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Jestin M, Sharma S, Jhaveri D, Mitchell B, Micciche D, Venkataraman V, Lambert K. Mental health differences in medical students based on curriculum and gender. BMC Med Educ 2023; 23:971. [PMID: 38115013 PMCID: PMC10731840 DOI: 10.1186/s12909-023-04946-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The prevalence of mental health struggles among students in medical school is widely reported; however, little is known about how it is impacted by the medical school curriculum. This study aimed to evaluate differences in anxiety, depression, and emotional exhaustion in medical students based on gender, class year, and curriculum. METHODS An anonymous online survey consisting of questions from established, validated questionnaires about demographics, anxiety, depression, emotional exhaustion, and personal health behaviors was sent to 817 medical students who attended Rowan-Virtua School of Osteopathic Medicine during the Spring of 2021. When applying to this school, each of these students had the option to choose either the problem-based learning (PBL) or lecture-based learning (LBL) curriculum track. RESULTS The survey was completed by 222 students. Females experienced higher levels of anxiety, depression, and emotional exhaustion than males. Students in the PBL had lower levels of emotional exhaustion than their peers in the LBL. Increase in emotional exhaustion was most pronounced between 1st and 2nd year students. Emotional exhaustion was inversely correlated with sleep and exercise. CONCLUSIONS On average, students who were either male or in the PBL curriculum experienced less mental distress in the form of anxiety, depression, and emotional exhaustion than their peers. While gender continues to be an established factor in how mental distress is experienced, the reduced levels of emotional exhaustion in PBL students is a novel finding that can potentially shed light on how to better optimize medical education. Despite the inherent selection bias and lower number of PBL students, to our knowledge, this is the first study comparing two different curricula within a single institution. This finding along with a focus on good sleep and exercise habits may provide a path for improving mental health in medical students.
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Affiliation(s)
- Maxim Jestin
- Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA.
| | - Shelly Sharma
- Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA
| | - Deval Jhaveri
- Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA
| | | | - Dean Micciche
- Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA
| | | | - Kathryn Lambert
- Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA
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Matsumoto R, Motomura E, Shiroyama T, Okada M. Impact of the Japanese Government's 'General Principles of Suicide Prevention Policy' on youth suicide from 2007 to 2022. BJPsych Open 2023; 10:e16. [PMID: 38112073 PMCID: PMC10755549 DOI: 10.1192/bjo.2023.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/05/2023] [Accepted: 10/27/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND The Japanese Government programme 'General Principles of Suicide Prevention Policy' (GPSPP) contributed to decreasing suicide mortality rates (SMRs) before the COVID-19 pandemic, but they increased after the pandemic. AIMS To identify risk factors for youth suicide and the impact of GPSPP on youth suicide. METHOD Annual suicide numbers during 2007-2022 were obtained from government databases. SMRs of student and non-student youths were analysed with a linear mixed-effects model. Interrupted time-series analysis was conducted to investigate temporal relations between three GPSPP periods and SMRs with 52 suicide motives among high school, special vocational school and university students. Multiple regression analysis was conducted to investigate the influence of grade repetition on university student SMRs. RESULTS Non-student youth SMRs were higher than student SMRs. School-related (worrying about the future/underachievement), health-related (mainly mental illness) and family-related (conflict with parent and severe verbal reprimands) motives were major motives for student SMRs. During the first GPSPP period (2007-2012), no student SMRs decreased. During the second period (2012-2017), university and special vocational school student SMRs increased, but high school student SMRs were unchanged. In contrast, during the third period (2017-2022), with the exception of male special vocational school students, all SMRs increased. Unexpectedly, long-term grade repetition was negatively associated with health-related SMRs. CONCLUSIONS These findings suggest that GPSPP-supported programmes in schools partially contributed to student suicide prevention. To suppress increasing student SMRs, social/life support specialists should participate in in-school support services to bolster the social standing and lives of students who repeat grades or experience setbacks.
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Affiliation(s)
- Ryusuke Matsumoto
- Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Japan
| | - Eishi Motomura
- Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Japan
| | - Takashi Shiroyama
- Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Japan
| | - Motohiro Okada
- Department of Neuropsychiatry, Division of Neuroscience, Graduate School of Medicine, Mie University, Japan
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Young C, Daly K, Hurtado A, Phillips A, Woods J, Caceres J, Lee WW. Applying Kern's Model to the Development and Evaluation of Medical Student Well-Being Programs. J Gen Intern Med 2023; 38:3047-3050. [PMID: 37340253 PMCID: PMC10593687 DOI: 10.1007/s11606-023-08265-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023]
Abstract
The Liaison Committee on Medical Education (LCME) requires that well-being programs must be "effective." Yet most medical schools do not robustly assess their well-being programs. Most evaluate their programs using one question on the Association of American Medical College's annual Graduation Questionnaire (AAMC GQ) survey for fourth-year students on their satisfaction with well-being programs, which is inadequate and nonspecific and only assesses a specific time in training. In this perspective, we, as members of the AAMC Group on Student Affairs (GSA) - Committee on Student Affairs (COSA) Working Group on Medical Student Well-being, suggest adapting Kern's 6-step approach to curriculum development as an effective framework to guide the development and evaluation of well-being programs. We suggest strategies for applying Kern's steps to well-being programs, with attention to conducting needs assessments, identifying goals, implementation, and evaluation and feedback. While each institution will have unique goals emerging from their needs assessment, we put forth five common medical student well-being goals as examples. Applying a rigorous and structured approach to developing and evaluating undergraduate medical education well-being programs will involve defining a guiding philosophy and clear goals and implementing a strong assessment strategy. This Kern-based framework can help schools meaningfully assess the impact of their initiatives on student well-being.
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Affiliation(s)
- Chantal Young
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Katherine Daly
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Alicia Hurtado
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amelia Phillips
- Department of Medical Education, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jeffrey Woods
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Jennifer Caceres
- Florida Atlantic University Schmidt College of Medicine, Boca Raton, FL, USA
| | - Wei Wei Lee
- University of the Chicago Pritzker School of Medicine, Chicago, IL, USA.
- Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
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Collins C, Pichan C, McGee L, Siden JY, Brower K. Assessing Student Burnout, Treatment Acquisition, and Barriers to Care to Prompt Changes in a Student Mental Healthcare Program. Acad Psychiatry 2023; 47:164-168. [PMID: 35879597 PMCID: PMC9311347 DOI: 10.1007/s40596-022-01685-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/05/2022] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Medical students demonstrate disproportionately higher levels of burnout and depression than their non-medical age-matched peers. Few studies have been conducted about rates of treatment acquisition and the barriers to care among students with mental health concerns. This study further characterizes rates of burnout, obstacles to treatment, and program preference for medical students at The University of Michigan. METHODS In June 2020, a 31-question survey eliciting information regarding student burnout, well-being, barriers to care, and improvements to overcome such barriers was sent to 588 current and recently graduated medical students at The University of Michigan. Participation was anonymous and voluntary, with optional response to each question. RESULTS Ultimately, 312 (53%) students responded. Pre-clinical and core clinical students were significantly more burned out than clinical elective students, with pre-clinical students' odds ratio (OR) of 2.45 and core clinical students' OR of 2.48. Most participants (81%) reported concerns regarding their emotional well-being. Two-thirds (66%) indicated a new or previously diagnosed mental health concern, with 37% of these students never having sought treatment. Commonly reported barriers to care and suggested improvement to mental health services are outlined. Commonly reported barriers to care were financial concerns, time constraints, and stigma-related fear of career-ending consequences. CONCLUSIONS This study showed stratification of the high levels of burnout among medical students. Student-driven feedback and survey results can help prompt medical schools to develop more robust mental healthcare models and drive much-needed structural changes.
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Affiliation(s)
- Claire Collins
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Cayla Pichan
- University of Michigan Medical School, Ann Arbor, Michigan, USA.
| | - Lauren McGee
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Kirk Brower
- University of Michigan Medical School, Ann Arbor, Michigan, USA
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Wyszomirska J, Bąk-Sosnowska M, Daniel-Sielańczyk A. Anxious and Angry: Early Emotional Adaptation of Medical Students in a Situational Crisis on the Example of the COVID-19 Pandemic. Int J Environ Res Public Health 2023; 20:1847. [PMID: 36767210 PMCID: PMC9914417 DOI: 10.3390/ijerph20031847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The COVID-19 pandemic is an example of a situational crisis resulting in emotional destabilization. The aim of the study was to analyze changes in the level of anxiety and anger in medical students during the early adaptation to the situational crisis, and to estimate the risk factors for fear and anger in this group. METHODS Participants were 949 medical students (M = 22.88, SD = 4.10) in the first stage on March 2020, and 748 (M = 22.57, SD = 3.79) in the second stage on June 2020. The STAI, STAXI-2, and our own questionnaire were used. RESULTS First vs the second stage: anxiety state (p < 0.001), anger state (p = 0.326), and feeling angry (p < 0.05). The regression model (F(14.1681) = 79.01, p < 0.001) for the level of anxiety state explains 39% of the dependent variable variance (r2 = 0.39). The model for the anger-state level (F(6.1689) = 68.04, p < 0.001)-19% (r2 = 0.19). CONCLUSIONS During the early adaptation to the situational crisis, the general level of anxiety decreased, but anger was at the same level. The anxiety was explained by contact with potentially or objective infected persons, and the level of anger was based on the need for greater social support.
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Affiliation(s)
- Julia Wyszomirska
- Department of Psychology, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Monika Bąk-Sosnowska
- Center for Psychosomatics and Health Prevention, WSB University in Dąbrowa Górnicza, 41-300 Dąbrowa Górnicza, Poland
| | - Anna Daniel-Sielańczyk
- Department of Psychology, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
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Hale EW, Davis RA. Supporting the future of medicine: Student mental health services in medical school. Front Health Serv 2023; 3:1032317. [PMID: 36926507 PMCID: PMC10012806 DOI: 10.3389/frhs.2023.1032317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
Background Mental health issues are common among United States medical students, and the AAMC has established recommendations for student mental health services provided by medical schools. Few studies directly compare mental health services at medical schools across the United States and, to our knowledge, none analyze how well schools adhere to the established AAMC recommendations. Objective To determine whether mental health services at United States medical schools adhere to established guidelines. Methods From October 2021 to March 2022, we obtained student handbooks and policy manuals from 77% of the accredited LCME United States medical schools. The AAMC guidelines were operationalized and placed into a rubric format. Each set of handbooks was independently scored against this rubric. A total of 120 handbooks were scored and the results were compiled. Results Rates of comprehensive adherence were very low, with only 13.3% of schools displaying adherence to the full set of AAMC guidelines. Partial adherence was higher, with 46.7% of schools meeting at least one of three guidelines. Portions of guidelines whose requirements reflected a standard for LCME accreditation displayed a higher rate of adherence. Conclusion The low rates of adherence across medical schools, as measured by handbooks and Policies & Procedures manuals, represents an opportunity to improve the mental health services within United States allopathic schools. An increase in adherence could be a step towards improving the mental health of United States medical students.
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Affiliation(s)
- Elijah W Hale
- School of Medicine, University of Colorado, Aurora, CO, United Status
| | - Rachel A Davis
- School of Medicine, University of Colorado, Aurora, CO, United Status.,School of Medicine, University of Colorado, Aurora, CO, United Status
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Sperling EL, Hulett JM, Sherwin LB, Thompson S, Bettencourt BA. Prevalence, characteristics and measurement of somatic symptoms related to mental health in medical students: a scoping review. Ann Med 2023; 55:2242781. [PMID: 37552776 PMCID: PMC10411307 DOI: 10.1080/07853890.2023.2242781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Somatic symptoms related to mental health in medical students are under-researched, with nothing on the topic being published in the United States in over three decades. This scoping review is the first of its kind to explore the prevalence, type and severity of somatic symptoms induced by stress, anxiety, depression and burnout amongst medical students, with the objective of describing the significance and breadth of this issue. METHODS PRISMA-ScR guidelines were used to guide this review. A comprehensive search was performed of 22 databases, followed by bibliographic and hand searching. Inclusion criteria were published, peer-reviewed articles with a sample of medical students and at least one measure of somatic symptoms related to mental health, in English or with an English-language translation. Excluded were review, companion and editorial articles. Coding was done by an experienced coder trained in systematic review techniques. Two authors reviewed each article. RESULTS Twenty-nine articles met inclusion criteria, representing 16 countries, 31 schools/teaching hospitals and 9,887 medical students. The prevalence of somatic symptoms ranged from 5.7 to 80.1%, and somatic symptoms were overwhelmingly found to be significantly correlated with mental ill-health. Somatic symptoms included back pain, neck pain, headaches, sleep disturbances and functional gastrointestinal disorders. Eleven different outcome measures were used, with varying degrees of validity and reliability, which were compared and assessed. CONCLUSIONS Somatic symptoms appear strongly correlated with mental ill-health in medical students, and are likely highly prevalent. This review highlights the need for further research on somatic symptoms of mental ill-health in medical students, particularly in the United States, and the addition of larger, multi-institutional cohorts to expand our understanding of prevalence, incidence and inciting factors of somatic symptoms. Longitudinal studies tracking somatic symptoms' effect on career trajectory and professional burnout levels are also needed. Finally, future research should explore interventions for reducing physical symptom burden in medical students.
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Affiliation(s)
- Edie L. Sperling
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
- College of Osteopathic Medicine of the Pacific-Northwest, Western University of Health Sciences, Lebanon, OR, USA
| | - Jennifer M. Hulett
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
- Ellis Fischel Cancer Center, University of Missouri, Columbia, MO, USA
| | | | - Sarah Thompson
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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Niedobylski S, Michta K, Wachoł K, Niedziałek K, Łopuszańska U, Samardakiewicz M, Próchnicki M. Academic burnout, self-esteem, coping with stress and gratitude among Polish medical students – a cross sectional study. Current Problems of Psychiatry 2022; 0. [DOI: 10.2478/cpp-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Introduction: Academic burnout is emerging as an essential obstacle in education process. Students of the most challenging fields of study with high degrees of stress are thought to be at the highest risk. Medical studies are considered one of them. The aim of the study was to measure the levels of academic burnout, stress and gratitude among Polish medical students of Medical University of Lublin, and determine their styles of coping with stress.
Materials and methods: A cross-sectional study was conducted using a questionnaire comprised of the following: Maslach Burnout Inventory – Student Survey (MBI-SS), Rosenberg Self-Esteem Scale (SES), a Coping Inventory for Stressful Situations (CISS) and a Gratitude Questionnaire Six-Item form (GQ-6). The data was obtained from 773 medical students.
Results: Total number of 169 students (21.86%) met criteria for academic burnout. When it comes to 354 participants, they displayed signs of low self-esteem (45.8%). The number of 18 students showed low level of gratitude, while gratitude level of the majority of them – 496 (64.17%) was high. The most common style of coping with stress was emotions-oriented style – 354 students (48.29%), followed by task-oriented style – 345 students (47.07%). Burnout subscales turned out to be associated with age, year of study, self-esteem, gratitude and different styles of coping with stress to the various extent.
Conclusions: The prevalence of academic burnout among Polish medical students is high compared with general population across various occupations. Utilisation of protective characteristics of high self-esteem, gratitude and healthy coping methods can result in development of efficient anti-burnout prevention strategies and intervention tools.
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Berliant M, Rahman N, Mattice C, Bhatt C, Haykal KA. Barriers faced by medical students in seeking mental healthcare: A scoping review. MedEdPublish 2022. [DOI: 10.12688/mep.19115.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Medical students commonly exhibit mental health issues. Despite the availability of professionals on medical campuses, seeking help continues to be a challenge for some students. Our review aimed to identify the barriers medical students face when seeking professional mental healthcare. Methods: A Medical Subject Headings (MeSH) search was created for articles using PubMed, Embase, and PsychINFO databases to identify articles specifically about medical students and their barriers to professional mental healthcare. Inclusion criteria included articles in which barriers to mental healthcare were either the primary variable or one of multiple study results. No date limits were imposed. Reviews, pilot projects, or articles that did not address barriers to mental healthcare faced by medical students or focused on veterinary or dental students were excluded. A total of 454 articles were identified and screened by title/abstract and then full text. Data were extracted from 33 articles using an independent framework. Barriers identified were compiled and reported. Results: From a total of 33 articles, the most identified barriers were fear of negative effect on residency/career opportunities, fear of confidentiality breach, stigma and fear of shaming from peers, lack of perceived seriousness/normalization of symptoms, lack of time, and fear of documentation on academic record. Students also preferred to seek care outside of their institution from fear of their provider being an academic preceptor. Conclusions: Many of the barriers to mental healthcare faced by medical students relate to a fear of academic and career reprisal, and fear of confidentiality breach. It appears that despite recent efforts to decrease stigma surrounding mental illness, many medical students struggle to seek appropriate support. Access to mental healthcare can be improved by increasing transparency regarding what information will be displayed on academic records, dispelling common myths about mental healthcare, and increasing awareness about resources available for medical students.
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Oliveira L, Teixeira A, Duarte I. The Appraisal of Self-Care Agency Scale-Revised (ASAS-R): Reliability and Validity among Portuguese Medical Students. Int J Environ Res Public Health 2022; 19:ijerph191710848. [PMID: 36078563 PMCID: PMC9518396 DOI: 10.3390/ijerph191710848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 05/16/2023]
Abstract
Self-care agency plays an important role in an individual's health. Considering the particularities of their education, it can be a protective factor for the mental health of medical students. This study aims to validate the Portuguese version of the Appraisal of Self-care Agency Scale-Revised (ASAS-R) in Portuguese medical students. A cross-sectional, quantitative, and analytical online study was conducted between 23 April 2021, and 15 July 2021. Exploratory factor analysis (EFA) was performed to test the internal structure of the ASAS-R. Correlations with the SHS (Subjective Happiness Scale), SWLS (Satisfaction with Life Scale), and MHI (Mental Health Inventory) were calculated using Pearson's coefficient so as to test convergent validity. Internal consistency was evaluated using inter-item correlation, corrected item-total correlation, and Cronbach's alpha. The total sample included 781 individuals. EFA yielded a 3-factor solution accounting for 53.9% of the explained variance. Pearson's coefficients obtained between the 3 factors of ASAS-R and the total scores of the 3 construct-related scales demonstrated adequate convergent validity. Total Cronbach's alpha value was 0.85, while the Cronbach's alpha of the three factors was 0.81, 0.55, and 0.83, respectively. This study demonstrated that ASAS-R is a valid and reliable instrument for measuring self-care agency among Portuguese medical students.
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Affiliation(s)
- Lídia Oliveira
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Andreia Teixeira
- Department of Community Medicine, Information and Decision in Health (MEDCIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), University of Porto, 4200-319 Porto, Portugal
- ADiT-LAB, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial Nun’Álvares, 4900-347 Viana do Castelo, Portugal
| | - Ivone Duarte
- Department of Community Medicine, Information and Decision in Health (MEDCIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), University of Porto, 4200-319 Porto, Portugal
- Correspondence:
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Tugnoli S, Casetta I, Caracciolo S, Salviato J. Parental bonding, depression, and suicidal ideation in medical students. Front Psychol 2022; 13:877306. [PMID: 35992478 PMCID: PMC9386274 DOI: 10.3389/fpsyg.2022.877306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe psychological condition of university students has been the focus of research since several years. In this population, prevalence rates of depression, suicidal ideation, anxiety disorders and substance abuse are higher than those of the general population, and medical students are more likely to have mental health issues than other students.AimsThis study deals with the psychological condition of medical students, with a focus on correlations between depression, suicidal ideation and the quality of the perceived parenting style. Gender differences were also considered.MethodsA cross-sectional study was conducted on a population of medical students, with an online questionnaire consisting of a personal data sheet for demographic and anamnestic data, and of three self-rating scales: the Beck Depression Inventory II (BDI-II), for the screening of depressive symptoms; the Beck Hopelessness Scale (BHS), to assess suicidal ideation; the Parental Bonding Instrument (PBI), to investigate the memory of the attitude of one’s parents in the first 16 years of life. Two main affective dimensions were considered by PBI: “care” (affection and empathy) and “protection” (intrusiveness, controlling and constraint). Four different patterns of parenting styles are so evidenced: Neglectful Parenting (low care/low protection), Affectionless Control (low care/high protection), Optimal Parenting (high care/low protection), and Affectionate Constraint (high care/high protection).ResultsOverall, 671 students (182 males and 489 females) participated. Females, compared to males, experienced more distress and self-injurious behaviors, while males experienced more drugs or alcohol abuse. The BHS and BDI-II scores correlated positively with the PBI score for “protection” and negatively with that for “care.” Affectionless Control and Neglectful Parenting were associated with higher medians of BHS and BDI-II scores.ConclusionThe study confirms that the undergraduate medical student population has higher prevalence of depression and suicidal ideation than those detectable in the general population (respectively, 50.2% and 16.7% vs. 15–18% and 9.2%) and that some specific parenting styles correlate with these two clinical variables. The impact of Affectionless Control and Neglectful Parenting on suicidal ideation and depressive symptomatology was more pronounced in females than in males. For males, the role of the father seemed to have less impact on the affective roots of suicidal thoughts and depression.
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Fekih-Romdhane F, Daher-Nashif S, Alhuwailah AH, Al Gahtani HMS, Hubail SA, Shuwiekh HAM, Khudhair MF, Alhaj OA, Bragazzi NL, Jahrami H. The prevalence of feeding and eating disorders symptomology in medical students: an updated systematic review, meta-analysis, and meta-regression. Eat Weight Disord 2022; 27:1991-2010. [PMID: 35067859 DOI: 10.1007/s40519-021-01351-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/20/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Medical students have a higher risk of developing psychological issues, such as feeding and eating disorders (FEDs). In the past few years, a major increase was observed in the number of studies on the topic. The goal of this review was to estimate the prevalence risk of FEDs and its associated risk factors in medical students. METHODS Nine electronic databases were used to conduct an electronic search from the inception of the databases until 15th September 2021. The DerSimonian-Laird technique was used to pool the estimates using random-effects meta-analysis. The prevalence of FEDs risk in medical students was the major outcome of interest. Data were analyzed globally, by country, by research measure and by culture. Sex, age, and body mass index were examined as potential confounders using meta-regression analysis. RESULTS A random-effects meta-analysis evaluating the prevalence of FEDs in medical students (K = 35, N = 21,383) generated a pooled prevalence rate of 17.35% (95% CI 14.15-21.10%), heterogeneity [Q = 1528 (34), P = 0.001], τ2 = 0.51 (95% CI 0.36-1.05), τ = 0.71 (95% CI 0.59-1.02), I2 = 97.8%; H = 6.70 (95% CI 6.19-7.26). Age and sex were not significant predictors. Body mass index, culture and used research tool were significant confounders. CONCLUSION The prevalence of FEDs symptoms in medical students was estimated to be 17.35%. Future prospective studies are urgently needed to construct prevention and treatment programs to provide better outcomes for students at risk of or suffering from FEDs. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis.
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Oláh B, Rádi BM, Kósa K. Barriers to Seeking Mental Help and Interventions to Remove Them in Medical School during the COVID-19 Pandemic: Perspectives of Students. IJERPH 2022; 19:ijerph19137662. [PMID: 35805319 PMCID: PMC9265856 DOI: 10.3390/ijerph19137662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022]
Abstract
Medical students are at increased risk for psychological morbidity but the majority of those with mental health problems do not seek professional care. We aimed to uncover the viewpoints of medical students regarding barriers and facilitators to using university mental health services and their attitudes and preferences towards online counselling. Four semi-structured focus groups were conducted (n = 26, mean age = 21.8, ±1.88, 73% males). After reaching data saturation, interviews were audio-recorded, transcribed and content-analysed by two independent coders. Intrapersonal barriers emerged to be perceived low risk, excessive self-reliance, lack of belief in the effectiveness of service, lack of openness. Interpersonal factors were the following: assumed long waiting list, insufficient provision of service information, fear of exposure, and not being familiar with the counsellor and the process. Extrapersonal barriers such as insurance problems, the number of available sessions, adverse sociocultural attitudes, fear of stigmatisation were identified. Students suggested that the university should provide psychoeducation and routine screening, apply social marketing and stigma reduction campaigns, improve information flow, and offer not only personal but also online video counselling to target removing these barriers. The results provide a reference for the redesign of mental health services to facilitate their access by students. Implications and limitations are discussed.
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Affiliation(s)
- Barnabás Oláh
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.M.R.); (K.K.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
- Correspondence: ; Tel.: +36-52-411-600 (ext. 54360)
| | - Bence Márk Rádi
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.M.R.); (K.K.)
| | - Karolina Kósa
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.M.R.); (K.K.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
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Abrams MP, Salzman J, Espina Rey A, Daly K. Impact of Providing Peer Support on Medical Students’ Empathy, Self-Efficacy, and Mental Health Stigma. IJERPH 2022; 19:ijerph19095135. [PMID: 35564535 PMCID: PMC9099875 DOI: 10.3390/ijerph19095135] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/07/2022] [Accepted: 04/15/2022] [Indexed: 01/09/2023]
Abstract
Background: Peer-support programs in medical school can buffer feelings of inadequacy, anxiety, social isolation, and burnout, drawing upon the benefits of near-peer-support resources. This study examined the effects of providing support to students in a medical school peer-support program. Methods: Using a pre-post, quasi-experimental study design, the investigators surveyed medical students who were peer supporters in their second through fourth years of medical school with four measures assessing (1) empathy, (2) self-efficacy, (3) mental health stigma, and (4) likelihood to assist peers with mental health problems to examine if serving as a volunteer peer supporter had any effect. Participants included 38 medical students that were actively enrolled peer supporters during the 2020–2021 year at a United States allopathic medical school. Results: Medical students who participated as peer supporters were found to have higher ratings of empathy scores (Z = −1.964, p = 0.050, r = 0.34) and self-efficacy scores (Z = −2.060, p = 0.039, r = 0.35) after participation in the program. No significant changes were noted for mental health stigma or likelihood to assist peers with mental health problems. Discussion: Peer-support programs present a low-cost, sustainable modality to promote wellbeing in medical students. There is a growing body of literature documenting the benefits of peer-support services. This brief, novel study examined the effects of providing peer support on the peer supporters and found higher self-reported ratings of empathy and self-efficacy after participation. These findings underscore peer-support programs as a valuable wellness resource not only for medical students who use the services but for those who provide them as well.
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Affiliation(s)
- Matthew P. Abrams
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA;
- Correspondence: ; Tel.: +1-619-227-9228
| | - Joshua Salzman
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA;
| | - Andrea Espina Rey
- Focused Inquiry & Research Experience Module Department, College of Medicine, University of Central Florida, Orlando, FL 32827, USA;
| | - Katherine Daly
- Department of Clinical Sciences and Student Affairs, College of Medicine, University of Central Florida, Orlando, FL 32827, USA;
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Dederichs M, Nitsch FJ, Apolinário-Hagen J. Piloting an Innovative Concept of e-Mental Health and mHealth Workshops With Medical Students Using a Participatory Co-design Approach and App Prototyping: Case Study. JMIR Med Educ 2022; 8:e32017. [PMID: 35006085 PMCID: PMC8787659 DOI: 10.2196/32017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/22/2021] [Accepted: 11/06/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND Medical students show low levels of e-mental health literacy. Moreover, there is a high prevalence of common mental illnesses among medical students. Mobile health (mHealth) apps can be used to maintain and promote medical students' well-being. To date, the potential of mHealth apps for promoting mental health among medical students is largely untapped because they seem to lack familiarity with mHealth. In addition, little is known about medical students' preferences regarding mHealth apps for mental health promotion. There is a need for guidance on how to promote competence-based learning on mHealth apps in medical education. OBJECTIVE The aim of this case study is to pilot an innovative concept for an educative workshop following a participatory co-design approach and to explore medical students' preferences and ideas for mHealth apps through the design of a hypothetical prototype. METHODS We conducted a face-to-face co-design workshop within an elective subject with 26 participants enrolled at a medical school in Germany on 5 consecutive days in early March 2020. The aim of the workshop was to apply the knowledge acquired from the lessons on e-mental health and mHealth app development. Activities during the workshop included group work, plenary discussions, storyboarding, developing personas (prototypical users), and designing prototypes of mHealth apps. The workshop was documented in written and digitalized form with the students' permission. RESULTS The participants' feedback suggests that the co-design workshop was well-received. The medical students presented a variety of ideas for the design of mHealth apps. Among the common themes that all groups highlighted in their prototypes were personalization, data security, and the importance of scientific evaluation. CONCLUSIONS Overall, this case study indicates the feasibility and acceptance of a participatory design workshop for medical students. The students made suggestions for improvements at future workshops (eg, use of free prototype software, shift to e-learning, and more time for group work). Our results can be (and have already been) used as a starting point for future co-design workshops to promote competence-based collaborative learning on digital health topics in medical education.
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Affiliation(s)
- Melina Dederichs
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Felix Jan Nitsch
- Comparative Psychology, Institute for Experimental Psychology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jennifer Apolinário-Hagen
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Abstract
BACKGROUND Identification of barriers to mental healthcare seeking among medical students will help organize student mental health services in medical colleges across India. This study was conducted to estimate the prevalence of depression, anxiety disorders, and suicidal behavior among medical students and to identify the potential barriers to mental healthcare seeking among them. METHODS In this cross-sectional observational study, the medical students from a medical college in South India were asked to complete a structured pro forma for sociodemographic details, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Questionnaire (GAD-7),and Suicide Behaviors Questionnaire-Revised (SBQ-R). The barriers to mental healthcare seeking were assessed using the mental health subscale of Barriers to Healthcare Seeking Questionnaire for medical students. A cut-off of 15 was used for determining the presence of depression on PHQ-9. A cut-off of 10 on GAD-7 indicated the presence of anxiety disorder, and a cut-off of 7 on SBQ-R indicated suicidal risk. RESULTS Out of the 425 participants, 59 (13.9%) were found to have depression (moderately severe or severe) and 86 (20.2%) were found to have anxiety disorders (moderate or severe). A total of 126 (29.6%) students were found to have a suicidal risk. Preference for informal consultations, concerns about confidentiality, and preference for self-diagnosis were the most commonly reported barriers to mental healthcare seeking. Students with psychiatric disorders perceived more barriers to mental healthcare seeking than students without psychiatric disorders. CONCLUSIONS One-fourth of the medical students were detected to have depression and/or anxiety disorders. Establishing student mental health services, taking into account the perceived barriers, will go a long way in improving medical students' mental well-being.
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Affiliation(s)
- Praveen Arun
- Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
| | | | - Pradeep Thilakan
- Dept. of Psychiatry, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India
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Abdel-Hady D, Baklola M, Terra M, El-Gilany AH. Patterns and barriers of mental health service utilization among medical students: a cross-sectional study. Middle East Curr Psychiatry 2022; 29:98. [PMCID: PMC9750729 DOI: 10.1186/s43045-022-00267-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The prevalence of mental health problems among medical students has been steadily rising. It is greater than the prevalence of mental health problems among other students, negatively impacting students, and their future careers. The study aims to estimate the prevalence of the self-reported need for mental health care, the pattern of utilization of mental health services, and the different barriers that hinder medical students from seeking professional help. Results This study was conducted among medical students at Mansoura University, using a structured self-reported online questionnaire to collect the need for mental health services, sociodemographic details, the pattern of utilization of mental health services, and the barriers using a Likert scale of 30 items named Barriers to Access to Care Evaluation Version 3. According to this study, 77.77% felt the need for mental health care. The independent predictors for feeling the need for mental health care were female sex and urban residence with an adjusted odds ratio of 2.7 and 1.9, respectively. Regarding mental healthcare needs, most of the barriers were instrumental and attitudinal related. Lack of information about how to access services and solve the problem by themselves was the most common barriers followed by time and financial affords. Conclusions It appears that Mansoura medical students are at higher risk of feeling the need for mental care. Considerable barriers to help-seeking remain prevalent, including both logistical (e.g., time) and informational (e.g., lack of knowledge about the available services).
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Affiliation(s)
- Doaa Abdel-Hady
- grid.10251.370000000103426662Public Health and Community Medicine Department, Faculty of Medicine, Mansoura University, 60El-Gomhoria Street, Mansoura, 35516 Egypt
| | - Mohamed Baklola
- grid.10251.370000000103426662Faculty of Medicine, Mansoura University, 60El-Gomhoria Street, Mansoura, 35516 Egypt
| | - Mohamed Terra
- grid.10251.370000000103426662Faculty of Medicine, Mansoura University, 60El-Gomhoria Street, Mansoura, 35516 Egypt
| | - Abdel-Hady El-Gilany
- grid.10251.370000000103426662Public Health and Community Medicine Department, Faculty of Medicine, Mansoura University, 60El-Gomhoria Street, Mansoura, 35516 Egypt
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Hurtado T, Wilkinson S, Battaglia B, Gilbertson E, Shipman H, Robinson M, O'Brien K, Shayman C, Gelhard S, Wilde B, Fix M, Anderson K, Tsai T, Wonsor B, Stevenson A, Richards B. Rethinking Career Exploration Interventions to Influence Student Help-Seeking Perspectives. Acad Med 2021; 96:S187-S188. [PMID: 34705686 DOI: 10.1097/acm.0000000000004304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Thomas Hurtado
- Author affiliations: T. Hurtado, S. Wilkinson, B. Battaglia, E. Gilbertson, H. Shipman, M. Robinson, K. O'Brien, C. Shayman, S. Gelhard, B. Wilde, M. Fix, K. Anderson, T. Tsai, B. Wonsor, A. Stevenson, B. Richards, University of Utah School of Medicine
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Foong CC, Bashir Ghouse NL, Lye AJ, Khairul Anhar Holder NA, Pallath V, Hong WH, Sim JH, Vadivelu J. A qualitative study on self-regulated learning among high performing medical students. BMC Med Educ 2021; 21:320. [PMID: 34090439 PMCID: PMC8178823 DOI: 10.1186/s12909-021-02712-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 05/04/2021] [Indexed: 06/06/2023]
Abstract
BACKGROUND Self-regulated learning (SRL) is an important contributing element to the academic success of students. Literature suggests that the understanding of SRL among medical students is obscure as there is still some uncertainty about whether high performing medical students use SRL. This study explored the characteristics of high performing medical students from the SRL perspective to gain a better understanding of the application of SRL for effective learning. METHODS Twenty-one students who scored at the 90th percentile in written knowledge-based assessment consented to participate in this study. Each student wrote a guided reflective journal and subsequently attended a semi-structured interview. Students were prompted to explain the rationales for their answers. The data were then analysed using thematic analysis to identify patterns among these students from the SRL perspective. Two coders analysed the data independently and discussed the codes to reach a consensus. RESULTS High performing students set goals, made plans, and motivated themselves to achieve the goals. They put consistent efforts into their studies and applied effective learning strategies. They also employed coping mechanisms to deal with challenges. High performing students regularly evaluated their performance and adopted new strategies. CONCLUSIONS This study reported that high performing students applied SRL and described the rationales of practice. Medical schools could design SRL-driven interventions to enhance the learning experiences of medical students. Recommendations are made for students on how to apply SRL.
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Affiliation(s)
- Chan Choong Foong
- Medical Education and Research Development Unit (MERDU), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Nur Liyana Bashir Ghouse
- Medical Education and Research Development Unit (MERDU), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - An Jie Lye
- Medical Education and Research Development Unit (MERDU), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nurul Atira Khairul Anhar Holder
- Medical Education and Research Development Unit (MERDU), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Vinod Pallath
- Medical Education and Research Development Unit (MERDU), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Wei-Han Hong
- Medical Education and Research Development Unit (MERDU), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Joong Hiong Sim
- Medical Education and Research Development Unit (MERDU), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Jamuna Vadivelu
- Medical Education and Research Development Unit (MERDU), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Vaa Stelling BE, West CP. Faculty Disclosure of Personal Mental Health History and Resident Physician Perceptions of Stigma Surrounding Mental Illness. Acad Med 2021; 96:682-685. [PMID: 33496429 DOI: 10.1097/acm.0000000000003941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PROBLEM Distress, depression, and burnout are common during medical training. Stigma surrounding seeking help for mental illness during medical training may involve fear of negative peer perceptions, academic jeopardy, and adverse future career consequences. Faculty disclosure of personal mental health illness may reduce stigma surrounding mental health disorders and reassure and encourage trainees to seek help when needed. APPROACH The authors aimed to assess the impact of faculty disclosure of mental health issues on stigma toward help-seeking during training, self-reflection about mental health, and resident physician awareness of mental health resources. Three self-selected faculty members shared their personal experiences with depression and mental health during a confidential noon conference intended for internal medicine residents at Mayo Clinic Rochester as part of their core curriculum in December 2016. Institutional and community mental health resources were provided. After the conference, attendees completed an anonymous survey assessing self-reported knowledge, attitudes, and behaviors surrounding mental health during medical training. OUTCOMES One hundred percent of residents (39/39) agreed that they enjoyed the conference. Thirty-five of 39 (89.7%) respondents agreed that their knowledge of available mental health resources increased and 33/39 (84.6%) agreed they were more likely to pursue mental health resources after attending the conference. Thirty-eight of 39 (97.4%) residents agreed that faculty sharing their personal struggles destigmatizes mental health issues during training, and the same percentage reported engaging in postconference self-reflection regarding their own mental health and well-being. NEXT STEPS Resident conference sessions during which faculty self-disclose personal mental health experiences may help decrease the stigma of mental health issues during medical training and increase the likelihood residents will seek assistance when needed. The authors encourage further study of longer-term outcomes and actual help-seeking behaviors across learner levels and training environments.
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Affiliation(s)
- Brianna E Vaa Stelling
- B.E. Vaa Stelling is assistant professor of medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-3018-2517
| | - Colin P West
- C.P. West is professor of medicine, medical education, and biostatistics, Divisions of General Internal Medicine and Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-1628-5023
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Kowalska J, Wójtowicz D, Szczepańska-Gieracha J. Physical Activity and the Emotional State of Physiotherapy Students Who Finish Their Education. Int J Environ Res Public Health 2021; 18:4572. [PMID: 33925832 PMCID: PMC8123397 DOI: 10.3390/ijerph18094572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 12/02/2022]
Abstract
This study aimed to evaluate the emotional state and the level of the sense of coherence in the context of physical activity among physiotherapy students and investigate how the participating students' emotional state changed after two years of studying and what factors were associated with the mood disorders. The study group consisted of 110 students-79 female and 31 male. The Back Depression Inventory (BDI), the Sense of Coherence Questionnaire (SOC-29) and the Perceived Stress Questionnaire (PSQ) were used. The results presented an increase in depressive symptoms during the studies of a group of physiotherapy students. Physical activity can play a protective role in the prevention and treatment of mood disorders. The students who regularly engaged in physical activity exhibited better mood, a lower perceived stress level and a higher level of the sense of coherence as compared to the physically inactive students.
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Affiliation(s)
- Joanna Kowalska
- Department of Physiotherapy, University School of Physical Education, 51-612 Wroclaw, Poland; (D.W.); (J.S.-G.)
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Sampogna G, Lovisi GM, Zinno F, Del Vecchio V, Luciano M, Gonçalves Loureiro Sol É, Unger RJG, Ventriglio A, Fiorillo A. Mental Health Disturbances and Related Problems in Italian University Medical Students from 2000 to 2020: An Integrative Review of Qualitative and Quantitative Studies. Medicina (Kaunas) 2020; 57:medicina57010011. [PMID: 33374475 PMCID: PMC7823352 DOI: 10.3390/medicina57010011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: The presence of mental health problems in the population of medical students in Italy has been evaluated in several cross-sectional studies, which have used different methodologies and study designs. However, a global overview of the prevalence of mental health problems in Italian medical students is not available, although this would be essential for promoting preventive strategies and supportive treatments. Materials and Methods: An integrative review aiming to describe the prevalence of mental health problems in Italian medical students has been performed. Results: The most relevant findings are the high prevalence of substance use, in particular alcohol and nicotine, and of depressive and anxiety disorders in Italian medical students. In particular, substance use ranges from 13 to 86%, which is higher compared to Italian students coming from other faculties. Italian medical students show a high rate of smoking and of depressive symptoms of about 20%. Conclusions: Our findings highlight the need to develop appropriate supportive interventions for the medical student population, which are rarely provided and implemented among the routine activities of Italian medical universities. A relevant aspect to be considered is the stigma and anticipated discrimination attached to mental disorders, which reduce the help-seeking process in medical students.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (F.Z.); (V.D.V.); (M.L.); (A.F.)
- Correspondence: ; Tel.: +39-081-566-6531
| | - Giovanni Marcos Lovisi
- Institute of Studies in Collective Health—Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil; (G.M.L.); (É.G.L.S.); (R.J.G.U.)
| | - Francesca Zinno
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (F.Z.); (V.D.V.); (M.L.); (A.F.)
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (F.Z.); (V.D.V.); (M.L.); (A.F.)
| | - Mario Luciano
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (F.Z.); (V.D.V.); (M.L.); (A.F.)
| | - Érika Gonçalves Loureiro Sol
- Institute of Studies in Collective Health—Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil; (G.M.L.); (É.G.L.S.); (R.J.G.U.)
| | - Roberto José Gervásio Unger
- Institute of Studies in Collective Health—Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil; (G.M.L.); (É.G.L.S.); (R.J.G.U.)
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy;
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (F.Z.); (V.D.V.); (M.L.); (A.F.)
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Abstract
Background: Medical students are reluctant to access mental health services, despite having high rates of anxiety and depression. This reluctance persists through residency and into practice. Physicians and trainees who are unwell deliver lower quality patient care, behave less professionally, communicate less effectively and are at an increased risk for burnout and suicide. Little is known about whether students would disclose a mental health diagnosis on a state board medical license application.Objectives: The objectives of this study were to determine whether University of New Mexico School of Medicine (UNM SOM) students would be willing to disclose a mental health diagnosis on a medical licensing application if prompted to do so, and, if not, to identify the reasons for their unwillingness to do so.Design: We electronically invited all UNM SOM students enrolled in the Classes of 2019, 2020, 2021, and 2022 to participate in a confidential RedCap survey about mental health diagnoses and treatment. Four e-mail invitations and reminders were sent to students over a one-month period.Results: Response rate was 50.1%. Thirty-six percent of all respondents considered themselves to have had a mental health condition prior to medical school, and 47% of all respondents perceived a decline in mental health during medical school. The majority of respondents who perceived they had a mental health diagnosis (51%) stated they would not disclose this information on a New Mexico Medical Board (NMMB) license application. Fear of stigmatization, fear of repercussions, and a belief that such disclosure was irrelevant were the top reasons for non-disclosure.Conclusion: Students who perceive themselves to have mental health diagnoses are unlikely to disclose their mental health status on state medical board licensing applications when asked to do so. Addressing barriers to disclosure of mental health diagnoses is necessary for building a healthier physician workforce.
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Affiliation(s)
- Ian Fletcher
- School of Medicine, University of New Mexico, Albuquerque, USA
| | - Michael Castle
- School of Medicine, University of New Mexico, Albuquerque, USA
| | - Aaron Scarpa
- School of Medicine, University of New Mexico, Albuquerque, USA
| | - Orrin Myers
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Elizabeth Lawrence
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
- CONTACT Elizabeth Lawrence Department of Internal Medicine, University of New Mexico School of Medicine, Fitz Hall, Room 107 MSC08 47001, Albuquerque, NM87131, USA
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Seera G, Arya S, Sethi S, Nimmawitt N, Ratta-Apha W. Help-seeking behaviors for mental health problems in medical students: Studies in Thailand and India. Asian J Psychiatr 2020; 54:102453. [PMID: 33271732 DOI: 10.1016/j.ajp.2020.102453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To compare the rate of help-seeking from mental health professionals (MHPs) and other sources of help for mental health problems of medical students in Thailand and India, and explore factors associated with help-seeking from MHPs. METHODS Cross-sectional survey-based study was conducted in two medical schools in Thailand and India. Students were asked to rate their preferences for each source of help on a Likert-scale basis. Mental health status was measured by the General health questionnaire-12 (GHQ-12). Attitudes and stigma toward mental illness were collected using the Mental illness clinician's attitude scale: medical student version or MICA v2. RESULTS 593 students participated in the survey. The percentage of students who chose to seek help from any source was lower in Thailand than in India. 81 % of students in India site chose to seek help from MHPs, compared to 66 % in Thailand site. The risk factors for avoiding seeking help from MHPs in Thailand were history of alcohol use (OR = 1.88, p = .014) and total GHQ score (OR = 1.11, p = .006), whereas having GHQ score ≥ 2 was a significant risk factor in India (OR = 2.20, p = .044). Total MICA score, which reflected overall attitude toward mental illness, was not associated with seeking help from MHPs. CONCLUSIONS The rate of help-seeking behaviors for mental health problems and factors associated differed between medical students in Thailand and India. A high GHQ score was a common risk factor of not seeking help from MHPs in both countries.
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Affiliation(s)
- Genis Seera
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
| | - Sidharth Arya
- Department of Psychiatry, Pt BDS University of Health Sciences, Rohtak, India.
| | - Sujata Sethi
- Department of Psychiatry, Pt BDS University of Health Sciences, Rohtak, India.
| | - Neshda Nimmawitt
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
| | - Woraphat Ratta-Apha
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
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Atkinson SR. Elevated psychological distress in undergraduate and graduate entry students entering first year medical school. PLoS One 2020; 15:e0237008. [PMID: 32776950 PMCID: PMC7416945 DOI: 10.1371/journal.pone.0237008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023] Open
Abstract
Background Psychological distress in medical students is a global issue and poses a risk to their health, academic performance, and ability to care for patients as clinicians. There has been limited research on psychological distress levels in students prior to starting medicine and no direct comparison between undergraduate and graduate-entry students. Methods Psychological distress was assessed using the 21-item Depression Anxiety and Stress Scale in 168 undergraduate-entry and 84 graduate-entry medical students at two separated campuses of the same university in the orientation week prior to starting classes. Mean scores and severity proportions were compared between the two cohorts of students. Demographic data was also collected and compared to distress scores using subgroup analysis. Results The response rate for the study was 60.9%. The majority of undergraduate and graduate-entry medical students were within the normal limits for depression (67.2% versus 70.2%, p = 0.63), anxiety (56.5% versus 44.0%, p = 0.06), and stress scores (74.4% versus 64.2%, p = 0.10). There was no significant difference between severity groups except for severe stress (2.3% versus 9.5%, p = 0.01). The mean scores of the clinically distressed groups indicated moderate levels of depression, moderate anxiety, and moderate stress scores. There were no significant differences between undergraduate or graduate-entry students for depressive ( x¯ = 17.02 versus 15.76, p = 0.43), anxiety ( x¯ = 14.22 versus 13.28, p = 0.39), and stress scores ( x¯ = 20.83 versus 22.46, p = 0.24). Female gender and self-believed financial concerns were found be associated with higher levels stress in graduate entry students. Conclusions The majority of medical students enter medical school with normal levels of psychological distress. However, a large number of undergraduate and graduate-entry medical students have significant levels of depressive, anxiety, and stress levels, without a significant difference between undergraduate or graduate-entry students. There are several limitation of this study but the results suggest that education and intervention may be required to support students from the earliest weeks of medical school.
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Affiliation(s)
- Sean R. Atkinson
- School of Rural Health, Monash University, Churchill, Australia
- * E-mail:
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Thiemann P, Brimicombe J, Benson J, Quince T. When investigating depression and anxiety in undergraduate medical students timing of assessment is an important factor - a multicentre cross-sectional study. BMC Med Educ 2020; 20:125. [PMID: 32326926 PMCID: PMC7181528 DOI: 10.1186/s12909-020-02029-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/01/2020] [Indexed: 05/30/2023]
Abstract
BACKGROUND Symptoms of depression and anxiety experienced by undergraduate medical students have become a prominent concern. Evidence about students' depression and anxiety including prevalence, trajectory during medical education, gender differences and comparisons with age-matched peers is conflicting. However few studies of medical students' mental health specify the precise time of assessment. Proximity to examinations may be relevant. Precise identification of the time of data collection might help explain contradictory findings and facilitate provision of more timely support. METHODS This study addressed whether: 1)Proximity of final examinations affected students' depression and anxiety symptoms2)Males and females differed in this respect. We analysed data provided by 446 final year students from 6 UK medical schools. These students were a subset of data provided by 14 UK medical schools which participated in an online survey comparing first and final year students and in which final year response rates exceeded 30%. We used the Hospital Anxiety and Depression Scale to assess symptoms of depression and anxiety and the norms to indicate potentially clinically relevant cases. We grouped students into those for whom final exams were imminent i.e. within 2 months of completing the survey (n = 164) and those for whom exams were more distant or had been taken (n = 282). We used parametric and non-parametric tests to compare both groups and gender differences in respect of depression and anxiety sum scores and cases rates. RESULTS For both depression and anxiety male and female students facing imminent final exams recorded greater prevalence and significantly higher mean scores. The effect size of differences for anxiety were large. No substantial gender differences were found for depression. Regardless of the timing of final exams female students recorded both significantly higher mean scores and clinically relevant rates for anxiety. CONCLUSIONS Proximity to final exams negatively affected the mental health of both male and female final year students. The study suggests that there may be times in the undergraduate medical curriculum when additional or targeted support is needed. It also highlights the need for research to provide a greater specificity of context when investigating medical students' mental health.
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Affiliation(s)
- Pia Thiemann
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - James Brimicombe
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - John Benson
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thelma Quince
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Martin A, Chilton J, Gothelf D, Amsalem D. Physician Self-disclosure of Lived Experience Improves Mental Health Attitudes Among Medical Students: A Randomized Study. J Med Educ Curric Dev 2020; 7:2382120519889352. [PMID: 32363235 PMCID: PMC7180952 DOI: 10.1177/2382120519889352] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/29/2019] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Depression and suicidal ideation are common among medical students, a group at higher risk for suicide completion than their age-normed peers. Medical students have health-seeking behaviors that are not commensurate with their mental health needs, a discrepancy likely related to stigma and to limited role-modeling provided by physicians. METHODS We surveyed second-year medical students using the Attitudes to Psychiatry (ATP-30) and Attitudes to Mental Illness (AMI) instruments. In addition, we asked questions about role-modeling and help-seeking attitudes at baseline. We then conducted a randomized trial of an intervention consisting of 2 components: (a) a panel of 2 physicians with personal histories of mental illness speaking about their diagnosis, treatment, and recovery to the students, immediately followed by (b) small-group facilitated discussions. We repeated the ATP-30 and AMI after the active/early group was exposed to the panel, but before the control/late group was similarly exposed. RESULTS Forty-three medical students participated (53% women). The majority of students (91%) agreed that knowing physicians further along in their careers who struggled with mental health issues, got treatment, and were now doing well would make them more likely to access care if they needed it. Students in the active group (n = 22) had more favorable attitudes on ATP-30 (P = .01) and AMI (P = .02) scores, as compared with the control group (n = 21). CONCLUSION Medical students can benefit from the availability of, and exposure to physicians with self-disclosed histories of having overcome mental illnesses. Such exposures can favorably improve stigmatized views about psychiatry, or of patients or colleagues affected by psychopathology. This intervention has the potential to enhance medical students' mental health and their health-seeking behaviors.
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Affiliation(s)
- Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Standardized Patient Program, Yale School of Medicine, New Haven, CT, USA
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
- Andrés Martin, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06520, USA.
| | - Julie Chilton
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Doron Gothelf
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
- Sheba Medical Center, Ramat-Gan, Israel
| | - Doron Amsalem
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
- Sheba Medical Center, Ramat-Gan, Israel
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Kotera Y, Green P, Sheffield D. Mental health of therapeutic students: relationships with attitudes, self-criticism, self-compassion, and caregiver identity. British Journal of Guidance & Counselling 2019. [DOI: 10.1080/03069885.2019.1704683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gold JA, Hu X, Huang G, Li WZ, Wu YF, Gao S, Liu ZN, Trockel M, Li WZ, Wu YF, Gao S, Liu ZN, Rohrbaugh RM, Wilkins KM. Medical student depression and its correlates across three international medical schools. World J Psychiatry 2019; 9:65-77. [PMID: 31799151 PMCID: PMC6885454 DOI: 10.5498/wjp.v9.i4.65] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/26/2019] [Accepted: 05/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Medical students have high rates of depression, anxiety, and burnout that have been found to affect their empathy, professional behaviors, and performance as a physician. While studies have examined predictors for burnout and depression in the United States (US), no study, to our knowledge, has compared depression in medical students cross-culturally, or has attempted to examine the effect of factors influencing rates including burnout, exercise, stress, unmet mental health needs, and region.
AIM To examine rates of depression in three international cohorts of medical students, and determine variables that may explain these differences.
METHODS Convenience samples of medical students from three countries (US, China, and a Middle Eastern country whose name remains anonymous per request from the school) were surveyed in this observational study. Using the Patient Health Questionnaire-2 (PHQ-2) and a modified Maslach Burnout Inventory, depression and burnout were examined among medical students from the three cohorts (n = 473). Chi-square test and analysis of variance were used to examine differences in demographics, behavioral, and psychological variables across these three schools to identify potentially confounding descriptive characteristics. Analysis of covariance compared depression and the emotional exhaustion component of burnout identified through Principal Component Analysis across countries. Multiple linear regression was used to analyze the impact of demographic, behavioral, and psychological variables on screening positive for depression.
RESULTS Medical students from the Middle Eastern country had the highest rates of positive depression screens (41.1%), defined as a PHQ-2 score of ≥ 3, followed by China (14.1 %), and then the US (3.8%). More students in the Middle Eastern school had unmet mental health needs (50.8%) than at the medical school in China (34.8%) or the school in the US (32.8%) (Pearson chi-square significance < 0.05). Thus, PHQ-2 scores were adjusted for unmet mental health needs; however, the Middle Eastern country continued to have the highest depression. Adjusting for PHQ-2 score, medical students from the US scored the highest on emotional exhaustion (a measure of burnout). Demographic variables did not significantly predict medical student depression; however, lack of exercise, unmet mental health needs, stress, and emotional exhaustion predicted nearly half of depression in these cohorts. In comparison to the US, coming from the Middle Eastern country and China predicted higher levels of depression.
CONCLUSION Depression rates differ in three international cohorts of medical students. Measured factors contributed to some observed differences. Identifying site-specific prevention and intervention strategies in medical student mental health is warranted.
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Affiliation(s)
- Jessica A Gold
- Department of Psychiatry, Washington University in St Louis, St Louis, MO 63110, United States
| | - Xinran Hu
- Department of Psychiatry, Yale University, New Haven, CT 06511, United States
| | - Gan Huang
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Wan-Zhen Li
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Yi-Fan Wu
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Shan Gao
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Zhe-Ning Liu
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Mickey Trockel
- Department of Psychiatry, Stanford University, Stanford, CA 94305, United States
| | | | | | | | | | - Robert M Rohrbaugh
- Department of Psychiatry, Yale University, New Haven, CT 06511, United States
| | - Kirsten M Wilkins
- Department of Psychiatry, Yale University, New Haven, CT 06511, United States
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Nagy GA, Fang CM, Hish AJ, Kelly L, Nicchitta CV, Dzirasa K, Rosenthal MZ. Burnout and Mental Health Problems in Biomedical Doctoral Students. CBE Life Sci Educ 2019; 18:ar27. [PMID: 31150319 PMCID: PMC6755223 DOI: 10.1187/cbe.18-09-0198] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Although burnout and mental health problems may adversely impact quality of scientific research, academic productivity, and attrition in biomedical doctoral training programs, very little research has been done on this topic. Recent studies have used brief survey methods to begin to explore burnout and mental health problems in biomedical doctoral students. In this pilot study, biomedical doctoral students (N = 69; 12% of enrolled biomedical doctoral students at a large research institution's school of medicine in the United States) were administered standardized psychiatric interviews and self-report questionnaires focused on dimensions of burnout, mental health symptoms, and academic outcomes. We discovered high levels of burnout, depression, and anxiety. Additionally, we identified that burnout was significantly associated with thoughts related to dropping out, subjective appraisal of employment opportunities, functional impairment due to a mental health problem, and having at least one current psychiatric disorder. These findings extend prior research indicating the presence of significant emotional health challenges doctoral students in biomedical graduate programs face involving high burnout and difficulties with the training environment. We outline several recommendations and next steps to programmatically understand and address these emerging emotional wellness concerns in biomedical doctoral students.
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Affiliation(s)
- Gabriela A. Nagy
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710
| | - Caitlin M. Fang
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710
| | | | - Lisalynn Kelly
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710
| | - Christopher V. Nicchitta
- Department of Cell Biology, Office of Biomedical Graduate Education, Duke University Medical Center, Durham, NC 27710
| | - Kafui Dzirasa
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710
- Center for Neuroengineering, Duke University Medical Center, Durham, NC 27710
- Duke Institute for Brain Sciences, Duke University Medical Center, Durham, NC 27710
- Departments of Biomedical Engineering and Neurobiology, Duke University, Durham, NC 27705
| | - M. Zachary Rosenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27705
- *Address correspondence to: M. Zachary Rosenthal ()
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Ayala EE, Winseman JS, Johnsen RD, Mason HRC. U.S. medical students who engage in self-care report less stress and higher quality of life. BMC Med Educ 2018; 18:189. [PMID: 30081886 PMCID: PMC6080382 DOI: 10.1186/s12909-018-1296-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 07/25/2018] [Indexed: 05/04/2023]
Abstract
BACKGROUND Research on student wellness has highlighted the importance of self-care for medical students; however, scholars have yet to identify the extent to which self-reported engagement in self-care behaviors is associated with attenuation of the negative relationship between stress and quality of life during the initial years of medical education. METHODS Using a self-report survey designed to measure self-care, perceived stress, and quality of life, we hypothesized that self-care would moderate the relationship between stress and psychological quality of life in medical students, as well as stress and physical quality of life. An online questionnaire was completed by 871 medical students representing 49 allopathic medical colleges throughout the U.S. between December 2015 and March 2016. The survey assessed perceived stress, self-care, quality of life and a variety of demographic variables. Regression analyses were used to assess interaction effects of self-care on the relationships between stress and quality of life. RESULTS Self-reported engagement in self-care appeared to moderate the relationships between perceived stress and both physical (p < .001) and psychological (p = .002) quality of life. As the level of reported engagement in self-care increased, the strength of the inverse relationship between perceived stress and both physical and psychological quality of life appeared to weaken. CONCLUSIONS Our findings suggest that self-reported engagement in self-care activities is associated with a decrease in the strength of the relationship between perceived stress and quality of life in medical students. Students who disclose utilizing a multitude of self-care practices throughout their training may also sustain greater resiliency and lower risk for higher levels of distress during medical education.
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Affiliation(s)
- Erin E. Ayala
- Department of Counseling Psychology, Saint Mary’s University of Minnesota, 2500 Park Avenue, Minneapolis, MN 55404 USA
| | - Jeffrey S. Winseman
- Department of Psychiatry, Albany Medical College, 25 Hackett Blvd, Albany, NY 12208 USA
| | - Ryan D. Johnsen
- Department of Emergency Medicine, HealthPartners Institute Regions Hospital, 640 Jackson Avenue, Saint Paul, MN 55101 USA
| | - Hyacinth R. C. Mason
- Departments of Medical Education and Family and Community Medicine, Albany Medical College, 47 New Scotland Avenue, 12208 Albany, NY, USA
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Abstract
To date, there is little research on personal crisis experiences of mental health professionals. The aim of this study was to explore some of the reasons for why self-disclosure is so difficult and how these difficulties may prevent productive forms of coproduction. These questions are addressed both from a psychiatrist's autoethnographic account and from the perspective of a peer worker who works in various coproductive relationships. It is shown that mental health professionals often revert to an "I-as-we", speaking of themselves as a collective and thereby reifying the boundaries between 'vulnerable users' and 'invulnerable professionals'. Ethnographic examples are given, of how these boundaries are produced by a continuous, often invisible, and powerful category work. It is discussed how the dichotomous logic of these boundaries can cause people on both sides to feel reduced to a representation of a certain species, which can take on an existential dimension. Ways out are identified for mental health professionals to self-reflexively engage with their own crisis experience in coproductive and other relationships.
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Affiliation(s)
- Sebastian von Peter
- Department of Psychiatry, Medical University Brandenburg, Neuruppin, Germany
| | - Gwen Schulz
- Psychiatric University Clinic Hamburg Eppendorf, Hamburg, Germany
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Abstract
This study examined the prevalence of depressive symptoms and suicidal ideation among 220 first year undergraduate university students in Ireland. Data were collected using the Centre for Epidemiological Studies Depression Scale and the Suicidal Behaviours Questionnaire. Findings indicated that 59% of participants experienced depressive symptoms and 28.5% had suicidal ideation. Financial stress and poor relationships with both parents, increased the odds of experiencing depressive symptoms. Sexual orientation, financial stress, and poor relationships with fathers, increased the odds of experiencing suicidal ideation. Suicidal ideation was also higher in those who had sought help in the past from mental health professionals. Nurses need to be aware of the factors associated with mental ill-health in this population.
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Affiliation(s)
- Aine Horgan
- a School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork , Cork , Ireland
| | - Peter Kelly
- b School of Health Sciences, Waterford Institute of Technology , Waterford , Ireland
| | - John Goodwin
- c School of Nursing and Midwifery, University College Cork , Cork , Ireland
| | - Laura Behan
- d School of Applied Psychology, University College Cork , Ireland
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Abstract
Physician and trainee distress, from burnout and depression to suicide risk, has been recognized as a serious threat to physicians, health care systems and to the optimal delivery of health care. To address this problem, the American Foundation for Suicide Prevention (AFSP) adapted the Interactive Screening Program (ISP) for use by medical schools nationwide. Much is known about the problem, but less is known about the effectiveness of programs and solutions. This program evaluation utilized data from six medical schools' implementation of ISP over a seven-year period (2007–2013) to quantify openness to help-seeking and engagement with each step of program outreach. Descriptive statistics were used to quantify participants' engagement: reviewing the counselor's response; exchanging dialogue messages with the counselor; requesting to meet with the counselor in person; and requesting referral for mental health treatment. Chi-square distribution tests were used to determine differences in level of risk and rates of engagement among medical students, residents and fellows, and faculty physicians. A total of 1,449 individuals, including medical students, residents and faculty physicians, completed the questionnaire; 1,413 (97.5%) were designated as having high or moderate distress and only 5.3% were receiving any type of counseling or therapy. Among program participants, prevalence rates of high distress were higher among medical students and residents versus faculty physicians. The rate of program engagement was high overall with 81.2% reviewing the counselor's response; further engagement was highest among those most distressed, with 32.2% engaging in online dialogue with a program counselor. ISP was a feasible tool for engaging at-risk medical students, residents and physicians who were not currently utilizing mental health services.
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Affiliation(s)
- Maggie Mortali
- Ms. Mortali is Director of the Interactive Screening Program at the American Foundation for Suicide Prevention
| | - Christine Moutier
- Dr. Moutier is Chief Medical Officer at the American Foundation for Suicide Prevention
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Amarasuriya SD, Jorm AF, Reavley NJ. Predicting intentions to seek help for depression among undergraduates in Sri Lanka. BMC Psychiatry 2018; 18:122. [PMID: 29728075 PMCID: PMC5935961 DOI: 10.1186/s12888-018-1700-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 04/23/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Studies have found that although there are high rates of depression among university students, their help-seeking practices are poor. It is important to identify students who are less likely to seek the necessary help, to encourage better help-seeking among them. This study, which was conducted among undergraduates in Sri Lanka, examined the associations between personal characteristics of the undergraduates and their intentions to seek help for depression. METHODS This was a cross-sectional study in which 4461 undergraduates (Male: n = 1358, 30.4%, Female: n = 3099, 69.5%; Mean age = 22.18; SD = 1.47) indicated their intentions to seek help if personally affected by depression, which was described in a hypothetical vignette about a peer experiencing depression symptomatology. The predictors of the undergraduates' help-seeking intentions, including their sociodemographic characteristics, prior exposure to and recognition of the problem, and their stigma towards those with depression were examined using binary logistic regression analyses models. RESULTS The undergraduates' ability to recognise the problem was one of the strongest predictors of their intentions to seek professional help. Those with higher levels of stigma were less likely to seek both professional and informal help. While females were less likely to consider professional help, they were more likely to consider the help of informal help-providers and to consider religious strategies. Medical undergraduates and those who had sought help for personal experiences of the problem were also more likely to consider informal help. However, all these associations resulted in small effect sizes, except for those between recognition of the problem and the undergraduates' intentions to seek professional help, where medium to very large effect sizes were observed in the case of some the associations examined. CONCLUSIONS Improvement of problem-recognition may be a key strategy for improving help-seeking among these undergraduates. Reduction of stigma may also be associated with better depression-related help-seeking of undergraduates. Females and medical undergraduates need to be educated about the importance of seeking appropriate types of help, and their informal social networks must be educated about how best to help them.
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Affiliation(s)
- Santushi D. Amarasuriya
- 0000000121828067grid.8065.bDepartment of Medical Humanities, Faculty of Medicine, University of Colombo, PO Box 271, 25, Kynsey Road, Colombo 8, Sri Lanka ,0000 0001 2179 088Xgrid.1008.9Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, VIC 3010 Australia
| | - Anthony F. Jorm
- 0000 0001 2179 088Xgrid.1008.9Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, VIC 3010 Australia
| | - Nicola J. Reavley
- 0000 0001 2179 088Xgrid.1008.9Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, VIC 3010 Australia
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Farquhar J, Lie D, Chan A, Ow M, Vidyarthi A. Understanding Medical Students' Experience with Stress and Its Related Constructs: A Focus Group Study from Singapore. Acad Psychiatry 2018; 42:48-57. [PMID: 28421479 DOI: 10.1007/s40596-017-0703-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 03/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE In order to protect medical students from burnout and its untoward psychiatric effects, it is imperative to understand their stress, burnout, coping, and resilience experiences. This study aimed to derive collective definitions from the medical student perspective, to identify common themes of students' experiences, and to distinguish pre-clinical and clinical year students' experiences relating to these four constructs. METHODS The authors conducted focus groups of medical students in Singapore across 4 years using a semi-structured question guide. Participants shared their understanding, experiences, and the relationships between stress, burnout, coping, and resilience. Coders independently evaluated construct definitions and derived common themes through an iterative process, and compared transcripts of pre-clinical and clinical year students to determine differences in experience over time. RESULTS Nine focus groups (54 students, 28 females, mean age 24.3) were conducted. Students identified common definitions for each construct. Nine themes emerged within three domains: (1) relating constructs to personal experience, (2) interrelating stress, burnout, coping, and resilience, and (3) understanding the necessity of stress. Compared to clinical students, pre-clinical students reported theory-based rather than reality-based experiences and exam-induced stress, defined constructs using present rather than future situations, and described constructs as independent rather than interrelated. CONCLUSIONS This sample of medical students in Singapore shares a common understanding of stress, burnout, coping, and resilience, but experiences these uniquely. They perceive a positive role for stress. These findings build upon prior literature, suggesting an interrelationship between stress and its related constructs and adding the novel perspective of students from an Asian country.
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Affiliation(s)
| | - Desiree Lie
- Duke-NUS Medical School, Singapore City, Singapore
| | | | - Mandy Ow
- Duke-NUS Medical School, Singapore City, Singapore
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Ayala EE, Omorodion AM, Nmecha D, Winseman JS, Mason HRC. What Do Medical Students Do for Self-Care? A Student-Centered Approach to Well-Being. Teach Learn Med 2017; 29:237-246. [PMID: 28632007 DOI: 10.1080/10401334.2016.1271334] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
UNLABELLED Phenomenon: Despite the promotion of medical student health and wellness through recent program and curricular changes, research continues to show that medical education is associated with decreased well-being in medical students. Although many institutions have sought to more effectively assess and improve self-care in medical students, no self-care initiatives have been designed using the explicit perspectives of students themselves. APPROACH Using concept mapping methodology, the research team created a student-generated taxonomy of self-care behaviors taken from a national sample of medical students in response to a brainstorming prompt. The research team examined how students' conceptualizations of self-care may be organized into a framework suitable for use in programming and curricular change in medical education. FINDINGS Ten clusters of self-care activities were identified: nourishment, hygiene, intellectual and creative health, physical activity, spiritual care, balance and relaxation, time for loved ones, big picture goals, pleasure and outside activities, and hobbies. Using results of the two-dimensional scaling analysis, students' individual self-care behaviors were organized within two orthogonal dimensions of self-care activities. Insights: This concept map of student-identified self-care activities provides a starting point for better understanding and ultimately improving medical student self-care. Students' brainstormed responses fit within a framework of varying levels of social engagement and physical-psychological health that included a wide range of solitary, social, physical, and mental health behaviors. As students' preferred self-care practices did not often include programmatic activities, medical educators may benefit from consulting this map as they plan new approaches to student self-care and in counseling individual students searching for more effective ways to ease the burdens of medical school.
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Affiliation(s)
- Erin E Ayala
- a Department of Psychiatry , Albany Medical Center , Albany , New York , USA
| | | | | | - Jeffrey S Winseman
- a Department of Psychiatry , Albany Medical Center , Albany , New York , USA
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Damiano RF, de Andrade Ribeiro LM, Dos Santos AG, da Silva BA, Lucchetti G. Empathy is Associated with Meaning of Life and Mental Health Treatment but not Religiosity Among Brazilian Medical Students. J Relig Health 2017; 56:1003-1017. [PMID: 27783262 DOI: 10.1007/s10943-016-0321-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The purpose of this study was to investigate the influence of spirituality, religiosity, personal beliefs, and previous contact with health issues on the level of empathy in medical students. Jefferson Scale of Empathy-Student Version, WHOQOL-Spirituality, Religiousness and Personal Beliefs, and Duke University Religion Index were applied to 285 Brazilian medical students. The findings suggest that meaning of life and previous mental health treatment but not Religiosity were positively related to empathy. We suggest that more attention should be given for prevention and treatment of mental health issues, and further studies are needed to understand and replicate these findings.
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Affiliation(s)
- Rodolfo Furlan Damiano
- College of Medicine and Health Sciences, Pontifical Catholic University of São Paulo, Rua Bruno Biagioni, 115, Sorocaba, SP, CEP 18051-870, Brazil.
| | | | - Amanda Guedes Dos Santos
- College of Medicine and Health Sciences, Pontifical Catholic University of São Paulo, Rua Bruno Biagioni, 115, Sorocaba, SP, CEP 18051-870, Brazil
| | - Barbara Almeida da Silva
- College of Medicine and Health Sciences, Pontifical Catholic University of São Paulo, Rua Bruno Biagioni, 115, Sorocaba, SP, CEP 18051-870, Brazil
| | - Giancarlo Lucchetti
- School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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Abstract
An elevated risk for suicide among veterinarians has stimulated research into the mental health of the veterinary profession, and more recently attention has turned to the veterinary student population. This qualitative study sought to explore UK veterinary students' perceptions and experiences of university life, and to consider how these may affect well-being. Semi-structured interviews were conducted with 18 students from a single UK school who were purposively selected to include perspectives from male, female, graduate-entry, standard-entry (straight from high school), and widening participation students across all 5 years of the program. Three main themes were identified: a deep-rooted vocation, navigating belongingness, and finding balance. Participants described a long-standing goal of becoming a veterinarian, with a determination reflected by often circuitous routes to veterinary school and little or no consideration of alternatives. Although some had been motivated by a love of animals, others were intrinsically interested in the scientific and problem-solving challenges of veterinary medicine. Most expressed strong feelings of empathy with animal owners. The issue of belongingness was central to participants' experiences, with accounts reflecting their efforts to negotiate a sense of belongingness both in student and professional communities. Participants also frequently expressed a degree of acceptance of poor balance between work and relaxation, with indications of a belief that this imbalance could be rectified later. This study helps highlight future avenues for research and supports initiatives aiming to nurture a sense of collegiality among veterinary students as they progress through training and into the profession.
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Goodwin J, Behan L, Kelly P, McCarthy K, Horgan A. Help-seeking behaviors and mental well-being of first year undergraduate university students. Psychiatry Res 2016; 246:129-135. [PMID: 27693865 DOI: 10.1016/j.psychres.2016.09.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 11/30/2022]
Abstract
University students demonstrate poor help-seeking behatabviors for their mental health, despite often reporting low levels of mental well-being. The aims of this study were to examine the help-seeking intentions and experiences of first year university students in terms of their mental well-betabing, and to extaplore these students' views on formal (e.g. psychiatrists) and informal (e.g. friends) help-seeking. Students from a universitytab in the Republic of Ireland (n=220) completed an online questionnaire which focused on mental well-being and help-seeking behaviors. Almost a third of students had sought help from a mental health professional. Very few students reported availing of university/online supports. Informal sources of help were more popular than formal sources, and those who would avail and had availed of informal sources demonstrated higher well-being scores. Counselors were the source of professional help most widely used. General practitioners, chaplains, social workers, and family therapists were rated the most helpful. Those with low/average well-being scores were less likely to seek help than those with higher scores. Findings indicate the importance of enhancing public knowledge of mental health issues, and for further examination of students' knowledge of help-seeking resources in order to improve the help-seeking behaviors and mental well-being of this population group.
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Affiliation(s)
- John Goodwin
- School of Nursing and Midwifery, University College Cork, Republic of Ireland; Mercy University Hospital, Cork, Republic of Ireland
| | - Laura Behan
- School of Applied Psychology, University College Cork, Republic of Ireland; Department of Clinical and Experimental Sciences, University of Southampton, United Kingdom
| | - Peter Kelly
- School of Nursing and Midwifery, University College Cork, Republic of Ireland
| | - Karen McCarthy
- Department of Occupational Science and Occupational Therapy, University College Cork, Republic of Ireland
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Republic of Ireland.
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Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, Sen S, Mata DA. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA 2016; 316:2214-2236. [PMID: 27923088 PMCID: PMC5613659 DOI: 10.1001/jama.2016.17324] [Citation(s) in RCA: 1118] [Impact Index Per Article: 139.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies. OBJECTIVE To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students. DATA SOURCES AND STUDY SELECTION Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included. DATA EXTRACTION AND SYNTHESIS Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. MAIN OUTCOMES AND MEASURES Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview. RESULTS Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, -0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%. CONCLUSIONS AND RELEVANCE In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.
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Affiliation(s)
- Lisa S Rotenstein
- Harvard Medical School, Boston, Massachusetts2Harvard Business School, Boston, Massachusetts
| | - Marco A Ramos
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Matthew Torre
- Harvard Medical School, Boston, Massachusetts4Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Michael J Peluso
- Harvard Medical School, Boston, Massachusetts5Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Srijan Sen
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor8Department of Psychiatry, University of Michigan, Ann Arbor
| | - Douglas A Mata
- Harvard Medical School, Boston, Massachusetts9Division of MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts10Brigham Education Institute, Boston, Massachusetts
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Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, Sen S, Mata DA. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA 2016. [PMID: 27923088 DOI: 10.1001/jama.2016.17324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies. Objective To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students. Data Sources and Study Selection Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included. Data Extraction and Synthesis Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Main Outcomes and Measures Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview. Results Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, -0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%. Conclusions and Relevance In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.
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Affiliation(s)
- Lisa S Rotenstein
- Harvard Medical School, Boston, Massachusetts2Harvard Business School, Boston, Massachusetts
| | - Marco A Ramos
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Matthew Torre
- Harvard Medical School, Boston, Massachusetts4Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Michael J Peluso
- Harvard Medical School, Boston, Massachusetts5Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Srijan Sen
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor8Department of Psychiatry, University of Michigan, Ann Arbor
| | - Douglas A Mata
- Harvard Medical School, Boston, Massachusetts9Division of MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts10Brigham Education Institute, Boston, Massachusetts
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Agarwal G, Lake M. Personal Transition to the Profession: A Novel Longitudinal Professional Development and Wellness Medical Student Curriculum. Acad Psychiatry 2016; 40:105-108. [PMID: 26742500 DOI: 10.1007/s40596-015-0463-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 11/10/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Gaurava Agarwal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - MaryBeth Lake
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Amarasuriya SD, Jorm AF, Reavley NJ. Perceptions and intentions relating to seeking help for depression among medical undergraduates in Sri Lanka: a cross-sectional comparison with non-medical undergraduates. BMC Med Educ 2015; 15:162. [PMID: 26419827 PMCID: PMC4589186 DOI: 10.1186/s12909-015-0453-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/22/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND This study attempts to understand whether medical undergraduates in Sri Lanka would seek help for depression. This was done by examining their perceptions and intentions relating to seeking help for depression, using the responses of non-medical undergraduates as the baseline for comparison. METHOD Medical (n = 620) and non-medical undergraduates (n = 4050) at the University of Colombo responded to a questionnaire which included a vignette about a depressed undergraduate, a depression measure, an open-ended question examining their intentions to seek help if affected by the problem described in the vignette, and scales examining their perceptions about the helpfulness of various help-seeking options for dealing with the problem. The latter items were also administered among mental health professionals to assess expert opinion on dealing with depression. Logistic regression models were used to examine if medical undergraduates differed from non-medical undergraduates in their rates of depression, help-seeking perceptions and help-seeking intentions. These models were also used to examine if being depressed was associated with differences in the help-seeking perceptions and intentions of medical undergraduates. RESULTS Medical and non-medical undergraduates did not differ in their odds of being depressed. Overall, the medical undergraduates were more likely to appraise professional help positively. However, they did not differ from non-medical undergraduates in relation to their intentions to seek such help if affected by the problem personally. They were also more likely to indicate their intentions to seek help from parents and family. Furthermore, medical undergraduates who screened positive for Major Depression were less likely to appraise some of the recommended professional and informal help-seeking options as being 'helpful', with only 50 % considering that it was 'unhelpful' to deal with the problem alone. There was also no difference in their help-seeking intentions as compared to those screening negative for Major Depression. DISCUSSION AND CONCLUSIONS Although medical training seems to be associated with better help-seeking beliefs, interventions are needed to improve these medical undergraduates' intentions to personally seek professional help for depression. It is concerning that medical undergraduates who are depressed might be less likely to consider it beneficial to seek help and instead, deal with the problem alone.
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Affiliation(s)
- Santushi D Amarasuriya
- Behavioural Sciences Stream, Faculty of Medicine, University of Colombo, PO Box 271, 25, Kynsey Road, Colombo 8, Sri Lanka.
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Victoria, 3010, Australia.
| | - Anthony F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Victoria, 3010, Australia.
| | - Nicola J Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Victoria, 3010, Australia.
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