A longitudinal study of students' depression at one medical school

Empathy and Coping in Allied Health Sciences: Gender Patterns

This study aimed to examine the patterns of associations between empathy and coping among undergraduate men and women studying at Allied Health Sciences. This cross-sectional study is part of a larger longitudinal study conducted in an Allied Health Sciences School. Participants were 183 undergraduate students from 12 training programs (e.g., Physiotherapy, Occupational Therapy, Speech Therapy). Their mean age was 20.79 years (SD = 2.64), and they were in their first, third, and fourth years of school. The instruments were the Brief-COPE and the Interpersonal Reactivity Index (IRI). Empathy correlated with coping strategies in both genders, though showing different patterns of association. First, distinct coping strategies were associated with the same empathy dimension (perspective taking) among women (positive reframing and self-blame) and among men (active coping). Second, the same three coping strategies appeared in both genders (seeking emotional or instrumental support and resorting to religion) but associated with different empathy dimensions (cognitive empathy among women and mostly emotional empathy among men). Third, among women (but not among men), two coping strategies (positive reframing and behavioral disengagement) were each simultaneously correlated with cognitive and emotional empathy in opposite directions. Fourth, emotional empathy correlated, only among women, with several coping strategies considered to be maladaptive (behavioral disengagement, denial and substance use). Among men, only one significant coping strategy was considered to be maladaptive (behavioral disengagement) and it was negatively correlated with cognitive empathy (perspective taking). Unlike in women, relationships between the empathic dimension of fantasy and coping strategies were non-significant among men. These distinct patterns of associations emerged despite significant differences in empathy by gender (fantasy, personal distress and empathic concern) and in coping strategies (instrumental support, emotional support, religion and venting). These results support the idea that the display of empathy might be associated with gender differences in the underlying empathy dimensions and in the coping strategies used to deal with stress in the undergraduate programs of Allied Health Sciences.

Assessing the Psychological Impacts of COVID-19 in Undergraduate Medical Students

Medical education has been uniquely affected by the Novel Coronavirus Disease 2019 (COVID-19). As the pandemic's psychological impacts on medical students remain unclear, this study assessed COVID-19's impacts on undergraduate medical students' stress and anxiety. A nationwide, online survey was administered via email chains between June-August 2020 to first-fourth year medical students in the United States. Demographics, 4-point Perceived Stress Scale that measures stress, 7-point Generalized Anxiety Disorder Scale that measures anxiety, and the impacts of social, health, and academic stressors due to COVID-19 were collected. Of the 852 students who participated, 66.1% experienced mild, moderate, or severe anxiety. Mean PSS-4 score was 7.25/16. Stress was highest in second- through fourth-year students. Students with preexisting mental health conditions had significantly higher stress and anxiety scores, and higher percentage of stress attributed to COVID-19. Trust in government institutions during COVID-19 was the highest stressor in first- and second-year students. Delay/availability of standardized exams was the highest stressor for third-year students. Impact on rotations/residencies was the highest stressor for fourth-year students. Understanding how students' anxiety and stress have changed due to COVID-19 will allow educators to identify students in need and guide recommendations on the implementation of psychological interventions and support strategies.

Risk Factors of Burnout among Egyptian Medical Students: A Cross-sectional Study

Background:

Burnout is characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. It was initially investigated among employees and restricted to those who work in human services and educational institutions. However, this study aimed to evaluate the prevalence and associated risk factors of burnout among Egyptian medical students in Damietta Faculty of Medicine, Al-Azhar University.

Methods :

This cross-sectional study was conducted between December 2017 and March 2018, involved first to sixth-year medical students. The questioner consisted of four sections: 1) Sociodemographics and personal characteristics of participants such as age, gender, and academic year; 2) Burnout measurement: Burnout was measured by MBI-SS, a modified form of MBI-GS; 3) Related risk factors; 4) association between burnout and performance.

Results:

Out of 322 students, 222 students completed the questionnaire with a 67% response rate. The mean age was 21.1 ± 1.9, and 197 (88.7%) students were males. Our analysis demonstrated that the prevalence of burnout was 51.8%. In terms of subscales, 198 participants have high emotional exhaustion, 201 showed a high degree of depersonalization, and 110 participants have personal accomplishment. There was a significant difference between both groups in terms of gender (p=0.01) and marital status (p=0.005). Regression analysis demonstrated that high-risk factors related to studying burden, social burden, and future burden are associated with a higher risk of burnout with odd ratio (OR= 1.10, 95% CI (1.05-1.155), p<0.05), (OR= 1.05, 95% CI (1.01-1.09), p<0.05), and (OR= 1.15, 95% CI (1.05-1.26), p<0.05), respectively.

Conclusion:

This study found that the burnout prevalence was 52% with quite a high percentage of emotional exhaustion (EE) and depersonalization (DP), and a low level of personal accomplishment. Moreover, a significant association between gender, grade of medical school, marital status, and risk factors related to the study burden, future burden, and social burden.

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.

Assessment of Student Perspectives on Improving Wellness in Medical School: Qualitative Results from a Cross-Sectional Survey of Medical Students in Florida

PURPOSE

Helping medical students maintain wellbeing has become an important concern, as many medical students report a decline in their mental health during the course of their training. To improve students' wellbeing, some schools have implemented wellness programs into their curricula. While there is growing research about the effectiveness of these programs, little is known about what medical students themselves desire to support their wellbeing. This study aimed to assess medical student perspectives regarding the most effective ways to promote wellness during medical school.

PARTICIPANTS AND METHODS

To address this gap in the literature, a survey was administered to medical students at the nine medical schools in the state of Florida. Participants included 864 medical students, whose anonymous responses were analyzed descriptively as well as qualitatively to determine major themes.

RESULTS

Students provided novel suggestions and recommendations, including ideas for curricular additions and changes, cultural changes within schools, promoting positive behaviors and extracurricular activities, and providing resources for students.

CONCLUSION

Based on the participants' responses, it is evident that wellness is an important issue to medical students and, given the variety of suggestions, schools should strongly consider what wellness changes to implement and whether participation in them should be mandatory. The results of this study will be a resource to medical schools and educators who are considering curricular changes to address medical student wellbeing.

Depression, Suicidal Ideation and Perceived Stress in Italian Humanities Students: A Cross-Sectional Study

Mental health issues are common among university students. Nevertheless, few studies focused on Italian students. This study aimed to assess prevalence and associated factors of perceived stress (PS), depressive symptoms (DS) and suicidal ideation (SI) in an Italian sample. A cross-sectional study was conducted amongst a convenience sample of students in humanities field (2018). Questionnaires were self-administered. Outcomes were assessed through Beck Depression Inventory-II (DS, SI) and Perceived Stress Scale (PS). Multivariable regressions were performed (p-value < 0.05 significant; sample size = 203). DS and SI prevalence was 30.6% and 8.8%. PS median score was 20 (IQR = 11), 87.7% reported moderate/severe PS. DS likelihood was increased by psychiatric disorders family history and not attending first year of course and decreased by not thinking that university hinders personal activities. Chronic disease and higher stress score increased SI probability; good/excellent family cohesion reduced it. Being female, thinking that university hinders resting/relaxing, seeing a psychologist/psychiatrist were positively associated with PS; having no worries about future was negatively associated. A high prevalence of mental health issues was reported, with miscellaneous associated factors that were linked to both private and social aspects. Universities must be aware of this to provide efficient preventive measures.

Responding to Racism in the Clinical Setting: A Novel Use of Forum Theatre in Social Medicine Education

Issues of race have traditionally been addressed in medical school curricula in a didactic manner. However, medical school curricula often lack adequate opportunity for the application of learning material relating to race and culture. When confronted with acts of racism in clinical settings, students are left unprepared to respond appropriately and effectively. Forum Theatre offers a dynamic platform by which participants are empowered to actively engage with and become part of the performance. When used in an educational context, Forum Theatre can be a powerful tool for students to interact with a wide variety of social issues. This paper describes the process by which one medical school designed a workshop in the Forum Theatre style to equip students to respond to racism observed in clinical settings. Based on real student experiences, the Responding to Racism in the Clinical Setting workshop was designed to give students an opportunity to combine cultural humility, communication theory and conflict resolution skills in order to prepare for interactions in clinical stages of medical education. As a result of workshop evaluations, surveys, and written reflections, the authors propose that Forum Theatre is a novel teaching modality for incorporating issues of race and culture into medical curriculum.

An exploration of medical student attitudes towards disclosure of mental illness

Background: Medical students are reluctant to access mental health services, despite having high rates of anxiety and depression. This reluctance persists through residency and into practice. Physicians and trainees who are unwell deliver lower quality patient care, behave less professionally, communicate less effectively and are at an increased risk for burnout and suicide. Little is known about whether students would disclose a mental health diagnosis on a state board medical license application.Objectives: The objectives of this study were to determine whether University of New Mexico School of Medicine (UNM SOM) students would be willing to disclose a mental health diagnosis on a medical licensing application if prompted to do so, and, if not, to identify the reasons for their unwillingness to do so.Design: We electronically invited all UNM SOM students enrolled in the Classes of 2019, 2020, 2021, and 2022 to participate in a confidential RedCap survey about mental health diagnoses and treatment. Four e-mail invitations and reminders were sent to students over a one-month period.Results: Response rate was 50.1%. Thirty-six percent of all respondents considered themselves to have had a mental health condition prior to medical school, and 47% of all respondents perceived a decline in mental health during medical school. The majority of respondents who perceived they had a mental health diagnosis (51%) stated they would not disclose this information on a New Mexico Medical Board (NMMB) license application. Fear of stigmatization, fear of repercussions, and a belief that such disclosure was irrelevant were the top reasons for non-disclosure.Conclusion: Students who perceive themselves to have mental health diagnoses are unlikely to disclose their mental health status on state medical board licensing applications when asked to do so. Addressing barriers to disclosure of mental health diagnoses is necessary for building a healthier physician workforce.

Toward Resilience: Medical Students' Perception of Social Support

Context

There is strong evidence that social support—particularly perceived social support—functions as a protective factor for health. Few studies have investigated how medical students perceive the types of social support they experience.

Objective

To determine how osteopathic medical students perceive social support, understand the factors that influence their perceptions, and explore how group participation in a cocurricular, academic program could affect student perceptions.

Methods

In this cross-sectional study of 983 medical students at a multicampus osteopathic medical school in the Midwest, potential respondents were invited by email in March 2018 to participate in a self-reported evaluation of their perceived social support using a 40-question Interpersonal Support Evaluation List (ISEL). The demographic variables included gender, race, age, current phase in medical school, Hispanic heritage, campus assignment, and hometown population type. A total score for each type of social support and a summative score for overall perceived social support were calculated. Descriptive statistics were applied to provide a summary of the distribution of study variables. Bivariate analyses were conducted using student t test and analysis of variance (ANOVA) statistic to determine distribution of 4 social support constructs and overall social support by all the study variables; α < .05 was considered statistically significant. Linear regression analysis was performed to determine the association between all study variables and 4 social support constructs. Pairwise interactions were calculated to determine whether the association differed by any of the study variables.

Results

Self-esteem support was the lowest type of perceived social support overall in the total sample (mean [SD], 23.5[2.0]). Hispanic students reported lower overall mean perceived social support than those who did not identify as Hispanic (100 vs 104; P=.04). Older study participants had higher mean tangible support compared with their younger counterparts (26.25 vs. 25.60, P=.018; t [264]=1.18). Older study participants also had higher mean appraisal support compared with their younger counterparts (26.57 vs. 25.92, P=.06; t [266]=1.27). Female medical students reported lower levels of belonging support overall (mean [SD] 26.79, [2.10]). Students from rural hometowns reported a higher sense of belonging support than any other group. Female students from suburban and urban hometowns reported lower levels of belonging support compared with women from rural hometowns (Adj. β=−0.96, P=.01). Students who participated in the rural and urban underserved program had higher self esteem support compared with those who did not participate in the rural and urban underserved program (Adj. β=−1.30, P=.05). Students in the clinical phase of medical education reported lower levels of belonging support than students in the preclinical phase (26.14 vs. 26.69, P=.05; t[256]=1.07).

Conclusions

It is critical to understand the ways medical students experience social support and the factors that contribute to it. Longitudinal studies following medical students over time would contribute to a more complete understanding of social support in medical students as they move from preclinical to the clinical phases of medical school.

Perceived Stigma Towards Psychological Illness in Relation to Psychological Distress Among Medical Students in Riyadh, Saudi Arabia

OBJECTIVE

Due to the high prevalence of psychological distress among medical students and its related functional and cognitive implications, this study aimed to investigate the association between perceived stigma and psychological distress, estimate the prevalence of each level of distress among medical students, and determine the independent significant risk factors of outcome variables for each level of psychological distress.

METHODS

A cross-sectional study was performed that surveyed medical students at King Saud University in 2018. Using the modified and validated stigma scale for receiving psychological help along with Kessler psychological distress scale, the survey measured perceived stigma towards mental illness in relation to the level of psychological distress.

RESULTS

Among the 524 participants, 395 surveys were completed. Participants had a mean age of 21.56 years old, and 53% were female. The overall prevalence of severe psychological distress was 30.7% (N = 161). Furthermore, 25.6% of participants reported experiencing moderate distress (N = 134). Additionally, a significant association was found between females and severe psychological distress. Moreover, family income was significantly associated with severe psychological distress in the extreme lower and upper groups (5000-10,000 SR and above 20,000 SR). Participants with high levels of psychological distress were more likely than those with low levels to agree or strongly agree with 3 out of 10 items related to perceived stigma.

CONCLUSIONS

Medical students with moderate/severe psychological distress disclosed more concerns regarding stigma, particularly about perceived consequences of their mental health issues being revealed to others. Such opinions could cause physical health problems and decrease quality of life.

Depression, anxiety, and burnout among medical students and residents of a medical school in Nepal: a cross-sectional study

BACKGROUND

Medical students and residents were found to have suffered from depression, anxiety, and burnout in various studies. However, these entities have not been adequately explored in the context of Nepal. We proposed to determine the prevalence of depression, anxiety, burnout, their associated factors, and identify their predictors in a sample of medical students and residents in a Nepalese medical school.

METHODS

It was a cross-sectional study with 651 medical students and residents chosen at random between December 2018 and February 2019. The validated Nepali version of Hospital Anxiety and Depression Scale, the Copenhagen Burnout Inventory, and Medical Students' Stressor Questionnaire were used to assess depression, anxiety, burnout, and stressors respectively. We used univariate and multivariable logistic regression analyses to identify the correlation of predictor variables with depression, anxiety, and burnout.

RESULTS

The overall prevalence of burnout (48.8%; 95% CI 44.9-52.7) and anxiety (45.3%; 95% CI 41.4-49.2) was more than that of depression (31%; 95% CI 27.5-34.7). Burnout and depression were more prevalent in residents than in medical students (burnout: 64.5% vs 37.6%, P-value < 0.0001; depression: 33.7% vs 29.1%, P-value 0.21). Whereas, medical students were found more anxious than residents (46.3% versus 43.96%, P-value 0.55). Academic related stressors caused high-grade stress to participants. Multivariable model for depression significantly showed anxiety, personal burnout, and work-related burnout as risk enhancing correlates; satisfaction with academic performance as a protective correlate. Similarly, the multivariate model for anxiety significantly identified female gender, depression, personal burnout, teaching and learning related stressors, and past history of mental illness as risk enhancing correlates; being satisfied with academic performance, getting adequate sleep, and being a second-year resident as protective correlates. The logistic model for burnout significantly showed being a first-year resident, depression, anxiety, and drive and desire related stressors as positive predictors. None of the variables were identified as significant negative predictors of burnout.

CONCLUSIONS

A high prevalence of depression, anxiety, and burnout was seen among medical students and residents. Most of them were stressed with academic-related factors. A strong correlation between teaching and learning-related stressors with depression and anxiety may be a call for an efficient and more student-friendly curriculum.

Redesigning the Learning Environment to Promote Learner Well-Being and Professional Development

There is a high prevalence of burnout and depression among medical students and residents (or learners), which can negatively impact them personally, their professional development, and the patients to whom they provide care. Educators have a responsibility for the system-level factors that influence learners' well-being. In this Invited Commentary, the authors outline strategies institutions and affiliated training sites responsible for educating learners can take to pursue the recommended goal related to learners, their well-being, and the learning environment in the National Academies of Sciences, Engineering, and Medicine consensus study report, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being.

Work engagement in medical students: An exploratory analysis of the relationship between engagement, burnout, perceived stress, lifestyle factors, and medical student attitudes

There is a need to expand the current focus of burnout in medical trainees so that we can understand not only trainee distress but also trainee well-being. Work engagement as measured by the Utrecht Work Engagement Scale-15 (UWES-15) is a positive construct that is conceptually related to burnout and is a component of the Job Demands-Resources Model (JD-R). We sought to explore the relationship of work engagement to burnout, perceived stress, lifestyle factors, and medical student attitudes to testing whether work engagement could serve as a positive construct to study medical student well-being. We surveyed 287 1st and 2nd-year medical students at a large academic medical center in the United States. Our survey consisted of demographic measures, UWES-15, Burnout Measure short version, Perceived Stress Scale-4, lifestyle factors, and medical student attitudes. Statistical analysis revealed work engagement is negatively correlated with burnout and perceived stress. Work engagement and its subscales are correlated to exercise, sleep, drugs and alcohol use, maintaining relationships, and financial stress. Work engagement is negatively correlated with thoughts of dropping out and questioning the decision to enter medical school. Work engagement can be a useful measure to assess medical student well-being and identify areas for intervention.

Pattern and Correlates of Depression among Medical Students: An 18.Month Follow-Up Study

BACKGROUND

Medical students are subjected to various challenges, which are possibly etiological in the onset and persistence of depression. There is inadequate research on the longitudinal pattern and correlates of the emotional health of medical students in India. We aim to delineate the longitudinal pattern of depression among medical students and the factors predictive of depression.

METHODS

An 18-month follow-up design with 350 students (2012 intake) from two medical colleges in Kerala, India, was employed. A semistructured questionnaire and the Patient Health Questionnaire 9 were administered 2, 8, and 18 months into the course.

RESULTS

Depression was present in 42.80%, 36.20%, and 42.50% of the students at the three assessments. Variables significantly associated with depression on univariate analysis were the course not being of the student's choice at the first assessment; having an unemployed parent (mother) at the second assessment; alcohol use and male gender at the third assessment. On multivariate analysis, male gender (OR = 1.95[1.11-3.41]) and the presence of depression at 2 months (OR = 2.30[1.31-4.05]) and 8 months (OR = 2.48[1.39-4.44]) were predictive of depression at 18 months.

CONCLUSIONS

The high rates of depression and the pattern of high rates early in the course among the medical students contrasts with that reported from other countries. Early depression and male gender were predictive of depression later in the course. The implications of this are to be taken into consideration when undergraduate intervention programs are planned.

Medicine and Horsemanship: The Effects of Equine-assisted Activities and Therapies on Stress and Depression in Medical Students

This study examined the use of an equine-assisted brief course module on stress and depression among medical students (n = 28), a demographic known to experience high pressure. Evidence supports that animal-assisted therapies can lead to the improvement of health and quality of life, particularly in terms of cognitive, psychological, and physical benefits. This study used the seven-session Kane Medicine and Horsemanship program; students completed pre- and post-measures one week before and after the course. Participation in the course significantly reduced perceived stress (p: 0.001), depression (p: <0.001), stress severity (p: 0.014), and stress frequency (p: 0.001) among medical students. This approach should be further investigated as an option for improving well-being among medical students.

Pre-clinical Stress Management Workshops Increase Medical Students' Knowledge and Self-awareness of Coping with Stress

OBJECTIVES

To investigate the effects of a stress management workshop on medical students' knowledge of stress and potential coping strategies.

METHODS

A panel discussion with small group breakouts on stress in clinical medicine, learning challenges, competition with colleagues, handling stressful events, and recognizing burnout symptoms was conducted with medical students entering clerkships. A longitudinal survey design was utilized to measure pre-, post-, and long-term (3-month) changes in knowledge (impact of stress on personal health, learning, and patient care), confidence, perceived skills, and attitude (towards utilizing adaptive coping strategies) among participating students (N = 135). Paired t test and multivariate analyses were performed to assess the differences between survey responses on a 5-point Likert scale.

RESULTS

Survey response rates were pre-90.4%, post-77%, and long-term post-71.1%. Compared to pre-workshop, students reported significant improvement in all four domains immediately post-workshop: knowledge (4.4 vs. 4.7, p < 0.05), confidence (3.6 vs. 3.9, p < 0.05), perceived skills (3.3 vs. 3.7, p < 0.05), and attitude (2.6 vs. 2.8, p < 0.05). Compared to immediate post-workshop, students' scores slightly decreased at 3 months but were overall significantly higher than the pre-workshop scores.

CONCLUSIONS

A stress management workshop can improve medical students' knowledge of the impact of stress as well as the use of adaptive stress coping strategies.

Incidence and Risk Factors of Depressive Symptoms in Chinese College Students

PURPOSE

Previous surveys have shown an increase in the prevalence of depression among college students. However, knowledge on the incidence and risk factors of depressive symptoms in Chinese college students is limited. The aim of the present study was to determine the two-year cumulative incidence of depressive symptoms in Chinese college freshmen and identified related psychosocial risk factors.

PATIENTS AND METHODS

A prospective survey was used to examine the cumulative incidence and risk factors of depressive symptoms (as assessed by the Centre for Epidemiological Study-Depression Scale, CES-D) among undergraduate freshmen. Five times (baseline, 5, 12, 17, and 24 months later) of self-reported data were collected from the students.

RESULTS

Of the initial 758 non-depressed respondents at baseline, 235 developed depressive symptoms (CES-D ≥ 16) during the follow-up period. The two-year cumulative incidence was estimated to be 42% and not significantly different between males and females (χ2=3.138, df =1, p=0.077). Logistic regression model showed that female gender (OR=0.43, 95% CI (0.28-0.64)), high level of self-esteem (OR=0.67, 95% CI (0.52-0.86)), and moderate exercise (OR=0.71, 95% CI (0.55-0.92)) reduced the onset of depressive symptoms; while high levels of baseline anxiety (OR=1.48, 95% CI (1.12-1.94)), Eysenck Personality Questionnaire-Neuroticism (OR=1.40, 95% CI (1.09-1.79)), concern over mistakes (OR=1.35,95% CI (1.07-1.71)), daytime sleepiness (OR=1.28, 95% CI (1.02-1.60)), mild exercise (OR=1.25, 95% CI (1.01-1.55)) increased the new onset of depressive symptoms.

CONCLUSION

The high two-year cumulative incidence indicates that depressive symptoms are an important mental problem in Chinese college students. The present findings on the risk factors of depressive symptoms in Chinese college students may be useful for the design of student health screening and intervention programs.

Impact of Student Perceptions of the Educational Program on Burnout in Medical School

INTRODUCTION

Burnout is considered to be at the opposite end of the continuum from engagement. People who experience burnout first go through various intermediate patterns that lead to burnout, which in medical students is associated with reduced empathy, intention to leave school, and suicidal ideation. Thus, understanding how to mitigate burnout is of primary importance. In this study, we investigate if students' positive perceptions of the educational program's alignment with adult education principles decreased symptoms suggestive of typical patterns of intermediate burnout.

METHODS

We conducted a cross-sectional survey study of all currently enrolled Duke-NUS Medical School students in Singapore (n = 238). An electronic questionnaire contained demographic questions and additional measures for factors known to be associated with burnout, including depression, anxiety, social support, and workload. In addition, we measured students' perceptions of how well the educational program aligned with adult learning principles by using a modified version of the Andragogical Practices Inventory (API) to suit medical education. An intermediate pattern of burnout was measured using the Maslach Burnout Inventory (MBI). Using logistic regression, we then assessed the unique association between the presence of an intermediate pattern of burnout with students' perceptions of the educational program's alignment with adult learning principles.

RESULTS

The survey response rate was 52%. Overall, 76% (95% CI 67-84%) displayed symptoms suggestive of an intermediate pattern of burnout. Perceptions of the educational program's alignment with adult learning principles were found to be inversely related to the pattern of burnout after controlling for depression, anxiety, and subjective workload.

DISCUSSION AND CONCLUSION

Though adult learning theory is the subject of rich debate, the results of this study suggest that promoting educational activities that are aligned with adult learning principles may help to ultimately reduce the risk of burnout in medical school students.

Comparing levels of psychological stress and its inducing factors among medical students

Objective

This study aimed to determine and compare degrees of psychological stress and inducing factors thereof among first to fifth year medical students (MS).

Methods

This cross-sectional study was conducted on 468 female MS. We used the Kessler 10 Psychological Distress Inventory consisting of questions on a range of stress-inducing factors.

Results

A total of 67.9% students reported physiological stress. The percentage of MS without stress and with mild, moderate, and severe stress was 32%, 24%, 22%, and 21.8%, respectively. The highest prevalence of physiological stress was found among first-year students (82.6%). Stress scores significantly decreased with advancement in the year of study, except for the final year (p = 0.001). We found that the first year of medical studies (0.022), academic stress (0.001), the presence of a physical problem (0.001), and being married (0.002) were independent risk factors for high perceived stress (HPS), as shown by K10 scores >24. A total of 11.1% students consulted a psychiatrist, whereas 3.4% admitted taking some medication for stress.

Conclusion

This study infers that the first year of medical studies, academic stress, the presence of a physical problem, and being married are independent risk factors for HPS. We recommend mandatory stress screening for MS in all medical colleges. Ideally, the screening should be repeated every six months and students identified as having HPS should be provided with counselling, mental health services, and a proper follow-up.

Medical Student Psychological Distress and Mental Illness Relative to the General Population: A Canadian Cross-Sectional Survey

PURPOSE

To provide national data on Canadian medical students' mental health and show how their mental health compares with that of similarly aged postsecondary graduates from the general population.

METHOD

In 2015-2016, the authors conducted a survey of medical students in all years of study at all 17 Canadian medical schools. The surveys included validated items and instruments to assess for psychological distress, suicidal ideation, and diagnosed mood and anxiety disorders. Comparative analyses were performed between medical students and similarly aged postsecondary graduates using data from the Canadian Community Health Survey-Mental Health 2012.

RESULTS

The participation rate across all medical students was 40.2% (4,613/11,469). Relative to the general population of postsecondary graduates aged 20-34, medical students aged 20-34 had significantly higher rates of diagnosed mood disorders, diagnosed anxiety disorders, suicidal ideation, and psychological distress. Among medical students, being female was associated with having a mood or anxiety disorder, lifetime suicidal ideation, moderate or severe psychological distress, and higher mean Kessler Psychological Distress Scale 6-item summative scores. Being in clinical training was associated with having suicidal ideation, moderate or severe psychological distress, and mood and anxiety disorders.

CONCLUSIONS

Compared with postsecondary graduates from the general population, medical student respondents had significantly higher rates of psychological distress, suicidal ideation, and mood and anxiety disorders. Further research is needed to understand the factors that are contributing to these higher rates.

Mental health and wellbeing of medical students in Nigeria: a systematic review

In addition to the stresses common to medical school training, medical students in Nigeria face additional peculiar contemporary social problems due to income inequality, poverty, insecurity and political instability. These have a direct impact on their mental health and wellbeing. The aim of this study was to systematically review articles reporting on the epidemiology of psychiatric disorders among medical students in Nigeria. Studies were identified using MEDLINE, HINARI, African Journal Online (AJOL) and Google Scholar databases using search terms encompassing psychiatric morbidity amongst medical students. No date restrictions were applied to the search. The pooled prevalence estimate was calculated for each disorder. Psychological distress was present in 25.2% of the students, perceived stress in 60.5%, depression in 33.5% and anxiety in 28.8%. The current use of at least one psychoactive substance was present in up to 44.2%, while 35.5% of all the respondents had experienced one or more forms of abuse during their training as medical students. The prevalence of psychiatric disorders among medical students in Nigeria is high. Positive coping mechanisms such as religiosity, positive reframing and resilience which were identified in this review should be optimized to reduce the burden.

The relationship between perfectionism and symptoms of depression in medical school applicants

BACKGROUND

The association between perfectionism and depression in the medical profession can ultimately influence physicians' performance negatively. In medical students, especially maladaptive perfectionism is connected with distress and lower academic performance. The expression of perfectionism and symptoms of depression at the time of medical school application is not known. Therefore, we explored perfectionism and symptoms of depression in participants of multiple mini-interviews for medical school admission and investigated possible differences between applicants who were eventually admitted or rejected.

METHODS

After the multiple mini-interviews admission procedure at Hamburg Medical School in August 2018, 146 applicants filled out a questionnaire including sociodemographic data and the following validated instruments: Multidimensional Perfectionism Scale by Hewitt and Flett (MPS-H), Multidimensional Perfectionism Scale by Frost (MPS-F), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and a 10-item version of the Big Five Inventory (BFI-10). The two groups of admitted and rejected applicants were compared and the correlation between symptoms of depression and perfectionism further explored.

RESULTS

The admitted applicants were significantly more extrovert and had lower depression scores compared to the rejected applicants. In both groups, the composite scales of Adaptive Perfectionism (r = .21, p = .011) and Maladaptive Perfectionism (r = .43, p < .001) as well as their components correlated significantly with the PHQ-9 results. Maladaptive Perfectionism accounted for about 18% of variance in the PHQ-9 score.

CONCLUSIONS

Rejected medical school applicants who participated in a multiple mini-interviews admission procedure showed higher levels of depression symptoms than admitted applicants. The degree of depressive symptoms can be partly explained by Maladaptive Perfectionism scores. Since coping in medical school and in postgraduate medical education require robust mental health, perfectionism questionnaires could be an additional tool in medical school selection processes.

Predicting future performance in medical students. A longitudinal study examining the effects of resilience on low and higher performing students

Introduction: Medical students have high rates of distress and burnout, exacerbated by a high academic workload. Resilience is stated to mitigate such stress, and even allow positive adaptations in the face of such challenges. Despite this, no research has examined the relationship of resilience on the academic performance of medical students. Methods: The goal of our study was to investigate the association between resilience on academic performance. We surveyed all year 2, 3, and 4 medical students (n = 160), and combined this with data on past and future course performance. We conducted an analysis of the internal consistency and validity of the RS-14, suggesting two factors: which we represent as self-assuredness and drive. We then analyzed future course performance using multiple regression. Results: Models utilizing the combined RS-14 score suggested past-performance as the only significant predictor of future course performance. Considering self-assuredness and drive as separate predictors demonstrated self-assuredness to be a predictor of improved performance in lower-than-average students, whilst drive was a predictor of improvement in higher-than-average students. Conclusions: We suggest that the conceptualization of resilience needs greater nuance, and consideration in tandem with broader psychosocial concepts, as it may exert different effects for different students.

Predicting stress and test anxiety among 1st-year chiropractic students

OBJECTIVE

We evaluated perceived stress in 1st-year chiropractic students and the relationship between perceived stress and test anxiety. Moreover, we sought student-identified stressors that complicate chiropractic education.

METHODS

We tested 3 hypotheses in a longitudinal descriptive study: (1) student-perceived stress would increase over 6 months of chiropractic training, (2) depression level and grade-point average (GPA) at matriculation would predict student-perceived stress 6 months into the program, and (3) perceived stress would correlate with cognitive and emotional test anxiety levels. Assessments used were prematriculation GPA, perceived chiropractic college stress (PCCS), the Center for Epidemiologic Studies Depression Scale, and the Test Anxiety Inventory.

RESULTS

Four hundred and seven students participated during 2014 and 2015. PCCS increased 18% after 6 months (t₍₄₀₆₎ = 6.32, p < .001, d = .33). Prematriculation GPA was not a significant predictor of PCCS at 6 months, p = .082. By contrast, the Center for Epidemiologic Studies Depression Scale at the beginning of the chiropractic training program was a significant predictor p < .001, multiple R² = 7.1%. PCCS correlated with test anxiety worry and emotionality (r = .37, p < .001 and r = .35, p < .001, respectively). The top 4 stressors identified by students were (by priority) finances, time for a life outside school, personal competence/endurance, and curriculum/environment.

CONCLUSION

Our findings are consistent with perceived stress increases during medical school. Surprisingly, prematriculation GPA, a widely used academic performance predictor, was a poor predictor of PCCS, while depression level at matriculation was a moderate predictor. PCCS correlated with test anxiety worry and emotionality, known academic performance impediments.

Investigating the Relationship Between Resilience, Stress-Coping Strategies, and Learning Approaches to Predict Academic Performance in Undergraduate Medical Students: Protocol for a Proof-of-Concept Study

Background

The evolution of an undergraduate medical student into an adept physician is perpetual, demanding, and stressful. Several studies have indicated medical students have a higher predominance of mental health problems than other student groups of the same age, where medical education acts as a stressor and may lead to unfavorable consequences such as depression, burnout, somatic complaints, decrease in empathy, dismal thoughts about quitting medical school, self harm and suicidal ideation, and poor academic performance. It is imperative to determine the association between important psychoeducational variables and academic performance in the context of medical education to comprehend the response to academic stress.

Objective

The aim of this proof-of-concept study is to determine the relationship between resilience, learning approaches, and stress-coping strategies and how they can collectively predict achievement in undergraduate medical students. The following research questions will be addressed: What is the correlation between the psychoeducational variables resilience, learning approaches, and stress-coping strategies? Can academic performance of undergraduate medical students be predicted through the construction of linear relationships between defined variables employing the principles of empirical modeling?

Methods

Study population will consist of 234 students registered for the MBBS (Bachelor of Medicine, Bachelor of Surgery) at Mohammed Bin Rashid University of Medicine and Health Sciences distributed over 4 cohorts. Newly registered MBBS students will be excluded from the study. Various psychoeducational variables will be assessed using prevalidated questionnaires. For learning approaches assessment, the Approaches and Study Skills Inventory for Students questionnaire will be employed. Resilience and stress-coping strategies will be evaluated using the Wagnild-Young resilience scale and a coping strategies scale derived from Holahan and Moos’s Coping Strategies Scale, respectively. Independent variables (resilience, stress-coping strategies, and learning approaches) will be calculated. Scores will be tested for normality by using the Shapiro-Wilk test. An interitem correlational matrix of the dependent and independent variables to test pairwise correlation will be formed using Pearson bivariate correlation coefficients. Regression models will be used to answer our questions with type II analyses of variance in tests involving multiple predictors. Regression analyses will be checked for homogeneity of variance (Levine test) and normality of residuals and multicollinearity (variance inflation factor). Statistical significance will be set at 5% (alpha=.05). Effect sizes will be estimated with 95% CIs.

Results

Psychoeducational instruments in the form of validated questionnaire have been identified in relation to the objectives. These questionnaires have been formatted for integration into Google forms such that they can be electronically distributed to the consenting participants. We submitted the proposal to MBRU institutional review board (IRB) for which exemption has been awarded (application ID: MBRU-IRB-2019-013). There is no funding in place for this study and no anticipated start date. Total duration of the proposed research is 12 months.

Conclusions

Psychoeducational instruments used in this study will correlate resilience, stress-coping strategies, and learning approaches to academic performance of undergradudate medical students. To the best of our knowledge, no study exploring the multidimensional association of key psychoeducational variables and academic performance in undergraduate medical students has been pursued. Investigated variables, resilience, learning approaches, and stress-coping strategies, are individual traits, however; students’ learning history before they joined MBRU is unknown, so our research will not be able to address this specific aspect.

International Registered Report Identifier (IRRID)

PRR1-10.2196/14677

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.

Medicine's Shame Problem

BACKGROUND

Physician mental health is an increasingly discussed topic. Despite the progress made regarding the discussion of physician mental health, these issues remain concerning. In particular, the discussion as to why these issues are so problematic remains limited. Contributors can include bullying, the "hidden curriculum" of medicine, how the medical culture handles errors, and importantly, shame.

OBJECTIVE

This narrative review evaluates the literature on bullying and abuse in medicine, how abuse can exacerbate shame, how the handling of medical errors can exacerbate shame, how shame can negatively affect mental health, and how the medical community and leaders can mitigate these issues.

DISCUSSION

Physician mental health remains an important issue. Job-related stressors, bullying, medicine's hidden curriculum, medical error, traumatic patient encounters, and perfectionism can contribute to physician depression and burnout. Shame may underlie these factors. Shame is a universal emotion that leads to poor self-esteem, depression, eating disorders, abuse, and addiction. However, shame can be addressed and overcome, especially via acknowledgment, vulnerability, and empathy. The medical community can provide some of these techniques by encouraging environments of kindness and respect, giving constructive rather than destructive feedback, providing empathy and support after a medical error, and encouraging mutual learning environments where questions are asked with respect in order to enhance learning. This is opposed to hierarchies and "pimping," where questions are asked with intimidation and disrespect.

CONCLUSIONS

Shame is likely a contributor to physician mental health issues. For shame resilience to occur, it must not be kept secret and mutual support should be provided. By addressing the possible causes behind physician mental health concerns, including shame, more solutions can be proposed.

Changes in Undergraduate Students’ Psychological Well-Being as They Experience University Life

The onset of most lifetime mental disorders occurs during adolescence, and the years in college, as the final stage of adolescence in a broad sense, deserve attention in this respect. The psychological well-being of undergraduate students can influence not only their academic and professional success, but also the development of society as a whole. Although previous studies suggested psychiatric disorders are common in the adult population, there was little consistent information available about undergraduate students’ mental health problems. This research aimed to describe the changes in depression, anxiety, and stress of Chinese full-time undergraduate students as they experienced university life using the Depression Anxiety Stress Scales-21 (DASS-21). The main conclusions of our study were as follows: (1) on average, students’ severity scores of depression during the four academic years varied between 7.22 and 7.79, while stress scores ranged from 9.53 to 11.68. However, the anxiety scores of college students in the first three years turned out to be 7.40, 7.24 and 7.10, respectively, slightly overtaking the normal threshold of 7. These results indicated that Chinese college students, in general, were mentally healthy with regard to depression and stress, but their average anxiety levels were beyond normal in the first three years. (2) As for the proportions of students with different degrees of severity, approximately 38% to 43% of college students were above the normal level of anxiety, about 35% above the normal level of depression, and around 20% to 30% above the normal level of stress. (3) There were significant differences in the psychological health states of students of different years, especially among the sophomores, juniors, and seniors; the highest score of depression, anxiety, and stress all appeared in the first or second year on average, but some improvements were achieved in the third and last years. The findings suggested that colleges and universities need to pay special attention to psychologically unhealthy students, and with concerted efforts by the government, formulate mental health policies in the prevention, detection, and treatment of students’ psychiatric disorders, rather than just focusing on their average levels of mental health.

Changes in Undergraduate Students' Psychological Well-Being as They Experience University Life

The onset of most lifetime mental disorders occurs during adolescence, and the years in college, as the final stage of adolescence in a broad sense, deserve attention in this respect. The psychological well-being of undergraduate students can influence not only their academic and professional success, but also the development of society as a whole. Although previous studies suggested psychiatric disorders are common in the adult population, there was little consistent information available about undergraduate students' mental health problems. This research aimed to describe the changes in depression, anxiety, and stress of Chinese full-time undergraduate students as they experienced university life using the Depression Anxiety Stress Scales-21 (DASS-21). The main conclusions of our study were as follows: (1) on average, students' severity scores of depression during the four academic years varied between 7.22 and 7.79, while stress scores ranged from 9.53 to 11.68. However, the anxiety scores of college students in the first three years turned out to be 7.40, 7.24 and 7.10, respectively, slightly overtaking the normal threshold of 7. These results indicated that Chinese college students, in general, were mentally healthy with regard to depression and stress, but their average anxiety levels were beyond normal in the first three years. (2) As for the proportions of students with different degrees of severity, approximately 38% to 43% of college students were above the normal level of anxiety, about 35% above the normal level of depression, and around 20% to 30% above the normal level of stress. (3) There were significant differences in the psychological health states of students of different years, especially among the sophomores, juniors, and seniors; the highest score of depression, anxiety, and stress all appeared in the first or second year on average, but some improvements were achieved in the third and last years. The findings suggested that colleges and universities need to pay special attention to psychologically unhealthy students, and with concerted efforts by the government, formulate mental health policies in the prevention, detection, and treatment of students' psychiatric disorders, rather than just focusing on their average levels of mental health.

Changes in Undergraduate Students’ Psychological Well-Being as They Experience University Life

The onset of most lifetime mental disorders occurs during adolescence, and the years in college, as the final stage of adolescence in a broad sense, deserve attention in this respect. The psychological well-being of undergraduate students can influence not only their academic and professional success, but also the development of society as a whole. Although previous studies suggested psychiatric disorders are common in the adult population, there was little consistent information available about undergraduate students’ mental health problems. This research aimed to describe the changes in depression, anxiety, and stress of Chinese full-time undergraduate students as they experienced university life using the Depression Anxiety Stress Scales-21 (DASS-21). The main conclusions of our study were as follows: (1) on average, students’ severity scores of depression during the four academic years varied between 7.22 and 7.79, while stress scores ranged from 9.53 to 11.68. However, the anxiety scores of college students in the first three years turned out to be 7.40, 7.24 and 7.10, respectively, slightly overtaking the normal threshold of 7. These results indicated that Chinese college students, in general, were mentally healthy with regard to depression and stress, but their average anxiety levels were beyond normal in the first three years. (2) As for the proportions of students with different degrees of severity, approximately 38% to 43% of college students were above the normal level of anxiety, about 35% above the normal level of depression, and around 20% to 30% above the normal level of stress. (3) There were significant differences in the psychological health states of students of different years, especially among the sophomores, juniors, and seniors; the highest score of depression, anxiety, and stress all appeared in the first or second year on average, but some improvements were achieved in the third and last years. The findings suggested that colleges and universities need to pay special attention to psychologically unhealthy students, and with concerted efforts by the government, formulate mental health policies in the prevention, detection, and treatment of students’ psychiatric disorders, rather than just focusing on their average levels of mental health.

Stress and the brain: Perceived stress mediates the impact of the superior frontal gyrus spontaneous activity on depressive symptoms in late adolescence

Identifying factors for the prediction of depression is a long-standing research topic in psychiatry and psychology. Perceived stress, which reflects the tendency to appraise one's life situations as stressful and overwhelming, has emerged as a stable predictor for depressive symptoms. However, the neurobiological bases of perceived stress and how perceived stress influences depressive symptoms in the healthy brain remain largely unknown. Here, we investigated these issues in 217 healthy adolescents by estimating the fractional amplitude of low-frequency fluctuations (fALFFs) via resting-state functional magnetic resonance imaging. A whole-brain correlation analysis showed that higher levels of perceived stress were associated with greater fALFF in the left superior frontal gyrus (SFG), which is a core brain region for cognitive control and emotion regulation-related processes. Mediation analysis further indicated that perceived stress mediated the link between the fALFF in the left SFG and depressive symptoms. Importantly, our results remained significant even when excluding the influences of head motion, anxiety, SFG gray matter structure, and school environment. Altogether, our findings suggested that the fALFF in the left SFG is a neurofunctional marker of perceived stress in adolescents and revealed a potential indirect effect of perceived stress on the association between the SFG spontaneous activity and depressive symptoms.

Learning in a High-Stress Clinical Environment: Stressors Associated with Medical Students' Clerkship Training on Labor and Delivery

Phenomenon: Obstetrics and gynecology can be a high-stress clinical environment for medical students due to the specialty's fast-paced and unpredictable nature. Little is known about learning stressors for medical students on the obstetrics and gynecology clerkship to inform stress-reducing interventions and improve learning experience. This study investigated (a) which aspects of the learning environment are most stressful for obstetrics and gynecology clerkship students, (b) how perceived learning stressors in this environment differ for medical students and teachers (residents, fellows, and faculty), and (c) what interventions students propose to address these stressors. Approach: From May 2015 to April 2016, we conducted semistructured individual interviews with 3rd-year medical students from obstetrics and gynecology clerkship cohorts (n = 52) as well as clerkship teachers (n = 10) at an academic medical center. Two investigators used a qualitative Framework Method approach to analyze the interview data and agree upon final themes. Findings: We identified labor and delivery as the most stressful learning environment and four labor and delivery-related themes of students' learning stressors: context (pace, logistics, nature of childbirth, and nonroutine schedule), learning tasks (student role and assignments and the amount of new knowledge and skills), communication (terminology used in conversation and interacting with the labor and delivery team), and clinical scenario (crisis, emergency, and patient refusal of student involvement). Whereas students identified context as causing most of the stress, teachers concentrated on stressors related to learning tasks. Insights: Learning stressors associated with students' educational experience in the clinical context of labor and delivery are challenging for medical students. In addition to the specific content of these challenges, the recognition that teachers' assumptions about sources of stressors are different from those of students is an important finding and has implications for changing the learning environment. Clerkship programs are encouraged to provide practical guidelines and embed an introduction of the clinical learning environment into the Obstetrics and Gynecology clerkship orientation curriculum.

Depression Among First- and Fifth-Year Medical Students in Riyadh, Saudi Arabia

BACKGROUND

Depression, which is characterized by persistent sadness, is a highly prevalent and serious medical disease that affects more than 300 million individuals worldwide. It is hypothesized that the onset of depressive symptoms in medical students occurs due to prolonged exposure to the stressful environment of medical colleges. Hence, we aimed to determine the presence of depressive symptoms and compare the level of depression between the first-year and fifth-year medical students in Riyadh city, Saudi Arabia.

MATERIALS AND METHODS

This cross-sectional study was performed with convenient sampling from 2 medical colleges in Riyadh in the Kingdom of Saudi Arabia from October to November 2017. The English version of Beck's Depression Inventory questionnaire was used in this study. Statistical analysis was administered using SPSS via chi-square test, and P-value less than 0.05 was considered statistically significant.

RESULTS

The questionnaire was answered by 241 participants. The age variable shows a bimodal distribution. The mean age of first-year and fifth-year students was 19±0.8 years and 23±2.1 years, respectively. Fifth-year students comprised 53.5% of the total sample, and male students accounted for 63.1% of the total sample. After analysis, the results show that male students scored higher than female students on the lower side of the scale in both years. Most of the first-year female students scored a higher level of depression compared with male students (P=0.001), whereas no difference between males and females (P=0.04) was found in the fifth-year students' data.

CONCLUSION

Our study shows a new pattern of reported depressive symptoms among first-and fifth-year medical students. In addition, the study suggests that depression is more common in female medical students as compared with their male counterparts. For future studies, we recommend using randomized sampling in a cohort study including all levels of medical students to further investigate and confirm the findings.

A Clinical Care Monitoring and Data Collection Tool (H3 Tracker) to Assess Uptake and Engagement in Mental Health Care Services in a Community-Based Pediatric Integrated Care Model: Longitudinal Cohort Study

BACKGROUND

National recommendations for pediatric integrated care models include improved capacity for care coordination and communication across primary care and specialty mental health providers using technology, yet few practical, short-term solutions are available for low-resource, community-based pediatric integrated care clinics.

OBJECTIVE

The goal of the paper is to describe the development and features of a Web-based tool designed for program evaluation and clinician monitoring of embedded pediatric mental health care using a community-partnered approach. In addition, a longitudinal study design was used to assess the implementation of the tool in program evaluation, including clinical monitoring and data collection.

METHODS

Biweekly meetings of the partnered evaluation team (clinic, academic, and funding partners) were convened over the course of 12 months to specify tool features using a participatory framework, followed by usability testing and further refinement during implementation.

RESULTS

A data collection tool was developed to collect clinic population characteristics as well as collect and display patient mental health outcomes and clinical care services from 277 eligible caregiver/child participants. Despite outreach, there was little uptake of the tool by either the behavioral health team or primary care provider.

CONCLUSIONS

Development of the H3 Tracker (Healthy Minds, Healthy Children, Healthy Chicago Tracker) in two community-based pediatric clinics with embedded mental health teams serving predominantly minority children is feasible and promising for on-site program evaluation data collection. Future research is needed to understand ways to improve clinic integration and examine whether promotion of primary care/mental health communication drives sustained use.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02699814; https://clinicaltrials.gov/ct2/show/NCT02699814 (Archived by WebCite at http://www.webcitation.org/772pV5rWW).

Effect of academic stressors on eating habits among medical students in Riyadh, Saudi Arabia

Context:

Stress can be defined as an integral response of the organism to pressures from the internal or external environment with the aim to maintain homeostasis. Usually, it has a negative impact on human health. Medical students can feel stress during their preclinical studies due to overload of work such as assignments, lectures, and seminars. As a result, their appetite can be affected by skipping meals eating fast food.

Aims:

The aim of this study was to assess the pattern of eating habits and to define its association with stress among medical students.

Settings and Design:

This cross-sectional study was conducted among the medical students of Al-Imam Muhammed Ibn Saud Islamic University.

Subjects and Methods:

The sample consist of 105 Arabian males (100%) with 21-year old being the average. We use questionnaires divided into three sections.

Statistical Analysis Used:

SPSS.

Results:

We have confirmed three hypotheses: freshman would have Higher Stress Levels than sophomores and junior, the spread of fast food restaurants increases the chance for students to eat Unhealthy Foods, and the students Who Have High Stress Levels Would Eat More Unhealthy Foods Than Students Who Have Low Stress Levels.

Conclusions:

Our findings have revealed the importance to develop a specific intervention program with the aim to decrease the stress in medical students. We suggest also the development of accurate university programs with resources well programmed and well established, development of the educational program with the aim to promote healthy eating habits in medical students, the longitudinal courses should be converted to Blocks to decrease the Academic stress on students.

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.

A Prognostic Index to Identify the Risk of Developing Depression Symptoms Among U.S. Medical Students Derived From a National, Four-Year Longitudinal Study

PURPOSE

To determine baseline individual and school-related factors associated with increased risk of developing depression symptoms by year four (Y4) of medical school, and to develop a prognostic index that stratifies risk of developing depression symptoms (Depression-PI) among medical students.

METHOD

The authors analyzed data from 3,743 students (79% of 4,732) attending 49 U.S. medical schools who completed baseline (2010) and Y4 (2014) surveys. Surveys included validated scales measuring depression, stress, coping, and social support. The authors collected demographics and school characteristics and conducted multivariate analysis to identify baseline factors independently associated with Y4 depression symptoms. They used these factors to create a prognostic index for developing depression. They randomly divided the data into discovery (n = 2,455) and replication (n = 1,288) datasets and calculated c statistics (c).

RESULTS

The authors identified eight independent prognostic factors for experiencing depression symptoms during training within the discovery dataset: age; race; ethnicity; tuition; and baseline depression symptoms, stress, coping behaviors, and social support. The Depression-PI stratified four risk groups. Compared with the low risk group, those in the intermediate, high, and very high risk groups had an odds ratio of developing depression of, respectively, 1.75, 3.98, and 9.19 (c = 0.71). The replication dataset confirmed the risk groups.

CONCLUSIONS

Demographics; tuition; and baseline depression symptoms, stress, coping behaviors, and social support are independently associated with risk of developing depression during training among U.S. medical students. By stratifying students into four risk groups, the Depression-PI may allow for a tiered primary prevention approach.

Veterinary Student Stress, the Benefit of Canine Pets, and Potential Institutional Support of Dog Ownership

The stress of veterinary school and the high prevalence of psychological distress among veterinary students have been well documented. Pet ownership is known to improve overall health and reduce stress among the public. Yet, for veterinary students, owning a pet (especially a dog) can offer both rewards and challenges. The academic schedule for veterinary students often comprises long hours that can make caring for a dog challenging. This study explores the area of veterinary students' dog care options and perspectives by examining two aspects of this issue: (a) currently available options, as reported by academic administrators, and (b) perceived need for these options, as reported by veterinary students. A survey of associate deans for academic affairs (n = 30) found that routine on-site kenneling options for student-owned dogs are available at eight (26.6%) veterinary schools. Simultaneously, results of a student survey (n = 768) revealed a great desire for on-campus services. Among students who did not have access to on-campus kenneling facilities, 71.5% (453 of 634) felt that creating these options would be important or very important. Across all students surveyed, 76% (581 of 764) felt it would be important to have on-site dog housing/care available. Students experience considerable stress over having to find accommodations or care for their dogs while engaged in academic activities. Thus, providing on-site boarding and care options for student-owned dogs can play an important role in both recruiting prospective veterinary students and enhancing the well-being of those currently in the program.

In their own words: stressors facing medical students in the millennial generation

BACKGROUND

Medical student exposure to stressors is associated with depression, burnout, somatic distress, decreases in empathy, serious thoughts about dropping out of medical school, suicidal ideation, and poor academic performance. Despite this, there have been no recent, multicenter, qualitative studies assessing medical students' perceptions of their greatest stressor(s).

OBJECTIVE

The goal of this study was to identify the most significant stressors noted by medical students themselves, in order to inform the development of programs and policies to reduce medical student distress.

DESIGN

Medical students from the nine schools in the state of Florida were invited to complete an anonymous online questionnaire assessing wellness and distress. Students were notified that all responses were voluntary and that individual responses would not be linked to themselves or their program. This paper focuses on students' responses to fixed-response items regarding their experience of stress and open-ended responses to the following question: 'What do you consider to be the greatest stressor(s) facing medical students?' Qualitative data were analyzed using the Grounded Theory method of data analysis.

RESULTS

Results confirmed the impact of several stressors highlighted in previous studies (e.g., excessive workload, difficulties with studying and time management, conflicts in work-life balance and relationships, medical school peer relations, health concerns, and financial stressors). However, students also reported unique system-level concerns that have not consistently been highlighted in past research (e.g., medical school administrative failures, concerns about lack of assistance with career planning, and assessment-related performance pressure.

CONCLUSIONS

Though individually focused interventions have demonstrated some success, medical students self-report stressors that may be better addressed through system-level changes.

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.

Factors Associated with Depression and Anxiety Symptoms Among Medical Students in Bahrain

OBJECTIVES

Medical training can be a stressful experience and may negatively impact mental health for some students. The purpose of this study was to identify the prevalence of depressive and anxiety symptoms among medical students in one international medical university in the Kingdom of Bahrain and to determine associations between these symptoms, the students' characteristics, and their satisfaction with life.

METHODS

This is a cross sectional study using a self-administered questionnaire, distributed to 350 enrolled medical students. We used Beck's Depression Inventory (BDI-II) and Beck's Anxiety Inventory (BAI) instruments to assess depressive and anxiety symptoms. The Satisfaction With Life Scale (SWLS) was used to measure global cognitive judgments of one's life satisfaction. Sociodemographic details including social background and academic information were also documented.

RESULTS

Forty percent (n = 124) of the participants had depressive symptoms, of which 18.9% (n = 58) met the criteria for mild, 13% (n = 40) for moderate, and 8.5% (n = 26) for severe depressive symptoms. Depressive symptoms were associated with Arab ethnicity (χ ² = 5.66, p = .017), female gender (χ ² = 3.97, p = .046), relationship with peers (p < .001), year of study (χ ² = 13.68, p = .008), and academic performance (p < 0.001). Anxiety symptoms were present in 51% (n = 158) of students. Anxiety symptoms were associated with female gender (χ ² = 11.35, p < 0.001), year of study (χ ² = 10.28, p = .036), and academic performance (χ ² = 14.97, p = .002).

CONCLUSION

The prevalence of depressive and anxiety symptoms among medical students was high. Medical universities in the Middle East may need to allocate more resources into monitoring and early detection of medical student distress. Medical education providers are encouraged to provide adequate pastoral and psychological support for medical students, including culturally appropriate self-care programs within the curriculum.

Students' Perceptions of Trigger Warnings in Medical Education

Phenomenon: Trigger warnings are verbal statements or written warnings that alert students in advance to potentially distressing material. Medical education includes numerous subjects frequently identified as triggers, such as abuse, rape, self-injurious behaviors, eating disorders, drug and alcohol addiction, and suicide. Thus, exploring medical students' perceptions of trigger warnings may provide a valuable perspective on the use of these warnings in higher education.

APPROACH

As part of a larger descriptive, cross-sectional survey study on medical education, we assessed 1st- and 2nd-year medical students' perceptions of trigger warnings in the preclinical curriculum. Five questions specific to trigger warnings explored students' knowledge, prior experience, and perceptions of trigger warnings in medical education. Frequencies of individual question responses were calculated, and qualitative data were analyzed via content and thematic analyses.

FINDINGS

Of the 424 medical students invited to participate, 259 completed the survey (M = 24.8 years, SD + 3.4, 51.4% female, 76.1% White, 53.7% 1st-year students). Few students (11.2%) were aware of the term trigger warning and its definition. However, after being presented with a formal definition on the online survey, 38.6% reported having had a professor use one. When asked whether they supported the use of trigger warnings in medical education, respondents were distributed fairly equally by response (yes = 31.0%, maybe = 39.2%, no = 29.7%). Qualitative analysis revealed three themes: (a) Trigger Warnings Allow Students to Know What is Coming and Prepare Themselves: Respondents believed that trigger warnings would benefit students with a history of trauma by providing them additional time to prepare for the material and, if appropriate, seek professional help; (b) Students Need to Learn How to Handle Distressing Information: Respondents agreed that they needed to learn and cope with highly sensitive material because they would be confronted with difficult and unexpected situations in clinical practice; and (c) Trigger Warnings Help Students Understand the Severity of the Material: Respondents felt that trigger warnings may help students understand the severity of the material being covered and increase awareness about trauma and its effects on health and well-being. Insights: Findings did not reach consensus for or against the use of trigger warnings in medical school; however, students emphasized the importance of learning how to cope with distressing material. Trigger warnings may represent a teaching tool to facilitate classroom discussions about the severity of trauma-related material and problem-focused coping strategies.

Assessment of life skills of medical students in Mashhad, Iran, in 2015

Background

Developing social skills and mental health is a crucial part of the psychosocial health status of medical students.

Objective

The aim of this study was to assess the life skills of medical students in Mashhad University of Medical Sciences (MUMS).

Methods

This cross-sectional study was performed in Mashhad University of Medical Sciences, Iran in 2015. By census method, 146 interns were entered into the study. The life skill questionnaire, consisting of 144 questions, was used as the measurement tool. Over 3 months, all the medical students in internship period were asked to complete the questionnaire. Data were analyzed by independent-samples t-test, one-way ANOVA, and Mann-Whitney with SPSS version 11.5 software.

Results

Women were shown to have higher decision-making ability than men (p=0.046). It was also shown in the study that social behavior (p=0.018), participation in activities that improve benefits (p=0.006), critical thinking (p=0.007), observing and using safety points (p=0.005), and mental health status (p=0.034) were significantly lower in men than in women. The data also suggests that men (13.97±4.7249) are more likely to become global citizens than women (12.15±3.6298) (p=0.010). Furthermore, there was a significant difference when comparing smoking and non-smoking in freedom and justice (p=0.003) and becoming a global citizen (p=0.012).

Conclusion

Our study provides helpful information about medical students’ life skills for policy makers and university authorities. We suggest that gender differences should be considered during life skill training.

Prevalence of poor mental health among medical students in Nepal: a cross-sectional study

BACKGROUND

Poor mental health among medical students is widely acknowledged. Studies on mental health among medical students of Nepal are lacking. Therefore, we conducted a study to determine the prevalence of mental disorders.

METHODS

A cross-sectional study was conducted among medical students at KIST Medical College and Teaching Hospital, Nepal from December 2016 to February 2017. Our survey instrument consisted of the Patient Health Questionnaire (PHQ) and questions about socio-demographic factors, smoking, marijuana use, suicidal ideation and thoughts of dropping out of medical school.

RESULTS

The prevalence rates were 29.2% (95% CI, 24.4% - 34.3%) depression, 22.4% (95% CI, 18.0% - 26.9%) medium to highly severe somatic symptoms, 4.1% (95% CI, 2.0% - 6.2%) panic syndrome, 5.8% (95% CI, 3.4% - 8.3%) other anxiety syndrome, 5% (95% CI, 2.7% - 7.3%) binge eating disorder and 1.2% (95% CI, 0.0% - 2.3%) bulimia nervosa. Sixteen students [4.7% (95% CI, 2.4% - 6.9%)] seriously considered committing suicide while in medical school. Thirty-four students [9.9% (95% CI, 6.8% - 13.1%)] considered dropping out of medical school within the past month. About 15% (95% CI, 11.1% - 18.6%) of the students reported use of marijuana during medical school.

CONCLUSIONS

We found high prevalence of poor mental health among medical students of Nepal. Future studies are required to identify the factors associated with poor mental health.