Stress and depression among medical students: a cross-sectional study

OBJECTIVE To assess the exposure to different stressors and the prevalence of depression among medical students at different levels of education, taking gender differences into account. DESIGN Students were asked to complete a new stress inventory called the Higher Education Stress Inventory (HESI), the Major Depression Inventory (MDI), slightly modified, and questions on suicidal ideation developed by Meehan. SETTING The study was carried out at the Karolinska Institute Medical University, Stockholm, Sweden. Matched controls from the general population were used. PARTICIPANTS All registered students in Years 1, 3 and 6 were enrolled in the study (n = 342). The response rate was 90.4%. RESULTS Year 1 students gave high ratings to the workload and lack of feedback stressors. Year 3 students gave high ratings to 'Worries about future endurance/competence' and 'Pedagogical shortcomings'. In Year 6, both the latter factors were rated highly, but Year 6 students also gave higher ratings than the 2 other groups to 'Non-supportive climate'. In all 3 cohorts students complained of lack of feedback. Female students gave higher ratings than males to 4 out of 7 factors. Several stress factors were identified as being associated with depression. The prevalence of depressive symptoms among students was 12.9%, significantly higher than in the general population, and was 16.1% among female students versus 8.1% among males. A total of 2.7% of students had made suicide attempts, but none during the previous year. CONCLUSION Year 1 students indicated experiencing the highest degree of pressure from studies. A gender difference regarding stress levels was also seen, where women reported higher levels of stress than men. Medical students had higher depression rates than the general population, and women students had higher rates than men.