Sergio Baldassin, from the ABC Regional Medical School, Brazil, led a team of researchers who carried out a study on 481 medical students in the private medical school near the São Paulo state capital.
He said, “We used cluster analyses to better describe the characteristics of depressive symptoms - affective, cognitive, and somatic. This is the first study to directly evaluate, in a cross-sectional design, the characteristics of depressive symptoms by applying such clusters”.
Affective symptoms represent the core symptoms of a depressive mood, based on students’ reported levels of sadness, dissatisfaction, episodes of crying, irritability and social withdrawal. The cognitive cluster assessed pessimism, sense of failure or guilt, expectation of punishment, dislike of self, suicidal ideation, indecisiveness and change in body image. Finally, the somatic cluster assessed the presence of slowness, insomnia, fatigue, loss of weight and loss of sexual interest. Baldassin said, “There was a high prevalence towards depressive symptoms among medical students, particularly females, mainly involving the somatic and affective clusters. Of the students in our study, 38% had at least 10 of a possible 63 symptoms of depression”.
The authors' cluster analysis found that the reasons for most students’ depression scores were in the affective cluster, and that the problem was at its worst in the internship years. Cognitive cluster symptoms were also highest in this year, probably due to feelings of fear and insecurity about entry into the hospital environment. According to Baldassin, “Frequently pre-internship students fear they ‘know nothing’, and are insecure about the physical examination of other people”. Likewise, somatic cluster scores were highest during internship, reflecting sleepless nights on call, devoid of friend and family support.
Having a parent who is a doctor was found to reduce the depression risk.
The authors conclude, “The increased depression scores during the internship period of medical school are associated with a decrease in student health, and this is probably the period when professors and educators should try to be most aware of suicidal thoughts and risk in their students”.
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