Prevalence and factors associated to depression and suicidal behavior among medical students

Neres, Bárbara Santos Pereira; Aquino, Maria Luiza Andrade; Pedroso, Vinicius Sousa Pietra

doi:10.1590/0047-2085000000351

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Original Article • J. bras. psiquiatr. 70 (4) • 2021 • https://doi.org/10.1590/0047-2085000000351 copy

Prevalence and factors associated to depression and suicidal behavior among medical students

Prevalência e fatores associados a depressão e comportamento suicida entre estudantes de medicina

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

Depression and suicidal behavior have been described as major problems among medical students. The aim of this study was to assess the prevalence of depression and suicidal behavior among medical students of an institution and to investigate possible associated variables.

Methods:

The authors carried out a cross-sectional study through a self-administered questionnaire, including the Beck Depression Inventory (BDI) and the Beck’s Suicide Intent Scale (BSIS) instruments. The diagnosis of depression was based on an instrument adapted according to the DSM-IV and ICD-10 criteria. Logistic regression was performed to search for depression predictor variables.

Results:

In a total of 381 students, the prevalence of depression was 27.6%. Suicidal ideation of moderate to severe intensity was observed in 10.5% of the sample. About 6% of students had previously attempted suicide. Consumption of licit and illicit drugs was frequent among the participants, reaching 78% and 24% of the sample, respectively. The demand for specialized treatment was lower than expected among students with depression. Logistic regression revealed that female gender, reduced interpersonal contact with friends, reduced physical activity, difficulty in facing new situations and high perception of personal pressure were risk factors for depression.

Conclusion:

The prevalence of depression and suicidal behavior among medical students is higher than in the general population. There is a need for further studies to enable a better understanding of the risk factors and variables at play, which is fundamental for the development of early intervention strategies and support for students.

KEYWORDS
Medical students; depression; suicide

		n	%
Sex
	Female	256	68.1
	Male	120	31.9
Course cycle
	Basic (1^st to 4^th semester)	149	39.5
	Clinical (5^th to 8^th semester)	159	42.2
	Internships (9^th to 12^th semester)	69	18.3
Place of birth
	Belo Horizonte	204	54.1
	State of Minas Gerais (except Belo Horizonte)	147	38.9
	Other states in Brazil	21	5.6
	Other countries	5	1.3
Living situation
	Alone	104	27.4
	Accompanied	275	72.6
Funding resource
	Does not use	232	61.4
	FIES	83	22.0
	Prouni	33	8.7
	Institutional/union scholarship	28	7.4
	FIES + scholarship	2	0.5
Romantic relationships
	Yes	182	47.9
	No	198	52.1

		n	%
Lifetime PS use
Alcohol		295	78.0
Cigarettes/tobacco		297	78.4
Illicit drugs		90	23.8
	Cannabinoids	43	11.4
	Stimulants and synthetics	15	4.0
	Opioids	2	0.5
	Solvents	4	1.1
Current frequency of PS use
Alcohol
	Never	9	3.0
	01 to 03 doses/week	185	62.5
	04 to 06 doses/week	53	17.9
	07 to 09 doses/week	23	7.8
	>10 doses/week	26	8.8
Cigarretes/Tobacco
	Never	297	78.4
	Eventually	72	19.0
	Every day	10	2.6
Illicit drugs
	Never	228	76.2
	Rarely	59	15.6
	Eventually	29	7.8
	Every day	2	0.5

		Major depression				p
		Yes		No
		n	%	n	%
Psychological treatment
	Current	21	20.0	32	11.8	0.040^* * p<0.05;
	Past	50	47.6	119	43.9
	Not	34	32.4	120	44.3
Psychiatric treatment
	Current	18	17.1	10	3.7	<0.001^* ***** p≤0.001.
	Past	26	24.8	49	18.1
	Not	61	58.1	211	78.1

		Major depression				p
		Yes		No
		n/mean	%/(SD)	n/mean	%/(SD)
Sex
	Female	83	79.0	170	63.4	0.004^ p≤0.01;
	Male	22	21.0	98	36.6	0.004^ p≤0.01;
BDI		17.8	(8.5)	7,1	(5.4)	<0.001^* ***** p≤0.001.
BSIS		4.15	(6.3)	1,23	(3.8)	<0.001^* ***** p≤0.001.
Previous suicide attempts
	Never	84	86.6	192	95.5	0.016^* * p<0.05;
	One attempt	8	8.2	7	3.5
	More than one attempt	5	5.2	2	1.0
Course cycle
	Basic (1^st to 4^th semester)	38	36.2	111	40.8	0.021^* * p<0.05;
	Clinical (5^th to 8^th semester)	55	52.4	104	38.2
	Internships (9^th to 12^th semester)	12	11.4	57	21.0
Place of birth
	Belo Horizonte	55	52.4	148	55.0	0.463
	State of Minas Gerais (except Belo Horizonte)	40	38.1	106	39.4
	Other states in Brazil	9	8.6	12	4.5
	Other countries	1	0.9	3	1.1
Romantic relationship
	Yes	44	41.9	137	50.4	0.589
	No	61	58.1	135	49.6	0.589
Living situation
	Alone	41	39.0	62	22.9	0.002^ p≤0.01;
	Accompanied	64	61.0	209	77.1	0.002^ p≤0.01;
Alcohol use
	Yes	81	78.6	211	77.6	0.263
	No	22	21.4	61	22.4	0.263
Illicit drugs use
	Yes	27	25.7	63	23.2	0.680
	No	78	74.3	208	76.8	0.680
Frequency of alcohol use
	1 to 3 doses/week	54	71.1	129	61.7	0.307
	4 to 6 doses/week	14	18.4	39	18.7
	7 to 9 doses/week	3	3.9	20	9.6
	>10 doses/week	5	6.6	21	10.0
Stress relief activities
	Meet friends	81	77.1	246	90.4	0.001^* ***** p≤0.001.
	Date with romantic partner	45	42.9	131	48.2	0.355
	Participates in social/cultural events	74	70.5	218	80.1	0.044^* * p<0.05;
	Reads literary books	26	24.8	66	24.3	0.934
	Stay with family	67	63.8	200	73.5	0.063
	Use of alcoholic beverages	45	42.9	108	39.7	0.576
	Use of cigarettes/tobacco	11	10.5	22	8.1	0.462
	Use of illicit drugs	6	5.7	11	4.0	0.484
	Practice sports	3	2.9	30	11.1	0.012^ p≤0.01;
Degree of satisfaction with the course
	Bad	3	2.9	0	0	<0.001^* ***** p≤0.001.
	Reasonable	14	13.5	10	3.7
	Good	45	43.3	92	34.4
	Excellent	42	40.3	166	61.9
Stress factors
	Large volume of contents	76	72.4	155	57.0	0.006^ p≤0.01;
	High workload	73	69.5	138	50.7	0.001^* ***** p≤0.001.
	Academic curriculum	68	64.8	131	48.2	0.004^ p≤0.01;
	Personal pressure	92	87.6	201	73.9	0.004^ p≤0.01;
	Labor market	35	33.3	77	28.3	0.339
	Facing new situations	32	30.5	46	16.9	0.012^* * p<0.05;
	Contact with patients	13	12.4	16	5.9	0.035^* * p<0.05;
	Lack of time for him/herself, friends and family	78	74.3	125	46.0	<0.001^* ***** p≤0.001.
	Lack of leisure time	75	71.4	113	41.5	<0.001^* ***** p≤0.001.

	B	OR	CI 95%	p
Sex (male)	-0.92	0.40	0.19-0.86	0.018*
Meeting friends	-1.17	0.31	0.12-0.83	0.020*
Practicing sports	-1.91	0.15	0.04-0.57	0.005**
Personal pressure	0.89	2.43	1.07-5.52	0.033*
Facing new situations	0.76	2.15	1.06-4.36	0.035*

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[1] Address for correspondence: Vinicius Sousa Pietra Pedroso. Departamento de Medicina, Pontifícia Universidade Católica de Minas Gerais, Rua do Rosário, 1081 – 32604-115 – Betim, MG, Brazil. E-mail: viniciuspietra@yahoo.com.br