Prevalence of depressive symptoms among medical students: overview of systematic reviews

Abstract

Context The prevalence of depressive symptoms among medical students has been found to be higher than among other students because of their longer studying time, higher workload and larger financial burden. Despite the availability of reviews examining this, some have focused solely on one country, whereas others used databases containing papers of solely one language; therefore, the results from reviews might not be comprehensive. Against this background, this overview aims to synthesise the results from all the published systematic reviews of depression among medical students, in order to provide a more accurate result. Methods A systematic search was conducted of online databases for published systematic reviews or meta‐analyses examining the prevalence of depressive symptoms among medical students. The findings of individual studies included in these reviews were extracted and then combined with a random‐effects model. Subgroup analysis was conducted by regions. Results A total of 10 studies were selected in this overview, involving 249 primary studies and 162 450 medical students. MEDLINE was the most popular database used in these studies. The overlapping of primary studies in these reviews was appreciably high, except for three studies that focused on specific countries. The overall pooled prevalence was 27.0% (95% CI, 24.7–29.5%). Significant subgroup differences were detected (p < 0.001). The pooled prevalence among studies in the Western Pacific Region was the lowest, 18.9% (95% CI, 11.7–29.0%), whereas that in Africa (40.9%) was the highest (95% CI, 28.8–54.4%). The top five significant factors associated with depressive symptoms were: (i) year of study; (ii) gender; (iii) personal issues; (iv) family relations or issues, and (v) health status. Conclusions Depression affected around a quarter of medical students in general and 40.9% of students in Africa. It is suggested that medical schools and health authorities should introduce preventive measures to curb the high prevalence of depressive symptoms.

Emotional socialisation and burnout in medicine and the role of medical educators

“…Empirical evidence from the findings of Tam et al . and other studies indicate there is work to be done to foster emotional well‐being and competence in medical students, as well as in junior doctors.…”

“…Recent studies highlight the need for a renewed focus on helping medical students and junior doctors to understand that emotional responses, such as feeling out of control, are an inevitable part of delivering health care and should not be repressed or avoided. Depression in medical students is associated with year of study, gender, personal issues, family relationships and health status . The number and nature of the factors associated with burnout add credence to the notion that medical students and junior doctors require bespoke support to enable them to experience, express and regulate their emotions because unregulated emotions can influence the quality of the medical care they deliver.…”

“…However, Tam et al. 's findings about prevalences of depression amongst medical students across the world highlight the imperative to improve the emotional support that is provided by senior doctors and other health care professionals in clinical practice. Positive role models who are able to articulate their own emotions in an honest and authentic manner have been reported to convey the importance of recognising, dealing with and expressing emotions to medical students .…”

“…Emotions have physiological and cognitive elements, but are also shaped by cultural practices and social influences. 6,7 Tam et al's overview 8 of systematic reviews found that almost 25% of medical students in general and over 40% of medical students in Africa are affected by depression that is associated with sociocultural factors. Efforts to improve medical students' and junior doctors' emotional regulation must consider not only practical guidance, but also the sociocultural factors that influence the understanding and expression of emotion in clinical practice.…”

“…Depression in medical students is associated with year of study, gender, personal issues, family relationships and health status. 8 The number and nature of the factors associated with burnout add credence to the notion 5,6 that medical students and junior doctors require bespoke support to enable them to experience, express and regulate their emotions because unregulated emotions can influence the quality of the medical care they deliver. Medical schools and postgraduate educational organisations endeavour to provide person-centred well-being and mental health support to medical students and junior doctors.…”