Protective and risk factors for the mental health of medical students from their perspective

ABSTRACT Introduction: Many studies have shown the high prevalence of mental disorders among medical students. Several known factors contribute to putting students at risk and protecting them from mental disorders. Objective: To analyse, from the student’s perspective, the factors that influence their mental health, particularly factors associated with the structure of the medical course, and to collect suggestions for interventions that can contribute to reducing suffering and promoting students’ mental health. Methods: A cross-sectional, observational, qualitative, and analytical study was conducted at a private medical school in the interior of São Paulo state (Brazil) in 2019. Since 2006, the course has been structured in active methodologies, with a three-years clerkship program. Participants answered the online questionnaire formulated by the authors. Results: A total of 263 students participated in the study (41.7% of the total), with a proportional distribution across the six years of the course. Average age 22.9 years (18 to 31 years). Most the participants (66.5%) were female, 25.5% (18.4 - 30.4%; 95% CI) reported having some mental disorder, diagnosed by psychiatrists in 85.5% of cases: anxiety disorders (11.4%); depressive disorders (11.0%); attention deficit hyperactivity disorder (1.9%) and others. The symptoms most mentioned by students were: lack of energy (45.3%); irritability (42.6%); distress (38.4%), and sadness (32.3%). The most mentioned protective factors for mental health were: friends and family relationships (24%); course structure (22.6%); teachers and staff (6.9%); physical activity (6.9%). The most mentioned aggressor factors were: complexity, course pressure and demands (23.7%); issues related to group work (20%); student assessment process (9.7%); oppressive hierarchy and hazing (8.1%), and professional insecurity (6.2%). They suggest interventions: discussions on the topic throughout the course in curricular (47.8%) and extracurricular activities (29.7%); group and individual therapeutic actions (21.7%); integrative practices (12.8%), and teacher training (6.1%). Conclusions: Although universally observed factors favour the mental health of medical students and others harm it, each educational institution must identify its primary risk and protective factors, correcting weaknesses and strengthening protective attitudes towards students.