Vulnerable in the end - Longitudinal study among medical students on mental health and personal and work-related resources over a 5.5-year-period.

BACKGROUND: Mental health problems are common in medical professionals and their development already starts at the undergraduate level. Studies on medical students can replicate higher prevalence for depression and burnout in this group, but they normally compare semester cohorts in an anonymized, cross-sectional approach and without a preventive perspective. METHODS: We surveyed medical students at the beginning and end of their medical curriculum and collected data on burnout, depressivity, work related experience and salutogenesis parameters with validated self-administered questionnaires. Most remarkably we obtained the data from the same 58 individuals after 5.5 years, representing data of the highest quality in order to compare the mental health status at the beginning and the end of our students´ medical curriculum. RESULTS: Our results not only show a severe exacerbation of physical, mental and emotional burnout in the participants at the end of their studies. The students also do not seem to have sufficient personal (resilience) or social resources (e.g. experience of social support) for coping with their mental health problems around the time of their graduation. CONCLUSIONS: Our participants reflect a development of mental health during their medical studies at university that is paving the way to the devastating prevalence of mental disorders and suicide in health professionals. From our results we derive an urgent need to integrate self-care and active coping in the learning goals of medical curricula.

Gender as an underestimated factor in mental health of medical students.

BACKGROUND: In Germany, currently two out of three medical students are female. Several studies corroborate that medical students show a significantly higher prevalence of stress-related mental disorders than the population in general. AIMS: We aimed to evaluate, if gender has an influence on the distribution of mental stress parameters and learning style among male and female medical students. METHODS: We investigated a total of 758 students of the medical faculty at the University of Erlangen-Nuernberg, Germany, using standardized and validated psychological questionnaires on depressive symptoms (BDI-II), burnout (BOSS-II) and quality of life (SF-12). In addition, we screened the students for their learning styles according to Kolb. RESULTS: Out of 723 participants who declared their gender, 57.8% were female and 37.6% were male. Female students showed significantly higher values for depressiveness as well as for emotional and cognitive burnout, whereas the mental quality of life was significantly lower. A considerably higher percentage of male students with a converging or an accommodating learning style were found in comparison to their female fellows. CONCLUSIONS: We postulate that an adaptation of the medical curriculum content to the investigated factors may contribute to a higher mental stability and less stress-related symptoms in medical students.

Development of depression and deterioration in quality of life in German dental medical students in preclinical semesters.

PURPOSE: Early intervention to counter mental disorders during the course of studies in dentistry is indicated in view of the pronounced prevalence of burnout in this student collective. To assess the proportion of students in whom these risk states can be quantified in measurable parameters for concrete mental disorders, we conducted surveys among students of dental medicine during the first 2.5 years of their studies. METHODS: We surveyed a total of 163 students of dental medicine in their first 5 semesters of study. Standardized, validated psychological questionnaires on depressive symptoms (Beck Depression Inventory; BDI-II) and mental and physical quality of life (Short Form Survey; SF-12) were used in the survey, with per-semester participant quotas of around 90%. RESULTS: Regarding depression, the students were within the range of the normal populace at the beginning of the 1st semester. Symptoms of depression then became more pronounced with every succeeding semester. In the fifth semester, the average levels determined were equivalent to a depression with a clinical treatment indication. Hardly any change was registered for physical wellbeing in the quality of life questionnaire. The mental sum scores, however, reflected dramatic downturns in quality of life. Highly significant correlations between the parameters described here - depressivity and mental quality of life - were observed in all semesters. CONCLUSION: The participating students begin their course of studies at the level of the average populace for the symptoms surveyed, then develop, on average, a clinically manifest depression after 2.5 years. The personal experience of a deterioration of mental quality of life appears to be crucial in the phenomena observed.

Risk factors for mental disorders develop early in German students of dentistry.

PURPOSE: We investigated mental risk factors such as symptoms of burnout and sense of coherence in students of dental medicine at the University of Erlangen in the context of a learning type survey. Our aim was to assess the presence of analogies to the results we had previously determined for students of human medicine. METHODS: We surveyed a total of 163 dentistry students during the first 2.5 years, up to the first state examination. To ensure comparability, the data were collected from all students at the beginning of each semester. Standardized, validated questionnaires on burnout symptoms (Burnout Screening Scales; BOSS-II), sense of coherence (Sense of Coherence Scale; SOC-L9) and learning type according to Kolb were used in the survey. RESULTS: A total of about 90% of the students provided responses to the voluntary survey. The extent and manifest dynamics of the stress levels observed can be characterized as dramatic. Having started out at cognitive and emotional stress levels typical of the normal populace, a massive deterioration of these parameters was observed in the students by the time they were facing their first state examination in the 5th semester. At the same time, their sense of coherence also suffered a pronounced drop-off. No significant learning type-correlated differences were determined in a mean comparison of the measured parameters. CONCLUSION: Based on the results obtained, we see a need for preventive course offerings to students of dentistry to reduce the prevalence of mental disorders in this group. We discern additional potential for enhancement of mental health with courses more specifically geared to the different learning styles among the students.

[What is known about the outcome as adults for children with fetal alcohol syndrome (FAS)/fetal alcohol spectrum disorders (FASD)?]. / Was wird aus Kindern mit fetalem Alkoholsyndrom (FAS)/fetalen Alkoholspektrumstörungen (FASD) im Erwachsenenalter?

In the field of adult psychiatry in German-speaking countries, little attention is as yet paid to the psychic defects that a fetus can sustain as a result of prenatal exposure to alcohol. Although children of alcohol-dependent mothers do present to psychiatric institutions as adults with manifold symptoms, e. g., attention deficit disorders, affective disorders or intellectual disability, fetal alcohol spectrum disorders are rarely diagnosed as an underlying cause. Appropriate therapy guidelines do not exist. Current review papers within the German-speaking countries usually stem from paediatric and adolescent psychiatry or medicine. Based on a selected review of the literature, the following paper addresses and discusses the disease entity of fetal alcohol spectrum disorders and fetal alcohol syndrome and their significance for adult psychiatry and also identifies open questions and research requirements, e. g., the development of diagnostic instruments or the establishment of diagnostic categories.

[How does maternal alcohol consumption during pregnancy affect the development of attention deficit/hyperactivity syndrome in the child]. / Einfluss des mütterlichen Alkoholkonsums während der Schwangerschaft auf die Entwicklung von ADHS beim Kind.

Besides genetic susceptibility, environmental factors and gene-environment interactions are of central interest in research on attention deficit/hyperactivity disorder in children. Focusing on maternal behaviour during pregnancy, prenatal maternal alcohol consumption is associated with behavioural disorders in children. In animal models, developmental disorders of brain structures as well as subsequent behavioural disorders - similar to findings in attention deficit disorder - were caused by prenatal alcohol exposure. These findings occur in small rodents (mice, rats) as well as in primates and can be caused by even moderate alcohol exposure. In foetal alcohol syndrome (FAS) and foetal alcohol spectrum disease (FASD) in humans, symptoms like hyperactivity, disruptive or impulsive behaviour along with reduced attention and slower reaction time are observed. These findings resemble the symptoms of ADHD. For that reason, children diagnosed with FAS/FASD are frequently diagnosed with ADHD in parallel. Even small amounts of alcohol during pregnancy are responsible for cognitive and behavioural impairments like a significantly decreased IQ. About 50 % of adult ADHD patients show alcohol abuse or dependency and/or other substance disorders. Due to this, a higher rate of prenatal exposition to psychoactive substances for children of mothers affected with ADHD seems probable. However, there are no sufficient data on ADHD and its association to substance abuse in pregnancy, which makes it difficult to quantify the impact of genetic and environmental causes for the development of childhood ADHD. So far, no link could be proven with a high level of evidence between moderate prenatal alcohol consumption and the development of childhood ADHD. It has to be recognised that all present studies are based on self-reported alcohol consumption. Data collected by this methodology are usually severely biased to an underestimation of alcohol abuse. Objective tests for alcohol abuse in pregnancy, such as the analysis of fatty acid ethyl esters or ethyl glucuronide in foetal feces after birth, show rates of alcohol consumption in pregnant women which are dramatically higher than reported. Therefore, studies investigating the association between prenatal alcohol exposure and ADHD should incorporate the analysis and validation of more objective methods, such as parameters for alcohol degradation.