Tribhuvan University Institute of Medicine, Kathmandu, Nepal.
Department of Psychiatry and Mental Health, Tribhuvan University Institute of Medicine, Kathmandu, Nepal.
BMC Psychiatry. 2020 Jun 15;20(1):298. doi: 10.1186/s12888-020-02645-6.
Medical students and residents were found to have suffered from depression, anxiety, and burnout in various studies. However, these entities have not been adequately explored in the context of Nepal. We proposed to determine the prevalence of depression, anxiety, burnout, their associated factors, and identify their predictors in a sample of medical students and residents in a Nepalese medical school.
It was a cross-sectional study with 651 medical students and residents chosen at random between December 2018 and February 2019. The validated Nepali version of Hospital Anxiety and Depression Scale, the Copenhagen Burnout Inventory, and Medical Students' Stressor Questionnaire were used to assess depression, anxiety, burnout, and stressors respectively. We used univariate and multivariable logistic regression analyses to identify the correlation of predictor variables with depression, anxiety, and burnout.
The overall prevalence of burnout (48.8%; 95% CI 44.9-52.7) and anxiety (45.3%; 95% CI 41.4-49.2) was more than that of depression (31%; 95% CI 27.5-34.7). Burnout and depression were more prevalent in residents than in medical students (burnout: 64.5% vs 37.6%, P-value < 0.0001; depression: 33.7% vs 29.1%, P-value 0.21). Whereas, medical students were found more anxious than residents (46.3% versus 43.96%, P-value 0.55). Academic related stressors caused high-grade stress to participants. Multivariable model for depression significantly showed anxiety, personal burnout, and work-related burnout as risk enhancing correlates; satisfaction with academic performance as a protective correlate. Similarly, the multivariate model for anxiety significantly identified female gender, depression, personal burnout, teaching and learning related stressors, and past history of mental illness as risk enhancing correlates; being satisfied with academic performance, getting adequate sleep, and being a second-year resident as protective correlates. The logistic model for burnout significantly showed being a first-year resident, depression, anxiety, and drive and desire related stressors as positive predictors. None of the variables were identified as significant negative predictors of burnout.
A high prevalence of depression, anxiety, and burnout was seen among medical students and residents. Most of them were stressed with academic-related factors. A strong correlation between teaching and learning-related stressors with depression and anxiety may be a call for an efficient and more student-friendly curriculum.
在多项研究中发现，医学生和住院医师患有抑郁、焦虑和倦怠。然而，在尼泊尔的背景下，这些实体尚未得到充分探讨。我们提出在尼泊尔一所医学院的医学生和住院医师样本中，确定抑郁、焦虑、倦怠的患病率、相关因素，并确定其预测因素。
这是一项横断面研究，于 2018 年 12 月至 2019 年 2 月期间随机选择了 651 名医学生和住院医师。使用经过验证的尼泊尔版医院焦虑和抑郁量表、哥本哈根倦怠量表和医学生应激源问卷分别评估抑郁、焦虑、倦怠和应激源。我们使用单变量和多变量逻辑回归分析来确定预测变量与抑郁、焦虑和倦怠的相关性。
倦怠（48.8%；95%CI 44.9-52.7）和焦虑（45.3%；95%CI 41.4-49.2）的总体患病率均高于抑郁（31%；95%CI 27.5-34.7）。住院医师的倦怠和抑郁患病率高于医学生（倦怠：64.5%比 37.6%，P 值<0.0001；抑郁：33.7%比 29.1%，P 值 0.21）。然而，医学生比住院医师更焦虑（46.3%比 43.96%，P 值 0.55）。与学术相关的应激源给参与者带来了高度的压力。抑郁的多变量模型显著显示焦虑、个人倦怠和与工作相关的倦怠是增强风险的相关因素；对学业表现的满意度是保护性相关因素。同样，焦虑的多变量模型显著确定了女性、抑郁、个人倦怠、教学相关应激源和既往精神病史是增强风险的相关因素；对学业表现满意、获得充足睡眠和作为二年级住院医师是保护性相关因素。倦怠的逻辑模型显著表明，作为一年级住院医师、抑郁、焦虑和与驱动力和欲望相关的应激源是积极的预测因素。没有发现任何变量是倦怠的显著负预测因素。
医学生和住院医师中存在较高的抑郁、焦虑和倦怠患病率。他们中的大多数人都承受着与学术相关的因素的压力。教学相关应激源与抑郁和焦虑之间的强烈相关性可能是对更高效、更以学生为中心的课程的呼吁。
