Depression, stress and anxiety in medical students: A cross-sectional comparison between students from different semesters

Objective: To compare the prevalence of anxiety, depression, and stress in medical students from all semesters of a Brazilian medical school and assess their respective associated factors. Method: A cross-sectional study of students from the twelve semesters of a Brazilian medical school was carried out. Students filled out a questionnaire including sociodemographics, religiosity (DUREL - Duke Religion Index), and mental health (DASS-21 - Depression, Anxiety, and Stress Scale). The students were compared for mental health variables (Chi-squared/ ANOVA). Linear regression models were employed to assess factors associated with DASS-21 scores. Results: 761 (75.4%) students answered the questionnaire; 34.6% reported depressive symptomatology, 37.2% showed anxiety symptoms, and 47.1% stress symptoms. Significant differences were found for: anxiety - ANOVA: [F = 2.536, p= 0.004]between first and tenth (p= 0.048) and first and eleventh (p= 0.025) semesters; depression - ANOVA: [F = 2.410, p= 0.006] between first and second semesters (p= 0.045); and stress - ANOVA: [F = 2.968, p= 0.001] between seventh and twelfth (p= 0.044), tenth and twelfth (p= 0.011), and eleventh and twelfth (p= 0.001) semesters. The following factors were associated with (a) stress: female gender, anxiety, and depression; (b) depression: female gender, intrinsic religiosity, anxiety, and stress; and (c) anxiety: course semester, depression, and stress. Conclusion: Our findings revealed high levels of depression, anxiety, and stress symptoms in medical students, with marked differences among course semesters. Gender and religiosity appeared to influence the mental health of the medical students.