Assessment of the needs and demand for psychiatric care among medical students: cross-sectional study

Résumé

Introduction Studying medicine is a demanding and time-consuming course of study, which can be a major stress factor and affect quality of life (QOL). Medical students are at high risk of developing mood disorders. This could lead to a need for psychiatric care (PC) that is not necessarily equivalent to the demand. Objectives Determine the prevalence of depression, anxiety and stress in medical students, assess their QOL and subjective need for PC. Methods This was a descriptive cross-sectional study conducted over a 5-month period in a Tunisian medical school. Sampling was stratified random. Sociodemographic and clinical data were collected using a questionnaire. Depression, anxiety and stress were assessed using the Depression Anxiety and Stress Scale: DASS-21. QOL was assessed using the generic 36-item Short-Form Health Survey (SF-36). Subjective assessment of difficulties and need for help was carried out using the “KIT ELADEB: Lausanne Self-Assessment Scales for Difficulties and Needs”. Results The study included 308 students with a median age of 21. Some (18.8%) were smokers, 15.9% drank alcohol, and 5.2% used psychoactive substances (PAS). A Family psychiatric history (PH) was present in 15.4% of cases, and 14.3% of students had personal PH. Median DASS scores were: depression 18 (interquartile range (IQR) = 16-27), anxiety 20 (IQR = 18), and stress 16 (IQR = 42). The rates of extremely severe and severe depression were 27.6% and 12.3% respectively, while 50.6% had extremely severe and 12% severe anxiety. Some 29.2% of students had severe to extremely severe stress. Mean SF-36 scores were 61.19 ± 16.83, referring to the Léan cut-off value (66.7), 58.1% had impaired QOL, 15.9% of participants had consulted a psychiatrist, 78.9% had felt the need to do so, and 59% had foregone such help. Factors associated with severe depression included advanced age (p=0.007), graduate education (p<10-3), PAS use (p<10-3), and PH (p<10-3). Anxiety was predicted by female gender (FG) (p=0.04), SPA use (p=0.03), and PH (p<10-3). Stress was associated with age (p=0.039), course of study (p=0.008), lack of leisure activities (p=0.003), smoking (p=0.004), alcoholism (p=0.009), use of PAS (p=0.003), and PH (p=0.000). Students who consulted a psychiatrist were more likely to have depression (p<10-3), stress (p<10-3), and impaired QOL (p<10-3). Participants who expressed a subjective need to consult a psychiatrist were significantly associated with FG (p<10-3), depression (p<10-3), anxiety (p<10-3), stress (p<10-3), and alterations in the mental health (p=0.008), vitality (p=0.006), social functioning (p=0), and general QOL (p=0.002) dimensions of the SF-36. Conclusions The obvious deterioration in the mental health and QOL of medical students, and the mismatch between the need for and demand for PC, should initiate a debate on recommendations to improve the well-being of our future doctors. Disclosure of Interest None Declared

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