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Abstract

The high level of academic stress among medical students in the initial years of study negatively affects their health. This review aimed to analyze the data on features of a medical students' mental status and its dynamics in the course of study. The analysis was applied to the scientific publications (mainly over the past 5 years) on the issue of academic stress and medical students' mental status in different countries from computer databases: PubMed, Medical-Science, eLibrary, Web of Science, and Scopus. It is established that those entering medical schools are characterized by a high level of stress and anxiety, and in the first 3 years of study, their strengthening is observed. In addition, a high level of suicidality risk is noted: From 45% to 83% of the students had suicidal thoughts. The most significant stress situations for medical students are sessions and examinations. Due to the high study load and the need to prepare for classes for the following day, more than half of the students were sleep deprived (<6 h). To overcome stress, a significant part consumed alcohol and smoked tobacco, which is a risk factor of addiction. From there, medical and psychological aid should be available for medical students. It is necessary to train them in proper time management, methods of optimal self-study with educational materials as well as constructive ways to overcome stress, auto- and hetero-aggressive trends, effective conflict resolution, and relaxation methods which will keep students healthy mentally and prevent emotional burnout.
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Academic stress and its effect on medical students’ mental
health status
Victoria V. Ruzhenkova*, Victor A. Ruzhenkov, Inna S. Lukyantseva, Natalia A. Anisimova
INTRODUCTION
The medical student’s activity is one of the intense
emotional types of work, which affects the level
of their mental and somatic health.[1,2] Among
medical students, the prevalence of burnout and
mental disorders is increasing.[3] At the same time,
medical education implies reinforcing the idea that
physicians should be invincible and immune to
mental disorders.[4] Medical students have a high level
of academic stress,[5] and senior students cope with it
better than initial year ones.[6] Academic stress is higher
among foreign students who have poor knowledge of
a local language, live in a hostel[7] - here, a number of
emotional difficulties caused by initial adjustment and
immersion into a new ethnocultural environment,[8]
changed living conditions, new requirements for
educational adjustment,[9] and the need to master a
Department of Psychiatry, Narcology, and Clinical Psychology, Belgorod State University 301015, 85 Pobedy St., Belgorod,
Russia
*Corresponding author: Victoria V. Ruzhenkova, Department of Psychiatry, Narcology and Clinical Psychology of the
Federal State Agrarian University VO, Belgorod State National Research University, 301015, 85 Pobedy St., Belgorod, Russia.
E-mail: ruzhenkova@bsu.edu.ru
Received on: 24-02-2018; Revised on: 27-04-2018; Accepted on:29-05-2018
Access this article online
Website: jprsolutions.info ISSN: 0975-7619
new language for a year are added. An important role
is played by migrational stress associated with the
absence of familiar environment and lack of support
from relatives.[10]
In this regard, this review aimed to analyze the data
on features of a medical students’ mental status and its
dynamics in the course of study.
MATERIALS AND METHODS
The analysis was applied to the scientific publications
(mainly over the past 5 years) on the issue of academic
stress and medical students’ mental status in different
countries from computer databases: PubMed, Medical-
Science, eLibrary, Web of Science, and Scopus.
RESULTS AND DISCUSSION
The study demonstrates high prevalence of depression
and anxiety among medical students, with levels of
overall psychological stress consistently higher than
those of the general population and age-comparable
ABSTRACT
The high level of academic stress among medical students in the initial years of study negatively affects their health. This
review aimed to analyze the data on features of a medical students’ mental status and its dynamics in the course of study. The
analysis was applied to the scientific publications (mainly over the past 5 years) on the issue of academic stress and medical
students’ mental status in different countries from computer databases: PubMed, Medical-Science, eLibrary, Web of Science,
and Scopus. It is established that those entering medical schools are characterized by a high level of stress and anxiety, and
in the first 3 years of study, their strengthening is observed. In addition, a high level of suicidality risk is noted: From 45%
to 83% of the students had suicidal thoughts. The most significant stress situations for medical students are sessions and
examinations. Due to the high study load and the need to prepare for classes for the following day, more than half of the
students were sleep deprived (<6 h). To overcome stress, a significant part consumed alcohol and smoked tobacco, which is
a risk factor of addiction. From there, medical and psychological aid should be available for medical students. It is necessary
to train them in proper time management, methods of optimal self-study with educational materials as well as constructive
ways to overcome stress, auto- and hetero-aggressive trends, effective conflict resolution, and relaxation methods which will
keep students healthy mentally and prevent emotional burnout.
KEY WORDS: Academic stress, Addictive behavior, Anxiety, Asthenia, Depression, Mental disorders, Mental health
Review Article
Victoria V. Ruzhenkova, et al.
Drug Invention Today | Vol 10 • Issue 7 • 2018
1172
peers.[11-13] Moreover,[14] among those entering
medical schools, the prevalence of stress, anxiety, and
depression is 3.6%, 54.5%, and 1.9%, respectively.
Severe stress is observed in 33.8% of medical students,
with females 2.3–11.8 times more likely to develop
stress than males,[15,16] especially in their 1st year.[17]
According to other sources,[18] the overall level of
anxiety among male and female students is the same,
although female students express their concern more
when communicating with patients and their relatives.
The highest prevalence of stress occurs during the first
3 years of study, with a gradual decrease from 58.3%
to 56.6% - by the 4th and 25% by the 6th year.[19] At this
period, the use of various psychoactive substances,
such as alcohol, chewing khat, and smoking
cigarettes, is a common practice among stressed
students: Students under stress chewed khat 3 times
more often, smoked cigarettes 4.5 times more often,
and took alcohol 2 times more often. One of the ways
to relieve psychological tension and counter stress for
students is smoking tobacco.[20] Thus, the choice of
non-constructive ways to counter stress may be a risk
factor of addictive behavior in medical students.
Among medical students, 17% suffer from moderate
and severe depression and 49% have burnout.
A significantly greater risk of depression is associated
with inadequate support from family and friends
as well as other medical students.[21] These data are
consistent with Russian studies[22] - a survey of 2-year
students after 3 months from the beginning of the
course using the hospital anxiety and depression scale
revealed anxiety symptoms in 43.7% of the students
(27% of subclinical cases and 16.7% of clinical ones)
and in 15.6% of cases - depression (3.1% - clinical and
12.5% - subclinical). Among 1st year students, anxiety
was revealed in 64.5% of the cases, half of the cases
are clinical. The majority of the students - 98.8%
had asthenia of different intensities (MFI-20 test),
moderate and severe in more than half of the cases.
In 92.3% of the cases, it was accompanied by sleep
disorders.
The most significant stress situations for medical
students are session and examination periods,[2,23]
and the main sources of stress are academic
factors,[14,24] such as pressure from teachers and a
family, competition between students, vast volumes
of information to be studied, increase of study load
before examinations, a lack of time for revision, a great
absence rate resulted in missed assignments, poor
academic performance, failure to receive the expected
grades, too long study period, the need to deal with
cadaveric material and a tight schedule, as well as a
lack of skills in time management and self-discipline,
inability to establish priorities, and disappointment in
the chosen profession.[25,26]
The high level of academic stress, in turn, causes
emotional burnout in medical students,[27,28] negatively
affects overall health and academic performance,[29-31]
and contributes to the development of anxiety and
depression. According to the study of Oku et al.,[32]
39% of medical students have a “poor mental health
status.” In addition, medical students have a high
level of suicidal risk: From 45% to 83% of them have
suicidal thoughts.[6,22,33]
Due to the high study load and the need to prepare for
classes for the following day, a third of the students
(30.7%) reduced their sleep time to 4–5 h a day;
another 33.1% slept no more than 6 h. In addition,
88.6% of the students showed pre-insomnia, middle
insomnia, and post-insomnia (in 72.3% of the cases
in various combinations). A fifth of the students
(24.1%), in turn, thought about quitting their studies at
a medical school and mastering another profession.[22]
High levels of stress and emotional burnout are
associated with a decrease in life satisfaction,
thoughts of falling out of life, and suicidal ideation;
they reduce performance, commitment to study, and
increase a stress level.[27] The motivation for choosing
a medical specialty is different, and students who
come to medicine due to an illness, family member’s
death is more vulnerable to emotional burnout.[34]
The risk of burnout is doubled from the 3rd to the
6th year of study regardless of a gender.[35] This may
be caused by the wishful thinking on transition to
clinical departments or when starting working with
patients. Another risk factor for forming cynicism,
burnout, and poor academic performance is a lack of
altruism.[36]
According to Ludwig et al.[37] in the 3rd year of study,
a significant increase in the proportion of students at
risk of depression (39%) was noted compared to the
1st year (28.4%). This may be related to the transition to
clinical courses, which are quite a stressful experience
for medical students.[38] However, already by the
fourth course,[39] there was a decrease in the severity
of anxiety and depression. The authors associate this
with the adjustment to stress during the clinical year.
A clinical department teachers’ attitude to the students
and work they perform may also be a determining
factor: Respect, more detailed explanation of material,
demonstration, and teaching practical skills, which
promotes students’ greater confidence and better
adjustment to stress.
Stress and anxiety result in distraction during
reading and simplification of studies,[29] anxiety and
depression - to expulsion from medical schools,
impairment in ability to work effectively, strained
relations, burnout, and development of suicidal
tendencies.[39]
Victoria V. Ruzhenkova, et al.
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Drug Invention Today | Vol 10 • Issue 7 • 2018
Students’ support systems available at school are of
great importance for prevention of academic stress. For
medical schools, it is required to identify students who
suffer from depression as early as possible, especially
when depression has been for a long time.[40]
It is known that medical students with a higher level
of anxiety and depression often deny support systems
or have difficulties accessing it.[41] At the same time,
meeting the individual students’ needs and providing
them with a safe environment are the key elements of a
successful self-help program in stressful situations.[42]
As defined by the students themselves, social support
from peers and teachers, consulting services, and
various extracurricular activities are the most useful.[43]
They emphasize the need for individual psychotherapy
sessions and trainings aimed at reducing emotional
tension and increasing social intelligence.[44]
The analysis of coping strategies used by medical
students may serve as a material for consulting on
their personal development with respect to future
career.[45] Attention to each student’s adaptive
capabilities and coping resources may facilitate
their adjustment and minimize burnout.[46] Repeated
visits to a specialized student’s consulting center
at a high level of psychological stress increase the
level of general functioning.[47] The usual approach
to supporting students is to offer them short-term
correction programs that improve attitude to studies
and are focused on preventing failures.[48] According
to other data,[49] a plenty of self-study programs to
train skills and develop strategies aimed at improving
the psychological health and students’ performance
demonstrate only a short-term improvement in
depression and anxiety reduction.
Gain in mental health reduces the adverse effects of
emotional burnout.[12] In addition, improvement of the
physicians’ ability to reveal their own health problems
will enhance their credibility as of role models and
their ability to provide optimal care for patients.[50]
CONCLUSION
Thus, in the course of study at medical schools, students
face a host of stress factors, the most significant
of which are academic: High study load and a lack
of time management skills to prepare for classes,
excessive pressure from teachers, and disappointment
in choosing the profession. The above-mentioned
factors undermine medical students’ mental health
and lead to asthenic, anxious and anxious-depressive
disorders, and emotional burnout. Altruistic motives
for choosing a physician’s profession as well as
confidence in their choice are protective factors for
students, but unfortunately, it is almost impossible to
influence them. Furthermore, students often use non-
constructive ways to counter stress causing addictive
behavior, such as smoking, drinking alcohol, and
abuse of social networks. The target for programs
of medical and psychological aid should be a lack
of time management skills to prepare for classes,
inability to set priorities. It is necessary to train
students in the proper time management, methods of
optimal self-study with educational materials as well
as constructive ways to overcome stress, methods of
relaxation, effective conflict resolution, and countering
the auto- and hetero-aggressive trends. It is reasonable
to increase the availability of psychological support
systems for students, to fight the stigma and beliefs
in the shame of psychological problems. In addition,
it is necessary to optimize a class schedule, replenish
funds of school libraries, and train academic teaching
staff with respect to psychological pressure reduction.
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Source of support: Nil; Conflict of interest: None Declared
... The psychological adaptation of medical students and young doctors is of interest in many countries [1][2][3][4][5][6]. Research consistently shows a high prevalence of mental disorders and psychological stress among medical students [3,[7][8][9], significantly higher than in the general population [10,11]. ...
... Medical students report pressure from their professional environment and academic studies are the main source of stress [3,5,15]. These stressful conditions may lead to high burnout rates [16][17][18][19][20][21]. ...
... Although a screening survey is not sufficient to make a diagnosis, data obtained clearly indicated a high probability of common mental disorders in the study sample. Academic stress and the pressure of the professional environment were rated as the leading global sources of stress in medical students [3,5,15]. This was confirmed in our survey, where academic studies were the most frequently cited source of stress (89% of respondents). ...
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Background Despite the general interest of researchers around the world, there are few studies on the psychological wellbeing and burnout among medical students in Russia. The aim of this study was to perform screening for minor psychiatric disorders, burnout, problematic alcohol use, and quantify the psychological issues and stress among a sample of medical students in St. Petersburg, Russia. Results According to the GHQ-12, screening for minor mental disorders was positive in 140 students (85%). Screening for burnout using the OLBI showed positive results in 121 (73%) students for disengagement and 132 (80%) students for exhaustion. Screening with the CAGE tool identified a risk of alcohol consumption in 33 students (20%). Most students reported academic studies as the main source of stress in their life (n = 147; 89.1%). Conclusions This study identified very high levels of stress, burnout, risk of minor mental disorders, and problematic alcohol use among medical students in St. Petersburg, Russia. These findings suggest more attention is needed to the poor mental wellbeing and health in medical students in Russia.
... Our study explored the general population of students, independent of their degree of study. Likewise, the data collection was conducted early in the semester, which is not a season of examinations, which can further explain why students did not have high levels of stress, since Ruzhenkova et al. (2018) and Smith and Yang (2017) found that examination stress is highly related to academic stress. Table 1 also presents the correlations between the three variables investigated on this study. ...
... This finding is consistent with earlier studies that found that higher levels of stress take a toll on coping skills of students by consuming more resources, which manifests physically and psychologically (Stankovska et al., 2018). Higher levels of stress are also found to have significant effects on overall health and decreased life satisfaction (Ruzhenkova et al., 2018). Additionally, higher levels of perceived academic stress are related to lower well-being (Xiang et al., 2019) Likewise, since this study employed almost 85% first-and secondyear students, higher levels of academic stress are expected of them, which affects their well-being (Shelton, 2017). ...
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Studies on commuting are largely focused on working individuals and much less on students. Prior to the COVID-19 pandemic, a number of students opted to study in the universities in Metro Manila, which raises the question as to how satisfaction with travel to school has influenced the psychological well-being of students. This non-experimental study made use of Hayes’ mediation analysis to investigate the relationship between 367 students’ satisfaction with travel going to school and students’ psychological well-being as well as the indirect effect of academic stress in that relationship. The result showed that satisfaction with travel to school and academic stress are weakly negatively correlated. On the other hand, satisfaction with travel and psychological well-being are weakly positively related. Those who were dissatisfied with their commute were also found to report lower psychological well-being. The mediation analysis showed that students’ satisfaction with travel to school indirectly affects psychological well-being through academic stress, wherein satisfaction with travel does not directly affect psychological well-being.
... Motivation is defined as the urge to do something. In medical students, an internal motivation to continue medical school is positively correlated with academic achievement and a level of self-confidence in students [12,13]. Students who do not have the internal motivation to carry out their educational process will tend to experience mental and emotional disorders and have suicidal thoughts. ...
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Suicide is a deliberate act to end one’s life. Suicidal incidents are often found among medical students. The suicide rate among medical students is very high when compared with students of other majors. A study in the United States stated that prevalence of suicidal ideation in medical students was 11%, twice of the general population, while the prevalence of attempted suicide was 6.9%. Several factors related to the academic situation that contribute to mental disorders among medical students include pressure in medical education, demand for good skills and long education time. These factors make them prone to depression, burnout, and various emotional and mental disorders that can trigger suicide. Therefore, efforts are needed to prevent and detect the possibility of suicidal behavior. This effort must be carried out in a multidisciplinary manner. Optimizing the academic atmosphere, family involvement, the social environment, and the ability of adequate health facilities are needed. Keywords: Suicide, Medical Students, Prevention
... Exposure to stress is generally linked to negative outcomes. Among them is more incidence of psychological disorders like generalized anxiety disorder, reduced well-being, posttraumatic stress disorder, major depressive disorder, suicidal ideation, and suicide (Ruzhenkova et al, 2018). Therefore, the capacity to regulate emotions is perceived as the mediator for stress management (Finlay-Jones et al., 2015). ...
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Nature bestowed humans with emotions. The stresses of the modern-day world have a negative effect; hence, people are becoming more emotionally volatile, less self-motivated, and less compassionate. Consequently, the levels of Emotional Intelligence (EI) continue to decline. Furthermore, the daily challenge of dealing effectively with emotions is critical to human beings because our brains are hard-wired to give emotions the upper hand: Our view of the world, how we react to it and adjust our behaviour accordingly is largely influenced by emotions. Emotional Intelligence (EI) skills are huge contributors to overall health as well as success in life, which is attributed to their impact on the ability to motivate and self-manage. This study assesses the level of EI among Students in Kenya Medical Training Colleges. The sample comprised 372 participants aged between 17 and 25 years. Data were collected using a researcher developed questionnaire and an emotional intelligence assessment tool with five components/subscales. These are: intrapersonal skills, interpersonal skills, stress management skills, adaptability, and general mood. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20. The average scores for all participants were as follows: 41.9 for intrapersonal; 28.3 for interpersonal; 30.8 for stress management; 23.9 for adaptability; and 25.3 for general mood. Consequently, the overall average scores were 150.2 which falls under the high level of EI based on the criteria for measuring EI. The implication is that the students at Kenya Medical Training College have a high level of emotional intelligence
... Medical students often feel guilty for not using their free time to study. 23 In this study, we found that the source of stress with the lowest score among medical students was Drive & Desire Related Stressor. This can be supported by the fact that the medical profession is a profession that is respected in society and is considered as a proud career, so the motivation for the medical students to become part of these professionals tends to be high and come from themselves. ...
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Background: Medical students are a population that is considered vulnerable to experience stress during the COVID-19 pandemic, especially with the heavy learning load and changes in the learning system that were initially carried out face-to-face. Currently, there are limited data regarding the stress of studying online in medical students and their effect on learning achievement. This study aimed to determine the stress effect of studying online in medical students on their academic achievement. Methods: This study was an analytic observational study with a cross-sectional approach. 112 samples were obtained from students of Bachelor of Medicine and Medical Doctor in one of the universities in Bali with the instruments that were distributed via Google Form. Primary data collection was carried out using the Medical Student Stressor Questionnaire (MSSQ) questionnaire, while secondary data collection was obtained from the average score of three-block exams done online during the COVID-19 pandemic. Results: The stress level of medical students in online learning was dominated by high stress (55.4%) with the majority cause due to Academic Related Stressor (ARS). There is a significant relationship (p = 0.021) between the incidence of stress and learning achievement in students (-0.217, 95% CI -0.39 to -0.03). The learning system preference that was chosen by the students is dominated by a 50% online learning system and 50% offline as much as 27.7%. Conclusion: The results indicated that there is a high level of stress among medical students. There is a correlation between stress events and medical student’s achievement during online learning.
... Academic stress positively correlated with students' mental problems (Deb et al., 2015). A study reported that a high study load and the need to prepare for the next day's class were factors of academic stress, making students more likely to commit suicide (Ruzhenkova et al., 2018). Some studies suggest that academic stress may increase during external events that trigger academic stress due to lack of control and loneliness related to social isolation (Mosanya, 2020). ...
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The world has experienced a tremendous impact over the past two years due to the COVID-19 pandemic. One of the impacts is the change in the learning system from offline classes to online classes. Not a few studies say that online learning impacts students' psychology, one of which is academic stress. This study examines the effect of academic stress on positive mental health in college students during the COVID-19 pandemic. A total of 76 psychology students in Central Java, Indonesia, participated in this study. The results show a significant effect of academic stress on positive mental health in students during online learning during the COVID-19 pandemic. The implications of the results of this study are discussed in detail
... As indicated above, college can be a time of increased stress for college students in general; elevated stress can be even more significant for students who are enrolled in clinically oriented programs such as medicine, nursing, and allied health disciplines (e.g., Beck et al., 2020;Bergmann et al., 2019;Dziegielewski et al., 2004;Finkelstein et al., 2007;Frögéli et al., 2019;Ruzhenkova et al., 2018). Not only must students in these programs be successful in academically challenging courses, they must also meet the demands of clinical practicum experiences. ...
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Purpose The purpose of this review article was to define mindfulness and discuss its use with college students, students majoring in clinical programs, and communication sciences and disorders (CSD) students in particular. Method Literature was reviewed regarding mindfulness, stress, perfectionism, and self-compassion. Furthermore, how these issues relate to college students in general, students in clinically related majors, and specifically to CSD students was discussed. Research using a mindfulness practice with CSD students was reviewed and two methods of incorporating a mindfulness practice into an ongoing CSD curriculum (i.e., as part of a graduate course on counseling and as part of an undergraduate course on the graduate application process) were discussed. Results A short mindfulness practice has been found to decrease the perceived and biological stress levels of CSD undergraduate and graduate students. Participation in this practice has also been found to help CSD students ameliorate negative aspects of perfectionism and to increase self-compassion. Use of the mindfulness practice within the curriculum was accepted by students. Conclusion The use of a short mindfulness practice can successfully be incorporated into an ongoing CSD curriculum and appears to be an effective method of improving students' overall well-being.
... Consistent with the findings for CSD and SWK students, students who are preparing for a career in other helping professions such as medicine, nursing, allied health disciplines, and teaching experience greater stress than students in other academic disciplines (Bergmann et al., 2019;Frögéli et al., 2019;Katz et al., 2018;Ruzhenkova et al., 2018). College can be a time when stress levels are exacerbated for many students; students in clinically oriented programs appear to face even greater levels of stress due to the added responsibilities of practicum demands and learning to work with individuals who are experiencing difficulties in their lives. ...
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Purpose To further inform faculty and clinical educators interested in facilitating the overall well-being of their students, areas causing stress for undergraduate (UGs) and graduate (Gs) students in communication sciences and disorders (CSD) and in social work (SWK) were explored. The perceived stress levels as well as levels and types of perfectionism demonstrated by students, as well as the methods used to manage stress, were also explored. Method A survey of 193 CSD students (105 UGs and 88 Gs) and 137 SWK students (104 UGs and 33 Gs) from the same institution was conducted. The survey asked respondents to list their top 3 stressors, as well as the stress management practices in which they engaged, and to complete the Perceived Stress Scale and the Almost Perfect Scale–Revised. Results CSD UGs were the only group who indicated that the graduate school admission process was a major stressor; other stressors listed by UGs in CSD and SWK were similar. CSD Gs were the only group who listed clinic as stressful, and SWK Gs listed finances as a more prominent stressor than did CSD Gs. Stress management practices were primarily similar. No differences existed between UGs and Gs on measures of perceived stress and perfectionism. More CSD respondents demonstrated healthy aspects of perfectionism than did SWK respondents. CSD respondents' stress levels were lower overall than those of SWK respondents. Conclusions Similarities and differences existed between CSD and SWK respondents regarding stressors, stress management practices, perceived stress levels, and perfectionism. This information can provide faculty and clinical educator with insight regarding our students' overall well-being.
... Also, it has been reported that high levels of stress induce a variety of reactions that lead to increased health risk (3). So, it is important to manage stress for the academic, psychological and physical wellbeing of health professionals and students (4). ...
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The aim of this study was to analyze the self-perceived general health, oral care, stress, academic environment, and harmful habits of Mexican dental students during the COVID-19 quarantine period. This descriptive observational study consisted of a self-perception survey that was sent to dental students undergoing virtual classes. Five sections were analyzed: General Health, Oral Health, Stress, Academic Environment and Habits. For each question, students were asked to rate their perception prior to, and during the contingency, which allowed a comparison to be made between both times for each inquiry. The answers were collected into Microsoft Excel and the statistical analyses were performed using SPSS v.20. A statistically significant difference was observed between the academic years for the variables: “physical exercise” prior to quarantine, “emotional problems” and “work-load” during quarantine, and “academic efficiency” for both times. A trend towards unfavorable perception in relation to general health, academic environment, and harmful habits was observed among dental students during social isolation derived from the pandemic. It is notable that 1st-year students presented a greater impact on all the variables of interest.
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Introduction Clinical training in the undergraduate medical course places multiple stressors on trainees, which have been held to lead to heightened distress, depression, suicide, substance misuse/abuse and poor mental health outcomes. To date, evidence for morbidity in trainees is largely derived from cross-sectional survey-based research. This limits the accuracy of estimates and the extent to which predispositional vulnerabilities (biological and/or psychological), contextual triggers and longer-term consequences can be validly identified. Longitudinal clinical assessments embedded within a biopsychosocial framework are needed before effective preventative and treatment strategies can be put in place. Methods and analysis This study is an observational longitudinal cohort study of 330 students enrolled in the undergraduate medicine course at the University of New South Wales (UNSW) Sydney, Australia. Students will be recruited in their fourth year of study and undergo annual assessments for 4 consecutive years as they progress through increasingly demanding clinical training, including internship. Assessments will include clinical interviews for psychiatric morbidity, and self-report questionnaires to obtain health, psychosocial, performance and functioning information. Objective measures of cognitive performance, sleep/activity patterns as well as autonomic and immune function (via peripheral blood samples) will be obtained. These data will be used to determine the prevalence, incidence and severity of mental disorder, elucidate contextual and biological triggers and mechanisms underpinning psychopathology and examine the impact of psychopathology on performance and professional functioning. Ethics and dissemination Ethics approval has been granted by the UNSW human research ethics committee (reference HC16340). The findings will be disseminated through peer-reviewed publications and conference presentations, and distributed to key stakeholders within the medical education sector. The outcomes will also inform targeted preventative and treatment strategies to enhance stress resilience in trainee doctors.
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Background Factors associated with depression of medical students are poorly understood. The purpose of this study is to determine the prevalence of depression in medical students, its change during the course, if depression persists for affected students, what are the factors associated with depression and how these factors change over time. Methods A prospective, longitudinal observational study was conducted at the Medical School of the University of Minho, Portugal, between academic years 2009–2010 to 2012–2013. We included students who maintained their participation by annually completing a questionnaire including Beck Depression Inventory (BDI). Anxiety and burnout were assessed using the State Trait Anxiety Inventory and Maslach Burnout Inventory. Surveys on socio-demographic variables were applied to evaluate potential predictors, personal and academic characteristics and perceived difficulties. ANOVA with multiple comparisons were used to compare means of BDI score. The medical students were organized into subgroups by K-means cluster analyses. ANOVA mixed-design repeated measurement was performed to assess a possible interaction between variables associated with depression. Results The response rate was 84, 92, 88 and 81% for academic years 2009–2010, 2010–2011,2011-2012 and 2012/2013, respectively. Two hundred thirty-eight medical students were evaluated longitudinally. For depression the prevalence ranged from 21.5 to 12.7% (academic years 2009/2010 and 2012/2013). BDI scores decreased during medical school. 19.7% of students recorded sustained high BDI over time. These students had high levels of trait-anxiety and choose medicine for anticipated income and prestige, reported more relationship issues, cynicism, and decreased satisfaction with social activities. Students with high BDI scores at initial evaluation with low levels of trait-anxiety and a primary interest in medicine as a career tended to improve their mood and reported reduced burnout, low perceived learning problems and increased satisfaction with social activities at last evaluation. No difference was detected between men and women in the median BDI score over time. Conclusions Our findings suggest that personal factors (anxiety traits, medicine choice factors, relationship patterns and academic burnout) are relevant for persistence of high levels of BDI during medical training. Medical schools need to identity students who experience depression and support then, as early as possible, particularly when depression has been present over time.
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Medical school students often experience emotional difficulties when handling the challenges of their formation, occasionally leading to burnout. In this study, we measured the prevalence of burnout and its relationships with perceived stress, perceived social support, and alexithymia in medical students from the largest academic medical community in Romania. A cross-sectional survey was administered to a randomized sample of 299 preclinical medical students at the University of Medicine in Bucharest. Participants completed four standardized questionnaires. In addition to the assessment of burnout prevalence, stepwise backward regression was used to establish which variables had the highest correlation to burnout components. Further, t-tests were run to assess gender-related differences. Overall, burnout prevalence was 15.05%. Perceived stress was found to be the strongest predictor of emotional exhaustion and lack of accomplishment, while the strongest predictors of depersonalization were low perceived social support (in women) and alexithymia (in men). Women appear to be more vulnerable to two of the components of burnout (emotional exhaustion and low personal accomplishment) and associate higher perceived stress and alexithymia. These results suggest that interventions addressing academic burnout could benefit from being gender-specific, with focus on key elements, such as perceived stress and alexithymia.
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Background Medical students have been found to report high levels of perceived stress, yet there is a lack of theoretical frameworks examining possible reasons. This cross-sectional study examines correlates of perceived stress in medical students on the basis of a conceptual stress model originally developed for and applied to the general population. The aim was to identify via structural equation modeling the associations between perceived stress and emotional distress (anxiety and depression), taking into account the activation of personal resources (optimism, self-efficacy and resilient coping). Methods Within this cross-sectional study, 321 first year medical students (age 22 ± 4 years, 39.3% men) completed the Perceived Stress Questionnaire (PSQ-20), the Self-Efficacy Optimism Scale (SWOP) and the Brief Resilient Coping Scale (BRCS) as well as the Patient Health Questionnaire (PHQ-4). The statistical analyses used t-tests, ANOVA, Spearman Rho correlation and multiple regression analysis as well as structural equation modeling. Results Medical students reported higher levels of perceived stress and higher levels of anxiety and depression than reference samples. No statistically significant differences in stress levels were found within the sample according to gender, migration background or employment status. Students reported more self-efficacy, optimism, and resilient coping and higher emotional distress compared to validation samples and results in other studies. Structural equation analysis revealed a satisfactory fit between empirical data and the proposed stress model indicating that personal resources modulated perceived stress, which in turn had an impact on emotional distress. Conclusions Medical students’ perceived stress and emotional distress levels are generally high, with personal resources acting as a buffer, thus supporting the population-based general stress model. Results suggest providing individual interventions for those students, who need support in dealing with the challenges of the medical curriculum as well as addressing structural determinants of student stress such as course load and timing of exams.
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Background To evaluate personal and institutional factors related to depression and anxiety prevalence of students from 22 Brazilian medical schools. Methods The authors performed a multicenter study (August 2011 to August 2012), examining personal factors (age, sex, housing, tuition scholarship) and institutional factors (year of the medical training, school legal status, location and support service) in association with scores of Beck Depression Inventory (BDI) and State Trait Anxiety Inventory (STAI). Results Of 1,650 randomly selected students, 1,350 (81.8 %) completed the study. The depressive symptoms prevalence was 41 % (BDI > 9), state-anxiety 81.7 % and trait-anxiety in 85.6 % (STAI > 33). There was a positive relationship between levels of state (r = 0,591, p < 0.001) and trait (r = 0,718, p < 0.001) anxiety and depression scores. All three symptoms were positively associated with female sex and students from medical schools located in capital cities of both sexes. Tuition scholarship students had higher state-anxiety but not trait-anxiety or depression scores. Medical students with higher levels of depression and anxiety symptoms disagree more than their peers with the statements “I have adequate access to psychological support” and “There is a good support system for students who get stressed”. Conclusions The factors associated with the increase of medical students’ depression and anxiety symptoms were female sex, school location and tuition scholarship. It is interesting that tuition scholarship students showed state-anxiety, but not depression and trait-anxiety symptoms.
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Background: Stress and its psychological manifestations are currently a major source of concern. Medical education poses challenging and potentially threatening demands for students throughout the world. Objectives: To determine the prevalence and factors associated with perceived stress in medical students in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia. Materials and methods: This was a cross-sectional study on all medical students of batches 9, 10, and 11, which constituted all the enrolled students. Data were collected using a questionnaire based on the Kessler10 psychological distress instrument with a total score ranging from 10 to 50 points in addition to some sociodemographic characteristics. Appropriate statistical test procedures were used to study the magnitude of stress and its risk factors. Results: Mean stress score of the eighty participants was 26.03 ± 9.7. Students with severe stress constituted 33.8%, and 30% were well. Severe stress was significantly associated with female gender and junior level. Nervousness, feeling hopeless, feeling restless, and depressed were the most important factors affecting students' stress scores. Factor analysis revealed three hidden factors for stress in this group, namely, depression, nervousness, and age. Conclusion: Stress in medical students is prevalent and significantly associated with the female gender and the junior level. Implementation of coping programs is necessary.
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Background Medical practitioners and students are at increased risk of a number of personal and psychological problems. Stress and anxiety due to work-load and study requirements are common and self-care methods are important in maintaining well-being. The current study examines perceptions of and satisfaction ratings with a mindfulness based stress reduction (MBSR) programme for 1st year (compulsory) and 2nd year (optional) Graduate Entry Medical School students. MethodsA mixed method pre and post study of Year 1 (n = 140) and Year 2 (n = 88) medical students completing a 7 week MBSR course compared student satisfaction ratings. Thematic analysis of feedback from the students on their perception of the course was also carried out. ResultsYear 1 students (compulsory course) were less satisfied with content and learning outcomes than Year 2 students (optional course) (p < .0005). Thematic analysis of year 1 student feedback identified themes including great concept, poorly executed; and less discussion, more practice. Year 2 themes included session environment and satisfaction with tutors. Conclusions The MBSR course was associated with high levels of satisfaction and positive feedback when delivered on an optional basis. Catering for the individual needs of the participant and promoting a safe environment are core elements of a successful self-care programme.
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Background The stress associated with the physician’s work is generally acknowledged and is related to well-being and life satisfaction. The presented study was designed to extract the role of coping strategies in identifying differentiated styles of success in a medical career during medical education. Methods The participants were examined when they applied to medical school and each subsequent academic year. The final study took place four years after graduation. The baseline questionnaire measured coping strategies. The follow-up questionnaire consisted of measures of: quality of life, work stress and burnout, satisfaction with medicine as a career, and professional competency. Results Based on coping strategies assessed during admission and preclinical years of medical study, some aspects of success in the participants’ future medical career can be predicted. Students who take action and deal directly with a problem, neither accept resignation, nor reduce tension by expressing feelings would most probably resist future burnout. However, despite the fact that they obtain the highest quality of life or earn the highest income they would be, at the same time, the least satisfied with chosen career, as well as being more likely to be characterised by a low level of competence. Conclusions Assessment of coping strategies at the beginning of medical education could be taken into consideration as an instrument to diagnose a specific trend in physicians’ career development.
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Background Burnout is a major issue among medical students. Its general characteristics are loss of interest in study and lack of motivation. A study of the phenomenon must extend beyond the university environment and personality factors to consider whether career choice has a role in the occurrence of burnout. Methods Quantitative, national survey (n = 733) among medical students, using a 12-item career motivation list compiled from published research results and a pilot study. We measured burnout by the validated Hungarian version of MBI-SS. Results The most significant career choice factor was altruistic motivation, followed by extrinsic motivations: gaining a degree, finding a job, accessing career opportunities. Lack of altruism was found to be a major risk factor, in addition to the traditional risk factors, for cynicism and reduced academic efficacy. Our study confirmed the influence of gender differences on both career choice motivations and burnout. Conclusion The structure of career motivation is a major issue in the transformation of the medical profession. Since altruism is a prominent motivation for many women studying medicine, their entry into the profession in increasing numbers may reinforce its traditional character and act against the present trend of deprofessionalization.
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Prior research has suggested that dental students experience high rates of stress, anxiety, and mood concerns, which have been linked to poor academic performance, health concerns, and substance abuse. The aim of this study was to evaluate the impact of an embedded counseling office at the University of Iowa College of Dentistry & Dental Clinics in its first three academic semesters. Data were gathered from students attending appointments, and two inventories were used to monitor students' counseling progress and gather psychological outcomes data: the Counseling Center Assessment of Psychological Symptoms-34 (CCAPS-34) and the Outcome Rating Scale (ORS). In the three semesters, 55 students attended 251 counseling appointments, with an average of 4.5 appointments per student. Their presenting psychological concerns included academic concerns, time management, test anxiety, study skills, low self-esteem, self-care, interpersonal conflicts, anxiety, depression, stress management, sexual concerns, substance abuse, eating/body image concerns, work-life balance, and financial issues. The CCAPS-34 data showed that, at initial clinical assessment, students experienced moderate levels of depression, generalized anxiety, social anxiety, academic distress, and overall psychological distress; 45 (82%) showed clinically significant symptoms on at least one CCAPS-34 subscale. The ORS data further showed that the students entered counseling experiencing high levels of psychological distress. A positive relationship was found between number of counseling appointments and increased overall functioning. These results suggest that an embedded counseling office can help dental schools meet the needs of their students.