Stress and Depression Among Medical Students During Four Years in Medical School

Background:

Undergraduate medical education is a unique experience with significant time commitment, multiple stressors, and challenges with long lasting personal and professional impact. It has been shown that medical students are vulnerable to certain poor health behaviors, while also facing increased psychological stress, symptoms of depression, and related health complications. There is a paucity of data on longitudinal change in psychological stress during medical school years.

Methods:

This single center longitudinal study began in September 2009 with the entering cohort (2013 batch). A self‐administered survey that captured demographics, validated tools to screen for symptoms of depression (PHQ9), and stress (Perceived Stress Scale,PSS) was conducted. Then yearly same survey was done at annual health screening or electronically. Here we are presenting longitudinal data on our first cohort during 4 years of medical school.

Results:

Number of participants was 110(>90%) in 2009 and it decreased to 70 (60%) to the beginning of fourth year in 2012. Although medical students have lower mean score in stress scale (perceived stress scale) in general, there was an increase unadjusted stress score at the beginning of second year and then again beginning of fourth year (highest). Stress score change from baseline to the beginning of fourth year was statistically significant (11.42 +/‐ 5.75 vs 15.46 +/‐ 6.43, p = <0.0001). Similarly students don’t meet criteria for depression but statistically significant increase in unadjusted PHQ‐9 score (depression screen) beginning of second (2.18 +/‐ 2.14 vs 3.48 +/‐ 4.60, p = 0.0128) year and fourth year (2.18 +/‐ 2.14 vs 3.42 +/‐ 3.83, p = 0.0070) compared to baseline. During four year period 1 student met criteria for severe depression and 5 for moderately severe depression and 7 for mild depression.

Conclusions:

Screening tests for stress and depression showed that medical students have increased stress and depression score at the beginning of second and fourth yearS. We as teachers in hospital medicine should be aware of these subtle changes to become effective teachers in the wards and classrooms.