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Antecedente de Ansiedade, Síndrome do Pânico ou Depressão e Análise do Impacto na Qualidade de Vida em Estudantes de Medicina
Abstract
Alta competicao por resultados, muitas horas de estudo, carga horaria academica elevada, entre outros motivos, sao apontadas como causa do elevado indice de ansiedade, pânico e depressao nos estudantes de Medicina. Avalia-se o impacto do historico diagnosticado pelo medico dessas patologias na qualidade de vida dos estudantes de Medicina por meio de pesquisa transversal com aplicacao do questionario da Organizacao Mundial da Saude para avaliacao da qualidade de vida – formato curto (WHOQOL-BREF), acrescido de um questionario com perguntas relacionadas a historico de ansiedade, sindrome do pânico ou depressao anterior, religiao e onde residem seus familiares em 405 alunos de Medicina da cidade de Sao Paulo, Brasil. Nos resultados, os alunos com historico previo de ansiedade, pânico ou depressao (34,57%) obtiveram pior indice de qualidade de vida demonstrado nos dominios fisico, psicologico, relacao social e ambiental, quando comparados ao grupo sem historico previo de depressao (p < 0,005). Alunos que relatam ter religiao tem melhor qualidade de vida, com indices superiores no dominio psicologico (p < 0,005). Estudantes cujas familias residem em outras cidades tem historico mais elevado de ansiedade, sindrome do pânico ou depressao (teste exato de Fisher = 0.014). Conclusao: neste trabalho, historia de ansiedade, pânico ou depressao e alunos sem religiao apresentam piores indices de qualidade de vida e devem ser monitorados por programas especiais para melhorar o bem-estar, com enfase para os alunos provenientes de outras cidades.
... Os dados foram coletados entre os anos de 2016 e de 2017. O WHOQOL-Bref é constituído por 26 questões, apresentando duas perguntas sobre qualidade de vida geral (FLECK et al., 2000;SERINOLLI;OLIVA;EL-MAFARJEH, 2015). Este instrumento permite "[...] delimitar características psicométricas satisfatórias para se proceder à avaliação da qualidade de vida" (FIGUEIREDO et al., 2014, p. 437). ...
... Os dados foram coletados entre os anos de 2016 e de 2017. O WHOQOL-Bref é constituído por 26 questões, apresentando duas perguntas sobre qualidade de vida geral (FLECK et al., 2000;SERINOLLI;OLIVA;EL-MAFARJEH, 2015). Este instrumento permite "[...] delimitar características psicométricas satisfatórias para se proceder à avaliação da qualidade de vida" (FIGUEIREDO et al., 2014, p. 437). ...
... Os dados foram coletados entre os anos de 2016 e de 2017. O WHOQOL-Bref é constituído por 26 questões, apresentando duas perguntas sobre qualidade de vida geral (FLECK et al., 2000;SERINOLLI;OLIVA;EL-MAFARJEH, 2015). Este instrumento permite "[...] delimitar características psicométricas satisfatórias para se proceder à avaliação da qualidade de vida" (FIGUEIREDO et al., 2014, p. 437). ...
OBJETIVO: Analisar a relação da qualidade de vida com problemas de saúde mental (estresse, Síndrome de Burnout e depressão) em estudantes de medicina de uma faculdade do interior do Nordeste.MÉTODOS: Estudo de caráter transversal, analítico, com abordagem quantitativa, tendo como local de estudo a cidade de Patos na Paraíba. A amostra final foi composta por 138 alunos do curso de medicina das Faculdades Integradas de Patos (FIP), sendo adotada uma amostra constituída por 77% do universo de pesquisa, conforme critérios de inclusão e exclusão do estudo. Para a coleta de dados utilizou-se instrumentos validados para mensurar qualidade de vida, Síndrome de Burnout, estresse e depressão. As análises dos dados seguiram os critérios estabelecidos em cada um dos artigos de validação.RESULTADOS: A qualidade de vida apresentou correlação negativa com a exaustão emocional (ρ=-0,29; p<0,05), com a descrença (ρ=-0,31; p<0,05), com a depressão (ρ=-0,29; p<0,05) e com as fases do estresse; enquanto se correlacionou positivamente com eficácia profissional (ρ=0,19; p<0,05). Quanto aos domínios da Síndrome de Burnout (exaustão emocional e descrença) observou-se correlação positiva com as fases do estresse. Por fim, os efeitos da depressão na qualidade de vida dos estudantes se sobrepuseram aos demais problemas de saúde mental, possivelmente em função da multicolinearidade (ρ=-2,70; p<0,05).CONCLUSÕES: Os estudantes de medicina apresentam diversos problemas de saúde mental que interferem na qualidade de vida, comprometendo desempenho acadêmico, desenvolvimento de habilidades e cuidados com os pacientes.
... Ter histórico de depressão pode, inclusive, ser um fator para o desenvolvimento de ansiedade e estresse patológico (O'Hara et al., 2014). Consequentemente, o histórico de depressão pode influenciar negativamente na qualidade de vida dos alunos (Serinolli et al., 2015). ...
A saúde mental de universitários é uma temática crescente na literatura científica, principalmente devido ao aumento da prevalência de transtornos psicológicos. Com o intuito de aprofundar aspectos como: a vulnerabilidade, fatores de risco e de proteção e consequências para a saúde dos estudantes foi realizada uma revisão de literatura das publicações dos últimos 10 anos. Elegeram-se as seguintes bases de dados: PsycInfo, Dialnet, Scielo Brasil, PePSic; e a Web of Science e analisados 161 artigos. Contatou-se que Brasil, Estados Unidos e Espanha foram os países com maior número de publicações. A metodologia adotada pela maioria das pesquisas foi a quantitativa, destacando-se delineamentos descritivos, experimentais, correlacionais e transversais. A maioria das publicações tiveram como público-alvo estudantes das áreas de saúde e verificou-se uma necessidade de validação de instrumentos específicos para o contexto acadêmico. Estudos futuros podem ampliar as discussões acerca do suicídio acadêmico e também discutir possibilidades de prevenção, propostas de intervenção e a saúde mental em estudantes de mestrado e doutorado.
... Quando não tratada adequadamente, esta doença desequilibra o desempenho normal do cérebro, favorecendo altos índices de comorbidades psiquiátricas, como os distúrbios de ansiedade (ansiedade generalizada, síndrome do pânico, episódios de ansiedade pós-traumática e fobias), além de propiciar maior incidência de doenças autoimunes e cardiovasculares (SERINOLLI MI, et al., 2015). ...
Objetivo: Analisar a prevalência do transtorno depressivo em acadêmicos de medicina conforme idade, sexo e período do curso em que se encontravam. Métodos: Revisão sistemática de artigos publicados nos últimos 15 anos nas bases de dados PubMed, LILACS e Google Acadêmico, dentre os quais sete estudos corresponderam aos critérios de inclusão pré-estabelecidos nesta pesquisa. Resultados: A prevalência de sintomas depressivos variou entre 8,9% e 79%, sendo as mulheres mais acometidas pelo transtorno. Foram considerados como fatores desencadeantes a carga horária excessiva, amplo conteúdo programático e insegurança quanto à aprendizagem e ao desempenho nas avaliações curriculares e provas de residência. Considerações finais: A jornada acadêmica, desde a preparação para o vestibular até o internato, impacta significativamente na saúde psicológica dos estudantes de medicina. Embora a prevalência da depressão nesses alunos seja superior à média da população geral, a busca por assistência psicológica pelos acadêmicos é, ainda, insatisfatória. Palavras-chave: Saúde Mental, Transtorno Depressivo, Estudantes de Medicina.
... The domain social relations composed of facets personal relationships, social support and sexual activity presented an average of 14.50 in the present study, losing only to the physical domain in the general classification and occupying the highest mean for the female corroborating with study by Raquel, Kuroishi and Mandrá (2016) [16] who, when comparing the QOL of speechlanguage pathology students in different graduation periods, observed a higher average in this area, being higher in the fourth period (G2 = 73.74, SD ± 18.41), followed by the second = 72.22, ...
... Even if they are in a health service, the lack of maturity about the diagnosis and/or the fear of punishment by the medical preceptors, medical assistants or tutors lead the students to self-medication [18]. ...
Objective: To evaluate the general quality of life in medical students.
Method: This is a cross-sectional observational study of 320 students from the Federal University of Mato Grosso do Sul, located in Campo Grande, Brazil, who answered the WHOQOL-BREF quality of life assessment instrument.
Results: The medical students evaluated having a good general quality of life and good satisfaction with their health. According to the domains, the psychological domain was smaller than the social relationships and environment domains. The students had a difference in the values of the WHOQOL-BREF scores only between the psychological and the environment domains and lower values in the men, in the physical and psychological domains. During the years of the course, there was a difference between the domains only for the 3rd grade of the course, with lower scores for the psychological domain. In each domain, the values of the WHOQOL-BREF scores were higher in the second grade compared to the 5th grade in the social relationships domain, and in the environmental domain. The 1st grade had lower values than the 6th grade.
Conclusion: Medical students have a positive characterization of the quality of life, although it is less in the psychological domain, by the frequency of negative feelings not enjoying life or concentrating in a satisfactory way. Female students are more fragile in the psychological and physical domain than male students.
Keywords: Quality of life; Medical students; Medical Education.
Introdução: Os estudantes de medicina compõem um grupo suscetível à cefaleia, em razão da alta carga de estresse e alterações de sono. Objetivos: analisar a prevalência de cefaleia em estudantes de medicina correlacionando-a com o período de avaliação e com a qualidade/horas do sono. Métodos: Estudo transversal realizado com estudantes de medicina do 1º ao 8º período de um Centro Universitário em Minas Gerais. Foram aplicados questionário sociodemográfico, Headache Screening Questionnaite (HSQ) e Escala de Sonolência de Epworth (ESE). Resultados: 39 (16,6%) foram diagnosticados com CTT e 41 (17,45%) com migrânea. 96 (40,85%) tiveram o diagnóstico de sonolência excessiva. Há evidências inconclusivas sobre a significância da associação entre as variáveis cefaleia e horas de sono em semana de provas. Discussão: A prevalência de CTT está abaixo dos valores encontrados em outros estudos. Já a prevalência da migrânea encontra-se próxima ou elevada quando comparada à literatura. Fatores como faixa etária, atividade física e estresse estão relacionados com a ocorrência de cefaleia. Conclusão: Um grande número de acadêmicos refere cefaleia durante a graduação, sendo necessário que haja estratégias de orientação e educação com o estudante de medicina.
O objetivo deste estudo foi avaliar a qualidade de vida (QV) dos estudantes de dois cursos de Odontologia da Universidade Federal do Ceará (UFC) durante a pandemia da Coronavirus Disease 2019. Foi realizado um estudo transversal, com coleta de dados em maio de 2020, por meio de questionários que mensuraram as variáveis sociodemográficas, relacionadas ao curso e comportamentais, além do World Health Organization Questionnaire for Quality of Life-bref. Foi realizada regressão logística multinomial. Ocorreu a participação de 396 estudantes. Observou-se que 64,1% dos acadêmicos apresentavam-se insatisfeitos quanto à QV. Variáveis como renda mensal (p=0,018), religião (p=0,012), qualidade do sono (p<0,001), insônia (p<0,001) e prática de atividade física (p<0,001) foram associadas com a insatisfação com a QV. A QV dos acadêmicos de Odontologia da UFC foi insatisfatória, a partir da análise dos baixos escores dos questionários, sendo importante que todos os envolvidos no processo educacional sejam sensíveis a esta realidade, a fim de tentar modificá-la.
A depressão e a ansiedade dificultam os afazeres diários das pessoas acometidas, incluindo a pré-disposição ao lazer, afetando diretamente o setor de turismo. Buscando pesquisar esta evidência, o presente artigo tem por objetivo avaliar se a ansiedade e a depressão interferem na prática do turismo, tanto no período pandêmico como após. Para tanto realizou-se uma survey no sul do Brasil, por meio da técnica de bola de neve, oriunda da rede de contatos on-line da pesquisadora. A amostra contou com a participação de 340 indivíduos que responderam o questionário on-line no período da Covid-19. Os resultados indicaram que durante a pandemia, apenas a ansiedade afeta no interesse em viajar. Após a pandemia; tanto a ansiedade como a depressão, demonstrou influência no interesse pela viajem a turismo. Conclui-se assim, que de fato, a ansiedade e a depressão ocasionam malefícios para a saúde e o bem-estar das pessoas.
Resumo Este artigo pretende destacar aspectos negligenciados dentro do curso de medicina, concernentes à necessidade de um olhar atento para as demandas que se associam à saúde mental dos estudantes. A partir de uma revisão sistemática, propõe-se refletir e orientar discussões sobre a construção da medicina enquanto profissão, ciência e responsável pelo bem-estar dos indivíduos, inclusive dos médicos ainda em formação. O trabalho selecionou 19 artigos, entre 2014 e 2020, que respeitaram os critérios de elegibilidade, enquadrando-se na busca pela correlação entre o curso médico e a precarização psíquica. Assim, propõe-se uma discussão sobre os processos estressores e desencadeadores de sintomas de depressão, ansiedade e outros transtornos. Foi possível concluir que a medicina se configura como uma graduação recheada de peculiaridades com relação ao seu funcionamento e, por isso, precisa ser vista sob a ótica dessa multiplicidade, entendendo os prejuízos causados pelas pressões pessoais e sociais sobre o ser e saber médico. Fica evidente que pensar a saúde mental dos estudantes propicia um campo de manejo mais efetivo no que tange ao olhar sobre o outro que padece e que necessita de cuidados.
Introdução: No decorrer dos anos, a expressiva mudança em todos os níveis da sociedade passou a obrigar o ser humano a ter a capacidade de adaptação física, mental e social, e, consequentemente, os estudantes de graduação vivenciam esse cotidiano diariamente, tornando-se vulneráveis a diversos fatores estressores, podendo assim, desencadear desequilíbrios na sua saúde mental. Objetivo: O ingresso á universidade pode apresentar uma situação ameaçadora, visto que é uma fase adaptativa em que o jovem adulto terá mais responsabilidades, podendo se tornar mais ansioso e depressivo. Em vista disso, objetivo deste estudo é discutir os fatores estressores que acometem muitos estudantes da graduação, e, a partir disso, propor medidas preventivas. Metodologia: Trata-se de um estudo realizado através de pesquisa documental por meio de Revisão Integrativa de Literatura, considerando como fonte artigos científicos que atestam a proposta desta pesquisa. Como critérios de inclusão, foram selecionadas publicações no idioma em português e inglês, com textos na íntegra e acessível gratuitamente nas bases de dados, no período de 2012 a 2018. Os critérios de exclusão foram textos indisponíveis, duplicados nas bases de dados e que não atendiam o objetivo do presente estudo. Resultados e discussão: Após leituras e releituras dos artigos e com base nas análises dos pesquisadores investigados, foi possível elencar dados numéricos positivos que revelam o sofrimento emocional dos graduandos da saúde. As principais evidências encontradas foram o uso de questionários próprios de saúde mental, os quais norteavam e davam ênfase nas resoluções dos artigos. Conclusão: Analisando as evidências podemos constatara vulnerabilidade e fatores estressores que desenvolve inúmeros desequilíbrios psíquicos emocionais nos estudantes universitários, podendo se aplicar a medidas estratégicas que previnam doenças e promovam a saúde mental desses estudantes.
Introdução. O impacto da pandemia de COVID-19 na Saúde Mental tem vindo a ser reconhecido e destacado. Para ultrapassar as dificuldades no acesso aos cuidados da saúde durante este período têm surgido algumas estratégias, tais como a criação de Linhas de Apoio Psicológico e esta abordagem foi, assim, adotada pelo Serviço de Psiquiatria e Saúde Mental do Centro Hospitalar Vila Nova de Gaia/Espinho. O objetivo deste estudo é a caracterização sociodemográfica dos pacientes que acederam à Linha, a análise das patologias mais prevalentes e a reflexão sobre a importância da sua utilização em pacientes já acompanhados previamente por Psiquiatria. Material e Métodos. Foram registrados dados relativos a variáveis sociodemográficas e clínicas dos pacientes que recorreram à Linha e realizada uma análise estatística quantitativa e descritiva. Resultados. Dentre os 100 contatos realizados, 29% foram relativos ao agravamento de sintomatologia ansiosa e depressiva e 18% a alterações comportamentais decorrentes de exacerbação de sintomas psicóticos, havendo registos também de dúvidas relacionadas à prescrição e gestão de psicofármacos. A maioria das situações foram geridas telefonicamente com medidas psicoeducativas, 39% com recurso a ajustes terapêuticos minor e uma reduzida percentagem foi orientada para avaliação presencial. Conclusão. Os dados obtidos encontram-se de acordo com o reportado na literatura que demonstra que a sintomatologia ansiosa e depressiva são as mais prevalentes no contexto desta pandemia. É essencial que sejam dinamizadas mais estratégias por profissionais de saúde com experiência clínica e em articulação com os cuidados de saúde nos períodos de crise e que sejam realizados mais estudos para compreender de que forma este auxílio pode ser otimizado.
O curso de medicina tem sido apontado como fator de risco para o desenvolvimento de sintomas depressivos e ansiosos nos estudantes. O objetivo foi estimar a prevalência de sintomas depressivos e ansiosos em acadêmicos de medicina em uma universidade pública. Trata-se de um estudo descritivo, realizado com estudantes de uma universidade pública. Foram utilizados questionário sociodemográfico, Inventário de Depressão de Beck e Inventário de Ansiedade de Beck. Participaram 33 estudantes com idade entre 20 e 25 anos de idade, maioria do sexo feminino, solteiros e que não moram com a família. A maioria participa de alguma atividade de lazer. A prevalência de sintomas depressivos foi de 27,3% e de ansiedade foi de 54,48%. Encontramos maior relação de sintomas de depressão e ansiedade no sexo feminino, nos que moram longe da família e usam a internet/redes sociais. Tocar instrumentos musicais, praticar atividade física, leitura extracurricular, ir ao cinema foram apontados como fatores de proteção. Esse estudo mostrou que sintomas de depressão e ansiedade são comuns nos estudantes de medicina e os fatores de proteção e de risco precisam ser considerados durante a graduação.
Resumo: No Ensino Superior as rotinas estressantes muitas vezes contribuem para o desenvolvimento de transtorno de ansiedade ou para agravamento de quadros pré-existentes. Esse estudo teve como objetivo realizar uma revisão sistemática da literatura em periódicos nacionais de 2005 a 2019 sobre transtorno de ansiedade em estudantes universitários. Os artigos foram pesquisados nas seguintes bases de dados: Google Acadêmico, SciELO, LILACS e Pepsic. Utilizou-se o critério de inclusão apenas de periódicos com a temática ansiedade em universitários e a partir da análise dos resumos foram obtidos 37 artigos. Desta forma, foram excluídos os artigos que não se adequavam ao critério adotado. Os resultados conduziram a estudos de caracterização (13), intervenção (13), prevalência (5), relato de experiência (2) e construção de instrumento (1). As publicações sobre caracterização e intervenção foram as que apresentaram maior incidência pelo fato de determinar e ter ferramentas e mesmo estratégias para melhor intervir no próprio contexto estudantil. O estudo vem a contribuir com a prática de novas pesquisas sobre o tema e amplia o conhecimento sobre os fatores que implicam nos transtornos de ansiedade em estudantes do Ensino Superior. Uma das limitações do estudo foi não ter incluído outras fontes de dados como livros, dissertações e teses.Palavras-chave: estudante universitário; transtorno de ansiedade; revisão sistemáticaAbstract: In Higher Education, stressful routines often contribute to the development of anxiety disorder or getting worse pre-existing conditions. This study aimed to conduct a systematic review of the literature in national journals from 2005 to 2019 on anxiety disorder in university students. The articles were searched in the following databases: Google Scholar, SciELO, LILACS and Pepsic. The inclusion criterion was used only for journals with the theme anxiety in university students and from the analysis of abstracts 37 articles were obtained. Thus, articles that did not fit the adopted criterion were excluded. The results led to characterization studies (13), intervention (13), prevalence (5), experience report (2) and instrument construction (1). The publications on characterization and intervention were those with the highest incidence due to the fact of determining and having tools and even strategies to better intervene in the student context itself. The study contributes to the practice of new research on thetopic and expands knowledge about the factors that imply anxiety disorders in higher education students. One of the limitations of the study was that it did not include other data sources such as books, dissertations and theses.Keywords:university student; anxiety disorder; systematic review
No Ensino Superior as rotinas estressantes muitas vezes contribuem para o desenvolvimento de transtorno de ansiedade ou para agravamento de quadros pré-existentes. Esse estudo teve como objetivo realizar uma revisão sistemática da literatura em periódicos nacionais de 2005 a 2019 sobre transtorno de ansiedade em estudantes universitários. Os artigos foram pesquisados nas seguintes bases de dados: Google Acadêmico, SciELO, LILACS e Pepsic. Utilizou-se o critério de inclusão apenas de periódicos com a temática ansiedade em universitários e a partir da análise dos resumos foram obtidos 37 artigos. Desta forma, foram excluídos os artigos que não se adequavam ao critério adotado. Os resultados conduziram a estudos de caracterização (13), intervenção (13), prevalência (5), relato de experiência (2) e construção de instrumento (1). As publicações sobre caracterização e intervenção foram as que apresentaram maior incidência pelo fato de determinar e ter ferramentas e mesmo estratégias para melhor intervir no próprio contexto estudantil. O estudo vem a contribuir com a prática de novas pesquisas sobre o tema e amplia o conhecimento sobre os fatores que implicam nos transtornos de ansiedade em estudantes do Ensino Superior. Uma das limitações do estudo foi não ter incluído outras fontes de dados como livros, dissertações e teses.
Altos níveis de ansiedade são considerados um fenômeno que, infelizmente, está presente na vida de muitas pessoas. Estes elevados índices de ansiedade podem causar distúrbios tais como a compulsão alimentar e a obesidade. Este estudo tem como objetivo verificar se a ansiedade influencia na compulsão alimentar e na obesidade de alunos da Universidade Federal do Pampa (Campus Dom Pedrito). Usando um conjunto de dados coletados por um survey com 373 acadêmicos da universidade UNIPAMPA. Uma abordagem de regressão é empregada para estudar o impacto das variáveis latentes associadas à compulsão alimentar e a obesidade. Os resultados indicam que a ansiedade pode ter influência na compulsão alimentar. Por outro lado, observou-se que a ansiedade não provoca a obesidade. Os resultados mostram que a compulsão alimentar influencia na obesidade. Além disso, presupõe-se que a compulsão alimentar pode ser uma variável mediadora na relação entre a ansiedade e a obesidade.
Objetivos: verificar sintomas de depressão entre os estudantes do curso de enfermagem em
uma universidade privada. Métodos: trata-se de um estudo transversal de caráter descritivo,
com abordagem quantitativa. Amostra constituída por 79 estudantes do Curso de
Bacharelado em Enfermagem. Foram aplicados o questionário sociodemográfico e o
questionário Hospital Anxiety and Depression Scale (HADS). Foram respeitados os princípios
éticos expressos na Resolução nº 510/2016. Resultados: a análise dos resultados demonstrou
que os sintomas depressivos estacam presentes em 45,56% da amostra. Conclusão: os
resultados contribuem para análise da saúde mental dos acadêmicos do curso de
enfermagem, e a necessidade da promoção do bem-estar psicológico destes estudantes.
Introduction:
In recent years, the quality of life of medical students has been questioned, given the context in which they are inserted. Stress as a result of the number of long hours, difficulty in reconciling academic and personal life, exposure to situations of pain and suffering, have been shown to be the main factors for the decrease in quality of life of these students. The aim of this study was to assess the quality of life of medical students and its associated factors.
Method:
Cross-sectional study with 419 medical students from a public institution in Goiás. The study was carried out with students over 18 years old and enrolled in the second to the eighth semester of medical school, between 2017 and 2018. Sociodemographic and lifestyle questionnaires and the World Health Organization Questionnaire for Quality of Life - Brief Form (WHOQOL-BREF) were used.
Results:
The factors related to low quality of life were: female gender, the use of stimulants, thinking about giving up medical school and having comorbidities. Those related to a better quality of life were consuming fruits and vegetables, practicing physical activity, more sleeping time and stress management.
Conclusion:
This study found a set of factors capable of interfering with the quality of life of these students, suggesting the need for interventions aimed at pedagogical and psychological support.
Introdução:
Nos últimos anos, tem-se questionado sobre a qualidade de vida dos estudantes de Medicina dado o contexto em que estão inseridos. O estresse como resultado do somatório de carga horária extensa, dificuldade de conciliar a vida acadêmica com a pessoal e exposição a situações de dor e sofrimento tem-se mostrado como o principal fator para a queda da qualidade de vida desses acadêmicos. O objetivo deste estudo foi avaliar a qualidade de vida de acadêmicos de Medicina e seus fatores associados.
Método:
Trata-se de um estudo transversal realizado com 419 acadêmicos do curso de Medicina de uma fundação pública de Goiás. Foram incluídos alunos a partir de 18 anos e matriculados no curso do segundo ao oitavo período, de 2017 a 2018. Utilizaram-se os questionários sociodemográfico e de hábitos de vida e o World Health Organization Questionnaire for Quality of Life - Brief Form (WHOQOL-bref).
Resultados:
Os fatores relacionados com a baixa qualidade de vida foram: sexo feminino, utilizar estimulantes, pensar em desistir do curso e possuir comorbidade. Os relacionados com melhor qualidade de vida foram consumir frutas e hortaliças, praticar atividade física, mais tempo de sono e gestão do estresse.
Conclusão:
Este estudo encontrou um conjunto de fatores capazes de interferir na qualidade de vida desses estudantes, sugerindo a necessidade de intervenções direcionadas ao apoio pedagógico e psicológico.
O estresse é resultado da relação entre o indivíduo e seu ambiente produtivo interferindo na capacidade profissional e na qualidade de vida. O presente estudo objetivou analisar o impacto do estresse na qualidade de vida e condutas de saúde de residentes multiprofissionais de um hospital universitário. Trata-se de um estudo transversal, quantitativo, realizado junto a totalidade de residentes multiprofissionais em saúde (RMS) (n=98) de um hospital de ensino. Utilizou-se questionários validados: WHOQOL-BREF, avaliando-se a qualidade de vida; National College Health Risk Behavior Survey, para avaliar condutas de saúde e o ‘Inventário de Sintomas de Stress para Adultos de Lipp’ para avaliação do estresse. Aplicou-se testes t de student, qui-quadrado e exato de Fisher, obtendo-se que a maioria (n=63; 64%) dos RMS não apresentou nenhum sinal de estresse e 46% (n=35) algum nível de estresse, sendo 85% na fase resistência. Verificou-se que os RMS com estresse apresentaram QV significativamente menor nos domínios físico, psicológico meio ambiente e QV global (p0,05). Às condutas de saúde, houve associação de estresse apenas com tentativa de suicídio (p=0,0005), as demais condutas: uso do tabaco, comportamento alimentar, prática de atividade física, uso do álcool e outras drogas, comportamento sexual, segurança no trânsito e comportamentos relacionados à violência, não apresentaram associação (p0,05). Conclui-se que a queda na qualidade de vida dos RMS com estresse é preocupante, e mesmo com poucas mudanças de condutas de saúde com a exposição ao estresse entre os investigados, defende-se a relevância e a gravidade do achado em relação à variável tentativa de suicídio.
Depression is one of the most common mental illnesses in the world. It is estimated that there are 350 million people worldwide who have some form of depression. In the United States, 16 million people had a depressive episode in the past year. A condition affecting one’s mood and action, depression can affect one’s life substantially. According to the most recent World Health Organization, depression is the leading cause of disability worldwide and is believed to be a major contributor to the overall global burden of disease.
The purpose of this case study was to systematically review yoga interventions aimed at improving depressive symptoms. The duration of the intervention period varied greatly, with the majority being 30 days or longer. Despite the limitations, it can be concluded that the yoga interventions with acupressure, proper diet and natural remedies were effective in reducing depression.
Objetivo: Analisar as habilidades sociais, os níveis de estresse e de sonolência diurna em estudantes de Medicina em diferentes momentos da graduação. Métodos: trata-se de uma investigação do tipo descritiva transversal quantitativa, sendo a amostra não probabilística, discentes de todos períodos letivos da Faculdade de Medicina da Universidade de Rio Verde, Rio Verde, Goiás, Brasil. Os dados coletados foram idade, sexo, período letivo, além três questionários validados na literatura com os instrumentos: Inventario de Habilidades Sociais de Del Prette e Del Prette, Inventários de Estresse Percepcionado e Escala de Sonolência Diurna de Epworth. Os dados foram analisados no programa SPSS, versão 22.0, sendo submetidos a que verificou-se distribuição normal, utilizando demais testes paramétricos. Também realizou-se análise estatística descritiva, correlacionando os instrumentos. Por fim, foi verificado a confiabilidade interna do instrumento. Resultados: Existe um número significativo de estudantes de Medicina com um péssimo desempenho em habilidades sociais (59,2%), sendo estes associados a escores patológicos de sonolência diurna e altos níveis de estresse em mais da metade da população estudada, piorando com decorrer do curso. Conclusão: O desenvolvimento das habilidades sociais durante a graduação garante o aprimoramento das relações pessoais e profissionais, contribuindo para a formação integral do médico e uma prática médica mais competente e humana.
The demands placed on medical trainees pose a challenge to personal wellbeing, leading to burnout and erosion of empathy. However, it is unclear at what point in medical education this decline begins. Although many schools have begun to design and implement wellness programs for their students, the medical education community's experience in evaluating their impact is limited.
The authors designed a wellness needs assessment of all medical students at the Albert Einstein College of Medicine in order to assess students' health behaviors, stress and depressive symptoms. The online survey was administered to all medical students from the classes of 2014 and 2015 at the beginning of their first year of medical school and again at the end of their third year. Chi-square and T-tests were run comparing the survey responses of the two classes.
There was a significant increase in perceived stress from an average of 5.51 in the first year to 6.49 in the third year (p = .0001). The number of students at risk for depression, defined as a CES-D score greater than 16, was 94 (28.4 %) in the first year and 131 (39.0 %) in their third year (p = .004).
This study demonstrates a significant increase in the proportion of students at risk for depression in their third year as compared to the first year as well as an increase in perceived stress. In response to these findings, the authors took a multi-disciplinary approach in the development of a comprehensive program to address student wellness, including efforts to address issues specific to the clinical clerkships. This program is unique in that its design, inception and ongoing evaluation have taken the needs of an entire medical school class into account.
The stigma of obesity is a common and overt social bias. Negative attitudes and derogatory humor about overweight/obese individuals are commonplace among health care providers and medical students. As such, medical school may be particularly threatening for students who are overweight or obese.
The purpose of our study was to assess the frequency that obese/overweight students report being stigmatized, the degree to which stigma is internalized, and the impact of these factors on their well-being.
We performed cross-sectional analysis of data from the Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES) survey.
A total of 4,687 first-year medical students (1,146 overweight/obese) from a stratified random sample of 49 medical schools participated in the study.
Implicit and explicit self-stigma were measured with the Implicit Association Test and Anti-Fat Attitudes Questionnaire. Overall health, anxiety, depression, fatigue, self-esteem, sense of mastery, social support, loneliness, and use of alcohol/drugs to cope with stress were measured using previously validated scales.
Among obese and overweight students, perceived stigma was associated with each measured component of well-being, including anxiety (beta coefficient [b] = 0.18; standard error [SE] = 0.03; p < 0.001) and depression (b = 0.20; SE = 0.03; p < 0.001). Among the subscales of the explicit self-stigma measure, dislike of obese people was associated with several factors, including depression (b = 0.07; SE = 0.01; p < 0.001), a lower sense of mastery (b = -0.10; SE = 0.02; p < 0.001), and greater likelihood of using drugs or alcohol to cope with stress (b = 0.05; SE = 0.01; p < 0.001). Fear of becoming fat was associated with each measured component of well-being, including lower body esteem (b = -0.25; SE = 0.01; p < 0.001) and less social support (b = -0.06; SE = 0.01; p < 0.001). Implicit self-stigma was not consistently associated with well-being factors. Compared to normal-weight/underweight peers, overweight/obese medical students had worse overall health (b = -0.33; SE = 0.03; p < 0.001) and body esteem (b = -0.70; SE = 0.02; p < 0.001), and overweight/obese female students reported less social support (b = -0.12; SE = 0.03; p < 0.001) and more loneliness (b = 0.22; SE = 0.04; p < 0.001).
Perceived and internalized weight stigma may contribute to worse well-being among overweight/obese medical students.
Clinical works at the intersection of 'spirituality, religion, theology and medicine' are studied to identify various aspects of what constitutes spirituality, what contributes to spiritual health and how to provide spiritual-healers for our current health-care system.
Spiritual care in the current medical world can be classed grossly into two departments: complementary and alternative medicine, considered as proxy variable for spirituality, and physician-initiated clinical Chaplaincy, informed by theology. The large body of research on 'self' as a therapeutic tool, though, falls into subtle categories: phenomenological studies, empathy, embodied care, and mindfulness-based therapies. Development in the field of 'spiritual medicine' has focused on spirituality-related curricula.
As mindfulness-based meditation programs help build deep listening skills needed to stay aware of the 'self', Clinical Pastoral Education trains the chaplain to transcend the 'self' to provide embodied care. Clinical chaplaincy is the destination for health-care professionals as well as theological/religious scholars who have patients' spiritual health as their primary focus. Medical education curricula that train students in chaplain's model of transpersonal-mindfulness/empathy founded on neuro-physiological principles would help them gain skills in embodied care. Such education would seamlessly integrate evidence-based clinical practice and spiritual-theological concepts.
Resilience is a capacity to face and overcome adversities, with personal transformation and growth. In medical education, it is critical to understand the determinants of a positive, developmental reaction in the face of stressful, emotionally demanding situations. We studied the association among resilience, quality of life (QoL) and educational environment perceptions in medical students.
We evaluated data from a random sample of 1,350 medical students from 22 Brazilian medical schools. Information from participants included the Wagnild and Young's resilience scale (RS-14), the Dundee Ready Educational Environment Measure (DREEM), the World Health Organization Quality of Life questionnaire - short form (WHOQOL-BREF), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI).
Full multiple linear regression models were adjusted for sex, age, year of medical course, presence of a BDI score ≥ 14 and STAI state or anxiety scores ≥ 50. Compared to those with very high resilience levels, individuals with very low resilience had worse QoL, measured by overall (β=-0.89; 95% confidence interval =-1.21 to -0.56) and medical-school related (β=-0.85; 95%CI=-1.25 to -0.45) QoL scores, environment (β=-6.48; 95%CI=-10.01 to -2.95), psychological (β=-22.89; 95%CI=-25.70 to -20.07), social relationships (β=-14.28; 95%CI=-19.07 to -9.49), and physical health (β=-10.74; 95%CI=-14.07 to -7.42) WHOQOL-BREF domain scores. They also had a worse educational environment perception, measured by global DREEM score (β=-31.42; 95%CI=-37.86 to -24.98), learning (β=-7.32; 95%CI=-9.23 to -5.41), teachers (β=-5.37; 95%CI=-7.16 to -3.58), academic self-perception (β=-7.33; 95%CI=-8.53 to -6.12), atmosphere (β=-8.29; 95%CI=-10.13 to -6.44) and social self-perception (β=-3.12; 95%CI=-4.11 to -2.12) DREEM domain scores. We also observed a dose-response pattern across resilience level groups for most measurements.
Medical students with higher resilience levels had a better quality of life and a better perception of educational environment. Developing resilience may become an important strategy to minimize emotional distress and enhance medical training.
Undergraduate medical students have been the most distressed group among the student population. Depression and anxiety have been found to be more prevalent in this group of students compared to others.
This study was conducted to determine the prevalence and predictors of suicidality among undergraduate medical students in a public university.
This was an analytical cross-sectional study, conducted in a public university in Selangor, Malaysia. Data were collected using self-administered questionnaires from January to February 2013, and analysed using the Statistical Package for Social Sciences Software (version 21).
Out of 625 undergraduate medical students, 537 (85.9%) participated in the study. The prevalence of the suicidality among undergraduate medical students was 7.0%. The significant predictors of suicidality based on multiple logistic regression were the respondent's lifetime suicide attempts (Adjusted Odds Ratio, AOR 10.4, 95% CI 2.7 to 40.9); depression (AOR 5.9, 95% CI 1.5 to 23.0); breaking off a steady love relationship (AOR 5.4, 95% CI 1.3 to 22.4); hopelessness (AOR 4.9, 95% CI 1.1 to 21.6); and something valued being lost or stolen (AOR 4.4, 95% CI 1.2 to 15.9).
These findings indicate that mental health care services should be strengthened at university level. The results show a need for an intervention programme to reduce suicidality among the undergraduate medical students.
Background
Past research suggests that medical students experience high levels of psychological distress.
Objective
The aim of the current study was to investigate the relationships among engagement in self-care behaviours, dispositional mindfulness, and psychological distress.
Methods
The sample consisted of 139 female and 68 male Australian medical students (N=207) aged 17–41 years (M=21.82, SD=3.62) across the 5 years of the Monash University medical course. Participants completed an online survey comprising a demographics questionnaire, the Five Facet Mindfulness Questionnaire, the Health-Promoting Lifestyle Profile II, and the Depression, Anxiety, and Stress Scales.
Results
Results revealed significant and interpretable multivariate correlations between distress and both mindfulness and self-care. Furthermore, the dispositional mindfulness observation subscale was found to be a significant moderator of the relationship between several dimensions of self-care and psychological distress.
Conclusions
The present study points to the potential of self-care and mindfulness to decrease medical student distress and enhance well-being.
This study was designed to estimate the prevalence of depression and the factors that influence it in Korean medical students.
We evaluated depression in 122 first- and second-year medical students in December 2011 using the Korean Beck Depression Inventory (K-BDI). Sixteen potential factors were considered: gender, class year, grade point average, breakfast habits, residence type, leisure activity, sleep satisfaction, relationship status, a close friend or a significant other, finances, present health status, history of mood disorders, family history of mood disorders, religion, and self-esteem.
The average BDI score was 8.9. There were 80 (65.6%), 16 (13.1%), 15 (12.3%), and 11 (9.0%) students with minimal, mild, moderate, and severe depression, respectively. The group with depressive symptoms comprised males with a total BDI score > or =24 and females with total BDI > or =25 and constituted 9.0% of students. Students in the depressive symptom group had lower self-esteem and lower grade point averages and were more frequently ill, less likely to be in a relationship, and more likely to have a history of mood disorders (p<0.05 for all). In particular, low self-esteem score was an independent factor.
The BDI scores in our study were similar to those that have been reported in other countries but slightly higher than in other Korean medical and university students. Self-esteem, grade point average, health status, history of mood disorders, family history of mood disorders, and presence of a significant other correlated significantly with depression in medical students.
Introduction: depression, besides causing great psychological distress, may lead to poor academic performance and social relationships. Objective: to examine the prevalence of depressive symptoms in medical students from a northeastern region of Brazil. Methods: the population comprised 1024 students from first to twelfth semesters of two medical schools in Cariri, Ceará, Brazil. We used the questionnaire on sociodemographic characteristics and the Beck Depression Inventory II version. Results: the prevalence in this population for the diagnosis of depression was 28.8%.652 (63.7%) complied with all protocols to stay in research. After logistic regression, had a negative impact on studentsmental health: female Odds Ratio adjusted (ORa) (95% CI): 1.83 (1.19 to 2.82), reasonable physical health ORa (95% CI): 3.15 (2 0.09 to 4, 73), uncertainty about professional future ORa (95% CI): 2.97 (1.65 to 5.34), desire to change course ORa (95% CI): 2.51 (1.63 to 3.86), good social relationship but without participation in social activities ORa (95% CI): 1.96 (1.27 to 3.04), relationship difficulties ORa (95% CI): 11.40 (4.32 to 30.14) and rare leisure activities (95% CI): 2.45 (1.49 to 4.04) or eventual leisure activities ORa (95% CI): 3.04 (1.70 to 5.42). Conclusion: there was a high prevalence of depression among medical students in this region. Female, reasonable physical health, uncertainty over future career, desire to change course, do not participate in social activities and / or difficulties in relationships, sporadic or rare leisure activity were associated with increased risk of developing depressive symptoms.: Interventions are vital in the field of Public Health to take care of the professionals who look after the population. Medical students with a high prevalence of depression have difficulty caring for people both during and after their graduation when exercising their function as doctors.
Objectives:
This study aimed to assess prevalence rate of depression and perceptions regarding stigma associated with depression amongst medical students.
Materials and Methods:
A cross-sectional survey was conducted amongst 331 undergraduate medical students at a private medical college in Gujarat. Data was collected, which comprised of socio-demographic details, Patient Health Questionnaire (PHQ-9), and a 22-item semi-structured questionnaire to assess personal, perceived, and help-seeking stigma. Univariate analysis and chi-square tests were used to test for association between variables.
Results:
Overall prevalence of depression was found to be 64%. Highest level of depression was seen in first year. Moderate to severe depression was found in 26.6% students. 73.3% students felt that having depression would negatively affect their education, and 52.3% saw depression as a sign of personal weakness. Females more strongly believed that students would not want to work with a depressed student (50.9% v/s 36.2%) and that if depressed, they would be unable to complete medical college responsibilities (61.9% v/s 44.1%). With increasing academic year, there was increase in stigma about disclosing depression to friends (P = 0.0082) and increase in stigma about working with a depressed student (P = 0.0067). Depressed students felt more strongly than non-depressed students on 10 items of the stigma questionnaire.
Conclusions:
High stigma exists among students about the causation of depression, and there exists an environment in which students discriminate fellow colleagues based on the presence of depression. This raises need for increasing awareness and support from peers and faculty.
Introduction:
High prevalence of depression and anxiety symptoms has been observed in medical students.
Objective:
To identify predictors of depressive symptoms according to CES-D in students during their first year of medical education.
Methods:
We evaluated 517 students in their first year of medical education with the following instruments: Centers for Epidemiology Studies for Depression Scale, State-Trait anxiety inventory, and stressors list. A linear regression analysis was carried out to evaluate variables predicting high CES-D scores.
Results:
We observed that anxiety and depressive symptoms were more frequent in women, as well as stressors. Predictors of depression were state of anxiety, stressors, and low socioeconomic level.
Conclusions:
It is important to implement support measures for students who live with stress factors, suffering anxiety, or with a low socioeconomic level.
A formação médica atual encontra-se estruturada a partir de um modelo tecnocientífico. No entanto, na contemporaneidade surgem propostas orientadas por um projeto ético-humanista que tensionam esse modelo com vistas a sua transformação. Neste ensaio, considera-se o Sistema Único de Saúde (SUS) como superfície de emergência de novas demandas que alavancam as transformações requeridas na educação médica brasileira. A proposta estabelecida pelas Diretrizes Curriculares do Ensino Médico de 2001 sugere a inserção precoce do aluno em cenários diversificados de ensino-aprendizagem e enfatiza o papel desempenhado pela atenção básica nesse processo. Entende-se que a instituição de novos cenários de prática, a valorização das dimensões psicossocial e antropológica do adoecer e a incorporação de tecnologias relacionais na formação médica possibilitam uma reorientação do olhar sobre os aspectos subjetivos do adoecimento, permitindo uma compreensão ampliada do processo saúde-doença. Considerando que inovações no processo de trabalho possibilitam mudanças na prática clínica e na produção da atenção à saúde, questiona-se a possibilidade de emergência de um novo estilo de pensamento médico.
OBJECTIVE: The aim of this study is to determine and compare the prevalence of depression and the suicide risk among the students from Minas Gerais Medical Science College (FCMMG), a private institution that offers medicine, physical therapy and occupational therapy courses. METHODS: 342 students were selected according to a random sample by quota. The psychiatric diagnosis was taken by using the Mini International Neuropsychiatric Interview (MINI). The rates of the prevalence of depression and suicide risk were esteemed according to the course, gender and length in the course. For comparison, it was used the qui-square test (chi2) or the exact Fishers test, with a significance level of 5% (p
O presente estudo é parte da pesquisa de doutorado que teve por objetivo estimar a prevalência de Transtornos Mentais Menores (TMM) na população de estudantes universitários dos cursos de Ciência da Computação, Direito, Letras e Enfermagem, da Universidade Estadual de Mato Grosso do Sul e do curso de Enfermagem da Universidade Federal de Mato Grosso do Sul, como também verificar a associação de algumas variáveis sociais e acadêmicas com os TMM. O estudo incluiu todos os estudantes dos referidos cursos, matriculados no primeiro semestre de 2002, e foi do tipo corte transversal. A pesquisa contou com uma amostra de 558 sujeitos, sendo 396 (71%) do sexo feminino e 161 (29%) do sexo masculino. Para coleta dos dados utilizaram-se dois questionários auto-aplicáveis: QSG-60 e QDSD. Constatou-se uma prevalência de 25% de TMM entre os estudantes, destacando-se, como transtorno principal, os distúrbios psicossomáticos.
Context: Although numerous studies have examined the role of latent variables in the structure of comorbidity among mental disorders, none has examined their role in the development of comorbidity. Objective: To study the role of latent variables in the development of comorbidity among 18 lifetime DSM-IV disorders in the World Health Organization World Mental Health Surveys. Design: Nationally or regionally representative community surveys. Setting: Fourteen countries. Participants: A total of 21 229 survey respondents. Main Outcome Measures: First onset of 18 lifetime DSM-IV anxiety, mood, behavior, and substance disorders assessed retrospectively in the World Health Organization Composite International Diagnostic Interview. Results: Separate internalizing (anxiety and mood disorders) and externalizing (behavior and substance disorders) factors were found in exploratory factor analysis of lifetime disorders. Consistently significant positive time-lagged associations were found in survival analyses for virtually all temporally primary lifetime disorders predicting subsequent onset of other disorders. Within-domain (ie, internalizing or externalizing) associations were generally stronger than between-domain associations. Most time-lagged associations were explained by a model that assumed the existence of mediating latent internalizing and externalizing variables. Specific phobia and obsessive-compulsive disorder (internalizing) and hyperactivity and oppositional defiant disorders (externalizing) were the most important predictors. A small number of residual associations remained significant after controlling the latent variables. Conclusions: The good fit of the latent variable model suggests that common causal pathways account for most of the comorbidity among the disorders considered herein. These common pathways should be the focus of future research on the development of comorbidity, although several important pairwise associations that cannot be accounted for by latent variables also exist that warrant further focused study
Background:
Medical school attrition is important--securing a place in medical school is difficult and a high attrition rate can affect the academic reputation of a medical school and staff morale. More important, however, are the personal consequences of dropout for the student. The aims of our study were to examine factors associated with attrition over a ten-year period (2001-2011) and to study the personal effects of dropout on individual students.
Methods:
The study included quantitative analysis of completed cohorts and qualitative analysis of ten-year data. Data were collected from individual student files, examination and admission records, exit interviews and staff interviews. Statistical analysis was carried out on five successive completed cohorts. Qualitative data from student files was transcribed and independently analysed by three authors. Data was coded and categorized and key themes were identified.
Results:
Overall attrition rate was 5.7% (45/779) in 6 completed cohorts when students who transferred to other medical courses were excluded. Students from Kuwait and United Arab Emirates had the highest dropout rate (RR = 5.70, 95% Confidence Intervals 2.65 to 12.27;p < 0.0001) compared to Irish and EU students combined. North American students had a higher dropout rate than Irish and EU students; RR = 2.68 (1.09 to 6.58;p = 0.027) but this was not significant when transfers were excluded (RR = 1.32(0.38, 4.62);p = 0.75). Male students were more likely to dropout than females (RR 1.70, .93 to 3.11) but this was not significant (p = 0.079).Absenteeism was documented in 30% of students, academic difficulty in 55.7%, social isolation in 20%, and psychological morbidity in 40% (higher than other studies). Qualitative analysis revealed recurrent themes of isolation, failure, and despair. Student Welfare services were only accessed by one-third of dropout students.
Conclusions:
While dropout is often multifactorial, certain red flag signals may alert us to risk of dropout including non-EU origin, academic struggling, absenteeism, social isolation, depression and leave of absence. Psychological morbidity amongst dropout students is high and Student Welfare services should be actively promoted. Absenteeism should prompt early intervention. Behind every dropout statistic lies a personal story. All medical schools have a duty of care to support students who leave the medical programme.
BACKGROUND: Rates of depression among medical students have been shown to be high and related to year of study and other factors. We report on cluster of symptoms related to depression and their association with other difficulties in specific domains. METHODS: 481 (Response rate=79.8%) medical students completed a questionnaire about areas of difficulty in the medical school (studies, leisure, colleagues, professors, and patients), and Beck Depression Inventory (BDI). We studied correlation among areas of difficulty and clusters of BDI along with year in the course. RESULTS: Two areas which contributed most difficulty were studies and leisure. The significant associations for studies were seen between somatic cluster of depressive symptoms and the level of the course. Difficulties associated with leisure activities and with colleagues were correlated with the affective cluster of symptoms of depression. Activities related to clinical matters especially working with patients in the internship year were associated with somatic clusters. The different associations confirmed that rather than relying on scores emphasis should be placed on clusters of symptoms. LIMITATIONS: Sample from a single medical school. CONCLUSIONS: Although the clusters are associated with specific difficulties, it is important that educators and health professionals are aware of streesors the medical students face. The correlations if confirmed in future studies with qualitative factors could guide the development of more specific therapeutic or curriculum interventions.
Depression among medical students is an area of increasing concern worldwide. This study aimed to assess the prevalence of depression and its associated factors among medical students.
A stratified random sample of 400 students was assessed using Beck Depression Inventory by investigators. Associations between depression and class of studying, social factors like alcohol use, drug addiction, family problems, family history of depression, and staying away from home were analyzed by univariate analysis.
The overall prevalence of depression was found to be 71.25%. Among those with depression, a majority (80%) had mild and moderate degree of depression. The study showed that 46.3% (132) of the depressed were females and 53.7% (153) were males. According to cut-off scores, 115 students (29.8%) scored as normal (0-9), 111 (27.8%) as mild (10-18), 117 (29.3%) as moderate (19-29), 30 (7.5%) as severe (30-40), and 27 (6.7%) as very severe (>40) depression. The prevalence of depression was comparatively less among 1(st) and 2(nd) year medical students (57% and 50%, respectively) and the difference between the grade of depression and year of studying was found to be significant (χ(2)=122, P<0.001). The prevalence was significantly more among those with family problems and family history of depression.
Depression is highly prevalent among medical students in this area. Our findings point to the importance of broad screening and psychiatric counseling of this vulnerable population.
To determine the prevalence of depression among male and female medical students, its change over time and whether depression persists for affected students.
Longitudinal study comprising annual questionnaire surveys which included the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D).
Between 2007 and 2010 all 1112 students entering the Core Science component (Year 1) and all 542 students entering the Clinical component (Year 4) of the Cambridge (UK) medical course were followed-up annually.
We analysed, separately for men and women, mean HADS-D scores, the proportions whose scores indicated depression at different time-points and for students maintaining participation, the number of occasions on which their HADS-D scores indicated depression.
725 Core Science and 364 Clinical students participated. Mean HADS-D scores ranged between 3.34 and 3.49 among all Core Science students and between 2.16 and 2.91 among all Clinical students. There was no difference between men and women in median HADS-D scores. Prevalence of depression ranged between 5.7% and 10.6% among all Core Science students and between 2.7% and 8.2% among all Clinical students. Over time Core Science students displayed no increase in mean HADS-D score. Among Clinical students only men displayed a small increase (time coefficient 0.33 (95% CI 0.11 to 0.55)). Prevalence did not increase over time. 220 Core Science and 150 Clinical students participated throughout the study. Of these, 18.2% and 10.6%, respectively, recorded HADS-D scores indicating depression on at least one occasion. Of 56 students recording depression at some point, 37 did so only once.
Prevalence of depression among participants was similar to that reported for comparable groups. Among men approaching the end of clinical studies depression scores increased. In all years a minority of students displayed depression; for some this persisted. Mechanisms are needed to identify and support students suffering from depression, particularly when persistent.
How multiple forms of psychological distress coexist in individual medical students has not been formally studied.
To explore the prevalence of various forms of distress in medical students and their relationship to recent suicidal ideation or serious thoughts of dropping out of school.
All medical students at seven US schools were surveyed with standardized instruments to evaluate burnout, depression, stress, mental quality of life (QOL), physical QOL, and fatigue. Additional items explored recent suicidal ideation and serious thoughts of dropping out of medical school.
Nearly all (1846/2246, 82%) of medical students had at least one form of distress with 1066 (58%) having ≥3 forms of distress. A dose-response relationship was found between the number of manifestations of distress and recent suicidal ideation or serious thoughts of dropping out. For example, students with 2, 4, or 6 forms of distress were 5, 15, and 24 fold, respectively, more likely to have suicidal ideation than students with no forms of distress assessed. All forms of distress were independently associated with suicidal ideation or serious thoughts of dropping out on multivariable analysis.
Most medical students experience ≥1 manifestation of distress with many experiencing multiple forms of distress simultaneously. The more forms of distress experienced the greater the risk for suicidal ideation and thoughts of dropping out of medical school.
Establishing an evidence-based method of improving knowledge and attitudes concerning depression has been identified as a priority in Chinese medical education. The purpose of this study was to determine whether a self-directed learning strategy as a part of student-centred education improved knowledge of and attitudes towards depression among Chinese medical students.
A controlled trial in which 205 medical students were allocated to one of two groups: didactic teaching (DT) group or a combined didactic teaching and self-directed learning (DT/SDL) group. The DT/SDL group continued having a series of learning activities after both groups had a lecture on depression together. Student's knowledge and attitudes were assessed immediately after the activities, one month and six months later.
The intervention (DT/SDL) group showed substantially greater improvements in recognition of depression as a major health issue and identifying helpful treatments than the DT group. Only the DT/SDL group demonstrated any improvement in attitudes. This improvement was sustained over six months.
Self-directed learning is an effective education strategy in improving medical students' knowledge of and attitudes towards depression.
People with mental illness face stigma and discrimination in a variety of settings which can have an economic impact.
The aim of this paper was to identify literature on the economic impact of mental illness stigma.
A systematic review of the literature identified 30 papers from 27 studies by searching electronic databases and hand searching reference lists.
Mental illness stigma/discrimination was found to impact negatively on employment, income, public views about resource allocation and healthcare costs.
Stigma and discrimination regarding mental health problems lead to adverse economic effects for people with these conditions. Interventions that reduce stigma may therefore also be economically beneficial.
High levels of depression in junior doctors prompted this research into the prevalence of depression in medical students, compared with other non-medical university students. We also explored potential vulnerability factors that may be associated with student depression.
A comparative cross-sectional internet-based questionnaire design was used. This self-administered questionnaire, consisting of demographic details and questions about potential vulnerability factors, was disseminated to both medical and non-medical life-sciences students via their university e-mail accounts. The Patient Health Questionnaire 9 (PHQ-9), a self-completed depression-specific questionnaire, was included.
Non-medical students showed a higher prevalence of moderate and severe depressive symptoms than their medical student peers, although medical students reported more symptoms of mild depression. Multivariable logistic regression analysis indicated that belonging to an ethnic minority (p = 0.021), and having a personal (p < 0.001) or family history of depression (p < 0.001) were associated with a higher risk of depression. Having studied for a previous degree appeared to be protective against depression (p = 0.029). Around half (50% of medical and 54% of non-medical) students indicated that they would not feel able to consult their university tutors if depressed.
Significant levels of depression were reported by both medical and non-medical students. Potential vulnerability factors included: a personal or family history of depression, point of degree entry and belonging to an ethnic minority. The reluctance of students to consult their tutors about such problems highlights the potentially stigmatising nature of depression, and reinforces the need for higher education institutions to address these issues.
There is a concerning prevalence of depression and suicidal ideation among medical students, a group that may experience poor mental health care due to stigmatization.
To characterize the perceptions of depressed and nondepressed medical students regarding stigma associated with depression.
Cross-sectional Web-based survey conducted in September-November 2009 among all students enrolled at the University of Michigan Medical School (N = 769).
Prevalence of self-reported moderate to severe depression and suicidal ideation and the association of stigma perceptions with clinical and demographic variables.
Survey response rate was 65.7% (505 of 769). Prevalence of moderate to severe depression was 14.3% (95% confidence interval [CI], 11.3%-17.3%). Women were more likely than men to have moderate to severe depression (18.0% vs 9.0%; 95% CI for difference, -14.8% to -3.1%; P = .001). Third- and fourth-year students were more likely than first- and second-year students to report suicidal ideation (7.9% vs 1.4%; 95% CI for difference, 2.7%-10.3%; P = .001). Students with moderate to severe depression, compared with no to minimal depression, more frequently agreed that "if I were depressed, fellow medical students would respect my opinions less" (56.0% vs 23.7%; 95% CI for difference, 17.3%-47.3%; P < .001), and that faculty members would view them as being unable to handle their responsibilities (83.1% vs 55.1%; 95% CI for difference, 16.1%-39.8%; P < .001). Men agreed more commonly than women that depressed students could endanger patients (36.3% vs 20.1%; 95% CI for difference, 6.1%-26.3%; P = .002). First- and second-year students more frequently agreed than third- and fourth-year students that seeking help for depression would make them feel less intelligent (34.1% vs 22.9%; 95% CI for difference, 2.3%-20.1%; P < .01).
Depressed medical students more frequently endorsed several depression stigma attitudes than nondepressed students. Stigma perceptions also differed by sex and class year.
Depression is considered as one of the most important etiological academic failure in educational systems, that induced decrease social, professional and educational performance, therefore, recognize this problem is necessary for suppression educational failure in students and increase social position in the academic period and increase mental health in educational society. The aim of this study was determine prevalence depression in the medical students also the relationship with educational failure in the jahrom university medical science.Material and methodThis cross- sectional study was performed on all students (150), this study had two groups students; successful and unsuccessful students. A Beck questionnaire as well as a questionnaire for personal data especially those related to depression were used, the collected data was statistically analyzed using SPSS.Results45.5 percent students had mild to severe depression and there was relationship between depression and academic achievement (po/oo4), 75 percent successful students and 39.4 percent unsuccessful students had mild to moderate depression. There was no significant relationship between depression and sex, academic major, occupation and level of parental education.Conclusion
According to the findings, There are high prevalence sense of depression especially between unsuccessful students therefore, the follow up of mental health and personality and activation of mental consultaion centers is necessary.
The accomplished young man graduated medical school in May and, as a resident, quickly impressed his coworkers.
“He stood out among the doctors we have encountered because of his decisiveness, brilliance, kindness, and humility,” a nurse recalled. “Our patients always had great praises for him, because he really showed how caring he was.”
Medicimage/sciencesource.com
That apparently was not enough for the young physician. But no one will ever really know what was going through his mind, because he was 1 of 2 first-year residents who, only a few days apart in late August, jumped to their deaths from buildings in New York City. The nurse’s comment about him was one of many condolences posted online.
Purpose:
Many medical students experience distress during medical school. If matriculating medical students (MMSs) begin training with similar or better mental health than age-similar controls, this would support existing concerns about the negative impact of training on student well-being. The authors compared mental health indicators of MMSs versus those of a probability-based sample of the general U.S. population.
Method:
In 2012 all MMSs at six U.S. medical schools were invited to participate in a survey during orientation. The research team surveyed a probability-based sample of U.S. individuals using the same questions in 2011. Individuals from the population sample who completed a four-year college degree and matched within the appropriate age strata (< 30, 31-35, 36-40, > 40) were compared with MMSs. Surveys included demographics and validated instruments to measure burnout; depression symptoms; and mental, emotional, physical, and overall of quality of life (QOL).
Results:
Demographic characteristics of the 582/938 (62%) responding MMSs were similar to U.S. MMSs. Relative to 546 age-similar college graduates, MMSs had lower rates of burnout (27.3% versus 37.3%, P < .001) and depression symptoms (26.2% versus 42.4%, P < .0001) and higher scores across the four QOL domains assessed relative to controls (all P < .0001). These findings persisted on multivariate analysis after adjusting for age, sex, relationship status, and race/ethnicity.
Conclusions:
These findings, along with high rates of distress reported in medical students and residents, support concerns that the training process and environment contribute to the deterioration of mental health in developing physicians.
Background:
The paper reports on the development of the WHOQOL-BREF, an abbreyiated version of the WHOQOL-100 quality of life assessment.
Method:
The WHOQOL-BREF was derived from data collected using the WHOQOL-100. It produces scores for four domains related to quality of life: physical health, psychological, social relationships and environment. It also includes one facet on overall quality of life and general health.
Results:
Domain scores produced by the WHOQOL-BREF correlate highly (0.89 or above) with WHOQOL-100 domain scores (calculated on a four domain structure). WHOQOL-BREF domain scores demonstrated good discriminant validity, content validity, internal consistency and test-retest reliability.
Conclusion:
These data suggest that the WHOQOL-BREF provides a valid and reliable alternative to the assessment of domain profiles using the WHOQOL-100. It is envisaged that the WHOQOL-BREF will be most useful in studies that require a brief assessment of quality of life, for example, in large epidemiological studies and clinical trials where quality of life is of interest. In addition, the WHOQOL-BREF may be of use to health professionals in the assessment and evaluation of treatment efficacy.
Stigmatisation towards depression has previously been reported amongst medical students from a variety of backgrounds. This study explored personal and perceived stigmas associated with depression, and their relationship with demographics, knowledge of depression, levels of personal stress and history of medical illness amongst Australian-trained medical students. A cross-sectional survey was undertaken amongst students enroled June-to-August 2009 across four Australian medical schools. In total, 1010 students completed the survey, a response rate of 29.6%. Approximately 25% of students reported a past history of depression. Higher stress (K-10 scores) was reported by females and those with a past history of depression. On a scale of 0-to-5, the mean (±S.D.) personal and perceived stigma depression scores were 1.83±1.49 and 4.05±1.42 respectively. In multivariate analysis, higher perceived stigma and K-10 scores, a past history of anxiety and Year 3 of medical school indicated higher personal stigma scores. Perceived stigma was positively associated with K-10 scores, personal stigma scores, and a Caucasian background. Our findings suggest a high level of personal and particularly perceived stigma associated with depression amongst medical students, especially those displaying higher levels of stress. Adequate support and screening for psychological stress may de-stigmatise depression and improve mental health amongst future Australian doctors.
Medical student burnout is prevalent, and there has been much discussion about burnout and professionalism in medical education and the clinical learning environment. Yet, few studies have attempted to explore relationships between those issues using validated instruments.
Medical students were surveyed at the beginning of their fourth year using the Maslach Burnout Inventory, the Jefferson Scale of Physician Empathy-Student Version, and the Professionalism Climate Instrument. The data were analyzed using Statistical Package for the Social Sciences, and Spearman correlation analysis was performed.
Scores indicative of higher medical student burnout were associated with lower medical student empathy scores and with lower professionalism climate scores observed in medical students, residents, and faculty.
Investigators observed relationships between medical student burnout, empathy, and professionalism climate. These findings may have implications for the design of curriculum interventions to promote student well-being and professionalism.
Now a days, college students frequently have more complex problems than they used to have over a decade ago - greater difficulties in relationships; and more severe problems, such as depression, anxiety and thoughts of suicide. Counseling helps students to understand themselves and the world around them, and to adjust themselves more efficiently and appropriately to other fellow beings.
To determine as to what extent the medical students were able to cope up with their anxiety and depression with the help of counseling.
In the experimental design 'Before-and -after with control design', Beck Anxiety Inventory and Beck Depression Inventory were administered to 120 medical students who were randomly selected from a private medical college, comprising of 30 males and 30 females in each of the two groups, viz., the experimental group and the control group.
Means, standard deviations, t test and one-way ANOVA were used to analyze the data.
Anxiety and depression among the students were found to be reduced after counseling. Male and female students in the experimental group showed decrease in the levels of anxiety and depression; whereas the control group, which did not get the benefit of counseling, continued to have the same levels of anxiety and depression.
Counseling is helpful in building self-confidence and the capacity to adjust, by reducing anxiety and depression among medical college students.
Comorbidity of depressive and anxiety disorders is common and has been shown to be a consistent predictor of chronicity. Comorbidity patterns among specific depressive and anxiety disorders have not been extensively reported. This study examines comorbidity patterns and temporal sequencing of separate depressive and anxiety disorders using data from a large psychiatric cohort.
Baseline data (N = 1,783) of the Netherlands Study of Depression and Anxiety, collected between September 2004 and February 2007, were used. Current and lifetime comorbidity rates for depressive and anxiety disorders (DSM-IV-TR criteria) were calculated. Associations of comorbidity with sociodemographic, vulnerability, and clinical characteristics, and temporal sequencing of disorders were examined.
Of those with a depressive disorder, 67% had a current and 75% had a lifetime comorbid anxiety disorder. Of persons with a current anxiety disorder, 63% had a current and 81% had a lifetime depressive disorder. Comorbidity of depressive and anxiety disorders was associated with more childhood trauma (OR = 1.19; 95% CI, 1.06-1.33), higher neuroticism (OR = 1.05; 95% CI, 1.02-1.08), earlier age at onset of first disorder (OR = 1.59; 95% CI, 1.22-2.07), longer duration of depressive and/or anxiety symptoms (OR = 1.01; 95% CI, 1.01-1.01), and higher symptom severity (ORs ranging from 1.01 to 1.03; all P values < .05). In 57% of comorbid cases, anxiety preceded depression, and in 18%, depression preceded anxiety. Comorbidity with preceding depression compared to preceding anxiety was associated with a shorter duration of symptoms of depressive and/or anxiety symptoms (OR = 0.99; 95% CI, 0.98-0.99), earlier age at first onset (OR = 0.46; 95% CI, 0.31-0.68), and fewer fear symptoms (OR = 0.98; 95% CI, 0.97-0.99).
Comorbidity rates in anxiety and depressive disorders were very high, indicating that it is advisable to assess both disorders routinely regardless of the primary reason for consultation. This is especially important since comorbid patients showed a specific vulnerability pattern, with more childhood trauma, neuroticism, and higher severity and duration of symptoms.
This nationwide cross-sectional study assessed the prevalence, possible risk factors, and impact of depression among Korean medical students.
Of all medical students (14,095) registered in 41 medical schools in 2006 in South Korea, 7,357 (52.2%) completed the survey. Depression was measured using the patient-rated version of the Mini International Neuropsychiatric Interview (MINI-PR). Data on academic functioning, and sociodemographic characteristics were also obtained.
Current, one-year, and lifetime prevalence of major depressive disorder (MDD) were 2.9%, 6.5%, and 10.3%, respectively. Possible risk factors for one-year MDD were female gender, lower class years, admission track with exemption from entrance exam, living alone at a lodging house or a rented room, and financial difficulty (P < .05). The grade point averages (GPAs) of students with MDD were significantly lower than those of nondepressed students for both semesters (t = 3.8, P < .001; t = 4.8, P < .001). The odds ratio of students with MDD of receiving a GPA below 2.0 was 1.8 (CI 1.4-2.4) as compared with nondepressed students.
This study demonstrated that Korean medical students experience depression frequently. It also highlighted the possible risk factors of MDD among medical students and pervasive association of depression with poor functioning.
This ongoing column is dedicated to the challenging clinical interface between psychiatry and primary care-two fields that are inexorably linked.In this article, we examine the somber issue of suicide among physicians. While there is some variation in the literature regarding prevalence, the majority of studies indicates higher rates of suicide among physicians than the general population, particularly among female physicians. Potential contributory factors include various Axis I disorders (especially mood, drug use, and alcohol-related disorders), cognitive style, psychosocial factors, and particular personality characteristics. We urge physicians to be aware of these risk factors.
304 first- and second-year medical students were prospectively assessed for depression with a monthly Beck Depression Inventory (BDI). Students scoring above nine on the BDI and a control group were then interviewed with the NIMH Diagnostic Interview Schedule. The incidence of major depression or probable major depression by DSM-III criteria during the first two years of medical school was 12%. The lifetime prevalence was 15%, three times greater than the rate in the general population. An episode of depression prior to medical school was much more common among the depressed students (69 vs. 8%, P less than 0.001) as was a family history of treated depression (46 vs. 21%, P less than 0.025). The elevated rate of depression during medical school does not appear to be a result of the medical school experience alone. Rather, it suggests a positive bias of unknown nature in the selection of students predisposed to depression.
Medical school is recognized as a stressful environment that often exerts a negative effect on the academic performance, physical health, and psychological well-being of the student.
Stress, coping, depression, and somatic distress were examined among 69 third-year students completing a psychiatry clerkship in 1992-93 at the University of Mississippi School of Medicine. Stress was assessed using the Medical Education Hassles Scale-R. Coping was assessed using the Coping Strategies Inventory. Depression was assessed using the Center for Epidemiologic Studies-Depression Scale, and somatic distress was assessed using the Wahler Physical Symptoms Inventory. Statistical methods included correlational analysis and hierarchical regression.
Clinical levels of depression were found in 16 (23%) of the students, and 39 (57%) endorsed high levels of somatic distress. Stress accounted for a large percentage of the distress variance (i.e., 29% to 50%). Coping efforts contributed significant variance to the prediction of distress above and beyond that accounted for by stress alone, especially in relation to depression. Coping efforts classified by Engagement strategies were associated with fever depressive symptoms, while coping efforts classified by Disengagement strategies were associated with higher levels of depressive symptoms.
Because students who employed coping efforts characterized by Engagement strategies suffered from fewer depressive symptoms, the results suggest that training in these types of strategies may be a useful intervention to lessen the negative consequences of stress among medical students.
Data are presented on the general population prevalences, correlates, comorbidities, and impairments associated with DSM-III-R phobias.
Analysis is based on the National Comorbidity Survey. Phobias were assessed with a revised version of the Composite International Diagnostic Interview.
Lifetime (and 30-day) prevalence estimates are 6.7% (and 2.3%) for agoraphobia, 11.3% (and 5.5%) for simple phobia, and 13.3% (and 4.5%) for social phobia. Increasing lifetime prevalences are found in recent cohorts. Earlier median ages at illness onset are found for simple (15 years of age) and social (16 years of age) phobias than for agoraphobia (29 years of age). Phobias are highly comorbid. Most comorbid simple and social phobias are temporally primary, while most comorbid agoraphobia is temporally secondary. Comorbid phobias are generally more severe than pure phobias. Despite evidence of role impairment in phobia, only a minority of individuals with phobia ever seek professional treatment.
Phobias are common, increasingly prevalent, often associated with serious role impairment, and usually go untreated. Focused research is needed to investigate barriers to help seeking.
Results from the CMA's 1998 Physician Resource Questionnaire are in, and they point to a serious decline in physician morale. The PRQ, the country's most important poll of physician attitudes, provides an annual "state-of-the-nation" message for the medical profession.
About one quarter of the more than 69,000 medical students in this country suffer symptoms of mental illness, including 7% to 18% with substance use disorders. Subjective distress and physical health needs of medical students are also common and have been linked to training stresses. This first large-scale study of medical student health care examined students' physical and mental health concerns and their perceptions of academic vulnerability associated with personal illness. A 7-page, confidential written survey was given to 1,964 students at nine US medical schools in 1996 and 1997. A total of 1,027 students participated (52% response rate). Nearly all (90%) reported needing care for various health concerns, including 47% having at least one mental health or substance-related health issue. A majority of students expressed a preference for health care outside their training institution, largely due to confidentiality concerns, and 90% preferred health insurance allowing off-site care. Students expressed varying levels of concern about academic jeopardy in association with personal illness, with physical health problems such as arthritis causing the least concern and alcohol and drug abuse triggering the most concern. Consistent differences were detected in these views based on respondent's gender, training level, and institution. Most medical students perceive the need for personal health care. Nevertheless, fear of academic reprisal may prevent medical students from seeking necessary care for their health problems during training. This phenomenon may be linked in important but poorly recognized ways to emerging illness and to impairment among medical students and physicians. Women, minority, and clinical students appear more sensitive to the connection between health and academic vulnerability. Constructive implications for medical school curricula, policies, and health care services are discussed.
Absence of a common diagnostic interview has hampered cross-national syntheses of epidemiological evidence on major depressive episodes (MDE). Community epidemiological surveys using the World Health Organization Composite International Diagnostic Interview administered face-to-face were carried out in 10 countries in North America (Canada and the US), Latin America (Brazil, Chile, and Mexico), Europe (Czech Republic, Germany, the Netherlands, and Turkey), and Asia (Japan). The total sample size was more than 37,000.
Lifetime prevalence estimates of hierarchy-free DSM-III-R/DSM-IV MDE varied widely, from 3% in Japan to 16.9% in the US, with the majority in the range of 8% to 12%. The 12-month/lifetime prevalence ratio was in the range 40% to 55%, the 30-day/12-month prevalence ratio in the range 45% to 65%, and median age of onset in the range 20 to 25 in most countries. Consistent socio-demographic correlates included being female and unmarried. Respondents in recent cohorts reported higher lifetime prevalence, but lower persistence than those in earlier cohorts. Major depressive episodes were found to be strongly co-morbid with, and temporally secondary to, anxiety disorders in all countries, with primary panic and generalized anxiety disorders the most powerful predictors of the first onset of secondary MDE.
Major depressive episodes are a commonly occurring disorder that usually has a chronic-intermittent course. Effectiveness trials are needed to evaluate the impact of early detection and treatment on the course of MDE as well as to evaluate whether timely treatment of primary anxiety disorders would reduce the subsequent onset, persistence, and severity of secondary MDE. Copyright
Little is known about lifetime prevalence or age of onset of DSM-IV disorders.
To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication.
Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview.
Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older.
Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders.
Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups.
About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
Depression is a highly prevalent condition that results in substantial functional impairment. Advocates have attempted in recent years to make the 'business case' for investing in quality improvement efforts in depression care, particularly in primary care settings. The business case suggests that the costs of depression treatment may be offset by gains in worker productivity and/or reductions in other healthcare spending. In this paper, we review the evidence in support of this argument for improving the quality of depression treatment. We examined the impact of depression on two of the primary drivers of the societal burden of depression: healthcare utilisation and worker productivity. Depression leads to higher healthcare utilisation and spending, most of which is not the result of depression treatment costs. Depression is also a leading cause of absenteeism and reduced productivity at work. It is clear that the economic burden of depression is substantial; however, critical gaps in the literature remain and need to be addressed. For instance, we do not know the economic burden of untreated and/or inappropriately treated versus appropriately treated depression. There remain considerable problems with access to and quality of depression treatment. Progress has been made in terms of access to care, but quality of care is seldom consistent with national treatment guidelines. A wide range of effective treatments and care programmes for depression are available, yet rigorously tested clinical models to improve depression care have not been widely adopted by healthcare systems. Barriers to improving depression care exist at the patient, healthcare provider, practice, plan and purchaser levels, and may be both economic and non-economic. Studies evaluating interventions to improve the quality of depression treatment have found that the cost per QALY associated with improved depression care ranges from a low of 2519 US dollars to a high of 49,500 US dollars. We conclude from our review of the literature that effective treatment of depression is cost effective, but that evidence of a medical or productivity cost offset for depression treatment remains equivocal, and this points to the need for further research in this area.
Little is known regarding health-related quality of life and its relation with physical activity level in the general population. Our primary objective was to systematically review data examining this relationship.
We systematically searched MEDLINE, EMBASE, CINAHL, and PsycINFO for health-related quality of life and physical activity related keywords in titles, abstracts, or indexing fields.
From 1426 retrieved references, 55 citations were judged to require further evaluation. Fourteen studies were retained for data extraction and analysis; seven were cross-sectional studies, two were cohort studies, four were randomized controlled trials and one used a combined cross sectional and longitudinal design. Thirteen different methods of physical activity assessment were used. Most health-related quality of life instruments related to the Medical Outcome Study SF-36 questionnaire. Cross-sectional studies showed a consistently positive association between self-reported physical activity and health-related quality of life. The largest cross-sectional study reported an adjusted odds ratio of "having 14 or more unhealthy days" during the previous month to be 0.40 (95% Confidence Interval 0.36-0.45) for those meeting recommended levels of physical activity compared to inactive subjects. Cohort studies and randomized controlled trials tended to show a positive effect of physical activity on health-related quality of life, but similar to the cross-sectional studies, had methodological limitations.
Cross-sectional data showed a consistently positive association between physical activity level and health-related quality of life. Limited evidence from randomized controlled trials and cohort studies precludes a definitive statement about the nature of this association.
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