Mental health and quality of life across 6 years of medical training: A year-by-year analysis.

BACKGROUND: Despite growing evidence on medical students' mental health deterioration, studies have primarily used short follow-up periods and not followed the students throughout their medical training. OBJECTIVE: To assess mental health (stress, anxiety, and depression) and quality of life changes throughout their medical program, we followed up with the same cohort of students for 6 years. METHODS: This longitudinal prospective study followed up with the same group of medical students at a Brazilian public medical school from 2014 to 2020. The study analyzed sociodemographic data, mental health (including depression, anxiety, and stress [DASS-21]), quality of life (WHOQOL-BREF), satisfaction from studying to be a physician, and happiness with life. General linear mixed models were used for the analyses. RESULTS: The cohort included 80 Brazilian medical students (63.7% women; mean age = 19.6 years [SD = 2.21]). A high prevalence of depressive symptoms, anxiety, and stress was found throughout medical training, with more than 50% of students having significant symptoms. Mental health, happiness, and quality of life levels tended to be better in the first and last semesters, being worse in the middle of the program. However, satisfaction from studying to become a doctor decreased in the second semester, remained low throughout the program, and never returned to baseline levels. CONCLUSION: Mental health and quality of life levels remained high throughout the medical program, with better levels in the first and last semesters and falling in the middle of the program. These data can help managers and educators understand how psychological distress affects medical students.

MEASURING HEALTH STUDENTS' ATTITUDES, PERCEPTIONS AND READINESS FOR INTERPROFESSIONAL LEARNING: RELIABILITY, VALIDITY AND PSYCHOMETRIC PROPERTIES OF THREE SCALES ADAPTED INTO PORTUGUESE.

Background and Purpose: To adapt, validate and assess the psychometric properties of the Readiness for Interprofessional Learning Scale (RIPLS-19 items), Interdisciplinary Education Perception Scale (IEPS-18 items) and Team Skills Scale (TSS-17 items) in 484 undergraduate students. Methods: Transcultural adaptation of the scales was performed. Internal consistency, test-retest reliability, factor analysis, and convergent and discriminant validity were determined. Results: The instruments showed good internal consistency and test-retest reliability for total score. However, factor analyses revealed differences in the subscales compared to the original validations. The RIPLS detected more differences, discriminating gender, race, course semester and course enrolled. The TSS and IEPS detected differences in age and course enrolled. Conclusions: These scales appear to have satisfactory psychometric properties and could be used in both research and education. The subscales, however, should be interpreted with caution.

The current status of "spirituality and health" teaching in Brazilian medical schools: a nationwide survey.

BACKGROUND: Recent data on the teaching of "spirituality and health" (S/H) in medical schools are needed. In this study, we aimed to investigate the current status of S/H teaching in Brazilian medical schools, the opinions of medical directors/deans on this topic and the factors associated with its incorporation into the curriculum. METHODS: A nationwide cross-sectional survey was carried out in 2021. Information concerning the S/H content in the curricula of medical schools was obtained through medical school representatives and other sources. Medical school representatives were asked about their opinions of and barriers to S/H teaching. Regression models were used to evaluate the factors associated with the incorporation of such content into the curriculum. RESULTS: Information on the incorporation of S/H content in medical curricula was retrieved from different sources for all 342 (100%) Brazilian medical schools. Among the representatives, 150 (43.9%) completed the online form. An increase in the S/H content in Brazilian medical schools was observed (from 40% to 2011 to 65.5% in 2021). Most medical school representatives agreed that this issue is important in medical training and that more space in the curriculum is needed. However, they also observed several barriers, such as a lack of knowledge of medical teachers/faculty, a lack of time, and the topic not being included in teaching plans. The most important factors that influenced the incorporation of S/H teaching in medical schools and representatives' opinions were a lack of time and knowledge, professor preparedness and standardized national competency requirements. CONCLUSION: These results could help medical educators rethink the incorporation of S/H content into their curricula.

Mental health throughout the medical career: A comparison of depression, anxiety, and stress levels among medical students, residents, and physicians.

BACKGROUND: Different stages of a physician's career may be associated with different types of mental health impairment. AIMS: This study aimed to compare symptoms of anxiety, depression, and stress and their associated factors among medical students, medical residents, and physicians. METHODS: A cross-sectional study was conducted. Data collection included sociodemographic data, religiosity (Duke University Religion Index), and mental health (21-item Depression, Anxiety and Stress Scale - DASS-21) data. The comparison between the groups was performed using ANOVA, and the associated factors were evaluated via linear regression models. RESULTS: The sample consisted of 1,417 participants: 778 medical students, 190 medical residents, and 468 established physicians. Medical students had significantly higher depression, anxiety, and stress scores as compared to medical residents and established physicians. However, regarding DASS 21 scores, no significant differences were found between established physicians and medical residents. The factors associated with mental health in the different groups showed that being married and male were associated with better mental health among physicians and medical residents, while the factors of male gender, being in later years of the course, and lower religious attendance were associated with better mental health in students. CONCLUSION: Medical students had worse mental health outcomes when compared to residents and established physicians. Interventions are needed to minimize suffering during medical education and career.

Factors Associated with Motivation in Medical Students: A 30-Month Longitudinal Study.

This longitudinal study aimed to assess the factors associated with motivation in 303 Brazilian medical students after a 30-month follow-up. Their demographics, study habits, sleep quality, motivation (Brazilian version of the Academic Motivation Scale-BAMS), learning approaches (R-SPQ-2F scale), and stressors (MSSF-Medical Student Stress Factor scale) were examined. We found an increase in amotivation and extrinsic motivation through external regulation (e.g., "I come to school to earn a degree") and a decrease in intrinsic motivation and extrinsic motivation through integrated regulation (e.g., "because studying broadens our horizons") in medical students after the 30-month follow-up. Students in earlier stages of medical training showed greater increases in amotivation. Factors such as the learning approach, hours spent studying, sex, stressors, studying just before examinations, and sleep problems were predictors of the different dimensions of motivation. Medical students' motivation changed negatively as medical training progressed.

Comparison of the Role of Different Levels of Religiousness and Spirituality in Controversial Ethical Issues and Clinical Practice among Brazilian Resident Physicians: Results from the Multicenter SBRAMER Study.

This study compares clinical practice and objections to controversial ethical issues among 836 Brazilian resident physicians according to levels of religiousness/spirituality. Residents with low religiousness/spirituality (s/r) believed less in the influence of spirituality on clinical practice, were less comfortable addressing this issue, tended to listen less carefully and try to change the subject more than other groups. Residents with high spirituality and low religiousness (S/r) inquired more about religious/spiritual issues, while those with high religiousness/spirituality (S/R) were more supportive and reported fewer barriers to addressing these issues. Concerning ethical issues (e.g., physician-assisted suicide, withdrawal of life support, abortion), S/R had more objections than others.

Short and medium-term effects of different teaching strategies for interprofessional education in health professional students: A randomized controlled trial.

BACKGROUND: Interprofessional education (IPE) is recognized as important for teaching in healthcare. However, few studies comparing active versus traditional strategies for this teaching approach have been conducted. OBJECTIVES: This study aims to compare the use of different educational strategies (i.e. active learning versus formal lectures) for teaching interprofessional geriatric competencies in health professional students from different healthcare courses. DESIGN: Randomized controlled trial. SETTINGS: Public university. PARTICIPANTS: Health professional students (nursing, physiotherapy, medicine, nutrition and psychology courses). METHODS: Different theoretical educational strategies (active learning in intervention group versus formal lectures in control group) were associated with case-based group discussions. The RIPLS (Readiness for Interprofessional Learning Scale), IEPS (Interdisciplinary Education Perception Scale) and TSS (Team Skills Scale) instruments were applied at 3 timepoints: on first day of class, on last day of class and at 6 months post-intervention. RESULTS: Of 151 eligible students, 99 concluded all stages of the study and were subsequently included in the analysis. A significant increase in scores on the RIPLS, IEPS and TSS was measured on the last day of class and this performance gain persisted after 6 months for both strategies. However, no significant performance difference between the two strategies was found. Similarly, although student satisfaction was very good, no difference in ratings between the strategies was evident. CONCLUSIONS: The results of this project, besides developing and fostering important discussion on IPE, can add to the literature and aid researchers in IPE by furthering knowledge on how different teaching strategies can impact future health professionals.

Smartphone Use, Digital Addiction and Physical and Mental Health in Community-dwelling Older Adults: a Population-based Survey.

This study aims to assess mobile technology use (cell phones and smartphones), level of digital addiction, and the association of these factors with physical, mental and social health and quality of life (QOL) in community-dwelling older adults. A population-based study of a city with a low-income population in Brazil was carried out. Sociodemographics, cognition(MMSE), mental health(DASS-21), QOL(WHOQOL-bref), sleep quality(Pittsburgh Index), instrumental activities of daily living(Lawton), loneliness(UCLA), digital addiction(Internet Addiction Test) and cell phone/smartphone use were investigated. A total of 668 older adults (93.6% of total) were included; 175(26.2%) owned cell phones, 172(25.7%) smartphones and 321(48.1%) no mobile device. Smartphones owners were predominantly younger, white, had higher income, MMSE scores and social support, and were less dependent. However, no group differences were observed for depression, anxiety or stress symptoms, QOL, sleep disturbances or loneliness. Among 172 smartphone users, Structural Equation Models revealed that the degree of digital addiction was correlated with better physical and environmental conditions, in detriment of a poorer sleep quality. Hours of use were not correlated with health outcomes, whereas greater importance of the smartphone in life correlated with less depressive symptoms and lower loneliness. Different from previous studies in adults or adolescents, older adults who were smartphones users had similar health outcomes than those without Internet access. These findings serve to further our understanding on technology use in this age group.

Resilience and Mental Health Among Regularly and Intermittently Active Older Adults: Results From a Four-Year Longitudinal Study.

BACKGROUND: This study aims to investigate whether regularly active individuals have different levels of mental health and resilience compared to intermittently active individuals. METHODS: In this 4-year longitudinal study, 180 older people were included. General linear models were used to assess the level of physical activity, psychological resilience, and mental health among regularly and intermittently active older adults. RESULTS: Those who maintained regular physical activity were more resilient than those who did not. However, no differences were observed for mental health outcomes. Although those with higher levels of resilience had fewer mental health problems, there were no significant differences between the groups based on their level of physical activity. CONCLUSION: Differences in resilience levels favoring regularly active individuals were found. In both groups, resilience was inversely associated with mental health problems. These findings may help elucidate the underlying mechanisms in the relationship between physical activity and health outcomes.

The role of positive behaviors, attitudes and virtues in the mental health of community-dwelling older adults: A 1-year follow-up study.

OBJECTIVES: Few studies have investigated the influence of positive behaviors, attitudes and virtues on mental health outcomes of older adults, particularly in developing countries. The aim of this longitudinal study was to investigate the influence of positive behaviors, attitudes and values on the mental health (depression, anxiety and stress) of Brazilian older adults treated in primary care. METHODS: A longitudinal study, with a 1-year follow-up, of older adults seen by Family Medicine teams was conducted. Instruments were applied assessing traditional factors (cognition, physical activity, sleep, quality of life, social support), behavioral factors (religiousness, spirituality, satisfaction with life, resilience, altruism, volunteerism, loneliness, meaning in life) and mental health (depression, anxiety and stress). Analyses using linear and logistic regression models were performed. RESULTS: A total of 490 older adults (91.8% of individuals assessed at baseline) were included. Traditional factors such as gender, sleep problems, ethnicity and alcohol use, as well as positive behavioral factors including loneliness, resilience and well-being at baseline, were found to be associated with mental health at 1-year follow-up. Similarly, changes in scores for quality of life, loneliness, religiousness, feeling at peace, sleep problems and altruism were associated with changes in mental health scores. CONCLUSIONS: The results revealed that positive behavioral factors influenced the mental health of older adults as much as traditional factors and should therefore be addressed by health professionals and medical managers.

Altruism, Volunteering and Cognitive Performance Among Older Adults: A 2-Year Longitudinal Study.

This study aims to investigate whether altruism and volunteering are associated differently with cognitive functioning in community-dwelling older adults. A 2-year longitudinal study of 291 Brazilian older adults was conducted. In the baseline analysis, altruism, but not volunteering, was associated with higher scores for the composite cognitive score, the Mini-Mental State Examination, the verbal fluency and the CERAD Recall. Concerning the longitudinal analyses, volunteering at baseline, but not altruism, was associated with verbal fluency and CERAD Word List Recall after 2 years of follow up. Same results were obtained while investigating changes in score. Altruism and volunteering were associated with cognitive tests, albeit in different ways. Volunteering, but not altruism, was associated with lower cognitive decline. However, altruism, but not volunteering, was associated with higher absolute score on these tests. These findings can further understanding of this new field of health research.

Relationship Between Mental Health, Resilience, and Physical Activity in Older Adults: A 2-Year Longitudinal Study.

The aim of this study was to longitudinally investigate the association between resilience and mental health in older adults and to determine the influence of physical activity on this relationship. A total of 291 older adults were included in a 2-year follow-up study. Adjusted linear regression models evaluated the association between resilience at baseline and mental health after 2 years in sufficiently and insufficiently physically active older adults. A negative correlation was found between resilience at baseline and depression, anxiety, and stress after 2 years for the overall sample. This association changed after stratifying the group. Sufficiently physically active individuals made greater use of the resilience components "Self-Sufficiency" and "Perseverance," whereas insufficiently physically active individuals made greater use of "Meaning of Life" and "Existential Singularity." Physical activity can influence the relationship between resilience and mental health. These results can help guide the devising of more effective interventions for this age group.

The association of mental health with positive behaviours, attitudes and virtues in community-dwelling older adults: Results of a population-based study.

BACKGROUND: Despite major advancements in understanding of the factors associated with mental health in older adults, studies assessing positive behaviours, attitudes and virtues are still scarce in the literature. AIMS: This study aims to investigate whether factors related to positive behaviours, attitudes and virtues are associated with mental health (i.e. depression, anxiety and stress) and satisfaction with life in Brazilian community-dwelling older adults. METHODS: A population-based, cross-sectional study of Brazilian older adults who were users of the public health system and seen by Family Health teams was conducted in 2017. Instruments were applied to assess cognition, physical activity, sleep, quality of life, social support, religiousness, spirituality, satisfaction with life, resilience, altruism, volunteerism, loneliness, meaning in life and mental health (i.e. depression, anxiety and stress). Analyses were carried out using linear and logistic regression models. RESULTS: A total of 534 (93.5%) older adults were included. Positive behavioural factors and values including volunteerism, meaning in life, resilience, peace, loneliness, faith and religiousness were associated with mental health outcomes (i.e. depression, anxiety and stress), as were traditional factors, such as sleep, gender, social support and cognitive state. CONCLUSIONS: Aspects related to positive behaviour, attitudes and virtues can impact the mental health of the older population. These results can serve to alert health professionals on the importance of addressing these factors and help guide the implementation of preventive measures and interventions for this age group.

The Use of Feedback in Improving the Knowledge, Attitudes and Skills of Medical Students: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

This study aims to investigate the effectiveness of the use of different feedback modalities in improving the knowledge, attitudes, and skills of medical students compared to students receiving no feedback or unstructured feedback. A systematic review and meta-analysis of randomized controlled trials was conducted based on a search of the Cochrane, ERIC, PubMed, Scopus, and Web of Science databases. A total of 26 studies were included for the systematic review and 13 for the meta-analysis. The meta-analysis revealed that the use of feedback was associated with better results compared to control groups (SMD = 0.80 [0.56-1.04], p < 0.001), and also when only high-quality studies were included (SMD = 0.86 [0.56-1.16], p < 0.001). Our findings revealed high heterogeneity in the use of feedback in medical education. However, the results of most of the studies and of the meta-analysis were positive, showing that feedback had a positive influence on the education-learning process of the students. PROSPERO registration: CRD42018112688.

Spirituality, religiousness, and mental health: A review of the current scientific evidence.

Research in the field of "Spirituality and Health" has been growing, with spirituality/religiousness (S/R) being consistently related to both physical and mental health. The objective of this article is to provide an updated review of the current scientific evidence on the relationship between S/R and mental health, highlighting the most important studies. As a secondary objective, the mechanisms that explain this relationship and the interventions that utilize this information in treating mental disorders will be discussed. The findings reveal a large body of evidence across numerous psychiatric disorders. Although solid evidence is now available for depression, suicidality, and substance use, other diagnosis, such as post-traumatic stress disorder, psychosis, and anxiety, have also shown promising results. The effects of S/R on mental health are likely bidirectional, and the manner in which religious beliefs are used to cope with distress (i.e. negative and positive), may affect mental health outcomes. Despite these findings, the mechanisms that explain these associations and the role of S/R interventions need further study. Concerning clinical practice, mental health providers should ask patients about S/R that are important in their lives to provide holistic and patient-centered care.

Factors associated with successful aging in Brazilian community-dwelling older adults: When physical health is not enough.

OBJECTIVES: To determine the main factors (physical, psychological, social and spiritual) associated with successful aging in community-dwelling older adults. METHODS: A cross-sectional study of older adults was conducted evaluating successful aging (Successful Aging Scale-SAS) and its associated factors (sociodemographics, resilience, religiosity/spirituality, meaning in life, quality of life, social support, self-reported diseases, mental health, medications used, among others) using regression models. RESULTS: A total of 534 older adults were assessed. Linear regression models showed an association of higher SAS score with greater resilience (Beta = 0.371, p < 0.001), spiritual well-being - meaning (Beta = 0.174, p < 0.001) and quality of life - physical (Beta=0.203, p < 0.001), fewer diseases (Beta=-0.128, p < 0.001), greater meaning in life (Beta=0.116, p = 0.001), less loneliness (Beta=-0.133, p = 0.001), lower tobacco use (Beta=0.080, p = 0.013), greater quality of life - environment (Beta=-0.092, p = 0.013) and more frequent religious attendance (Beta=0.068, p = 0.035). CONCLUSION: The study results suggested that physical factors, although relevant, were not the main factors associated with successful aging.

Religiosity/Spirituality and Mental Health and Quality of Life of Early Pregnant Women.

The present study aims to investigate how religious/spiritual (R/S) beliefs are associated with depressive, anxious and stress symptoms and quality of life (QOL) of 160 Brazilian women in early pregnancy. In this cross-sectional study, religiosity/spirituality (DUREL, Daily Spiritual Experiences, Brief-RCOPE), mental health (DASS-21) and quality of life (WHOQOL-Bref) were assessed. Negative R/S coping was associated with higher levels of depressive, anxious and stress symptoms and worse physical and psychological QOL. On the other hand, positive R/S coping, intrinsic religiosity, and spirituality were associated with better psychological QOL, while only spirituality was associated with better social QOL.

Influence of Religiousness and Spirituality on Remission Rate, Mental Health, and Quality of Life of Patients With Active Crohn's Disease: A Longitudinal 2-Year Follow-up Study.

BACKGROUND AND AIMS: Studies on inflammatory bowel disease [IBD] have shown that religiousness and spirituality [R/S] were associated with better mental health and quality of life [QOL]. However, longitudinal studies assessing the impact of R/S on long-term clinical outcomes of Crohn's disease [CD] are scarce. The aim of this study was to assess the influence of R/S on the course of CD after a 2-year follow-up and to determine whether these R/S beliefs were associated with mental health and QOL. METHODS: A longitudinal 2-year follow-up study was conducted at a referral centre for IBD, including patients with moderately to severely active CD. Clinical data, disease activity [Harvey-Bradshaw Index], QOL [Inflammatory Bowel Disease Questionnaire-IBDQ], depression and anxiety [Hospital Anxiety and Depression Scale-HADS], and R/S [Duke Religion Index-DUREL, Spirituality Self-Rating Scale-SSRS, and Spiritual/Religious Coping-SRCOPE scale] were assessed at baseline and at the end of the 2-year follow-up. Linear and logistic regression models were employed. RESULTS: A total of 90 patients [88.2%] were followed up for 2 years. On logistic regression, baseline levels of spirituality (odds ratio [OR] = 1.309; 95% confidence interval [CI]= 1.104-1.552, p = 0.002) and intrinsic religiousness [OR = 1.682; 95% CI = 1.221-2.317, p = 0.001] were predictors of remission at 2 years. On linear regression, the different dimensions of R/S did not significantly predict IBDQ or anxiety and depression scores after 2 years. CONCLUSIONS: R/S predicted remission of CD patients after a 2-year follow-up. However, these beliefs failed to predict mental health or QOL. Health professionals who treat CD should be aware of the religious and spiritual beliefs of their patients, given these beliefs may impact on the disease course.

Empathy, well-being, and mental health: do gender differences diminish by the end of medical school?

This study aims to investigate if medical students demonstrate differences related to gender in terms of empathy, burnout, tolerance, openness to spirituality, well-being, and mental health, and to examine whether these differences vary across levels of medical training. A cross-sectional study was conducted in the first semester of 2015 in a Brazilian medical school. The following were evaluated: quality of life (WHOQOL-Bref), burnout (Oldenburg), mental health (DASS-21), empathy (Empathy Inventory and ESWIM), and tolerance, well-being, and openness to spirituality (ESWIM). We investigated how these outcomes varied in terms of gender, stage of medical training, and its interaction using a two-way MANOVA. A total of 776 students were included and important differences were observed. As medical training advanced, the differences between genders that were present during students' initial years (greater empathy, worse quality of life, and worse mental health among women) tended to become nonsignificant during the clerkship years. In addition, a significant interaction between stage and gender was found for ESWIM Wellness; WHOQOL; DASS Anxiety and DASS Stress. These results may denote a shortcoming in the way medical schools approach gender differences. Educators should consider these findings when restructuring curricula to respect gender differences, thus fostering their respective potentials.

Religiosity and Spirituality of Resident Physicians and Implications for Clinical Practice-the SBRAMER Multicenter Study.

OBJECTIVES: To assess the attitudes, knowledge, and experiences of Brazilian resident physicians regarding religiosity/spirituality (R/S), factors associated with addressing this issue, and its influence on clinical practice. METHODS: We report results of the multicenter "Spirituality in Brazilian Medical Residents" (SBRAMER) study involving 7 Brazilian university centers. The Network for Research Spirituality and Health (NERSH) scale (collecting sociodemographic data, opinions about the R/S-health interface, and respondents' R/S characteristics) and the Duke Religion Index were self-administered. Logistic regression models were constructed to determine those factors associated with residents' opinions on spirituality in clinical practice. RESULTS: The sample comprised 879 resident physicians (53.5% of total) from all years of residency with 71.6% from clinical specialties. In general, the residents considered themselves spiritual and religious, despite not regularly attending religious services. Most participants believed R/S had an important influence on patient health (75.2%) and that it was appropriate to discuss these beliefs in clinical encounters with patients (77.1%), although this was not done in routine clinical practice (14.4%). The main barriers to discussing R/S were maintaining professional neutrality (31.4%), concern about offending patients (29.1%), and insufficient time (26.2%). Factors including female gender, clinical specialty (e.g., internal medicine, family medicine, psychiatry) as opposed to surgical specialty (e.g., surgery, obstetrics/gynecology, orthopedics), having had formal training on R/S, and higher levels of R/S were associated with greater discussion of and more positive opinions about R/S. CONCLUSION: Brazilian resident physicians held that religious and spiritual beliefs can influence health, and deemed it appropriate for physicians to discuss this issue. However, lack of training was one of the main obstacles to addressing R/S issues in clinical practice. Educators should draw on these data to conduct interventions and produce content on the subject in residency programs.