Sintomas depressivos e trajetórias de qualidade de vida relacionada à saúde de estudantes de Medicina ao longo do curso de graduação

Abstract

Medical training is characterized by an environment of progressive and intense stress that favors the development of depressive symptoms in students. Such distress negatively impacts students’ learning process, professional development, interpersonal and doctor-patient relationships. Several cross-sectional and longitudinal studies indicate that medical students show some impairment in their health related quality of life (HRQoL). The aim of this study was to assess the presence of depressive symptoms and health related quality of life trajectories (HRQoL) of medical students during medical training and verify possible relations among HRQoL, depressive symptoms and clinical and sociodemographic variables. Medical students completed an HRQoL instrument (SF-36) and a scale of depressive symptoms (Beck Depression Inventory - BDI) once a year during medical school. The SF-36 scores of each year were compared and correlated with sociodemographic variables and with the scores and clusters extracted from the BDI through factor analysis. There were no differences in BDI scores and in the domains and summaries of the SF-36 among the different years of medical training (p < 0.05). Mental component summary scores of the SF-36 were lower than the physical component scores throughout the course. Variations of the SF-36 scores were explained by variations in the pain and vitality domains in male and female students, respectively. The sociodemographic and clinical variables did not correlate with scores of the SF-36 and BDI. The SF-36 domain and summary scores showed negative correlations with the presence of depressive symptoms. Three BDI clusters were extracted by factor analysis: low self-esteem/dissatisfaction, subjective symptoms and somatic symptoms. The low self-esteem/dissatisfaction and subjective symptoms clusters of BDI showed moderate correlations (r = 0.3; p < 0.05) with the domain and summary scores of the SF-36, and were used as dependent variables for the multiple regression analysis. We obtained a model of moderate explanation of the variance for the cluster low self-esteem/dissatisfaction (R2 = 0.34; p < 0.05) with the variables vitality, social and emotional aspects, mental health and mental component summary. The variable that contributed most to the model was the summary of the mental component (ß = -1.94; p = 0.05). The perception of medical students' well being is worse in the mental than in the physical dimension and correlates with depressive symptoms. Among medical students, the association between depressive symptoms and HRQoL is explained by low self-esteem and dissatisfaction. Medical educators must propose strategies for identifying students with higher mental health vulnerability and provide psycho-pedagogic support as well as educational models and scenarios of professional practices that can contribute to reducing psychological distress.