A longitudinal study of students' depression at one medical school

Sustainable benefits of mindfulness training in health professions education

BACKGROUND

Healthcare work and even studies towards a healthcare profession is associated with a high prevalence of distress. According to recent meta-analyses, half of the medical students worldwide suffer from burn out prior to residency, and 34% of nursing students suffer from depression. The aim of this study was to investigate healthcare students' long-term experiences of mindfulness training, and whether, how and why students were continuing their mindfulness practice after graduation. Further, to assess if background characteristics were associated with continuing mindfulness practice.

METHODS

A mixed method survey study based on predetermined and open-ended questions. Qualitative and quantitative data were analysed concurrently to assess effects on, and a deepened understanding of stress management, use of mindfulness in relation to patients, oneself and others, and continued practice of mindfulness.

RESULTS

Two hundred one of the 380 (52,8%) students completing the mindfulness based stress management course (MBSM) answered the questionnaire. Of all, 175 (87,1%) students also answered free text questions. The qualitative analysis identified five themes: "Positive" Experiences, "Negative" Experiences, "Origin and development of interest in mindfulness" and "Continuing practice of mindfulness". A considerable proportion of the participants experienced increased acceptance, relaxation, ability to face difficulties, self-compassion and better interaction with patients, but some participants also experienced negative experiences such as aversiveness and ineffectiveness of the course. Those continuing to practice mindfulness after graduation were more likely (85.3%) to say that the gained competence helped in their relationship with patients, compared to those who did not continue to practice (57.1%); (chi2 = 18.13; df = 2; p < 0.001). Among those who had previous mindfulness or similar experience, 84% continue to practice mindfulness after the course, compared to 50% of those who had no previous experience (chi2 = 26; df = 1; p < 0.001).

CONCLUSION

The long-term follow-up of mindfulness training for healthcare students shows that participants maintain a sustained capability to handle stressful work situations in their professional practice and develop a more compassionate relationship with themselves. We argue that skills to care for one's inner environment, such as learning mindfulness as a student, can contribute to a sustainable future professional life. However, further research is needed to confirm the transferability of the results.

Mental Health in Swiss Veterinary Medicine Students: Variables Associated with Depression Scores

Mental health and well-being in veterinary students has become an important area of study, given the high levels of mental distress compared to other professions. Although research has identified poor mental health of veterinary students, few studies have examined positive factors such as self-compassion, which can have a favorable effect on mental health. The aim of this study was to examine self-reported symptoms of depression and factors influencing this construct, such as loneliness, self-compassion, and various demographic aspects in Swiss veterinary students. A sample of 374 Swiss veterinary students completed online measures including a demographic questionnaire, the Center for Epidemiological Studies Depression Scale-Revised (CESD-R), a short form of the University of California Loneliness Scale (UCLA-9), and the short form of the Self-Compassion Scale (SCS-SF). Results showed that 54.3% of the students were above the CESD-R cut-off score for depression, indicating a higher likelihood to suffer from depression. Results from the backward selection linear regression showed loneliness to be a risk factor, while self-compassion and rural upbringing were protective of depression. Findings suggest that Swiss veterinary students are highly burdened and may benefit from interventions aimed at reducing loneliness and improving self-compassion.

Factors associated with mental health and quality of life among Brazilian medical students: a three-year longitudinal study

BACKGROUND

Despite several studies on the mental health of medical students, there is insufficient research on long-term follow-ups.

AIMS

To investigate the associated factors and changes in the quality of life and mental health of a group of medical students followed-up for three years.

METHODS

An observational, prospective cohort study was conducted. Four classes were followed during the first three years of the medical course. The study included sociodemographic data, mental health data using the DASS-21 scale, and quality-of-life data using the WHOQOL-BREF scale. Linear regression models were used for analysis.

RESULTS

A total of 201 (66.1%) medical students responded to both data collection waves after a three-year follow-up. Depressive symptoms(p < 0.001), anxiety(p = 0.037), and stress(p < 0.001) increased. Additionally, physical(p < 0.001), psychological(p < 0.001), and social(p = 0.003) quality of life decreased. Worse mental health at baseline and being a woman were associated with worse mental health after three years, while higher income at baseline was associated with better quality of life after three years.

CONCLUSIONS

The mental health and quality of life of the medical students worsened after three years, being influenced by gender, income, and mental health at baseline. Educators and managers must be aware of these factors to minimize suffering in medical schools.

Unveiling the interplay of medical professionalism, mental well-being and coping in medical students: a qualitative phenomenological study

BACKGROUND

Medical students face significant stress and challenges that impact their professional development by affecting their levels of medical professionalism (MP), coping ability, and mental well-being (MWB). Given the high-stakes environment of medical education, understanding the interplay between these factors is crucial. This study aims to explore undergraduate medical students' lived experiences of MP, coping strategies (CSs), and MWB to inform the development of effective support systems.

METHODS

A qualitative phenomenological study was conducted using Focus Group Discussions (FGDs) to capture the lived experiences of 40 medical students from first, third, and fifth years of study. Participants, selected through purposive sampling, represented diverse backgrounds (with 27 females, 18 fifth-year students, and 30 Malays). Seven FGDs, each with 5-10 participants, were conducted via Zoom©, yielding comprehensive qualitative data. An inductive coding approach was applied through iterative transcript analysis to ensure robust findings.

RESULTS

Analysis revealed two themes related to MWB: 'mental well-being issues,' highlighting persistent mental health challenges, and 'happiness,' illustrating factors that sustain well-being. CSs were categorized into 'positive coping,' including seeking support, and 'negative coping,' such as denial. For MP, two themes emerged: 'inter-medical professionalism,' focusing on communication with others, and 'intra-medical professionalism,' emphasizing ethical self-conduct.

CONCLUSION

The interplay between CSs, MP, and MWB is complex and deeply intertwined. The findings highlight the importance of developing targeted interventions to support medical students in managing stress, maintaining professionalism, and enhancing their mental well-being throughout their training. Future research should further explore these themes to inform policy and curriculum development in medical education.

CLINICAL TRIAL NUMBER

Not applicable.

Burnout in dental students: Navigating stress, exhaustion and academic pressure

Background and Aim

Dentistry is quite a challenging profession which demands physical and mental efforts along with patient interaction, resulting in burnout. Student burnout is defined as 'negative reactions resulting in emotional exhaustion, depersonalization, and diminished personal accomplishment along with reduced academic efficiency due to prolonged academic stress'. Burnout is commonly associated with high stress levels, anxiety and depression. Students' well-being may improve if these psychological issues are addressed and managed at an early age. This study aimed to determine the prevalence of burnout in dental students of our institute and find its relationship to socio-demographic characteristics.

Materials and Methods

This questionnaire-based study was conducted in our institute, and a total of 200 dental students were included in the study. Students were surveyed using a self-reported questionnaire that included 25 questions related to burnout symptoms, stress, anxiety, depression and demographic characteristics. The Google Forms questionnaire was sent via e-mail to the target students, and their responses were recorded.

Results

The study showed that the following categories of students were more stressed than others: postgraduate students (28.1%), students belonging to middle-class socioeconomic status (77.4%) and female (54.3%) students.

Conclusion

It is pertinent to mention here that in our study, we have not used any specific scale like depression anxiety stress scale-21 (DASS-21), Maslach Burnout Inventory scale, etc., Instead, we prepared a questionnaire for dental students of our institute based on anxiety, stress, etc., Hence, we are of the opinion that further research is warranted to explore additional factors contributing to burnout and mental health issues among dental students and to develop effective strategies for prevention and intervention.

Anxiety, depression, and insomnia among medical and non-medical students in Jordan: a cross-sectional study

Background

Depression, the leading cause of disability worldwide, has worsened due to the COVID-19 pandemic, with key risk factors including age, gender, and socioeconomic status. Jordan is experiencing an increase in mental health issues, particularly among children, adolescents, and university students, yet negative attitudes and structural barriers limit access to mental healthcare This study provides a comprehensive analysis of depression, anxiety, and sleep quality among Jordanian undergraduate students.

Methods

This cross-sectional study was conducted between December 2023 and March 2024. The study used the Generalized Anxiety Disorder scale (GAD-7), the Patient Health Questionnaire (PHQ-9), and the Insomnia Severity Index (ISI) to evaluate these mental health factors. Data collection involved a self-administered survey, distributed online and in paper format. Multiple linear regression was utilized to pinpoint significant predictors.

Results

A total of 1181 participants completed the survey, with an average age of 20.43 years. Among the respondents, 74.2% were female, and 35.1% were medical students. Predictors of GAD-7 scores included year of study for medical students, with PHQ-9 scores and male gender serving as negative predictors. For non-medical students, both PHQ-9 and ISI scores positively predicted higher GAD-7 scores. ISI scores were positively influenced by age and PHQ-9 scores for medical students, whereas for non-medical students, age, PHQ-9, and GAD-7 scores were positive predictors.

Conclusion

The study demonstrates that non-medical students experience higher levels of depression, insomnia, and anxiety than their medical counterparts. These findings highlight the necessity for targeted mental health interventions and awareness programs for all undergraduate students.

Peer Mentoring by Medical Students for Medical Students: A Scoping Review

Medical school transitions pose challenges for students. Mentoring programs may aid students, but evidence supporting peer/near-peer mentoring in medical school is unclear. Our review explores peer mentoring's benefits, elements for success and challenges. Searches in major databases yielded 1676 records, resulting in 20 eligible studies involving 4591 participants. Longitudinal (n = 15) and shorter, focused programs were examined. Mentors and mentees reported psychosocial, professional and academic benefits. Essential elements included matching, orientation and clear goals, with training crucial yet balanced to avoid mentor overload. Social congruence underpinned successful peer mentoring, particularly benefiting under-represented groups. Challenges include balancing mentor load and logistics.

The evaluation of depressive, anxiety symptoms and sleep disturbance in college students post- pandemic era across UAE: a multicentric survey

The COVID-19 epidemic has had a significant worldwide impact, requiring measures such as quarantine, social isolation, and the closing down of educational institutions, increasing concerns about student safety. This study evaluated the mental health and sleep status of 201 college students in the UAE after the epidemic. The sample consisted primarily of females (72.1%) and students aged 21-23 years (42.3%), with the majority residing in Dubai (62.7%). The findings revealed unsettling levels of insomnia risk and significant gender variations in emotional states, with females displaying higher degrees of distress. These findings underscore the negative consequences of the pandemic on student well-being and the importance of having access to mental health care, as well as calling for specialized treatments to address the individual needs of various student groups.

Rate and sociodemographic correlates of depression, anxiety, and stress among domestic and overseas medical students: A cross-sectional observation from a private medical college in Bangladesh

Background

Depression, anxiety, and stress are the commonly encountered mental health conditions among medical students. Overseas environment may add additional burden to the existing environment. However, comparison of the rate and associated factors of depression, anxiety, stress among domestic and overseas students has not been attempted in Bangladesh. We aimed to assess the rate and associated factors of depression, anxiety, stress among domestic and overseas medical students in the country.

Methods

This cross-sectional study was conducted among 360 undergraduate medical students in 2021. Data were collected by self-reporting instruments by a stratified random sampling method by the Depression, Anxiety, and Stress Scale-21 scale. Bivariable and multivariable binary logistic regression analyses were done by computing crude odds ratio and adjusted odds ratio with 95% confidence interval to identify the associated factors.

Results

Among the 360 undergraduate medical students, 181 were domestic and 179 overseas ones. 44.8% of domestic students reported depressive symptoms, 45.3% reported anxiety symptoms, and 33.1% reported stress. On the other hand, half of overseas students experienced depression (50.3%) and anxiety (52.5%), and 41.3% experienced stress. Female medical students were found vulnerable for developing depression, anxiety, and stress than males.

Conclusions

The study revealed higher rates of depression, anxiety, and stress among overseas undergraduate medical students enrolled in a private medical school of Bangladesh. Private medical college authorities could consider special services for overseas students to ensure adequate psychosocial support.

Unraveling psychological burden: the interplay of socio-economic status, anxiety sensitivity, intolerance of uncertainty, and stress in first-year medical students

BACKGROUND

The escalating prevalence of mental health issues among young adults, set against the backdrop of a global healthcare system under pressure, underscores the necessity for cultivating a resilient medical workforce. This study investigates the influence of socio-economic status (SES) on psychological well-being, with a particular focus on Anxiety Sensitivity (AS) and Intolerance of Uncertainty (IU) among first-year medical students. Understanding the psychological dimensions affecting medical students is crucial for fostering a future medical workforce that is both capable and mentally healthy.

METHODS

This research involved 321 first-year medical students, evaluated using the Perceived Stress Questionnaire (PSQ), Anxiety Sensitivity Index (ASI), the Intolerance of Uncertainty Scale (UI-18), and the Student Self-Efficacy Scale (SSE), alongside socio-economic categorization. Employing descriptive statistics, ANOVA, and correlation analyses, the study aimed at elucidating the SES impact on AS and IU, among other psychological constructs.

RESULTS

The analysis revealed significant SES-related differences, especially in the realms of Anxiety Sensitivity and Intolerance of Uncertainty. Notably, ASI_C (cognitive concerns) exhibited strong positive correlations with both UI_A (reduced ability to act due to IU) (Pearson's r = 0.562, p < 0.001) and UI_B (burden due to IU) (Pearson's r = 0.605, p < 0.001), highlighting the link between cognitive aspects of anxiety and uncertainty intolerance. Furthermore, UI_C (vigilance due to IU) was significantly associated with SES (F(4, 316) = 2.719, p = 0.030, η² = 0.033), pointing to the complex ways in which socio-economic factors modulate responses to uncertainty. Self-efficacy emerged as a significant counterbalance, showing protective associations against the adverse effects of heightened Anxiety Sensitivity and Intolerance of Uncertainty.

CONCLUSION

Our findings indicate that lower socio-economic status is associated with higher levels of Anxiety Sensitivity and Intolerance of Uncertainty, which contribute to increased stress among first-year medical students. Additionally, Self-Efficacy emerged as a significant protective factor, mitigating the expressions of AS and IU. Although medical faculties cannot change SES characteristics within their student body, recognizing its impact allows for the development of tailored support systems to address the unique challenges faced by students from diverse socio-economic backgrounds. This study underscores the necessity of considering social diversity, particularly regarding AS and IU characteristics, to foster a supportive and effective medical education environment with an outlook on sustainable mental health in a demanding work context.

How Student and Faculty Perceptions Differ on the Stressors that Medical Students Face

OBJECTIVES

Medical education is notorious for the stress that students face as they strive to succeed both academically and clinically. This stress has been linked to declining academic performance and worsening mental health. To combat these negative outcomes, it is essential for medical school faculty and administration to address common stressors among medical students. No studies have addressed whether medical school faculty and students perceive stressors similarly, however.

METHODS

In this two-part study, data collected from medical students in 2021 to 2022 to identify their most significant sources of stress were used to create a survey that queries the frequency and intensity of these stressors. This survey was distributed to medical students and faculty at the same institution. The responses between students and faculty were compared and student data also were analyzed by academic year to observe changes in perception that accompany progression through the medical curriculum.

RESULTS

The results showed that faculty overestimated the impact of certain stressors on medical students (eg, in-house examinations, US Medical Licensing Examination Steps 1 and 2 examinations, and patient interactions). In addition, preclinical students were more concerned with finding extracurricular activities, missing opportunities, and performing research compared with clinical students.

CONCLUSIONS

This study demonstrated that although faculty anticipated most medical student stressors, there are significant gaps that still need to be addressed to better reduce and respond to the stress experienced by medical students.

The prevalence of depression and anxiety among medical students in Yemen: A cross-sectional study

BACKGROUND

Medical students may experience mental health disorders like anxiety and depression during medical school, which can negatively impact their productivity, education, and overall quality of life. Currently, there are no studies examining the mental health of medical students in Yemen. Our study aimed to estimate prevalence of depression and anxiety among Yemeni medical students.

METHODS

The study utilized a cross-sectional design. A survey was conducted using validated psychometric tests: the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. A survey of medical students from 10 Yemeni medical schools took place from June 6 to July 20, 2023. It included only actively enrolled students in the 7-year undergraduate program.

RESULTS

A total of 706 responses were collected. The prevalence of depression was 48.4 % for cases classified as moderate, moderately severe, and severe, while it was 20 % for cases categorized as moderately severe and severe. The rate of suicide ideation was 14.7 %. Anxiety was found to have a prevalence of 34.8 % for cases categorized as moderate and severe. Furthermore, both depression and anxiety were higher among females, and in earlier academic years; all of these associations had a p-value <0.05. Conversely, age, living status, income stability, and displacement risk all showed no significant association with depression or anxiety.

CONCLUSION

Our study highlighted the prevalence of depression and anxiety among Yemeni medical students. Tailored interventions are imperative to address these challenges. Future research needs to examine the root causes that might contribute to these disorders.

Mental health and quality of life across 6 years of medical training: A year-by-year analysis

BACKGROUND

Despite growing evidence on medical students' mental health deterioration, studies have primarily used short follow-up periods and not followed the students throughout their medical training.

OBJECTIVE

To assess mental health (stress, anxiety, and depression) and quality of life changes throughout their medical program, we followed up with the same cohort of students for 6 years.

METHODS

This longitudinal prospective study followed up with the same group of medical students at a Brazilian public medical school from 2014 to 2020. The study analyzed sociodemographic data, mental health (including depression, anxiety, and stress [DASS-21]), quality of life (WHOQOL-BREF), satisfaction from studying to be a physician, and happiness with life. General linear mixed models were used for the analyses.

RESULTS

The cohort included 80 Brazilian medical students (63.7% women; mean age = 19.6 years [SD = 2.21]). A high prevalence of depressive symptoms, anxiety, and stress was found throughout medical training, with more than 50% of students having significant symptoms. Mental health, happiness, and quality of life levels tended to be better in the first and last semesters, being worse in the middle of the program. However, satisfaction from studying to become a doctor decreased in the second semester, remained low throughout the program, and never returned to baseline levels.

CONCLUSION

Mental health and quality of life levels remained high throughout the medical program, with better levels in the first and last semesters and falling in the middle of the program. These data can help managers and educators understand how psychological distress affects medical students.

Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints

PURPOSE

Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary.

METHODS

Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed.

RESULTS

221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once.

CONCLUSIONS

Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.

A Pilot Study of Symptoms of Major Depressive Disorder in Medical Students at an Osteopathic Medical School Before and After High-Stakes Examinations

Background

Given the high prevalence of symptoms of major depressive disorder (MDD) in medical students, identifying factors that impact the development of such symptoms is important. Previous data suggest that medical students can experience symptoms of MDD after medical school exams. It is not known if medical students experience more symptoms of MDD directly before or after exams. The aim of the current study is to determine the prevalence of symptoms of MDD in first- and second-year medical students directly before and after high-stakes medical school examinations.

Methods

Two anonymous surveys were sent via REDCap to first- and second-year medical students at the University of New England College of Osteopathic Medicine. A pre-exam survey on the day of the exam asking about the past three days' MDD symptoms, and a post-exam survey sent three days after the exam asking about MDD symptoms experienced after the exam was sent out to a total of 391 students with a response rate of 23%.

Results

First- and second-year medical students regardless of gender experienced symptoms of MDD at higher rates before exams than afterwards. Female students experienced symptoms of MDD (as defined by the DSM-5) including sadness, sleep disturbances, and feelings of guilt or worthlessness at a greater rate compared to males before exams. After exams, females were more likely to experience sleep disturbances and decreased energy. Second-year male students were the least likely to experience symptoms of MDD.

Conclusion

First- and second-year medical students can experience symptoms of MDD surrounding exams. This study highlights the emotional burden that students may carry near exams. It underscores the importance of further research on this topic to evaluate the effect exams have on the mental health of medical students during their training.

A Case-Control Study on Factors Associated With Secondary Amenorrhea Among the Medical Students of Universiti Malaysia Sabah

BACKGROUND AND AIM

This study aimed to evaluate the association between body mass index (BMI), anxiety, stress, depression, hormones, and secondary amenorrhea among female medical students at Universiti Malaysia Sabah (UMS).

METHODS

In this case-control study, UMS undergraduate female medical students aged 19-25 years who did not menstruate in the last three months (with a previous history of a regular menstrual cycle) or six months (with a history of irregular menstruation) were included as cases (40 students), and students with similar criteria but no menstrual irregularities were recruited in the study as controls (40 students). The study was conducted at Polyclinic UMS from January 1, 2021, until December 31, 2022. The chi-squared test and odd ratio examined the association of the above-mentioned factors with the secondary amenorrhea. A p-value less than 0.05 was considered significant, and an odds ratio if the confidence interval did not contain one was considered significant.

RESULT

Both the groups had a similar frequency of different BMI grades. The cases exhibited significantly higher levels of depression, anxiety, and stress than the controls. Again, the cases demonstrated higher estradiol (E2), testosterone, and thyroid-stimulating hormone (TSH) levels and lower levels of luteinizing hormone (LH) than those with regular menstruation. The research also revealed that a one-unit decrease in follicle-stimulating hormone (FSH) levels corresponds to a threefold increase in the risk of experiencing secondary amenorrhea, while the risk escalates to fourfold for LH. Moreover, E2, testosterone, and TSH levels exhibited protective effects on secondary amenorrhea.

CONCLUSION

Anxiety, serum LH, and FSH were significantly associated with secondary amenorrhea. Future studies should address the diurnal variation of the hormones and consider the participants' circumstances to get a proper effect of hormonal influence and stress.

Evaluation the validity and reliability of the perceived medical school stress scale in Turkish medical students

Medical education can be a challenging and stressful process. Additional stressors can make the medical education process even more complex and impair a student's attention and concentration. To the authors' knowledge, there is no valid and reliable scale to measure medical school stress in Turkish medical students. Therefore, this study aimed to determine the validity and reliability of the Perceived Medical School Stress (PMSS) Scale in Turkish medical students. The Perceived Medical School Stress Scale is a self-assessment tool developed to measure medical school-induced stress in medical students. It consists of 13 items divided into two subdimensions. Scale items are answered using a four-point (0-4) Likert system The total score that can be obtained from the PMSS ranges from 0 to 52, with higher scores indicating higher levels of perceived stress. First, the scale was applied as a pilot to 52 students by performing the scale's back-and-forth translation into Turkish. Then, the scale was applied to 612 volunteer medical students to ensure validity. Convergent validity and confirmatory factor analysis are used to assess the construct validity of a scale. Test-retest, item correlations, and Cronbach's alpha coefficients are used to evaluate the reliability of a scale. As a result of confirmatory factor analysis, the two-factor structure of the original scale was confirmed. The fit indices of the model obtained showed excellent fit. The Generalized Anxiety Disorder-7 (GAD-7) Scale was used for convergent validity. The GAD-7 is a self-assessment tool that measures the level of generalized anxiety. It is answered with a four-point Likert scale for the last two weeks. The score that can be obtained from the scale is between 0-21. A score of ten or more indicates possible anxiety disorder. The students' mean perceived medical school stress score was 39.80±8.09, and their GAD-7 score was 11.0±5.5. A significant positive relationship was found between the total scores of the scales (r = .48, P < .001). The Cronbach's alpha value of the scale was .81, and test-retest reliability was significant for all scale items (P < .001 for all). No item was deleted according to Cronbach's alpha values and item-total correlations. There was no significant relationship between Turkish version of the PMSS and GAD-7 scores and age, sex, income status, tobacco use, or exercise (P>.05). The Turkish version of the Perceived Medical School Stress Scale is a valid and reliable scale that can be used to investigate the medical school-specific stress of students.

Suicidal ideation, attempts and its determinants among young adults in Meghalaya: a cross sectional study

OBJECTIVES

Suicide is a major health issue in India. With the advent of the COVID-19 pandemic, people have experienced loss on a tremendous scale. The impact of these losses on the youth will be massive leading to a rise in depression cases, suicidal ideation and ultimately suicidal attempts. Hence there is a need to determine the prevalence of suicidal ideation, suicide attempts and the predictors for both suicidal ideation and attempts among the young adults in Meghalaya.

METHODS

This cross-sectional study was conducted among the students aged 18-25 years in NEIGRIHMS and Synod College in Shillong between March to April 2022. Data was collected by using questionnaire method.

RESULTS

The prevalence of suicidal ideation and suicidal attempts was found to be 15.9 % (12.3-20.3) and 5.8 % (3.7-8.9) respectively. There was a strong relationship for suicidal ideation with urban students, with less family members, those who had unhealthy relationship with their parents, stress, complicated relationship/loss of loved ones and also those with experience of violence/abuse and behavioural problems. However, the attempts were found to be associated only with the loss of the loved ones.

CONCLUSIONS

The prevalence, though smaller is a serious concern considering the fact that the burden of suicides is on a rise and hence regular mental health counselling along with the management of the stress is needed at the educational institutional level which could prove to be beneficial to the students.

An exploratory university-based cross-sectional study of the prevalence and reporting of mistreatment and student-related factors among Thai medical students

BACKGROUND

Mistreatment is a behavior that reflects disrespect for the dignity of others. Mistreatment can be intentional or unintentional, and can interfere with the process of learning and perceived well-being. This study explored the prevalence and characteristics of mistreatment, mistreatment reporting, student-related factors, and consequences among medical students in Thai context.

METHODS

We first developed a Thai version of the Clinical Workplace Learning Negative Acts Questionnaire-Revised (NAQ-R) using a forward-back translation process with quality analysis. The design was a cross-sectional survey study, using the Thai Clinical Workplace Learning NAQ-R, Thai Maslach Burnout Inventory-Student Survey, Thai Patient Health Questionnaire (to assess depression risk), demographic information, mistreatment characteristics, mistreatment reports, related factors, and consequences. Descriptive and correlational analyses using multivariate analysis of variance were conducted.

RESULTS

In total, 681 medical students (52.4% female, 54.6% in the clinical years) completed the surveys (79.1% response rate). The reliability of the Thai Clinical Workplace Learning NAQ-R was high (Cronbach's alpha 0.922), with a high degree of agreement (83.9%). Most participants (n = 510, 74.5%) reported that they had experienced mistreatment. The most common type of mistreatment was workplace learning-related bullying (67.7%), and the most common source was attending staff or teachers (31.6%). People who mistreated preclinical medical students were most often senior students or peers (25.9%). People who mistreated clinical students were most commonly attending staff (57.5%). Only 56 students (8.2%) reported these instances of mistreatment to others. Students' academic year was significantly related to workplace learning-related bullying (r = 0.261, p < 0.001). Depression and burnout risk were significantly associated with person-related bullying (depression: r = 0.20, p < 0.001, burnout: r = 0.20, p = 0.012). Students who experienced person-related bullying were more often the subject of filed unprofessional behavior reports, concerning conflict or arguments with colleagues, being absent from class or work without reasonable cause, and mistreatment of others.

CONCLUSIONS

Mistreatment of medical students was evident in medical school and was related to the risk for depression and burnout, as well as the risk of unprofessional behavior.

TRIAL REGISTRATION

TCTR20230107006(07/01/2023).

The impact of perceived social support and coping on distress in a sample of Atlantic Canadian health professional students during COVID-19 compared to pre-COVID peers

PURPOSE

Students pursuing higher education and health professional (HP) programs (e.g., nursing, pharmacy, social work, medicine) experience stressors including academic pressures, workload, developing professional competencies, professional socialization, the hidden curriculum, entering clinical practice and navigating relationships with colleagues. Such stress can have detrimental effects on HP students physical and psychological functioning and can adversely affect patient care. This study examined the role of perceived social support and resilience in predicting distress of Atlantic Canadian HP students during the COVID-19 pandemic and compared the findings to a pre-COVID population of age and sex matched Canadians.

METHOD

Second year HP students (N = 93) completed a survey assessing distress, perceived social support, and resilience and open-ended questions on student awareness of supports and counselling available to them, their use/barriers to the services, and the impact of COVID-19 on their personal functioning. HP student responses were also compared with age and sex matched Canadian peers from data collected prior to COVID-19.

RESULTS

It was found that HP students reported moderate to severe psychological distress, and while they reported high levels of social support on a measure of perceived social support they also reported that the COVID-19 pandemic made them feel isolated and that they lacked social support. It was found that the sample of HP students reported significantly higher psychological distress than the mean scores of the age and sex matched sample of Canadian peers.

CONCLUSIONS

These findings call for creation of more tailored interventions and supports for HP students.

Headache-a challenge across medical students' life: a systematic review and meta-analysis

BACKGROUND

Headache is a disabling disease that affects psychosocial factors. Medical students are recognized to be more susceptible to psychological stress than other. Quantitative summaries of prevalence studies on this subject are limited. The aim of this study was to quantify and comprehend the variance in prevalence at the global and regional levels.

METHODS

We used a comprehensive search approach to find studies on headaches prevalence in the medical literature published between November 1990 and May 5, 2022. Database searched were PubMed, Scopus, EMBASE, and Google Scholar. Studies that reported headaches (unspecified, migraine, or tension-type headache (TTH)) in medical students were included. Subgroup analysis and meta-regression were applied to investigate heterogeneity, with the risk of bias tool employed to assess study quality. PROSPERO number CRD42022321556 was assigned to the study protocol.

RESULTS

Out of 1561 studies, 79 were included. The pooled prevalence estimates of unspecified headache, migraine, and TTH were 70.44% (95% CI: 63.32-77.57), 18.9% (95% CI: 15.7-22.0), and 39.53% (95% CI: 31.17-47.90), respectively. TTH and migraine were more prevalent in Eastern Mediterranean and American region. TTH and migraine were less prevalent in higher income countries.

CONCLUSION

Although the prevalence of headaches among medical students varies in different countries, it is higher than the general population of the same age. Higher stressors and overwork in these students may contribute to this condition. The well-being of medical students should be a priority for the relevant authorities.

Mental health treatment-seeking behaviors in medical students: A mixed-methods approach

Background

Healthcare professionals can experience problems regarding mental health and emotional well-being (e.g. burnout) at a higher degree compared to their non-physician counterparts. Fear of stigma is often a barrier to seeking treatment among physicians. However, there is a shortage of studies related to mental health and treatment seeking among trainees and medical students.

Objectives

This study sought to examine mental health in U.S. medical students, factors contributing to mental health symptoms, and obstacles to seeking treatment.

Design and Methods

This cross-sectional study was conducted through a confidential survey sent out in fall 2021, with 510 U.S. medical student participants. This survey included scales to assess depression (the Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder-7), past year symptoms of hazardous drinking (Alcohol Use Disorder Identification Test), and past 30-day binge drinking days. The survey also included free-response questions about their reasons for seeking mental health care if they did (facilitators) and any barriers that kept them from seeking treatment.

Results

About one-quarter of participants met criteria for possible depressive (24%) or anxiety disorders (24%); 9% of the sample drank at hazardous drinking levels. Between 47% and 60% of those who screened positive for depression, anxiety, or hazardous drinking reported an unmet need for mental health services. Anxiety and depression were cited as the most common reasons to seek treatment; concerns about stigma from peers and professional retaliation were notable for being barriers to treatment.

Conclusion

Our sample of medical students reported notable prevalence of probable depression or anxiety disorder, while also reporting needing more support to improve their mental health. Despite this, barriers exist that may discourage medical students from seeking needed treatments. Findings from this study aim to encourage discussion and positive change in the healthcare community regarding perception and attitudes toward mental health and substance use treatment.

Career Regret and Health-Related Quality of Life among Medical Students: A Nationwide Cross-Sectional Study in Jordan

OBJECTIVES

Medical students have a lower quality of life (QoL) when compared to the general population. This lower QoL is associated with multiple factors such as burnout and depressive symptoms. QoL can be reflected in the degree of career satisfaction and career regret. We aim to study the prevalence of career regret in Jordanian medical students and its association with QoL and other related factors.

METHODS

This national cross-sectional study consisted of an anonymous online survey distributed to medical students enrolled in all six Jordanian medical schools over a period of 6 weeks. A validated tool was used to assess QoL and students were asked a series of questions related to their career satisfaction and career regret.

RESULTS

A total of 544 medical students completed the survey. The mean age was 21.5 ± 1.63 years (range 17-29), with 45.6% being males. The overall mean physical health score was 45.9 ± 5.17, and the overall mean mental health score (mental component summary (MCS)) was 42.04 ± 5.52. 76.3% of students have regretted studying medicine, citing stress as the main reason. There was a significant relation between the year of study and the percentage of career regret. Additionally, mean MCS was significantly lower in students who were frequently or always thinking about dropping out of medical school.

DISCUSSION

The high percentage of career regret and the low mental QoL in Jordanian students are alarming findings, highlighting an underlying source of psychological distress in Jordanians. This calls for further investigations into the psychological health of medical students, as well as interventions to prevent the development of consequences that can impact both students and their future patients.

Investigating the Impact of Community Volunteerism on the Mental Health of Medical Students

OBJECTIVE

This study aimed to analyze the impact of community service on the mental health of medical students through their perception of stress.

METHODS

The 10-item Perceived Stress Scale was used to measure the stress levels of 82 medical students over a 3-month period. Additional survey questions gauged students' weekly volunteer experiences in clinical and nonclinical settings and their perceived effects on stress and quality of life.

RESULTS

Results found an inverse relationship between the number of clinical volunteer hours and perceived stress (P = .0497). Nonclinical and total volunteer hours were correlated with both reduced perceived stress levels (nonclinical P = .0095, total P = .0052) and better quality of life (nonclinical P = .0301, total P = .0136). All individual perceived stress scores fell into the low or moderate stress ranges of the Perceived Stress Scale per the week-to-week analysis.

CONCLUSION

The preliminary results raised important research questions about the impact of volunteering on medical student perceived stress. As medical students face higher levels of stress in comparison to the general population, it is exceedingly important to determine methods to decrease their risk of compromising their mental health. This study may aid in decision-making and research in favor of or against offering community service opportunities as part of the core medical education curriculum.

Communication Apprehension and Willingness to Communicate in Veterinary Medicine Students: Implications for Mindfulness and Communication Training

Across two studies we investigated the relationship among mindfulness, rumination, depression, stress, anxiety, communication apprehension, and willingness to communicate among veterinary medicine students. Study 1 tested a hypothesized path model of the relationship with 148 third-year students. Study 2 confirmed the path model with second sample of 160 third-year students. Mindfulness had a direct negative relationship with communication apprehension and a direct positive relationship with willingness to communicate, whereas depression, anxiety, and stress each had a direct negative relationship with communication apprehension and willingness to communicate. Rumination was also directly associated with communication apprehension and willingness to communicate, and it was mediated through depression, anxiety, and stress. These findings suggest mindfulness training may mitigate depression, anxiety, and stress and their attendant effects on communication apprehension and willingness to communicate.

Somatization symptoms-prevalence and risk, stress and resilience factors among medical and dental students at a mid-sized German university

Objective

Previous studies have shown that an increased prevalence of mental illness can be found among medical and dental students. Among these, somatization symptoms are severely understudied. The present study examined the prevalence of somatization symptoms in a subpopulation of medical and dental students and aimed at finding associated risk and resilience factors.

Methods

A cross-sectional survey was conducted using a self-reporting questionnaire, including the SOMS-2, the Becks-Depression-Inventory-II (BDI-II), the NEO-Five-Factor-Inventory, and a questionnaire on socio-demographics for possible risk and resilience factors. A total of 271 medical and dental students of a mid-sized German university completed the questionnaire.

Results

The Somatization index yielded a mean of 9.12 symptoms for the total sample, which is 1.2 SD higher than the reported norm. A total of 50.7% of the medical students and 63.6% of the dental students transcend a critical somatization score. Significant positive associations for eight general risk factors, four university related stress factors, and a significant negative association for seven resilience factors were found.

Conclusion

Medical and even more dental students at the studied university showed a high burden of somatoform complaints. Also, factors were found that could be of etiological relevance and others that could be used to enhance resilience. Both could present an opportunity for the prevention of somatization disorders but prospective and multicenter studies with an aged-matched comparison group are needed to obtain a more accurate overview.

Assessing medical students' perception and educational experience during COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic has significantly impacted the traditional delivery of medical education. Medical education programmes have had to cope with limitations on face-to-face learning, and accelerate the adoption of digital learning. In addition, the pandemic has potential serious implications on the psychological well-being of medical students. We aim to assess the changes in perceptions and experiences of medical students as a consequence of this pandemic.

METHODS

Cross-sectional survey of medical students at Trinity College Dublin (TCD) between March and April 2022 was performed. The survey explored student satisfaction with the current education program, teaching delivery and the impact of COVID-19 on education and student well-being.

RESULTS

175 medical students participated in the survey. Overall, the majority of students were happy/neutral with their medical education. 93 (53.1%) felt tutorials and problem-based learning (PBL) to be the most effective method of teaching, followed by laboratory and clinical placements in 78 participants (44.6%) and hybrid-learning in 85 participants (48.6%). There was a mixed reaction to the changes in the delivery of education brought about by the pandemic. 67 participants (40.6%) felt happy with the changes, another 64 participants (38.8%) felt neutral, whilst only 34 participants (20.6%) were unhappy. However, most participants felt the pandemic negatively impacted their mental health, with 96 participants (55.8%) reporting negative responses. 58% of participants (n = 102/175) reported utilising the student support services at university campus and 49% (n = 50) were satisfied with their services.

CONCLUSION

Digital content and delivery confer the benefit of greater flexibility in learning, the ability to learn at one's own pace and in a preferred environment, however lacks the advantage of bedside teaching and hands-on training. Our findings reinforce the potential advantages of online learning.

Behavioral and psychosocial predictors of depression in Bangladeshi medical students: a cross-sectional study

BACKGROUND

Depression, stress, and anxiety were found in a large number of medical undergraduate students, indicating a neglected aspect of their psychology that required immediate attention. The goal of this study was to find out the prevalence of depression among medical students, as well as potential psychosocial and behavioral predictors for depression.

METHODS

This cross-sectional study was conducted from July to November 2021 among 840 randomly selected medical students from four medical colleges using stratified random sampling. Data were collected using a semi-structured, self-administered questionnaire and were analyzed through the SPSS v.23 software. Multiple regression was performed to assess the effect of several behavioral and psychosocial factors on depression.

RESULTS

Among the 840 study participants, 55.7% (n= 468) were female and 44.3% (n= 372) were male. According to the data, the prevalence of depression, anxiety, perceived stress among medical students was found to be 28.8%, 65% and 85% respectively. A strong link was found between depression and anxiety, stress, poor sleep quality, poor academic performance, and a negative social and romantic relationship status.

CONCLUSIONS

A significant number of medical students are depressed. In order to prevent and treat depression, medical students should be screened for depression and its associated factors.

Province- and Individual-Level Influential Factors of Depression: Multilevel Cross-Provinces Comparison in China

Rapid social change has given rise to a general increase in psychological pressure, which has led to more and more Chinese people suffering from depression over the past 30 years. Depression was influenced not only by individual factors but also by social factors, such as economy, culture, politics, etc. These social factors were measured at the national, provincial, or community levels. However, little literature reported the influence of province-level factors on the depression of Chinese. This study examined the effects of province-level and individual-level factors on depression of Chinese respondents aged 16–97 years. We conducted a multilevel analysis of the 2018 wave survey of the Chinese Family Panel Studies (CFPS), with 19,072 respondents nested within the 25 Chinese provinces. Data for the province-level were extracted from the National Bureau of Statistics of China, including three predictors: gross regional product (GRP) per capita, expenditure for social security and employment (ESSE), and rural and urban household income inequality. Depression was measured with the eight-item short version of the Center for Epidemiologic Studies Depression Scale (CES-D8). The study found that respondents who were female, 30–59 years, divorced or widowed, less educated, rural residents, less body mass index (BMI), or had lower household income tended to report higher levels of depressive symptoms. After adjustment for individual-level features, a significant effect of provinces still survived. The respondents who lived in a province with higher GRP, higher ESSE, or smaller rural and urban household income inequality reported lower depressive symptoms. Our results demonstrated that individual features did not fully explain depression. Economic and social factors appeared to impact depression and have to be considered when the government planned for improved public depression. Meanwhile, our research also provided a suggestion for the government of some provinces to investigate and improve depression.

Effect of cognitive behavioral therapy program on mental health status among medical student in Palestine during COVID pandemic

BACKGROUND

The COVID-19 pandemic had a profound psychological influence on everyone in society, and the impact it had on students, particularly medical students, cannot be underestimated. The main purpose of this study is to (1) determine the prevalence of mental disorders among medical students and their associated factors, and (2) examine the effectiveness of cognitive behavior therapy on mental health problems among medical students.

METHODS

Between March and May 2021, we conducted a randomized controlled study on two phases among medical students at An-Najah National University. Data were collected using an online questionnaire and the Arabic version of the 12-item General Health Questionnaire (GHQ-12). We also used the MEDAS tool to assess their Mediterranean Diet (MD) adherence. In the second phase, sixty-six students were recruited and assigned randomly to control and intervention groups. Intervention impact was assessed using 12-item General Health Questionnaire at two-time points; baseline, and 8 weeks post-intervention. The interventional model used was cognitive behavioral therapy, and the control group received no treatment.

RESULTS

A total of 329 students were included in the analysis of the first phase of the study. Approximately 28% of students had mental health problems. We found a significant relationship between good mental health status with a higher level of physical activity level, longer sleeping hours, and shorter entertainment time (p < 0.05). In the second phase of the study, a total of 91 students were included. Overall, using the CBT program showed a significant improvement in the outcome measures. At 8 weeks post-intervention, students had lower scores on total GHQ-12, depression, anxiety, and social dysfunction.

CONCLUSION

These findings propose that adequate attention must be paid to the mental health of medical students and that CBT programs can be used for the management of mental health problems among medical students.

Higher Dietary Inflammatory Index Scores Are Associated With Stress and Anxiety in Dormitory-Residing Female University Students in the United Arab Emirates

Dormitory-residing university students are at-risk of mental health problems related to unhealthy diets. The purpose of this study was to assess the association between dietary inflammatory potential and mental health of dormitory-residing female university students. This cross-sectional study was comprised of 260 undergraduate females residing in dormitories of the largest university in United Arab Emirates during Spring 2019. The Energy-adjusted Dietary Inflammatory Index (E-DIITM) scores calculated from 37 food parameters were derived from two 24-h dietary recalls. The logistic regression analysis was used to estimate odds ratios (ORs) and 95% CIs for the E-DII score in relation to depression, anxiety, and stress. The E-DII scores (mean = 2.98 ± 1.17) were categorized into: tertile 1 (−1.96–2.62), tertile 2 (2.63–3.52), and tertile 3 (3.53–5.60), representing less to more proinflammatory diets. Students in the E-DII tertile 3 had significantly higher depression, anxiety, and stress scores. The logistic regression analysis showed that each point increase in the E-DII score was associated with symptoms of stress (OR = 1.41; 95% CI: 1.12–1.77; p = 0.003) and anxiety (OR = 1.35; 95% CI: 1.07–1.69; p = 0.01). Relative to students in the E-DII tertile 1, those students in the E-DII tertile 3 were more likely to be at higher risk of stress and anxiety ORE−DIItertile3vs1 = 2.89 (1.44–5.79) and 2.88 (1.49–5.56), respectively. Overall, stress and anxiety were associated with proinflammatory diets in dormitory-residing female university students, suggesting the need for targeted interventions to increase the anti-inflammatory capacity of diet and improve mental wellbeing in students on university campuses.

A cross sectional study: The association between sleeping quality and stress among second and third medical students at the University of Jordan

OBJECTIVE

Medicine is considered one if not the most stressful educational field. Thus, the aim of this study is to investigate the prevalence of stress and poor sleeping quality among medical students and the association between them.

METHOD

This cross-sectional study was conducted at the University of Jordan on second- and third-year medical students. The questionnaire consisted of: 1) Demographics; 2) The assessment tools which were Pittsburgh Quality of Sleep Index (PSQI) and Kessler Psychological Distress Status (K10). Binary logistic regression, chi-square and linear regression were used to investigate the association between PSQI, K10, and their determinants.

RESULTS

The mean for PSQI score was 6.76 ± 3.32. PSQI scores interpretation revealed that 61.7% of the 282 participants of this study were poor sleepers. Logistic regression results showed that only the category of not napping at all from the napping hours variable was significantly associated with sleeping quality. Furthermore, the mean of K10 scores was 24.5 ± 8.5. K10 scores revealed that 66.3% of the participants were stressed. Logistic regression results showed that gender and regular exercise were significantly associated with psychological distress. Additionally, chi-square test, logistic regression and linear regression showed that PSQI was significantly associated with K10 (P <0.01).

CONCLUSIONS

Stress and poor sleeping quality in medical students at the University of Jordan were highly prevalent and strongly associated. What determined PSQI was daytime napping, and for K10 were regular exercise and gender. Further investigations into stress and sleep quality in the Arabian region are needed.

Training for Awareness, Resilience and Action (TARA) for medical students: a single-arm mixed methods feasibility study to evaluate TARA as an indicated intervention to prevent mental disorders and stress-related symptoms

BACKGROUND

Medical students have a higher risk for depression, anxiety, stress-related symptoms, burnout, and suicide, and more rarely seek professional help or treatment than the general population. Appeals are being made to address the mental health and resilience of physicians-to-be. The novel program Training for Awareness, Resilience, and Action (TARA) was originally developed to treat depressed adolescents, targeting specific neuroscientific findings in this population. TARA has shown feasibility and preliminary efficacy in clinically depressed adolescents and corresponding brain-changes in mixed community adolescent samples. The present study investigated the feasibility and acceptability of TARA as a potential indicated prevention program for symptoms of depression, anxiety, stress and burnout in Swedish medical students.

METHODS

We conducted a single-arm trial with 23 self-selected students in their early semesters of medical school (mean age 25.38 years, 5 males and 18 females), with or without mental disorders. All participants received TARA. Self-reported symptoms of depression, anxiety, perceived stress and psychological inflexibility were collected before (T0) and after the intervention (T1). Qualitative data on the participants' experiences of TARA were collected in focus-group interviews conducted halfway through the program and upon completion of the program. Individual interviews were also conducted 2 years later. Qualitative content analysis was performed.

RESULTS

The mean attendance rate was 61.22% and the dropout rate was 17.40%. The Child Session Rating Scale administered after every session reflected an overall acceptable content, mean total score 34.99 out of 40.00. Trends towards improvement were seen across all outcome measures, including the Hospital Anxiety and Depression Scale Anxiety (t = 1.13, p = 0.29) and Depression (t = 1.71, p = 0.11) subscales, Perceived Stress Scale (t = 0.67, p = 0.51) and Avoidance and Fusion Questionnaire for youth (t = 1.64, p = 0.10). None of the participants deteriorated markedly during the intervention. Qualitative content analysis resulted in a main theme labeled: "An uncommon meeting-ground for personal empowerment", with 4 themes; "Acknowledging unmet needs", "Entering a free zone", "Feeling connected to oneself and others" and "Expanding self-efficacy".

CONCLUSION

TARA is feasible and acceptable in a mixed sample of Swedish medical students. The students' reports of entering an uncommon meeting-ground for personal empowerment supports effectiveness studies of TARA in this context.

Why do students struggle in their first year of medical school? A qualitative study of student voices

BACKGROUND

Struggling at medical school incorporates academic failure, course disruption and early course exit. Struggling is usually multi-factorial involving academic, personal, financial and health factors. Struggling students may fail to engage with available support. First year students are particularly susceptible as they transition to university and a professional career.

METHODS

The study aim was to explore medical students' own voices on struggling and assess how they match up to existing literature. During one academic year, all first year medical students at the University of Birmingham (UK) who opted to leave or were required to withdraw (n = 52) were asked to participate in an individual exit interview. Fifteen students responded and fourteen (27%) agreed to be interviewed. Interviews were face to face (n = 10), telephone (n = 3) and via email (n = 1). Interviews were unstructured and led by a general open question. Framework analysis identified key data themes.

RESULTS

Students described year one of medical school as a critical transition. They simultaneously needed to adapt to being a university student, a medical student and a doctor. A six-group typology of students emerged, each of which struggled with one or more of these adaptations. The groups were: wrong degree choice, mental health problems, acute crisis, at capacity, slow starter and family rock. Some students experienced an isolated problem from within this typology. Most had a multi-factorial story of struggling. Mental health problems and acute crises were the most common issues. Early professional identity formation was a key hurdle. Help-seeking behaviours were varied.

CONCLUSIONS

This study explores the narratives of medical students who struggled from an early stage and presents a data-driven typology of their issues. It advances existing qualitative understanding of this topic, which to date is predominantly derived from educator perceptions and not specific to early course issues. Although our results broadly cohere with existing knowledge, we also present novel findings which may reflect our focus on first year students. Issues around early professional identity formation may reflect the increasing emphasis on professionalism in medical school curricula. Listening to these narratives could help university staff to identify students at risk of struggling for targeted support.

An Innovative Program Using Magic to Provide Early Clinical Experiences for Preclinical Medical Students: Goals, Experiences, and Results of the MagicAid Program

Objective

Effectively training medical students in compassion, communication, and empathy is essential in fostering a holistic approach to patient care. We sought to address this by implementing an early clinical experience service learning program for medical students in the initial years of their medical education.

Methods

Medical students at Stony Brook University initiated, designed, and facilitated the volunteer program, which provides students a framework to learn magic therapy and engage with pediatric patients. The program includes an introductory presentation, training course, and organized bedside sessions with patients. To evaluate the program, a sample of participants partook in a focus group, written questionnaire, and/or online survey.

Results

From 2015 to 2020, 130 students participated in magic therapy rounds, engaging 1391 patients. Nine themes of student benefit emerged from qualitative analysis, including acquisition of familiarity with the hospital and healthcare team, cultivation of communication skills, contribution to improvement of patient affect, development of empathic qualities and techniques, and improvement in psychological health. Students were very satisfied with their experiences and viewed the activity as helpful for patients, parents, staff, and themselves.

Conclusions

The program engaged students in compassionate patient care within a holistic approach to patient care early in training.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-021-01456-y.

The Prevalence of Stress Among Medical Students Studying an Integrative Curriculum During the COVID-19 Pandemic

PURPOSE

Stress is a psychological shift that negatively affects student achievement. We sought to investigate the extent of stress in the medical students at our university.

PATIENTS AND METHODS

A total of 337 medical students representing three program phases were represented. Stress was measured using a questionnaire divided into three main parts: 10-question Kessler instruments, 10-questions specific to identifying the causes of stress, and a qualitative component to report additional information. For the Kessler questionnaire, a score of less than 20 was considered negative for stress of any level (alert) and scores of 20-24 were considered mild stress (resistance phase), 25-29 moderate stress (near exhaustion), and 30-50 severe stress (exhaustion). Descriptive studies in the form of mean, standard deviation, and confidence interval (CI) were used in addition to the chi-squared test for estimate significant differences between variables. A P-value of <0.05 was considered significant.

RESULTS

The prevalence of stress was 85.5%, with a slight male predominance. The prevalence of stress was seen among the male students during Phase I (88.25%), followed by male students during Phase III (87.7%), female students during phase II (86.5%), male students during phase II (84.5%), female students during phase I (83.3%) and female students during phase III (80.4%). Stress was uniformly high during phase I (86.2%) followed by phase II (85.4%) and phase III (85.1%), and 85% of stress was obtained from the number and content of assessments.

CONCLUSION

There is a high level of stress throughout the curriculum. The number of assessments and the number of modules and their content are the primary sources of stress. Student mentorship, including academic, psychic, and social counseling, may help predict and manage stress and improve student performance. Detection of stress among the students is a major issue for program monitoring and development.

Well-being, Perceived Stress and Their Relations with Health-Relevant Behaviours Among Italian Medical Students: a Cross-Sectional Study at Sapienza University of Rome

Medical education is widely known to be demanding and stressful, with elevated levels of anxiety and depression among medical students. This study aims at examining well-being, perceived stress and quality of life in a sample of Italian first-year medical students in order to investigate the relations between these variables and individual characteristics and behaviours. An anonymous cross-sectional questionnaire was administered to a sample of 407 Italian first-year medical students. Psychological well-being, perceived stress and quality of life were assessed using standardised questionnaires PGWBI, PSS, SF-12. Data were analysed with multivariate statistical methods. Significant differences in PGWBI, PSS and SF-12 scores were found between males and females (with poorer scores for females), between smokers and non-smokers (with poorer scores for smokers) and between students who reported cannabis use in their lifetime and students who did not (with poorer scores for those who smoked cannabis). Logistic regression showed that gender (OR 0.38, 95% CI 0.24–0.61), reported cannabis use (OR 1.82, 95% CI 1.07–3.09) and regular physical exercise (OR 0.54, 95% CI 0.34–0.86) were significant predictors of distress. In summary, this study shows that female medical students and students who reported negative health behaviours and sporadic drug use reported lower psychological well-being and quality of life and higher stress, while positive health behaviours might prevent distress.

Resilience matters: Student perceptions of the impact of COVID-19 on medical education

Introduction

We assessed students' perception of the impact of the pandemic on their well-being, education, academic achievement, and whether grit and resilience alter students’ ability to mitigate the stress associated with disruptions in education. We hypothesized that students would report a negative impact, and those with higher grit and resilience scores would be less impacted.

Methods

A multidisciplinary team of educators created and distributed a survey to medical students. Survey results were analyzed using descriptive statistics, ANOVA, and multivariate linear regressions. A p-value <.05 was considered statistically significant.

Results

A total of 195 students were included in the study. Approximately 92% reported that clinical education was negatively affected, including participants with higher grit scores. Students with higher resilience scores were more optimistic about clinical education. Those with higher resilience scores were less likely to report anxiety, insomnia, and tiredness.

Conclusion

More resilient students were able to manage the stress associated with the disruption in their education. Resiliency training should be year-specific, and integrated into the UME curriculum due to the different demands each year presents.

Network connectivity between benevolent childhood experiences and uncertainty stress among Chinese university students

BACKGROUND

The purpose of this study was to explore the association between benevolent childhood experiences (BCEs) and uncertainty stress among Chinese university students by network analysis.

METHODS

A total of 1,830 university students from three Chinese cities were recruited. Respondents' BCEs and uncertainty stress were self-reported using online questionnaire. The structure of the BCEs-uncertainty stress and related centrality indicators were examined for this sample.

RESULTS

The overall network model showed that "no ways to suit the important changes in life" was the most influential, followed by "all things are not going well," "feel that there is nothing to do," and "worry about the future." And in this network, the most influential bridge symptom was "having a positive self-concept."

CONCLUSION

The central symptoms of the BCEs-uncertainty stress network should be prioritized as targets in interventions and prevention efforts to reduce uncertainty stress among Chinese university students. Improving university students' positive self-concept is important to alleviate the level of uncertainty stress among Chinese university students.

Gender Disparities in Symptoms of Depression After Medical School Exams and Student Coping Strategies for Postexam Depression Symptoms

CONTEXT

Little research exists to determine if medical students experience symptoms of depression after examinations and if symptoms vary by gender.

OBJECTIVES

Determine if is there a difference between male and female medical students in the number of symptoms of major depressive disorder (MDD) experienced after exams, as well as which coping strategies are used by students to alleviate depression symptoms.

METHODS

An anonymous and secure survey was sent via university email to first, second, and third-year medical students after exams for 2 consecutive exam periods. Surveys that were not fully completed were excluded from the analysis.

RESULTS

A total of 162 out of 550 students completed the survey for a response rate of 30%. Overall, a greater proportion of female students experienced more symptoms of depression compared to males. This was statistically significant for the Diagnostic and Statistical Manual of Mental Disorders 5th Edition symptoms of MDD: depressed mood, anhedonia, changes in sleep, fatigue, and difficulty with concentration after exams compared to their male counterparts. Male first-year medical students experienced higher rates of depression compared to their third-year counterparts. Most students exhibited coping strategies that helped them feel less depressed. The 3 most common coping strategies reported were: reaching out to social support networks, physical activity/exercise, and engaging in hobbies.

CONCLUSIONS

Both gender and year in a medical school play a role in the number of symptoms of depression experienced after medical school exams. Recognizing that examinations can be a trigger of depressive symptoms in medical students, particularly female and first-year students, has important implications on student mental health. Helping students recognize these symptoms and employ healthy coping strategies may further help alleviate these symptoms. Long-term consequences of experiencing symptoms of depression after recurrent exams in medical school are unknown and require further research.

Depressive Symptoms and Burnout Among Medical Students: a Prospective Study

BACKGROUND

Depressive symptoms and burnout are common among medical students. However, few studies have investigated their trajectory over the course of medical school.

OBJECTIVE

Evaluate year-by-year changes in depressive and burnout symptoms over the course of medical school training.

DESIGN

Prospective study.

PARTICIPANTS

Medical students who matriculated at a private medical school in Maryland from 2010 to 2016 (n=758).

MAIN MEASURES

Clinically significant depressive symptoms were defined as a score of ≥10 on the 9-item Patient Health Questionnaire (PHQ-9), and burnout was measured using the Maslach Burnout Inventory (MBI). High emotional exhaustion, high depersonalization, and low personal accomplishment were defined as scores of ≥ 27, ≥10, and ≤33 on the respective MBI subscales.

KEY RESULTS

At matriculation, the prevalences of significant depressive symptoms, high emotional exhaustion, high depersonalization, and low personal accomplishment were 4.3%, 9.4%, 8.6%, and 37.7%, respectively. After adjustment for age, sex, race/ethnicity, marital status, and cohort, compared with year 1, the odds of significant depressive symptoms was significantly higher at the beginning of the 2nd, 3rd, and 4th years of study (ORs=2.63, 2.85, and 3.77, respectively; all ps<0.001). Compared with the 1st year, the odds of high emotional exhaustion also increased during the 2nd, 3rd, and 4th years of study, (ORs=3.46, 4.79, 8.20, respectively; all ps<0.001), as did the odds of high depersonalization (ORs=3.55, 6.14, 12.53, respectively; all ps<0.001). The odds of low personal accomplishment did not significantly differ across years of study.

CONCLUSIONS

The results of this study suggest that symptoms of depression and burnout may increase during medical school. Because of the high prevalence of depressive symptoms and burnout in medical students, interventions earlier in the medical career pathway that aim to prevent, detect, and treat these symptoms may be of benefit to the physician community.

CANDIDATE: A tool for generating anonymous participant-linking IDs in multi-session studies

Background

To ensure the privacy of participants is an ethical and legal obligation for researchers. Yet, achieving anonymity can be technically difficult. When observing participants over time one needs mechanisms to link the data from the different sessions. Also, it is often necessary to expand the sample of participants during a project.

Objectives

To help researchers simplify the administration of such studies the CANDIDATE tool is proposed. This tool allows simple, unique, and anonymous participant IDs to be generated on the fly.

Method

Simulations were used to validate the uniqueness of the IDs as well as their anonymity.

Results

The tool can successfully generate IDs with a low collision rate while maintaining high anonymity. A practical compromise between integrity and anonymity was achieved when the ID space is about ten times the number of participants.

Implications

The tool holds potential for making it easier to collect more comprehensive empirical evidence over time that in turn will provide a more solid basis for drawing reliable conclusions based on research data. An open-source implementation of the tool that runs locally in a web-browser is made available.

Stress and its correlates among medical students in six medical colleges: an attempt to understand the current situation

Abstract

Background

Medical students encounter various stressors during their studies. The study aimed to assess stress levels, sources, and associated determinants among Sudanese medical students. An online questionnaire-based study was conducted among 617 undergraduate medical students of 6 different universities in Sudan. A 19-item questionnaire was utilized to assess stress sources, in addition to demographics, stress manifestations, and coping strategies.

Results

The overall prevalence of stress was 31.7% (p < 0.01). The main sources of stress were time pressure, heavy workload, fear of failure, and examination frequency. One-third of students indicated that they experienced at least one source of psychosocial- and teaching-related stress. Female medical students were more significantly stressed due to academics than males. Also, fourth- and fifth-year students were academically more stressed in comparison to the first-year students. Poisson regression analysis model showed that first-year students were less stressed than the final-year students in relation to academics (odds = 0.888, P = 0.003). Male medical students, across all study years, were far less stressed than females (odds = 0.901, P = 0.000153). Expectedly, ‘studying medicine by choice’ was associated with decreased odds for psychosocial stressors (odds = 0.885, P = 0.00781), and improved model-fit (chi-squared = 6.8952, P = 0.008643). Also, the year of study was a predictor of teaching-related stress development.

Conclusions

Female medical students were more stressed due to academics than males. On the other hand, final-year students were more academically stressed than first-year students. Female medical students were likely having stress related to academic stress development, while being first-year medical student was a predictor of not developing academic stress. Studying medicine by choice’ was associated with ability to cope against stress.

Navigating the Infinite Number of Educational Resources: The Development of a Publicly Available Surgical Educational Digital Resource Library

OBJECTIVE

There has been an explosion of digital resources available for general surgical education and board preparation. This makes it difficult for a new learner, regardless of their training level, to determine which resources best fit their needs. The uncertainty surrounding resource selection due to the large number of options causes stress, anxiety, and inefficiency for surgical learners. Our objective was to develop a digital surgical educational resource library to assist with selection.

DESIGN

A needs assessment via multi-center focus groups encompassing all levels of learners from various subspecialties and training levels (medical students, trainees, junior surgeons, and senior surgeons) was performed to determine what information is desired in a surgical resource library. We conducted follow-up interviews and surveys to learn which resources were most commonly used for studying throughout training.

SETTING

Multi-institutional RESULTS: The initial needs assessment detailed requests for an expansive array of surgical resources characterized by media type and price. We identified 104 resources that met these criteria. There were 33 resources used by medical students, 37 by residents, 16 used specifically for surgical boards preparation, and 25 by attending surgeons. These resources were composed of textbooks, review books, question banks, audio resources, video resources, and review courses. The prices of the resources ranged from free to greater than 400 dollars.

CONCLUSIONS

A digital resource library should be broad and must address needs that change along a learner's career. Changes and improvements are required not only to meet the changing needs of the learners, but also to ensure the library remains current with the ever-growing number of resources. We plan to incorporate reviews of the resources from those surveyed to help visitors of the online library determine which resources may best suit their needs. Development of a digital resource library may assist learners by helping them easily identify what is available and has been peer reviewed allowing them to determine what best meets their educational needs.

Depression, Anxiety, and Stress During Times of COVID-19: An Analysis of Youngsters Studying in Higher Education in India

This study addressed the critical problems of depression, anxiety, and stress, which are prevalent among students pursuing higher education. Specifically, this article aimed to study the level of psychological distress due to the COVID-19 pandemic experienced by young people studying in higher education institutions in India. The study also attempted to identify various coping strategies students adopted to overcome this difficult time. Following a descriptive research design, this study used surveys to collect primary data from 235 students in graduate and undergraduate programs in India. The DASS-21 scale was used to check the levels of depression, anxiety, and stress students experienced. Furthermore, a four-point COPE scale was used to identify coping strategies students adopted. The results showed that students experienced high levels of stress and anxiety during the ongoing COVID-19 pandemic. Although depression levels were not alarming, most students were worried about several aspects of their lives and careers. However, because the data were collected from a relatively small sample, the study is likely not generalisable. Furthermore, most of the data were collected online, which has its limitations. This research likely has significant implications for various stakeholders, such as students, parents, institutions, counsellors, and government and non-government bodies, because it may help them take appropriate actions. These research contributions are original and novel, because the COVID-19 pandemic has posed unprecedented challenges and inspired new solutions to the problems of students and society.

Prevalence of Low Self-esteem and Mental Distress among Undergraduate Medical Students in Jimma University: A Cross-Sectional Study

Background

Medical students often experience chronic stress. Self-esteem is one of the most important factors in the process of psychosocial growth and has remarkable effect on thoughts, feelings, values, and goals. The aim of this study was to assess the prevalence and associated factors of low self-esteem (LSE) and mental distress among Medical Students of Jimma University.

Method

This cross-sectional study was conducted in Jimma University from June to July, 2018. Self-esteem was measured with Rosenberg self-esteem scale. Self-administered Short form with General Health Questionnaire was used to assess presence of mental distress.

Result

Out of 422 students enrolled to the study, 279 (66.1%) were male, and 413 (97.9 %) were 18 to 25 years of age. The prevalence of LSE and mental distress were 19.0%, and 19.7 %, respectively. Students who had LSE had 5 times higher risk of having mental distress, AOR= 5.1 (95% CI, 2.9-8.9). Moreover, female students had higher risk of developing mental distress (AOR=1.9, 95% CI, 1.1-3.3). Students who had poor social support were 4.3 times at higher risk of developing LSE, AOR=4.3 (95% CI, 1.9-9.8). Those who reported to have poor academic performance were also more likely to have LSE AOR= 3.7 (95% CI, 1.3-10.0).

Conclusion

One in five medical students had LSE and it is strongly associated with metal distress. Female students were at higher risk of mental distress. Preventive, curative and rehabilitative mental health services should be available for medical students with particular attention to those with poor social support.

Physical Activity and the Emotional State of Physiotherapy Students Who Finish Their Education

This study aimed to evaluate the emotional state and the level of the sense of coherence in the context of physical activity among physiotherapy students and investigate how the participating students' emotional state changed after two years of studying and what factors were associated with the mood disorders. The study group consisted of 110 students-79 female and 31 male. The Back Depression Inventory (BDI), the Sense of Coherence Questionnaire (SOC-29) and the Perceived Stress Questionnaire (PSQ) were used. The results presented an increase in depressive symptoms during the studies of a group of physiotherapy students. Physical activity can play a protective role in the prevention and treatment of mood disorders. The students who regularly engaged in physical activity exhibited better mood, a lower perceived stress level and a higher level of the sense of coherence as compared to the physically inactive students.