How Medical Students Manage Depression, Anxiety, and Stress: A Cross-Sectional Study

Introduction

Due to the intense pressure and stress of the training process, medical students face a higher risk of burnout and depression than the general US population [1]. They must pursue extracurriculars, like research, to be competitive for residency applications. Common stressors include academics, peer-to-peer relationships, and finances [2], which can impact sleep quality, physical and mental health, and academic performance [3]. Stress can lead to burnout, with some even considering leaving medicine [4]. Medical students may cope with stress through healthy habits like exercise or harmful ones like alcohol abuse [5,6].

This study explores how first- and second-year medical students manage and reduce stress, to improve medical student wellness efforts.

Methods

Participants and Recruitment

Overall, 120 first-year and 126 second-year students at a California allopathic medical school were contacted via institutional email to complete an anonymous survey. One survey round was sent, with 27 responses collected.

Measures

The survey comprised 2 demographic questions (school year and gender); 24 multiple-choice questions on stress management; 1 free-response question for any unlisted stress management activities and their frequency; and 21 randomly shuffled questions from the Depression, Anxiety and Stress Scale–21 Items (DASS-21) [7]. The hobbies listed were based on community observation.

Statistical Analysis

Data were analyzed using IBM SPSS Statistics (version 28.0.1.0). Normality was assessed via the Kolmogorov-Smirnov test. For nonnormally distributed data, a Kruskal-Wallis test (via k independent samples) was conducted, with gender and school year as the grouping variables and the range being 1-2. Additionally, Spearman correlations were obtained through SPSS’s bivariate correlation function.

Ethical Considerations

This study received ethical approval from the California University of Science and Medicine Institutional Review Board (HS-2023‐56) on November 27, 2023. Informed consent was obtained from all participants included in the study for data collection and analyses. Identifying information was not collected. Participants were not compensated.

Results

The Kolmogorov-Smirnov test found that neither the questions nor the DASS-21 subscores were normally distributed. The Kruskal-Wallis results are presented in Table 1. Spearman correlations showed that school year was positively and moderately correlated with stress (r₂₇=.699; P<.001), anxiety (r₂₇=.585; P<.001), and depression (r₂₇=.408; P=.03).

Second-year medical students had mild depression (13.67), with moderate anxiety (11.17) and stress (20.50; Figure 1). In contrast, first-year medical students were in the “normal” range across all categories. This demonstrates that second-year medical students experience higher levels of distress.

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Discussion

Female participants were more likely to read (H₁=4.994; P=.02) and talk with friends (H₁=5.888; P=.02). This aligns with the existing literature, as women have been shown to read more than men, but this could also be due to our limited sample size [8]. Exercise habits did not significantly differ by school year (P=.09) or gender (P=.71). Prior studies have shown that exercise reduces burnout and improves quality of life [6], suggesting that medical schools should encourage physical activity, especially for students studying remotely.

First-year medical students were more likely to go out with friends (H₁=5.081; P=.02). Second-year medical students had varied schedules, due to rotations or professional development semesters, which at this institution are a dedicated 6-month period for self-directed activities such as research projects or studying for the United States Medical Licensing Examination (USMLE) Step exams. This may limit socialization opportunities compared to first-year medical students, who remain on a shared schedule. On the DASS-21, second-year medical students had moderate stress levels compared to first-year medical students—who had “normal” stress levels (a 15-point difference)—potentially due to clinical rotations, professional development semesters, or Step 1 exam preparation. The 6‐ to 8-week “dedicated” study period is highly stressful, and despite Step 1’s transition to a pass-or-fail grade, concerns remain about its impact on mental health. However, it is important to acknowledge that due to the limited sample size (n=27), it would be difficult to make broad generalizations. Similarly, this raises the question of validity, as students at other medical schools may have different experiences.

These findings highlight the need to focus on increasing social support through events such as mug painting, potlucks, or board game nights. This will help students build a network, better cope with stress, and reduce the negative feelings they experience [9]. Future research should focus on optimizing such interventions not only for second-year medical students but also for third- and fourth-year medical students, who were not included in this study. Future studies should also measure stress management and stress levels longitudinally across cohorts of various institutions so that standardized approaches can be developed, which can further be adjusted to fit the cultures of individual institutions.