The Influence of Maladaptive Perfectionism on Anxiety and Depressive Symptoms in Healthcare Students: A Multi-Institutional Cross-Sectional Study

Background: Healthcare individuals including students studying in medical, nursing and allied healthcare, face significant psychological distress and depression during their schooling and clinical training. One factor that might make them more vulnerable to this stress is “perfectionism”. The demanding nature of healthcare education, combined with intense competition among peers and high expectations for performance increases the unhealthy perfectionism. This study aimed to evaluate the association between unhealthy perfectionism and symptoms of anxiety and depression among healthcare students across multiple institutions and different geographic regions. Methods: A cross sectional survey was conducted among 354 undergraduate healthcare participants. The participants were from multiple institutions in the Caribbean, India and the United States between September 2025 and March 2026. Participants completed three questionnaire - the Frost Multidimensional Perfectionism Scale (FMPS), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7 (GAD-7). Participants were recruited using convenience and snowball sampling methods via institutional contacts from peers, student organizations, academic networks, friend’s network, and social media platforms. Pearson's correlation and multivariable linear regression analyses were performed after adjusting for age, sex, academic year, and sleep duration. Statistical significance was set at P < 0.05. Results: A total of 354 healthcare students participated with a mean age of 25.5 ± 2.5 years (range: 22–31 years), and 61% were females. Moderate to severe anxiety was observed in 28.6% of participants (n = 101), while 24.3% (n = 86) had moderate to severe depressive symptoms. Maladaptive perfectionism was moderately and positively associated with anxiety (r = 0.49, p < 0.001) and depressive symptoms (r = 0.44, p < 0.001). In multivariable regression analysis, maladaptive perfectionism independently predicted anxiety (β = 0.41, 95% CI: 0.32–0.50; p < 0.001) and depressive symptoms in all the participants (β = 0.36, 95% CI: 0.27–0.45; p < 0.001) after controlling for potential confounders. Participants reporting poor sleep quality had significantly higher anxiety and depression scores than those with adequate sleep (p < 0.01). Female student’s participants had a higher prevalence of moderate to severe anxiety than male’s student participants (31.6% vs. 23.9%), however, this difference was not statistically significant (p = 0.08). Conclusion: Maladaptive perfectionism was independently associated with higher anxiety and depressive symptoms among healthcare students across diverse geographic settings. These findings highlight the importance of early identification of perfectionistic traits and implementation of institution based mental health interventions to reduce psychological distress and enhance the academic wellbeing. Longitudinal studies are warranted to establish causal relationships.