A study of stress, anxiety, and depression among postgraduate medical students

The Mental Health Challenges of Medical Postgraduates in Chengalpattu District, Tamil Nadu: Are they being Educated or Exploited?

Introduction Globally, psychological morbidity among medical postgraduates (PGs) is an often overlooked and underreported condition. The study was done to find the prevalence of depression and stress among PGs and to find and explore the associated factors contributing to their stress and depression.  Methodology The study followed a convergent parallel mixed-method approach, in which qualitative and quantitative data were collected simultaneously. The quantitative component was a cross-sectional study among 224 medical PGs pursuing their course in the Chengalpattu district of Tamil Nadu, India. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), and stress was evaluated using the perceived stress scale (PSS). A convenience sampling technique was followed. A pre-tested structured questionnaire was used to collect data regarding their interpersonal relationships with peers, seniors, and faculty members; their sleep patterns; and details regarding their family. Data was collected via an online platform. The qualitative component was collected by three focus group discussions (FGDs) conducted on virtual video calls with eight members in each FGD. The topic guide included semi-structured questions regarding the challenges in their postgraduate course and areas they felt needed improvement in the medical education system. Quantitative data was analyzed using SPSS Statistics version 26 (IBM Corp., Armonk, NY, USA), and qualitative data was collected using QualCoder version 3.5 (Colin C, QualCoder, Massachusetts Institute of Technology, Cambridge, MA, USA) and analyzed using thematic analysis. Results The mean age of the study participants was 27± 3 years. The prevalence of depression was found to be 46.4%, and stress was found to be 53.2%. A logistic regression model using the enter method and a linear regression model at a 95% confidence interval were used to find the predictors of depression and stress, respectively, among the PGs. The major predictors of depression were age of less than 27 years, clinical subject stream, less than six hours of sleep per day, inadequate knowledge of the course, and unapproachable faculty in the department. The major predictors of stress included all of the above, along with the feeling of discrimination on the grounds of language and religion. By qualitative analysis, the major themes identified were emotional and mental challenges PGs face in the course, gaps in postgraduate training, exploitation and unfair practices in the department, systematic barriers to education, and recommendations for improvement as perceived by the PGs. Conclusion The study found that around half of the study participants were screened positive for depression and stress. Some of the PGs responded that they experienced emotional abuse from seniors and faculties, expressed their need for an unbiased and neutral psychologist on campus, and expressed the need for a proper grievance redressal cell in the institution. At the institutional and departmental levels, measures could be taken to understand the mental health challenges faced by the PGs in an empathetic, non-judgmental, and holistic manner to reduce the psychological morbidity among them.

The relationship between challenge-hindrance stressors and innovative behavior among medical postgraduates in China: the mediation role of academic engagement and the moderating effect of relaxation

This study investigated the relationship between challenge-hindrance stressors and innovative behavior of medical postgraduates in China, examining the mediating role of academic engagement and the moderating effect of relaxation. Drawing from a sample of 437 medical postgraduates from three Chinese universities, our findings revealed that challenge stressors positively correlated with innovative behavior, while the direct relationship between hindrance stressors and innovative behavior was not statistically significant. Furthermore, academic engagement mediated the relationship between two types of stressors and innovative behavior. Challenge stressors enhanced academic engagement, which in turn fostered innovative behavior. Conversely, hindrance stressors were found to diminish academic engagement, which in turn indirectly limited innovative behavior. Additionally, relaxation was identified as a moderating factor that helped mitigate the negative effects of hindrance stressors on academic engagement and indirectly on innovative behavior. These results suggested that academic engagement as a mechanism played a pivotal role in determining how different stressors influenced innovative behavior, underscoring the need for stress management, particularly through relaxation techniques, to maintain high levels of academic engagement and innovative behavior. This study offers practical insights for medical education policymakers and educators in China, emphasizing the importance of balancing stressors and incorporating relaxation practices to enhance the innovative capabilities of medical postgraduates in demanding academic environments.

Challenge-Hindrance Stressors and Academic Engagement Among Medical Postgraduates in China: A Moderated Mediation Model

Background

Improving academic engagement of medical postgraduates is crucial for enhancing the quality of learning and the development of medical education. Due to medical postgraduates face high levels of stress and rigorous demands, yet the mechanisms linking challenge-hindrance stressors to academic engagement in this context remain largely unexplored. This study aims to explore the comprehensive relationship between challenge-hindrance stressors and academic engagement among medical postgraduates in China.

Methods

Data were collected from 437 medical postgraduates in China, to investigate their challenge-hindrance stressors, emotional exhaustion, learning, relaxation and academic engagement. Among these postgraduates, 40.3% were male and 59.7% were female, with the mean age of the participants being 25.71 years. Statistical procedures were conducted using Mplus 8.3, ensuring a robust analysis of the data collected.

Results

Our study showed that both challenge and hindrance stressors are significantly positively correlated with emotional exhaustion among Chinese medical postgraduates, and emotional exhaustion is negatively associated with academic engagement. Emotional exhaustion mediates the relationship between challenge-hindrance stressors and academic engagement. Learning plays a protective role, moderating the challenge stressors and emotional exhaustion relationship and its indirect effect on academic engagement. However, relaxation was not identified as a significant moderating factor in this context.

Conclusion

Our findings not only revealed emotional exhaustion as a potential mechanism underlying the relationship between challenge-hindrance stressors and academic engagement but also validated the moderating role of learning in mitigating the adverse effects of challenge stressors on emotional exhaustion and academic engagement among Chinese medical postgraduates. This comprehensive insight into the complex dynamics between different stressors and academic engagement provides both theoretical and empirical evidence for medical universities. It underscores the importance of interventions to enhance academic engagement in stressful environments and serves as a valuable reference for the development of reasonable assessment systems. These contributions are crucial for fostering a supportive educational atmosphere and promoting the well-being of medical postgraduates.

Anxiety Status of Female Chinese Ph.D. Candidates and Its Association with Sports

Given that stress leads to more anxiety among female Ph.D. candidates, more attention should be paid to their healthy lifestyle options. Several studies have shown that there is a negative correlation between sports and anxiety. This study took female Chinese Ph.D. candidates’ anxiety and sports participation as the research objects. A questionnaire entitled “Investigation on anxiety and sports of Ph.D. candidates” was used to explore the characteristics of anxiety in female Chinese Ph.D. candidates and to investigate the association between anxiety and sports in female Chinese Ph.D. candidates. A total of 588 Ph.D. candidates participated in the questionnaire survey. Some 21 invalid questionnaires were eliminated through the standard deviation of the items of the scale, and 567 valid questionnaires were finally obtained. The questionnaire survey was conducted online from 26 February to 15 March 2022, using the convenience sampling method. The results show that the anxiety level of female Chinese Ph.D. candidates is higher than that of male Ph.D. candidates and that the anxiety level of female Ph.D. candidates in a non-sports discipline is the highest. Weekly sports participation significantly lowers female Ph.D. candidates’ anxiety level (p < 0.01). Physical fatigue caused by study and work hinders female Ph.D. candidates from participating in sports (p < 0.05). Some female Chinese Ph.D. candidates in a negative emotional state are unwilling to participate in sports (p < 0.01). Future research should formulate different types of sports intervention programs suitable for alleviating the anxiety of female Ph.D. candidates.

Prevalence and changes in depressive symptoms among postgraduate students: A systematic review and meta-analysis from 1980 to 2020

Education actively helps us develop our well-being and health, but postgraduate students are at high risk of depression. The prevalence of depression symptoms varies from 6.2% to 84.7% among them, and its changes throughout the years remains unclear. The present study aimed to estimate the real prevalence of depression symptoms among postgraduate students and the changes from 1980 to 2020. Thirty-seven primary studies with 41 independent reports were included in the meta-analysis (none reports were in high-quality, three were medium-to-high quality, 20 were low-to-medium quality, and 18 were low-quality), involving 27,717 postgraduate students. The pooled prevalence of overall, mild, moderate, and severe depression symptoms was 34% (95% CI: 28-40, I²  = 98.6%), 27% (95% CI: 22-32, I²  = 85.8%), 13% (95% CI: 8-21, I²  = 97.3%), and 8% (95% CI: 6-11, I²  = 81.0%), respectively. Overall, the prevalence of depression symptoms remained relatively constant through the years following 1980 (overall: β = -0.12, 95% CI: [-0.39, 0.15], p = 0.39; mild: β = 0.24, 95% CI: [-0.02, 0.51], p = 0.07; moderate: β = -0.24, 95% CI: [-0.75, 0.26], p = 0.34; severe: β = 0.13, 95% CI: [-0.25, 0.51], p = 0.50). Doctoral students experienced more depressive symptoms than did master's students (43% vs. 27%; Q = 2.23, df = 1, p = 0.13), and studies utilising non-random sampling methods reported a higher prevalence of mild depression and lower moderate depression symptoms than those that used random sampling (overall: 34% vs. 29%; Q = 0.45, df = 1, p = 0.50; mild: 29% vs. 21%; Q = 1.69, df = 1, p = 0.19; moderate: 16% vs. 25%; Q = 1.79, df = 1, p = 0.18; severe: 8% vs. 9%; Q = 0.13, df = 1, p = 0.72) despite these differences was not statistically significant. The prevalence of depression symptoms was moderated by the measurements and the quality of primary studies. More than one-third of postgraduates reported depression symptoms, which indicates the susceptibility to mental health risk among postgraduates. School administrators, teachers, and students should take joint actions to prevent mental disorders of postgraduates from increasing in severity.

Impacts of COVID-19 and social isolation on academic staff and students at universities: a cross-sectional study

BACKGROUND

"The impacts of the Coronavirus Disease 2019 (COVID-19) pandemic and the shutdown it triggered at universities across the world, led to a great degree of social isolation among university staff and students. The aim of this study was to identify the perceived consequences of this on staff and their work and on students and their studies at universities.

METHOD

The study used a variety of methods, which involved an on-line survey on the influences of social isolation using a non-probability sampling. More specifically, two techniques were used, namely a convenience sampling (i.e. involving members of the academic community, which are easy to reach by the study team), supported by a snow ball sampling (recruiting respondents among acquaintances of the participants). A total of 711 questionnaires from 41 countries were received. Descriptive statistics were deployed to analyse trends and to identify socio-demographic differences. Inferential statistics were used to assess significant differences among the geographical regions, work areas and other socio-demographic factors related to impacts of social isolation of university staff and students.

RESULTS

The study reveals that 90% of the respondents have been affected by the shutdown and unable to perform normal work or studies at their institution for between 1 week to 2 months. While 70% of the respondents perceive negative impacts of COVID 19 on their work or studies, more than 60% of them value the additional time that they have had indoors with families and others. .

CONCLUSIONS

While the majority of the respondents agree that they suffered from the lack of social interaction and communication during the social distancing/isolation, there were significant differences in the reactions to the lockdowns between academic staff and students. There are also differences in the degree of influence of some of the problems, when compared across geographical regions. In addition to policy actions that may be deployed, further research on innovative methods of teaching and communication with students is needed in order to allow staff and students to better cope with social isolation in cases of new or recurring pandemics.

Perceived academic-related sources of stress among graduate nursing students in a Jamaican University

BACKGROUND

Graduate education is essential for the improvement of professions by facilitating advancements in career paths, personal growth and enhancing a country's economy. Graduate students frequently view graduate education as moderate to very stressful and this can have a negative impact on their lives. Stress can result in impaired coping, poor academic performance and reduction in cognitive functioning, resulting in the antithesis of academic success.

OBJECTIVE

A qualitative study was done to gain insight into the perception and sources of academic- related stress among graduate nursing students at an urban school of nursing in Jamaica.

DESIGN

A purposive sample of Master of Science in Nursing students in their penultimate semester for the academic year 2017/ 2018 were invited to participate in the study.

METHODS

Nine students participated and each was assigned a selected pseudonym. Data were collected using one- to-one semi-structured interviews and interviews were transcribed verbatim. Thematic content analysis was used to determine emerging themes and coding was done manually.

RESULTS

The themes that emerged were: (1) Workload (2) Research (3) Prioritization (4) Lack of support (5) Lack of feedback (6) Balancing school life (7) Very stressful (8) Expectations of lecturers. Participants perceived that graduate education was very stressful to overwhelming. Academic-related stress was multi-factorial and predominantly due to the rigid curriculum structure. Contributing factors included increased workload; time constraints; the research course itself; lack of support and timely response from research supervisors and delayed responses from the Ethics Committee.

CONCLUSION

It is very important for educators and curriculum developers to implement innovative strategies that are essential in providing an environment that will facilitate learning and to mitigate stress faced by graduate students.

Association of educational stress with depression, anxiety, and substance use among medical and engineering undergraduates in India

BACKGROUND

Students pursuing higher education are subject to high stress levels which could be associated with dysfunctional coping. Maladaptive coping is known to be operative in manifesting as psychopathology as depression, anxiety, suicidal ideation, and substance abuse. This study aimed to elaborate the psychological morbidity among professional undergraduates in general and medical students in particular, its evolution over the years and its psychosocial correlates.

METHODOLOGY

The study examined medical students (n = 202) and age-matched engineering students (n = 145) belonging to the first and final year for psychological stress and coping, educational stress, domestic and professional concerns, depression, anxiety, and substance abuse. Psychometric scales along with demographic questionnaire were used to assess and quantify stress and psychological morbidity.

RESULTS

Medical students had higher levels of stress (psychological and education related) and higher psychological morbidity (depression and anxiety). Stress scores correlated positively with depression and anxiety scores and negatively with substance use score. Psychological stress other than educational stress was noted to be predictors of alcohol use in the sample.

CONCLUSION

Our study elucidates that medical students face higher levels of psychological and education-related stressors and have higher levels of psychological morbidity than students from engineering colleges. Psychoactive substances are used as a form of self-medication to alleviate stress.

Clinical Anxiety among Saudi Postgraduate Pediatric Dentistry Students in Jeddah City

Objective

To determine anxiety in relation to gender, Grade Point Average (GPA), level of education and academic and clinical situations in Jeddah, Saudi Arabia. Also, to identify academic and clinical anxiety levels among postgraduate pediatric dentistry students.

Methods

A cross-sectional study at governmental training hospitals was conducted. All registered postgraduate students in pediatric dental programs during the year 2015-2016 were included in the study. A self-administered questionnaire was distributed electronically to 60 postgraduate pediatric dentistry students aged between 25 and 45 years old. The questionnaire is composed of 55 questions that investigated demographic data, academic and clinical related situations including investigations, diagnosis, treatment, and complications in treatment.

Results

The study showed a higher anxiety level in younger age dental students (76.7% compared to 23.3%) and Saudi board residents (60%). Comparing gender differences in anxiety revealed that a significant difference (P ≤ 0.05) was found and anxiety seems to be more among female dental students (2% very anxious, 64% slightly anxious, and 34% not anxious) as compared to male dental students (8% very anxious, 69% slightly anxious, and 23% not anxious).

Conclusions

There was increased awareness, detailed understanding, and handling of the patients by senior postgraduate pediatric dentistry students compared to junior students.