Prevalence and Associated Factors of Depression in Medical Students in a Northern Thailand University: A Cross-Sectional Study

Exercise, mental well-being and burnout in Thai medical students in 2020-2021: an online cross-sectional survey

INTRODUCTION

Within the Thai medical curriculum, its rigorous education framework, demanding schedules and high academic standards can contribute to psychological distress. Regular physical activity has consistently shown positive effects on mental health. The aim of the study was to investigate the association between exercise and psychological well-being, including depression, anxiety, and burnout, in Thai medical students, and factors related to insufficient exercise and depression.

METHODS

The cross-sectional study was conducted among medical students in the university hospital during 2020-2021. Participants completed self-administered questionnaires consisting of demographic data, Godin-Shephard Leisure-Time Physical Activity Questionnaire, depression screening (9Q), Thai General Health Question-28 (4 domains: somatic symptoms, anxiety and insomnia, social dysfunction, severe depression), and Maslach burnout inventory (Emotional exhaustion (EE), Depersonalization (DP), Reduced Personal Achievement (rPA).

RESULTS

Of the 404 participants, 50.5% were women, the mean age (SD) was 21.06 (1.8) years, and 52% were in clinical years. The prevalence of insufficient exercise was 59.6%, depression (30.2%), somatic symptoms (27.7%), anxiety (30.7%), insomnia (89.4%), social dysfunction (89.4%), high level of EE (32.4%), DP (21%), and rPA (56.7%). Insufficient exercise was associated with moderate to severe depression (OR 2.89, 95% CI 1.16-7.25), anxiety and insomnia (OR 1.56, 95% CI 1.01-2.43), social dysfunction (OR 2.51, 95% CI 1.31-4.78), burnout in part due to high rPA (OR 2.4, 95% CI 1.4-4.13), and study in clinical years (OR 1.91, 95% CI 1.28-2.87). After adjusted significant factors, only studying in the clinical year, social dysfunction, and burnout in part of rPA were related to insufficient exercise.

CONCLUSIONS

High rates of insufficient exercise, psychological challenges, and burnout were prevalent among medical students. To effectively address these issues, medical school should advise students to participate in regular exercise, promoting mental well-being and healthier lifestyles.

The personality traits with depression and suicidal ideation among Thai medical students: a university-based multiregional study

BACKGROUND

The prevalence of depression in medical students was greater than in the general population. Knowing of predictive factors for depression among medical students is useful. The objectives of this study included the assessment of personality traits as well as the association between the personality traits and the presence of symptoms of depression, and suicidal ideation among medical students covering several regions of Thailand.

METHODS

From April to July 2023, a cross-section study was conducted. The participants included first to sixth-year medical students studying at three Faculties of Medicine in Thailand; Prince of Songkla University; Ramathibodi Hospital, Mahidol University; and Chiang Mai University. Using the online process, the questionnaires were composed of three sections; demographic data; the International Personality Item Pool-NEO (IPIP-NEO), Thai version; and the Patient Health Questionnaire-9 (PHQ-9), Thai version. Demographics, personality traits, depression, and suicidal ideation were analyzed using descriptive statistics. The results were presented as frequency, mean, and standard deviation (SD) or median and interquartile range (IQR). The association between independent variables and the presence of depression was identified using binary logistic regression analysis, and the association with suicidal ideation was identified using ordinal logistic regression analysis.

RESULTS

The 868 medical students participated in this study. Most of them were female (63.5%), Buddhist (82.0%), and first-year medical students (31.8%). The mean age (SD) was 20.8 (2.2) years, and the mean cumulative Grade Point Average (SD) was 3.5 (0.4). They reported the median (IQR) score of PHQ-9 as 6.0 (3.0-9.0), 238 participants (27.4%) presented with depression, and 138 (15.9%) participants reported suicidal ideation. According to the IPIP-NEO, participants with depression or suicidal ideation had higher Neuroticism scores and lower Extraversion, Agreeableness, and Conscientiousness scores compared to those without such issues. An increase in the Neuroticism score was linked to higher odds of depression, while an increase in the Conscientiousness score was associated with lower odds of depression. Suicidal ideation significantly increased with higher Neuroticism scores and the presence of a psychiatric illness.

CONCLUSIONS

More than a quarter of Thai medical students reported depression. A higher Neuroticism and lower Extraversion, Agreeableness, and Conscientiousness scores related to depression. Therefore, medical schools may benefit from knowing medical students' personality traits, to identify coping mechanisms and predict those at a higher risk of developing depression in the future.

The Association of HHV-6 and the TNF-α (-308G/A) Promotor with Major Depressive Disorder Patients and Healthy Controls in Thailand

Major depressive disorder (MDD) is a silent global health problem that can lead to suicide. MDD development is suggested to result from numerous risk factors, including genetic factors. A precise tool for MDD diagnosis is currently not available. Recently, inflammatory processes have been identified as being strongly involved in MDD development and the reactivation of human herpesvirus type 6 (HHV-6), upregulating cytokines such as TNF-α, which are associated with MDD. Therefore, this study aimed to determine the association of HHV-6 with genetic factors, especially TNF-α mutation, in MDD patients and their relatives compared to healthy controls. The Patient Health Questionnaire (PHQ-9) was used to evaluate MDD status, and 471 oral buccal samples were investigated for HHV-6 infection and viral copy number by qPCR. TNF-α (-308G/A) gene mutation and the cytokines TNF-α, IL-6, and IL-10 were analyzed by high-resolution melting (HRM) analysis and enzyme-linked immunosorbent assay (ELISA). Whole-exome sequencing of buccal samples was performed to analyze for genetic factors. The results showed significantly higher HHV-6 positivities and viral loads in MDD patients (15/59 (25.67%) and 14,473 ± 16,948 copies/µL DNA) and their relatives (blood relatives 17/36 (47.22%) and 8146 ± 5656 copies/µL DNA); non-blood relatives 7/16 (43.75%) and 20,721 ± 12,458 copies/µL DNA) compared to the healthy population (51/360 (14.17%) and 6303 ± 5791 copies/µL DNA). The TNF-α (-308G/A) mutation showed no significant difference. Surprisingly, 12/26 (46.15%) participants with the TNF-α (-308G/A) mutation showed HHV-6 positivities at higher rates than those with wild-type TNF-α (-308G) (70/267 (26.22%)). HHV-6-positive participants with TNF-α (-308G/A) showed higher levels of TNF-α, IL-6, and IL-10 than those of negative control. Exome analysis revealed that common mutations in immune genes were associated with depression. Therefore, this study unveiled the novel association of inflammatory gene TNF-α (-308G/A) mutations with HHV-6 reactivation, which could represent a combined risk factor for MDD. This result could induce further research on MDD development and clinical applications.

Resilience, Perceived Stress from Adapted Medical Education Related to Depression among Medical Students during the COVID-19 Pandemic

The COVID-19 pandemic disrupted several routine teaching methods in clinical settings which causing psychological distress among medical students. This study aims to explore the association of perceived stress related to the adapted medical education, resilience, and depression among medical students at a medical school in northern Thailand during the COVID-19 outbreak. A total of 437 medical students were recruited in January 2022. Data were obtained using self-administered online questionnaires, including demographic data, perceived challenges in learning online classes, the Resilience Inventory (RI-9), and the Patient Health Questionnaire 9 (PHQ-9). Binary logistic regression analysis was employed to explore factors associated with depression (PHQ-9 ≥ 9). A total of 27% of the participants were identified as having depression. Logistic regression revealed that the presence of previous psychiatric conditions (ß = 2.80, p < 0.05), stress from lack of in-person contact with peers (ß = 1.48, p < 0.05), stress from lack of in-person communication with teachers (ß = 1.49, p < 0.05), and level of resilience (ß = 0.88, p < 0.001) were independently associated factors for depression among medical students. Level of resilience was negatively correlated with depressive symptoms (r = −0.436, p < 0.001). The rate of depression among medical students was higher during the pandemic. Resilience was associated with depression. Strengthening resilience might have an important implication for depression among medical students.

Personality Traits and Mental Health among Lebanese Medical Students: The Mediating Role of Emotional Intelligence

Medical students face daily challenges such as large workload, time commitment and clinical environment pressure leading to a higher risk of psychological distress. The aim of our study was to assess the relationship between personality traits and depression, anxiety, and stress among Lebanese medical students and to evaluate the mediating role of emotional intelligence (EI) in this association. This cross-sectional study was conducted between June and December of 2019. Participants were from seven medical schools in Lebanon. Higher extraversion (B = -0.11), higher neuroticism (B = -0.28) and higher emotional intelligence (B = -0.03) were significantly associated with lower depression. Higher neuroticism (B = -0.29) and higher emotional intelligence (B = -0.03) were significantly associated with lower anxiety. Higher openness to experience (B = 0.07) and higher agreeableness (B = 0.08) were significantly associated with higher stress, whereas higher neuroticism (B = -0.05) was associated with lower stress. EI mediated the association between extraversion and depression and openness to experience and depression. EI mediated the association between extraversion and anxiety and openness to experience and anxiety. The results of this study were different from those previously cited in the literature. This could be secondary to the mediating role of emotional intelligence. This study consequently opens up the possibility of new studies highlighting the role of emotional intelligence in the possible preservation of medical students' mental health.

Prevalence of common mental health problems and associated factors among university students visiting Supara mental health service: A cross-sectional study

Background: Early studies found that the mental health problems rate was relatively high in university students. We aimed to investigate the prevalence of mental problems and associated factors in university students. Methods: We conducted a cross-sectional descriptive study at Supara mental health service in the Faculty of Medicine Vajira Hospital between February 2020 to June 2021. The primary outcome was the prevalence of psychiatric diagnosis according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The secondary assessments included the Patient Health Questionnaire-9 (PHQ-9), 8 items from the Mini International Neuropsychiatric Interview (MINI) to assess suicidal risk (8Q), and the Thai Mental Health Indicator (TMHI-15). The prevalence of mental health problems was presented by frequency and percentage. In addition, multivariable regression analysis was used to identify potential predictors of mental health problems.   Results: A total of 184 participants (62% female; mean age = 22.49 years (SD 3.93) were recruited. The depressive disorders, adjustment disorders, and anxiety disorders rates were 57.1%, 15.2% and 13.6%, respectively. Grade point averages (GPAs) below 3.0 (OR=3.09, 95%CI: 1.17-8.14) and a family history of mental disorder (OR=3.40, 95%CI: 1.10-10.48) were significant associated factors of moderate to severe mental health problems. Detecting and screening these factors may help the university to provide early detection and treatment for students. Conclusions: Depressive disorders were the most common mental health disorders. Females, low GPAs and a family history of mental disorder were predictors of moderate to severe mental health problems.

Prevalence of common mental health problems and associated factors among university students visiting Supara mental health service: A cross-sectional study

Background: Early studies found that the mental health problems rate was relatively high in university students. We aimed to investigate the prevalence of mental problems and associated factors in university students. Methods: We conducted a cross-sectional descriptive study at Supara mental health service in the Faculty of Medicine Vajira Hospital between February 2020 to June 2021. The primary outcome was the prevalence of psychiatric diagnosis according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The secondary assessments included the Patient Health Questionnaire-9 (PHQ-9), 8 items from the Mini International Neuropsychiatric Interview (MINI) to assess suicidal risk (8Q), and the Thai Mental Health Indicator (TMHI-15). The prevalence of mental health problems was presented by frequency and percentage. In addition, multivariable regression analysis was used to identify potential predictors of mental health problems.   Results: A total of 184 participants (62% female; mean age = 22.49 years (SD 3.93) were recruited. The depressive disorders, adjustment disorders, and anxiety disorders rates were 57.1%, 15.2% and 13.6%, respectively. Grade point averages (GPAs) below 3.0 (OR=3.09, 95%CI: 1.17-8.14) and a family history of mental disorder (OR=3.40, 95%CI: 1.10-10.48) were significant associated factors of moderate to severe mental health problems. Detecting and screening these factors may help the university to provide early detection and treatment for students. Conclusions: Depressive disorders were the most common mental health disorders. Females, low GPAs and a family history of mental disorder were predictors of moderate to severe mental health problems.