Depressive Symptoms in Medical Students and Their Association with Hormonal and Socioeconomic Variables

Paula, Gabriel Marcelo Rêgo de; Silva, Vanessa Izidoro Alves; Tenorio, Mariane Soriano Duarte Prado; Pinto, Daniela Queiroz; Vasconcelos, Camila Calado de; Barbosa, Ana Soraya Lima

doi:10.1590/1981-5271v44.4-20200013.ING

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ORIGINAL ARTICLE • Rev. bras. educ. med. 44 (04) • 2020 • https://doi.org/10.1590/1981-5271v44.4-20200013.ING copy

Depressive Symptoms in Medical Students and Their Association with Hormonal and Socioeconomic Variables

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Introduction:

Depression disables and compromises quality of life, so that its high prevalence in medical students is a relevant problem. It is known that hormonal variables, such as cortisolemia, as well as socioeconomic factors can be related to the onset of depressive symptoms. This study aimed to verify the prevalence of depressive symptoms in medical students at a University Center in Maceió and analyze their correlation with serum cortisol levels, lifestyle and socioeconomic profile.

Method:

Quantitative, analytical and cross-sectional study of medical students from a private medical school in Maceió. A sample of 122 students participated in the study, which applied the Beck Depression Inventory, socioeconomic questionnaire and serum cortisol dosage.

Results:

Of the 78 women and 44 men participating in the study, 40 cases of depressive symptoms were identified (32.9%), of which 3 cases had severe depressive symptoms (2.5%), 9 cases had moderate depressive symptoms (7.4%) and 28 had mild depressive symptoms (23.0%). As for the cortisol levels, the mean value obtained was 12.72 µg/dL, with a maximum and minimum value of 29.7 µg/dL and 0.9 µg/dL, respectively. No correlation was found between depressive symptoms and morning serum cortisol levels in this study. Among the explanatory variables analyzed, only religion attained a statistically significant correlation with depressive symptoms, with a prevalence of higher scores in students who did not have a religion.

Conclusion:

It can be emphasized that there is a high prevalence of depression among medical students. The results obtained in this study show that the hypothalamic-pituitary-adrenal axis alteration is not the only etiology associated with the development of depression. In turn, religious practice showed to be statistically significant in relation to the lowest rate of depressive symptoms, revealing itself as a probable protective factor against the development of depression.

Keywords:
Depression; Hydrocortisone; Medical Students; Medical Education; Religion

Classification of depressive symptoms	Male		Female		Total
Classification of depressive symptoms	n	%	n	%	N	%
0 to 13 - None	28	63.7	46	59.0	74	60.6
14 to 19 - Mild	5	11.4	23	29.5	28	23.0
20 to 28 - Moderate	4	9.0	5	6.4	9	7.4
29 to 63 - Severe	2	4.5	1	1.3	3	2.5
DWA*	5	11.4	3	3.8	8	6.5
TOTAL	44	100	78	100	122	100

Classification of serum cortisol values	Total
Classification of serum cortisol values	n	%
< 6,7 µg/dL. - Below the RV*	11	9.0
6,7 a 22,6 µg/dL. - Within the RV*	104	85.3
> 22,6 µg/dL. - Above the RV*	7	5.7
TOTAL	122	100

Sociodemographic characteristics
	n	%*		n	%*		n	%*		n	%*
Gender			Ethnicity			Age group			Level of schooling
Male	39	34	White	60	52	18 to 23 years	78	69	Higher education	17	15
Female	75	66	Black	3	3	24 to 29 years	27	24	Incomplete Higher education	97	85
			Yellow	3	3	30 to 35 years	4	3
			Brown	47	41	36 to 41 years	5	4
			Indigenous	0	0
			DWA **	1	1
Professional activities			Duration of professional activity			Personal income			Number of people contributing to income
Dentistry	2	2	No activity at the moment	100	88	No income of their own	56	49	1 person	25	22
Pharmacy	2	2	< 5 years	5	4	Up to 1 minimum wage	5	4	2 people	76	67
Others	10	9	6 to 15 years	8	7	1 to 6 minimum wages	15	13	3 people	6	5
No professional activities	99	86	16 to 25 years	1	1	7 to 12 minimum wages	1	1	4 or more people	6	5
DWA**	1	1				> 12 minimum wages	13	12	DWA**	1	1
						DWA**	24	21
Housing conditions			Number of people in the house			Monitoring by health professional			Student Financing Program
Owns home	75	66	One	16	14	No	78	68	Yes	32	28
Rented house	21	18	Two	22	19	Yes	36	32	No	81	71
Student residence	1	1	Three	28	24				DWA**	1	1
Family home	16	14	Four	24	21
DWA**	1	1	Five or more	20	18
			DWA**	4	4
Religion
Catholic	67	58
Evangelist	13	11
Spiritualist	14	12
Jewish	0	0
Muslim	0	0
Seicho-no-Ie	0	0
No religion	16	14
Another	2	1
DWA**	2	1

Life habits
	N	%*		n	%*		n	%*		n	%*
Current semester			Time spent in in-class study			Time spent in extra-class study			Breaks during the study period
Second	14	12	< 30h	11	10	< 30h	94	83	Yes	106	93
Third	29	26	30 to 44h	89	78	30 to 44h	17	14	No	8	7
Fourth	20	18	> 44h	9	8	> 44h	0	0
Fifth	14	12	DWA**	5	4	NDR**	3	3
Sixth	24	21
Seventh	1	1
Eighth	12	10
Personal life impaired by the workload			Hours of sleep a day			Weekly physical activity			Alcohol consumption
Yes	94	83	< 6h	51	45	Once	7	6	Yes	60	53
No	20	17	6 a 8h	63	55	Twice	22	19	No	49	43
						3 to 5 times	49	43	DWA**	4	4
						> 5 times	2	2
						Does not practice	33	29
Smoking			Illicit drug use
Yes	0	0	No	109	95
No	114	100	Marijuana / Hashish	1	1
			Others	1	1
			DWA**	3	3

Variable	H (chi²)	P
Gender	1.031	0.30
Age range	2.032	0.56
Religion	4.266	0.03*
Sleep duration (hours)	1.572	0.20
In-class studies (hours)	0.478	0.78
Extra-class studies (hours)	2.943	0.08
Physical activity (days)	0.792	0.37
Alcohol consumption	0.131	0.71

Variable	H (chi²)	p
Gender	3.136	0.07
Age range	5.082	0.16
Religion	1.146	0.56
Sleep duration (hours)	0.012	0.90
In-class studies (hours)	3.009	0.39
Extra-class studies (hours)	1.503	0.45
Physical activity (days)	0.815	0.36
Alcohol consumption	1.135	0.56

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[1] ADDRESS FOR CORRESPONDENCE
Gabriel Marcelo Rêgo de Paula. Rua Professor Luis Lavenere Machado, 383, Trapiche da Barra, Maceió, AL, Brasil. CEP: 57010-383. E-mail: gabrielmarcelodp@gmail.com