Document Type : Original Article

Authors

1 Department of Neuroscience, “Rita Levi Montalcini,” University of Torino, Torino, Italy

2 School of Medicine, University of Torino, Torino, Italy

Abstract

BACKGROUND: Previous studies have reported that medical students show high rates of depression,
anxiety, and stress levels, but mixed findings were found regarding possible differences between
gender and different years of medical training. This study evaluated depression, anxiety, and stress
levels and psychiatric drug use in students in an Italian medical school and investigated the differences
between gender and year of study.
MATERIALS AND METHODS: This cross‑sectional study included 694 medical students in their
1st (n = 286), 4th (n = 209), and 6th (n = 199) year of study. The questionnaire included demographic
information, self‑report questionnaires regarding depression, anxiety, and stress, and questions
about psychiatric drug use. Data analysis was performed using SPSS/Ver 22 through descriptive and
analytic statistics, including Mann–Whitney U‑test, Fisher’s exact test, and GLM two‑way ANOVA.
RESULTS: Depression, anxiety, and stress symptoms were reported by 365 (52.6%), 428 (61.7%),
and 545 (78.5%) medical students, respectively. Female students in their 4th year of study reported
higher depression levels than males of the same year (P = 0.004), whereas levels of anxiety were
higher in 6th‑year female students compared with those in their 1st and 4th years (P = 0.001; P = 0.025).
Stress levels were consistently higher in females than in males for all 3 years (1st year: P = 0.041;
4th year: P < 0.001; 6th year: P = 0.004). No gender differences were found in the use of psychiatric
and stimulant drugs.
CONCLUSION: This study provides preliminary evidence suggesting the importance of planning
interventions aimed at reducing emotional distress among medical students that should be targeted
on gender and year of the study.

Keywords

1. Quek TT, Tam WW, Tran BX, Zhang M, Zhang Z, Ho CS, et al.
The global prevalence of anxiety among medical students:
A meta‑analysis. Int J Environ Res Public Health 2019;16:2735.
2. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review
of depression, anxiety, and other indicators of psychological
distress among U.S. and Canadian medical students. Acad Med
2006;81:354‑73.
3. Hope V, Henderson M. Medical student depression, anxiety and
distress outside North America: A systematic review. Med Educ
2014;48:963‑79.
4. Elzubeir MA, Elzubeir KE, Magzoub ME. Stress and coping
strategies among Arab medical students: Towards a research
agenda. Educ Health (Abingdon) 2010;23:355.
5. Mao Y, Zhang N, Liu J, Zhu B, He R, Wang X. A systematic review
of depression and anxiety in medical students in China. BMC Med
Educ 2019;19:327.
6. Zeng W, Chen R, Wang X, Zhang Q, Deng W. Prevalence of
mental health problems among medical students in China:
A meta‑analysis. Medicine (Baltimore) 2019;98:e15337.
7. Puthran R, Zhang MW, Tam WW, Ho RC. Prevalence of
depression amongst medical students: A meta‑analysis. Med
Educ 2016;50:456‑68.
8. Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C,
et al. Prevalence of depression, depressive symptoms, and suicidal
ideation among medical students: A systematic review and
meta‑analysis. JAMA 2016;316:2214‑36.
9. Pacheco JP, Giacomin HT, Tam WW, Ribeiro TB, Arab C,
Bezerra IM, et al. Mental health problems among medical students
in Brazil: A systematic review and meta‑analysis. Braz J Psychiatry
2017;39:369‑78.
10. Mahroon ZA, Borgan SM, Kamel C, Maddison W, Royston M,
Donnellan C. Factors associated with depression and anxiety
symptoms among medical students in Bahrain. Acad Psychiatry
2018;42:31‑40.
11. Pham T, Bui L, Nguyen A, Nguyen B, Tran P, Vu P, et al. The
prevalence of depression and associated risk factors among
medical students: An untold story in Vietnam. PLoS One
2019;14:e0221432.
12. Damiano RF, de Oliveira IN, Ezequiel OD, Lucchetti AL,
Lucchetti G. The root of the problem: Identifying major sources of
stress in Brazilian medical students and developing the Medical
Student Stress Factor Scale. Braz J Psychiatry 2020;43:35‑42.
13. Manjareeka M, Yadav S. Predictors of high achievers in Indian
medical undergraduates: Association with emotional intelligence
and perceived stress. J Educ Health Promot 2020;9:202.
14. Roncero C, Egido A, Rodríguez‑Cintas L, Pérez‑Pazos J,
Collazos F, Casas M. Substance use among medical students:
A literature review 1988‑ 2013. Actas Esp Psiquiatr 2015;43:109‑21.
15. MacLean L, Booza J, Balon R. The impact of medical school on
student mental health. Acad Psychiatry 2016;40:89‑91.
16. Alebachew W, Semahegn A, Ali T, Mekonnen H. Prevalence,
associated factors and consequences of substance use among
health and medical science students of Haramaya University,
eastern Ethiopia, 2018: A cross‑sectional study. BMC Psychiatry
2019;19:343.
17. Jafari N, Loghmani A, Montazeri A. mental health of medical
students in different levels of training. Int J Prev Med
2012;3:S107‑12.
18. Silva V, Costa P, Pereira I, Faria R, Salgueira AP, Costa MJ, et al.
Depression in medical students: Insights from a longitudinal
study. BMC Med Educ 2017;17:184.
19. Steiner‑Hofbauer V, Holzinger A. How to cope with the
challenges of medical education? Stress, depression, and coping in
undergraduate medical students. Acad Psychiatry 2020;44:380‑7.
20. Worly B, Verbeck N, Walker C, Clinchot DM. Burnout,
perceived stress, and empathic concern: Differences in female
and male Millennial medical students. Psychol Health Med
2019;24:429‑38.
21. Brenneisen Mayer F, Souza Santos I, Silveira PS, Itaqui Lopes MH,
de Souza AR, Campos EP, et al. Factors associated to depression
and anxiety in medical students: A multicenter study. BMC Med
Educ 2016;16:282.
22. Cipra C, Müller‑Hilke B. Testing anxiety in undergraduate
medical students and its correlation with different learning
approaches. PLoS One 2019;14:e0210130.
23. Shokrpour N, Bazrafcan L, Ardani AR, Nasiraei S. The factors
affecting academic burnout in medical students of Mashahd
University of Medical Sciences in 2013‑2015. J Educ Health Promot 2020;9:232.
24. Karimi N, Saadat‑Gharin S, Tol A, Sadeghi R, Yaseri M,
Mohebbi B. A problem‑based learning health literacy intervention
program on improving health‑promoting behaviors among girl
students. J Educ Health Promot 2019;8:251.
25. Papazisis G, Siafis S, Tsakiridis I, Koulas I, Dagklis T, Kouvelas D.
Prevalence of cannabis use among medical students: A systematic
review and meta‑analysis. Subst Abuse 2018;12:1178221818805977.
26. Bert F, Lo Moro G, Corradi A, Acampora A, Agodi A, Brunelli L,
et al. Prevalence of depressive symptoms among Italian medical
students: The multicentre cross‑sectional “PRIMES” study. PLoS
One 2020;15:e0231845.
27. Messina G, Quercioli C, Troiano G, Russo C, Barbini3 E, Nisticò F,
et al. Italian medical students quality of life: Years 2005‑2015. Ann
Ig 2016;28:245‑51.
28. Pighi M, Pontoni G, Sinisi A, Ferrari S, Mattei G, Pingani L, et al.
Use and propensity to use substances as cognitive enhancers in
Italian medical students. Brain Sci 2018;8:197.
29. Volpe U, Ventriglio A, Bellomo A, Kadhum M, Lewis T,
Molodynski A, et al. Mental health and wellbeing among Italian
medical students: A descriptive study. Int Rev Psychiatry
2019;31:569‑73.
30. Beck AT, Beck RW. Screening depressed patients in family
practice. A rapid technic. Postgrad Med 1972;52:81‑5.
31. Spielberger C. Manual for the State‑Trait Anxiety
Inventory (STAI) (Form Y: Self‑Evaluation Questionnaire).
Redwood City, CA: Mind Garden; 1983.
32. Cohen S, Kamarck T, Mermelstein R. A global measure of
perceived stress. J Health Soc Behav 1983;24:385‑96.
33. Binkin N, Gigantesco A, Ferrante G, Baldissera S. Depressive
symptoms among adults 18‑69 years in Italy: Results from the
Italian behavioural risk factor surveillance system, 2007. Int J
Public Health 2010;55:479‑88.
34. Istat. Mental Health at Various Stages of Life; 2018.
Available from: https://www.istat.it/en/archivio/219812
. [Last accessed on 2020 May 24].
35. Kuehner C. Why is depression more common among women
than among men? Lancet Psychiatry 2017;4:146‑58.
36. Ribeiro AG, Cruz LP, Marchi KC, Tirapelli CR, Miasso AI.
Antidepressants: Use, adherence and awareness among medical
students. Cien Saude Colet 2014;19:1825‑33.
37. Nalçakan AD, Şahin EA, Yalcinkaya OK, Ak S. Antidepressant
awareness and stigmatizing attitudes toward depression and
antidepressants, a comparison between first and sixth‑year medical
students. Int J Soc Psychiatry 2021;2021 Jan 5;20764020985545.
Online ahead of print.
38. Altannir Y, Alnajjar W, Ahmad SO, Altannir M, Yousuf F,
Obeidat A, et al. Assessment of burnout in medical undergraduate
students in Riyadh, Saudi Arabia. BMC Med Educ 2019;19:34.
39. Leombruni P, Di Lillo M, Miniotti M, Picardi A, Alessandri G,
Sica C, et al. Measurement properties and confirmatory factor
analysis of the Jefferson Scale of Empathy in Italian medical
students. Perspect Med Educ 2014;3:419‑30.