Research Article: How to Cope with the Challenges of Medical Education? Stress, Depression, and Coping in Undergraduate Medical Students

Date Published: February 20, 2020

Publisher: Springer International Publishing

Author(s): Verena Steiner-Hofbauer, Anita Holzinger.


Up to 90% of medical students experience stress. Studies have observed a relationship between stress and depression. Coping strategies to deal with stress and depression are of great interest. This study aimed to evaluate the prevalence of stress and depression and the efficacy of coping strategies in undergraduate medical students.

This survey was conducted with 589 second-year and sixth-year students in 2017 at the Medical University of Vienna. The questionnaire included a stress and coping questionnaire, depression screening, substance use questionnaire, and questionnaire concerning leisure time activities.

The coping strategies were included in a regression model to assess their predictive value for stress and depression screening scores. The most common stressor was performance pressure overload (92.1%). Overall, 52.4% of the participating students reached critical scores in the depression screening. Positive thinking and active coping were associated with lower stress scores. Positive thinking also was a protective factor against depressive symptoms. Less than 2% of all students reached high-risk values for substance use.

Accessible counseling for students in need of psychological care should be provided. Different interventions of positive psychology showed a positive impact on depression screening scores.

Partial Text

To find out details about the mental health of students at the Medical University of Vienna, a cross-sectional survey was conducted among students during the preclinical training in the second-year and sixth-year students after their clinical training. This sampling strategy makes it possible to compare the preclinical level, mainly at the beginning of the study, and the clinical level after 1 year of clinical internship at the end of medical education.

Overall stress scores were 50.7 points in the sixth year and 44.3 points in the second year with a mean of 47.5 over both groups. In both years, women experienced significantly more stress than men did (p < .05; second year, 49.2 vs. 43.8 points in SCI scores; sixth year, 55.3 vs. 45.5 points in SCI scores). Table 1 shows the top five stressors for second- and sixth-year female and male students (Table 1).Table 1Top 5 stressors of female and male students of 2nd and 6th year (%)Female%Male%2nd year2nd year  Performance pressure overload92.2Performance pressure overload88.3  High expectations for themselves91.3High expectations for themselves81.1  Uncertainty about life goals72.5Uncertainty about life goals69.4  Uncertainty about studies67.9Uncertainty about studies59.2  Social expectations60.1Uncertainty about relationship54.66th year6th year  Performance pressure overload85.5Uncertainty about studies80.5  High expectations for themselves85.5High expectations for themselves76.8  Uncertainty about studies84.2Uncertainty about life goals74.7  Uncertainty about life goals82.9Performance pressure overload73.6  Financial uncertainties77.6Financial uncertainties and uncertainty about relationship56,3 In this study, we investigated the prevalence of stress and depressive symptoms as well as the prevalence of functional and dysfunctional coping strategies among male and female students in clinical and preclinical training. However, the authors wanted to know if and how stress and depression screening scores are associated with different coping strategies. Second-year students experienced more stress than their sixth-year colleagues. Female students in both groups experienced more stress than did male students. Critical depression screening scores of ≥ 16 were more prevalent in the second-year group. Overall, about 50% of all students obtained critical depression screening scores in the CES-D screening. Seeking social support was the most frequently used coping strategy, but it reduced neither stress nor depression screening scores. Turning to religion was slightly associated with higher stress scores. Active coping and positive thinking were associated with lower stress scores and positive thinking was associated with lower depression screening scores. Risky substance use was uncommon in our sample. Alcohol, tobacco, and cannabis were the most used substances; the use of other drugs was rare.   Source:


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