A Pilot Study of Symptoms of Major Depressive Disorder in Medical Students at an Osteopathic Medical School Before and After High-Stakes Examinations

Abstract

Background

Given the high prevalence of symptoms of major depressive disorder (MDD) in medical students, identifying factors that impact the development of such symptoms is important. Previous data suggest that medical students can experience symptoms of MDD after medical school exams. It is not known if medical students experience more symptoms of MDD directly before or after exams. The aim of the current study is to determine the prevalence of symptoms of MDD in first- and second-year medical students directly before and after high-stakes medical school examinations.

Methods

Two anonymous surveys were sent via REDCap to first- and second-year medical students at the University of New England College of Osteopathic Medicine. A pre-exam survey on the day of the exam asking about the past three days’ MDD symptoms, and a post-exam survey sent three days after the exam asking about MDD symptoms experienced after the exam was sent out to a total of 391 students with a response rate of 23%.

Results

First- and second-year medical students regardless of gender experienced symptoms of MDD at higher rates before exams than afterwards. Female students experienced symptoms of MDD (as defined by the DSM-5) including sadness, sleep disturbances, and feelings of guilt or worthlessness at a greater rate compared to males before exams. After exams, females were more likely to experience sleep disturbances and decreased energy. Second-year male students were the least likely to experience symptoms of MDD.

Conclusion

First- and second-year medical students can experience symptoms of MDD surrounding exams. This study highlights the emotional burden that students may carry near exams. It underscores the importance of further research on this topic to evaluate the effect exams have on the mental health of medical students during their training.

Keywords:

• depression
• medical school
• examinations
• gender
• MDD

Compliance with Ethical Standards

Two secure surveys were sent via university e-mail to first- and second-year medical students at the University of New England College of Osteopathic Medicine (UNECOM) in Biddeford, Maine, using the REDcap program. No minors were involved in the survey, so all participants were able to consent for themselves. A consent form was attached to each survey (please see additional document with submission labeled consent form). After reading the consent, the first question of the survey was: “Please read the attached Informed Consent Statement and choose if you would like to participate in the survey”. Participants were then asked to select yes or no (as noted in Figure 1a and 1b, and if they selected no, they were asked to not finish the survey. The survey remained anonymous. The survey was created by the authors and asked about the symptoms of major depressive disorder (MDD) as described in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The consent form, survey, and research project were approved by the University of New England (UNE) IRB and is in compliance with the Declaration of Helsinki. All data were collected anonymously via REDcap.

Acknowledgment

An abstract of this paper was presented at the American Association of Colleges of Osteopathic Medicine Educating Leaders Conference 2022 as a virtual poster presentation in April 2022. The poster was published online: https://www.aacom.org/docs/default-source/aacom-awards/s2-2022_poster.pdf?sfvrsn=a6a0cacf_6

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest in the research, authorship, or publication of this manuscript.

Additional information

Funding

The authors received no financial support for the research, writing of the manuscript, or publication of this work.