Stress, substance use, and suicidal ideation among first- and final-year medical students in an Indian hospital: a cross-sectional study.

Abstract

Objectives: To compare the prevalences of mental health problems, substance use, and suicidal ideation between first-year and final-year medical students.

Methods: First- and final-year medical students at ESIC Medical College and Hospital, Faridabad, Haryana, India, were invited to participate in a survey using consecutive sampling. The 21-item Depression, Anxiety and Stress Scale (DASS-21) was used to assess depression, anxiety, and stress. The 10-item Drug Abuse Screening Test was used to assess drug use during the previous 12 months. The 10-item Alcohol Use Disorders Identification Test was used to evaluate alcohol consumption patterns, drinking behaviours, and alcohol-related problems. The six-item Fagerström Test for Nicotine Dependence was used to assess frequency of use, compulsion, and level of nicotine dependence. The four-item Suicidal Behaviour Questionnaire-Revised was used to assess suicidal thoughts and behaviours.

Results: Of 160 medical students approached, 20 declined to participate; 140 (70 each from the first and final years) were included in the analysis. Most students were single (90.0% among first-year students and 58.6% among final-year students). Students who were in a relationship had lower DASS-21 scores than those who were single (32.8 vs 40.6, p = 0.03). The mean DASS-21 score was higher among first-year students than among final-year students (41.6 vs 35.7, p = 0.07). However, final-year students had higher proportions of hazardous-to-dependent alcohol use (14.3% vs 1.4%, p = 0.004), moderate-to-severe drug use (17.1% vs 1.4%, p = 0.006), and smoking during the previous year (37.1% vs 7.1%, p < 0.001). Overall, 20.0% of first-year students and 15.7% of final-year students had a high risk of suicidal behaviour. DASS-21 scores were moderately correlated with Drug Abuse Screening Test scores in both first-year students (r = 0.43, p < 0.001) and final-year students (r = 0.37, p < 0.001), as well as in both first-year students (r = 0.43, p < 0.001) and final-year students (r = 0.37, p < 0.001), as well as Suicidal Behaviour Questionnaire-Revised scores in both first-year students (r = 0.41, p < 0.001) and final-year students (r = 0.44, p < 0.001). In binary logistic regression, higher DASS-21 scores predicted both high-risk suicidal behaviour (adjusted odds ratio [OR] = 1.06 per unit, p < 0.001) and moderate-to-severe drug use (adjusted OR = 1.08 per unit, p = 0.001). Final-year students had higher odds of moderate-to-severe drug use (adjusted OR = 23.70, p = 0.032), independent of psychological distress. Older age predicted high-risk suicidal behaviour (adjusted OR = 1.65 per year, p = 0.017).

Conclusion: Medical students in an Indian hospital experience a high burden of psychological distress. Although first-year students exhibit greater emotional distress, final-year students demonstrate a higher prevalence of substance use, which may reflect maladaptive coping behaviours. Early, continuous, institution-based mental health interventions are needed.