Factors related to academic performance in medical students / Factores relacionados con el desempeño académico en estudiantes de medicina

Abstract Introduction Academic performance in medical students can be influenced by several factors, including those related to mental health and family relationships. Objective To examine the factors affecting academic performance in medical students, specifically considering potential diagnoses of depression. Method A survey was conducted among 747 fourth-year medical students. The survey included questions on sociodemographic variables, mental health, and well-being. The Patient Health Questionnaire (PHQ) was utilized, encompassing sections on depression, anxiety, panic, eating habits, alcohol consumption, and the Stress Perception Scale. Academic performance was assessed based on students' Grade Point Average (GPA). Descriptive statistics, Pearson correlation coefficients, and a linear regression model were employed for data analysis. Results The study revealed several variables significantly associated with GPA. Age (r = -.388), financial situation (r = .241), relationships with cohabitants (r = .165), and relationships with peers (r = .217) were found to have a correlation with academic performance. Additionally, repeating a course was found to be significantly associated with a person's GPA (r = .518) even after controlling for depression. Discussion and conclusion The findings indicate that robust mental health, a favorable financial situation, and positive interpersonal relationships are crucial for achieving optimal academic performance in medical students. These results emphasize the need to address mental health concerns, promote a supportive social environment, and provide financial assistance to enhance the educational outcomes of medical students.

Resumen Introducción El desempeño académico de los estudiantes de medicina puede verse influenciado por varios factores, entre ellos los relacionados con la salud mental y las relaciones familiares. Objetivo Examinar los factores que afectan el desempeño académico en estudiantes de medicina, considerando específicamente los posibles diagnósticos de depresión. Método Se realizó una encuesta entre 747 estudiantes de cuarto año de la carrera de medicina. La encuesta incluyó preguntas sobre variables sociodemográficas, salud mental y bienestar. Se utilizó el Cuestionario de Salud del Paciente (PHQ), que comprende secciones sobre depresión, ansiedad, pánico, hábitos alimentarios, consumo de alcohol y la Escala de Percepción del Estrés. El desempeño académico se evaluó con base en el promedio de calificaciones (GPA) de los estudiantes. Se emplearon estadísticas descriptivas, coeficientes de correlación de Pearson y un modelo de regresión lineal para el análisis de datos. Resultados El estudio reveló varias variables significativamente asociadas con el GPA. Se encontró que la edad (r = -.388), la situación financiera (r = .241), las relaciones con los convivientes (r = .165) y las relaciones con los compañeros (r = .217) tenían correlación con el rendimiento académico. Además, se encontró que repetir un curso estaba significativamente asociado con el GPA de una persona (r = .518) incluso después de controlar la depresión. Discusión y conclusión Los hallazgos indican que una salud mental sólida, una situación financiera favorable y relaciones interpersonales positivas son cruciales para lograr un desempeño académico óptimo en los estudiantes de medicina. Estos resultados enfatizan la necesidad de abordar los problemas de salud mental, promover un entorno social de apoyo y brindar asistencia financiera para mejorar los resultados educativos de los estudiantes de medicina.

A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression Among University Students: A Secondary Analysis of a Randomized Clinical Trial.

Importance: Guided internet-delivered cognitive behavioral therapy (i-CBT) is a low-cost way to address high unmet need for anxiety and depression treatment. Scalability could be increased if some patients were helped as much by self-guided i-CBT as guided i-CBT. Objective: To develop an individualized treatment rule using machine learning methods for guided i-CBT vs self-guided i-CBT based on a rich set of baseline predictors. Design, Setting, and Participants: This prespecified secondary analysis of an assessor-blinded, multisite randomized clinical trial of guided i-CBT, self-guided i-CBT, and treatment as usual included students in Colombia and Mexico who were seeking treatment for anxiety (defined as a 7-item Generalized Anxiety Disorder [GAD-7] score of ≥10) and/or depression (defined as a 9-item Patient Health Questionnaire [PHQ-9] score of ≥10). Study recruitment was from March 1 to October 26, 2021. Initial data analysis was conducted from May 23 to October 26, 2022. Interventions: Participants were randomized to a culturally adapted transdiagnostic i-CBT that was guided (n = 445), self-guided (n = 439), or treatment as usual (n = 435). Main Outcomes and Measures: Remission of anxiety (GAD-7 scores of ≤4) and depression (PHQ-9 scores of ≤4) 3 months after baseline. Results: The study included 1319 participants (mean [SD] age, 21.4 [3.2] years; 1038 women [78.7%]; 725 participants [55.0%] came from Mexico). A total of 1210 participants (91.7%) had significantly higher mean (SE) probabilities of joint remission of anxiety and depression with guided i-CBT (51.8% [3.0%]) than with self-guided i-CBT (37.8% [3.0%]; P = .003) or treatment as usual (40.0% [2.7%]; P = .001). The remaining 109 participants (8.3%) had low mean (SE) probabilities of joint remission of anxiety and depression across all groups (guided i-CBT: 24.5% [9.1%]; P = .007; self-guided i-CBT: 25.4% [8.8%]; P = .004; treatment as usual: 31.0% [9.4%]; P = .001). All participants with baseline anxiety had nonsignificantly higher mean (SE) probabilities of anxiety remission with guided i-CBT (62.7% [5.9%]) than the other 2 groups (self-guided i-CBT: 50.2% [6.2%]; P = .14; treatment as usual: 53.0% [6.0%]; P = .25). A total of 841 of 1177 participants (71.5%) with baseline depression had significantly higher mean (SE) probabilities of depression remission with guided i-CBT (61.5% [3.6%]) than the other 2 groups (self-guided i-CBT: 44.3% [3.7%]; P = .001; treatment as usual: 41.8% [3.2%]; P < .001). The other 336 participants (28.5%) with baseline depression had nonsignificantly higher mean (SE) probabilities of depression remission with self-guided i-CBT (54.4% [6.0%]) than guided i-CBT (39.8% [5.4%]; P = .07). Conclusions and Relevance: Guided i-CBT yielded the highest probabilities of remission of anxiety and depression for most participants; however, these differences were nonsignificant for anxiety. Some participants had the highest probabilities of remission of depression with self-guided i-CBT. Information about this variation could be used to optimize allocation of guided and self-guided i-CBT in resource-constrained settings. Trial Registration: ClinicalTrials.gov Identifier: NCT04780542.

Study protocol for pragmatic trials of Internet-delivered guided and unguided cognitive behavior therapy for treating depression and anxiety in university students of two Latin American countries: the Yo Puedo Sentirme Bien study.

BACKGROUND: Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are highly prevalent among university students and predict impaired college performance and later life role functioning. Yet most students do not receive treatment, especially in low-middle-income countries (LMICs). We aim to evaluate the effects of expanding treatment using scalable and inexpensive Internet-delivered transdiagnostic cognitive behavioral therapy (iCBT) among college students with symptoms of MDD and/or GAD in two LMICs in Latin America (Colombia and Mexico) and to investigate the feasibility of creating a precision treatment rule (PTR) to predict for whom iCBT is most effective. METHODS: We will first carry out a multi-site randomized pragmatic clinical trial (N = 1500) of students seeking treatment at student mental health clinics in participating universities or responding to an email offering services. Students on wait lists for clinic services will be randomized to unguided iCBT (33%), guided iCBT (33%), and treatment as usual (TAU) (33%). iCBT will be provided immediately whereas TAU will be whenever a clinic appointment is available. Short-term aggregate effects will be assessed at 90 days and longer-term effects 12 months after randomization. We will use ensemble machine learning to predict heterogeneity of treatment effects of unguided versus guided iCBT versus TAU and develop a precision treatment rule (PTR) to optimize individual student outcome. We will then conduct a second and third trial with separate samples (n = 500 per arm), but with unequal allocation across two arms: 25% will be assigned to the treatment determined to yield optimal outcomes based on the PTR developed in the first trial (PTR for optimal short-term outcomes for Trial 2 and 12-month outcomes for Trial 3), whereas the remaining 75% will be assigned with equal allocation across all three treatment arms. DISCUSSION: By collecting comprehensive baseline characteristics to evaluate heterogeneity of treatment effects, we will provide valuable and innovative information to optimize treatment effects and guide university mental health treatment planning. Such an effort could have enormous public-health implications for the region by increasing the reach of treatment, decreasing unmet need and clinic wait times, and serving as a model of evidence-based intervention planning and implementation. TRIAL STATUS: IRB Approval of Protocol Version 1.0; June 3, 2020. Recruitment began on March 1, 2021. Recruitment is tentatively scheduled to be completed on May 30, 2024. TRIAL REGISTRATION: ClinicalTrials.gov NCT04780542 . First submission date: February 28, 2021.

Evaluation of quality of life and depression in patients with rheumatoid arthritis in a General Hospital / Evaluación de la calidad de vida y depresión en pacientes con artritis reumatoide en un hospital general

abstract Introduction: Rheumatoid arthritis (RA) is a chronic, inflammatory, and multisystemic disease that has an impact on the quality of life and is associated with depressive symptoms. Objectives: To evaluate the quality of life, overall health status, and depression in patients with RA. Patients and methods: A cross-sectional study was conducted in the outpatient Rheumatology Outpatient Department of a General Hospital in Mexico City. All patients met the criteria for rheumatoid arthritis according to the American Rheumatism Association, 1987. Clinical and sociodemographic characteristics were recorded. Four measurement tools were used: Arthritis Impact Measurement Scale (AIMS), Dunbar Questionnaire, a Visual Analog Scale, and the Beck Depression Inventory. Results: A total of 43 patients aged ≥ 18 years were evaluated. The highest AIMS scores were in social activity (6.49±1.93), pain (4.70±2.04), depression (4.70±2.23), and physical activity (4.03±2.10). The mean score with the Dunbar questionnaire was 6.48±1.87, the mean Visual Analog Scale score was 69.41±24.67, and the mean of the Beck inventory was 15.74±9.85. Conclusions: The presence of anxiety and depression has an impact on the quality of life of patients with RA, but not on the presence of comorbidity or disease activity. Depressive symptoms are common in patients with RA, and should therefore be considered when evaluating this rheumatological disease.

resumen Introducción: La artritis reumatoide (AR) es una enfermedad que afecta la calidad de vida de quienes la padecen y se asocia a sintomatologia depresiva. Objetivos: Evaluar la calidad de vida, el estado global de salud y depresión en pacientes con AR. Pacientes y métodos: Se trata de un estudio transversal y comparativo. Se incluyeron 43 adultos mayores, ≥ de 18 anos, con diagnóstico de AR según los criterios de la American Rheumatism Association de 1987, que acudían al servicio de consulta externa de Reumatologia de un hospital general en la ciudad de México. Se determinaron características clínicas y sociodemográficas. Se les aplicaron 4 índices: Escala de Medición del Impacto de la Artritis (AIMS), Cuestionario de Dunbar, Escala Análoga Visual y el Inventario de Depresión de Beck. Resultados: Se evaluaron 43 pacientes mayores de 18 anos, en su mayoría del sexo femenino. Para la AIMS, las puntuaciones más altas fueron en actividad social (6, 49 ± 1, 93), dolor (4,70 ± 2,04), depresión (4,70 ± 2,23) y actividad física (4,03 ± 2,10). Para el cuestionario de Dunbar la puntuación promedio fue de 6, 48 ± 1, 87, en la escala análoga visual la puntuación media fue de 69,41 ± 24,67, finalmente, en el inventario de Beck el promedio fue de 15,74 ±9,85. Conclusiones: La presencia de ansiedad y depresión se relacionan con la calidad de vida de los pacientes con AR mas no con la presencia de comorbilidad o actividad de la enfermedad. Los síntomas depresivos son comunes en pacientes con AR por lo que deben considerarse al evaluar esta enfermedad reumatológica.

[Factors that predict depression in medical students]. / Factores que predicen depresión en estudiantes de medicina.

INTRODUCTION: High prevalence of depression and anxiety symptoms has been observed in medical students. OBJECTIVE: To identify predictors of depressive symptoms according to CES-D in students during their first year of medical education. METHODS: We evaluated 517 students in their first year of medical education with the following instruments: Centers for Epidemiology Studies for Depression Scale, State-Trait anxiety inventory, and stressors list. A linear regression analysis was carried out to evaluate variables predicting high CES-D scores. RESULTS: We observed that anxiety and depressive symptoms were more frequent in women, as well as stressors. Predictors of depression were state of anxiety, stressors, and low socioeconomic level. CONCLUSIONS: It is important to implement support measures for students who live with stress factors, suffering anxiety, or with a low socioeconomic level.