Elsevier

Public Health

Volume 132, March 2016, Pages 92-100
Public Health

Original Research
Mental health among currently enrolled medical students in Germany

https://doi.org/10.1016/j.puhe.2015.12.014Get rights and content

Highlights

  • First year medical students have poorer mental health compared to general population, but better than among physicians.

  • Prevalence of psychotropic substances use with 10.7% was relatively high, however lower than reported among physicians.

  • Higher rates of mental disorders were presented among women and among those expecting financial difficulties.

  • Results calls for promotion of mental health with special emphasis on vulnerable groups.

Abstract

Objectives

The study identifies the prevalence of common mental disorders according to the patient health questionnaire (PHQ) and the use of psychotropic substances in a sample of currently enrolled medical students.

Study design

A cross-sectional survey with a self-administrated questionnaire.

Methods

All newly enrolled medical students at the University of Dusseldorf, with study beginning either in 2012 or 2013, respectively, were invited to participate. The evaluation was based on 590 completed questionnaires. Mental health outcomes were measured by the PHQ, including major depression, other depressive symptoms (subthreshold depression), anxiety, panic disorders and psychosomatic complaints. Moreover, information about psychotropic substances use (including medication) was obtained. Multiple logistic regression analysis was used to estimate associations between sociodemographic and socio-economic factors and mental health outcomes.

Results

The prevalence rates, measured by the PHQ, were 4.7% for major depression, 5.8% for other depressive symptoms, 4.4% for anxiety, 1.9% for panic disorders, and 15.7% for psychosomatic complaints. These prevalence rates were higher than those reported in the general population, but lower than in medical students in the course of medical training. In all, 10.7% of the students reported regular psychotropic substance use: 5.1% of students used medication ‘to calm down,’ 4.6% ‘to improve their sleep,’ 4.4% ‘to elevate mood,’ and 3.1% ‘to improve cognitive performance.’ In the fully adjusted model, expected financial difficulties were significantly associated with poor mental health (odds ratio [OR]: 2.14; 95% confidence interval [CI]: 1.31–3.48), psychosomatic symptoms (OR:1.85; 95% CI: 1.11–3.09) and psychotropic substances use (OR: 2.68; 95% CI: 1.51–4.75).

Conclusion

The high rates of mental disorders among currently enrolled medical students call for the promotion of mental health, with a special emphasis on vulnerable groups.

Introduction

Recent research has indicated an increased prevalence of common mental disorders and a lower quality of life in medical students during medical school training compared with the general population1, 2, 3, 4 or with students of other disciplines.5, 6

The stress of medical training is widely acknowledged, with an intensive and time-consuming workload, and large intellectual and emotional demands. Previous studies have suggested that higher academic load, long working hours, a competitive environment, work–life conflict, lack of recreational activities, being away from home, and financial problems may have an adverse effect on students' mental health.7, 8, 9, 10, 11, 12

A higher prevalence of mental health disorders among medical students has been reported worldwide. A systematic review by Dyrbye et al.4 showed that psychological distress among United States and Canadian medical students was consistently higher than that among the age-matched general population. Both in European countries and in Asia, studies have shown more or less similar patterns. Epidemiological data of poor mental health among medical students are available from India,13 China,14 Malaysia,15 Pakistan,16 and Saudi Arabia.17 Similar results have been provided from Great Britain,18 the Netherlands,19 and Norway.20, 21 All of these studies consistently demonstrate higher overall psychological distress and poorer mental health in terms of depressive symptoms, suicidal ideation, or psychosomatic complaints among medical students compared to both the general population or age-matched peers.

Negative consequences of poor mental health, such as poorer academic performance, alcohol and substance abuse, drop out, and suicide, have been reported among medical students.20, 22 It was established that students who were distressed in the beginning of educational programs were more likely to remain so throughout the training period.23 Furthermore, poor mental health due to medical education has been shown to be a predictor of later distress in the physician.20, 24, 25 On this account, identification of the health-relevant factors from early on in their development is highly important, not just for improved health, but also for the further career development of medical students.

Still, it is unknown to what extent work stress during medical education imposes a deleterious strain on medical students. Here we report about mental health of recently enrolled medical students. Particularly, the prevalence of common mental disorders and psychotropic drug medication among medical students immediately before starting medical education was examined. Moreover, the differences by sociodemographic and socio-economic factors were accounted for.

Section snippets

Study design

A cross-sectional study analyzing the prevalence of common mental disorders among currently enrolled medical students. This baseline examination is a part of the prospective cohort study ‘Healthy Learning in Duesseldorf’ (HeLD), accompanying the curriculum reform at the medical faculty of the Heinrich Heine University of Duesseldorf in Germany. This cohort study follows medical students from their first to their last day of medical school, with particular focus on poor mental health associated

Results

A total of 592 students were included in the study. Descriptive statistics of the study variables by gender are presented in Table 2. Mean age of our study sample was 21.13 years (SD 3.91), with significantly (almost one year) younger women in relation to men. The average academic performance, as measured by Abitur grade, was 1.59 (SD 0.70), with slightly better academic performance among women. The majority of first-year medical students (65.6%) came from academic households. Fathers were more

Discussion

The aim of the current investigation was to identify the prevalence of common mental disorders and associated socio-economic factors in a German medical student population, beginning at the first day of their medical training. Higher rates of mental health disorders were presented among women and among students expecting financial difficulties. As our investigation was provided at the very beginning of the educational program, the influence of the adverse study environment could be particularly

Ethical approval

The project was approved by the Ethics Committee of Heinrich Heine University, Germany (No. 4041 ‘Healthy learning in Duesseldorf’ Project).

Funding

None declared.

Competing interests

The authors declare no potential conflicts of interest.

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