Associations of pass-fail outcomes with psychological health of first-year medical students in a malaysian medical school

Students' perceptions and experiences of an online well-being programme: a phenomenological study protocol

BACKGROUND

The pandemic has ensued challenges across all sections of the human population such as livelihood and educational changes, which involve the abrupt shift to online learning, immensely affecting the students' well-being. Negative health consequences of e-learning among students stem from the increased demand for new technological skills, productivity, information overload and restriction of students to spend time with their peers.

OBJECTIVE

To explore the experiences of the students from the University of Santo Tomas-College of Rehabilitation Sciences (UST-CRS) who participated in the online well-being programme.

METHODOLOGY

A phenomenological design will be used to determine the participants' perceptions and experiences. Purposive sampling will be used to recruit 8-10 undergraduate students from UST-CRS ages 18-22 years, who participated in the well-being programme, and completed the study's quantitative counterpart. Semistructured, in-depth questions will be used to conduct a focus group discussion. The transcripts will be analysed using thematic analysis via the NVivo V.12 software.

ETHICS AND DISSEMINATION

The study protocol is approved by the UST-CRS Ethical Review Committee (Protocol Number: SI-2022-034 (V.4)). It will be implemented in accordance with the Declaration of Helsinki and the National Ethical Guidelines for Health and Health-Related Research, and Data Privacy Act. Findings will be published in accredited journals and presented in related scientific fora.

REGISTRATION ID

PHRR230214-005419; Philippine Health Research Registry.

Stress Levels and Stressors of Veterinary Students in Indonesia

Despite the growing collection of scientific publications on student stress levels, stress experienced by veterinary students in Indonesia has been less investigated. This study assessed the stress levels of veterinary students and investigated the stressors faced by veterinary students in Indonesia, both in undergraduate and professional programs. The study participants were 165 veterinary students from all universities offering veterinary medicine in Indonesia. The Perceived Stress Scale was used to evaluate stress levels, and the modified Veterinary Medical Stressor Inventory was used to indicate several stressors in this study, including academic performance, clinical graduation, negative evaluation, and online classes experienced by veterinary students. The findings show that most veterinary students in Indonesia experienced moderate stress levels. Results also found that female students experienced higher levels of stress than their male counterparts. The multiple regression result shows that stressors belonging to the academic group were the most significant, primarily in undergraduate students. Aside from academics, the rigorous veterinary medicine curriculum, loneliness, and peer competition are the major potential stressors.

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.

The causal relationship between social support and psychological well-being among undergraduate students in North China

BACKGROUND

Psychological well-being is an important part that undergraduate students and universities cannot neglect as it helps students lead a better study life at the university. Various studies revealed that social support can affect students' psychological well-being. However, the causal relationship between social support and psychological well-being has received little attention in North China. Therefore, the aim of the current study was to analyze the causal relationship between social support and psychological well-being among undergraduate students in North China.

MATERIALS AND METHODS

The survey approach was adopted and conducted with a total of 689 undergraduate students in North China. Data were collected using a reliable questionnaire. Data analysis was performed with descriptive statistics, Pearson's correlation, and structural equation modeling at P < 0.01 significance level using Statistical Package for Social Sciences (SPSS) and Linear Structural Relations (LISREL).

RESULTS

The overall levels of social support and psychological well-being among undergraduate students in North China were high. All observed variables in this study were significantly correlated. The findings also confirmed that the causal relationship between social support and undergraduate students' psychological well-being in North China fitted to the empirical data well (χ² [22, N = 689] = 27.69, χ²/degree of freedom [df] = 1.26, P = 0.19, goodness of fit index [GFI] = 0.99, adjusted goodness of fit index [AGFI] = 0.98, comparative fit index [CFI] = 1.00, standardized root mean square residual [SRMR] = 0.02, root mean square error of approximation [RMSEA] = 0.02).

CONCLUSIONS

Undergraduate students' psychological well-being had been significantly affected by social support in North China. The findings from the current study will be useful for university administrators to develop strategies for the enhancement of undergraduate students' psychological well-being.

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.

When the wheels fall off - Medical students' experiences of interrupted academic progression

INTRODUCTION

There is limited published research on medical students' perspectives of a significant interruption to their academic progression. This study sought to identify the factors that contribute to difficulties with academic progression and to understand how medical students successfully respond.

METHODS

This interpretive phenomenological study reports on the findings from in-depth interviews of 38 final year medical students who had experienced a significant academic interruption.

RESULTS

The two superordinate themes were: the factors contributing to the interruption and their experience of the interruption. Factors identified as contributing to the interruption were: workload, learning in medicine, motivation for medicine, isolation, adapting to local culture, health and external factors. Their experience of the interruption focused on stages of working through the process: 'what happened,' 'how it felt,' 'managing the failure,' 'accepting the failure' and 'making some changes.'

DISCUSSION

Each factor affected how the participants reacted and responded to the interruption. Regardless of the origins of the interruption, most reacted and responded in a comparable process, albeit with varying timespans. These reactions and responses were in a state of fluctuation. In order to succeed many stated they shifted their motivation from external to internal, in direct response to the interruption, resulting in changed learning behaviours.

CONCLUSIONS

The process of working through an interruption to academic progression for students may benefit from a model of interval debriefing, restorative academic and personal development support. Facilitation of this process could enable students to face an interruption constructively rather than as an insurmountable emotionally burdensome barrier. Medical schools could utilise these findings to implement further support strategies to reduce the number of significant academic disruptions.

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.

Patterns and barriers of mental health service utilization among medical students: a cross-sectional study

Background

The prevalence of mental health problems among medical students has been steadily rising. It is greater than the prevalence of mental health problems among other students, negatively impacting students, and their future careers. The study aims to estimate the prevalence of the self-reported need for mental health care, the pattern of utilization of mental health services, and the different barriers that hinder medical students from seeking professional help.

Results

This study was conducted among medical students at Mansoura University, using a structured self-reported online questionnaire to collect the need for mental health services, sociodemographic details, the pattern of utilization of mental health services, and the barriers using a Likert scale of 30 items named Barriers to Access to Care Evaluation Version 3. According to this study, 77.77% felt the need for mental health care. The independent predictors for feeling the need for mental health care were female sex and urban residence with an adjusted odds ratio of 2.7 and 1.9, respectively. Regarding mental healthcare needs, most of the barriers were instrumental and attitudinal related. Lack of information about how to access services and solve the problem by themselves was the most common barriers followed by time and financial affords.

Conclusions

It appears that Mansoura medical students are at higher risk of feeling the need for mental care. Considerable barriers to help-seeking remain prevalent, including both logistical (e.g., time) and informational (e.g., lack of knowledge about the available services).

Mental health among Thai medical students: Preadmission evaluation and service utilization

BACKGROUND AND AIMS

Mental illness among medical students is common. Identifying at-risk students can be beneficial in terms of prevention and treatment. This study examined the association between preadmission mental health evaluation and mental health service utilization among Thai medical students.

METHODS

The authors collected data from all first- to sixth-year students at one university hospital and three affiliated hospitals during the 2014 to 2019 academic year (n = 1642). Preadmission mental health was evaluated using the Thai Mental Health Indicators 66 (TMHI-66) questionnaire. Data from mental health service utilization included the dates of service and the clinical diagnosis. Data were analyzed using Cox regression, adjusted for sex, hometown, and affiliated hospital.

RESULTS

The prevalence of poor mental health was found to be 3.7% based on TMHI-66 results. The proportion of all students who sought mental health services was 8.3%, and they were mostly diagnosed with depressive disorder (3%), adjustment disorder (1.9%), and anxiety disorder (1.9%). Students with positive TMHI-66 results were more likely to seek out services at the faculty counseling center for one or more mental health problems (Hazard ratio [HR] = 2.11, 95% CI 1.11-4.04, P = .024).

CONCLUSION

Preadmission mental health was found to be associated with mental health service utilization. Depressive disorder was the most frequent mental illness among Thai medical students utilizing the faculty counseling services. Still, the number was far lower than the reported prevalence of mental disorders due to various reasons. Further studies are needed to investigate risk and protective factors for mental disorders to better promote mental health and encourage mental health service utilization in targeted students throughout medical education.

Development and validation of a questionnaire for evaluating knowledge of risk factors for teen depression among health care trainees of a Nigerian university

INTRODUCTION

Increasing knowledge of factors predisposing individuals to depression appears to be an important preventive strategy. However, there is no validated instrument for evaluating knowledge of risk factors for depression among adolescents. Therefore, we aimed to develop and validate a questionnaire to assess knowledge of risk factors for teen depression.

METHODS

Extensive literature search and expert consultations were carefully conducted. The content, face, and convergent validity of the prefinal Knowledge of Risk Factors for Teen Depression Questionnaire (KRFD-Q) were performed. The Cronbach's alpha and test-retest reliability of KRFD-Q were conducted. Exploratory factor analysis (EFA) was used to delineate the final items into distinct clusters. Participants' demographic characteristics were presented using descriptive statistics. All analyses were performed using SPSS version 20.

RESULTS

A total of 17 items were generated after an extensive literature search and expert consultations. Two items were considered as repetitions and thus deleted. The overall Cronbach's alpha of KRFD-Q was 0.72. Test-retest reliability (r = 0.83, P < .0001) and convergent validity (r = 0.61, P = .034) were satisfactory. The corrected item-total correlation of KRFD-Q ranged from 0.13 to 0.45. The EFA identified three factors, (1) family abuse, stress, and self-criticism (7 items), (2) social/relationship factors (5 items), and (3) genetic and economic factors (3 items).

DISCUSSION

The findings of this study demonstrate that 15-item KRFD-Q developed is satisfactorily valid and reliable to measure the knowledge of risk factors for teen depression among university undergraduate students.

Prevalence of Depression Among Health Sciences Students: Findings From a Public University in Malaysia

Background:

High rates of psychological problems including depression among university students have been reported in various studies around the world. The objectives of this study were to explore the prevalence of depressive disorder, as well as the associated sociodemographic factors (gender, origin, school, and year of study) among health sciences students.

Materials and Methods:

This cross-sectional study was conducted among 425 students from 5 different schools of health sciences at International Islamic University Malaysia, using the Patient Health Questionaire-9 (PHQ-9).

Results:

With a response rate of 85.9% (n = 365), the results showed a depressive disorder prevalence of 36.4%. The mean PHQ-9 score of the respondents was 8.10 (SD = 4.9), indicating mild depression severity. A statistically significant association was revealed between gender and severity of depression (P = 0.03), as well as between students’ origin and severity of depression (P = 0.02).

Conclusion:

The findings indicated high prevalence of depression among undergraduate health sciences students. While providing significant information to students’ affairs department, the study findings suggest the necessity to address depressive disorder in health sciences university students in Malaysia. Future research is needed to confirm these results in larger samples.

Emotional intelligence and anxiety, stress, and depression in Iranian resident physicians

Background:

Residency is one of the most critical periods of medical education. Residents are susceptible in high risk for mental problems which can affect the doctor–patient relationship. Emotional intelligence (EI) correlates closely with stress and mental health. Considering the important role of EI in medical education and with regard to lack of studies in this group in Iran, this study conducted to determine the relationship between EI and stress, anxiety, and depression in a sample of resident physician in our university of medical sciences.

Materials and Methods:

In this cross-sectional study, 245 residents were invited, but only100 questionnaires were analyzed, and the response rate was 41%. From this, 26 were men and 74 were women. Bar-on EI questionnaire, Depression Anxiety Stress Scales-21, for evaluating the stress, anxiety, and depression and demographic characteristics were used.

Results:

The mean score of EI in resident physician was 330.24 ± 38.5. The mean score of stress, anxiety, and depression was 17.8 ± 8.6, 10.04 ± 7.99, and 10.49 ± 8.67 respectively. There was a negative relation between mean score of anxiety (R = −0.0525), stress (R = −0.639), and depression (R = −0.644) with a mean score of EI.

Conclusion:

Higher EI appears to be good predictors of lower stress, anxiety, and depression in resident physician.

Research trends in studies of medical students' characteristics: a scoping review

The purpose of this study is to investigate domestic and international research trends in studies of medical students' characteristics by using the scoping review methods. This study adopted the scoping review to assess papers on the characteristics of medical students. The procedure of research was carried out according to the five steps of the scoping review. The full texts of 100 papers are obtained and are read closely, after which suitable 88 papers are extracted by us for this research. The review is mapped by the year of the study, source, location, author, research design, research subject, objective, and key results. The frequency is analyzed by using Microsoft Excel and SPSS. We found 70 papers (79.5%) on a single medical school, 15 (17.0%) on multiple medical schools, and three (3.4%) on mixed schools, including medical and nonmedical schools. Sixty-nine (79.5%) were cross-sectional studies and 18 (20.5%) were longitudinal studies. Eighty-two papers (93.2%) adopted questionnaire surveys. We summarized research trends of studies on medical students in Korea and overseas by topic, and mapped them into physical health, mental health, psychological characteristics, cognitive characteristics, social characteristics, and career. This study provides insights into the future directions of research for the characteristics of medical students.

Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis

IMPORTANCE

Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies.

OBJECTIVE

To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students.

DATA SOURCES AND STUDY SELECTION

Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included.

DATA EXTRACTION AND SYNTHESIS

Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression.

MAIN OUTCOMES AND MEASURES

Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview.

RESULTS

Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, -0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%.

CONCLUSIONS AND RELEVANCE

In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.

Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis

Importance

Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies.

Objective

To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students.

Data Sources and Study Selection

Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included.

Data Extraction and Synthesis

Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression.

Main Outcomes and Measures

Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview.

Results

Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, -0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%.

Conclusions and Relevance

In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.

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.

Resource-oriented coaching for reduction of examination-related stress in medical students: an exploratory randomized controlled trial

INTRODUCTION

The years spent in acquiring medical education is considered a stressful period in the life of many students. Students whose mental health deteriorates during this long period of study are less likely to become empathic and productive physicians. In addition to other specific stressors, academic examinations seem to further induce medical school-related stress and anxiety. Combined group and individual resource-oriented coaching early in medical education might reduce examination-related stress and anxiety and, consequently, enhance academic performance. Good quality evidence, however, remains scarce. In this study, therefore, we explored the question of whether coaching affects examination-related stress and health in medical students.

METHODS

We conducted a randomized controlled trial. Students who registered for the first medical academic examination in August 2014 at the University of Lübeck were recruited and randomized into three groups. The intervention groups 1 and 2 received a 1-hour psychoeducative seminar. Group 1 additionally received two 1-hour sessions of individual coaching during examination preparation. Group 3 served as a control group. We compared changes in self-rated general health (measured by a single item), anxiety and depression (measured by the hospital anxiety and depression scale), as well as medical school stress (measured by the perceived medical school stress instrument). In order to further investigate the influence of group allocation on perceived medical school stress, we conducted a linear regression analysis.

RESULTS

We saw a significant deterioration of general health and an increase in anxiety and depression scores in medical students while preparing for an examination. We found a small, but statistically significant, effect of group allocation on the development of perceived medical school stress. However, we could not differentiate between the effects of group coaching only and group coaching in combination with two sessions of individual coaching.

CONCLUSION

The health of medical students deteriorated while preparing for an examination. Short-term resource-oriented coaching might be an effective means of reducing medical school stress in candidates preparing for an examination.

Usefulness of the Patient Health Questionnaire-9 for Korean medical students

OBJECTIVE

Depression may be highly prevalent among medical students, lowering their functioning and quality of life. Using appropriate extant depression scales to screen for depression and determining factors associated with depression can be helpful in managing it. This study examines the validity and reliability of the Patient Health Questionnaire-9 (PHQ-9) for medical students and the relationship between their scores and sociodemographic variables.

METHODS

This study surveyed 174 medical students using demographic questionnaires, the PHQ-9, the Beck Depression Inventory (BDI), the Patient Heath Questionnaire-15 (PHQ-15), the Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS). It calculated the Cronbach's α for internal consistency and Pearson's correlation coefficients for test-retest reliability and convergent validity of the PHQ-9. In order to examine the relationship between depression and demographic variables, this study performed independent t tests, one-way analysis of variance, chi-square, and binary logistic regressions.

RESULTS

The PHQ-9 was reliable (Cronbach's α = 0.837, test-retest reliability, r = 0.650) and valid (r = 0.509-0.807) when employed with medical students. Total scores on the PHQ-9 were significantly higher among low-perceived academic achievers than among high-perceived academic achievers (p < 0.01). Depression was more prevalent in poor-perceived academic achievers than in high-perceived academic achievers. Similarly, poor-perceived academic achievers were at greater risk of depression than were high-perceived academic achievers (odds ratio [95 % confidence interval] 3.686 [1.092-12.439], p < 0.05).

CONCLUSIONS

The PHQ-9 has satisfactory reliability and validity in medical students in South Korea. Depression is related to poor-perceived academic achievement when measured with the PHQ-9. Early screening for depression with the PHQ-9 in medical students and providing prompt management to high scorers may not only be beneficial to students' mental health but also improve their academic performance.

The relationship between academic assessment and psychological distress among medical students: a systematic review

A systematic review was conducted to determine the relationship between academic assessment and medical student psychological distress with the aim of informing assessment practices. A systematic literature search of six electronic databases (Medline, Medline IN PROCESS, PubMed, EMBASE, Psychinfo, ERIC) from 1991 to May 2014 was completed. Articles focusing on academic assessment and its relation to stress or anxiety of medical students were included. From 3,986 potential titles, 82 full-text articles were assessed for eligibility, and 23 studies met review inclusion criteria. Studies focused on assessment stress or anxiety, and assessment performance. Consistent among the studies was the finding that assessment invokes stress or anxiety, perhaps more so for female medical students. A relationship may exist between assessment stress or anxiety and impaired performance. Significant risks of bias were common in study methodologies. There is evidence to suggest academic assessment is associated with psychological distress among medical students. However, differences in the types of measures used by researchers limited our ability to draw conclusions about which methods of assessment invoke greater distress. More rigorous study designs and the use of standardized measures are required. Future research should consider differences in students' perceived significance of assessments, the psychological effects of constant exposure to assessment, and the role of assessment in preparing students for clinical practice.

Influencing factors of mental health of medical students in China

This study investigated the mental health status of medical students in China, and analyzed the influencing factors in order to provide evidence for mental health education for medical students. A stratified cluster sampling method was used to recruit medical students from Huazhong University of Science and Technology, China. The questionnaire survey on general information and Symptom Checklist 90 (SCL-90) were used for investigation and analysis. The results showed among the 1137 valid questionnaires, 278 (24.45%) participants had SCL-90 score ≥ 160. The top three mental problems of medical students were obsessive-compulsive disorder, interpersonal sensitivity and depression in terms of the factor score ≥ 2.5 and the number of participants who reflected on the diseases. The third-year medical students had the worst mental health status, and fifth-year medical students had the best mental health status. Students from rural area had more psychological problems than those from urban area; furthermore, students with high professional satisfaction, those who were the single child of the family, non-poor students, and those whose parents had high education level had better mental health status. It was concluded that the mental health of medical students is not optimistic in China. Medical students have some mental health problems of different degrees. Factors that influence the mental health of medical students include academic pressure, professional satisfaction level and family environment.

Prevalence of stress in Casablanca medical students: a cross-sectional study

INTRODUCTION

Recently, an important literature data has reported that medical students experience stress more than students in other disciplines. In contrast, there is a significant shortage of the stress impact on the academic performance. The primary purpose of our study was to determine the prevalence of stress among Casablanca Medical students and to investigate if there is an association between stress and academic skills.

METHODS

A total of 275 participants studying at Casablanca Medical School were included. The study was conducted using a self-administered, anonymous questionnaire, which included four subscales on academic skills perception (Academic competence, Test competence, Time management and Strategic study habits) and a Test Anxiety scale to assess the degree of stress related to exams among medical students.

RESULTS

The overall findings showed that 52.7% of respondents were stressed by examinations, and the highest stress prevalence was among the fifth-year medical students. Measures of comparative stress degrees between male and female students did not show any statistical significant differences (p=0.34). Correlation analysis revealed negative association between stress and academic competence (-0.394), test competence (-0.426), time management (-0.240), strategic study (-0.183) respectively (p<0.001).

CONCLUSION

Medical educators and psychologists have to increase clinical awareness of stress among medical students, by establishing strategies for stress management.