Estresse, ansiedade, depressão, qualidade de vida e uso de drogas ao longo da graduação em medicina: estudo longitudinal

Abstract

Introduction: Medical students have been the subject of growing worldwide concern as they are particularly vulnerable to disorders such as stress, anxiety and depression, as well as decreased quality of life. Numerous factors seem to contribute to these issues, including characteristics linked to individuals and the learning environment. The high emotional and physical demand in the medical course makes it critical and highly vulnerable to the onset and maintenance of alcohol and other drug use. Although several studies have addressed these issues recently, there are still few longitudinal studies on the subjects, particularly in Brazil. Objectives: To longitudinally evaluate the prevalence and incidence of symptoms of depression, anxiety and stress, quality of life and use of psychoactive substances in the students of the Faculty of Medicine of the Federal University of Juiz de Fora (UFJF) throughout their undergraduation training, identifying the associated factors and comparing the different academic moments of the course. Methods: This is a two-year longitudinal study conducted between 2014 and 2016. Sociodemographics, mental health (DASS-21), quality of life - QoL (WHOQOL-Bref), the use of substances, alcohol, and tobacco (ASSIST), and religiousness (DUREL) were evaluated in a cohort consisting of four waves with all students enrolled and who agreed to participate in the research. Results: During the two-year follow-up, 327 (56.2%) students were evaluated for drug use and 312 (54.2%) for mental health and quality of life, responding to the four waves of the study. It was observed a high prevalence and incidence of emotional disorders in which almost 50% presented high levels of symptoms of depression, anxiety and stress in the two years of follow-up and approximately 1 in 5 students without initial symptoms were considered new cases until the end of the study. Quality of life and mental health levels remained practically stable between waves and with cyclical characteristics of mental health problems. Baseline factors such as depression, anxiety, stress, female gender, early stages of medical training, non-white ethnicity and low income were associated with poorer mental health and quality of life. No correlation of mental disorders and quality of life was found with religiosity. Regarding the use of drugs during life, it was 89.9% for alcohol, 34.5% for marijuana and 17.1% for sedatives. Tobacco had the highest incidence of use over the two years (16.4%), followed by alcohol (13.8%) and marijuana (13.8%). There was an increase in consumption of the nine substances studied. At least 24% of students would require intervention for alcohol use, 11.4% for tobacco and 6.5% for marijuana. Being a user of alcohol, cigarettes and marijuana on wave 1 was associated with greater substance use after two years; having organizational and non-organizational religiosity and being older were associated with less use. Conclusion: The results indicated a high prevalence and incidence of mental health problems and drug use in medical students. While some factors confer protection, others may increase the risk of negative outcomes. This data can help educators planning strategies to improve mental health, QoL, and to prevent the substance use among medical students.