The well-being of medical students: A biopsychosocial approach

Well-Being, Mental Health, and Study Characteristics of Medical Students before and during the Pandemic

Medical students report high demands, stressors, pressure to perform, and a lack of resources, and are therefore at a higher risk for mental strain and burnout. Due to the COVID-19 pandemic, study conditions have changed, and new challenges have emerged. Thus, this study aimed to examine medical students' well-being, mental health, and study characteristics before and during the pandemic. Data from 988 Austrian medical students were included into the cross-sectional comparisons, and 63 students were included into the longitudinal analyses (variance analyses/t-tests or appropriate non-parametric tests). Well-being before and during the pandemic did not differ significantly but the peri-pandemic cohort reported higher study satisfaction, more social support from lecturers, and less emotional exhaustion, cognitive demands, and stressors (information problems, organizational stressors, work overload). Longitudinally, work overload was also perceived to be higher before the pandemic; however, study satisfaction was lower. During the pandemic, approximately every seventh student exceeded the cut-off value for generalized anxiety disorder, and approximately every tenth student exceeded the cut-off value for major depression. These unexpected peri-pandemic results concerning constant high well-being, study satisfaction, and the perception of conditions may be based on response shift effects that require further exploration. The scores exceeding the reasonable cut-point for identifying probable cases of generalized anxiety disorder and depression may reflect medical students' needs, calling for an in-depth analysis if further health promotion is necessary.

Sleep quality and subjective well-being in healthcare students: examining the role of anxiety and depression

Objective

Sleep issues, negative emotions, and health conditions are commonly co-occurring, whereas their associations among healthcare students have yet to be elucidated. This study aimed to examine whether anxiety and depression mediate the relationship between sleep quality and subjective well-being in healthcare students.

Methods

A cross-sectional survey was conducted among Chinese healthcare students (N = 348). A battery of paper-and-pencil questionnaires-the Sleep Quality Questionnaire (SQQ), World Health Organization-Five Well-Being Index (WHO-5), and Patient Health Questionnaire-4 (PHQ-4) were applied. Descriptive analysis with means (standard deviations) and counts (proportions), Spearman correlation analysis between the SQQ, WHO-5, and PHQ-4, and mediation analysis via structural equation models were performed.

Results

Correlation analysis revealed statistically significant associations between sleep quality, anxiety and depression, and well-being among healthcare students. Mediation analysis identified that poor sleep quality produced relatively low levels of self-reported well-being, which were entirely attributable to anxiety and depression.

Conclusion

Sleep quality was associated with subjective well-being, and this interrelationship was fully mediated by anxiety and depression. Interventions aimed at promoting sleep quality of healthcare students may contribute to promoting their well-being by reducing anxiety and depression.

Medical students on the COVID-19 frontline: a qualitative investigation of experiences of relief, stress, and mental health

Objective

During the early stages of the COVID-19 pandemic, medical students were abruptly removed from clinical rotations and transitioned to virtual learning. This study investigates the impact of this shift on students' wellbeing and preparedness for advanced training.

Methods

Through qualitative research methods, including semi-structured interviews, the experiences of medical students working on the COVID-19 frontline were explored.

Results

The comprehensive findings of the study shed light on the profound emotional journey that medical students embarked upon during the relentless public health crisis. Within the chaos and overwhelming demands of the pandemic, medical students discovered a profound sense of purpose and fulfillment in their contributions to the welfare of the community. Despite the personal sacrifices they had to make, such as long hours, limited social interactions, and potentially risking their own health, students reported feelings of relief and gratitude.

Conclusion

Tailored support systems for medical students' wellbeing are crucial for improving healthcare delivery during crises. Medical schools should adopt a holistic curriculum approach, integrating interdisciplinary learning and prioritizing student wellbeing. Recognizing the pandemic's impact on students and implementing targeted support measures ensures resilience and contributes to an improved healthcare system.

A systematic review and meta-analysis of the association between young adults' sleep habits and substance use, with a focus on self-medication behaviours

Young adults (18-30 years) are vulnerable to sleep-wake disturbances and substance use, which are bi-directionally associated. The present work aims to organise the literature that deals with the association between sleep and substance use in young adults, also considering self-medication behaviours. We adopted a framework that accounts for the multidimensionality of sleep and the effect of different substances. We considered sleep disturbances (insomnia symptoms, sleep quality), sleep health dimensions (duration, satisfaction, efficiency, timing, daytime alertness), circadian characteristics (chronotype). Substances were alcohol, caffeine, nicotine, cannabis, others. We included 46 studies. The use of caffeine and nicotine was associated with higher odds of sleep disturbances. No significant effect was detected for sleep duration. In narrative findings, daytime dysfunction was associated with alcohol and caffeine use, and poor sleep satisfaction with nicotine use. Few evidence were available for the other sleep health dimensions. Evening chronotype was associated with alcohol, caffeine, and nicotine use. Few studies focused on cannabis or self-medication. Longitudinal results were inconclusive. We found a distinct pattern of associations between different substances and different sleep outcomes. Further investigation considering the multidimensionality of sleep would create a better understanding of the complex relationship between substance use and sleep health in young adults.

Health sciences students' career commitment, mental health, and physical activity during the COVID-19 pandemic

Objective: To understand the biopsychosocial dimensions of university health sciences students' experiences during the COVID-19 pandemic. Participants: Health sciences students (n = 297) from two universities in July and August 2020. Methods: Participants completed a Web-based survey asking about depression, anxiety, physical activity, coronavirus threat, and career commitment. Results: Moderate or severe depression and anxiety were reported by 28.6% and 31.3% of respondents, respectively. Depression and anxiety were positively correlated with perceived coronavirus threat and negatively correlated with career commitment and strenuous physical activity. A change in career commitment interests during the COVID-19 pandemic was reported by 11% of respondents. Conclusions: Identified factors that could be targeted by universities to support their students and secure career commitment include online learning challenges, ability to secure clinical placements, mental health (anxiety and depression), financial challenges, family pressure, and promotion of physical activity.

Social support and subjective well-being among postgraduate medical students: the mediating role of anxiety and the moderating role of alcohol and tobacco use

Medical students often face pressures from various sources in the course of postgraduate studies, and these factors have a negative impact on their subjective well-being. Previous researches have revealed that social support is a vital factor influencing subjective well-being, but unfortunately the underlying mechanism for this is unclear, especially for postgraduate medical students. The current study has inspected the effects of social support on subjective well-being of postgraduate medical students, the mediating role of anxiety and the moderating role of alcohol and tobacco use in the association between social support and subjective well-being of postgraduate medical students. A sample of 900 postgraduate medical students (Mage = 27.01 years, SD = 3.33) from The Second Affiliated Hospital of Nanchang University completed the Social Support Rating Scale, the Generalized Anxiety Disorder-7, the Tobacco and Alcohol Use Questionnaire and the Subjective Well-Being Scale. Analysis of the structural equation model revealed that anxiety partially mediated the relationship between social support and subjective well-being of postgraduate medical students, while alcohol and tobacco use moderated the relationship between anxiety and subjective well-being of postgraduate medical students. This study revealed how social support act upon subjective well-being of postgraduate medical students. This study provides a theoretical basis for promoting and enhancing the subjective well-being of postgraduate medical students.

Professional Stigma of Mental Health Issues: Physicians Are Both the Cause and Solution

After a medical student prompted medical faculty to tell their stories of depression and related mental health issues, the author wrote this article with the aim of decreasing the stigma of mental illness and encouraging treatment, as needed, in the medical profession. The professional culture of the house of medicine not only mimics society in attributing stigma to people with mental health issues but may also contribute to high rates of suicide in the ranks of health care professionals by leading to a delay in seeking treatment. Acculturation accelerates in the first year of medical school such that medical students experience an increase in burnout and depressive symptoms from prematriculation levels. It follows that faculty have a responsibility to improve the learning environment. Survey data from medical faculty at the author's institution showed that depression decreased respondents' willingness to seek mental health treatment because of the stigma and issues of access to help. Faculty attitudes toward mental health issues, including reluctance to admit having such issues, may be conveyed to medical students in the hidden curriculum that teaches them to keep depression hidden. Moreover, the fear of mental disorders is manifested in licensing and privileging applications under the guise of patient safety, contributing to a culture of shame and silence. As creators and guardians of this professional culture, medical faculty and other physicians must be the ones who change it. The same faculty who play a part in causing and perpetuating stigma related to mental health issues have the power to derive and enact some of the solutions. In addition to giving voice to a personal experience of mental health issues, this article offers suggestions for normalizing moderate to severe depression as a medical disorder, decreasing the stigma of mental health issues, and encouraging faculty to seek treatment.