Burnout and psychiatric morbidity among medical students entering clinical training: a three year prospective questionnaire and interview-based study

Marie E Dahlin, Bo Runeson, Marie E Dahlin, Bo Runeson

Abstract

Background: Mental distress among medical students is often reported. Burnout has not been studied frequently and studies using interviewer-rated diagnoses as outcomes are rarely employed. The objective of this prospective study of medical students was to examine clinically significant psychiatric morbidity and burnout at 3rd year of medical school, considering personality and study conditions measured at 1st year.

Methods: Questionnaires were sent to 127 first year medical students who were then followed-up at 3rd year of medical school. Eighty-one of 3rd year respondents participated in a diagnostic interview. Personality (HP5-i) and Performance-based self-esteem (PBSE-scale) were assessed at first year, Study conditions (HESI), Burnout (OLBI), Depression (MDI) at 1st and 3rd years. Diagnostic interviews (MINI) were used at 3rd year to assess psychiatric morbidity. High and low burnout at 3rd year was defined by cluster analysis. Logistic regressions were used to identify predictors of high burnout and psychiatric morbidity, controlling for gender.

Results: 98 (77%) responded on both occasions, 80 (63%) of these were interviewed. High burnout was predicted by Impulsivity trait, Depressive symptoms at 1st year and Financial concerns at 1st year. When controlling for 3rd year study conditions, Impulsivity and concurrent Workload remained. Of the interviewed sample 21 (27%) had a psychiatric diagnosis, 6 of whom had sought help. Unadjusted analyses showed that psychiatric morbidity was predicted by high Performance-based self-esteem, Disengagement and Depression at 1st year, only the later remained significant in the adjusted analysis.

Conclusion: Psychiatric morbidity is common in medical students but few seek help. Burnout has individual as well as environmental explanations and to avoid it, organisational as well as individual interventions may be needed. Early signs of depressive symptoms in medical students may be important to address. Students should be encouraged to seek help and adequate facilities should be available.

References

    1. Firth-Cozens J. Stress in medical undergraduates and house officers. Br J Hosp Med. 1989;41:161–4.
    1. Wallin U, Runeson B. Attitudes towards suicide and suicidal patients among medical students. Eur Psychiatry. 2003;18:329–33. doi: 10.1016/j.eurpsy.2003.03.006.
    1. Aktekin M, Karaman T, Senol YY, Erdem S, Erengin H, Akaydin M. Anxiety, depression and stressful life events among medical students: a prospective study in Antalya, Turkey. Med Educ. 2001;35:12–7. doi: 10.1046/j.1365-2923.2001.00726.x.
    1. Dyrbye LN, Thomas MR, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, Shanafelt TD. Personal life events and medical student burnout: a multicenter study. Acad Med. 2006;81:374–84. doi: 10.1097/00001888-200604000-00010.
    1. Firth-Cozens J. Individual and organizational predictors of depression in general practitioners. Br J Gen Pract. 1998;48:1647–51.
    1. Tyssen R, Vaglum P, Gronvold NT, Ekeberg O. Factors in medical school that predict postgraduate mental health problems in need of treatment. A nationwide and longitudinal study. Med Educ. 2001;35:110–20. doi: 10.1046/j.1365-2923.2001.00770.x.
    1. Firth-Cozens J, Greenhalgh J. Doctors' perceptions of the links between stress and lowered clinical care. Soc Sci Med. 1997;44:1017–22. doi: 10.1016/S0277-9536(96)00227-4.
    1. Rosvold EO, Bjertness E. Physicians who do not take sick leave: hazardous heroes? Scand J Public Health. 2001;29:71–5. doi: 10.1080/14034940151107082.
    1. Rosvold EO, Bjertness E. Illness behaviour among Norwegian physicians. Scand J Public Health. 2002;30:125–32. doi: 10.1080/14034940210133744.
    1. Toyry S, Rasanen K, Kujala S, Aarimaa M, Juntunen J, Kalimo R, Luhtala R, Makela P, Myllymaki K, Seuri M, et al. Self-reported health, illness, and self-care among finnish physicians: a national survey. Arch Fam Med. 2000;9:1079–85. doi: 10.1001/archfami.9.10.1079.
    1. Tyssen R, Rovik JO, Vaglum P, Gronvold NT, Ekeberg O. Help-seeking for mental health problems among young physicians: is it the most ill that seeks help? – A longitudinal and nationwide study. Soc Psychiatry Psychiatr Epidemiol. 2004;39:989–93. doi: 10.1007/s00127-004-0831-8.
    1. Chew-Graham CA, Rogers A, Yassin N. 'I wouldn't want it on my CV or their records': medical students' experiences of help-seeking for mental health problems. Med Educ. 2003;37:873–80. doi: 10.1046/j.1365-2923.2003.01627.x.
    1. Hooper C, Meakin R, Jones M. Where students go when they are ill: how medical students access health care. Med Educ. 2005;39:588–93. doi: 10.1111/j.1365-2929.2005.02175.x.
    1. Zoccolillo M, Murphy GE, Wetzel RD. Depression among medical students. J Affect Disord. 1986;11:91–6. doi: 10.1016/0165-0327(86)90065-0.
    1. Guthrie E, Black D, Bagalkote H, Shaw C, Campbell M, Creed F. Psychological stress and burnout in medical students: a five-year prospective longitudinal study. J R Soc Med. 1998;91:237–43.
    1. Tjia J, Givens JL, Shea JA. Factors associated with undertreatment of medical student depression. J Am Coll Health. 2005;53:219–24. doi: 10.3200/JACH.53.5.219-224.
    1. Givens JL, Tjia J. Depressed medical students' use of mental health services and barriers to use. Acad Med. 2002;77:918–21. doi: 10.1097/00001888-200209000-00024.
    1. Clark DC, Zeldow PB. Vicissitudes of depressed mood during four years of medical school. JAMA. 1988;260:2521–8. doi: 10.1001/jama.260.17.2521.
    1. Vaez M. PhD Thesis. Karolinska Institutet, Department of Public Health Sciences; 2004. Health and Quality of Life during Years at University. Studies on their Development and Determinants.
    1. Caplan RP. Stress, anxiety and depression in hospital consultants, general practitioners and senior health service managers. BMJ. 1994;309:1261.
    1. Grassi L, Magnani K. Psychiatric morbidity and burnout in the medical profession: an Italian study of general practitioners and hospital physicians. Psychother Psychosom. 2000;69:329–34. doi: 10.1159/000012416.
    1. Rosal MC, Ockene IS, Ockene JK, Barrett SV, Ma Y, Hebert JR. A longitudinal study of students' depression at one medical school. Acad Med. 1997;72:542–6. doi: 10.1097/00001888-199706000-00022.
    1. Enns MW, Cox BJ, Sareen J, Freeman P. Adaptive and maladaptive perfectionism in medical students: a longitudinal investigation. Med Educ. 2001;35:1034–42. doi: 10.1046/j.1365-2923.2001.01044.x.
    1. McManus IC, Keeling A, Paice E. Stress, burnout and doctors' attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMC Medicine. 2004;2:29. doi: 10.1186/1741-7015-2-29.
    1. Shaufeli W, Enzmann D. The burnout companion to study and practice – a critical analysis. London: Taylor and Francis; 1998.
    1. Hallsten L JM, Torgén M. Performance-based self-esteem. A driving force in burnout processes and its assessment. Stockholm: National Institute for Working Life; 2005.
    1. Dahlin M, Joneborg N, Runeson B. Performance-based self-esteem and burnout in a cross-sectional study of medical students. Med Teach.
    1. Gude T, Hjortdahl P, Anvik T, Baerheim A, Fasmer OB, Grimstad H, Tyssen R, Ekeberg O, Vaglum P. Does change from a traditional to a new medical curriculum reduce negative attitudes among students? A quasi-experimental study. Med Teach. 2005;27:737–9. doi: 10.1080/01421590500271498.
    1. Helmers KF, Danoff D, Steinert Y, Leyton M, Young SN. Stress and depressed mood in medical students, law students, and graduate students at McGill University. Acad Med. 1997;72:708–14. doi: 10.1097/00001888-199708000-00018.
    1. Gustavsson JP, Jonsson EG, Linder J, Weinryb RM. The HP5 inventory: definition and assessment of five health-relevant personality traits from a five-factor model perspective. Personality and Individual Differences. 2003;35:69–89. doi: 10.1016/S0191-8869(02)00142-3.
    1. Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: a cross-sectional study. Med Educ. 2005;39:594–604. doi: 10.1111/j.1365-2929.2005.02176.x.
    1. Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. The job demands-resources model of burnout. J Appl Psychol. 2001;86:499–512. doi: 10.1037/0021-9010.86.3.499.
    1. Bech P, Rasmussen NA, Olsen LR, Noerholm V, Abildgaard W. The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity. J Affect Disord. 2001;66:159–64. doi: 10.1016/S0165-0327(00)00309-8.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998. pp. 22–33.
    1. Richman JA, Flaherty JA. Gender differences in medical student distress: contributions of prior socialization and current role-related stress. Soc Sci Med. 1990;30:777–87. doi: 10.1016/0277-9536(90)90201-3.
    1. Sargent MC, Sotile W, Sotile MO, Rubash H, Barrack RL. Stress and coping among orthopaedic surgery residents and faculty. J Bone Joint Surg Am. 2004;86-A:1579–86.
    1. Ross S, Cleland J, Macleod MJ. Stress, debt and undergraduate medical student performance. Med Educ. 2006;40:584–589. doi: 10.1111/j.1365-2929.2006.02448.x.
    1. Amorim P, Lecrubier Y, Weiller E, Hergueta T, Sheehan D. DSM-IH-R Psychotic Disorders: procedural validity of the Mini International Neuropsychiatric Interview (MINI). Concordance and causes for discordance with the CIDI. Eur Psychiatry. 1998;13:26–34. doi: 10.1016/S0924-9338(97)86748-X.
    1. Facundes VLD, Ludermir AB. Common mental disorders among health care students. Rev Bras Psiquiatr. 2005;27:194–200. doi: 10.1590/S1516-44462005000300007.
    1. Firth-Cozens J. Emotional distress in junior house officers. Br Med J (Clin Res Ed) 1987;295:533–6.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir