RESUMEN
OBJECTIVE: To investigate any changes in mental distress levels over 20 years among medical students, as well as the clinical importance of these changes. DESIGN: Two cross-sectional surveys 20 years apart. SETTING: The surveys were performed at two Norwegian medical faculties in 1993 and 2015. PARTICIPANTS: One hundred and seventy-four first-year medical students in 1993 were compared with 169 students in 2015. MAIN OUTCOME MEASURES: Mental distress (Hopkins Symptom Checklist 5) and Mental Health Problems in Need of Treatment. RESULTS: Mental distress increased from 1993 to 2015 (p<0.001) due to a larger increase among female students, which seemed to be of clinical importance (Cohen's d=0.63). There was a significant gender difference in mental distress in 2015 (p=0.007), but not in 1993. Independent factors associated with mental distress in 2015 were female sex (p<0.001), low perceived social support from parents (p=0.023) and low perceived social support from other friends (p=0.048). Additional analyses showed that social support from friends was more important for female students than for their male peers. From 1993 to 2015, there was no significant increase in the proportion of female students reporting previous mental health problems in need of treatment (21.3% vs 27.8%), but we found a significant increase in help-seeking among those in need of treatment over these years from 30.0% (6/20) to 74.3% (26/35; p=0.003). CONCLUSIONS: We found a significant increase in mental distress among female medical students over the past 20 years, but also a promising increase in help-seeking among those in need of treatment. The strong and important association between low social support and mental distress should urge both universities and students to maintain students' social life after entering medical school.