Common mental disorders in medical students: A repeated cross-sectional study over six years / Transtorno mental comum em estudantes de medicina: Estudo transversal por inquéritos repetidos durante seis anos

Summary Introduction: Becoming a medical doctor is a very complex process. Factors related to the student's personality, the educational process and the daily experience with death contribute to peculiar psycho-emotional experiences, not always properly investigated during medical training. Objective: To estimate the prevalence of common mental disorders (CMD) and associated factors, over six years of medical undergraduate course among all students of a class at a public university in Brazil. Method: Cross-sectional study based on repeated surveys. All 40 students enrolled in 2006 in the first year of our medical school were included and evaluated annually until 2011 using the SRQ-20 and a structured questionnaire prepared by the authors on sociodemographic, personal and educational aspects. We performed logistic regression and correspondence analysis. Results: The 40 freshmen in the first evaluation had a mean age of 20 years (SD=2.4), 57.5% were female, and 41% were approved after taking their third entrance exam. The prevalence of CMD increased over the years: from 12.5% in the first year to 43.2% in the fifth. The following variables were potentially associated with CMD: female sex (PR=1.38), originating from capital cities (PR=1.97), the program was less than they expected (PR=3.20), discomfort with program activities (PR=2.10), dissatisfaction with teaching strategies (PR=1.38), and feeling that the program is not a source of pleasure (PR=2.06), being R2=28.8% and AIC=60.04. Conclusion: The factors potentially associated with the high prevalence of CMD were those related to medical training, showing that it is necessary to implement preventive measures and review the educational process in order to reduce the damages caused by the development of CMD.

Resumo Introdução: Tornar-se médico é um processo bastante complexo. Fatores relacionados a personalidade do aluno, processo educacional e experiência diária com dor e morte contribuem para vivências psicoemocionais peculiares, nem sempre devidamente investigadas durante a formação médica. Objetivo: Estimar a prevalência de transtornos mentais comuns (TMC) e fatores associados durante os seis anos de graduação entre todos os estudantes de uma turma de medicina de uma universidade pública brasileira. Método: Estudo transversal por inquéritos repetidos. Todos os 40 alunos admitidos em 2006 na escola médica pesquisada foram incluídos no estudo e avaliados anualmente até 2011 através do SRQ-20 e de um questionário estruturado elaborado pelos autores sobre aspectos sócio-demográficos, pessoais e educacionais. Realizadas regressão logística e análise de correspondência. Resultados: Os 40 calouros na primeira avaliação tinham média de idade de 20 anos (DP=2,4), sendo 57,5% do sexo feminino e 41% aprovados no terceiro vestibular. A prevalência TMC aumentou ao longo do curso: de 12,5% no primeiro ano para 43,2% no quinto. As seguintes variáveis foram potencialmente associadas à TMC no quinto ano: sexo feminino (RP=1,38), originários de capitais (RP=1,97), achar o curso menos do que esperava (RP=3,20), ter desconforto com as atividades do curso (RP=2,10), estar insatisfeito com estratégias de ensino (RP=1,38) e sentir que o curso não é fonte de prazer (RP=2,06) sendo R2=28,8% e AIC=60,04. Conclusão: Fatores potencialmente associados com alta prevalência de TMC foram relacionados à formação médica, mostrando que é necessário implementar medidas preventivas e revisão do processo educacional no intuito de reduzir os danos causados pelo desenvolvimento de TMC.

Common mental disorders in medical students: A repeated cross-sectional study over six years.

INTRODUCTION: Becoming a medical doctor is a very complex process. Factors related to the student's personality, the educational process and the daily experience with death contribute to peculiar psycho-emotional experiences, not always properly investigated during medical training. OBJECTIVE: To estimate the prevalence of common mental disorders (CMD) and associated factors, over six years of medical undergraduate course among all students of a class at a public university in Brazil. METHOD: Cross-sectional study based on repeated surveys. All 40 students enrolled in 2006 in the first year of our medical school were included and evaluated annually until 2011 using the SRQ-20 and a structured questionnaire prepared by the authors on sociodemographic, personal and educational aspects. We performed Poisson regression and correspondence analysis [corrected]. RESULTS: The 40 freshmen in the first evaluation had a mean age of 20 years (SD=2.4), 57.5% were female, and 41% were approved after taking their third entrance exam. The prevalence of CMD increased over the years: from 12.5% in the first year to 43.2% in the fifth. The following variables were potentially associated with CMD: female sex (PR=1.38), originating from capital cities (PR=1.97), the program was less than they expected (PR=3.20), discomfort with program activities (PR=2.10), dissatisfaction with teaching strategies (PR=1.38), and feeling that the program is not a source of pleasure (PR=2.06), being R2=28.8% and AIC=60.04. CONCLUSION: The factors potentially associated with the high prevalence of CMD were those related to medical training, showing that it is necessary to implement preventive measures and review the educational process in order to reduce the damages caused by the development of CMD.

Saúde Mental de Estudantes de Escolas Médicas com Diferentes Modelos de Ensino / Medical Students’ Mental Health under Different Educational Models

RESUMO Objetivos Avaliar a saúde mental dos estudantes, estratégias defensivas, fontes de estresse e alívio associadas a diferentes processos educacionais. Método Estudo qualitativo e transversal realizado em fevereiro de 2014 por meio de grupos focais e questionário semiestruturado com 78 estudantes do terceiro semestre de duas escolas médicas numa mesma universidade pública: uma com 53 anos, na capital, com modelo de ensino tradicional, e a outra com três anos, no interior,com modelo de Aprendizagem Baseada em Problemas (ABP). Foi realizada análise descritiva dos dados sociodemográficos, psicoemocionais e processo educacional do questionário e análise de conteúdo temática, além de interpretação psicodinâmica dos dados dos grupos focais. Resultados Responderam ao questionário 38 alunos da escola tradicionale 40 daABP, sendo a maioria do sexo masculino (52,6%), com idade 22+2 anos e solteiros (85%). Dois grupos focais com oito alunos de cada escola revelaram motivações, fontes de estresse e de alívio semelhantes entre os alunos, porém sofrimento psíquico menor nos alunos da ABP, que também referiram maior aproximação de seus professores e pactuação das tarefas. Conclusão O processo educacional foi associado a sofrimento psíquico por alunos de ambos os grupos.

ABSTRACT Objectives To evaluate student mental health, defensive strategies, sources of stress, and relief associated with different educational processes. Methods A qualitative and cross-sectional study was carried out in February 2014 through focus groups and semi-structured questionnaireson 78 students in the 3rd semester at two medical schools in the same public university: one with a 53-year history based in the state capital and that uses traditional teaching models, and the other founded only 3 years ago, located in the interior of the state and using Problem Based Learning (PBL). We carried out a descriptive analysis of the dataemergent from the questionnaire andperformed thematic content analysis, along with a psychodynamicinterpretationof data fromfocus groups. Results 38 students from the traditional school and 40 students from the PBL school answered the questionnaire. Most were men(52.6%) aged 22+2years and single(85%). Twofocus groups with8students fromeach schoolrevealedsimilar motivations, sources of stress andreliefamong students, but less psychological distresswas registered inPBLstudents,who reported greatercloseness with teachersand agreementon tasks. Conclusion Educationalprocesseswere associated withpsychological distress amongstudentsin both groups.

Common mental disorders and associated factors among final-year healthcare students / Transtornos mentais comuns e fatores associados entre estudantes de saúde do último ano

Objective: to assess the prevalence of common mental disorder (CMD) and to identify potential associated factors among medical, dental and nursing students. Methods: a cross-sectional study conducted in a public university in Northeast Brazil with 172 undergraduate students of the last three semesters of the medicine, dentistry and nursing courses, in February 2010, using the Self Reporting Questionnaire (SRQ-20) and a structured questionnaire developed by the authors. Logistic regression was performed for data analysis. Results: the prevalence of CMD was 33.7%. The courses presented no differences in CMD prevalence. The logistic regression analysis showed a strong association of the following variables with CMD: female (OR=4.34), lack of good expectations regarding the future (OR=5.83), course as not a source of pleasure (OR=7.52) and feeling emotionally tense (OR=11.23). Conclusion: the high prevalence suggests that immediate preventive measures should be implemented, such as the setting up of psycho-pedagogic support services for students, and teacher development programs. .

Objetivo: determinar a prevalência de transtorno mental comum (TMC) e identificar potenciais fatores associados entre estudantes de medicina, odontologia e enfermagem. Métodos: estudo transversal realizado em uma universidade pública no Nordeste do Brasil com 172 alunos de graduação dos últimos três semestres de Medicina, Odontologia e Enfermagem, em fevereiro de 2010, utilizando o Self Reporting Questionnaire (SRQ-20) e um questionário estruturado desenvolvido pelos autores. A análise dos dados foi realizada por regressão logística. Resultados: a prevalência de TMC foi de 33,7%. Os cursos não apresentaram diferenças na prevalência de TMC. A regressão logística mostrou uma forte associação entre as seguintes variáveis com TMC: sexo feminino (OR=4,34), não ter boas expectativas em relação ao futuro (OR=5,83), curso não ser uma fonte de prazer (OR=7,52) e sentir-se emocionalmente tenso (OR=11,23). Conclusão: a alta prevalência de TMC sugere que medidas preventivas imediatas devam ser implementadas, como: a criação de serviços de apoio psicopedagógico para alunos e programas de desenvolvimento docente. .

Common mental disorders and associated factors among final-year healthcare students.

OBJECTIVE: to assess the prevalence of common mental disorder (CMD) and to identify potential associated factors among medical, dental and nursing students. METHODS: a cross-sectional study conducted in a public university in Northeast Brazil with 172 undergraduate students of the last three semesters of the medicine, dentistry and nursing courses, in February 2010, using the Self Reporting Questionnaire (SRQ-20) and a structured questionnaire developed by the authors. Logistic regression was performed for data analysis. RESULTS: the prevalence of CMD was 33.7%. The courses presented no differences in CMD prevalence. The logistic regression analysis showed a strong association of the following variables with CMD: female (OR=4.34), lack of good expectations regarding the future (OR=5.83), course as not a source of pleasure (OR=7.52) and feeling emotionally tense (OR=11.23). CONCLUSION: the high prevalence suggests that immediate preventive measures should be implemented, such as the setting up of psycho-pedagogic support services for students, and teacher development programs.

Burnout Syndrome and associated factors among medical students: a cross-sectional study.

OBJECTIVES: To assess the prevalence and levels of burnout syndrome among medical students at the Universidade Federal de Sergipe-Brazil and to identify associated factors. METHODS: A cross-sectional study was performed with randomly selected students in 2009. The Maslach Burnout Inventory/Student Survey (MBI-SS) and a structured questionnaire on socio-demographic characteristics, the educational process, and individual aspects were used. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis. RESULTS: The prevalence of burnout was 10.3% (n = 369). The prevalence was higher among those who did not have confidence in their clinical skills (Odds Ratio-OR = 6.47), those who felt uncomfortable with course activities (OR = 5.76), and those who did not see the coursework as a source of pleasure (OR = 4.68). CONCLUSION: There was a significant prevalence of burnout among the medical students studied. Three variables, in particular, were associated with burnout and were directly related to the medical education process. Preventive and intervention measures must be adopted, and longitudinal studies should be conducted.

[Depressive symptoms among medical intern students in a Brazilian public university]. / Sintomas depressivos entre internos de medicina em uma universidade pública Brasileira.

OBJECTIVE: To estimate, among Medical School intern students, the prevalence of depressive symptoms and their severity, as well as associated factors. METHODS: Cross-sectional study in May 2008, with a representative sample of medical intern students (n = 84) from Universidade Federal de Sergipe (UFS). Beck Depression Inventory (BDI) and a structured questionnaire containing information on sociodemographic variables, teaching-learning process, and personal aspects were used. The exploratory data analysis was performed by descriptive and inferential statistics. Finally, the analysis of multiple variables by logistic regression and the calculation of simple and adjusted ORs with their respective 95% confidence intervals were performed. RESULTS: The general prevalence was 40.5%, with 1.2% (95% CI: 0.0-6.5) of severe depressive symptoms; 4.8% (95% CI: 1.3-11.7) of moderate depressive symptoms; and 34.5% (95% CI: 24.5-45.7) of mild depressive symptoms. The logistic regression revealed the variables with a major impact associated with the emergence of depressive symptoms: thoughts of dropping out (OR 6.24; p = 0.002); emotional stress (OR 7.43;p = 0.0004); and average academic performance (OR 4.74; p = 0.0001). CONCLUSION: The high prevalence of depressive symptoms in the study population was associated with variables related to the teaching-learning process and personal aspects, suggesting immediate preemptive measures regarding Medical School graduation and student care are required.

Sintomas depressivos entre internos de medicina em uma universidade pública brasileira / Depressive symptoms among medical intern students in a Brazilian public university

OBJETIVO: Estimar entre internos de medicina a prevalência de sintomas depressivos e sua intensidade, além dos fatores associados. MÉTODOS: Estudo transversal, em maio de 2008, com amostra representativa dos internos de medicina (n = 84) da Universidade Federal de Sergipe (UFS). Foram utilizados o Inventário de Depressão de Beck (IDB) e um questionário estruturado contendo informações sobre variáveis sociodemográficas, processo ensino-aprendizagem e aspectos pessoais. A análise exploratória dos dados foi realizada através de Estatística Descritiva e Inferencial. Finalmente foi realizada a análise de múltiplas variáveis através de regressão logística e cálculo das OR simples e ajustadas com seus respectivos intervalos de 95 por cento de confiança. RESULTADOS: A prevalência geral foi de 40,5 por cento, dos quais: 1,2 por cento (IC 95 por cento 0,0-6,5) foram de sintomas depressivos graves; 4,8 por cento (IC 95 por cento 1,3-11,7) de moderados; e 34,5 por cento de leves (IC 95 por cento 24,5-45,7). A regressão logística revelou as variáveis de maior impacto associadas ao aparecimento de sintomas depressivos: pensamento de abandonar o curso (OR 6,24; p = 0,002); tensão emocional (OR 7,43; p = 0,0004); e desempenho acadêmico regular (OR 4,74; p = 0,0001). CONCLUSÃO: A elevada prevalência de sintomas depressivos na população estudada esteve associada com variáveis relacionadas ao processo ensino-aprendizagem e aspectos pessoais, sugerindo a necessidade de medidas preventivas imediatas referentes à formação médica e à assistência ao estudante.

OBJECTIVE: To estimate, among Medical School intern students, the prevalence of depressive symptoms and their severity, as well as associated factors. METHODS: Cross-sectional study in May 2008, with a representative sample of medical intern students (n = 84) from Universidade Federal de Sergipe (UFS). Beck Depression Inventory (BDI) and a structured questionnaire containing informationon sociodemographic variables, teaching-learning process, and personal aspects were used. The exploratory data analysis was performed by descriptive and inferential statistics. Finally, the analysis of multiple variables by logistic regression and the calculation of simple and adjusted OR swith their respective 95 percent confidence intervals were performed. RESULTS: The general prevalence was 40.5 percent, with 1.2 percent (95 percent CI: 0.0-6.5) of severe depressive symptoms; 4.8 percent (95 percent CI: 1.3-11.7) of moderate depressive symptoms; and 34.5 percent (95 percent CI: 24.5-45.7) of mild depressive symptoms. The logistic regression revealed the variables with a major impact associated with the emergence of depressive symptoms: thoughts of dropping out (OR 6.24; p = 0.002); emotional stress (OR 7.43;p = 0.0004); and average academic performance (OR 4.74; p = 0.0001). CONCLUSION: The high prevalence of depressive symptoms in the study population was associated with variables related to the teaching-learning process and personal aspects, suggesting immediate preemptive measures regarding Medical School graduation and student care are required.

Burnout Syndrome and associated factors among medical students: a cross-sectional study

OBJECTIVES: To assess the prevalence and levels of burnout syndrome among medical students at the Universidade Federal de Sergipe-Brazil and to identify associated factors. METHODS: A cross-sectional study was performed with randomly selected students in 2009. The Maslach Burnout Inventory/Student Survey (MBI-SS) and a structured questionnaire on socio-demographic characteristics, the educational process, and individual aspects were used. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis. RESULTS: The prevalence of burnout was 10.3% (n = 369). The prevalence was higher among those who did not have confidence in their clinical skills (Odds Ratio-OR = 6.47), those who felt uncomfortable with course activities (OR = 5.76), and those who did not see the coursework as a source of pleasure (OR = 4.68). CONCLUSION: There was a significant prevalence of burnout among the medical students studied. Three variables, in particular, were associated with burnout and were directly related to the medical education process. Preventive and intervention measures must be adopted, and longitudinal studies should be conducted.

Common mental disorders among medical students at Universidade Federal de Sergipe: a cross-sectional study.

OBJECTIVE: Estimate the prevalence of common mental disorder and its associated factors among medical students of the Universidade Federal de Sergipe. METHOD: A cross-sectional study was carried out, applying Self Reporting Questionnaire-20 to 473 students from the 512 medical students enrolled in 2006 and compared with compared with a structured questionnaire by the authors containing information on the socio-demographic characteristics, the teaching-learning process and the psycho-emotional experiences of the students. Freshmen were excluded after initial comparison with the students already exposed to the medical course. Statistical analysis by multiple logistic regression after calculating simple and adjusted odds ratio (OR). RESULTS: The general prevalence of common mental disorder was 40% (n = 473); after exclusion of the freshmen it increased to 42.5% among students from the 2nd to the 12th semester. It was higher among those who did not have faith in their acquisition of the skills needed to become a good doctor (OR = 2.82), who felt less comfortable about course activities (OR = 3.75), who considered themselves emotionally stressed (OR = 2.14), among those who did not consider themselves happy (OR = 2.85), who believed that the course did not match their expectations (OR = 1.64) and those who had a prior diagnosis of mental disorder by a psychiatrist (OR = 3.78). CONCLUSION: The results suggest the necessity of changes to the teaching-learning process and the establishment of a preventive mental health program for medical students.

Common mental disorders among medical students at Universidade Federal de Sergipe: a cross-sectional study / Transtornos mentais comuns entre estudantes de medicina da Universidade Federal de Sergipe: estudo transversal

OBJECTIVE: Estimate the prevalence of common mental disorder and its associated factors among medical students of the Universidade Federal de Sergipe. METHOD: A cross-sectional study was carried out, applying Self Reporting Questionnaire-20 to 473 students from the 512 medical students enrolled in 2006 and compared with compared with a structured questionnaire by the authors containing information on the socio-demographic characteristics, the teaching-learning process and the psycho-emotional experiences of the students. Freshmen were excluded after initial comparison with the students already exposed to the medical course. Statistical analysis by multiple logistic regression after calculating simple and adjusted odds ratio (OR). RESULTS:The general prevalence of common mental disorder was 40 percent (n = 473); after exclusion of the freshmen it increased to 42.5 percent among students from the 2nd to the 12th semester. It was higher among those who did not have faith in their acquisition of the skills needed to become a good doctor (OR = 2.82), who felt less comfortable about course activities (OR = 3.75), who considered themselves emotionally stressed (OR = 2.14), among those who did not consider themselves happy (OR = 2.85), who believed that the course did not match their expectations (OR = 1.64) and those who had a prior diagnosis of mental disorder by a psychiatrist (OR = 3.78). CONCLUSION: The results suggest the necessity of changes to the teaching-learning process and the establishment of a preventive mental health program for medical students.

OBJETIVO:Estimar a prevalência de transtorno mental comum e fatores associados entre estudantes de Medicina da Universidade Federal de Sergipe. MÉTODO: Estudo transversal com 473 dos 512 matriculados em 2006, aplicando o Self Reporting Questionnaire-20 e um questionário estruturado sobre características sociodemográficas, processo ensino-aprendizagem e vivências psicoemocionais. Os calouros foram excluídos após comparação inicial com os alunos do 2> ao 12> períodos. Análise estatística por regressão logística múltipla, após estatística descritiva e cálculo das ORs simples e ajustadas. RESULTADOS: A prevalência de transtorno mental comum geral foi de 40 por cento (n = 473), mas com a retirada dos calouros, aumentou para 42,5 por cento (n = 433) entre os alunos do 2> ao 12> semestre, sendo maior entre aqueles que não acreditavam ter adquirido habilidades para se tornarem bons médicos (OR = 2,82), que se sentiam pouco confortáveis com as atividades do curso (OR = 3,75), que se consideravam emocionalmente tensos (OR = 2,14), nos que não se consideravam felizes (OR = 2,85), nos que achavam que o curso era menos do que esperavam (OR = 1,64) e nos que tiveram diagnóstico prévio de transtorno mental feito por psiquiatra (OR = 3,78). CONCLUSÃO: Os resultados sugerem a necessidade de mudanças no processo ensino-aprendizagem, bem como estruturação de programas para cuidar da saúde mental dos estudantes.