Introduction
A major meta-analysis conducted in 2016 found that 1 in 4 medical students internationally met the criteria for depression. Other studies have suggested that students of color face increased prevalence of depression and anxiety, as well as non-male gender students and students with disabilities. However, few studies have assessed student well-being across a multitude of identities and wellness aspects, as well as longitudinally, throughout all 4 medical school classes and years.
Methods
An anonymous, online survey was completed by MS1–4 students at the Spencer Fox Eccles School of Medicine. Questions were a mix of free response and multiple choice. Underrepresented (UR) identity was classified by ethnicity, gender, sexual orientation, first generation in medicine (FGIM), or none. Wellness scores of 0–100 (0 worst, 100 best) were self-reported by responders. Responders were allowed multiple identity categories. Excel and ANOVA were utilized for data analysis.
Results
122 responses were collected (24.4% response rate). Self-reported wellness scores decreased overall for respondents, with the largest decreases in scores coming from students underrepresented in medicine (URiM) by ethnicity, and students who are first-generation in medicine. Students URiM by gender and sexual orientation self-reported an increase in wellness scores during medical school. Wellness scores by year had the largest decrease in the MS2 year, correlating to the highest seeking of wellness services in the MS3 year. Most cited factors impacting wellness in order of descending frequency were: external stressors, academic difficulty, belonging in class, micro-aggressions, mistreatment, and discrimination. Students URiM by sexual orientation had the lowest indication of belonging in medical school, followed by URiM by ethnicity (p = 0.01). 49% of participants indicated at some point having suicidal ideation, and 20% indicated at least “sometimes” having suicidal ideation or more frequently. This was not statistically significant between identity groups.
Recommendations
There are disparities in student- reported wellness by identity and training stage at the UUSOM. Wellness scores have the largest disparity in URiM by ethnicity, however wellness scores decreased overall with second year being a key period for wellness decline. This suggests the need for initiatives that promote mental health, enhance support systems, and foster belonging among students such as opt-out mentorship programs that assign URiM students with URiM faculty.
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Identity-Based Challenges to Mental Health in Medical School by Bita Firouzi, Adam Gaudin, Karishma Shah, MD, PhD, Paloma Cariello, Rawad Farhat, MD, MSPH, Meghan Sullivan, LCSW & Michelle Vo, MD