Learning Environment, Academic Stressors, and Institutional Aspects as Determinants of Mental Health Outcomes in Medical Education.

Abstract

Objective: Examine associations between learning environment, academic stressors, and mental health among Brazilian medical students across different institutional contexts.

Methods: Cross-sectional study of 1,026 medical students from 74 public and private universities. Participants completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Johns Hopkins Learning Environment Scale (JHLES), and Medical Student Stressor Factor Scale (MSSF). Analyses included group comparisons, multiple regression, random forest modeling, and latent class analysis.

Results: Private university students reported significantly better learning environments than public university counterparts (M = 84.6 vs. 81.9, p < 0.001). Quota students, those admitted to universities through affirmative action policies, demonstrated higher depression scores (M = 14.2 vs. 12.8, p = 0.007) and academic stress levels (M = 134.0 vs. 129.1, p = 0.018). Academic stressors demonstrated significant associations with both depressive (β=0.103; p<0.001) and anxiety symptoms (β=0.103; p<0.001), while higher learning environment quality was associated with lower depressive symptom severity (β=-0.105; p=0.043). Latent classes identified high-risk (53.7%), moderate-distress (32.7%), and high-functioning (13.6%) profiles, with affirmative-action students overrepresented in higher-risk classes.

Conclusion: Students admitted via affirmative action in public universities face compounded vulnerabilities. Interventions should focus on reducing academic stress and improving learning environments, especially in public institutions serving disadvantaged groups.