Stress in medical training: we need to look at our students

Estresse na formação médica: precisamos olhar para nossos alunos

DEAR EDITOR,

It is well known that the mental health of medical students is a global problem of significant proportions¹. Rates of anxiety and depression, for example, are significantly higher among medical students than in the general population. In Brazil available studies indicate that this is also a reality². The interest in aspects related to the mental health of this population has been growing, as illustrated in the current issue of the Brazilian Journal of Psychiatry^3,4.

Risk factors for depression and anxiety include being female, presence of physical illness, medication use, dissatisfaction with the course being taken and being in the first year of medical school, although this final factor lacks consensus in the literature. In order to verify the possible extent of this issue in our institution, we carried out a pilot study evaluating the probability of a diagnosis of anxiety and/or depression among medical students at Universidade Federal do Rio Grande do Sul, Southern Brazil.

This study was cross-sectional and was approved by the Ethics Committee of the institution (CAAE 68132317.3.0000.5327). The data was collected between October and November, 2016, via non-identifiable online questionnaires (using Google Docs platform). Inclusion criteria were broad, including all regularly enrolled medical students at any stage of the course. This questionnaire, besides containing socio-demographic variables, was based on an instrument developed at Universidade Estadual Paulista to evaluate the probability of individuals’ being diagnosed with anxiety and/or depression according to DSM-IV⁵. It was developed for and tested on medical students and was based on the Hamilton Anxiety Questionnaire, the IDATE Inventories I and II and Beck’s anxiety and depression inventories.

Among the 217 students who answered the questionnaire, 65% showed scores compatible with possible or probable diagnosis of anxiety disorder (27% possible; 38% probable). In terms of the probability of diagnoses of depressive disorder, 23% were identified as being possibly diagnosed and 6%, probably diagnosed. The data obtained are consistent with the existing literature, indicating high probability of diagnoses of anxiety and depressive disorders. An association was also seen between the above diagnoses and poor sleep quality (p < 0.001 and p = 0.01, respectively), known to be associated with numerous negative health outcomes. As expected, the pilot study indicated associations between depression and anxiety (p < 0.001), as well as a recent and significant association between financial hardships and depression (p = 0.006). Considering the university’s recently established policy to offer access to public university to low income students, this data may indicate the need for better understanding of the impact of this factor on the mental health of many medical students and the resulting establishment of appropriate care for this potentially vulnerable population. More research to provide data on the mental health of medical students is fundamental, 1) in order to clarify the existence and extent of the problem and, 2) to provide aid aimed at the prevention and appropriate referral of students who face such difficulties. Medical students are future physicians and their mental health and well-being should be taken very seriously.

REFERENCES

• ¹
  Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students a systematic review and meta-analysis. JAMA. 2016;316(21):2214-36.
• ²
  Pacheco JP, Giacomin HT, Tam WW, Ribeiro TB, Arab C, Bezerra IM, et al. Mental health problems among medical students in Brazil: a systematic review and meta-analysis. Rev Bras Psiquiatr. 2017;39(4):369-78.
• ³
  Regis JMO, Ramos-cerqueira ATA, Lima MCP, Torres AR. Social anxiety symptoms and body image dissatisfaction in medical students: prevalence and correlates. J Bras Psiquiatr. 2018;67(2):65-73.
• ⁴
  Abreu TT, Maurílio ADO, Liguori CC, Vasconcelos D, Tavares DP, Manoel D, et al. O consumo de bebida alcoólica e o binge drink entre os graduandos de Medicina de uma Universidade de Minas Gerais. J Bras Psiquiatr. 2018;67(2):87-93.
• ⁵
  Botega NJ, Bio MR, Zomignani MA, Garcia Jr C, Pereira WAB. Transtornos do humor em enfermaria de clínica médica e validação de escala de medida (HAD) de ansiedade e depressão. Rev Saude Publica. 1995;29(5):355-63.

Publication Dates

• Publication in this collection
  Oct-Dec 2018

History

• Received
  31 July 2018
• Accepted
  5 Aug 2018