Abstract
BackgroundSymptoms of depression and anxiety experienced by undergraduate medical students have become a prominent concern. Evidence about students’ depression and anxiety including prevalence, trajectory during medical education, gender differences and comparisons with age-matched peers is conflicting. However few studies of medical students’ mental health specify the precise time of assessment. Proximity to examinations may be relevant. Precise identification of the time of data collection might help explain contradictory findings and facilitate provision of more timely support.MethodsThis study addressed whether:Proximity of final examinations affected students’ depression and anxiety symptomsMales and females differed in this respect.We analysed data provided by 446 final year students from 6 UK medical schools. These students were a subset of data provided by 14 UK medical schools which participated in an online survey comparing first and final year students and in which final year response rates exceeded 30%. We used the Hospital Anxiety and Depression Scale to assess symptoms of depression and anxiety and the norms to indicate potentially clinically relevant cases. We grouped students into those for whom final exams were imminent i.e. within 2 months of completing the survey (n = 164) and those for whom exams were more distant or had been taken (n = 282). We used parametric and non-parametric tests to compare both groups and gender differences in respect of depression and anxiety sum scores and cases rates.ResultsFor both depression and anxiety male and female students facing imminent final exams recorded greater prevalence and significantly higher mean scores. The effect size of differences for anxiety were large. No substantial gender differences were found for depression. Regardless of the timing of final exams female students recorded both significantly higher mean scores and clinically relevant rates for anxiety.ConclusionsProximity to final exams negatively affected the mental health of both male and female final year students. The study suggests that there may be times in the undergraduate medical curriculum when additional or targeted support is needed. It also highlights the need for research to provide a greater specificity of context when investigating medical students’ mental health.
Highlights
Symptoms of depression and anxiety experienced by undergraduate medical students have become a prominent concern
For the purpose of the analysis we divided the final year students into two groups: those who had their final exams within 2 months after participating in the survey and those for whom all final exams were more than 2 months away or who had taken either all or most their final exams when completing the survey
We selected 6 schools in which response rates were greater than 30% for final year students and for which we had details of the timing of final exams
Summary
Symptoms of depression and anxiety experienced by undergraduate medical students have become a prominent concern. The authors noted the relatively poor quality of studies, the use of different validated instruments which may not be entirely comparable, failure to report the cut-offscores used to indicate severity or otherwise of depression or anxiety and the use of varying cut-offscores for validated instruments. They indicated that better quality studies tended to report lower prevalence [7]. Studies of undergraduate medical students, undertaken in different countries, suggest that students experience increasing mental health issues including symptoms of depression and anxiety as their course progresses [11, 12]. Most studies have been cross-sectionaland where longitudinal studies have been undertaken, they are generally based in a single institution making generalisation difficult [16, 17]
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