Stress, substance use, and suicidal ideation among first- and final-year medical students in an Indian hospital: a cross-sectional study

OBJECTIVES: To compare the prevalences of mental health problems, substance use, and suicidal ideation between first-year and final-year medical students. METHODS: First- and final-year medical students at ESIC Medical College and Hospital, Faridabad, Haryana, India, were invited to participate in a survey using consecutive sampling. The 21-item Depression, Anxiety and Stress Scale (DASS-21) was used to assess depression, anxiety, and stress. The 10-item Drug Abuse Screening Test was used to assess drug use during the previous 12 months. The 10-item Alcohol Use Disorders Identification Test was used to evaluate alcohol consumption patterns, drinking behaviours, and alcohol-related problems. The six-item Fagerström Test for Nicotine Dependence was used to assess frequency of use, compulsion, and level of nicotine dependence. The four-item Suicidal Behaviour Questionnaire-Revised was used to assess suicidal thoughts and behaviours. In binary logistic regression, higher DASS-21 scores predicted both high-risk suicidal behaviour (adjusted odds ratio [OR] = 1.06 per unit, p < 0.001) and moderate-to-severe drug use (adjusted OR = 1.08 per unit, p = 0.001). Final-year students had higher odds of moderate-to-severe drug use (adjusted OR = 23.70, p = 0.032), independent of psychological distress. Older age predicted high-risk suicidal behaviour (adjusted OR = 1.65 per year, p = 0.017). CONCLUSION: Medical students in an Indian hospital experience a high burden of psychological distress. Although first-year students exhibit greater emotional distress, final-year students demonstrate a higher prevalence of substance use, which may reflect maladaptive coping behaviours. Early, continuous, institution-based mental health interventions are needed.