Medical students'

mental health
A MIXED METHODS STUDY

TAMIRES MARTINS BASTOS

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Qualitative Phase:
RESEARCHERS
Prof Lucas F. Garcia (Unicesumar)
Carolina S. Padoan (UFRGS)
Advisor: Prof. Simone Hauck
Cristina Pessi (HPSP)
Coadvisor: Prof. Pricilla Laskoski Luciana Terra (UFRGS)

Prof. Ana Margareth Bassols Patricia F. Lago (SPPA)

Medical students: Aurora Z.

Quantitative Phase:
Xavier, Vitória R. Astolfi, Natieli A.
Prof. Lisia von Diemen (UFRGS)
Garcia
Prof. Maurício Hoffmann (UFSM)
Daniela B. Benzano (UFRGS)
Felipe Ornell (UFRGS)
COLLABORATORS
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01 Overview
02 Objectives
03 Methods & Results
Paper #1 (qualitative)
CONTENTS
Paper #2 (quantitative)

04 Discussion
05 Other relevant outcomes
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01. OVERVIEW

Medical students’ mental health

Risk factors

Interventions

Barriers for help-seeking

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PREVALENCE OF
PSYCHIATRIC DISORDERS 33.8% Anxiety

27.2% Depression

11.1% Suicide ideation

17.2 – 32.4% Alcohol

Other drugs
Rotenstein, 2016; Quek, 2019; Jackson, 2016
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Outside college?
UK: 2010-2019

11,519 young people 17-24 years old

43.9% 🡪 higher education students

Older, female, white British,

higher parental education
GHQ:
→ Caseness: OR 0.91 (0.81, 1.02 95% CI)
→ Score difference: −0.37 (95% CI−0.60,−0.08)

Tabor, 2021
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Meanwhile, in Brazil… ANXIETY

Meta-analysis of 59 studies (-2016) 32.9%

Mental health problems correlated with lack of motivation, lower (6 studies)

emotional support and work overload.

Pacheco, 2017 (Braz J Psychiatry) DEPRESSION

30.6%

(25 studies)
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ALCOHOL prob. use

32.9%

(3 studies)
Picture:
https://veja.abril.com.br/educacao/ao-vivo-escolas-e-universidades-fazem-greve-contra-cortes-na-educacao/
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Suicide ideation (SI) and suicide attempt (SA)

FEMALE GENDER
n = 4,840
SA = 8.94% HOMOSEXUALITY

LOW INCOME BULLYING / PEERS

TRAUMA Alcohol & Tobacco

Marcon, 2020

Picture: https://www.healthline.com/health/suicide-and-suicidal-behavior#hotlines-and-resources
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WORSE QUALITY OF LIFE…

Female INDIVIDUAL
Black
LGBTQ … and MENTAL DISORDERS
Chronic illness
IMC > 30 Low income
Child / Adulthood trauma Quota
SOCIO Lack of emotional support
Previous psych. disorders ECONOMIC
Distance from the family
Non-medical parents

Period of medical school (?)

RISK Bullying by peers
FACTORS? ACADEMIC Harassment
ENVIRONMENT
Work overload
Competitiveness

Baldassin, 2008; Tempski, 2012; Figueiredo, 2014; Pacheco, 2017; Barbosa, 2018; Hauck, 2019; Solis, 2019; Marcon, 2020; Suarez, 2021
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n = 232
Male = 50.4%
Anxiety = 18.5% → 30.8% 1st vs 9.4% 6th = OR 3.79 (1.56-9.20)
Depression = 18.6%
= more anxiety
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Interventions

Meta-analysis of 36 studies

Heterogeneous, but favors global interventions. Group 🡪 no effectiveness after 6 months

Frajerman, 2020

INDIVIDUAL GROUP INSTITUTION

Screening for mental Mindfulness People-focused

disorders working culture
Mentoring/counseling
Support programs Grading pass/fail
Stress management
Financial support Curriculum structure
Relationships and
Peer support belonging Training staff/student

Rohe, 2005; Reed, 2011; Carrieri, 2020; Frajerman, 2020

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Interventions: the local panorama

UFRGS
STUDENTS
R$ 250 treatment of low-income students
Peer support & gatekeeprs
Materials and maps for help-seeking
Arenas, 2020

https://www.ufrgs.br/prae/ingresso-cota-renda-inferior/
https://www.ufrgs.br/saudemental/

FAMED

Referral to mental health treatment

Training to recognize students in mental distress
Mentoring program for all 1st years
Stress-reduction group interventions
Manfro, 2019
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Barriers for help-seeking

“70% believe they would benefit if there were

college resources to assist students with
emotional or psychological difficulties”.

All schools in the study had counseling services

Only 39.8% actually accessed them.

Merlo, 2017
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Barriers for help-seeking

CONFIDENTIALITY ISSUES STIGMA CULTURE OF STOICISM

Fear of lack of confidentiality Fear of losing job Normalization of symptoms

from health care providers opportunities
Expectation of punitive
Fear of documentation in the Fear of judgement response
academic record
Minimizing mental illness “The role of compulsiveness”

Gabbard, 1985, Carrieri, 2020; Wasson, 2016; Winter, 2017; Mihailescu, 2019
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02. OBJECTIVES
To understand the experience of medical students regarding medical training at the Universidade
Federal do Rio Grande do Sul (UFRGS) as well as factors associated with mental health outcomes.

STUDENTS’ PERSPECTIVE MENTAL HEALTH HELP-SEEKING BEHAVIOR

To understand medical To assess anxiety and To identify factors related to

students’ experience depressive symptoms, help-seeking behavior
regarding medical training, suicide ideation and the risk regarding mental health care,
well-being and mental health for alcohol abuse and using quantitative
using qualitative methods. dependence methodology.
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03. RESULTS
PAPER #1

2018
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METHODS

PROCEDURES

Focus Groups
Interviews
Questionnaire

July – December 2018

Recorded and transcribed
1st, 3rd. 5th, 7th, 11th semesters
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METHODS

PROCEDURES RIGOR AND RELIABILITY

Focus Groups 2 researchers

Interviews Grounded Feedback
Theory
Questionnaire External
Corbin & Strauss, 2014 supervision

July – December 2018 Consolidated Criteria for Reporting

Recorded and transcribed Qualitative Research (COREQ)
st rd th th th Tong, 2007
1 , 3 . 5 , 7 , 11 semesters
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RESULTS

Female: 68.8%
Heterosexual: 71.9%
Family same city: 46.9%
Psychiatric diagnosis: 68.8%
Family income: Saught treatment: 90%
< 3,000.00 21.9%
Suicidal ideation (life): 50%
3-5,000.00 18.8%
5-10,000.00 28.1% Suicidal ideation (month): 15.6%
> 10,000.00 31.2% Suicide attempt: 6.3%

8 Focus Groups + 2 Interviews (n=32)

 WELL-BEING 19

SOCIAL UNIVERSITY MEDICAL

BACKGROUND ENVIRONMENT CAREER

Experiences Training
Family
Demands
Institution
Life Outside Relationships Being a Doctor

Socioeconomic Climate Expectations

Factors

MENTAL HEALTH
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PAPER #2
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November 2019
February 2020

Sociodemographic
Mental Health
Relationships
Academic
22
Environment
Validated
instruments

Open field Data collection

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BECK DEPRESSION BECK ANXIETY ALCOHOL USE DISORDERS

INVENTORY (BDI-II) INVENTORY (BAI) (Based on AUDIT-C)

Cutoff > 10 Cutoff > 9 Cutoff = 4 (m); 3 (f)

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Methods
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ANALYSIS
“Are you currently in treatment for any aspect related to mental health”?
Yes / No, but I feel I need it. / No and I don’t think I need it.

BIVARIATE HIERARCHICAL
ANALYSIS BINARY LOGISTIC
REGRESSION

Chi-square
Independent Samples OR and 95% IC
No need vs other
Kruskal-Wallis Test
Need vs treating
Ajusted residuals
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RESULTS INVITED n=833 🡪 population

CONSENT n=436 🡪 52.3%

ANALYZED n=382 🡪 completed BAI and

BDI without missing
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RESULTS
State of birth
Family Income (R$/month)

<1,500

1,500-3,000

3,000-5,000

5,000-10,000

>10,000

0% 10% 20% 30% 40% 50%

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BLACK
HETERO WHITE
FEMALE 24.3%
MALE 55.7% 79.3% BI, PAN, A 73.6%
YELLOW
43% 11.3% 1.3%
OTHER HOMO
INDIGENOUS
1.3% 9.4%
28 0.8%
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RESULTS - CLINICAL PROFILE

45% → psychiatric diagnosis (life)

46,1% → suicide ideation (life)
11.5% → suicide ideation (last month)
6% → suicide attempt (life)
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n BAI BDI
50.5%
RESULTS - CLINICAL PROFILE 200
47.9%

150

32.5%
29.3%

100

19.1%
45% → psychiatric diagnosis (life)
46,1% → suicide ideation (life) 13.9%
50
11.5% → suicide ideation (last month)
5.8%
6% → suicide attempt (life)
1%
0
Minimum Mild Moderate Severe
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n BAI BDI
50.5%
RESULTS - CLINICAL PROFILE 200
47.9%

ANXIETY: 52.1%

150

32.5%
29.3% DEPRESSION: 49.5%

100

19.1%
45% → psychiatric diagnosis (life)
46,1% → suicide ideation (life) 13.9%
50
11.5% → suicide ideation (last month)
5.8%
6% → suicide attempt (life)
1%
0
Minimum Mild Moderate Severe
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n Risk of Alcohol Abuse
200

42.7% 50 medical students

39.8%
150 with moderate to
severe risk of alcohol
abuse were not
100
receiving mental
health care and
12.1% reported no need for
50
treatment…
5.3%

0
Low Moderate High Severe
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No need Treatment
n=109 n=147
(28.5%) (38.5%)

TREATMENT
MODALITIES

65 (17%) Psychotherapy + Pharmacotherapy

57 (15%) Psychotherapy only
26 (6.8%) Pharmacotherapy only
In need
1 (0.3%) Other
n=126 (33%)
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SELF BIVARIATE ANALYSIS HELP

PERCEPTION SEEKING

IN TREATMENT
X NO NEED IN TREATMENT X IN NEED
IN NEED
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LOGISTIC
REGRESSION

TABLE 4
IN TREATMENT
IN TREATMENT
IN NEED

VS VS

Step 1: symptoms NO NEED IN NEED

Step 2: intrinsic factors

Step 3:life experiences
Step 4: med school
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LOGISTIC
REGRESSION

TABLE 4

Step 1: symptoms
Step 2: intrinsic factors
Step 3:life experiences
Step 4: med school
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04. DISCUSSION

Mostly white, high-income, single, without

children, parents with higher education and
economically dependent on family
members;

Access by low-income, women and Black

people increased;

Anxiety, depression and suicide ideation

last month: like national trends;

Alcohol abuse underestimated by the

students. Credit:
https://www.feevale.br/pos-graduacao/stricto-sensu/programa-de-pos
-graduacao-em-diversidade-cultural-e-inclusao-social
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LIMITATIONS

Cross-sectional and causality;

Data collection close to the end of

FURTHER
academic year; DEBATE

Convenience sample and possible How to address the students

selection bias; who do not seek mental
health care?
Low participation of interns;
Interventions targeting
Cutoff for family income: different medical culture?
degrees of financial difficulties.
Grading system in
discussion?
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OTHER RELEVANT OUTCOMES

CLASSES
PSQ82 - PPG UFRGS
MED05517 - Medical School

SCIENTIFIC EVENTS
20th Joseph Sandler Conference
12th Geneva Conference PCM
XIV Congresso Gaúcho de Psiquiatria
XXII Congresso Gaúcho de Educação Médica
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THANK YOU
tamires.bastos@gmail.com