Factors in medical school that predict postgraduate mental health problems in need of treatment. A nationwide and longitudinal study

TLDR

Physicians experience a higher prevalence of mental health problems, especially during the first postgraduate years. The study aimed to determine the prevalence of mental health problems in the fourth postgraduate year and to assess whether such problems could already be predicted during medical school. A nationwide longitudinal postal questionnaire of 396 Norwegian medical students collected data on perceived mental health problems needing treatment, personality traits, perceived stress, coping skills, and diagnostic abilities, and logistic regression was used to analyze predictors. In the fourth postgraduate year, 17.2% reported mental health problems requiring treatment (no gender difference); multivariate analysis identified prior mental health issues, extraversion, perceived medical school stress, and wishful thinking as predictors, but these variables were inadequate for individual prediction, though the stress instrument may help target group‑based interventions.

Abstract

Physicians show an increased prevalence of mental health problems, the first postgraduate years being particularly stressful.To study the prevalence of mental health problems during the fourth postgraduate year, and to investigate whether it is already possible to predict such problems at medical school.A cohort of medical students (n=396) from all Norwegian universities, who were approached in their graduating semester (baseline) and in their fourth postgraduate year.A nationwide and longitudinal postal questionnaire survey, including measures of perceived mental health problems in need of treatment, personality, perceived stress and skills, and ways of coping. Data were analysed using logistic regression.Mental health problems in need of treatment during the fourth postgraduate year were reported by 17.2% (n=66), with no gender difference, possibly because of a higher prevalence among the men compared with the general population. A majority had not sought help. Univariate medical school predictors of mental health problems included: previous mental health problems; not being married/cohabitant; the personality traits 'vulnerability' (or neuroticism) and 'reality weakness'; perceived medical school stress, and lack of perceived diagnostic skills. In addition, the coping variables avoidance, blamed self and wishful thinking were univariate predictors. Multivariate analysis identified the following adjusted predictors: previous mental health problems; 'intensity' (extraversion); perceived medical school stress, and wishful thinking. Medical school variables were inadequate for predicting which individual students would experience postgraduate mental health deterioration. However, the perceived medical school stress instrument may be used for selecting a subgroup of students suitable for group-oriented interventions.