A longitudinal study of students' depression at one medical school

Mental health of Medical Students in Different Levels of Training

OBJECTIVES

Medical education and training can directly contribute to the development of psychological distress in medical students. This can lead to catastrophic consequences such as impaired academic performance, impaired competency, medical errors and attrition from medical school. This study aimed to assess the prevalence of psychological morbidity among Iranian medical students.

METHODS

This was a cross-sectional study. Samples of medical students in different levels of training (basic science, clinical clerkship, internship, and residency stage) were entered into the study. The 12-item General Health Questionnaire (GHQ-12) was used to measure psychological morbidity. Both univariate and multivariate analyses were used to report on findings.

RESULTS

In all, 220 medical students were invited to take part in the study. Of these, 192 students agreed to fill in the questionnaire. The mean age of respondents was 25.4 (SD = 5.2) and 53% were female. Overall 49.5% of the students scored above the threshold on the GHQ-12 (score > 3.5). The results obtained from logistic regression analysis indicated that female gender and level of training were the most significant contributing factors to increased psychological distress [OR for female gender = 2.99; OR for the basic science group = 6.73].

CONCLUSIONS

Psychological distress appears to be common in medical students and significantly varies by gender and level of training. The psychological well-being of medical students needs to be more carefully addressed, and closer attention to eliminating the risk factors is critical to prevent consequent adverse outcomes.

Factors affecting the performance of undergraduate medical students: a perspective

Context:

Performance of medical students in developing nations like India is perceived to have largely declined.

Aims:

We attempted to assess the reasons behind such trends.

Settings and Design:

Students in their third year of medical study were given a predesigned, pretested structured and validated questionnaire that they filled in anonymously. The key areas assessed were concentration, interest and understanding of the subject and other perceived causes of poor performance. Tests for descriptive statistics were applied for evaluation.

Results and Conclusions:

One hundred and fifty students participated in the study. Fifty-five (36.66%) students performed poorly. Male gender, inability to clear the previous professional examination at the first attempt, difficulty in understanding medium of instruction, self-assessed depression, sleep disorders and perceived parental and peer pressure and dissatisfaction with career choice were significantly linked with poor performance (P<0.05 for each factor). Socioeconomic status and regularity in class were not linked to academic performance.

Prevalence and persistence of depression among undergraduate medical students: a longitudinal study at one UK medical school

OBJECTIVES

To determine the prevalence of depression among male and female medical students, its change over time and whether depression persists for affected students.

DESIGN

Longitudinal study comprising annual questionnaire surveys which included the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D).

PARTICIPANTS

Between 2007 and 2010 all 1112 students entering the Core Science component (Year 1) and all 542 students entering the Clinical component (Year 4) of the Cambridge (UK) medical course were followed-up annually.

METHODS

We analysed, separately for men and women, mean HADS-D scores, the proportions whose scores indicated depression at different time-points and for students maintaining participation, the number of occasions on which their HADS-D scores indicated depression.

RESULTS

725 Core Science and 364 Clinical students participated. Mean HADS-D scores ranged between 3.34 and 3.49 among all Core Science students and between 2.16 and 2.91 among all Clinical students. There was no difference between men and women in median HADS-D scores. Prevalence of depression ranged between 5.7% and 10.6% among all Core Science students and between 2.7% and 8.2% among all Clinical students. Over time Core Science students displayed no increase in mean HADS-D score. Among Clinical students only men displayed a small increase (time coefficient 0.33 (95% CI 0.11 to 0.55)). Prevalence did not increase over time. 220 Core Science and 150 Clinical students participated throughout the study. Of these, 18.2% and 10.6%, respectively, recorded HADS-D scores indicating depression on at least one occasion. Of 56 students recording depression at some point, 37 did so only once.

CONCLUSIONS

Prevalence of depression among participants was similar to that reported for comparable groups. Among men approaching the end of clinical studies depression scores increased. In all years a minority of students displayed depression; for some this persisted. Mechanisms are needed to identify and support students suffering from depression, particularly when persistent.

Students perceived stress in academic programs: consequences for its management

BACKGROUND

Academic stress contributes to the deterioration of the students' quality of life. Psychological determinants involved in the stress process, trait anxiety and coping, have been neglected when assessing the role of academic programs in stress. This study aimed at determining whether academic programs are associated with a high level of perceived stress above and beyond potential personal and environmental risk factors, as well as coping strategies.

METHODS

A cross-sectional survey was conducted in 2009 among third-year medical (total n=170, participants 88%), dental (n=63, 94%), psychology (n=331, 61%) and sports sciences (n=312, 55%) students in Montpellier (France). The stress level experienced during the last 2months, trait anxiety and coping strategies were appraised. Substance use, psychological care, and stress triggers were also collected using a self-administered questionnaire.

RESULTS

Compared with medicine and after adjusting for gender and age, only the sports program was associated with a lower perceived stress risk: adjusted odds ratio: 0.54 [95% Confidence interval: 0.30; 0.99]. Substantial reductions in perceived stress risks were observed in science students after additional adjustments for non-academic stress triggers, substance use, psychological care (adjusted odds ratio: 0.20 [95% Confidence interval: 0.09; 0.41]), and also for trait anxiety and coping strategies (adjusted odds ratio: 0.23 [95% Confidence interval: 0.10; 0.54]). Compared with medicine and after these additional adjustments, psychology had a significantly lower perceived stress risk (0.34 [0.18; 0.64]; 0.40 [0.19; 0.86], respectively), dentistry had a similar risk (0.82 [0.35; 1.91]; 0.53 [0.20; 1.43], respectively).

CONCLUSION

Sports and psychology programs had a lower perceived stress risk compared with medicine. Personal and environmental risk factors and coping strategies modified the association between academic program and perceived stress. Developing efficient coping strategies in students and improving academic environment could contribute to prevent the potential deleterious consequences of stress.

A longitudinal investigation of depressive symptoms in undergraduate students of pharmacy in Syria

This prospective longitudinal study investigated depressive symptoms and its association with students' demographic, academic, and health factors in undergraduate students of pharmacy in Syria. Students attending any year (1st to 5th year) were assessed in the first semester (time 1) and in the second semester (time 2). An academic year comprises two semesters of 16 weeks each. Data for 450 students were analyzed at time 1, and 262 students were assessed at the two time points. Our results showed that most of the students experienced depressive symptoms, with a substantial percentage presenting moderate to severe levels of symptoms (35% or 450 students at time 1; 23% or 262 students at time 2). Across the two semesters, a significant decrease in depressive symptoms was observed for students with complete data at the two time points. Depressive symptoms at time 2 increased significantly with increasing depressive scores at time 1 and decreasing students' expectations about their academic performance. Our results support the clear need for dynamic, full-time, and accessible psychological services at the university to promote and assess mental health and to deliver psychological interventions to students at need.

Depressive symptoms among Mexican medical students: high prevalence and the effect of a group psychoeducation intervention

BACKGROUND

Several studies have demonstrated a higher prevalence of depression among medical students as compared to the general population. On the other hand, psychoeducational interventions have proven its efficacy on diminishing depressive symptoms. The aim of this study is to determine the prevalence of depressive symptoms among medical students in La Salle University and the effect that psychoeducation has on it.

METHODS

Students between the first and the eighth semester voluntarily answered the Beck Depression Inventory test in an anonymous way from 2006 to 2007. After determining the prevalence of depressive symptoms the psychoeducational program was established and prevalence of depressive symptoms was measured for two more years (2008-2009).

RESULTS

A total of 1958 students answered the test during the four years. In the first two years (2006-2007) the 36.29% of the students scored for positive depressive symptoms. The next two years (2008-2009), after the psychoeducation program, the prevalence of depressive symptoms diminishes in a significant manner, only 25.51% of the students have depressive symptoms (p<.0001).

LIMITATIONS

Because the test were answered anonymously, there is no way we can give neither specific attention nor follow-up to the students with depression. Also we can't determine the effect of the mental health group treatment among the medical students.

CONCLUSIONS

Even though the medical students have risks factors for developing depression, we prove that a psychoeducation program can be an effective alternative therapy for decreasing the prevalence of depressive symptoms among medical students.

Sleep disorder among medical students: relationship to their academic performance

BACKGROUND

Medical students are exposed to a significant level of pressure due to academic demands. Their sleep pattern is characterized by insufficient sleep duration, delayed sleep onset, and occurrence of napping episodes during the day.

OBJECTIVE

To examine the prevalence of sleep disorder among medical students and investigate any relationship between sleep disorder and academic performance.

METHODS

This is a cross-sectional self-administered questionnaire-based study. The participants were medical students of the first, second, and third academic years. The Epworth Sleepiness Scale (ESS) was also included to identify sleep disorder and grade point average was recorded for academic performance.

RESULTS

There were 491 responses with a response rate of 55%. The ESS score demonstrated that 36.6% of participants were considered to have abnormal sleep habits, with a statistically significant increase in female students (p = 0.000). Sleeping between 6-10 h per day was associated with normal ESS scores (p = 0.019) as well as the academic grades ≥ 3.75. Abnormal ESS scores were associated with lower academic achievement (p = 0.002).

CONCLUSION

A high prevalence of sleep disorder was found in this group of students, specifically female students. Analysis of the relationship between sleep disorder and academic performance indicates a significant relationship between abnormal ESS scores, total sleeping hours, and academic performance.

The prevalence and correlates of depressive symptoms from an Arabian setting: a wake up call

It has been shown that medical students have a higher rate of depressive symptoms than the general population and age- and sex-matched peers. This study aimed to estimate the prevalence of depressive symptoms among the medical students of a large school following a traditional curriculum and its relation to personal background variables. A descriptive-analytic, cross-sectional study was conducted in a medical school in Riyadh, Saudi Arabia. The medical students of King Saud University in Riyadh, Saudi Arabia, were screened for depressive symptoms using the 21-item Beck Depression Inventory. A high prevalence of depressive symptoms (48.2%) was found, it was either mild (21%), moderate (17%), or severe (11%). The presence and severity of depressive symptoms had a statistically significant association with early academic years (p < 0.000) and female gender (p < 0.002). The high prevalence of depressive symptoms is an alarming sign and calls for remedial action, particularly for the junior and female students.

Psychological services for US and international veterinary students

Given the importance of psychological services for veterinary students, a survey was administered to all US veterinary schools and many international ones, asking them to report on the amount and type of psychological support services they offer to students, faculty, and staff. This article reports on the results of this survey and presents suggestions for increasing the accessibility of counseling services. One objective of the current study was to initiate an avenue for ongoing communication between individuals involved in student counseling within each school. A list of individuals currently working in the field and their contact information is provided in Appendix 2.

Perceived medical school stress and the development of behavior and experience patterns in German medical students

BACKGROUND

Longitudinal data about the development of health risks and resources in relation to the performance of medical students are limited.

AIMS

To evaluate the development of study-related experience and the correlation to performance.

METHOD

Medical students in the first (2006), second (2008), and fifth years (2011) of their studies were surveyed with standard instruments for quality of life, study-related behavior and experience, perceived medical school stress, anxiety and depression, and grades in their first major exam.

RESULTS

The proportion of students with a healthy behavior and experience pattern decreased from 47.3% in the first year to 36.9% in the second year and 17.6% in the fifth year. This corresponded to an increase in the proportion of students at risk for burnout (7.1% first, 20% second, 19% fifth year). Students with a healthy behavior and experience pattern scored higher in self-perceived performance (p < 0.05) and objective grades. Stress and risk for burnout were important predictors for anxiety and depression.

CONCLUSIONS

The decrease in health and the increase in risk patterns indicate a need for prevention and health promotion that should not only focus on individual behavior but also address the contextual factor of study organization within medical school.

A study of depression and anxiety, general health, and academic performance in three cohorts of veterinary medical students across the first three semesters of veterinary school

This study builds on previous research on predictors of depression and anxiety in veterinary medical students and reports data on three veterinary cohorts from two universities through their first three semesters of study. Across all three semesters, 49%, 65%, and 69% of the participants reported depression levels at or above the clinical cut-off, suggesting a remarkably high percentage of students experiencing significant levels of depression symptoms. Further, this study investigated the relationship between common stressors experienced by veterinary students and mental health, general health, and academic performance. A factor analysis revealed four factors among stressors common to veterinary students: academic stress, transitional stress, family-health stress, and relationship stress. The results indicated that both academic stress and transitional stress had a robust impact on veterinary medical students' well-being during their first three semesters of study. As well, academic stress negatively impacted students in the areas of depression and anxiety symptoms, life satisfaction, general health, perception of academic performance, and grade point average (GPA). Transitional stress predicted increased depression and anxiety symptoms and decreased life satisfaction. This study helped to further illuminate the magnitude of the problem of depression and anxiety symptoms in veterinary medical students and identified factors most predictive of poor outcomes in the areas of mental health, general health, and academic performance. The discussion provides recommendations for considering structural changes to veterinary educational curricula to reduce the magnitude of academic stressors. Concurrently, recommendations are suggested for mental health interventions to help increase students' resistance to environmental stressors.

Potential barriers to veterinary student access to counselling and other support systems: perceptions of staff and students at a UK veterinary school

Considerable evidence suggests that veterinary surgeons' mental health is often poorer than comparable populations and that the incidence of suicide is higher among veterinary surgeons than the general public. Veterinary students also appear to suffer from high levels of anxiety and stress, and may possess inadequate coping strategies when faced with adversity. Veterinary students may find it difficult to access central university support systems due to their heavy workload and geographical isolation on some veterinary campuses. A previous study of University of Edinburgh fourth-year veterinary students found that support services located several miles from the main veterinary campus was a barrier to students accessing counselling services. Consequently, a pilot project was initiated, which provided a counselling service at the University of Edinburgh's rural Easter Bush veterinary campus one afternoon a week during 2010. As part of the evaluation of this service, web-based questionnaires were delivered via e-mail to all veterinary staff and students towards the end of the 12-month pilot period to evaluate perceptions of barriers to student counselling and to investigate student-valued support services. Questionnaire responses were received from 35 per cent of veterinary students and 52 per cent of staff. Stigmatisation of being unable to cope was a potent inhibitor of seeking support within the veterinary environment, but counselling was perceived as valuable by the majority of staff and students. Provision of an on-site counselling service was considered important for increasing ease of access; however, students viewed friends and family as their most important support mechanism. Workload was cited as the main cause of veterinary student stress. The majority of staff and student respondents perceived veterinary students as having an increased need for counselling support compared with other students.

Mental distress, alcohol use and help-seeking among medical and business students: a cross-sectional comparative study

BACKGROUND

Stress and distress among medical students are thoroughly studied and presumed to be particularly high, but comparative studies including other student groups are rare.

METHODS

A web-based survey was distributed to 500 medical students and 500 business students. We compared levels of study stress (HESI), burnout (OLBI), alcohol habits (AUDIT) and depression (MDI), and analysed their relationship with self-assessed mental health problems by logistic regression, with respect to gender.

RESULTS

Medical students' response rate was 81.6% and that of business students 69.4%. Business students scored higher on several study stress factors and on disengagement. Depression (OR 0.61, CI95 0.37;0.98) and harmful alcohol use (OR 0.55, CI95 0.37; 0.75) were both less common among medical students. However, harmful alcohol use was highly prevalent among male students in both groups (medical students 28.0%, business students 35.4%), and among female business students (25.0%). Mental health problems in need of treatment were equally common in both groups; 22.1% and 19.3%, respectively, and was associated with female sex (OR 2.01, CI95 1.32;3.04), exhaustion (OR 2.56, CI95 1.60;4.10), lower commitment to studies (OR 1.95, CI95 1.09;3.51) and financial concerns (OR 1.81 CI95 1.18;2.80)

CONCLUSIONS

Medical students may not be more stressed than other high achieving student populations. The more cohesive structure of medical school and a higher awareness of a healthy lifestyle may be beneficial factors.

Changes in diurnal salivary cortisol levels in response to an acute stressor in healthy young adults

BACKGROUND

Knowledge of the diurnal cortisol response to acute stress in healthy individuals can help us better understand the physiological and health effects of chronic stress.

OBJECTIVE

To compare the diurnal patterns of cortisol secretion of 15 medical students 2 weeks before a major written examination (control phase) and 2 weeks later at the time of the examination (acute stress phase).

DESIGN

Interrupted time series within-subjects.

RESULTS

During the acute stress phase, less cortisol was secreted over the course of the day, as demonstrated by a more prolonged and steeper decline in cortisol levels. In addition, higher cortisol levels were present in the evening. Despite these changes in the usual diurnal pattern, overall exposure to cortisol remained the same for both phases.

CONCLUSIONS

The results of this study suggest that specific adaptations to the diurnal pattern of cortisol are made in the face of acute stress, important information for understanding cortisol regulation in health and illness.

Impact of pass/fail grading on medical students' well-being and academic outcomes

OBJECTIVES

Many medical schools are currently undergoing curriculum reform. When considering the means by which students will be evaluated in a revised curriculum, the need to reduce the prevalences of depression and anxiety associated with academic stress must be weighed against the importance of academic outcomes. Pass/fail evaluation, as compared with tiered grading, is commonly presented as a means to adequately assess student performance while minimising stress and anxiety. The purpose of this literature review was to determine the impact of pass/fail grading on medical student well-being and academic outcomes.

METHODS

A systematic search was performed of the available literature published between January 1980 and August 2010, using the PubMed, Ovid Medline, Ovid PsycINFO and ERIC databases. Eligible papers assessed the impact of pass/fail grading on medical student well-being, academic outcomes or both. Academic outcomes included but were not limited to objective measures, such as performance on the US Medical Licensing Examination, and subjective measures, such as student desirability by residency programmes. Reference lists in identified papers were searched and all identified papers were run through a citation index.

RESULTS

Four papers met the inclusion criteria for both well-being and academic outcomes. An additional five papers met the inclusion criteria for academic outcomes only. The four papers that focused on well-being reported improvement in specified areas. No significant difference was identified in any of the five papers examining objective academic outcomes or in those papers that examined the quality of residency programmes attained. Results from two studies suggested that some programme directors believe pass/fail grading creates disadvantages for students in attaining a residency, whereas a third study yielded mixed results about its impact on residency attainment.

CONCLUSIONS

Student well-being is enhanced and objective academic performance is not adversely affected by a pass/fail evaluation system, but students' ability to obtain a desired residency programme may be hindered by individual programme directors' preferences for tiered grading systems. There is an overall paucity of literature on this topic and additional study is needed.

The Associations between Social Support, Health-Related Behaviors, Socioeconomic Status and Depression in Medical Students

OBJECTIVES

The objective of this study was to estimate the prevalence of depression in medical students and to evaluate whether interpersonal social support, health-related behaviors, and socio-economic factors were associated with depression in medical students.

METHODS

The subjects in this study were 120 medical students in Seoul, Korea who were surveyed in September, 2008. The subjects were all women and over the age of 20. Their age, body mass index (BMI), quality of sleep, diet, household income, smoking, alcohol consumption, exercise levels, and self-reported health status were surveyed. The degree of perceived social support was measured using the interpersonal support evaluation list (ISEL). Depression was evaluated using the center for epidemiology studies depression scale (CES-D).

RESULTS

The mean CES-D score was 14.1±8.6 and 37.1% of the participants appeared to suffer from depression. Low levels of perceived interpersonal support increased the risk of depression by more than 10 times and having higher household income did not necessarily decrease the risk of depression.

CONCLUSION

Medical students have a relatively high level of depression. Efforts should be made to encourage social support in order to promote mental health in medical students.

Sexual function and depressive symptoms among female North American medical students

INTRODUCTION

Depression and sexual dysfunction are often comorbid.

AIM

We explored the relationship between sexuality, sexual dysfunction, and depressive symptoms in female medical students in North America.

MAIN OUTCOME MEASURE

Female North American medical students were invited to participate in an internet survey. The CES-D was utilized to screen for depressive symptoms and an abbreviated Spielberger State-Trait Anxiety Index (STAI) was used to quantify anxiety symptoms.

METHODS

Subjects completed an ethnodemographic survey, a sexuality survey, and modified instruments for the quantification of sexual function (the Female Sexual Function Index [FSFI] and the Index of Sexual Life [ISL]). Multivariable logistic regression was used to explore the relationship between sexuality and depressive symptoms.

RESULTS

There were 1,241 female subjects with complete data on CES-D and STAI. Mean age was 25.4 years. Depressive symptoms (CES-D>16) were present in 46% of respondents and were more common in subjects with anxiety symptoms. Subjects who were Caucasian, younger than 28, heterosexual, and in a relationship were least likely to report depressive symptoms. High risk of female sexual dysfunction (HRFSD) was significantly associated with greater likelihood of depressive symptoms (odds ratio [OR] 2.25, P<0.001). After adjusting for ethnodemographic and sexual history factors, HRFSD remained significantly positively associated with depressive symptoms (OR 1.85, P<0.001). Analysis of FSFI and ISL domains indicated that depressive symptoms were most directly associated with worse orgasmic function, interference in sex life from stress and lack of partner, and lower general life satisfaction (P<0.05). Interestingly, greater ISL-sexual satisfaction was associated with greater odds of depressive symptoms (OR 1.40, P=0.01).

CONCLUSION

Depressive symptoms are common in female medical students. HRFSD is associated with depressive symptoms, although the relationship is complex when psychosocial factors are included in the multivariate model. Attention to sexuality factors from student health providers may enhance quality-of-life, academic achievement, and patient care.

The prevalence and impact of depression among medical students: a nationwide cross-sectional study in South Korea

PURPOSE

This nationwide cross-sectional study assessed the prevalence, possible risk factors, and impact of depression among Korean medical students.

METHOD

Of all medical students (14,095) registered in 41 medical schools in 2006 in South Korea, 7,357 (52.2%) completed the survey. Depression was measured using the patient-rated version of the Mini International Neuropsychiatric Interview (MINI-PR). Data on academic functioning, and sociodemographic characteristics were also obtained.

RESULTS

Current, one-year, and lifetime prevalence of major depressive disorder (MDD) were 2.9%, 6.5%, and 10.3%, respectively. Possible risk factors for one-year MDD were female gender, lower class years, admission track with exemption from entrance exam, living alone at a lodging house or a rented room, and financial difficulty (P < .05). The grade point averages (GPAs) of students with MDD were significantly lower than those of nondepressed students for both semesters (t = 3.8, P < .001; t = 4.8, P < .001). The odds ratio of students with MDD of receiving a GPA below 2.0 was 1.8 (CI 1.4-2.4) as compared with nondepressed students.

CONCLUSIONS

This study demonstrated that Korean medical students experience depression frequently. It also highlighted the possible risk factors of MDD among medical students and pervasive association of depression with poor functioning.

Change in depressive symptoms over higher education and professional establishment - a longitudinal investigation in a national cohort of Swedish nursing students

Background

There are indications of a high prevalence of psychological distress among students in higher education and also that distress increases over the course of study. However, not all studies on student distress controlled for sociodemographic differences and few followed development of distress over an extended period through professional establishment. We investigated if there is an independent effect of time in education and the first two years in the profession on depressive symptoms and mapped change over the period in a national cohort of students.

Methods

Data came from LANE, a nation-wide longitudinal panel survey of Swedish nursing students (N = 1700) who responded to annual questionnaires over five years from 2002 to 2007. Depressive symptoms were measured by the Major Depression Inventory and change over time analysed in a linear mixed effects model for repeated measures.

Results

There was a significant change in level of depressive symptoms over time: an increase from the first to later years in education and a decrease to levels similar to baseline after graduation and a year in the profession. The change in symptoms remained significant after adjustment for sociodemographic factors (p < 0.01). Symptom levels differed due to age, gender, household composition and prior nurse assistant training but change over time was similar in all groups. The correlation among the repeated measures, representing within individual correlation over time, varied between 0.44-0.60.

Conclusions

The findings indicate an independent but transitional effect of time in education and professional establishment on depressive symptoms. We think heightened distress over education abates as the graduate accommodates to the profession. Nevertheless, within education, the differences in depressive symptoms associated to demographic factors can help identify student groups more vulnerable to distress. Also, as individual differences in distress seem to persist over time, perhaps students highly distressed in the beginning of education can be helped by awareness among educators of the elevated levels of distress in late education.

Sources of stress and psychological morbidity among undergraduate physiotherapy students

OBJECTIVES

Professional education can be a stressful experience for some individuals, and may impact negatively on emotional well-being and academic performance. Psychological morbidity and associated sources of stress have not been investigated extensively in physiotherapy students. This study explored sources of stress, psychological morbidity and possible associations between these variables in undergraduate physiotherapy students.

DESIGN

A questionnaire-based survey. The Undergraduate Sources of Stress Questionnaire was used to identify sources of stress, and the General Health Questionnaire-12 (GHQ-12) was used to rate the prevalence of psychological morbidity, using a conservative GHQ threshold of 3 to 4 to determine probable 'cases'. Uni- and multivariate tests of correlation were used to analyse the data.

SETTING

An Irish educational institution.

PARTICIPANTS

One hundred and twenty-five physiotherapy undergraduate students.

RESULTS

More than one-quarter of all students (27%) scored above the GHQ threshold, indicating probable psychological morbidity. This is higher than the level of psychological morbidity reported by the general population. Regression analysis showed that academic (beta=0.31, P<0.001) and personal (beta=0.50, P<0.001) sources of stress subscales were significant coefficients, explaining 48% of the variance in psychological morbidity after controlling for part-time employment and hours spent studying. Individual significant items from these subscales were stressful events (beta=0.24, P=0.004), mood (beta=0.43, P< or =0.001) and overall level of stress (beta=0.35, P< or =0.001).

CONCLUSIONS

The results highlighted the emotional vulnerability of a significant proportion of physiotherapy students, with academic and personal issues being the greatest concern. While personal causes of stress such as stressful events and mood are more difficult to control, manipulation of curricular factors may have positive effects on academic sources of stress.

Medical student engagement and leadership within a new learning community

BACKGROUND

Many medical schools are establishing learning communities to foster cohesion among students and to strengthen relationships between students and faculty members. Emerging learning communities require nurturing and attention; this represents an opportunity wherein medical students can become involved as leaders. This study sought to understand issues related to active involvement among students who chose to become highly engaged in a newly developed learning community.

METHODS

Between April and June 2008, 36 students who assumed leadership roles within the Colleges Program were queried electronically with open-ended questions about their engagement. Qualitative analysis of the written responses was independently performed by two investigators; coding was compared for agreement. Content analysis identified major themes.

RESULTS

35 students (97%) completed the questionnaire. Motives that emerged as reasons for getting involved included: endorsing the need for the program; excitement with the start-up; wanting to give back; commitment to institutional excellence; and collaboration with talented peers and faculty. Perceived benefits were grouped under the following domains: connecting with others; mentoring; learning new skills; and recognition. The most frequently identified drawbacks were the time commitment and the opportunity costs. Ideas for drawing medical students into new endeavors included: creating defined roles; offering a breadth of opportunities; empowering students with responsibility; and making them feel valued.

CONCLUSIONS

Medical students were drawn to and took on leadership roles in a medical school curricular innovation. This example may prove helpful to others hoping to engage students as leaders in learning communities at their schools or those wishing to augment student involvement in other programs.

Ego defense mechanisms in Pakistani medical students: a cross sectional analysis

BACKGROUND

Ego defense mechanisms (or factors), defined by Freud as unconscious resources used by the ego to reduce conflict between the id and superego, are a reflection of how an individual deals with conflict and stress. This study assesses the prevalence of various ego defense mechanisms employed by medical students of Karachi, which is a group with higher stress levels than the general population.

METHODS

A questionnaire based cross-sectional study was conducted on 682 students from five major medical colleges of Karachi over 4 weeks in November 2006. Ego defense mechanisms were assessed using the Defense Style Questionnaire (DSQ-40) individually and as grouped under Mature, Immature, and Neurotic factors.

RESULTS

Lower mean scores of Immature defense mechanisms (4.78) were identified than those for Neurotic (5.62) and Mature (5.60) mechanisms among medical students of Karachi. Immature mechanisms were more commonly employed by males whereas females employed more Neurotic mechanisms than males. Neurotic and Immature defenses were significantly more prevalent in first and second year students. Mature mechanisms were significantly higher in students enrolled in Government colleges than Private institutions (p < 0.05).

CONCLUSIONS

Immature defense mechanisms were less commonly employed than Neurotic and Mature mechanisms among medical students of Karachi. The greater employment of Neurotic defenses may reflect greater stress levels than the general population. Employment of these mechanisms was associated with female gender, enrollment in a private medical college, and students enrolled in the first 2 years of medical school.

A comprehensive medical student wellness program--design and implementation at Vanderbilt School of Medicine

Research suggests that student burnout and mental illness are increasing in U.S. medical schools. In response, students and administrators developed the Vanderbilt Medical Student (VMS) Wellness Program to promote student health and well-being through coordination of many new and existing resources. This program consists of three core components: The Advisory College Program, The Student Wellness Committee, and VMS LIVE. Each of the core components includes separate and unique individual programs, but each of these three components collaborates with the other two to accomplish the broad wellness goal of maximizing student health, happiness, and potential. The VMS Wellness Program has had early success with substantial growth and outstanding student buy-in since its inception in 2005. Preliminary data indicate that nearly every student has participated in at least two components of the VMS Wellness Program. In addition to participation, student response has been highly satisfactory, as evidenced by their positive feedback. The VMS Wellness Program is the first published model of a comprehensive medical student wellness initiative. The development and design of the program described in this article may serve as a framework for other institutions.

Transtornos mentais comuns entre os estudantes do curso de medicina: prevalência e fatores associados

Objetivo: O objetivo do estudo foi estimar a prevalência de transtornos mentais comuns (TMC) entre os estudantes do curso de medicina da UFES e avaliar possíveis correlações entre TMC e fatores de risco. Métodos: Estudo transversal realizado de setembro a novembro de 2007 envolvendo 229 alunos do curso de medicina. O questionário utilizado foi autoaplicável e anônimo. Foram coletados dados socioeconômicos, informações sobre o curso, o processo de ensino-aprendizagem e a rede de apoio social. Para o rastreamento de TMC, utilizou-se o Self-Reporting Questionnaire (SRQ-20). Resultados: A prevalência total de TMC encontrada foi de 37,1% (IC 95%, 30,8%-43,4%), que esteve independentemente associada a não receber o apoio emocional necessário (OR = 7,4, IC 95%, 3,1-17,9) e relatar "dificuldade para tirar dúvidas em sala de aula por timidez" durante a infância ou adolescência (OR = 2,5, IC 95%, 1,0-6,1). Conclusão: Os dados demonstram elevada prevalência de TMC nessa população e a importância em subsidiar ações para prevenção e cuidado com a saúde mental dos estudantes, melhorando a qualidade de vida deles.

Burnout and serious thoughts of dropping out of medical school: a multi-institutional study

PURPOSE

Little is known about students who seriously consider dropping out of medical school. The authors assessed the severity of thoughts of dropping out and explored the relationship of such thoughts with burnout and other indicators of distress.

METHOD

The authors surveyed medical students attending five medical schools in 2006 and 2007 (prospective cohort) and included two additional medical schools in 2007 (cross-sectional cohort). The survey included questions about thoughts of dropping out, life events in the previous 12 months, and validated instruments evaluating burnout, depression symptoms, and quality of life (QOL).

RESULTS

Data were provided by 858 (65%) students in the prospective cohort and 2,248 (52%) in the cross-sectional cohort. Of 2,222 respondents, 243 (11%) indicated having serious thoughts of dropping out within the last year. Burnout (P < .0001), QOL (P < .003 each domain), and depressive symptoms (P < .0001) at baseline predicted serious thoughts of dropping out during the following year. Each one-point increase in emotional exhaustion and depersonalization score and one-point decrease in personal accomplishment score at baseline was associated with a 7% increase in the odds of serious thoughts of dropping out during the following year. On subsequent confirmatory multivariable analysis, low scores for personal accomplishment, lower mental and physical QOL, and having children were independent predictors of students having serious thoughts of dropping out during the following year.

CONCLUSIONS

Approximately 11% of students have serious thoughts of dropping out of medical school each year. Burnout seems to be associated with increased likelihood of serious thoughts of dropping out.

Study-related health and behavior patterns of medical students: A longitudinal study

BACKGROUND

Little is known about specific health risks and resources and their development influencing medical students' stress.

AIM

To evaluate the development of quality of life and study-related behavior and experience patterns among medical students.

METHODS

Data were collected in the first (n = 112 of 182 in 2006) and the fourth semesters (n = 164 of 176 in 2008). The instruments "Work-Related Behavior and Experience Patterns" (AVEM, including four main patterns: "Health", "Unambitious," "Overexertion," "Burnout") and "Short Form-12 Health Survey (SF-12)" were used at both points in time.

RESULTS

The medical students scored significantly lower on mental health compared with reference samples of young adults. The proportion of students with a healthy pattern decreased from 47.3% (95% CI 38.1-56.5%) in the first semester to 36.9% (29.4-44.4%) in the fourth semester. This corresponded to an increase in the proportion of students at risk for burnout from 7.1% (2.3-11.9%) to 20% (13.8-26.2%). At both time points, female students had a higher risk for overexertion and a lower prevalence of a healthy pattern than male students.

CONCLUSION

Our data provide evidence for a decrease in the healthy pattern and an increase in the burnout pattern. Intervention is needed, especially for students at risk for burnout.

Burnout during residency training: a literature review

OBJECTIVE

Burnout is a state of mental and physical exhaustion related to work or care giving activities. Burnout during residency training has gained significant attention secondary to concerns regarding job performance and patient care. This article reviews the relevant literature on burnout in order to provide information to educators about its prevalence, features, impact, and potential interventions.

METHODS

Studies were identified through a Medline and PsychInfo search from 1974 to 2009. Fifty-one studies were identified. Definition and description of burnout and measurement methods are presented followed by a thorough review of the studies.

RESULTS

An examination of the burnout literature reveals that it is prevalent in medical students (28%-45%), residents (27%-75%, depending on specialty), as well as practicing physicians. Psychological distress and physical symptoms can impact work performance and patient safety. Distress during medical school can lead to burnout, which in turn can result in negative consequences as a working physician. Burnout also poses significant challenges during early training years in residency. Time demands, lack of control, work planning, work organization, inherently difficult job situations, and interpersonal relationships, are considered factors contributing to residents' burnout. Potential interventions include workplace-driven and individual-driven measures. Workplace interventions include education about burnout, workload modifications, increasing the diversity of work duties, stress management training, mentoring, emotional intelligence training, and wellness workshops. Individual-driven behavioral, social, and physical activities include promoting interpersonal professional relations, meditation, counseling, and exercise.

CONCLUSIONS

Educators need to develop an active awareness of burnout and ought to consider incorporating relevant instruction and interventions during the process of training resident physicians.

Doctors with disabilities: licensed to practice?

Doctors deal with patient's disabilities every day but many in the profession have been nonplussed to see the focus of the disability rights lobbies shift from the recipients of care to the carers themselves. Until recently the number of practising doctors known to have significant disabilities was very low and for many reasons potential medical students were deterred from entering medical education. This piece would not even have been commissioned 14 years ago when the U.K. Disability Discrimination Act 1995 was passed. It is a measure of the change in society's view of disability, reinforced by law, that the issue of whether there are disabilities which, in themselves, render a doctor Unfit to practise can be analysed and discussed.

Promise of professionalism: personal mission statements among a national cohort of medical students

PURPOSE

While historic medical oaths and numerous contemporary medical organizations offer guidelines for professionalism, the nature of the professional aspirations, commitments, and values of current medical students is not well known. We sought to provide a thematic catalogue of individual mission statements written by medical students nationally.

METHODS

In the Healer's Art elective course, students write a personal mission statement about their highest professional values. In 2006-2007, we randomly selected 100 student mission statements from 10 representative schools nationally. Three researchers coded content using a team-based qualitative approach and categorized the codes into major themes. Student mission statements were compared with classic medical oaths and contemporary professionalism guidelines.

RESULTS

The mission statements were similar across different schools. Three major themes emerged, comprised of codes identified in 20% or more of the mission statements. The first theme, professional skills, includes dealing with the negatives of training, listening and empathy, growth and development. The second theme, personal qualities, includes wholeness, humility, and constancy/perfectionism. The third theme, scope of professional practice, includes physician relationships, positive emotions, healing, service, spirituality, and balance. Unlike the content of classic oaths and contemporary professionalism statements, the students' statements dealt with fears, personal-professional balance, love, nonhierachical relationships, self-care, healing, and awe as key to being a physician.

CONCLUSIONS

In their personal mission statements, this national cohort of medical students described an expanded view of physicianhood that includes such elements as presence, love, and awe. Medical school curricula may require adaptation to support the personal aspirations of those now entering the profession.

The learning environment and medical student burnout: a multicentre study

OBJECTIVES

Little is known about specific personal and professional factors influencing student distress. The authors conducted a comprehensive assessment of how learning environment, clinical rotation factors, workload, demographics and personal life events relate to student burnout.

METHODS

All medical students (n = 3080) at five medical schools were surveyed in the spring of 2006 using a validated instrument to assess burnout. Students were also asked about the aforementioned factors.

RESULTS

A total of 1701 medical students (response rate 55%) completed the survey. Learning climate factors were associated with student burnout on univariate analysis (odds ratio [OR] 1.36-2.07; all P < or = 0.02). Being on a hospital ward rotation or a rotation requiring overnight call was also associated with burnout (ORs 1.69 and 1.48, respectively; both P < or = 0.02). Other workload characteristics (e.g. number of admissions) had no relation to student burnout. Students who experienced a positive personal life event had a lower frequency of burnout (OR 0.70; P < or = 0.02), whereas those who experienced negative personal life events did not have a higher frequency of burnout than students who did not experience a negative personal life event. On multivariate analysis personal characteristics, learning environment and personal life events were all independently related to student burnout.

CONCLUSIONS

Although a complex array of personal and professional factors influence student well-being, student satisfaction with specific characteristics of the learning environment appears to be a critical factor. Studies determining how to create a learning environment that cultivates student well-being are needed.

Factors influencing treatment for depression among medical students: a nationwide sample in South Korea

OBJECTIVES

Depression is more frequently experienced and induces more severe consequences in medical students than in the general population. However, treatment rates for depression in medical students are still low. In this study, the authors investigated factors that affect treatment for depression and dispositions towards treating depression among South Korean medical students.

METHODS

A nationwide, cross-sectional survey was administered to medical students attending all 41 medical schools in South Korea (14,095 students). The questionnaire included the Beck Depression Inventory (BDI) and asked for data on socio-demographic variables, history of diagnosis or treatment for depression, knowledge of mental health problems and disposition to use mental health care.

RESULTS

A total of 7357 students (52.2%) from 36 schools responded to the survey. Of these, 689 (9.4%) were identified as being depressed via a BDI score higher than 16. Of the depressed respondents, only 61 (8.9%) had been diagnosed with depression and 67 (9.7%) had been treated for depression. Age was significantly associated with treatment behaviour for depression. Correct knowledge about the aetiology of depression and psychiatric medicine was significantly related to students' disposition to use psychiatric services and to receive psychopharmacotherapy as an option to resolve depression.

CONCLUSIONS

Accurate knowledge of depression and appropriate medication seems to be relevant to students seeking appropriate treatment for depression. The development of education programmes designed to improve medical students' knowledge of mental health problems and treatments would facilitate treatment seeking in medical students.

Depressive symptoms in medical students and residents: a multischool study

BACKGROUND

This multisite, anonymous study assessed depressive symptoms and suicidal ideation in medical trainees (medical students and residents).

METHOD

In 2003-2004, the authors surveyed medical trainees at six sites. Surveys included content from the Center for Epidemiologic Studies-Depression scale (CES-D) and the Primary Care Evaluation of Mental Disorders (PRIME-MD) (measures for depression), as well as demographic content. Rates of reported major and minor depression and of suicidal ideation were calculated. Responses were compared by level of training, gender, and ethnicity.

RESULTS

More than 2,000 medical students and residents responded, for an overall response rate of 89%. Based on categorical levels from the CES-D, 12% had probable major depression and 9.2% had probable mild/moderate depression. There were significant differences in depression by trainee level, with a higher rate among medical students; and gender, with higher rates among women (chi2 = 10.42, df = 2, and P = .005 and chi2 = 22.1, df = 2, and P < .001, respectively). Nearly 6% reported suicidal ideation, with differences by trainee level, with a higher rate among medical students; and ethnicity, with the highest rate among black/African American respondents and the lowest among Caucasian respondents (chi2 = 5.19, df = 1, and P = .023 and chi2 = 10.42, df = 3, and P = .015, respectively).

CONCLUSIONS

Depression remains a significant issue for medical trainees. This study highlights the importance of ongoing mental health assessment, treatment, and education for medical trainees.

The characteristics of depressive symptoms in medical students during medical education and training: a cross-sectional study

BACKGROUND

Medical education and training can contribute to the development of depressive symptoms that might lead to possible academic and professional consequences. We aimed to investigate the characteristics of depressive symptoms among 481 medical students (79.8% of the total who matriculated).

METHODS

The Beck Depression Inventory (BDI) and cluster analyses were used in order to better describe the characteristics of depressive symptoms. Medical education and training in Brazil is divided into basic (1st and 2nd years), intermediate (3rd and 4th years), and internship (5th and 6th years) periods. The study organized each item from the BDI into the following three clusters: affective, cognitive, and somatic. Statistical analyses were performed using analysis of variance (ANOVA) with post-hoc Tukey corrected for multiple comparisons.

RESULTS

There were 184 (38.2%) students with depressive symptoms (BDI > 9). The internship period resulted in the highest BDI scores in comparison to both the basic (p < .001) and intermediate (p < .001) periods. Affective, cognitive, and somatic clusters were significantly higher in the internship period. An exploratory analysis of possible risk factors showed that females (p = .020) not having a parent who practiced medicine (p = .016), and the internship period (p = .001) were factors for the development of depressive symptoms.

CONCLUSION

There is a high prevalence towards depressive symptoms among medical students, particularly females, in the internship level, mainly involving the somatic and affective clusters, and not having a parent who practiced medicine. The active assessment of these students in evaluating their depressive symptoms is important in order to prevent the development of co-morbidities and suicide risk.

Stress and depressive symptoms/dysphoria among US medical students: results from a large, nationally representative survey

This study determined rates and correlates of stress, depressive symptoms/dysphoria, and suicidal thoughts among US medical students. Data were obtained from a large-scale survey conducted at 16 representative medical schools. Students completed questionnaires during first-year orientation (n= 1846), at the time of transition to clinical rotations (n= 1630), and during the fourth year (n= 1469). Students entering the wards reported greater stress, more bad mental health days, and greater depressive feelings than first-year students, with fourth-year students reporting intermediate stress levels. The number of days of bad mental health in the past month, stress experienced in the past 12 months, and perceptions about the medical school's system for coping were independently associated with suicidal thoughts, which were reported by 9% of fourth-year students. Medical schools should undertake efforts to assist students' coping because a substantial proportion of students experience meaningful levels of stress, depressive symptoms (especially around the time of transitioning to clinical care rotations), and suicidal thoughts.

Symptoms of anxiety and depression in medical students and in humanities students: relationship with big-five personality dimensions and vulnerability to stress

AIMS

To evaluate the prevalence of anxiety and depression in medical students and in humanities students. To assess the relationship between symptoms of anxiety, symptoms of depression and Big-Five personality dimensions and vulnerability to stress in medical students.

METHODS

Randomly selected 338 medical students and 73 humanities students were evaluated for symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), for Big-Five personality dimensions using the Ten-Item Personality Inventory (TIPI), and for vulnerability to stress using the Stress Vulnerability Scale (SVS).

RESULTS

Symptoms of anxiety and symptoms of depression were prevalent in medical students (43% and 14%, respectively) and in humanities students (52% and 12%, respectively). In medical students the score on the HADS anxiety subscale and the score on the HADS depression subscale correlated negatively with the score on the TIPI Emotional Stability scale (r = -0.39, p < 0.01 and r = -0.2, p < 0.01, respectively) and correlated positively with the score on the SVS (r = 0.38, p < 0.01 and r = 0.44, p < 0.01, respectively).

CONCLUSIONS

Symptoms of anxiety and depression are prevalent in medical students and in humanities students. Severity of symptoms of anxiety and symptoms of depression in medical students is negatively related to emotional stability and positively related to stress vulnerability.

Perceived stress among male medical students in Egypt and Saudi Arabia: effect of sociodemographic factors

BACKGROUND AND OBJECTIVES

In Arab countries, epidemiological data about psychological morbidity among medical undergraduate students are scarce. This study sought to determine whether there was a difference in perceived stress levels of male medical students at Mansoura University, Egypt, compared with male medical students at King Faisal University, Saudi Arabia.

METHODS

The sample consisted of 304 male medical students in Egypt and and 284 male medical students in Saudi Arabia. The self-reported questionnaire covered four categories, including 15 items, on sources of stress (stressors). The perceived stress scale and hospital anxiety and depression scale were used to measure stress, anxiety and depression.

RESULTS

There was no significant difference between the two groups in number of stressors. However, Egyptian students were more likely to cite relationship, academic and environmental problems than Saudis. The prevalence of high stress was nearly equal in both groups. However, anxiety and depression were significantly higher among Egyptian than Saudi students. A logistic regression analysis of independent predictors of severe stress among both groups combined revealed that a satisfactory family income and university-graduated father were independent protective factors. The independent risk predictors were anxiety and number of stressors.

CONCLUSIONS

Stress, anxiety and depression are frequent among medical students. Counseling and preventive mental health services should be an integral part of the routine clinical facilities caring for medical students.

Mental health treatment needs for medical students: a national longitudinal study

Purpose

We aimed to study the occurrence and predictors of medical students' mental health problems that required treatment.

Subjects and methods

Medical students from all Norwegian universities (N = 421) were surveyed in their first term (T1), and 3 (T2) and 6 (T3) years later. The dependent variable was “Mental health problems in need of treatment”. Predictor variables included personality traits, medical school stress and negative life events.

Results

The lifetime prevalence of mental health problems was 15% at T1. At T2, of the 31% who reported problems during the first 3 years, a majority had not sought help. At T3, 14% reported problems during the preceding year. Adjusted predictors of problems at T2 were previous mental health problems (p < .001), low level of intensity personality trait (extraversion) (p < .01), reality weakness personality trait (p < .01), perceived medical school stress (p < .05) and negative life events (p < .05).

Discussion

Mental health problems during the first 3 years were predicted by previous problems, personality, medical school stress and negative life events.

Conclusion

A third of the students reported mental health problems during the first 3 years. Intervention should focus on both individual problems and contextual stress.

Sintomas depressivos em acadêmicos de medicina da Universidade Federal de Goiás: um estudo de prevalência

INTRODUÇÃO: O presente estudo teve como objetivo investigar a prevalência de sintomas depressivos em alunos de medicina da Universidade Federal de Goiás, comparando com a população em geral e verificando a possibilidade de determinado período do curso atuar como fator de risco. MÉTODO: Estudo transversal, descritivo, de amostra representativa de alunos regularmente matriculados na Faculdade de Medicina da Universidade Federal de Goiás. Foram selecionados 287 alunos do primeiro ao sexto ano através de sorteio aleatório simples. Utilizou-se, para avaliação, o Inventário de Depressão de Beck e um questionário de identificação. RESULTADOS: Na população entrevistada, 26,8% apresentaram sintomas depressivos de acordo com escores do Inventário de Depressão de Beck estabelecidos para este estudo. A prevalência de sintomas depressivos moderados e graves entre os entrevistados foi de 6,9%, enquanto 19,9% apresentaram sintomas leves. Em relação ao sexo, encontrou-se 33,5% de mulheres e 19% de homens com sintomas depressivos. Em relação ao ano em curso, houve maior prevalência entre os alunos do terceiro e do quarto ano. Tristeza, anedonia, baixa auto-estima, perfeccionismo, irritabilidade, desinteresse por pessoas, redução da capacidade de trabalho e cansaço excessivo foram os itens do Inventário de Depressão de Beck mais pontuados. CONCLUSÃO: A prevalência de sintomas depressivos encontrada neste estudo é superior à média encontrada na população em geral, havendo indicativo de que a escola médica possa ser um fator predisponente para tais sintomas.

What it's really like: the complex role of medical students in end-of-life care

BACKGROUND

Medical student end-of-life care training provides insight into the hidden curriculum and physician professional development.

DESCRIPTION

Second-year medical students at a university medical center listen to a panel discussion of 4th-year students and residents describing their end-of-life care experiences during clerkships. This discussion is intended to provide "anticipatory guidance" to 2nd-year students about challenging situations they might encounter on the wards. The purpose of this study was to analyze the content of the panel discussions by 4th-year students and residents to better understand their views of the end-of-life care curriculum.

EVALUATION

We performed a qualitative content analysis of transcripts from 2 years of panel discussions. Participants' comments focused primarily on the complexity of the role of medical students in end-of-life care. Three major themes emerged in the sessions: defining professional identity, conflicting expectations, and limited medical experience.

CONCLUSIONS

The role of medical students in end-of-life care can be complex, confusing, and contradictory. Emotional support and elucidating the hidden curriculum may assist students with the process of physician enculturation and end-of-life care education.

EXPERIENCED STRESS, PSYCHOLOGICAL SYMPTOMS, SELF-RATED HEALTH AND ACADEMIC ACHIEVEMENT: A LONGITUDINAL STUDY OF SWEDISH UNIVERSITY STUDENTS

In this study we investigated whether or not problems experienced during years at university affect academic achievement. Students enrolled full-time at a Swedish university were followed up from their year of entry in 1998/1999 through to 2000/2001 (N = 1,127) by self-administered questionnaires. Students' sociodemographic characteristics, their experience of stressors, psychological symptoms, and mental and general health ratings were linked to their academic achievement (degree completed). The extent to which various factors or groups of factors affect academic achievement was measured by a series of multiple logistic regression analyses. Older students, females, and those enrolled on comparatively shorter programs (3 years) tended to have higher odds of being awarded a degree. Experienced stress brought on by not coping academically and due to study support demands was a substantial barrier to students' academic achievement.

The first-year veterinary student and mental health: the role of common stressors

The present study evaluated the impact of academic and non-academic stressors on depression levels in a longitudinal investigation of 78 first-year veterinary medical students enrolled at Kansas State University (KSU). Students completed the Center for Epidemiological Studies Depression Scale during their first and second semesters to evaluate the dependent variable, depression. Students provided information about specific stressors and relevant demographic variables that yielded independent variables. One-third of veterinary medical students surveyed in their first and second semesters reported depression levels above the clinical cut-off; 15% of the sample experienced an increase in depression of at least one standard deviation, despite the apparent stability of the proportion of students experiencing significant depressive symptoms. Students whose depression scores increased by one standard deviation or who maintained scores above the clinical cut-off score were identified as struggling. Struggling students reported more first-semester homesickness and academic concerns, along with difficulty fitting in with peers and poorer perceived physical health during the second semester. This study helped to identify those students most prone to develop or maintain concerning depression scores. The discussion section addresses specific suggestions for intervening with struggling students.

Religiosity, anxiety, and depression among a sample of Iranian medical students

OBJECTIVE

There are many studies of religion and mental health in a Christian context, but studies in Islamic countries are few. Most previous studies used only a single question for measuring religion, and several of them showed negative associations between religion and indexes of anxiety or depression among older people. This study preliminary assesses the associations between religious variables, anxiety, and depression in a sample of Muslim students.

METHOD

This cross-sectional study examines a sample of medical students (N = 285) for association(s) between religiosity, anxiety, and depression. The subjects completed a Muslim religiosity questionnaire including religious beliefs, emotions, and behaviors subscales and the Beck anxiety and depression inventories during their psychiatry rotation at Roozbeh psychiatric hospital, Tehran, Iran.

RESULTS

all the three religious subscales were negatively associated with and negatively predicted depression and anxiety; but only prediction of anxiety by the religious beliefs score was statistically significant.

CONCLUSIONS

These findings provide further evidence for a protective role of religion against anxiety and depression but more studies are required.