Stress, poor mental health, and drug use among medical and pre-medical students.
For students pursuing a degree in medicine, it is not uncommon to have the feeling that you’re are constantly “beating the odds”. As health care professions become more and more sought after by undergraduates, it becomes more competitive and thus, more stressful to stand out amongst your peers. There have been several in-depth studies concerning the high levels of stress, anxiety and even depression that is widespread, in some degree, amongst medical students. These minor psychotic disorders are often a consequence of unmanageable workloads, abnormally high levels of stress, and severe sleep deprivation. In many cases, these students resort to use of prescription medication such as Ritalin and Aderall, which is medicinally used to treat symptoms of Attention Defecit Disorder (ADHD). While these substances are abused as a “study aid” to combat the rigorous curriculum of medical school, some students find themselves self-medicating stress with alcohol. Too often, students seeking health care professions find themselves in a state of poor mental health or substance abuse, a sacrifice most are willing to take to earn their degree. Studies have shown that once medical students find themselves in a state of poor mental health, they will avoid seeking help in order to protect their future careers.
Most medical students will experience several “all-nighters” in order to keep up with the massive workloads. A study published in BMC Research Notes investigated the relationship between sleep deprivation and academic performance as well as the respective perceptions of this relationship through the eyes of medical students and advisors. The research, conducted at a medical school in Saudi Arabia, discovered that a vast majority of students, almost 80%, had experienced varying levels of sleep deprivation and believed it negatively effected their academic performance. As one would expect, a majority agreed that the “demanding medical curriculum and stress of final exams lead to sleep deprivation, respectively”. The surveys also revealed that only 13.5% of these individuals received any counseling from their advisors for their unhealthy sleep patterns and not one of the advisors inquired about sleep patterns while counseling (AlFakri et al, 2015). While this is merely a study of one medical school, similar findings suggest that this is a common model and students often report “feelings of shame and embarrassment in admitting [mental] weakness” (Chew-Graham et al, 2003).
Stress is a common theme amongst students in all modes of higher education and graduate education, likewise, studies have shown that stress and consequent minor psychic disorders are prevalent worldwide amongst the medical student community. Another study published in BMC Research Notes analyzes stress among medical students in Bangladesh, which concluded that more than half of the surveyed students were suffering from “measurable academic stress” (Eva et al, 2015, p.1). If stress among medical students is so prevalent, should there be more accessible tools to combat this stress? Yet another study published in BMC Research Notes was conducted a study at a Brazilian medical school, in which the students took an elective course on coping strategies for professional stress. The surveys given to the students after the course showed that an overwhelming majority of the students experienced less stress, utilized the coping mechanisms, and perceived the course to be beneficial and useful (Dias Pereira et al, 2015).
Unfortunately, stress coping and time management education is not available to health care professionals unless they actively seek it out. Instead of utilizing healthy coping mechanisms, these students often turn to self-medication to deal with the demands of school. Use of methylphenidate, the psychotropic agent in ADHD medications, is very commonly used for cognitive enhancement in college students, but evidence from research by Cohen et al (2015) suggests that use of methylphenidate by medical students is “considerably higher than in the college student’s populations”. Shockingly, many of these first-time drug use was observed in the first year of medical school and drug use amongst students increased for every year in school. These statistics are visually represented in Figure 1 (Cohen et al, 2015, p.322). While some of the users were diagnosed and prescribed these medications, a majority of the students were not suffering from ADHD and admitted to using the drugs as a study aid.
In addition to prescription drug abuse, medical professionals and students experience varying degrees of alcohol abuse throughout their lives. A study done on second year medical students at the University of Leeds showed that a more than half of the participants drank more than the recommended limit of alcohol consumption per week (Pickard et al, 2000, p.148) Conversely, studies by McAuliffe et al (1991) found that health care professionals and health care professional students, were no more likely to abuse alcohol compared to other professions.
It is difficult to ignore challenges facing medical students worldwide. While academic stress does not always have negative results or mental health consequences, many students often find themselves experiencing symptoms of depression and anxiety, as a consequence of this stress. Health care education institutions have yet to make a strong movement towards solving this mental health issue and students remain hesitant to seek counseling for unhealthy sleep patterns, poor mental health, and drug use. Even more concerning is the abuse of prescription drugs and the failure of the medical community to respond.
Hypothesis:
While there is extensive research on stress, mental health, and drug use regarding medical students, there is not as much research regarding these same topics on “pre-med” students, undergraduate students pursuing acceptance to medical school. I hope to analyze the experiences of current pre-med students at the University of Denver (DU) and students currently in medical school after pursuing their undergraduate degree at DU. Based on these interviews, I would expect to see whether or not these students experience different levels of stress and anxiety due to academics, the source of this stress, and how they cope with it. I anticipate that the responses will reveal widespread stress amongst both pre-medical and medical students. I also hope to uncover findings about how students perceive this stress and whether or not they believe education in stress coping would be beneficial. Finally, by anonymous survey, I would like to find how prevalent drug use, specifically ADHD medication, is within the premedical student community at DU. I expect to find that students pursuing a degree in medicine, at any level, experience an exceptionally high amount of stress and pressure regarding their career path. I also believe that there may be common themes for the sources of this stress, reoccurring coping mechanisms, and a pattern of drug use to enhance academic performance.
References
AlFakri et al. (2015). Perceptions of pre‑clerkship medical students and academic advisors about sleep deprivation and its relationship to academic performance: a cross‑sectional perspective from Saudi Arabia. BMC Research Notes, 8, 1, 740-748.
doi: 10.1186/s13104-015-1755-y
Chew-Graham et al. (2003) ‘I wouldn’t want it on my CV or their records’: medical students’ experiences of help-seeking for mental health problems. Medical Education, 37, 873-880.
Cohen et al. (2015). Methylphenidate use among medical students at Ben-Gurion University of the Negev. Journal of Neurosciences in Rural Practice, 6, 3, 320-326.
Dias Pereira et al. (2015) Medical student stress: an elective course as a possibility of help. BMC Research Notes, 8, 1, 1-10.
doi: 10.1186/s13104-015-1399-y
Eva et al. (2015). Prevalence of stress among medical students: a comparative study between public and private medical schools in Bangladesh. BMC Research Notes, 8, 1, 1-7.
doi: 10.1186/s13104-015-1295-5
Pickard et al. (2000). Alcohol and drug use in second‐year medical students at the University of Leeds. Medical education, 34.2, 148-150.
W E McAuliffe et al. (1991). Alcohol use and abuse in random samples of physicians and medical students. American Journal of Public Health, 81, 2, 77-182.
doi: 10.2105/AJPH.81.2.177
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