Medical student depression, anxiety and distress outside North America: a systematic review

Social Anxiety and Its Comorbidity With Depression in Medical Students: A Network Analysis

Depression and social anxiety are highly comorbid in young adults, posing significant harm. This study aimed to identify central and bridge symptoms of depression and social anxiety in medical students, providing insights for intervention strategies. This cross-sectional study recruited 456 medical students. Depression symptoms were measured using the nine-item Patient Health Questionnaire (PHQ-9), while social anxiety was assessed using the Interaction Anxiousness Scale (IAS). Network analysis was utilised to examine symptom-level associations between depression and social anxiety. The study identified 'anxious at parties' and 'nervous with authority figures' as the most central symptoms, while 'nervous in informal gatherings' and 'fatigue' were the most bridge symptoms in the network of depression and social anxiety symptoms among medical students. These symptoms were crucial in the development of depression and social anxiety, indicating the target for interventions. The network analysis perspective suggests that the development of social anxiety in medical students is closely related to career development, while its comorbidity with depression is associated with social and emotional support. Distinct intervention strategies could target central and bridge symptoms to address social anxiety and its comorbidity with depression among medical students.

Exploring pre-clinical medical students' perception of and participation in active learning: A mixed-methods transnational study

BACKGROUND

Active learning is a learning process that promotes student engagement in constructing knowledge and conceptual understanding, improves critical thinking skills and develops professional competency. In recent years there has been a significant shift of emphasis in higher education from passive teacher-centred didactic teaching to active student-led learning. Although there is abundant literature about active learning, there is a gap in the knowledge of students' perception regarding factors that affect engagement in active learning activities. This project aimed to explore pre-clinical year medical students' perception of active learning and examine the factors that affect their participation in active learning activities.

METHODS

A mixed-method study was conducted with pre-clinical medical students at Newcastle University Medical School, UK, and Newcastle University Medicine Malaysia. A total of 266 students participated in an online survey questionnaire, with 25 students participating in focus group discussions (FGD). Quantitative data were analysed using descriptive analysis and qualitative data was analysed with thematic analysis.

RESULTS

The majority of students (94.7%) recognised that active learning is important for their learning, but had a narrow definition of what active learning constituted, and familiarity with active learning techniques was lacking. Many students' independent learning techniques were centred around methods of 'active recall', with factors affecting the utilisation of active learning techniques mainly focused on time availability, group dynamics in active teaching sessions and teaching styles of educators.

CONCLUSION

Students acknowledged the importance of active learning but are generally unfamiliar with ways to effectively utilise a broad range of active learning strategies. This study demonstrated that it is important for educators to understand firstly how students define active learning as well as how students interact with active learning taught sessions, to ensure that they create an environment where students feel confident to engage in active learning techniques.

Epidemiology of sleep disturbances among medical students in the Middle East and North Africa: a systematic review and meta-analysis

Background

Sleep disturbances and their associated health issues are common among medical students. Despite this, the epidemiology of sleep disturbances among medical students in the Middle East and North Africa (MENA) region remains inadequately understood. Our objective was to synthesise the prevalence of sleep disturbances, including poor sleep quality, insufficient sleep duration, and excessive daytime sleepiness (EDS), and their variation in relation to academic performance and stress levels.

Methods

We performed a systematic review and meta-analysis. Two independent reviewers searched PubMed, Web of Science, Google Scholar, and the reference lists of relevant studies and reviews up to May 2024. We assessed the quality of the included studies using a risk of bias tool. We performed meta-analyses using random-effects models and used Cochran's Q between-subgroups statistic to test for differences across subgroups. We used the I2 statistic to assess the statistical heterogeneity. Further, we assessed the publication bias using Doi plots.

Results

We included 150 studies conducted in 16 MENA countries. We found that 59.1% of medical students suffer from poor sleep quality (Pittsburgh Sleep Quality Index mean (x̄) = 8.5; 95% confidence interval (CI) = 7.0-10.1), 59.8% have insufficient sleep duration (<7 hours per night) averaging 6.1 hours per night (95% CI = 5.4-6.9), and 38.4% experience EDS (Epworth Sleepiness Scale x̄ = 8.6; 95% CI = 8.0-9.1). Our results indicate a significantly higher prevalence of poor sleep quality among students with moderate or high stress levels during the preclinical training period and in low-income MENA countries. A significantly higher prevalence of insufficient sleep duration was found among students during preclinical academic years. A significantly higher prevalence of EDS was found among students in public medical schools and those in low-income MENA countries. We observed no differences in poor sleep quality and EDS between students with poor and good academic performance.

Conclusions

Our findings highlight the substantial prevalence of sleep disturbances among MENA medical students. Medical schools must address this critical issue with targeted, locally informed, and culturally appropriate interventions. Further research is needed to assess the association between sleep disturbances and identify factors for tailored interventions that mitigate the adverse consequences on medical students' health and well-being.

Registration

Open Science Framework BF2A6.

Trajectories of medical students' empathy nowadays: a longitudinal study using a comprehensive framework of empathy

BACKGROUND

For more than a decade, the literature has been dominated by the notion that medical students may paradoxically lose their empathy during medical school. However, medical curricula have significantly evolved, and the question is whether this is still the case. The present study aimed to describe the trajectories of different dimensions of empathy from the beginning to the end of a six-year medical curriculum and explore the influence of different psychosocial and health-related factors.

METHODS

In an open cohort design, all medical students at the University of Lausanne (Switzerland) were invited to complete four waves of yearly online questionnaires. Cognitive, affective, and behavioral empathy were measured with three validated instruments, and emotion recognition was assessed with a performance test. For each measure, linear mixed models including an array of psychosocial and health-related potential covariates were modelled. Different temporal variance-covariance structures and nonlinear trajectories were tested.

RESULTS

The final sample included 3224 questionnaires completed by 1667 medical students. The cognitive and affective dimensions of empathy significantly increased in the first half of medical school, followed by a plateau, whereas behavioral empathy remained stable. For emotion recognition, a significant linear increase was observed. The only covariate with substantial influence was gender: students identifying as male presented similar trajectories of empathy and emotion recognition but with overall lower scores than students identifying as female or nonbinary.

CONCLUSIONS

This study revealed significant increases in cognitive empathy, affective empathy, and emotion recognition. Developments in today's medical curricula may have contributed to the observed increase in empathy. Future multisite studies are warranted to identify the features of the educational environment that impact the trajectories of empathy during medical school.

Suicidal behaviours and associated factors among Bangladeshi medical students: a systematic review and meta-analysis (2000-2024)

OBJECTIVES

Suicidal behaviours are common among medical students, and the prevalence might vary across various regions. Even though various systematic reviews have been conducted to assess the suicidal behaviours among medical students in general, no review has ever explored or carried out a sub-analysis to show the burden of suicidal behaviours among Bangladeshi medical students.

DESIGN

This is a systematic review and meta-analysis of prevalence studies among Bangladeshi medical students. The review applied truncated and phrase-searched keywords and relevant subject headings for study identification using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines.

DATA SOURCES

PubMed (Medline), Scopus, PsycINFO and Google Scholar databases were searched between January 2000 and May 2024.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The designed study included cross-sectional, case series, case reports and cohort studies of Bangladeshi medical students reporting suicidal behaviours (suicidal ideation, suicidal planning or suicidal attempts). Only freely accessible, full-text articles in English were included for analysis.

DATA EXTRACTION AND SYNTHESIS

Study screening, data extraction and methodological assessment were performed by two independent reviewers. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. A random-effects meta-analysis model was conducted to pool prevalence rates, complemented by narrative synthesis. Heterogeneity was assessed using the I 2 statistic.

RESULTS

Data were obtained from 6 eligible studies, including 1625 medical students (691 male) of Bangladesh. The pooled prevalence of lifetime suicidal behaviours was 25%, for suicidal ideation (95% CI: 14% - 37%, I 2=91%; p<0.01), 6% for suicidal plan (95% CI: 2% - 12%, I 2=91%; p<0.01), and 8% for suicidal attempt (95% CI: 1% - 17%, I 2=96%; p<0.01). The factors associated with suicidal ideation were female gender, depression, familial suicidal history and drug addiction. Only depression and drug addiction were significantly associated with suicidal attempts, while hanging was the most attempted method.

CONCLUSIONS

Suicidal behaviours particularly, suicidal ideation, are high among Bangladeshi medical students. However, very few studies were done in this country to quantify the burden and its associated factors.

PROSPERO REGISTRATION NUMBER

CDR 42023493595.

Navigating the medical journey: Insights into medical students' psychological wellbeing, coping, and personality

BACKGROUND AND AIMS

In recent years, increased awareness of the psychological wellbeing of healthcare professionals and students has become a pressing public health issue affecting care delivery. Medical students undergo rigorous training programs that can affect their psychological wellbeing. Despite increased awareness of mental health issues among medical students, research often focuses on negative aspects, overlooking potential positive contributors to wellbeing. This study aims to explore both negative and positive factors influencing medical students' psychological wellbeing, considering coping strategies and personality traits to inform targeted support measures for diverse student needs.

METHODS

A mixed-methods approach was employed to investigate medical students' psychological wellbeing, coping strategies, and personality traits. Quantitative data was gathered via self-report questionnaires and analysed using regression models. Additionally, qualitative insights were obtained from semi-structured interviews and analysed thematically to capture students' perceptions and experiences.

RESULTS

The analysis revealed moderate to high levels of stress, anxiety, and depression among medical students, along with decreased life satisfaction. Regression analysis showed that problem-focused coping positively impacted medical students' psychological wellbeing, whereas emotion-focused and avoidance coping showed less favourable effects. Notably, problem-focused coping partially mediated the relationship between stress and depression. Furthermore, personality traits, particularly agreeableness and conscientiousness, played a pivotal role in shaping medical students' coping strategies and mental health outcomes. Based on thematic analysis, codes gave rise to three overarching themes and corresponding subthemes.

CONCLUSIONS

The study underscores the significance of addressing both positive and negative factors impacting medical students' wellbeing and highlights the need for tailored support considering individual personality traits that influence coping strategies and mental health. It also identifies challenges within medical education, emphasising the necessity for stress management programs, mental health support, and curricula promoting problem-solving skills. Prioritising medical students' wellbeing may not only foster good mental health among future professionals but may also enhance future healthcare quality.

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.

Exploring the impact of depression, anxiety, stress, academic engagement, and dropout intention on medical students' academic performance: A prospective study

BACKGROUND

Depression, anxiety, and stress (DAS) have been linked to poor academic outcomes. This study explores the relationships among DAS, academic engagement, dropout intentions, and academic performance - measured by Grade Point Average (GPA) - in medical students. It aims to understand how these factors relate to each other and predict academic performance.

METHODS

Data were collected from 351 medical students (74.9 % female) through an online survey. The average age was 20.2 years. Psychometric instruments measured DAS, academic engagement, and dropout intentions. Structural equation modeling was used to test the relationships between these variables and their prediction of GPA.

RESULTS

DAS was negatively associated with academic engagement β̂=-0.501p<0.001 and positively associated with dropout intentions β̂=0.340p<0.001. Academic engagement positively predicted GPA β̂=0.298p<0.001 and negatively associated with dropout intentions β̂=-0.367p<0.001. DAS had a nonsignificant direct effect on GPA β̂=-0.008p=0.912. However, the indirect effect of DAS - via academic engagement - on GPA and dropout intention was statistically significant.

LIMITATIONS

The study's limitations include the use of a convenience sample and the collection of all variables, except GPA, at the same time point, which may affect the generalizability of the results.

CONCLUSIONS

The study supports the important role of DAS in its association with academic engagement and dropout intentions, which can predict GPA. Addressing DAS could enhance academic engagement and reduce dropout rates, leading to better academic performance.

Association between grit and depressive symptoms among medical students, moderated by academic performance

Depression amongst medical students is a crucial matter. Grit, which is a potentially modifiable psychological factor, has been inversely linked to depressive symptoms. However, it remains unclear how grit is associated with depression. This study aims to examine the relationship between grit and depressive symptoms and to further investigate the potential effect modification by academic performance on the association between grit and depression among medical students. We focus on the total grit score and its subscales, namely perseverance of effort and consistency of interest. A cross-sectional study was conducted using data from second-year medical students at Tokyo Medical and Dental University in Japan from 2020 to 2023. The participants responded to questionnaire surveys comprising the Center for Epidemiologic Studies Depression Scale and the Short Grit Scale. Linear regression analysis was performed to assess the association between grit and depressive symptoms. We also tested for effect modification by first-year Grade Point Average (GPA) on the association between grit and depression. The total grit score and its subscales, perseverance of effort and consistency of interest, were all inversely associated with depressive symptoms (b =  -4.7 [95%CI - 6.7 to - 2.6], b =  -3.7 [95%CI - 5.3 to - 2.1], b =  -1.8 [95%CI - 3.5 to - 0.2], respectively). While the interaction term for the total grit score and GPA was not significant, the interaction term for perseverance of effort and GPA was significant, indicating that the association between perseverance of effort and depression was stronger among the higher-achieving students. The interaction term for consistency of interest and GPA was also significant, indicating that the association was stronger among the lower-achieving students. We reveal a novel aspect of the association between grit and depressive symptoms in light of academic performance. The findings will contribute to future research on depression amongst medical students.

The Association of Plasma Selenium and Selenoprotein P Levels with Depression Severity and Anxiety Symptoms Among Medical Students in Latvia

Background and Objectives: Oxidative stress has been identified as a key process involved in different diseases, particularly depression. Selenium (Se) protects against oxidative stress, one of the pathogenic mechanisms involved in affective disorders. Selenium is incorporated into antioxidant selenoproteins, such as selenoprotein P, which acts as the main selenium-transport protein in plasma and as an extracellular oxidant defense mechanism. This study aimed to determine whether lower selenium and selenoprotein P levels correlate with high levels of depression and anxiety symptoms. Materials and Methods: The research design was a quantitative cross-sectional study among employed fourth-year medical students at Riga Stradins University in Latvia. The respondents were selected using convenience samples. The symptoms of anxiety were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale, and the symptoms of depression were assessed using the Patient Health Questionnaire-9 (PHQ-9) scale. Results: A total of 32 respondents participated; 90.6% (n = 29) were female. A significant association was found between selenoprotein P and symptoms of depression (p = 0.006), as well as between selenoprotein P and symptoms of anxiety (p = 0.012). The median selenium level was not significantly lower (p = 0.214) in the study group compared to the control group. Conclusions: There is a statistically significant correlation between selenoprotein P and symptoms of depression and anxiety, and there is a tendency for students with symptoms of depression and anxiety to have lower selenium levels. However, alternative unrecognized oxidative stress mechanisms involved in the development of symptoms of depression and anxiety, involving selenium and selenoprotein P pathways, may exist. Consequently, further research assessing possible alternative pathways and the effect size is required.

Effectiveness of an Internet-Based Self-Help Acceptance and Commitment Therapy Program on Medical Students' Mental Well-Being: Follow-Up Randomized Controlled Trial

BACKGROUND

Psychological distress is a growing problem among medical students worldwide. This highlights the need for psychological interventions to focus on mental health and improve well-being in this population.

OBJECTIVE

This study developed an internet-based, self-help, acceptance and commitment therapy program (iACT 2.0), aiming to examine its effectiveness in reducing depression, anxiety, stress, psychological inflexibility (PI), and obsessive-compulsive symptoms (OCSs) among medical students.

METHODS

A total of 520 Chinese postgraduate medical students were randomly assigned to either an iACT 2.0 intervention group (n=260; six online lessons, once every 5 days) or a control condition (n=260; without intervention). Participants completed questionnaires including the 21-item Depression Anxiety Stress Scale, the revised Obsessive-Compulsive Inventory, and the Multidimensional Psychological Flexibility Inventory at the preintervention (T1), postintervention (T2), and 1-month follow-up time points (T3). No therapist support was provided during the 1-month iACT 2.0 intervention period. Data were collected via an online platform and analyzed using repeated-measures ANOVA.

RESULTS

Participants in the intervention group demonstrated a significant decrease in depression, anxiety, stress, PI, and OCSs compared to the control group after the intervention (F=22.9-672.04, all P<.001). Specifically, the intervention group showed significant reductions in all measured outcomes from the preintervention to postintervention time point and at the 1-month follow-up (all P<.001). In contrast, no significant changes were observed in the control group over the same period (all P>.05). The groups did not differ significantly at baseline (all P>.05). Significant differences were noted at both the postintervention and follow-up time points (all P<.001).

CONCLUSIONS

This study demonstrated that the newly developed iACT 2.0 was effective in reducing depression, anxiety, stress, PI, and OCSs. Notably, the positive effects of the intervention persisted at the 1-month follow-up. This program can offer a useful addition to existing mental illness treatment and lead to improvements in clinical and psychotherapy planning while simultaneously reducing the burden on traditional counseling and services.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2300070725; https://tinyurl.com/2h75wx8n.

Common mental health problems in medical students and junior doctors - an overview of systematic reviews

BACKGROUND

Common mental health problems (CMHP) are prevalent among junior doctors and medical students, and the COVID-19 pandemic has brought challenging situations with education disruptions, early graduations, and front-line work. CMHPs can have detrimental consequences on clinical safety and healthcare colleagues; thus, it is vital to assess the overall prevalence and available interventions to provide institutional-level support.

AIMS

This overview summarises the prevalence of CMHPs from existing published systematic reviews and informs public health prevention and early intervention practice.

METHODS

Four electronic databases were searched from 2012 to identify systematic reviews on the prevalence of CMHPs and/or interventions to tackle them.

RESULTS

Thirty-six reviews were included: 25 assessing prevalence and 11 assessing interventions. Across systematic reviews, the prevalence of anxiety ranged from 7.04 to 88.30%, burnout from 7.0 to 86.0%, depression from 11.0 to 66.5%, stress from 29.6 to 49.9%, suicidal ideation from 3.0 to 53.9% and one obsessive-compulsive disorder review reported a prevalence of 3.8%. Mindfulness-based interventions were included in all reviews, with mixed findings for each CMHP.

CONCLUSIONS

The prevalence of CMHPs is high among junior doctors and medical students, with anxiety remaining relatively stable and depression slightly increasing during the COVID-19 pandemic. Future research on mindfulness-based interventions is required for a resilient and healthy future workforce.

PRISMA/PROSPERO

the researchers have followed PRISMA guidance. This overview was not registered with PROSPERO as it was conducted as part of an MSc research project.

A holistic approach to sustain and support lifelong practices of wellness among healthcare professionals: generating preliminary solid steps towards a culture of wellness

BACKGROUND

The COVID-19 pandemic has served as a catalyst for recognizing the challenging environments in which healthcare workers operate, underscoring the urgent need to enhance their wellness to better support themselves and others. The implementation of a culture of wellness within the context of healthcare education, with a particular emphasis on individual-level strategies, allows for the realization of its intrinsic value and significance as a foundation for broader organizational strategies. This approach facilitates the establishment of a sustainable culture of wellness that benefits both current and subsequent generations of healthcare professionals.

METHODS

We implemented our wellness program using a pragmatic pre-post study design for different settings. Our wellness intervention program was tested in three ways by creating combinations of different intensities (high, moderate, or low), delivery methods (face-to-face vs. virtual), different motivations (incentive, mandatory, or volunteer participation), and different timings (during medical programs or before entering into healthcare programs) among medical and nursing students. The effects of the wellness program were measured on quality of life, emotional intelligence, and efficacy scores among healthcare students. Statistical methods included repeated measures analysis of variance and paired t-tests.

RESULTS

A total of 224 students (13 in high, 145 in moderate, and 66 in low-dose interventions) participated in our study program. Most scores were significantly improved except for a few factors in the high-dose face-to-face Well-Teach intervention cohort. Among quality of life components, the average psychological scores were markedly increased after high (13.2 vs. 14.7, p = .018), moderate (13.9 vs. 14.8, p < .001), and low (12.8 vs. 13.4, p < .001) intensity intervention cohorts. The moderate and low intensity of wellness intervention cohorts had the highest impact on the total emotional intelligence scores (mean difference = 3.021, 95%CI:0.553-5.488, p = .008) and (mean difference = 5.197, 95%CI:3.057-7.337, p = < 0.001), respectively. The low-dose healthcare intervention program yielded improvements in all components of all scores to a greater extent than moderate-dose or high-dose with face-to-face intervention programs.

CONCLUSIONS

This study demonstrates that our multifaceted Well-Teach model can be used to improve the quality of life, emotional intelligence, and self-efficacy of healthcare students. Low- or moderate-intensity intervention programs integrated into the curriculum may be more practical in health sciences education to sustain and promote lifelong wellness practices as solid steps toward attaining a "culture of wellness". Our model should be considered to be beneficial, sustainable, cost-effective, comprehensive, and effective for current and future generations of healthcare providers.

Concerns of osteopathic medical students during the COVID-19 pandemic

OBJECTIVES

This study aims to quantify the areas of most concern in medical students in relation to their residency application in the setting of the COVID-19 pandemic and to identify risk factors for all that cause concern and specific areas of concern in a population with well-established high rates of anxiety at baseline. The COVID-19 pandemic introduced sweeping changes to medical education that had wide-ranging effects on medical students and their applications for medical residencies.

METHODS

In August 2020, we utilized a cross-sectional study to quantify student's areas of concern related to residency application related to the COVID-19 pandemic. We asked participants to rate their levels of concern in 15 different aspects related to medical residency applications and the perceived impact that COVID-19 had on each.

RESULTS

The survey was distributed to 984 osteopathic medical students, with 255 complete responses. The three areas of greatest impact were shadowing opportunities (4.15), volunteer opportunities (4.09), and conferencing opportunities (4.09). The most salient demographic variables were year in school, sex, and locale. Females reported higher levels of concern across all categories in the study compared to males, with statistical significance across all categories (all p<0.05, Range d=0.16 to 0.43), except for letters of recommendation and sub-internships.

CONCLUSIONS

The areas of most concern identified in our study were consistent with prior studies and may implicate the pressures that female medical students may feel compared to their male counterparts. The underlying cause(s) may be subject to future research.

The correlation between social adaptability and academic procrastination of undergraduate nursing students: the mediating role of resilience

BACKGROUND

How to mobilize nurses students' learning initiative, reduce the incidence of academic procrastination, and improve their social adaptability is a key factor in lowering nursing brain drain and improving nursing quality.

OBJECTIVE

To explore the mediating role of resilience in the correlation between social adaptability and academic procrastination of undergraduate nursing students.

METHODS

This study is a cross-sectional survey. The researchers conducted an electronic questionnaire survey of 962 nursing undergraduates in Guanzhong District, Shaanxi Province from November 2022 to April 2023, and adopted the intention sampling method. And make the following assumptions: (1) There is a significant negative correlation between academic procrastination and social adaptability. (2) Academic procrastination can directly affect the social adaptability of undergraduate nursing students, and it has a significant negative predictive effect. (3) Resilience can directly affect academic procrastination and social adaptability. At the same time, resilience plays an intermediary role between the two. In this study, the Aitken procrastination scale, the resilience scale, and the social adaptability diagnostic scale were used to evaluate undergraduate nursing students. SPSS27.0 software is used to analyze the data statistically, and the Hayes PROCESS Macro method is used to test the model.

RESULTS

The study's findings are as follows: 1) Academic procrastination significantly and negatively impacts social adaptability (c = -0.292, t = -6.407, p < 0.001). 2) Even when accounting for resilience, academic procrastination still significantly predicts lower social adaptability (c'= -0.204, t = -4.338, p < 0.001). 3) The Bootstrap method test of percentile bias correction indicates that resilience serves as a significant mediator between academic procrastination and social adaptability. Bootstrap SE = 0.018, 95% CI = (-0.124, -0.055). The indirect effect contributes to 29.79% of the total effect.

CONCLUSION

Resilience not only directly affects the academic procrastination and social adaptability of nursing students, but also partially intermediate the relationship between academic procrastination and social adaptability.

Development and validation of the Workplace Learning Inventory in Health Sciences Education: a multimethod study

Health sciences students face many challenges in regard to clinical practical learning. A better understanding of student learning is required to address student needs in this crucial phase. The theory of self-regulated learning provides a comprehensive view of learning and could serve as a basis for further research. There are instruments to assess self-regulated learning in preclinical academic learning. However, there are no such instruments for workplace learning. The aim of the present study is to provide a comprehensive inventory from which researchers can select those scales that are relevant to their research questions in the investigation of workplace learning. Hence, the aim is to develop and validate a set of scales to assess undergraduates' workplace learning in health sciences education in four areas (cognition, motivation, emotion, and context) on two levels (the learning process level and the metalevel). Study 1 is a qualitative multimethod study to identify indicators and develop items. It integrates the perspectives of students, teachers, and researchers and includes six steps: literature review, interviews, synthesis, item development, expert review, and cognitive pretesting. This study yields a set of scales for each area on both levels. Study 2 is a quantitative study to assess the psychometric properties. The results show acceptable values in terms of unidimensionality, reliability and validity for each of the 31 scales. The newly developed Workplace Learning Inventory is comprehensive; the scales are relevant to workplace learning and short enough that their administration is feasible in the workplace setting. The rigorous process of questionnaire development contributes to the validity of scales. By providing the Workplace Learning Inventory, we hope to encourage research on workplace learning in health sciences education from an educational psychology perspective.

Resilience, sleep quality and sleepiness in Peruvian medical students: a multicenter study

Background

Resilience can mitigate the negative impact produced by the COVID-19 pandemic. Medical students endure significant academic stress, so adjusting to sudden changes can present greater mental health challenges. The aim is to identify the level and prevalence of resilience and to know what are the educational variables and is sleep quality associated with resilience.

Methods

A cross-sectional study was conducted using an online questionnaire. The survey was elaborated in Google Forms and shared through social networks. The outcome was resilience, measured with the Connor Davidson Resilience Scale. Its association was assessed with sleep quality (measured with the Pittsburgh Sleep Quality Index), daytime sleepiness (measured with the Epworth Sleepiness Scale), and selected academic/sociodemographic variables. Generalized linear models were used to identify the association between the variables.

Results

Of 1277 participants, 35.7% experienced high resilience. Poor sleep quality and sleepiness were present in 88.4% and 36.0% of students, respectively. High resilience was associated with good sleep quality (PR:1.56; 95%CI: 1.34 - 1.83; p-value<0.001), absent sleepiness (PR:1.59; 95%CI: 1.32-1.91; p-value<0.001), male sex (PR: 1.21; 95%CI: 1.05-1.39; p-value 0.006), working (PR:1.14), having family responsibilities (PR: 1.36; 95%CI: 1.09-1.70; p-value 0.005) and spending more than 6 hours studying (PR: 1.35; 95%CI: 1.17-1.54; p-value<0.001).

Conclusion

4 out of 10 students presented high levels of resilience. The development of resilience depended on multiple individual and sociodemographic factors. These findings are important to support universities in developing resilience-building measures and strategies that can be implemented to mitigate the adverse pandemic event.

Validity Evidence of a Screening Tool for Early Detection of Clinical Crisis-Related Anxiety Amongst Medical Students

Construct: Psychological distress among students is a growing concern in medical education, even more so with the advent of COVID-19 pandemic. Anxiety is among students' mental health issues. High and persistent anxiety has many negative impacts on students' academic and personal life. Early detection is essential for timely intervention. Background: Currently, medical student anxiety is assessed using tools primarily designed for psychiatric purposes. Despite their excellent validity evidence, these tools contain sensitive items and do not explore stressors related to clinical activities. There is a need for contextualized tools to better identify anxiety-provoking factors specific to the medical education environment. Approach: We previously developed the Crisis Experience Rating Scale (CERS-7), a short screening tool to identify early on anxious students participating in clinical activities during the first wave of the COVID-19 pandemic. The present study sought to produce further validity evidence for the CERS-7. Medical students in their clinical years at two Swiss and one French medical school, all involved in COVID-19 clinical activity during the second wave of the pandemic, completed the CERS-7 and the State Anxiety Inventory (STAI-A), the best known and widely used tool to measure for general anxiety. We evaluated internal structure using confirmatory factor analysis (CFA) and relation to other variables using linear regression (LR) and receiver operating characteristic (ROC) curves with thresholds defined using the Youden index. Findings: There were 372 participants. CFA confirmed the two-factor structure of the CERS-7 scale from first-wave dataset. The CERS-7 total scale and subscales demonstrated validity evidence in relationship to the STAI-A scores and categories. A CERS-7 total scale score < 27.5 identified 93% of severely anxious students. Conclusion: The CERS-7 produces reliable scores to use for monitoring anxiety status when assigning students to clinical settings as well as for improving training conditions during clinical crisis.

Impostor phenomenon and its association with resilience in medical education - a questionnaire study among Swedish medical students

BACKGROUND

Concern over medical students' well-being is a global issue, with studies showing high psychological distress rates. Impostor Phenomenon (IP), i.e., underestimating one's abilities, attributing success to external factors, and feeling like a fraud, has been implicated as one reason behind these troubling findings. Meanwhile, resilience has been suggested to protect against psychological distress. This study aimed to investigate the prevalence of IP and its association with resilience among undergraduate medical students.

METHODS

The Clance Impostor Phenomenon Scale (CIPS), the Brief Resilience Scale (BRS), and sociodemographic questions were completed by 457 medical students registered in their 2-10th semester at a Swedish university. Of the respondents, 62.6% identified as women, 36.1% as men, and 1.3% as others.

RESULTS

The prevalence of IP was 58.4% (defined as CIPS score ≥ 62). According to the CIPS scoring guidelines, 10.3% of participants had low IP, 29.5% moderate, 41.6% frequent, and 18.6% intense IP. Of all participants, almost 90% experienced at least moderate and 60.2% frequent to intense IP. Women had significantly higher CIPS scores and lower BRS scores than men. In contrast, neither attending semester nor age group significantly impacted CIPS scores. Finally, there was a moderate inverse correlation between the level of resilience and the prevalence of IP.

CONCLUSIONS

Our findings suggest that the majority of Swedish medical students feels like an impostor, and of these students, most do so frequently. Furthermore, IP is more prevalent among female students - who also show lower levels of resilience. Moreover, our results indicated that IP could hinder achieving higher resilience. Future longitudinal studies should investigate how gender norms may contribute to IP feelings and explore the potential advantages of counteracting IP and strengthening resilience among medical students. However, targeted interventions addressing individual students' IP and resilience are insufficient. There is also a need to address structural aspects of the educational environment, such as gender stereotypes, that may contribute to IP.

Mistakes are not an option: aggression from peers and other correlates of anxiety and depression in pediatricians in training

Introduction

Pediatricians in training are a population at risk for anxiety and depression: they face long working hours, they are confronted with the suffering and death of a vulnerable population and may have personal characteristics that put them in danger. Nonetheless, few studies have looked at their prevalence and associated factors. We aimed to compare demographic, professional activities, adversities and perfectionism personality features between a group of pediatricians in training with depression and/or anxiety and a group of pediatricians in training without depression nor anxiety and, to identify the variables that increase the probabilities of depression and/or anxiety in pediatricians in training.

Methods

Pediatric residents who voluntarily answered an online survey distributed via personal and institutional social media channels from October 2019 to April 2021, as part of a cross-sectional study with medical specialists and residents from Mexico were included. Demographic information, professional activities and adversities, perfectionism personality features (Multidimensional Perfectionism Scale), depression and anxiety (ICD-11 PHC) were evaluated. For comparison purposes Chi-square tests (χ2) and independent sample t-tests were used. A logistic regression analysis was used to identify those variables that increase the probabilities of depression and/or anxiety.

Results

934 pediatric residents answered the survey. 11.6% reported having depression and 20% anxiety. Being single, a history of anxious or depressive episodes, being the resident in charge of a patient who died, aggressions from colleagues and a high concern for errors were associated with current depression and/or anxiety.

Discussion

Screening for depressive and anxious symptoms should be routinely performed from entry to the residency to favor early intervention. A shift from promoting perfectionism to a more compassionate training could serve a population facing so many adversities.

Suicidal behaviours and associated factors among medical students in Bangladesh: a protocol for systematic review and meta-analysis (2000-2024)

INTRODUCTION

Suicidal behaviour is common among medical students, and the prevalence rates might vary across various regions. Even though various systematic reviews have been conducted to assess suicidal behaviours among medical students in general, no review has ever assessed or carried out a sub-analysis to show the burden of suicidal behaviours among Bangladeshi medical students.

METHODS AND ANALYSIS

The research team will search the PubMed (Medline), Scopus, PsycINFO and Google Scholar databases for papers published between January 2000 and May 2024 using truncated and phrase-searched keywords and relevant subject headings. Cross-sectional studies, case series, case reports and cohort studies published in English will be included in the review. Review papers, commentaries, preprints, meeting abstracts, protocols and letters will be excluded. Two reviewers will screen the retrieved papers independently. Disagreements between two reviewers will be resolved by a third reviewer. Exposure will be different factors that initiate suicidal behaviours among medical students. The prevalence of suicidal behaviours (suicidal ideation, suicide plans and suicide attempts) in addition to the factors responsible, and types of suicide method will be extracted. Narrative synthesis and meta-analysis will be conducted and the findings will be summarised. For enhanced visualisation of the included studies, forest plots will be constructed. Heterogeneity among the studies will be assessed and sensitivity analysis will be conducted based on study quality. Included studies will be critically appraised using Joanna Briggs's Institutional critical appraisal tools developed for different study designs.

ETHICS AND DISSEMINATION

The study will synthesise evidence extracted from published studies. As the review does not involve the collection of primary data, ethical approval will not be required. Findings will be disseminated orally (eg, conferences, webinars) and in writing (ie, journal paper).

PROSPERO REGISTRATION NUMBER

CDR 42023493595.

Professional psychological qualities of Chinese medical students: theoretical models, questionnaire development, and relationship with mental health

Introduction

Professional psychological qualities are crucial for individuals' career development and overall well-being, especially in clinical medical professions. Medical students often face significant work, academic, and doctor-patient communication pressures, which can challenge their mental and emotional health. Measuring and understanding the relationship between medical students' professional psychological qualities and their mental health is of significant practical importance.

Methods

This study developed a comprehensive professional psychological qualities scale through a series of qualitative and quantitative studies, consisting of three main components and thirteen secondary dimensions. The scale's reliability was assessed using Cronbach's α coefficients. In Study 2, the scale was administered to 972 medical students to explore their anxiety and depression levels. A simple mediation analysis was conducted to investigate the relationship between professional psychological qualities, anxiety, and depression.

Results

The professional psychological qualities scale demonstrated satisfactory reliability, with a total scale α coefficient of 0.947 and subscale α coefficients ranging from 0.895 to 0.933. The mediation analysis revealed that medical students' professional psychological qualities directly negatively impact depression levels and indirectly positively influence them via their effects on anxiety levels, exhibiting an overall masking effect unrelated to depression levels.

Discussion

This study addresses the gap in research on the professional psychological qualities of medical students by providing a reliable measurement tool. The findings shed light on the complex mechanisms through which these qualities impact the mental health process. The scale can be used by other researchers to assess medical students' professional psychological qualities and further investigate their relationship with mental health outcomes.

The Interpersonal Psychological Theory of Suicide in Italian University Students: Validation of the INQ-15 and the ACSS-FAD

In the frame of the interpersonal psychological theory of suicide (IPTS), Interpersonal Needs Questionnaire (INQ-15) assesses thwarted belongingness (TB) and perceived burdensomeness (PB), related to suicidal ideation (SI); Acquired Capability for Suicide Scale-Fearlessness About Death (ACSS-FAD) measures this component which contributes to lethal self-harm. The objective was to evaluate the psychometric properties of INQ-15 and ACSS-FAD in a population of Italian university students. Since the Italian INQ-15 was already validated, we translated ACSS-FAD through a multistage procedure and administered both to 1,665 Italian university students. Factor analysis confirmed a two-factor-related model of INQ-15, one factor of ACSS-FAD, and good reliability for both. We proved the association between INQ-15 and current SI and between ACSS-FAD and lifetime suicidal planning and/or suicide attempt. The convergent and discriminant validities were in line with those of previous studies. Both tools are valid and reliable to assess the constructs associated with suicide outcomes according to IPTS.

Medical students' perspectives on a longitudinal wellness curriculum: a qualitative investigation

Introduction

There is growing concern about the mental health status of medical students. Medical students are at a higher risk for depression, anxiety, and burnout than non-medical students. The Undergraduate Medical Education (UGME) Office of Medical Learner Affairs at McGill University developed a Longitudinal Wellness Curriculum (LWC) to foster medical students' well-being, self-care, and adaptability.

Methods

We conducted a qualitative descriptive study to explore students' experiences with the LWC. We conducted three semi-structured focus groups involving a total of 11 medical students. We used thematic framework analysis for data analysis.

Results

We found four main themes related to participants' engagement with the curriculum: 1) diverse perceptions on curriculum relevance and helpfulness; 2) the benefits of experiential sessions, role model speakers, and supportive staff; 3) insights on student-friendly curriculum scheduling; and 4) the importance of wellness education and systemic interventions in medical education.

Conclusions

Most participants found the curriculum valuable and supported its integration into the academic curriculum. Experiential and active learning, diverse approaches to wellness, small group sessions, role modeling, and student-centered approaches were preferred methods. Inconvenient curriculum scheduling and skepticism over system-level support were seen as barriers to curriculum engagement and uptake. The findings of our study contribute to the development and implementation of wellness curriculum efforts in medical education.

Factors associated with substance use among preclinical medical students in Turkey: a cross-sectional study

Introduction

Medical students experience high levels of stress due to their rigorous training, which can negatively affect their mental health. This study aimed to investigate substance use habits of medical students at Istanbul University-Cerrahpaşa and the association on their mental health and demographic factors.

Methods

This cross-sectional survey study was conducted in March-April 2022 among preclinical medical students (years 1-3 of a 6-year program). A confidential, anonymous online survey consisting of four sections on sociodemographic and educational characteristics, nicotine use and dependence [Fagerström Test for Nicotine Dependence (FTND)], alcohol use [Alcohol Use Disorders Identification Test (AUDIT)], mental health status [12-item General Health Questionnaire (GHQ-12)], was distributed to 1131 students via WhatsApp and Telegram text messages. Mann-Whitney U and Kruskal Wallis tests compared variables' distribution in the questionnaire categories. Spearman's correlation assessed associations between scales. Significance was p < 0.05.

Results

The study included 190 medical students. A total of 26.3% of the participants were smokers, with 8.4% showing moderate to high levels of nicotine dependence. An estimated 45.8% and 8.4%reported low-risk consumption and risky usage of alcohol, respectively. There were statistically significant associations between substance use and demographic factors such as sex, GPA, and religious belief. The study found a statistically significant correlation between FTND scores and GHQ-12 scores, and, between FTND scores and AUDIT scores.

Conclusion

The findings of this study will inform the development of interventions to improve the mental health and academic performance of medical students at Istanbul University-Cerrahpaşa. Furthermore, it will raise awareness about the importance of addressing substance use among medical students in Turkey.

Music-based therapeutic interventions for medical school students with emotional regulation and mental health: a pre-post cohort study

Purpose

Depression and anxiety are prevalent mental health challenges among college students. Music therapy has shown effectiveness in addressing depressive symptoms and enhancing psychosomatic functioning. This study aimed to evaluate the effectiveness of a 4-step structured music therapy program in improving mood and reducing symptoms of depression and anxiety among medical school students.

Materials and methods

The self-controlled study involved 45 medical school students (21 men and 24 women) aged 18-24 years to examine the prevalence of depression and anxiety, common mental health issues among medical school students. Participants underwent psychological assessment using the Symptom Checklist-90 (SCL-90), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS). An 8-week music therapy intervention, comprising four steps-sociality, interaction, music lessons, and creative expression-was administered.

Results

Before-intervention, 55.6% and 15.6% students were identified as suffering from depression and anxiety respectively. Post-intervention, significant reductions in psychological distress, particularly in the Global Severity Index (GSI) and Positive Symptom Total (PST) on the SCL-90 scale, were observed (P < 0.05). Male students exhibited notable improvements in various psychological symptoms compared to females. Junior grade students demonstrated greater improvements, and clinical medicine students exhibited significant enhancements in specific areas post-intervention.

Conclusion

The structured music therapy program showed promising results in improving mood and regulating emotions among medical school students. Music therapy holds potential as a holistic approach to address mental health challenges in this demographic.

Continuing the conversation: a cross-sectional study about the effects of work-related adverse events on the mental health of Dutch (resident) obstetrician-gynaecologists (ObGyns)

BACKGROUND

Obstetrician-Gynaecologists (ObGyns) frequently face work-related adverse events such as severe obstetric complications and maternal or neonatal deaths. In 2014, the WATER-1 study showed that ObGyns are at risk of developing work-related posttraumatic stress disorder (PTSD), while many hospitals lacked a professional support system. The aim of the present study is to evaluate the current prevalence of work-related traumatic events and mental health problems among Dutch ObGyns, as well as to examine the current and desired support.

METHODS

In 2022, an online questionnaire was sent to all members of the Dutch Society of Obstetrics and Gynaecology (NVOG), including resident and attending ObGyns. The survey included questions about experienced work-related events, current and desired coping strategies, and three validated screening questionnaires for anxiety, depression, and PTSD (HADS, TSQ, and PCL-5).

RESULTS

The response rate was 18.8% and 343 questionnaires were included in the analysis. Of the respondents, 93.9% had experienced at least one work-related adverse event, 20.1% had faced a complaint from the national disciplinary board, and 49.4% had considered leaving the profession at any moment in their career. The prevalence rates of clinically relevant anxiety, depression, and psychological distress were 14.3, 4.4, and 15.7%, respectively. The prevalence of work-related PTSD was 0.9% according to DSM-IV and 1.2% according to DSM-5. More than half of the respondents (61.3%) reported the presence of a structured support protocol or approach in their department or hospital, and almost all respondents (92.6%) rated it as sufficient.

CONCLUSIONS

The percentages of anxiety, depression, psychological distress and PTSD are comparable to the similar study performed in 2014. Most Dutch ObGyns experience adverse events at work, which can be perceived as traumatic and, in certain cases, may lead to the development of PTSD. Structured support after adverse work-related events is now available in almost two-thirds of workplaces, and was mostly experienced as good. Despite substantial improvements in the availability and satisfaction of professional support after work-related adverse events, the prevalence rates of mental problems remain considerable, and it is imperative to sustain conversation about the mental well-being of ObGyns.

Mental health and burnout during medical school: Longitudinal evolution and covariates

BACKGROUND

Medical students' rate of depression, suicidal ideation, anxiety, and burnout have been shown to be higher than those of the same-age general population. However, longitudinal studies spanning the whole course of medical school are scarce and present contradictory findings. This study aims to analyze the longitudinal evolution of mental health and burnout from the first to the last year of medical school using a wide range of indicators. Moreover, biopsychosocial covariates that can influence this evolution are explored.

METHOD

In an open cohort study design, 3066 annual questionnaires were filled in by 1595 different students from the first to the sixth year of the Lausanne Medical School (Switzerland). Depression symptoms, suicidal ideation, anxiety symptoms, stress, and burnout were measured along with biopsychosocial covariates. The longitudinal evolution of mental health and burnout and the impact of covariates were modelled with linear mixed models.

RESULTS

Comparison to a same-aged general population sample shows that medical students reported significantly more depression symptoms and anxiety symptoms. Medical students' mental health improved during the course of the studies in terms of depression symptoms, suicidal ideation, and stress, although suicidal ideation increased again in the last year and anxiety symptoms remained stable. Conversely, the results regarding burnout globally showed a significant worsening from beginning to end of medical school. The covariates most strongly related to better mental health and less burnout were less emotion-focused coping, more social support, and more satisfaction with health.

CONCLUSION

Both improvement of mental health and worsening of burnout were observed during the course of medical school. This underlines that the beginning and the end of medical school bring specific challenges with the first years' stressors negatively impacting mental health and the last year's difficulties negatively impacting burnout.

Sociocultural adjustment and social support as predictors for international medical sciences students' anxiety during COVID-19

BACKGROUND

The prevalence of anxiety is high among international medical sciences students and it increased even more during the COVID-19 pandemic due to different restrictions and social isolation. Successful sociocultural adjustment and social support could be important factors in overcoming those challenges, however, there is a lack of studies which would investigate the role of those factors among inter- national medical students. This study aimed to assess the role of sociocultural adjustment and social support as predictors for international medical students' anxiety during COVID-19.

METHODS

Two measurements were conducted via self-reported questionnaires which consisted of three scales - SCAS, MSPSS and GAD-7. In total, 82 international medical students participated in both measurements in this longitudinal study.

RESULTS

The findings indicated that 37% of international students had symptoms of moderate or severe anxiety during their first year of studies at university. In the second year, during the COVID-19 pandemic and an official lockdown, 35% of international students had symptoms of moderate or severe anxiety. In addition, this study showed that gender and sociocultural adjustment did not play a role as predictors of students' anxiety during the second year of studies. However, this study revealed that social support provided by family during the first year of studies, as well as having friends or family members who had been ill with COVID-19 predicted higher levels of anxiety at second measurement, while sociocultural adjustment was an even stronger predictor of anxiety in the second year of studies of international medical students.

CONCLUSIONS

This knowledge can help to better understand how international medical students felt during the COVID-19 pandemic and what role the above- mentioned factors played in the students' anxiety. As the anxiety level is quite high among international medical students, universities and mental health service providers should take it into consideration and help them to overcome those challenges.

The Impact of COVID-19 on Mental Health in Medical Students: A Cross-Sectional Survey Study in Italy

Background: This study aimed to assess the impact of the COVID-19 pandemic in terms of the prevalence of anxiety, depression and stress symptoms in Italian medical students and to identify the associated factors. Design and Methods: A cross-sectional online survey was administered to second-sixth year medical students of the University of Torino, collecting data on the students' sociodemographics, COVID-19 exposure, anxiety, depression and stress symptoms. Three hierarchical regressions adjusted for age, gender and year of study were executed. Results: The sample size was 1359. The prevalence of anxiety, depression symptoms, moderate perceived stress and severe perceived stress was 47.8%, 52.1%, 56.2% and 28.4%, respectively. The factors associated with mental health symptoms were: being a woman, a family history of psychiatric disorders, living off-site, competitive/hostile climates and unsatisfying friendships among classmates, poor relationships with cohabitants, negative judgment of medical school choice, fear of COVID-19 infection, feelings of loneliness, distressing existential reflections, and a worsening psychological condition related to the pandemic. Being in the fourth or sixth year constituted a protective factor for depression symptoms. Conclusions: Mental health in medical students was associated with both COVID-independent and COVID-related factors. Accessibility to effective interventions must be increased to counteract these changes.

Development and validation of the physician self-efficacy to manage emotional challenges Scale (PSMEC)

BACKGROUND

Medical students experience emotional challenges during their undergraduate education, often related to work-based learning. Consequently, they may experience feelings of uncertainty and self-doubt, which can negatively affect their well-being. Therefore, it is crucial to support students' development of their ability to manage distressful situations. Self-efficacy beliefs may be a central aspect of supporting them in this development, and have been shown to relate to resilient factors such as students' motivation, learning, and well-being.

METHODS

We constructed a scale to measure medical students' physician self-efficacy to manage emotional challenges during work-based learning, the PSMEC scale. The aim of the present study was to evaluate some of the psychometric properties of the PSMEC scale. The scale consists of 17 items covering five subscales: (1) medical knowledge and competence, (2) communication with difficult patients and delivering bad news, (3) being questioned and challenged, (4) educative competence in patient encounters, and (5) ability to establish and maintain relationships with healthcare professionals. Data were collected from 655 medical students from all seven medical schools in Sweden. To investigate the scale's dimensionality and measurement invariance with regard to gender and time in education, single and multiple group confirmatory factor models were estimated using techniques suitable for ordered categorical data. Measures of Cronbach's alpha were calculated to evaluate internal consistency.

RESULTS

The scale showed good internal consistency on both the global dimension and the five subdimensions of self-efficacy. In addition, the scale was shown to be measurement invariant across genders and times in education, indicating that the scale means of male and female medical students and the scale means of students at the middle and end of their education can be compared.

CONCLUSIONS

The physician self-efficacy to manage emotional challenges scale demonstrated satisfactory psychometric properties, with regards to dimensionality, internal consistency, and measurement invariance relating to gender and time in education, and this study supports the usefulness of this scale when measuring self-efficacy in relation to emotional challenges.

It's very difficult to set the boundaries, it's human nature to want to respond: exploring health professions educators' responses to student mental health difficulties through a positioning theory lens

By virtue of their teaching role and contact with students, health professions (HP) educators are often the first point of connection for students who are experiencing mental health difficulties. Educators are increasingly expected to include some form of pastoral care in their role. Mental health-related interactions with students may have a negative emotional impact on educators, particularly when roles and expectations are not clearly defined and where boundaries are not managed effectively. Using positioning theory as a lens, this study explored how educators experienced such interactions and how this manifested in positions, storylines, and speech acts. Interviews were conducted with 27 HP educators at a faculty of medicine and health sciences. Reflexive thematic analysis using inductive coding identified themes corresponding to the nearing, weighted, ambivalent, and distancing positions participants adopted in relation to students with mental health difficulties. There was fluidity in and between positions, and more than one position could be occupied simultaneously; participants each moved through different positions in response to different relational situations. Multiple storylines informed these positions, representing how moral- and care-informed responsibility intersected with responsiveness to make certain actions possible or impossible. Normative and personal value narratives were evident in storylines, in many cases underscored by care or justice ethics. The value of positioning theory in facilitating reflective faculty development initiatives for educators engaged in these interactions is discussed.

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.

The effects of mindfulness-based interventions in medical students: a systematic review

The number of studies on the effects of mindfulness on healthcare professionals is increasing. The main aim of this study was to collate the quantitative results of original studies analyzing the effects of mindfulness-based interventions on a variety of outcomes in medical students. We also analyzed how the study design and characteristics of the intervention affect the results, and identified qualitative effects of mindfulness interventions. A literature search was performed in different databases in June 2020. Original articles meeting the following criteria were included: (1) at least 50% of the participants were medical students, (2) included a mindfulness intervention, (3) analyzed any outcome relating to mindfulness intervention, (4) peer-reviewed (5) written in English. Eventually, 31 articles including 24 different samples were included. Over half of the studies were RCTs. In over half of the studies, the intervention was 4- to 10-week original Mindfulness-Based Stress Reduction or Mindfulness-Based Cognitive Therapy or a modification of these. In general, satisfaction with the interventions was good. Based on a meta-analysis, after the intervention, the intervention group had statistically significantly fewer symptoms of stress and distress and had higher mindfulness than the controls. The beneficial effects persisted in follow-ups over months or years. Both long and shorter courses and courses with and without face-to-face sessions were effective. Both controlled and uncontrolled studies had statistically significant results. Qualitative results revealed potential factors behind the quantitative effects. The number of studies on mindfulness interventions in medical students has increased drastically. Mindfulness-based interventions seem to offer a good possibility to enhance medical students' well-being.

Prevalence of alcohol and other psychoactive substance abuse and association with depression among medical students in Niger Delta University, Bayelsa State

Introduction

alcohol and other psychoactive substances have adverse health effects, particularly on young people. This study determined the prevalence of alcohol and other psychoactive substance abuse and its association with depression among Niger Delta University, Bayelsa State, Nigeria, medical students.

Methods

a cross-sectional study involving 243 medical students who completed a patient-rated version of the Mini International Neuropsychiatric Interview (MINI-PR). For analyzing the data, descriptive and inferential statistics were employed.

Results

most respondents were 18 to 24 years old (67.1%), and 52.7% were male; the prevalence of major depressive episodes (current) and lifetime alcohol and other psychoactive use was 30.5%, 25.5%, and 21%, respectively. Also, the prevalence of current alcohol abuse and dependence was 5.8% and 4.9%, respectively. Alcohol use (χ2: 12.57, p = 0.001) and abuse (χ2: 22.33, p = 0.001) were significantly associated with depression. Psychoactive substance use was significantly associated with depression (χ2: 12.91, p = 0.001). The odds of having depression increased with the use of alcohol (OR: 3.54; 95% CI: 1.71-7.33) and psychoactive substances (OR: 4.52; 95% CI: 1.88-10.88).

Conclusion

alcohol and psychoactive substance use were significantly associated with depression. Organizing interventions to reduce such unhealthy social practices among medical students is necessary.

Cadaver Dissection Experience for First-Time Dissectors: a Hypothetical Three-Pronged Approach for Student Preparation

This systematic review synthesized evidence for the development of a preparatory process for first-time dissectors, geared toward improving cadaver dissection (CD) experiences. Eleven studies focused on pre-CD intervention were selected from a literature search in PubMed, the Education Resources Information Centre (ERIC), Google Scholar, PsycNET, and the Cochrane Library. A three-pronged preparatory process was formulated for first-time dissectors based on the evidence from the review. The process includes (1) background assessment; (2) pre-CD education; and (3) gradual exposure and desensitization. The preparatory process shows some hypothetical potential for decreasing negative CD-related experiences, but it still needs validation before implementation.

Relationship between attention deficit hyperactive disorders with life satisfaction among medical students in city of Hail, KSA

BACKGROUND

Attention deficit hyperactive disorder (ADHD) begins in childhood, and its symptoms persist into adulthood. Students with ADHD symptoms will be at increased risk of antisocial behavior, depression, and loss of inhibition. This study determines the relationship between ADHD and life satisfaction level among medical students in the city of Hail, KSA.

MATERIALS AND METHODS

This is a cross-sectional study that was conducted in a public-sector medical college. A total of 200 students were recruited through stratified cluster sampling. Validated, structured scales of ADHD and life satisfaction were used, and known psychiatric disorders among students were excluded from the study. Correlation and linear regression analyses were used to determine the relationship between ADHD and life satisfaction and identify the determinants of ADHD. P value < 0.05 was considered statistically significant.

RESULT

The prevalence rate of ADHD among medical students was 33.3%. Female gender, third-year academic year student, and 21-26-year-old age group were the high-risk groups of ADHD. Inattention (r = -0.263, P value -0.000) and hyperactivity (r = -0.260, P value 0.000) were significantly correlated with life satisfaction level, with 92% of the variability in life satisfaction determined by inattention and hyperactivity.

CONCLUSION

The burden of ADHD is high among medical students, and it negatively correlates with life satisfaction level. Students' academic and social functioning was affected due to ADHD. There is a need to address this issue with early diagnosis and management of this disorder.

Achievement Emotions of Medical Students: Do They Predict Self-regulated Learning and Burnout in an Online Learning Environment?

BACKGROUND

Achievement emotions have been proven as important indicators of students' academic performance in traditional classrooms and beyond. In the online learning contexts, previous studies have indicated that achievement emotions would affect students' adoption of self-regulated learning strategies and further predict their learning outcomes. However, the pathway regarding how different positive and negative achievement emotions might affect students' burnout through self-regulated learning among medical students in online learning environments remains unclear. In this study, the aim is to investigate how achievement emotions and self-regulated learning predict burnout among medical students in online education.

METHODS

This study involved 282 medical students who had attended online courses due to the sudden shift of learning mode caused by the COVID-19 pandemic in 2022. Confirmatory factor analysis was performed to examine the hypothesized factor structure, and structural equation modelling was conducted to test the hypothesized relationships among factors.

RESULTS

The results of structural equation modelling revealed that medical students' self-efficacy positively predicted their enjoyment (β = .57) and online self-regulated learning (β = .54). Learning-related boredom inhibited students' adoption of online self-regulated learning strategies (β = -.24), and it was positively associated with their burnout (β = .54). Learning-related anxiety was a positive predictor of online self-regulated learning (β = .38).

DISCUSSIONS

The results of this study suggest that achievement emotions experienced by medical students had a significant impact on their online self-regulated learning and burnout. Specifically, the experience of learning-related boredom was detrimental to the adoption of self-regulated learning strategies and increased the likelihood of burnout. However, learning-related anxiety, despite being a negative achievement emotion, was positively associated with students' online self-regulated learning. These findings have important implications for online teaching and learning, particularly in the post-pandemic era.

Wellbeing Convene during COVID-19: A pilot intervention for improving wellbeing and social connectedness for staff, students, residents, and faculty

Background

Canada is facing its worst crisis among healthcare workers in recent healthcare history. Anxiety, depression, suicidal ideation, and severe burnout are higher than before the COVID-19 pandemic. University Faculties of Medicine (FoMs) are vital to healthcare systems. Not only are they responsible for training personnel, but clinicians and staff from FoMs often work directly within healthcare systems. FoMs include students, staff, residents, faculty members, residents, researchers, and others, many experiencing higher stress levels due to pandemic tensions. Most FoMs emphasize cognitive and psychomotor learning needs. On the other hand, affective learning needs are not as well addressed within most FoMs. Finding innovative means to ameliorate mental and emotional health status, particularly at this critical juncture, will improve health and wellness, productivity, and retention. This article discusses a pilot program, Wellbeing Convene during COVID-19, in a Canadian FoM, which aimed to (1) provide staff, faculty, residents, and students with a toolkit for greater wellbeing and (2) build a sense of community during isolating times.

Results

Participants found the program beneficial in both regards. We recommend that these kinds of programs be permanently available to all members in FoMs, at no cost. Wellness programs alone, however, will not solve the root causes of mental and emotional stress, often based on concerns related to finances, hierarchical workplace structures, and nature of the work itself, among other factors.

Conclusion

Addressing the mental and emotional health of people in FoMs is vital to improving productivity and reducing stress of FoMs, healthcare professionals, and, ultimately, patients.

Constructing "Burnout": A Critical Discourse Analysis of Burnout in Postgraduate Medical Education

PURPOSE

In 1974, Dr. Herbert Freudenberger coined the term burnout. With the creation of the Maslach Burnout Inventory in 1984, burnout went from a pop psychology term to a highly studied phenomenon in medicine. Exponential growth in studies of burnout culminated in its adoption into the International Classification of Diseases-11 in 2022. Yet, despite increased awareness and efforts aimed at addressing burnout in medicine, many surveys report burnout rates have increased among trainees. The authors aimed to identify different discourses that legitimate or function to mobilize burnout in postgraduate medical education (PGME), to answer the question: Why does burnout persist in PGME despite efforts to ameliorate it?

METHOD

Using a Foucauldian discourse analysis, this study examined the socializing period of PGME as an entry point into burnout's persistence. The archive from which the discourses were constructed included over 500 academic articles, numerous policy documents, autobiographies, videos, documentaries, social media, materials from conferences, and threads in forums including Reddit.

RESULTS

This study identified 3 discourses of burnout from 1974-2019: burnout as illness, burnout as occupational stress, and burnout as existentialism. Each discourse was associated with statements of truth, signs and signifiers, roles that individuals play within the discourse, and different institutions that gained visibility as a result of differing discourses.

CONCLUSIONS

Burnout persists despite effort to ameliorate it because it is a productive construct for organizations. In its current form, it depoliticizes issues of health in favor of wellness and gives voice to the challenge of making meaning from the experience of being a clinician.

Healthcare-seeking of medical students: the effect of socio-demographic factors, health behaviour and health status - a cross-sectional study in Hungary

BACKGROUND

Medical students are more likely to have various physical and psychological issues, but less information is available about the healthcare-seeking behaviour for physical and mental health issues. The aim of this study is to determine the factors affecting medical students' healthcare-seeking when visiting a general practitioner (GP) and/or psychologist.

METHODS

688 medical students (326 International and 362 Hungarian,) participated in a cross-sectional study. The information was gathered using a self-administered online questionnaire and covered socio-demographic background, health behaviour, general and mental health status and healthcare-seeking. For analysing adjusted associations, multivariable logistic regression models were used.

RESULTS

Overall, 56.8% of medical students visit the GP; and 17.2%, the psychologist. Hungarian medical students visited the GP with chronic diseases, International medical students were more likely to visit a GP when they encountered sexual activity and had chronic diseases. Moreover, there was a significant correlation between sex, alcohol consumption, and perceived stress in the total sample of psychologist visits. When Hungarian medical students were in their clinical years and had a poor self-rated mental health, they were more likely to visit a psychologist. Whereas female international medical students and those who had poor self-rated mental health were more likely to seek psychological help.

CONCLUSION

Students visit a GP and/or psychologist is associated with a variety of factors, including socio-demographic background, health behaviours, and health issues. Medical schools should encourage help-seeking behaviours and early disclosure of medical students. Their ability to grasp healthcare attitudes and designing treatments will be important for both their academic success and future profession.

Knowledge and coping style about depression in medical students: A cross-sectional study in China

OBJECTIVES

The current study aimed at ascertaining the depression levels of medical students and their knowledge levels of depression, and exploring the relationship between the level of knowledge and coping styles of the medical students on depression.

METHODS

An online-based survey was developed in Changzhi Medical College. The questionnaire included demographic and socioeconomic data, questions about depression knowledge and copying styles of depression, and the Zung Self-Rating Depression Scale (SDS). A total of 1931 questionnaires were returned by respondents.

RESULTS

The medical students produced a mean SDS score of 44.29 (SD = 11.67). The prevalence of depression was 29.7%. Sophomore, female, and poor family relationships were parameters associated with a higher SDS score. The total correct rate for knowledge of depression was 64.14%. There were statistical differences between with depression students and non-depression students on the rate of the correct answers in the following questions:"Female has more probability", "Depression can be adjusted by oneself", "Associated with one's character", "Know cure method of depression", "Know drug use of depression", "Know depression influence for health", and "Know prevention method of depression". Depression students were more likely to have a lower rate of correct answer for above questions. Asking for help from psychological consultation was the primary coping mechanism among the medical students. The logistic regression analysis results found that depressed students who chose the coping way of no ways of coping were more likely to be females OR = 1.470 (1.078, 2.005), residents in rural area OR = 1.496 (1.038, 2.156), in poor family relationships OR = 2.428 (1.790, 3.293), and have lower cognitive level of depression knowledge OR = 1.920 (1.426, 3.226).

CONCLUSIONS

It is necessary to focus on mental health of medical students, especially in female, residents in rural area, in poor family relationships, and having lower cognitive level of depression knowledge. Medical students were insufficient on depression knowledge and coping styles, and efforts that train students know risk of impaired mental health could also improve diagnosis and treatment.

Vulnerable in the end - Longitudinal study among medical students on mental health and personal and work-related resources over a 5.5-year-period

BACKGROUND

Mental health problems are common in medical professionals and their development already starts at the undergraduate level. Studies on medical students can replicate higher prevalence for depression and burnout in this group, but they normally compare semester cohorts in an anonymized, cross-sectional approach and without a preventive perspective.

METHODS

We surveyed medical students at the beginning and end of their medical curriculum and collected data on burnout, depressivity, work related experience and salutogenesis parameters with validated self-administered questionnaires. Most remarkably we obtained the data from the same 58 individuals after 5.5 years, representing data of the highest quality in order to compare the mental health status at the beginning and the end of our students´ medical curriculum.

RESULTS

Our results not only show a severe exacerbation of physical, mental and emotional burnout in the participants at the end of their studies. The students also do not seem to have sufficient personal (resilience) or social resources (e.g. experience of social support) for coping with their mental health problems around the time of their graduation.

CONCLUSIONS

Our participants reflect a development of mental health during their medical studies at university that is paving the way to the devastating prevalence of mental disorders and suicide in health professionals. From our results we derive an urgent need to integrate self-care and active coping in the learning goals of medical curricula.

A student-driven mindfulness curriculum for first-year osteopathic medical students: a pilot study

CONTEXT

Medical education is stressful and can adversely affect the health and well-being of students. Although mindfulness-based interventions (MBIs) have been successfully utilized in other settings, little is known about the use of student-led interventions in undergraduate medical education.

OBJECTIVES

The objectives of this study are to assess student satisfaction with four student-selected and student-led mindfulness activities incorporated into mandatory small-group sessions, the immediate impact of these activities on student stress levels, and student use of these activities outside the mindfulness sessions.

METHODS

First-year osteopathic medical students voluntarily participated in weekly student-selected and student-led mindfulness activities once a week for 8 consecutive weeks during regularly scheduled class time. Activities included yoga postures, the 4-7-8 breathing technique, progressive muscle relaxation (PMR), and values affirmation. Each activity was completed twice during the 8 weeks. After each session, students could anonymously complete an electronic survey assessing participation, change in stress level, satisfaction with the activity, and mindfulness activities practiced outside the session. Survey questions included dichotomous, Likert-like, and multiple-choice responses. A chi-square test was utilized to analyze student responses from each week about the decrease in stress level, and satisfaction with the mindfulness activity, and student use of the activities outside the classroom. Wilcoxon rank sum tests were utilized to determine associations between outcomes, and a logistic regression model was utilized to determine relationships between the change in stress levels and other outcomes.

RESULTS

Of the 154 first-year medical students initially enrolled in the 2021-2022 academic year, 14 (9.1 %) to 94 (61.0 %) actively participated in the weekly mindfulness activities. Students indicated that the 4-7-8 breathing technique was the activity most practiced outside the mindfulness sessions (32.3 %, 43/133 total responses) across all weeks. The mindfulness activity with the highest percentage of reported decrease in stress level was the yoga postures in week 5 (94.8 %, 36/38), and both weeks of the yoga activities had the highest reported student satisfaction (95.7 %, 90/94 for week 1; 92.1 %, 35/38 for week 5). For students who answered the change in stress level question, the stress level decrease was related to participation in the weekly activity for weeks 1 through 7 (all p<0.03). For students who participated in mindfulness sessions, the odds of reporting a reduction in the stress level were 16.6 times (95 % CI, 6.8-47.2; p<0.001) that of students who did not participate. For those satisfied with the activities, the odds of reporting a reduction in stress level were 6.7 (95 % CI, 3.3-13.9; p<0.001).

CONCLUSIONS

Results suggested that the student-selected and student-led mindfulness activities may successfully reduce medical student stress in students who actively participate. However, additional research is needed to determine how to optimize mindfulness curricula implementation.

Critical Thinking, Generalized Anxiety in Satisfaction with Studies: The Mediating Role of Academic Self-Efficacy in Medical Students

BACKGROUND

The academic and emotional challenges faced by medical students can affect critical thinking and may also contribute to the development of increased generalized anxiety. Similarly, critical thinking and generalized anxiety can impact study satisfaction through the mediating mechanism of academic self-efficacy.

OBJECTIVE

The aim of this study was to assess the mediating role of academic self-efficacy between critical thinking and generalized anxiety in study satisfaction among medical students.

METHODS

A cross-sectional and explanatory study was conducted involving 259 Peruvian medical students aged between 18 and 35 (M = 20.29, SD = 2.84). The evaluation was based on self-reported questionnaires covering critical thinking, generalized anxiety, academic self-efficacy, and study satisfaction. Furthermore, a structural equation modeling (SEM) and mediation approach was employed to examine the relationships between variables.

RESULTS

The results showed an adequate fit of the model [χ2 (87) = 155, p < 0.001, CFI = 0.93, TLI = 0.92, RMSEA = 0.05 (CI: 0.04-0.07), SRMR = 0.07], demonstrating the impact of critical thinking and generalized anxiety. It was confirmed that academic self-efficacy has a positive effect on study satisfaction. Moreover, the mediating role of academic self-efficacy was confirmed between critical thinking and study satisfaction, as well as between generalized anxiety and study satisfaction.

CONCLUSIONS

Due to the high academic load on medical students, academic self-efficacy plays a mediating role in the relationship between critical thinking, generalized anxiety, and satisfaction with studies. The development of educational strategies will help to promote critical thinking and academic self-efficacy, as well as provide support to students with generalized anxiety, to enhance study satisfaction.

Prevalence of gastro-oesophageal reflux disease, and its associated risk factors among medical students: a nation-based cross-sectional study

BACKGROUND

Gastroesophageal reflux disease (GERD) is a common digestive problem in adults particularly medical students, who are one of the most vulnerable groups. Many variables, including lifestyle changes and psychological stress, increase the prevalence of GERD among undergraduate medical students. Therefore, this study aims to assess the prevalence, and risk factors of GERD, and its relationship with perceived stress among medical students in Egypt.

METHODS

In November and December of 2022, a cross-sectional descriptive study with an analytical component was carried out among medical students from six different universities. An online self-reported questionnaire was used to collect data. The questionnaire included data on sociodemographic characteristics, risk factors, lifestyle, the Arabic version of GerdQ, and the Arabic version of Cohen's Perceived Stress Scale (PSS).

RESULTS

The questionnaire was filled out by 964 medical students, the majority of whom were female (64%). Overall, 17.1% of participants reported symptoms of GERD. Logistic regression showed that smoking, high perceived stress, and a family history of GERD were the independent predictors of having GERD symptoms, with odds ratios of 4.1, 3.9, and 2.2, respectively.

CONCLUSION

GERD is a frequent condition among Egyptian medical students, affecting around one-fifth of them. In the fight against GERD, university-based smoking cessation and stress management programs may be influential.

The role of spirituality and religiosity on the suicidal ideation of medical students

BACKGROUND

There is solid evidence that spirituality and religiousness may reduce the suicidal ideation of individuals. However, studies are scarce on medical students.

AIMS

To investigate the relationship between spirituality, religiousness, and suicidal ideation among Brazilian medical students.

METHODS

This is a cross-sectional study including Brazilian medical students. Sociodemographic and health variables, suicidal ideation (item 9 of the Beck Depression Inventory - BDI), spiritual and religious Coping (Brief SRC), religiousness (Duke Religion Index), spiritual well-being - Meaning, Peace and Faith (FACIT SP-12), and depressive (PHQ-9) and anxiety (GAD-7) symptoms were assessed.

RESULTS

A total of 353 medical students were included, 62.0% presented significant depressive symptoms, 44.2% presented significant anxiety symptoms, and 14.2% presented suicidal ideation. In the adjusted Logistic Regression models, meaning (OR = 0.90, p = .035) and faith (OR = 0.91, p = .042) were associated with lower suicidal ideation, while negative spiritual and religious coping was associated with greater suicidal ideation (OR = 1.08; p = .006).

CONCLUSION

There was a high prevalence of suicidal ideation among Brazilian medical students. Spirituality and religiousness were associated with suicidal ideation in two different directions. These findings could help educators and health professionals to understand suicidal ideation among medical students, helping in the development of preventive strategies to mitigate such problem.

The association between how medical students were selected and their perceived stress levels in Year-1 of medical school

BACKGROUND

The prevalence of medical students' mental distress is high. While schools apply various methods to select a well-performing and diverse student population, little is known about the association between different selection methods and the well-being of these students during medical school. The present retrospective multi-cohort study assessed whether students selected by high grades, assessment, or weighted lottery showed different stress perception levels in Year-1 of medical school.

METHODS

Of 1144 Dutch Year-1 medical students, 650 (57%) of the cohorts 2013, 2014, and 2018 who were selected by high grades, assessment, or weighted lottery completed a stress perception questionnaire (PSS-14). A multilevel regression analysis assessed the association between selection method (independent variable) and stress perception levels (dependent variable) while controlling for gender and cohort. In a post-hoc analysis, academic performance (optimal vs. non-optimal) was included in the multilevel model.

RESULTS

Students selected by assessment (B = 2.25, p < .01, effect size (ES) = small) or weighted lottery (B = 3.95, p < .01, ES = medium) had higher stress perception levels than students selected by high grades. Extending the regression model with optimal academic performance (B=-4.38, p < .001, ES = medium), eliminated the statistically significant difference in stress perception between assessment and high grades and reduced the difference between weighted lottery and high grades from 3.95 to 2.45 (B = 2.45, p < .05, ES = small).

CONCLUSIONS

Selection methods intended to create a diverse student population - assessment and lottery - are associated with higher stress perception levels in Year-1 of medical school. These findings offer medical schools insights into fulfilling their responsibility to take care of their students' well-being.

The prevalence of depressive and anxiety symptoms among first-year and fifth-year medical students during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Medical students have higher risk of psychological disorders due to the relatively stressful environment. Educators are becoming increasingly aware of the impact of stresses on the students general well-being. The objective of the current study was to examine the prevalence of and risk factors for depressive and anxiety symptoms among first-year and fifth-year medical students. Additionally, we aimed to determine whether the COVID-19 pandemic has affected students' mental well-being.

METHODS

A cross-sectional study was performed at the College of Medicine at King Saud University between September 2020 and January 2021. The target population was first-year and fifth-year medical students. Depressive symptoms were screened using the 9-item Patient Health Questionnaire (PHQ-9), while anxiety symptoms were screened using the 7-item Generalized Anxiety Disorder assessment (GAD-7). Students were also directly asked about the effect of the COVID-19 pandemic on their mental well-being. Outcomes were compared between groups using the chi-squared test and Student's t test. Multivariate logistic regression analysis was performed to identify factors associated with depressive and anxiety symptoms.

RESULTS

A total of 182 medical students were included. Depressive symptoms (52.9% versus 35.8%, p = 0.020) and anxiety symptoms (35.6% versus 26.3%, p = 0.176) were higher in the first-year students than in the fifth-year students. Approximately 19.2% of the students were worried about acquiring COVID-19, 49.4% were worried about academic performance, and 30.8% were feeling sad, depressed or anxious during the COVID-19 pandemic. Independent risk factors for depressive symptoms included having concomitant anxiety, being worried about acquiring COVID-19, being worried about academic performance, and feeling sad, depressed or anxious. Independent risk factors for anxiety included having a lower grade point average and having concomitant depressive symptoms.

CONCLUSION

Medical students have an alarmingly high prevalence of depressive and anxiety symptoms, which might have been negatively impacted by the COVID-19 pandemic. There is a need for a special mental health program targeting new and current medical students.

The mediating role of psychological capital in the association between life satisfaction and depressive and anxiety symptoms among Chinese medical students during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Although life satisfaction is a predictor of depressive and anxiety symptoms, the mechanisms underlying this association are poorly understood. This study examined how psychological capital (PsyCap), a positive psychological state, mediated the association between life satisfaction and depressive and anxiety symptoms among Chinese medical students during the COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted at three medical universities in China. A self-administered questionnaire was distributed to 583 students. Depressive symptoms, anxiety symptoms, life satisfaction, and PsyCap were measured anonymously. A hierarchical linear regression analysis was performed to explore the effects of life satisfaction on depressive and anxiety symptoms. Asymptotic and resampling strategies were used to examine how PsyCap mediates the association between life satisfaction and depressive and anxiety symptoms.

RESULTS

Life satisfaction was positively associated with PsyCap and its four components. There were significant negative associations between life satisfaction, psychological capital, resilience, optimism, and depressive and anxiety symptoms among medical students. Self-efficacy was negatively associated with depressive and anxiety symptoms. Psychological capital (a×b = -0.3201, BCa 95% CI: -0.3899, -0.2446; a×b = -0.2749, BCa 95% CI: -0.3817, -0.1996), resilience (a×b = -0.2103, BCa 95% CI: -0.2727, -0.1580; a×b = -0.1871, BCa 95% CI: -0.2520, -0.1414), optimism (a×b = -0.2100, BCa 95% CI: -0.3388, -0.1150; a×b = -0.1998, BCa 95% CI: -0.3307, -0.0980), and self-efficacy (a×b = -0.0916, BCa 95% CI: 0.0048, 0.11629; a×b = 0.1352, BCa 95% CI: 0.0336, 0.2117) significantly mediated the association between life satisfaction and depressive and anxiety symptoms.

LIMITATIONS

This was a cross-sectional study, and causal relationships between the variables could not be ascertained. Self-reported questionnaire instruments were used for data collection, which may have recall bias.

CONCLUSIONS

Life satisfaction and PsyCap can be used as positive resources to reduce depressive and anxiety symptoms among third-year Chinese medical students during the COVID-19 pandemic. Psychological capital and its components (self-efficacy, resilience, and optimism) partially mediated the relationship between life satisfaction and depressive symptoms, and completely mediated the relationship between life satisfaction and anxiety symptoms. Therefore, improving life satisfaction and investing in psychological capital (especially self-efficacy, resilience, and optimism) should be included in the prevention and treatment of depressive and anxiety symptoms among third-year Chinese medical students. Additional attention is needed to pay for self-efficacy in such disadvantageous contexts.