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Bennett-Weston A, Keshtkar L, Jones M, Sanders C, Lewis C, Nockels K, Solomon J, Howick J. Interventions to promote medical student well-being: an overview of systematic reviews. BMJ Open 2024; 14:e082910. [PMID: 38724055 PMCID: PMC11086405 DOI: 10.1136/bmjopen-2023-082910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE To conduct an overview of systematic reviews that explore the effectiveness of interventions to enhance medical student well-being. DESIGN Overview of systematic reviews. DATA SOURCES The Cochrane Library of Systematic Reviews, MEDLINE, APA PsychInfo, CINAHL and Scopus were searched from database inception until 31 May 2023 to identify systematic reviews of interventions to enhance medical student well-being. Ancestry searching and citation chasing were also conducted. DATA EXTRACTION AND SYNTHESIS The Assessing the Methodological Quality of Systematic Reviews V.2 tool was used to appraise the quality of the included reviews. A narrative synthesis was conducted, and the evidence of effectiveness for each intervention was rated. RESULTS 13 reviews (with 94 independent studies and 17 616 students) were included. The reviews covered individual-level and curriculum-level interventions. Individual interventions included mindfulness (n=12), hypnosis (n=6), mental health programmes (n=7), yoga (n=4), cognitive and behavioural interventions (n=1), mind-sound technology (n=1), music-based interventions (n=1), omega-3 supplementation (n=1), electroacupuncture (n=1) and osteopathic manipulative treatment (n=1). The curriculum-level interventions included pass/fail grading (n=4), problem-based curriculum (n=2) and multicomponent curriculum reform (n=2). Most interventions were not supported by sufficient evidence to establish effectiveness. Eleven reviews were rated as having 'critically low' quality, and two reviews were rated as having 'low' quality. CONCLUSIONS Individual-level interventions (mindfulness and mental health programmes) and curriculum-level interventions (pass/fail grading) can improve medical student well-being. These conclusions should be tempered by the low quality of the evidence. Further high-quality research is required to explore additional effective interventions to enhance medical student well-being and the most efficient ways to implement and combine these for maximum benefit.
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Affiliation(s)
- Amber Bennett-Weston
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester College of Life Sciences, Leicester, UK
| | - Leila Keshtkar
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester College of Life Sciences, Leicester, UK
| | - Max Jones
- Leicester Medical School, University of Leicester College of Life Sciences, Leicester, UK
| | - Christopher Sanders
- Leicester Medical School, University of Leicester College of Life Sciences, Leicester, UK
| | - Cara Lewis
- Dartmouth College, Hanover, New Hampshire, USA
| | - Keith Nockels
- University Library, University of Leicester, Leicester, UK
| | - Josie Solomon
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester College of Life Sciences, Leicester, UK
- University of Lincoln, Lincoln, UK
| | - Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester College of Life Sciences, Leicester, UK
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Moore MB, Yang D, Raines AM, Bailey RK, Beg W. Intersection of anxiety and negative coping among Asian American medical students. Front Psychol 2022; 13:929227. [PMID: 36118486 PMCID: PMC9478586 DOI: 10.3389/fpsyg.2022.929227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Asian Americans comprise 21% of matriculating medical students in the United States but little is known about their mental health. With the growing focus on addressing the mental health of medical students, this systematic, nationwide survey assesses the relationship between anxiety and depression symptoms and coping skills among Asian American medical students. Materials and methods A survey tool comprised of Patient Health Questionnaire-9, General Anxiety Disorder-7, and questions related to coping were emailed to members of the Asian Pacific American Medical Students Association enrolled in a United States medical school during the 2016–2017 academic year. We evaluated associations between anxiety and coping as well as depression and coping. Results A total of 511 Asian American medical students completed the survey. Anxiety symptoms were positively correlated with an increase in negative coping skills. Depressive symptoms were not correlated with an increase in negative coping skills. Conclusion Professionals and medical schools that aim to improve the mental health of medical students should be aware of the needs of specific populations. Asian American students who experience anxiety were more likely to utilize avoidant or negative coping strategies. In addition, Asian American students who experience depressive symptoms were not more likely to utilize these negative coping strategies. Further research must be done to evaluate the factors that influence the use of negative coping strategies to better address anxiety within the Asian American medical student population.
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Affiliation(s)
- Michelle B. Moore
- LSU Health Sciences Center New Orleans, Louisiana State University, New Orleans, LA, United States
- *Correspondence: Michelle B. Moore,
| | - David Yang
- Department of Emergency Medicine, Yale University, New Haven, CT, United States
- David Yang,
| | - Amanda M. Raines
- Southeast Louisiana Veterans Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, New Orleans, LA, United States
- Amanda M. Raines,
| | - Rahn Kennedy Bailey
- LSU Health Sciences Center New Orleans, Louisiana State University, New Orleans, LA, United States
- Rahn Kennedy Bailey,
| | - Waania Beg
- LSU Health Sciences Center New Orleans, Louisiana State University, New Orleans, LA, United States
- Waania Beg,
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Lattie EG, Kashima K, Duffecy JL. An open trial of internet-based cognitive behavioral therapy for first year medical students. Internet Interv 2019; 18:100279. [PMID: 31534911 PMCID: PMC6743024 DOI: 10.1016/j.invent.2019.100279] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/21/2019] [Accepted: 09/02/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Medical students experience high rates of depression, and often face barriers to receiving traditional mental health services. Internet-based cognitive behavioral therapy (iCBT) programs offer a more accessible method of receiving care. Here, we conducted an open trial of an iCBT program for medical students and characterize program usage, program users, and self-reported psychosocial symptoms and coping skills. METHODS All incoming first year medical students at a large state-run university were invited to use an iCBT program which focused on mood management and mood symptom prevention. Participants received access to the 16-week program and completed measures of perceived stress, quality of life, and the development of cognitive and behavioral coping skills at baseline and end of program. RESULTS Of the 194 students in the class, 53 (27.32%) signed up to use the program. While the program attracted a representative portion of underrepresented minority students, program engagement among males was particularly low. Repeated use of the program was low. Self-reported symptoms of depression and anxiety were low at baseline, and continued to be low at end of program. Slight increases were observed from baseline to end of program in the self-reported use of cognitive coping skills. CONCLUSIONS Digital mental health tools appear to be of interest to first year medical students, but need to be better designed to support continued program use and to attract specific subgroups of students who may face additional barriers to seeking mental health services.
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Affiliation(s)
- Emily G. Lattie
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
| | - Kathleen Kashima
- College of Medicine, University of Illinois, Chicago, IL, United States
| | - Jennifer L. Duffecy
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
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Frajerman A. [Which interventions improve the well-being of medical students? A review of the literature]. Encephale 2019; 46:55-64. [PMID: 31767254 DOI: 10.1016/j.encep.2019.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
Physician's psychological distress has been known for more than a century. A meta-analysis found an increase in the suicide rate among physicians, compared to the general population, with a relative risk of 1.41 for men and 2.27 for women. Among interns, the prevalence of depression or depressive symptoms is estimated at 28.8% (IC 95%=25.3%-32.5%). The suffering of medical students prior to internship has been recognized more recently. But now there are many studies, and a few meta-analyses, which have evaluated the prevalence of anxiety, depression, burnout and, more generally, the lack of well-being. Among medical students, the prevalence of depression or depressive symptoms is estimated at 27.2% (IC 95%=24.7-29.9) and that of suicidal ideation of 11.2% (CI at 95%=9.0-13.7). Another meta-analysis found a prevalence of burnout of 44.2 % (IC 95%=33.4-55.0). Since the problem has been known researchers have tested interventions to improve the well-being of students. Our work aims to review interventions to help medical students and use validated scales. A review was published in 2016 about interventions on the learning environment, and the well-being of medical students was published; 28 studies were identified. But they did not systematically use validated questionnaires allowing a quantitative approach. Interventions included: pass/fail scoring systems (n=3), mental health programs (n=4), psycho-corporal skills programs (n=7), curriculum structure (n=3), multi-component program reform (n=5), wellness programs (n=4), and counseling/mentoring programs (n=3). We chose to focus only on studies using validated questionnaires. A search was performed in the MEDLINE biomedical electronic database until July 31, 2018. The inclusion criteria were: original study, in French or English, concerning medical students prior to internship involving an intervention to improve the well-being of medical students by measuring at least one criterion of psychological distress (anxiety, burnout, depression…) using a validated scale. Thirty-six studies were included in this review. The quality of the studies is very heterogeneous. We can distinguish three types of intervention: institutional (modification of the system of notation, classification…), in-group (management of the stress, therapy full of conscience, relaxation, psychoeducation…) or individual (screening and support custom). These interventions encompass all levels of prevention (primary, secondary and tertiary). There is limited effectiveness of group interventions. This effectiveness disappeared after SIX months with the exception of institutional interventions. The data set encourages us not to favor a single type of intervention but to promote a global intervention acting at all levels. In particular, researchers can draw on studies of doctors and interns. France is late to come to the issue with few published studies on interventions to improve the well-being of students, but recent awareness seems to have taken place. Our study has some limitations: restriction to French and English, the choice to select only comparative studies using validated scales which limited the number of studies selected but also the type of interventions not all of which allow a quantitative evaluation. In the interventions not taken into account in this review, several seem promising. They mainly involve secondary prevention: improving the training of staff and students in the detection of symptoms of depression, burnout and psychological stress, screening at-risk populations, and communication campaigns to combat the stigma of psychiatric disorders and encourage students to consult. But tertiary prevention is also of interest: have psychologists and psychiatrists in the faculties accessible to students who feel the need and can also accommodate. Finally, a certain number of faculties have set up vocational guidance and selection aids that are appreciated by students but have not been evaluated for their impact on students' health. Recent studies and meta-analyses indicate a significant prevalence of outstanding medical students, however, there is reason to be optimistic. Many health professionals and researchers are interested in the problem as well as the means to remedy it. Most studies are effective in the short term. However, the methodological limitations (low number of subjects, limited follow-up time…) and the heterogeneity of studies concerning interventions (mindfulness, psychoeducation…) on students do not allow us to conclude that they are effective in the long term. It should therefore rather move towards comprehensive care acting on the three levels of prevention: primary (institutional interventions/speech groups/psycho education), secondary (screening of subjects at risk, speech groups/psycho education/others) and tertiary (individual interventions).
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Affiliation(s)
- A Frajerman
- Inserm U1266 - GDR 3557 Institut de Psychiatrie, Institut de Psychiatrie et Neurosciences de Paris, 75014 Paris, France.
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Lacasse M, Audétat MC, Boileau É, Caire Fon N, Dufour MH, Laferrière MC, Lafleur A, La Rue È, Lee S, Nendaz M, Paquette Raynard E, Simard C, Steinert Y, Théorêt J. Interventions for undergraduate and postgraduate medical learners with academic difficulties: A BEME systematic review: BEME Guide No. 56. MEDICAL TEACHER 2019; 41:981-1001. [PMID: 31081426 DOI: 10.1080/0142159x.2019.1596239] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background: Clinical teachers often struggle to report unsatisfactory trainee performance, partly because of a lack of evidence-based remediation options. Objectives: To identify interventions for undergraduate (UG) and postgraduate (PG) medical learners experiencing academic difficulties, link them to a theory-based framework and provide literature-based recommendations around their use. Methods: This systematic review searched MEDLINE, CINAHL, EMBASE, ERIC, Education Source and PsycINFO (1990-2016) combining these concepts: medical education, professional competence/difficulty and educational support. Original research/innovation reports describing intervention(s) for UG/PG medical learners with academic difficulties were included. Data extraction employed Michie's Behavior Change Techniques (BCT) Taxonomy and program evaluation models from Stufflebeam and Kirkpatrick. Quality appraisal used the Mixed Methods Appraisal Tool (MMAT). The authors synthesized extracted evidence by adapting the GRADE approach to formulate recommendations. Results: Sixty-eight articles met the inclusion criteria, most commonly addressing knowledge (66.2%), skills (53.9%) and attitudinal problems (26.2%), or learner personal issues (41.5%). The most common BCTs were Shaping knowledge, Feedback/monitoring, and Repetition/substitution. Quality appraisal was variable (MMAT 0-100%). A thematic content analysis identified 109 interventions (UG: n = 84, PG: n = 58), providing 24 strong, 48 moderate, 26 weak and 11 very weak recommendations. Conclusion: This review provides a repertoire of literature-based interventions for teaching/learning, faculty development, and research purposes.
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Affiliation(s)
- Miriam Lacasse
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
| | - Marie-Claude Audétat
- Department of Family Medicine and Emergency Medicine, Université de Montréal , Montreal , Canada
- Family Medicine Unit (UIGP), University of Geneva , Geneva , Switzerland
- Department of Family and Emergency Medicine, Université de Sherbrooke , Sherbrooke , Canada
| | | | - Nathalie Caire Fon
- Department of Family Medicine and Emergency Medicine, Université de Montréal , Montreal , Canada
| | - Marie-Hélène Dufour
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
| | | | | | - Ève La Rue
- Department of Family and Community Medicine, University of Toronto , Toronto , Canada
| | - Shirley Lee
- Unit of Development and Research (UDREM), University of Geneva , Geneva , Switzerland
- Canadian Medical Protective Association , Ottawa , Canada
| | - Mathieu Nendaz
- Family Medicine Unit (UIGP), University of Geneva , Geneva , Switzerland
- Department of Medicine, University Hospitals , Geneva , Switzerland
| | | | - Caroline Simard
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
| | - Yvonne Steinert
- Institute of Health Sciences Education, Faculty of Medicine, McGill University , Montreal , Canada
| | - Johanne Théorêt
- Department of Family Medicine and Emergency Medicine, Université Laval , Quebec City , Canada
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Witt K, Boland A, Lamblin M, McGorry PD, Veness B, Cipriani A, Hawton K, Harvey S, Christensen H, Robinson J. Effectiveness of universal programmes for the prevention of suicidal ideation, behaviour and mental ill health in medical students: a systematic review and meta-analysis. EVIDENCE-BASED MENTAL HEALTH 2019; 22:84-90. [PMID: 30918000 PMCID: PMC10270399 DOI: 10.1136/ebmental-2019-300082] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/25/2019] [Accepted: 01/17/2019] [Indexed: 12/15/2022]
Abstract
QUESTION A growing body of work suggests that medical students may be particularly at risk of mental ill health, suicidal ideation and behaviour, resulting in recent calls to develop interventions to prevent these outcomes. However, few reviews have synthesised the current evidence base regarding the effectiveness of these interventions and provided guidance to improve future intervention efforts. STUDY SELECTION AND ANALYSIS The authors conducted a systematic review to identify studies of any design reporting the effectiveness of any universal intervention to address these outcomes in medical students. Embase, MEDLINE and PsycINFO databases were searched from their respective start dates until 1 December 2017. FINDINGS Data from 39 studies were included. Most investigated the effectiveness of relatively brief interventions designed to reduce stress; most commonly using mindfulness-based or guided meditation approaches. Only one implemented an intervention specifically designed to address suicidal ideation; none investigated the effectiveness of an intervention specifically designed to address suicidal behaviour. Five investigated the effects of curriculum-level changes. Overall, there was limited evidence of an effect for these programmes at both the postintervention and longest follow-up assessment on depression, anxiety and stress. CONCLUSIONS Relatively brief, individually focused, mindfulness-based interventions may be effective in reducing levels of anxiety, depression and stress in medical students in the short term. Effects on suicidal ideation and behaviour, however, remain to be determined. There has been a significant lack of attention on organisational-level stressors associated with medical education and training.
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Affiliation(s)
- Katrina Witt
- Turning Point, Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia
- Orygen, The National Centre for Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexandra Boland
- Orygen, The National Centre for Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Lamblin
- Orygen, The National Centre for Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D McGorry
- Orygen, The National Centre for Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Keith Hawton
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Samuel Harvey
- Black Dog Institute, Sydney, New South Wales, Australia
| | | | - Jo Robinson
- Orygen, The National Centre for Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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Romo-Nava F, Bobadilla-Espinosa RI, Tafoya SA, Guízar-Sánchez DP, Gutiérrez JR, Carriedo P, Heinze G. Major depressive disorder in Mexican medical students and associated factors: A focus on current and past abuse experiences. J Affect Disord 2019; 245:834-840. [PMID: 30699867 DOI: 10.1016/j.jad.2018.11.083] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/18/2018] [Accepted: 11/11/2018] [Indexed: 01/13/2023]
Abstract
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.
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Affiliation(s)
- Francisco Romo-Nava
- Lindner Center of HOPE Research Institute, Mason, OH, USA; Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Rosa I Bobadilla-Espinosa
- Departamento de Salud Pública de la Universidad Nacional Autónoma de México (UNAM), Unidad de Medicina Familiar No. 1, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Silvia A Tafoya
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Diana P Guízar-Sánchez
- Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Joaquín R Gutiérrez
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Pilar Carriedo
- Servicios Clínicos, Instituto Nacional de Psiquiatría ``Ramón de la Fuente Muñiz", Ciudad de México, México
| | - Gerhard Heinze
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México; Unidad de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México.
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Dyrbye LN, Wittlin NM, Hardeman RR, Yeazel M, Herrin J, Dovidio JF, Burke SE, Cunningham B, Phelan SM, Shanafelt TD, van Ryn M. A Prognostic Index to Identify the Risk of Developing Depression Symptoms Among U.S. Medical Students Derived From a National, Four-Year Longitudinal Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:217-226. [PMID: 30188367 DOI: 10.1097/acm.0000000000002437] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
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.
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Affiliation(s)
- Liselotte N Dyrbye
- L.N. Dyrbye is professor of medicine and medical education, Program on Physician Well-Being, Department of Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-7820-704X. N.M. Wittlin is PhD student, Department of Psychology, Yale University, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-0858-3576. R.R. Hardeman is assistant professor, Division of Health Policy and Management, University of Minnesota, School of Public Health, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0003-3913-5933. M. Yeazel is associate professor, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota. J. Herrin is assistant professor of medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-3671-3622. J.F. Dovidio is Carl Iver Hovland Professor of Psychology and professor of public health, Department of Psychology, Yale University, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-6110-8344. S.E. Burke is assistant professor, Department of Psychology, Syracuse University, Syracuse, New York; ORCID: https://orcid.org/0000-0002-6952-924X. B. Cunningham is assistant professor of health disparities, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-3205-5538. S.M. Phelan is associate professor of health services research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2091-6297. T.D. Shanafelt is Jeanie and Stewart Ritchie Professor of Medicine and associate dean, Stanford School of Medicine, Stanford, California; ORCID: https://orcid.org/0000-0002-7106-5202. M. van Ryn is Grace Phelps Distinguished Professor, Oregon Health & Science University School of Nursing, Portland, Oregon; ORCID: https://orcid.org/0000-0002-4258-7319
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Ayala EE, Winseman JS, Johnsen RD, Mason HRC. U.S. medical students who engage in self-care report less stress and higher quality of life. BMC MEDICAL EDUCATION 2018; 18:189. [PMID: 30081886 PMCID: PMC6080382 DOI: 10.1186/s12909-018-1296-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 07/25/2018] [Indexed: 05/04/2023]
Abstract
BACKGROUND Research on student wellness has highlighted the importance of self-care for medical students; however, scholars have yet to identify the extent to which self-reported engagement in self-care behaviors is associated with attenuation of the negative relationship between stress and quality of life during the initial years of medical education. METHODS Using a self-report survey designed to measure self-care, perceived stress, and quality of life, we hypothesized that self-care would moderate the relationship between stress and psychological quality of life in medical students, as well as stress and physical quality of life. An online questionnaire was completed by 871 medical students representing 49 allopathic medical colleges throughout the U.S. between December 2015 and March 2016. The survey assessed perceived stress, self-care, quality of life and a variety of demographic variables. Regression analyses were used to assess interaction effects of self-care on the relationships between stress and quality of life. RESULTS Self-reported engagement in self-care appeared to moderate the relationships between perceived stress and both physical (p < .001) and psychological (p = .002) quality of life. As the level of reported engagement in self-care increased, the strength of the inverse relationship between perceived stress and both physical and psychological quality of life appeared to weaken. CONCLUSIONS Our findings suggest that self-reported engagement in self-care activities is associated with a decrease in the strength of the relationship between perceived stress and quality of life in medical students. Students who disclose utilizing a multitude of self-care practices throughout their training may also sustain greater resiliency and lower risk for higher levels of distress during medical education.
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Affiliation(s)
- Erin E. Ayala
- Department of Counseling Psychology, Saint Mary’s University of Minnesota, 2500 Park Avenue, Minneapolis, MN 55404 USA
| | - Jeffrey S. Winseman
- Department of Psychiatry, Albany Medical College, 25 Hackett Blvd, Albany, NY 12208 USA
| | - Ryan D. Johnsen
- Department of Emergency Medicine, HealthPartners Institute Regions Hospital, 640 Jackson Avenue, Saint Paul, MN 55101 USA
| | - Hyacinth R. C. Mason
- Departments of Medical Education and Family and Community Medicine, Albany Medical College, 47 New Scotland Avenue, 12208 Albany, NY, USA
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Basudan S, Binanzan N, Alhassan A. Depression, anxiety and stress in dental students. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2017; 8:179-186. [PMID: 28553831 PMCID: PMC5457790 DOI: 10.5116/ijme.5910.b961] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 05/08/2017] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To measure the occurrence and levels of depression, anxiety and stress in undergraduate dental students using the Depression, Anxiety and Stress Scale (DASS-21). METHODS This cross-sectional study was conducted in November and December of 2014. A total of 289 dental students were invited to participate, and 277 responded, resulting in a response rate of 96%. The final sample included 247 participants. Eligible participants were surveyed via a self-reported questionnaire that included the validated DASS-21 scale as the assessment tool and questions about demographic characteristics and methods for managing stress. RESULTS Abnormal levels of depression, anxiety and stress were identified in 55.9%, 66.8% and 54.7% of the study participants, respectively. A multiple linear regression analysis revealed multiple predictors: gender (for anxiety b=-3.589, p=.016 and stress b=-4.099, p=.008), satisfaction with faculty relationships (for depression b=-2.318, p=.007; anxiety b=-2.213, p=.004; and stress b=-2.854, p<.001), satisfaction with peer relationships (for depression b=-3.527, p<.001; anxiety b=-2.213, p=.004; and stress b=-2.854, p<.001), and dentistry as the first choice for field of study (for stress b=-2.648, p=.045). The standardized coefficients demonstrated the relationship and strength of the predictors for each subscale. To cope with stress, students engaged in various activities such as reading, watching television and seeking emotional support from others. CONCLUSIONS The high occurrence of depression, anxiety and stress among dental students highlights the importance of providing support programs and implementing preventive measures to help students, particularly those who are most susceptible to higher levels of these psychological conditions.
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Affiliation(s)
- Sumaya Basudan
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Saudi Arabia
| | - Najla Binanzan
- Endodontic Postgraduate Program at the College of Dentistry, King Saud University, Saudi Arabia
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Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, Sen S, Mata DA. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA 2016; 316:2214-2236. [PMID: 27923088 PMCID: PMC5613659 DOI: 10.1001/jama.2016.17324] [Citation(s) in RCA: 1144] [Impact Index Per Article: 143.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies. OBJECTIVE To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students. DATA SOURCES AND STUDY SELECTION Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included. DATA EXTRACTION AND SYNTHESIS Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. MAIN OUTCOMES AND MEASURES Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview. RESULTS Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, -0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%. CONCLUSIONS AND RELEVANCE In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.
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Affiliation(s)
- Lisa S Rotenstein
- Harvard Medical School, Boston, Massachusetts2Harvard Business School, Boston, Massachusetts
| | - Marco A Ramos
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Matthew Torre
- Harvard Medical School, Boston, Massachusetts4Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Michael J Peluso
- Harvard Medical School, Boston, Massachusetts5Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Srijan Sen
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor8Department of Psychiatry, University of Michigan, Ann Arbor
| | - Douglas A Mata
- Harvard Medical School, Boston, Massachusetts9Division of MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts10Brigham Education Institute, Boston, Massachusetts
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Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, Sen S, Mata DA. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA 2016. [PMID: 27923088 DOI: 10.1001/jama.2016.17324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies. Objective To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students. Data Sources and Study Selection Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included. Data Extraction and Synthesis Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Main Outcomes and Measures Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview. Results Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, -0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%. Conclusions and Relevance In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.
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Affiliation(s)
- Lisa S Rotenstein
- Harvard Medical School, Boston, Massachusetts2Harvard Business School, Boston, Massachusetts
| | - Marco A Ramos
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Matthew Torre
- Harvard Medical School, Boston, Massachusetts4Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Michael J Peluso
- Harvard Medical School, Boston, Massachusetts5Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Srijan Sen
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor8Department of Psychiatry, University of Michigan, Ann Arbor
| | - Douglas A Mata
- Harvard Medical School, Boston, Massachusetts9Division of MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts10Brigham Education Institute, Boston, Massachusetts
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Wasson LT, Cusmano A, Meli L, Louh I, Falzon L, Hampsey M, Young G, Shaffer J, Davidson KW. Association Between Learning Environment Interventions and Medical Student Well-being: A Systematic Review. JAMA 2016; 316:2237-2252. [PMID: 27923091 PMCID: PMC5240821 DOI: 10.1001/jama.2016.17573] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Concerns exist about the current quality of undergraduate medical education and its effect on students' well-being. OBJECTIVE To identify best practices for undergraduate medical education learning environment interventions that are associated with improved emotional well-being of students. DATA SOURCES Learning environment interventions were identified by searching the biomedical electronic databases Ovid MEDLINE, EMBASE, the Cochrane Library, and ERIC from database inception dates to October 2016. Studies examined any intervention designed to promote medical students' emotional well-being in the setting of a US academic medical school, with an outcome defined as students' reports of well-being as assessed by surveys, semistructured interviews, or other quantitative methods. DATA EXTRACTION AND SYNTHESIS Two investigators independently reviewed abstracts and full-text articles. Data were extracted into tables to summarize results. Study quality was assessed by the Medical Education Research Study Quality Instrument (MERQSI), which has a possible range of 5 to 18; higher scores indicate higher design and methods quality and a score of 14 or higher indicates a high-quality study. FINDINGS Twenty-eight articles including at least 8224 participants met eligibility criteria. Study designs included single-group cross-sectional or posttest only (n = 10), single-group pretest/posttest (n = 2), nonrandomized 2-group (n = 13), and randomized clinical trial (n = 3); 89.2% were conducted at a single site, and the mean MERSQI score for all studies was 10.3 (SD, 2.11; range, 5-13). Studies encompassed a variety of interventions, including those focused on pass/fail grading systems (n = 3; mean MERSQI score, 12.0), mental health programs (n = 4; mean MERSQI score, 11.9), mind-body skills programs (n = 7; mean MERSQI score, 11.3), curriculum structure (n = 3; mean MERSQI score, 9.5), multicomponent program reform (n = 5; mean MERSQI score, 9.4), wellness programs (n = 4; mean MERSQI score, 9.0), and advising/mentoring programs (n = 3; mean MERSQI score, 8.2). CONCLUSIONS AND RELEVANCE In this systematic review, limited evidence suggested that some specific learning environment interventions were associated with improved emotional well-being among medical students. However, the overall quality of the evidence was low, highlighting the need for high-quality medical education research.
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Affiliation(s)
- Lauren T. Wasson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Amberle Cusmano
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Laura Meli
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Irene Louh
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | | | - Geoffrey Young
- Association of American Medical Colleges, Washington, D.C
| | - Jonathan Shaffer
- Department of Psychology, College of Liberal Arts and Sciences, University of Colorado at Denver
| | - Karina W. Davidson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
- NewYork-Presbyterian Hospital, New York, NY
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Melo K, Williams B, Ross C. The impact of nursing curricula on clinical practice anxiety. NURSE EDUCATION TODAY 2010; 30:773-778. [PMID: 20381219 DOI: 10.1016/j.nedt.2010.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 02/18/2010] [Accepted: 02/27/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND High levels of anxiety during clinical practice in nursing education may interfere with learning and contribute to poor mental health. The relationship between undergraduate curriculum design and clinical practice anxiety is unknown. METHODS A descriptive, comparative research design was used to compare levels of clinical practice anxiety in third year baccalaureate nursing students in a problem-based learning (PBLP) curriculum (n=53) with those in a traditional, lecture-based (TNP) curriculum (n=42). A secondary aim of this study was to explore relationships between some of the demographic characteristics of the student sample, students' predisposition to anxiety, clinical learning experiences, and clinical practice anxiety. Students anonymously completed three electronic questionnaires including: a demographic questionnaire, the Spielberger State-Trait Anxiety Inventory (STAI), and the Clinical Experience Assessment Form (CEAF). FINDINGS The PBL and the traditional group did not significantly differ on clinical practice anxiety. The mean scores on the STAI for this sample of nursing students were higher than those previously reported for the general population of university students. Implications for nursing education: strategies aimed at reducing nursing students' clinical practice anxiety are explored.
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Affiliation(s)
- Katherine Melo
- Faculty of Nursing, University of Alberta, 3rd Floor Clinical Sciences Building, University of Alberta, Edmonton, AB, Canada.
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Roh MS, Jeon HJ, Kim H, Han SK, Hahm BJ. The prevalence and impact of depression among medical students: a nationwide cross-sectional study in South Korea. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:1384-90. [PMID: 20453812 DOI: 10.1097/acm.0b013e3181df5e43] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
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.
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Affiliation(s)
- Myoung-Sun Roh
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
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Dyrbye LN, Thomas MR, Huschka MM, Lawson KL, Novotny PJ, Sloan JA, Shanafelt TD. A multicenter study of burnout, depression, and quality of life in minority and nonminority US medical students. Mayo Clin Proc 2006; 81:1435-42. [PMID: 17120398 DOI: 10.4065/81.11.1435] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the well-being of minority medical students in a multicenter sample of US medical students. PARTICIPANTS AND METHODS All 1098 medical students at 3 medical schools in Minnesota were surveyed in April 2004. Validated instruments were used to assess burnout, depression, and quality of life (QOL). Students were also asked about the prevalence of significant personal life events in the previous 12 months and strategies used to cope with stress. RESULTS Although symptoms of depression and overall burnout were similar among minority and nonminority students, minority students were more likely to have a low sense of personal accomplishment (P=.02) and lower QOL In a number of domains (all P< or =.05). These differences persisted on multivariate analysis that controlled for demographic characteristics and recent life events. Minority students were also more likely to have a child (P=.01), originate from outside Minnesota (P<.001), and experience a major personal Illness in the last 12 months (P=.03). CONCLUSION As a group, the minority medical students in this survey had a lower sense of personal accomplishment and QOL than nonminority students. Additional studies are needed to provide insight regarding the causes of these inequities and the unique challenges faced by minority medical students. Efforts to improve minority students' well-being, QOL, and learning experience may help prevent attrition among minority medical students and promote diversification in the physician workforce.
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Affiliation(s)
- Liselotte N Dyrbye
- Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
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Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:354-73. [PMID: 16565188 DOI: 10.1097/00001888-200604000-00009] [Citation(s) in RCA: 1242] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE To systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students. METHOD Medline and PubMed were searched to identify peer-reviewed English-language studies published between January 1980 and May 2005 reporting on depression, anxiety, and burnout among U.S. and Canadian medical students. Searches used combinations of the Medical Subject Heading terms medical student and depression, depressive disorder major, depressive disorder, professional burnout, mental health, depersonalization, distress, anxiety, or emotional exhaustion. Reference lists of retrieved articles were inspected to identify relevant additional articles. Demographic information, instruments used, prevalence data on student distress, and statistically significant associations were abstracted. RESULTS The search identified 40 articles on medical student psychological distress (i.e., depression, anxiety, burnout, and related mental health problems) that met the authors' criteria. No studies of burnout among medical students were identified. The studies suggest a high prevalence of depression and anxiety among medical students, with levels of overall psychological distress consistently higher than in the general population and age-matched peers by the later years of training. Overall, the studies suggest psychological distress may be higher among female students. Limited data were available regarding the causes of student distress and its impact on academic performance, dropout rates, and professional development. CONCLUSIONS Medical school is a time of significant psychological distress for physicians-in-training. Currently available information is insufficient to draw firm conclusions on the causes and consequences of student distress. Large, prospective, multicenter studies are needed to identify personal and training-related features that influence depression, anxiety, and burnout among students and explore relationships between distress and competency.
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Cariaga-Lo LD, Richards BF, Hollingsworth MA, Camp DL. Non-cognitive characteristics of medical students: entry to problem-based and lecture-based curricula. MEDICAL EDUCATION 1996; 30:179-186. [PMID: 8949551 DOI: 10.1111/j.1365-2923.1996.tb00740.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The effectiveness of problem-based learning (PBL) versus lecture-based learning (LBL) continues to be debated all over the world. These arguments have often been based on students' cognitive measures of performance. Little emphasis has been placed on non-cognitive factors that may directly or indirectly affect the medical school performance of students in either curriculum. The purpose of this study was to (1) document possible differences in student cognitive and non-cognitive characteristics at entry between the two curricula and (2) to explore the relationships that exist between cognitive and non-cognitive factors. Data were obtained from three medical school classes (n = 281). The results indicate that students who entered the PBL curriculum at this medical school had higher total Medical College Admission Test and undergraduate grade point average than students who entered the LBL curriculum. Students who entered the PBL curriculum were also more self-sufficient and were more likely to do well in individualistic and less structured settings. There were no strong correlations between cognitive and non-cognitive variables. Before conclusions can be drawn about the effectiveness of either PBL or LBL curricula, we need to document patterns in entry characteristics to control for a priori differences that affect student performance.
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Affiliation(s)
- L D Cariaga-Lo
- Office of Educational Research & Services, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27157, USA
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