Abstract
North American medical students are more depressed and anxious than their peers. In the UK, the regulator now has responsibility for medical students, which may potentially increase scrutiny of their health. This may either help or hinder medical students in accessing appropriate care. The prevalences of anxiety, depression and psychological distress in medical students outside North America are not clear. A better understanding of the prevalence of, risk factors for and results of psychological distress will guide the configuration of support services, increasingly available for doctors, for medical students too. The aim of this study was to examine the prevalences of depression, anxiety and psychological distress in students in medical schools in the UK, Europe and elsewhere in the English-speaking world outside North America. A systematic review was conducted using search terms encompassing psychological distress amongst medical students. OvidSP was used to search the following databases: Ovid MEDLINE (R) from 1948 to October 2013; PsycINFO from 1806 to October 2013, and EMBASE from 1980 to October 2013. Results were restricted to medical schools in Europe and the English-speaking world outside North America, and were evaluated against a set of inclusion criteria including the use of validated assessment tools. The searches identified 29 eligible studies. Prevalences of 7.7-65.5% for anxiety, 6.0-66.5% for depression and 12.2-96.7% for psychological distress were recorded. The wide range of results reflects the variable quality of the studies. Almost all were cross-sectional and many did not mention ethical approval. Better-quality studies found lower prevalences. There was little information on the causes or consequences of depression or anxiety. Prevalences of psychological distress amongst medical students outside North America are substantial. Future research should move on from simple cross-sectional studies to better-quality longitudinal work which can identify both predictors for and outcomes of poor mental health in medical students.
Highlights
EPIDEMIOLOGY Pancreatic cancer is the twelfth most common cancer in the US but represents the fourth leading cause of cancer death in both men and women (Howlader et al, 2014)
The prognosis is extremely poor with a 5-year survival rate of only 6.7% as pancreatic cancer is usually asymptomatic in the early stages of disease and most cases are diagnosed relatively late (Howlader et al, 2014)
A meta-analysis including 82 studies showed that smokers have a 75% increased risk of pancreatic cancer compared to non-smokers and that the increased risk persists at least 10 years after smoking cessation (Iodice et al, 2008)
Summary
EPIDEMIOLOGY Pancreatic cancer is the twelfth most common cancer in the US but represents the fourth leading cause of cancer death in both men and women (Howlader et al, 2014). A meta-analysis from 2010 found that individuals with chronic pancreatitis had a 13.3-fold higher risk of developing pancreatic cancer and a 5.8-fold increased risk after excluding cases diagnosed within 2 years of cancer diagnosis (Raimondi et al, 2010). A recent meta-analysis which evaluated risk based on different intensities of alcohol consumption provided evidence that heavy alcohol consumption (defined as >3 drinks per day) increases risk for pancreatic cancer by 22%, independent of tobacco use, whereas moderate alcohol consumption did not carry an increased risk (Tramacere et al, 2010) Another important risk factor is body mass index, which has been associated with an elevated risk of pancreatic cancer in several studies (Larsson et al, 2007; Arslan et al, 2010; Jiao et al, 2010; Genkinger et al, 2011). A recent meta-analysis involving more than 3-million individuals identified tobacco use, obesity, and heavy alcohol, among a host of other factors, as the 3 most important risk factors for pancreatic cancer while vegetable and fruit consumption offered the greatest protection against pancreatic diseases (Alsamarrai et al, 2014)
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