First- and last-year medical students: is there a
                    difference in the prevalence and intensity of anxiety and depressive
                    symptoms?

Bassols, Ana M.; Okabayashi, Lucas S.; Silva, Anais B. da; Carneiro, Bruna B.; Feijó, Fernando; Guimarães, Guilherme C.; Cortes, Gabriela N.; Rohde, Luis A.; Eizirik, Claudio L.

doi:10.1590/1516-4446-2013-1183

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Brazilian Journal of Psychiatry

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ORIGINAL ARTICLES • Rev. Bras. Psiquiatr. 36 (3) • Jul-Sep 2014 • https://doi.org/10.1590/1516-4446-2013-1183 copy

First- and last-year medical students: is there a difference in the prevalence and intensity of anxiety and depressive symptoms?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

Medical training is considered a significant stress factor. We sought to assess the prevalence and intensity of anxiety and depressive symptoms in medical students and compare samples of first-year and sixth-year students.

Method:

This was a cross-sectional study of first- and sixth-year medical students who attended classes regularly. The study instruments were a sociodemographic questionnaire, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI).

Results:

A total of 232 students (110 first-year, 122 sixth-year) completed the questionnaires, for a response rate of 67.4%. Overall 50.4% of respondents were male (56.4% of first-year and 45.1% of sixth-year students). Anxiety symptoms were reported by 30.8% of first-year students and 9.4% of sixth-year students (p < 0.001). Female students were more affected by anxiety. There were no significant between-group differences in depressive symptoms.

Conclusion:

A higher prevalence of anxiety symptoms was found in first-year medical students as compared with sixth-year students. Strategies should be developed to help medical students, particularly female students, manage these symptoms at the beginning of their medical training.

Medical students; depression; anxiety

Variable	First year (%)	Sixth year (%)	Total	p-value
Number of students, % (n)	47.4 (110)	52.6 (122)	232
Age, mean ± standard deviation^* * Student's t test.	20.7±2.6	25.34±2.7	23.1±3.2	-
Males^† † Pearson's chi-square test with continuity correction.	56.4	45.1	50.4	0.113
Involved in leisure activities^† † Pearson's chi-square test with continuity correction.	87	90.1	88.6	0.605
Living with family^† † Pearson's chi-square test with continuity correction.	59.6	45.9	52.4	0.051
Living in communal off-campus housing^‡ ‡ Pearson's chi-square.	7.3	6.6	6.9	> 0.999
Household income^‡ ‡ Pearson's chi-square. (categorical)
< R$ 3,000.00^§ § Equivalent to US$ 1,749.27 at the time of data collection.	16.8	108.3	12.3	0.021
R$ 3,000.00 to R$ 10,000.00^∥ ∥ Equivalent to US$ 1,749.27-5,830.90 at the time of data collection.	53.3	45.8	49.3
≥ R$ 10,000.00^¶ ¶ Equivalent to US$ 5,830.90 at the time of data collection.	29.0	45.8	38.3
Paid employment^† † Pearson's chi-square test with continuity correction.	10.0	35.5	23.4	< 0.001
Coffee intake^† † Pearson's chi-square test with continuity correction.	74.1	82.8	78.8	0.147
Alcohol/drug use^† † Pearson's chi-square test with continuity correction.	35.2	54.5	45.4	0.005
Physical illness^† † Pearson's chi-square test with continuity correction.	25.9	3.5	30.7	0.180
Medication use^† † Pearson's chi-square test with continuity correction.	33.6	51.3	42.8	0.012

	n (%)	Bivariate analysis		Poisson regression
		Relative risk, crude (95%CI)	p-value	Relative risk, adjusted (95%CI)	Adjusted p-value
Sex
Female	29 (26.6)	2.13 (1.19-3.80)	0.011	1.64 (0.88-3.04)	0.119
Male	14 (12.5)	1.00		1.00
Age
Lower than median (≤ 23 years)	29 (25.0)	1.87 (1.05-3.35)	0.034
Higher than median (> 23 years)	14 (13.3)	1.00
Year of medical school
First year	32 (30.8)	3.27 (1.74-6.16)	< 0.001	3.27 (1.75-6.08)	< 0.001
Sixth year	11 (9.4)	1.00		1.00
Involvement in leisure activities
Yes	35 (18.1)	0.59 (0.31-1.13)	0.111	0.66 (0.37-1.15)	0.144
No	8 (30.8)	1.00		1.00
Living with family
Yes	24 (20.5)	1.11 (0.65-1.91)	0.700
No	19 (18.4)	1.00
Living in communal off-campus housing
Yes	1 (7.1)	0.35 (0.05-2.37)	0.283
No	42 (20.3)	1.00
Family income
< R$ 3,000.00^* * Equivalent to US$ 1,749.27 at the time of data collection.	7 (25.0)	1.71 (0.47-3.91)	0.205
R$ 3,000.00 to R$ 10,000.00^† † Equivalent to US$ 1,749.27-5,830.90 at the time of data collection.	23 (21.5)	1.47 (0.78-2.77)	0.236
≥ R$ 10,000.00^‡ ‡ Equivalent to US$ 5,830.90 at the time of data collection.	12 (14.6)	1.00
Paid employment
Yes	4 (8.2)	0.36 (0.13-0.95)	0.040	0.48 (0.17-1.36)	0.167
No	39 (22.8)	1.00		1.00
Coffee intake
Yes	31 (18.0)	0.77 (0.42-1.41)	0.400
No	11 (23.4)	1.00
Alcohol/drug use
Yes	13 (13.3)	0.55 (0.30-1.00)	0.049	0.82 (0.45-1.48)	0.511
No	29 (24.2)	1.00
Cigarette smoking
Yes	3 (33.3)	1.73 (0.66-4.55)	0.264
No	40 (19.2)	1.00
Physical illness
Yes	20 (29.9)	2.13 (1.24-3.66)	0.006	1.44 (0.86-2.42)	0.165
No	21 (14.0)	1.00		1.00
Medication use
Yes	29 (31.9)	2.73 (1.53-4.86)	0.001	2.77 (1.47-5.20)	0.002
No	14 (11.7)	1.00		1.00
Satisfaction with the course
Dissatisfied	4 (44.4)	2.35 (1.06-5.19)	0.035	2.07 (1.06-4.06)	0.034
More or less satisfied	7 (16.3)	0.86 (0.41-1.81)	0.691	0.93 (0.49-1.77)	0.824
Satisfied	32 (18.9)	1.00

	n (%)	Bivariate analysis		Poisson regression
		Relative risk, crude (95%CI)	p-value	Relative risk, adjusted (95%CI)	Adjusted p-value
Sex
Female	25 (21.7)	1.41 (0.82-2.46)	0.217
Male	18 (15.4)	1.00
Age
Lower than median (≤ 23 years)	27 (22.1)	1.52 (0.87-2.67)	0.143	1.21 (0.52-2.80)	0.659
Higher than median (> 23 years)	16 (14.5)	1.00		1.00
Year of medical school
First year	24 (21.8)	1.40 (0.81-2.41)	0.224	0.91 (0.40-2.06)	0.814
Sixth year	19 (15.6)	1.00		1.00
Involvement in leisure activities
Yes	36 (17.7)	0.66 (0.33-1.33)	0.242
No	7 (26.9)	1.00
Living with family
Yes	22 (18.2)	0.95 (0.55-1.63)	0.859
No	21 (19.1)	1.00
Living in communal off-campus housing
Yes	5 (31.1)	1.78 (0.81-3.88)	0.150	1.64 (0.70-3.85)	0.257
No	38 (17.6)	1.00		1.00
Family income
< R$ 3,000.00^* * Equivalent to US$ 1,749.27 at the time of data collection.	7 (25.0)	1.67 (0.74-3.78)	0.215
R$ 3,000.00 to R$ 10,000.00^† † Equivalent to US$ 1,749.27-5,830.90 at the time of data collection.	21 (18.8)	1.26 (0.67-2.36)	0.482
≥ R$ 10,000.00^‡ ‡ Equivalent to US$ 5,830.90 at the time of data collection.	13 (14.9)	1.00
Paid employment
Yes	5 (9.3)	0.44 (0.18-1.07)	0.071	0.51 (0.20-1.29)	0.156
No	37 (20.9)	1.00		1.00
Coffee intake
Yes	29 (16.0)	0.60 (0.34-1.07)	0.085	0.66 (0.36-1.20)	0.178
No	13 (26.5)	1.00		1.00
Alcohol/drug use
Yes	20 (19.2)	1.09 (0.63-1.89)	0.751
No	22 (17.6)	1.00
Cigarette smoking
Yes	4 (40.0)	2.24 (0.99-5.03)	0.052	3.12 (1.30-7.51)	0.011
No	39 (17.9)	1.00		1.00
Physical illness
Yes	16 (22.9)	1.34 (0.77-2.32)	0.301
No	27 (17.1)	1.00
Medication use
Yes	22 (23.2)	1.40 (082-2.39)	0.218
No	21 (16.5)	1.00
Satisfaction with the course
Dissatisfied	8 (80.0)	5.48 (3.42-8.77)		4.32 (2.34-7.97)
More or less satisfied	9 (20.5)	1.40 (0.71-2.77)	< 0.001	1.14 (0.54-2.37)	< 0.001
Satisfied	26 (14.6)	1.00	0.333	1.00	0.731

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[1] Correspondence: Ana Margareth Siqueira Bassols, Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-903, Porto Alegre, RS, Brazil. E-mail: ambassols@gmail.com