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A comparative study of mental health of medical students in two countries

Elia Georgieva, A. Velkova, M. Vatansever, N. Hristov, P. Pesheva, I. Simeonova, D. Dimitrova


Results from many studies indicate that throughout medical education students experience high levels of stress and depression. The aim of the current study was to assess and compare Bulgarian and Turkish medical students' levels of stress and depression. A cross-sectional study was conducted with 546 students (276 foreign students from Medical University – Sofia and 270 medical students from several medical universities in Ankara). The study instrument included basic socio-demographic questions, Medical Student Stressor Questionnaire (MSSQ-40 items) and Beck Depression Inventory (BDI). Turkish medical students showed higher levels of stress and depression than foreign students from Bulgaria. We found that all types of stressors in medical students had a relationship with depression. Results of our study imply that medical students need access to psychological support throughout their education.


depression, medical education, stress

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Aktekin, M., Karaman, T., Senol, Y. Y., Erdem, S., Erengin, H., & Akaydin, M. (2001). Anxiety, depression and stressful life events among medical students: a prospective study in Antalya, Turkey. Medical education, 35(1), 12-17.

Amr, M., El Gilany, A. H., & El-Hawary, A. (2008). Does gender predict medical students’ stress in Mansoura, Egypt?. Medical education online, 13(1), 4481.

Baldassin, S., Silva, N., Alves, T. C. D. T. F., Castaldelli-Maia, J. M., Bhugra, D., Nogueira- Martins, M. C. F., ... & Nogueira-Martins, L. A. (2013). Depression in medical students: cluster symptoms and management. Journal of affective disorders, 150(1), 110-114.

Bassols, A. M., Okabayashi, L. S., Silva, A. B. D., Carneiro, B. B., Feijó, F., Guimarães, G. C., & Eizirik, C. L. (2014). First-and last-year medical students: is there a difference in the prevalence and intensity of anxiety and depressive symptoms?. Revista brasileira de psiquiatria, 36(3), 233-240.

5. Beck, A. T., Steer, R. A., & Carbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical psychology review, 8(1), 77-100.

Beck, A. T., Ward, C., Mendelson, M., Mock, J., & Erbaugh, J. (1961). Beck depression (BDI). Arch Gen Psychiatry, 4(6), 561-571.

Binienda, J., Schwartz, K., & Gaspar, D. (2001). Training in end-of-life care through interaction with dying patients. Academic Medicine, 76(5), 517.

Bjorksten, O., Sutherland, S., Miller, C., & Stewart, T. (1983). Identification of medical student problems and comparison with those of other students. Journal of Medical Education.

Bob, M. H., Popescu, C. A., Pîrlog, R., & Buzoianu, A. D. (2014). Personality factors associated with academic stress in first year medical students. Human and Veterinary Medicine, 6(1), 40-44.

Bore, M., Kelly, B., & Nair, B. (2016). Potential predictors of psychological distress and well-being in medical students: a cross-sectional pilot study. Advances in medical education and practice, 7, 125.

Clark, D. C., & Zeldow, P. B. (1988). Vicissitudes of depressed mood during four years of medical school. Jama, 260(17), 2521-2528.

Dahlin, M. E., & Runeson, B. (2007). Burnout and psychiatric morbidity among medical students entering clinical training: a three year prospective questionnaire and interview-based study. BMC Medical education, 7(1), 6.

Dennis, A. R., Wixom, B. H., & Vandenberg, R. J. (2001). Understanding fit and appropriation effects in group support systems via meta-analysis. MIS quarterly, 25(2), 167-193.

Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2005, December). Medical student distress: causes, consequences, and proposed solutions. In Mayo Clinic Proceedings (Vol. 80, No. 12, pp. 1613-1622). Elsevier.

Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Academic medicine, 81(4), 354-373.

Esses, V. M., Dovidio, J. F., Jackson, L. M., & Armstrong, T. L. (2001). The immigration dilemma: The role of perceived group competition, ethnic prejudice, and national identity. Journal of Social issues, 57(3), 389-412.

Fawzy, M., & Hamed, S. A. (2017). Prevalence of psychological stress, depression and anxiety among medical students in Egypt. Psychiatry research, 255, 186-194.

Frank E, Carrera JS, Stratton T, Bickel J, Nora LM. Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal survey. BMJ 2006; 333(7570): 682

Georgieva, E. K., Georgieva, L. M., Zahariev, V. S., & Pesheva, P. A. (2014). Stress and stress factors among medical students in Bulgaria. Albanian Med J, (1), 2.

Givens, J. L., & Tjia, J. (2002). Depressed medical students’ use of mental health services and barriers to use. Academic medicine, 77(9), 918-921.

Gupta, S., Choudhury, S., Das, M., Mondol, A., & Pradhan, R. (2015). Factors causing stress among students of a Medical College in Kolkata, India. Education for Health, 28(1), 92.

Guthrie, E., Black, D., Bagalkote, H., Shaw, C., Campbell, M., & Creed, F. (1998). Psychological stress and burnout in medical students: a five-year prospective longitudinal study. Journal of the Royal Society of Medicine, 91(5), 237-243.

Haidet P, Stein HF. The role of the student-teacher relationship in the formation of physicians: the hidden curriculum as process. J Gen Intern Med. 2006;21(1)(suppl):S16-S20.

Heru A, Gagne G, Strong D. Medical student mistreatment results in symptoms of posttraumatic stress. Acad Psychiatry 2009; 33(4):302-306.

Hofstede, G. (1980). H.(1980). Culture’s Consequences: International Differences in Work-related Values. Beverly Hills. CA: Sage Publications.

Kjeldstadli, K., Tyssen, R., Finset, A., Hem, E., Gude, T., Gronvold, N. T., ... & Vaglum, P. (2006). Life satisfaction and resilience in medical school–a six-year longitudinal, nationwide and comparative study. BMC medical education, 6(1), 48.

Melaku, L., Mossie, A., & Negash, A. (2015). Stress among medical students and its association with substance use and academic performance. Journal of Biomedical Education, 2015.

Mosley, T. H., Perrin, S. G., Neral, S. M., Dubbert, P. M., Grothues, C. A., & Pinto, B. M. (1994). Stress, coping, and well-being among third-year medical students. Academic Medicine.

Park, K. H., Kim, D. H., Kim, S. K., Yi, Y. H., Jeong, J. H., Chae, J., ... & Roh, H. (2015). The relationships between empathy, stress and social support among medical students. International journal of medical education, 6, 103.

Rautio A, Sunnari V, Nuutinen M, Laitala M. Mistreatment of university students most common during medical studies. BMC Medical Education 2005; 5(36).

Richman JA, Flaherty JA, Rospenda KM, Christensen ML. Mental health consequences and correlates of reported medical student abuse. JAMA 1992; 267: 692-694.

Rosenberg DA, Silver HK. Medical student abuse. An unnecessary and preventable cause of stress. JAMA 1984; 251 (6):739–742

Rosenthal, J. M., & Okie, S. (2005). White coat, mood indigo—depression in medical school. New England journal of medicine, 353(11), 1085-1088.

Rosiek, A., Rosiek-Kryszewska, A., Leksowski, Ł., & Leksowski, K. (2016). Chronic stress and suicidal thinking among medical students. International journal of environmental research and public health, 13(2), 212.

Saipanish, R. (2003). Stress among medical students in a Thai medical school. Medical teacher, 25(5), 502-506.

Saravanan, C., & Wilks, R. (2014). Medical students’ experience of and reaction to stress: the role of depression and anxiety. The Scientific World Journal, 2014.

Selye, H. (1974). Stress without distress. New York: The New American Library. Inc., A Signet Book, 1-51.

Sender, R., Salamero, M., Vallés, A., & Valdés, M. (2004). Psychological variables for identifying susceptibility to mental disorders in medical students at the University of Barcelona. Medical education online, 9(1), 4350.

Sherina, M. S., Rampal, L., & Kaneson, N. (2004). Psychological stress among undergraduate medical students. Medical Journal of Malaysia, 59(2), 207-211.

Sohail, N. (2013). Stress and academic performance among medical students. J Coll Physicians Surg Pak, 23(1), 67-71.

Tchen, G., Carter, A., Gibbons, P., & McLaughlin, P. (2001). What is the relationship between indicators of stress and academic performance in first year university students? A prospective study. Journal of Institutional Research, 10(2), 1-12.

Tyssen, R., Vaglum, P., Grønvold, N. T., & Ekeberg, Ø. (2001). Suicidal ideation among medical students and young physicians: a nationwide and prospective study of prevalence and predictors. Journal of affective disorders, 64(1), 69-79.

Yee, L. Y., & Yusoff, M. S. B. (2013). Prevalence and sources of stress among medical students in Universiti Sains Malaysia and Universiteit Maastricht. Education in medicine journal, 5(4).

Yusoff, M.S.B., Rahim, A.F.A., & Yaacob M.J. (2010). The development and validity of the Medical Student Stressor Questionnaire. ASEAN Journal of Psychiatry, 11 (1): 231-235.

Yusoff, M. S. B., Rahim, A. F. A., & Yaacob, M. J. (2010). Prevalence and sources of stress among Universiti Sains Malaysia medical students. The Malaysian journal of medical sciences: MJMS, 17(1), 30.

Георгиева, Елиа. Мениджмънт на стреса в медицината. София, 2014; 168. ИК “Фльорир”. ISBN: 978-954-410-029-2.



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