Vol 44 # 2 June 2012 - Kma.org.kw

June 2012
students experience lower levels of stress as compared
to males. In transition periods an elevation of stress
level among female students during the first study
year, and an increase of male students’ stress starting
later during the preclinical period with the overload of
information was noted in another study [10] . Although
we did not find any significant gender difference for
anxiety contrary to recent findings reporting female
dominance, we found that male students were more
depressed in all assessments.
Cost of medical education is an important challenge
especially for students from lower income families [26] .
Economic problems were also noted in recent studies as
the sources of stress in medical students [9,15] . Similarly,
students who reported lower family income were
significantly more anxious in A1 and more depressed
in A1 and A2 in our study. But in A3 students seemed
to be adapted to the economic conditions and their
HADS scores were like the higher income group.
Informed career selection is a suggested process for
a mature, realistic and objective decision making [14,27] .
Again our results replicates this suggestion pointing to
the importance of informed decision making. Students
who got no information about medical education and
working conditions were more anxious in A2 and A3.
In addition, especially, students who were not informed
about working conditions were more depressed in A1
and A2. Of course, it is important to keep in mind the
effect of desire for medical career [18] . Besides, there are
many contributing factors in decision process such
as economic factors, expectations, parental wishes or
other external influences etc [14,27,28] . Students’ reasons
for medical career selection and future expectations
seems to not have an effect on anxiety scores. External
influences in decision process and expecting better
economic conditions made students more depressed,
especially, in A1 and A2. It may be attributed to the
unwillingness and unmet expectations resulting from
uninformed decision making.
In addition to medical education medical students
face many personal and societal challenges [4] .
According to a study, family problems, interpersonal
problems, economic problems, career plans, physical
health, medical lecture workload and poor academic
performance increase the pressure on medical
students [15] . The most common sources of stress were
noted to be related to academic and psychosocial
concerns. The most important and severe sources of
stress were staying in hostel, high parental expectations,
vastness of syllabus, tests / exams, lack of time and
facilities for entertainment etc [17] . Stressful personal
life events such as illness or death of family members
etc were found to be related to students’ wellbeing [5] .
The main components of the students’ lives are their
education, their families and their intimate partners and
the presence of a negative event was found to increase
the risk of having a mental problem [25] . In a recent
KUWAIT MEDICAL JOURNAL 110
study, students who experienced negative personal life
events did not have a higher frequency of burnout than
students who did not experience a negative personal
life event. But personal characteristics, learning
environment and personal life events were all found
to be independently related to student’s burnout [4] .
The number of negative personal life events in the
last 12 months were also in correlation with the risk
of burnout [5] . Those who had suffered any negative
life events, such as failing an examination, death of a
parent and other social burdens, were more depressed
than those who had experienced positive life events [11] .
When students were asked about the most distressing
event in the last year, nearly half of them reported
educational problems such as failing the class or failure
to study in a faculty of their preference, loss of a family
member or breaking up with their partner because
of an infidelity or a quarrel [25] . Moreover, the level of
dissatisfaction in social activities was associated with
all psychological test scores for medical students. In
addition, romantic relationships and anxiety about
the future were determined as being the other factors
associated with psychological test scores [8] . Medical
students in Hong Kong reported a higher level of
psychological morbidity with concerns including
examinations, stress, career, adjusting to the new
medical curriculum and commitment to the course [12] .
Loss of relative was also one of the predictors of
depression and anxiety among students. Students who
had lost a close relative in last one year were 3.4 times
more likely to be depressed and suffer from anxiety
as compared to those who did not experience such a
loss [16] . Similarly, in this study we found that students
who faced an important problem in the past six months
were significantly more anxious and more depressed
in A2 and A3. But when it comes to the contributing
factors although problems about education and school
were the most reported, according to HADS scores these
were the least factors worsening their well-being. With
these results we could not claim that education related
factors were significant contributing factors for anxiety
and depression of medical students as noted before [15] .
A large proportion of students in both clinical and basic
science have potential psychological problems mainly
related to academics and psychosocial concerns [17] .
High academic achievement was noted to have a
positive effect on the mental health of students [25] . There
are both positive and negative correlations between
academic achievement and anxiety and depression in
medical students, regarding differing levels of severity
of anxiety or depression [15] . Similarly, problems related
to school in the past six months were mentioned
mostly but the HADS scores were in contrast in this
study. These results maybe attributed to different
factors unique to our faculty. In the faculty of Medicine
in Meram, every year, two-third of the all students in
the first three years got scores higher than 80 points out