULTS

A total of 447 students (98.9%) completed the survey. The measurement model showed adequate fit indices; all hypothesized factor loadings were significant. The proposed SR model also showed an acceptable fit (TLI = 0.92, IFI = 0.94, CFI = 0.94, RMSEA = 0.072); each path was supported except the path from empathy to burnout (β = 0.005). Empathy was positively associated with psychological well-being (β = 0.18). Perceived satisfaction of psychological needs was positively related to psychological well-being (β = 0.59), but strongly and negatively related to burnout (β = - 0.71). The model explained 50 and 44% of variances in burnout and psychological well-being, respectively.

CONCLUSIONS

Pharmacy students' empathy and psychological needs should be considered in pharmacy education systems to promote psychological adjustment.

Prevalence and correlates of depression among male medical students and interns in Albaha University, Saudi Arabia

Background:

Depression in medical students and interns appear higher than the general population, with evidence of mental health deterioration over a period of medical training.

Objectives:

To estimate the prevalence and evaluate the predictors of depression among male medical students and interns, Albaha University, Saudi Arabia.

Subjects and Methods:

A cross-sectional analytic study was conducted which includes a representative stratified random sample with the proportional allocation of male medical students and interns, College of Medicine, Albaha University (2017–2018). A questionnaire included sociodemographic characteristics of the participants as well as a medical and family history of depression, medical or psychiatric illness, abuse or violence, and the major traumatic event was utilized. In addition, the validated reliable Arabic version of Becks Depression Inventory (BDI) questionnaire was used to screen for depression.

Results:

The study included 161 medical students and 21 interns. Their age ranged between 19 and 26 years with a mean of 22.03 ± 1.94 years. Majority of the participants (98.9%) were Saudis and singles (84.6%). The prevalence of depression, based on the BDI scale, was 53.8%; it was mild in 25.8% and severe or extreme in 4.4% of the participants. No factor was significantly associated with depression. However, severe or extreme depression was more reported among students/interns with a history of domestic abuse or violence and those who had a history of major trauma or psychiatric event, P < 0.001.

Conclusion:

Depression is a common problem among male medical students and interns in AlBaha University, with no difference according to demographics, smoking history, family history of depression, history of chronic medical or psychiatric illness, history of domestic/violence abuse, and history of major trauma or psychiatric event.

Prevalence of anxiety and depressive symptoms among medical residents in Tunisia: a cross-sectional survey

OBJECTIVE

To assess the prevalence of anxiety and depressive symptoms and the associated risk factors among Tunisian medical residents.

DESIGN

Cross-sectional survey.

SETTING

Faculty of Medicine, Tunis.

PARTICIPANTS

All Tunisian medical residents brought together between 14 and 22 December 2015 to choose their next 6-month rotation.

INTERVENTION

The items of the Hospital Anxiety and Depression (HAD) questionnaire were employed to capture the prevalence of anxiety and/or depression among the residents. The statistical relationships between anxiety and depression (HAD score) and sociodemographic and work-related data were explored by Poisson regression.

RESULTS

1700 out of 2200 (77%) medical residents (mean age: 28.5±2 years, female: 60.8%) answered the questionnaire. The mean working hours per week was 62±21 hours; 73% ensured a mean of 5.4±3 night shifts per month; and only 8% of them could benefit from a day of safety rest. Overall, 74.1% of the participating residents had either definite (43.6%) or probable (30.5%) anxiety, while 62% had definite (30.5%) or probable (31.5%) depression symptoms, with 20% having both definite anxiety and definite depression. The total HAD score was significantly associated with the resident's age (OR=1.014, 95% CI 1.006 to 1.023, p=0.001); female gender (OR=1.114, 95% CI 1.083 to 1.145, p<0.0001); and the heavy burden of work imposed on a weekly or monthly basis, as reflected by the number of night shifts per month (OR=1.048, 95% CI 1.016 to 1.082, p=0.03) and the number of hours worked per week (OR=1.008, 95% CI 1.005 to 1.011, p<0.0001). Compared with medical specialties, the generally accepted difficult specialties (surgical or medical-surgical) were associated with a higher HAD score (OR=1.459, 95% CI 1.172 to 1.816, p=0.001).

CONCLUSION

Tunisian residents experience a rate of anxiety/depression substantially higher than that reported at the international level. This phenomenon is worrying as it has been associated with an increase in medical errors, work dissatisfaction and attrition. The means of improving the well-being of Tunisian medical residents are explored, emphasising those requiring immediate implementation.

Depressive Symptoms and Suicidal Ideation among Irish Undergraduate College Students

This study examined the prevalence of depressive symptoms and suicidal ideation among 220 first year undergraduate university students in Ireland. Data were collected using the Centre for Epidemiological Studies Depression Scale and the Suicidal Behaviours Questionnaire. Findings indicated that 59% of participants experienced depressive symptoms and 28.5% had suicidal ideation. Financial stress and poor relationships with both parents, increased the odds of experiencing depressive symptoms. Sexual orientation, financial stress, and poor relationships with fathers, increased the odds of experiencing suicidal ideation. Suicidal ideation was also higher in those who had sought help in the past from mental health professionals. Nurses need to be aware of the factors associated with mental ill-health in this population.

Childhood maltreatment: A predictor of mental health problems among adolescents and young adults

Child maltreatment is a risk factor for detrimental effects on mental health that may extend to adulthood. This study aimed to examine the association between exposure to childhood maltreatment, socio-demographic factors, and students' mental health status and self-esteem. A cross-sectional study enrolled a representative sample of 1270 students from Kuwait University. An anonymous self-administered questionnaire included students' socio-demographic characteristics, history of exposure to childhood physical and/or emotional maltreatment, DASS-21 to assess mental health status, and Rosenberg self-esteem scale was used. Chi-square test and binary logistic regression models were applied. The study found that among participants, 49.6%(95% CI: 64.8%-52.4%), 63.0%(95% CI: 60.3%-65.7%), and 43.8%(95% CI: 41.1%-46.6%) reported having depression, anxiety, and stress respectively. Moreover, 22.5%(95% CI: 20.1%-24.8%) and 18.6%(95% CI:16.5%-20.9%) reported childhood physical and emotional maltreatment, respectively; while 12.7% reported both. Multivariate analysis revealed that experiencing childhood physical and emotional maltreatment were independent contributors to reporting depression and anxiety; while exposure to only emotional maltreatment contributed to reporting stress. Gender, GPA, childhood enrollment in private/public schools, number of close friends, were other contributors to mental health problems. Participants' median score of self-esteem was 17/30, and only childhood emotional maltreatment was a significant predictor to low self-esteem after adjustment for other confounders. Mental health problems, and experiencing childhood physical and emotional maltreatment were prevalent relatively high among university students. Childhood corporal and emotional maltreatment were independent predictors to adolescents and young adults' mental health problems. Experiencing childhood emotional maltreatment predicted low self-esteem. Further research to assess culture factors associated with childhood maltreatment is recommended.

Undergraduate medical students' perceptions and intentions regarding patient safety during clinical clerkship

BACKGROUND

The purpose of this study was to examine undergraduate medical students' perceptions and intentions regarding patient safety during clinical clerkships.

METHODS

Cross-sectional study administered in face-to-face interviews using modified the Medical Student Safety Attitudes and Professionalism Survey (MSSAPS) from three colleges of medicine in Korea. We assessed medical students' perceptions of the cultures ('safety', 'teamwork', and 'error disclosure'), 'behavioural intentions' concerning patient safety issues and 'overall patient safety'. Confirmatory factor analysis and Spearman's correlation analyses was performed. In total, 194(91.9%) of the 211 third-year undergraduate students participated.

RESULTS

78% of medical students reported that the quality of care received by patients was impacted by teamwork during clinical rotations. Regarding error disclosure, positive scores ranged from 10% to 74%. Except for one question asking whether the disclosure of medical errors was an important component of patient safety (74%), the percentages of positive scores for all the other questions were below 20%. 41.2% of medical students have intention to disclose it when they saw a medical error committed by another team member.

CONCLUSIONS

Many students had difficulty speaking up about medical errors. Error disclosure guidelines and educational efforts aimed at developing sophisticated communication skills are needed. This study may serve as a reference for other institutions planning patient safety education in their curricula. Assessing student perceptions of safety culture can provide clerkship directors and clinical service chiefs with information that enhances the educational environment and promotes patient safety.

The four-domain structure model of a depression scale for medical students: A cross-sectional study in Haiphong, Vietnam

Depression is a common mental health problem with a higher prevalence in medical students than in the general population. This study aims to investigate the association between depressive symptoms, particularly those in each domain of the Center for Epidemiological Studies Depression (CES-D) Scale, and related factors. A cross-sectional study was conducted with a random sample of 1319 medical students at Haiphong University of Medicine and Pharmacy in 2016. The CES-D scale and a self-reported questionnaire were used to identify the prevalence of depressive symptoms and related risk factors. Univariate and multivariate logistic regression were performed to assess the risk factors associated with depressive symptoms and the score for each structure factor. Depressive symptoms were observed in 514 (39%) students, including more males than females (44.2% vs 36.9%, p = 0.015). Students whose mothers' highest education level was primary school had a higher prevalence of depressive symptoms than students whose mothers had higher education levels (p = 0.038). There was a significant relationship between depressive symptoms and stressful life events, especially a decline in personal health. A higher correlation was found between the somatic complaints and depressive affect domains. The impacts of risk factors differed for each domain of the depression scale. Only the factor of achieving excellence showed no statistically significant associations with depressive symptoms and the scores on the four domains considered in this study. The high prevalence of depressive symptoms among medical students with risk factors and the impact of these risk factors on each domain of depression scale need further clarification to alleviate depression in students during their medical training.

Life satisfaction and happiness associated with depressive symptoms among university students: a cross-sectional study in Korea

BACKGROUND

This cross-sectional study investigated the impact of life satisfaction and happiness, as well as the prevalence and correlates of depressive symptoms in a large sample of university students.

METHODS

We included 2338 students at 6 universities in 1 metropolitan city and 2 provinces of Korea. Depressive symptoms were assessed by the Beck Depression Inventory, and scores of 16 or higher were categorized as the presence of depression. Various sociodemographic, life satisfaction, happiness, and clinical factors (alcohol consumption and sleep quality) were measured. According to the presence of depression, sociodemographic, life satisfaction, happiness, and clinical characteristics were compared using statistical analyses. Further, a logistic regression model was constructed to examine the impact of life satisfaction, happiness, and clinical factors on depression.

RESULTS

Among participants, 13.4% were identified as having depression. Life satisfaction and happiness were associated with a lower risk of depression, while hazardous alcohol drinking and poor sleep quality were related to a higher risk of depression. In addition, female gender, subjective body shape as obese, and insufficient pocket money were found to be significant correlates of depressive symptoms.

CONCLUSIONS

This study demonstrated possible risk and protective factors of underlying depressive symptoms. Especially, our findings suggest that improvement in life satisfaction and happiness would be important in the prevention and management of depression. Our findings may contribute to developing specialized mental health programs for prevention, screening, and treatment of depression among university students.

Measuring stress in medical education: validation of the Korean version of the higher education stress inventory with medical students

BACKGROUND

Medical students face a variety of stressors associated with their education; if not promptly identified and adequately dealt with, it may bring about several negative consequences in terms of mental health and academic performance. This study examined psychometric properties of the Korean version of the Higher Education Stress Inventory (K-HESI).

METHODS

The reliability and validity of the K-HESI were examined in a large scale multi-site survey involving 7110 medical students. The K-HESI, Beck Depression Inventory (BDI) and questions regarding quality of life (QOL) and self-rated physical health (SPH) were administered.

RESULTS

Exploratory factor analysis of the K-HESI identified seven factors: Low commitment; financial concerns; teacher-student relationship; worries about future profession; non-supportive climate; workload; and dissatisfaction with education. A subsequent confirmatory factor analysis supported the 7-factor model. Internal consistency of the K-HESI was satisfactory (Cronbach's α = .78). Convergent validity was demonstrated by its positive association with the BDI. Known group validity was supported by the K-HESI's ability to detect significant differences on the overall and subscale scores of K-HESI according to different levels of QOL and SPH.

CONCLUSIONS

The K-HESI is a psychometrically valid tool that comprehensively assesses various relevant stressors related to medical education. Evidence-based stress management in medical education empirically guided by the regular assessment of stress using reliable and valid measure is warranted.

Prevalence and incidence of mental health problems among Dutch medical students and the study-related and personal risk factors: a longitudinal study

BACKGROUND

A high prevalence of mental health problems (i.e. depression and/or anxiety) has been found in medical students in comparison with the general population. Therefore, the objective was first to study the prevalence and 1-year incidence of symptoms of depression, anxiety and any mental health problems among Dutch medical students and, second, to study which study-related and personal factors present a risk of these mental health problems.

METHODS

A 1-year prospective longitudinal study was performed among medical students of two medical faculties in the Netherlands (n=951). Health problems and study-related and personal factors were measured with an online questionnaire. Mental health problems were assessed by depression and/or anxiety symptoms (BSI-DEP and BSI-ANG). Univariate and multivariate hierarchical logistic regression analyses were performed to examine which of the study-related and personal factors predict mental health problems.

RESULTS

At follow-up, 36%, 28% and 48% of the medical students reported symptoms of depression, anxiety and mental health problems, respectively. The incidence between 2010 and 2011 for depression was 20%, 17% for anxiety and 25% for mental health problems. Students who are worried about their own health during medical education are at an increased risk of future mental health problems (OR 2.0 [1.3-2.9], p=0.00). Excessive drinking behavior is a protective factor in this study (OR 0.7 [0.5-0.9], p=0.02).

CONCLUSION

This study shows that only two out of nine factors are significantly associated with mental health problems among Dutch medical students, one risk factor and one protective factor.

Assessment of depression and suicidal behaviour among medical students in Portugal

OBJECTIVES

To examine depression and suicidal behaviour and associated factors in a sample of medical students in Portugal.

METHODS

We conducted a cross-sectional study design of 456 native Portuguese medical students from the 4^th and 5^th year at the University of Lisbon. Participants answered a self-report survey including questions on demographic and clinical variables. Statistical analyses were conducted using the chi-square test, with a Monte Carlo simulation when appropriate.

RESULTS

Depression among medical students was 6.1% (n=28) and suicidal behaviour 3.9% (n=18). Higher depression scores were noted in female medical students (χ²=4.870,df=2,p=0.027), students who lived alone (χ²=8.491,df=3,p=0.037), those with poor physical health (χ²=48.269,df=2,p<0.001), with poor economic status (χ²=8.579,df=2,p=0.014), students with a psychiatric diagnosis (χ²=44.846,df=1,p=0.009), students with a family history of psychiatric disorders (χ²=5.284,df=1,p=0.022) and students with high levels of anxiety (χ²=104.8, df=3, p<0.001).  Depression scores were also higher in students with suicidal ideation (χ²=85.0,df=1,p<0.001), suicidal plan (χ²=47.9,df=1,p<0.001) and suicidal attempt (χ²=19.2,df=1,p<0.001). Suicidal behaviour was higher in medical students who lived alone (χ²=16.936,df=3,p=0.001), who had poor physical health (χ²=18,929,df=2,p=0.001), poor economic status (χ²=9.181,df=2,p=0.01), who are/were in psychopharmacology treatment (χ²=30.108,df =1,p<0.001), and who had high alcohol use (χ²=7.547,df=2,p=0.023), severe depression (χ²=88.875,df=3,p<0.001) and high anxiety levels (χ²=50.343,df=3,p<0.001). The results also revealed that there were no differences between students in the 4^th and 5^th years of medical school regarding rate of depression and suicidal behaviour.

CONCLUSIONS

Since depression and suicidal behaviour are mental health problems affecting a significant proportion of medical students, medical schools should implement programs that promote mental health wellness, physical health and economic status between other factors.

The association between chronotype and perceived academic stress to depression in medical students

Depression is a multifactorial illness that is highly prevalent among medical students (MS). Chronotypes, which reflect circadian preference in humans, as well as academic stress have been associated with depression in different populations. However, it is not known how chronotype and stress might alone or in combination, associate with depression in MS. Thus, we aimed to evaluate the association between stress, chronotype and depression in MS. In a cross-sectional study, we evaluated a total of 1068 medical students from a public Medical School in Mexico City. The Patient Health Questionnaire-9 (PHQ-9) was used to evaluate depressive symptom severity and the presence of a current depressive episode with a cutoff score of 10 or higher. The Morning-Evening Questionnaire (MEQ) was used to establish chronotype and the Academic Stress Inventory was used to measure perceived academic stress (PAS). We observed that depressive symptom severity was higher in non-morning chronotypes and moderate/severe PAS groups. A factorial ANOVA showed an association between PAS groups and depressive symptom severity. Linear regression showed an association between depressive symptom severity and variables such as PAS scores (p = 0.001), family history of depression (p = 0.001), gender (p = 0.001) and academic year (p = 0.029). Logistic regression analysis showed that evening chronotype (OR: 2.3, 95% CI: 1.2-4.3, p = 0.01) and severe PAS (OR: 4.4, 95% CI: 2.8-7.0, p = 0.0001) were associated with depression. Further, MS with the combination of severe PAS and morning (OR: 5.9, 95% CI: 1.6-22.2, p = 0.01), intermediate (OR: 7.5, 95% CI: 2.3-24.4, p = 0.001) or evening (OR: 10.6, 95% CI: 2.8-40.0, p = 0.001) chronotypes showed a greater association with depression than any PAS or chronotype group alone. Being female, perceiving restricted or limited economic resources, having severe scores of academic stress, and evening chronotype were associated with an increased probability to suffer a current depressive episode. Collectively, these results show that chronotype and PAS are factors associated with depression in MS, and when combined promote this association. Our results might aid in early identification of MS susceptible to depression. Future research could focus on the implementation of simple, low cost preventive strategies, such as chronotype-oriented academic schedules.

Depression, Anxiety and Symptoms of Stress among Baccalaureate Nursing Students in Hong Kong: A Cross-Sectional Study

This study examines the prevalence of depression, anxiety and symptoms of stress among baccalaureate nursing students in Hong Kong. Recent epidemiological data suggest that the prevalence of mild to severe depression, anxiety and stress among qualified nurses in Hong Kong stands at 35.8%, 37.3% and 41.1%, respectively. A total of 661 nursing students were recruited to participate in our cross-sectional mental health survey using the Depression, Anxiety and Stress Scale 21. Multiple logistic regression was used to determine significant relationships between variables. Working in general medicine, being in financial difficulty, having sleep problems, not having leisure activity and perceiving oneself in poor mental health were significant correlates of past-week depression, anxiety and stress. Year of study, physical inactivity and family crisis in the past year correlated significantly with depression. Imbalanced diets significantly correlated with anxiety. Stress was significantly associated with a lack of alone time. This is the first study to confirm empirically that clinical specialty, financial difficulties and lifestyle factors can increase nursing students’ levels of depression and anxiety and symptoms of stress. Prevention, including the early detection and treatment of mental disorder, promises to reduce the prevalence of these indicators among this group.

The MD Blues: Under-Recognized Depression and Anxiety in Medical Trainees

Background

Mental health disease is under recognized in medical professionals.

Objective

To screen medical students (MS), residents and fellows for major depressive disorder (MDD) and generalized anxiety disorder (GAD) under the new era of work hour reform with age-matched controls from a large representative cross-sectional survey.

Methods

We conducted an anonymous online survey at a medical university in 2013–2014. We incorporated the Patient Health Questionnaire 2 (PHQ-2) to screen for MDD and the generalized anxiety disorder scale (GAD-7) to screen for GAD, along with additional questions on life stressors and academic performance. We compared these results to age-matched controls from the National Health and Nutrition Examination Survey (NHANES) database.

Results

126 residents/fellows and 336 medical students participated voluntarily. 15.1% and 15.9% of postgraduates as well as 16.4% and 20.3% of MS screened positive for MDD and GAD, respectively. When compared to national estimates, the prevalence of a positive screen for MDD was over five-fold higher in medical trainees compared to age-matched controls (16% vs. 2.8%, p<0.0001). Similarly, the prevalence of a positive screen for GAD was over eight-fold higher in medical trainees (19% vs. 2.3%, p<0.0001).The prevalence was consistently higher within age strata. 33.3% of postgraduates and 32% of MS believe there is a significant impact of depression or anxiety on their academic performance. For stress relief, one fifth of residents/fellows as well as MS reported alcohol use.

Conclusions

The stresses of medical education and practice may predispose trainees to psychopathological consequences that can affect their academic performance and patient care. The current study showed a significantly higher rate of MDD and GAD positive screens in medical trainees than the prevalence in an age-matched U.S. population, despite significant work hour reform for medical trainees. Increased awareness and support services are required at all levels of medical training. We propose that the ACGME and the Institute of Medicine may consider these findings when implementing future changes to work hour regulations.

Effects of a brief mindfulness-based intervention program for stress management among medical students: the Mindful-Gym randomized controlled study

Pursuing undergraduate medical training can be very stressful and academically challenging experience. A 5-week mindfulness-based stress management (MBSM/Mindful-Gym) program was developed to help medical students cope with stress. The aim of this study was to evaluate the effectiveness of the intervention in reducing stress among students in a medical school in Malaysia. Seventy-five medical students participated in the program. They were stratified according to years of studies and randomly allocated to intervention (N = 37) and control groups (N = 38). The following outcome variables were measured at pre- and post-intervention: mindfulness (with Mindful Awareness Attention Scale); perceived stress (with Perceived Stress Scale); mental distress (with General Health Questionnaire), and self-efficacy (with General Self-efficacy Scale). Hierarchical multiple regressions were used to analyse the effect of group (intervention vs. control) on changes in the outcome variables. There were significant improvements at one week post-intervention in all outcome variables: mindfulness (β = 0.19, ΔR2 = 0.04, p = .040, f (2) = 0.05), perceived stress (β = -0.26, ΔR2 = 0.07, p = .009, f (2) = 0.10); mental distress (β = -0.28, ΔR2 = 0.10, p = .003, f (2) = 0.15); and self-efficacy (β = 0.30, ΔR2 = 0.09, p < .001, f (2) = 0.21). Six months after the intervention, those who had joined the program reported higher self-efficacy compared to those in the control group (β = 0.24, ΔR2 = 0.06, p = .020, f (2) = 0.08); but there was no difference in other outcome measures. More than 90% of the participants found the program applicable in helping patients and all reported that they would recommend it to others. This study indicates that the program is potentially an effective stress management program for medical students in Malaysia.

Perceptions and intentions relating to seeking help for depression among medical undergraduates in Sri Lanka: a cross-sectional comparison with non-medical undergraduates

BACKGROUND

This study attempts to understand whether medical undergraduates in Sri Lanka would seek help for depression. This was done by examining their perceptions and intentions relating to seeking help for depression, using the responses of non-medical undergraduates as the baseline for comparison.

METHOD

Medical (n = 620) and non-medical undergraduates (n = 4050) at the University of Colombo responded to a questionnaire which included a vignette about a depressed undergraduate, a depression measure, an open-ended question examining their intentions to seek help if affected by the problem described in the vignette, and scales examining their perceptions about the helpfulness of various help-seeking options for dealing with the problem. The latter items were also administered among mental health professionals to assess expert opinion on dealing with depression. Logistic regression models were used to examine if medical undergraduates differed from non-medical undergraduates in their rates of depression, help-seeking perceptions and help-seeking intentions. These models were also used to examine if being depressed was associated with differences in the help-seeking perceptions and intentions of medical undergraduates.

RESULTS

Medical and non-medical undergraduates did not differ in their odds of being depressed. Overall, the medical undergraduates were more likely to appraise professional help positively. However, they did not differ from non-medical undergraduates in relation to their intentions to seek such help if affected by the problem personally. They were also more likely to indicate their intentions to seek help from parents and family. Furthermore, medical undergraduates who screened positive for Major Depression were less likely to appraise some of the recommended professional and informal help-seeking options as being 'helpful', with only 50 % considering that it was 'unhelpful' to deal with the problem alone. There was also no difference in their help-seeking intentions as compared to those screening negative for Major Depression.

DISCUSSION AND CONCLUSIONS

Although medical training seems to be associated with better help-seeking beliefs, interventions are needed to improve these medical undergraduates' intentions to personally seek professional help for depression. It is concerning that medical undergraduates who are depressed might be less likely to consider it beneficial to seek help and instead, deal with the problem alone.

Psychological well-being status among medical and dental students in Makkah, Saudi Arabia: a cross-sectional study

OBJECTIVES

Medical and dental students experience poor psychological well-being relative to their peers. This study aimed to assess the psychological well-being among medical and dental students in Saudi Arabia, identify the high-risk groups and assess the association between the psychological well-being and the academic performance.

METHODS

In this cross-sectional study, 422 preclinical medical and dental students at Umm Al-Qura University, Saudi Arabia, were recruited to assess their depression, anxiety, stress, self-efficacy and satisfaction with life levels using 21-items Depression Anxiety Stress Scale (DASS-21), General Self-Efficacy (GSE) scale and Satisfaction With Life Scale (SWLS). Students' academic weighted grades were obtained later. Descriptive statistics and univariate general linear model were used to analyse data.

RESULTS

High levels of depression (69.9%), anxiety (66.4%) and stress (70.9%) were indicated, whereas self-efficacy (mean = 27.22, sd = 4.85) and life satisfaction (mean = 23.60, sd = 6.37) were within the normal range. Female medical students had higher psychological distress in contrast to dental students. In general, third-year students were more depressed and stressed in comparison with second-year students, except for stress among dental students. Moreover, all females had higher self-efficacy than males. Life satisfaction was higher within the second-year and high family income students. Depression was the only psychological variable correlated with the academic performance.

CONCLUSION

High levels of psychological distress were found. Female medical students had higher psychological distress than males, whereas male dental students had higher distress than female. Medical students at third year were more depressed and stressed. Dental students were more depressed in the third year, but more stressed in the second year. Attention should be directed towards reducing the alarming levels of depression, anxiety and stress among medical and dental students.

Support for medical students with mental health problems: a conceptual model

OBJECTIVE

Medical students experience higher prevalence of mental illness than age-matched controls and are less likely to access appropriate help when this happens. The aim of this study was to determine the range of strategies deployed by medical schools to support medical students with mental health concerns and to use this to identify distinct categories.

METHODS

Websites and documents relating to all 32 UK medical schools were looked at, as were reports for quality assurance visits carried out by the General Medical Council (UK). A structured telephone interview was carried out with medical schools. Support services were examined by tracing the path that might be taken by a hypothetical student with mental health concerns of varying severity, seeing what was required and what was available at each stage.

RESULTS

A range of support strategies is available to most medical students both from their medical school and from generic services in the university. Medical students will usually first contact a personal tutor or a senior member of faculty or be contacted by them as a result of concerns raised either via performance issues or by another student. While individual support interventions are mostly based on evidence of effectiveness, there is no unifying theory in terms of what constitutes effective support. To enable analysis of support interventions and comparison across providers, a six-stage conceptual model of prevention was developed. The six stages are the following: prevention, identification, referral, escalation, treatment, and reintegration.

CONCLUSIONS

The staged model, derived from analysis of existing interventions, provides a framework for evaluation of current provision and comparison of different methods of delivery. Moreover, it provides a framework for future research.

Depression in military medicine cadets: a cross-sectional study

BACKGROUND

Military medicine cadets undergo strenuous military training alongside demanding medical studies. This stressful and complex educational environment can lead to the emergence of depressive symptoms. We investigated the prevalence of depressive symptoms in a cohort of military medicine cadets.

METHODS

We conducted a descriptive questionnaire-based cross-sectional study among Greek military medicine cadets in the undergraduate program of the Hellenic Military School of Combat Support Officers. The Greek translation of the Zung self-rating depression scale questionnaire was used to screen for the presence of depressive symptoms. In addition, demographic, academic and dietary information was collected. The Shapiro-Wilk test of normality, Pearson correlation test, Chi-square test, t-test and Mann Whitney U test were employed for statistical analysis.

RESULTS

We enrolled 55 female and 91 male military medicine cadets with a mean age of 19.84 years (SD = 0.99). The mean Zung crude score was 43.32 (SD = 4.55): 42.8 (SD = 4.43) for female cadets and 43.64 (SD = 4.6) for male cadets. Cadets were further subdivided into low and high risk groups for the presence of depressive symptoms. We identified 57 (39 %) cadets with a total Zung crude score of 45 or above: 21 females and 36 males. Statistical analysis did not reveal any significant differences between the two groups based on gender, year of training, academic performance, alcohol consumption, smoking status, vitamin supplementation, dietary habits or BMI.

CONCLUSIONS

We report a high prevalence of depressive symptoms in a cohort of military medicine cadets that underscores the need for effective screening and appropriate and timely interventions. We did not identify any related risk factors. Military medicine cadets are exposed to a challenging military and medical training environment, and thus represent a group at risk for development of depression.

Both hair cortisol levels and perceived stress predict increased symptoms of depression: an exploratory study in young adults

OBJECTIVE

Depressive symptoms are a common mental health problem among young adults, but the physiological mechanisms that mediate between stress and depressive symptoms remain unclear. Accordingly, this exploratory study (1) examined how hair cortisol concentrations were associated with self-perceived stress and depressive symptoms in a sample of young adults and (2) tested whether hair cortisol could explain variance in depressive symptoms beyond perceived stress before and after controlling for levels of vigorous physical activity (VPA).

METHODS

The sample consisted of 42 exercise and health science university students (20 males, 22 females; mean age = 21.2 years). Cortisol concentrations were extracted from hair strands close to the scalp. Participants completed self-rating questionnaires about depressive symptoms and perceived stress.

RESULTS

Students with elevated hair cortisol levels tended to report lower depressive symptoms and lower perceived stress. Increased perceived stress was associated with higher depressive symptoms, and both hair cortisol and perceived stress predicted depressive symptoms after controlling for VPA.

CONCLUSIONS

The present data suggest that elevated hair cortisol levels do not necessarily constitute a health risk. Hair cortisol measurement can serve as a noninvasive and painless biomarker of chronic stress and mental disorders; however, additional research is needed.

Identity and norms: the role of group membership in medical student wellbeing

Medical students experience high levels of mental health problems, which can lead to poor academic performance, substance abuse and burnout. The current paper draws on social psychology to explore the factors underpinning wellbeing in medical students. From the literature it is evident that there is a strong association between group membership and wellbeing. There is also evidence, however, that when the norms of a group prescribe unhealthy behaviours, group members who identify strongly with the group are likely to engage in those behaviours. It was hypothesized that (a) there would be a positive relationship between identification and wellbeing in medical students, (b) perceptions of norms would be positively related to unhealthy behaviour which would be negatively related to wellbeing and (c) identification would be positively related to levels of norm-related unhealthy behaviour. Ninety-two Australian medical students completed measures of identification, endorsement of norms, own behaviour in relation to norms and three indicators of wellbeing. The results supported the first hypothesis and showed only partial support for the second, suggesting a primarily positive role of group processes in medical student wellbeing. The implications for interventions to improve wellbeing in medical schools and directions for future research are discussed.

Depressive symptoms in medical students: prevalence and related factors

PURPOSE

This study was designed to estimate the prevalence of depression and the factors that influence it in Korean medical students.

METHODS

We evaluated depression in 122 first- and second-year medical students in December 2011 using the Korean Beck Depression Inventory (K-BDI). Sixteen potential factors were considered: gender, class year, grade point average, breakfast habits, residence type, leisure activity, sleep satisfaction, relationship status, a close friend or a significant other, finances, present health status, history of mood disorders, family history of mood disorders, religion, and self-esteem.

RESULTS

The average BDI score was 8.9. There were 80 (65.6%), 16 (13.1%), 15 (12.3%), and 11 (9.0%) students with minimal, mild, moderate, and severe depression, respectively. The group with depressive symptoms comprised males with a total BDI score > or =24 and females with total BDI > or =25 and constituted 9.0% of students. Students in the depressive symptom group had lower self-esteem and lower grade point averages and were more frequently ill, less likely to be in a relationship, and more likely to have a history of mood disorders (p<0.05 for all). In particular, low self-esteem score was an independent factor.

CONCLUSION

The BDI scores in our study were similar to those that have been reported in other countries but slightly higher than in other Korean medical and university students. Self-esteem, grade point average, health status, history of mood disorders, family history of mood disorders, and presence of a significant other correlated significantly with depression in medical students.