The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis

Travis T. C. Quek1,2, Wilson Tam3, Bach Xuan Tran4,5,6, Zhang7, Cyrus S. H. Ho8
1Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119007, Singapore
2Institute of Cognitive Neuroscience, Huaibei Normal University, Huaibei 235000, China
3Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore 119007, Singapore
4Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam
5Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
6Vietnam Young Physicians’ Association, Hanoi 100000, Vietnam
7School of Education, Huaibei Normal University, Huaibei 235000, China
8Department of Psychological Medicine, National University Health System, Singapore 119007, Singapore

Tóm tắt

Anxiety, although as common and arguably as debilitating as depression, has garnered less attention, and is often undetected and undertreated in the general population. Similarly, anxiety among medical students warrants greater attention due to its significant implications. We aimed to study the global prevalence of anxiety among medical students and the associated factors predisposing medical students to anxiety. In February 2019, we carried out a systematic search for cross-sectional studies that examined the prevalence of anxiety among medical students. We computed the aggregate prevalence and pooled odds ratio (OR) using the random-effects model and used meta-regression analyses to explore the sources of heterogeneity. We pooled and analyzed data from sixty-nine studies comprising 40,348 medical students. The global prevalence rate of anxiety among medical students was 33.8% (95% Confidence Interval: 29.2–38.7%). Anxiety was most prevalent among medical students from the Middle East and Asia. Subgroup analyses by gender and year of study found no statistically significant differences in the prevalence of anxiety. About one in three medical students globally have anxiety—a prevalence rate which is substantially higher than the general population. Administrators and leaders of medical schools should take the lead in destigmatizing mental illnesses and promoting help-seeking behaviors when students are stressed and anxious. Further research is needed to identify risk factors of anxiety unique to medical students.

Từ khóa


Tài liệu tham khảo

Dyrbye, 2006, Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students, Acad. Med., 81, 354, 10.1097/00001888-200604000-00009

Wolf, 1994, Stress, coping and health: Enhancing well-being during medical school, Med. Educ., 28, 8, 10.1111/j.1365-2923.1994.tb02679.x

Mosley, 1994, Stress, coping, and well-being among third-year medical students, Acad. Med., 69, 765, 10.1097/00001888-199409000-00024

Aktekin, 2001, Anxiety, depression and stressful life events among medical students: A prospective study in Antalya, Turkey, Med. Educ., 35, 12, 10.1046/j.1365-2923.2001.00726.x

Weiller, 1998, Prevalence and recognition of anxiety syndromes in five European primary care settings. A report from the WHO study on Psychological Problems in General Health Care, Br. J. Psychiatry Suppl., 34, 18, 10.1192/S0007125000293471

Kroenke, 2007, Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection, Ann. Intern. Med., 146, 317, 10.7326/0003-4819-146-5-200703060-00004

Rynn, 2004, Generalized anxiety disorder: Acute and chronic treatment, CNS Spectr, 9, 716, 10.1017/S1092852900022367

Testa, 2013, Psychiatric emergencies (part I): Psychiatric disorders causing organic symptoms, Eur. Rev. Med. Pharmacol. Sci., 17, 55

Eysenck, 2007, Anxiety and cognitive performance: Attentional control theory, Emotion, 7, 336, 10.1037/1528-3542.7.2.336

Moran, 2016, Anxiety and working memory capacity: A meta-analysis and narrative review, Psychol. Bull., 142, 831, 10.1037/bul0000051

Runswick, 2018, The effects of anxiety and situation-specific context on perceptual-motor skill: A multi-level investigation, Psychol. Res., 82, 708, 10.1007/s00426-017-0856-8

Hope, 2014, Medical student depression, anxiety and distress outside North America: A systematic review, Med. Educ., 48, 963, 10.1111/medu.12512

Khuwaja, 2004, Prevalence and factors associated with anxiety and depression among family practitioners in Karachi, Pakistan, J. Pak. Med. Assoc., 54, 45

Al Saadi, T., Zaher Addeen, S., Turk, T., Abbas, F., and Alkhatib, M. (2017). Psychological distress among medical students in conflicts: A cross-sectional study from Syria. BMC Med. Educ., 17.

Carter, 2016, Predictors of psychological resilience amongst medical students following major earthquakes, N. Z. Med. J., 129, 17

Loh, 2005, Impact of a spreading epidemic on medical students, Malays, 12, 43

Wong, 2007, Anxiety among university students during the SARS epidemic in Hong Kong, Stress Health: J. Int. Soc. Investig. Stress, 23, 31, 10.1002/smi.1116

Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., and Group, P. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med., 6.

Herzog, R., Alvarez-Pasquin, M.J., Diaz, C., Del Barrio, J.L., Estrada, J.M., and Gil, A. (2013). Are healthcare workers intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health, 13.

Hedges, 1998, Fixed-and random-effects models in meta-analysis, Psychol. Methods, 3, 486, 10.1037/1082-989X.3.4.486

Ho, R.C., Zhang, M.W., Tsang, T.Y., Toh, A.H., Pan, F., Lu, Y., Cheng, C., Yip, P.S., Lam, L.T., and Lai, C.M. (2014). The association between internet addiction and psychiatric co-morbidity: A meta-analysis. BMC Psychiatry, 14.

Egger, 1997, Bias in meta-analysis detected by a simple, graphical test, BMJ, 315, 629, 10.1136/bmj.315.7109.629

UN Statistics Division (2010). Standard Country or Area Codes for Statistical Use, UN Statistics Division.

Beck, 1988, An inventory for measuring clinical anxiety: Psychometric properties, J. Consult. Clin. Psychol., 56, 893, 10.1037/0022-006X.56.6.893

Zigmond, 1983, The hospital anxiety and depression scale, Acta Psychiatr. Scand., 67, 361, 10.1111/j.1600-0447.1983.tb09716.x

Lovibond, S.H., and Lovibond, P.F. (1995). Manual for the Depression Anxiety Stress Scales, Psychology Foundation.

Spitzer, 2006, A brief measure for assessing generalized anxiety disorder: The GAD-7, Arch. Intern. Med., 166, 1092, 10.1001/archinte.166.10.1092

Abdallah, 2014, Depression, anxiety and stress among first year medical students in an Egyptian public university, Int. Res. J. Med. Sci., 2, 11

Ahmed, 2009, Cognitive emotions: Depression and anxiety in medical students and staff, J. Crit. Care, 24, e1, 10.1016/j.jcrc.2009.06.003

Akhtar, 2019, Depression and Anxiety among International Medical Students in Germany: The Predictive Role of Coping Styles, JPMA J. Pak. Med. Assoc., 69, 230

Akvardar, 2003, Substance use in a sample of Turkish medical students, Drug Alcohol Depend., 72, 117, 10.1016/S0376-8716(03)00192-3

Alaqeel, 2017, Prevalence of Irritable Bowel Syndrome and Its Association with Anxiety among Medical Students at King Saud bin Abdulaziz University for Health Sciences in Riyadh, Pak. J. Med. Sci., 33, 33, 10.12669/pjms.331.12572

Alvi, 2010, Depression, anxiety and their associated factors among medical students, J. Coll. Physicians Surg. Pak., 20, 122

Amr, 2008, Does gender predict medical students’ stress in Mansoura, Egypt?, Med. Educ. Online, 13, 12, 10.3402/meo.v13i.4481

Ashton, 1995, Personality, lifestyles, alcohol and drug consumption in a sample of British medical students, Med. Educ., 29, 187, 10.1111/j.1365-2923.1995.tb02828.x

Azad, 2017, Anxiety And Depression in Medical Students of a Private Medical College, J. Ayub Med. Coll. Abbottabad, 29, 123

Bassols, 2014, First- and last-year medical students: Is there a difference in the prevalence and intensity of anxiety and depressive symptoms?, Braz J. Psychiatry, 36, 233, 10.1590/1516-4446-2013-1183

Baykan, 2012, Depression, anxiety, and stress among last-year students at Erciyes University Medical School, Acad. Psychiatry, 36, 64, 10.1176/appi.ap.11060125

Bogowicz, 2018, Alcohol and other substance use among medical and law students at a UK university: A cross-sectional questionnaire survey, Postgrad. Med. J., 94, 131, 10.1136/postgradmedj-2017-135136

Casey, 2016, Graduate-entry medical students: Older and wiser but not less distressed, Australas. Psychiatry, 24, 88, 10.1177/1039856215612991

Chandavarkar, 2007, Anxiety symptoms and perceived performance in medical students, Depress. Anxiety, 24, 103, 10.1002/da.20185

Chen, 2018, Harm avoidance and depression, anxiety, insomnia, and migraine in fifth-year medical students in Taiwan, Neuropsychiatr. Dis. Treat., 14, 1273, 10.2147/NDT.S163021

Coentre, 2016, Assessment of depression and suicidal behaviour among medical students in Portugal, Int. J. Med. Educ., 7, 354, 10.5116/ijme.57f8.c468

Moreira, 2018, Anxiety, Depression and Academic Performance: A Study Amongst Portuguese Medical Students Versus Non-Medical Students, Acta Med. Port., 31, 454, 10.20344/amp.9996

Machado, 2013, Relationship between academic performance and affective changes during the first year at medical school, Med. Teach., 35, 404, 10.3109/0142159X.2013.769675

Ediz, 2017, Depression and anxiety among medical students: Examining scores of the beck depression and anxiety inventory and the depression anxiety and stress scale with student characteristics, Cogent Psychol., 4, 1283829, 10.1080/23311908.2017.1283829

Amr, 2008, Perceived stress among male medical students in Egypt and Saudi Arabia: Effect of sociodemographic factors, Ann. Saudi Med., 28, 442

Eller, 2006, Symptoms of anxiety and depression in Estonian medical students with sleep problems, Depress. Anxiety, 23, 250, 10.1002/da.20166

Fawzy, 2017, Prevalence of psychological stress, depression and anxiety among medical students in Egypt, Psychiatry Res., 255, 186, 10.1016/j.psychres.2017.05.027

Francis, B., Gill, J.S., Yit Han, N., Petrus, C.F., Azhar, F.L., Ahmad Sabki, Z., Said, M.A., Ong Hui, K., Chong Guan, N., and Sulaiman, A.H. (2019). Religious Coping, Religiosity, Depression and Anxiety among Medical Students in a Multi-Religious Setting. Int. J. Environ. Res. Public Health, 16.

Gan, 2019, Anxiety, depression and quality of life of medical students in Malaysia, Med. J. Malays., 74, 57

Garcia, 2017, Acute effects of energy drinks in medical students, Eur. J. Nutr., 56, 2081, 10.1007/s00394-016-1246-5

Ghodasara, 2011, Assessing student mental health at the Vanderbilt University School of Medicine, Acad. Med., 86, 116, 10.1097/ACM.0b013e3181ffb056

Haghighi, M., and Gerber, M. (2018). Does mental toughness buffer the relationship between perceived stress, depression, burnout, anxiety, and sleep?. Int. J. Stress Manag.

Hu, 2019, Maladaptive perfectionism, impostorism, and cognitive distortions: Threats to the mental health of pre-clinical medical students, Acad. Psychiatry, 43, 381, 10.1007/s40596-019-01031-z

Ibrahim, 2013, Prevalence and Predictors of Anxiety and Depression among Female Medical Students in King Abdulaziz University, Jeddah, Saudi Arabia, Iran. J. Public Health, 42, 726

Ibrahim, 2015, Prevalence of anxiety and depression among medical and pharmaceutical students in Alexandria University, Alex. J. Med., 51, 167

Ibrayeva, 2018, Depression, Anxiety and Somatic Distress in Domestic and International Undergraduate Medical Students in Kazakhstan, Iran. J. Public Health, 47, 919

Iqbal, 2015, Stress, anxiety and depression among medical undergraduate students and their socio-demographic correlates, Indian J. Med. Res., 141, 354, 10.4103/0971-5916.156571

Jafari, 2017, Measurement invariance of the Depression Anxiety Stress Scales-21 across medical student genders, Int. J. Med. Educ., 8, 116, 10.5116/ijme.58ba.7d8b

James, 2017, Psychosocial correlates of perceived stress among undergraduate medical students in Nigeria, Int. J. Med. Educ., 8, 382, 10.5116/ijme.59c6.3075

Karaoglu, 2010, Anxiety and depression in medical students related to desire for and expectations from a medical career, West Indian Med. J., 59, 196

Knipe, 2018, Mental health in medical, dentistry and veterinary students: Cross-sectional online survey, BJPsych Open, 4, 441, 10.1192/bjo.2018.61

Kulsoom, 2015, Stress, anxiety, and depression among medical students in a multiethnic setting, Neuropsychiatr. Dis. Treat., 11, 1713

Kunwar, 2016, Study of Depression, Anxiety and Stress among the Medical Students in two Medical Colleges of Nepal, Kathmandu Univ. Med. J., 14, 22

Leao, 2011, Well-being and help-seeking: An exploratory study among final-year medical students, Rev. Assoc. Med. Bras., 57, 379, 10.1590/S0104-42302011000400009

Liu, 1997, Life events and anxiety in Chinese medical students, Soc. Psychiatry Psychiatr. Epidemiol., 32, 63, 10.1007/BF00788922

Lupo, 2011, Religiosity, anxiety and depression among Israeli medical students, Isr. Med. Assoc. J., 13, 613

Mahroon, 2018, Factors associated with depression and anxiety symptoms among medical students in Bahrain, Acad. Psychiatry, 42, 31, 10.1007/s40596-017-0733-1

Manchevska, 2014, The prevalence of high anxiety and substance use in university students in the Republic of Macedonia, Pril (Makedon Akad Nauk Umet Odd Med. Nauki), 35, 67

Brenneisen Mayer, F., Souza Santos, I., Silveira, P.S., Itaqui Lopes, M.H., de Souza, A.R., Campos, E.P., de Abreu, B.A., Hoffman Ii, I., Magalhaes, C.R., and Lima, M.C. (2016). Factors associated to depression and anxiety in medical students: A multicenter study. BMC Med. Educ., 16.

Mousa, O.Y., Dhamoon, M.S., Lander, S., and Dhamoon, A.S. (2016). The MD Blues: Under-Recognized Depression and Anxiety in Medical Trainees. PLoS ONE, 11.

Moutinho, 2017, Depression, stress and anxiety in medical students: A cross-sectional comparison between students from different semesters, Rev. Assoc. Med. Bras. (1992), 63, 21, 10.1590/1806-9282.63.01.21

Moutinho, 2019, Mental health and quality of life of Brazilian medical students: Incidence, prevalence, and associated factors within two years of follow-up, Psychiatry Res., 274, 306, 10.1016/j.psychres.2019.02.041

White, 2000, Factors influencing alcohol and illicit drug use amongst medical students, Drug Alcohol Depend., 59, 125, 10.1016/S0376-8716(99)00108-8

Dinan, 2018, Examining stress: An investigation of stress, mood and exercise in medical students, Ir. J. Psychol. Med., 35, 63, 10.1017/ipm.2017.54

Pagnin, 2014, The relation between burnout and sleep disorders in medical students, Acad. Psychiatry, 38, 438

Pickard, 2000, Alcohol and drug use in second-year medical students at the University of Leeds, Med. Educ., 34, 148, 10.1046/j.1365-2923.2000.00491.x

Prinz, 2012, Burnout, depression and depersonalisation--psychological factors and coping strategies in dental and medical students, GMS Z Med. Ausbild, 29, Doc10

Rab, 2008, Rates of depression and anxiety among female medical students in Pakistan, East Mediterr Health J., 14, 126

Rezaei, 2018, Sleep quality and its association with psychological distress and sleep hygiene: A cross-sectional study among pre-clinical medical students, Sleep Sci., 11, 274, 10.5935/1984-0063.20180043

Samaranayake, 2011, Satisfaction with life and depression among medical students in Auckland, New Zealand, N. Z. Med. J., 124, 12

Saravanan, 2014, Medical students’ experience of and reaction to stress: The role of depression and anxiety, Sci. World J., 2014, 737382, 10.1155/2014/737382

Serra, 2015, Prevalence of depressive and anxiety symptoms in medical students in the city of Santos, J. Bras. Psiquiatr., 64, 213, 10.1590/0047-2085000000081

Shi, M., Liu, L., Wang, Z.Y., and Wang, L. (2015). The mediating role of resilience in the relationship between big five personality and anxiety among Chinese medical students: A cross-sectional study. PLoS ONE, 10.

Sun, 2011, Correlations between psychological symptoms and social relationships among medical undergraduates in Anhui Province of China, Int. J. Psychiatry Med., 42, 29, 10.2190/PM.42.1.c

Talih, F., Daher, M., Daou, D., and Ajaltouni, J. (2018). Examining burnout, depression, and attitudes regarding drug use among lebanese medical students during the 4 years of medical school. Acad. Psychiatry.

Tempski, P., Santos, I.S., Mayer, F.B., Enns, S.C., Perotta, B., Paro, H.B., Gannam, S., Peleias, M., Garcia, V.L., and Baldassin, S. (2015). Relationship among Medical Student Resilience, Educational Environment and Quality of Life. PLoS ONE, 10.

van Venrooij, L.T., Barnhoorn, P.C., Giltay, E.J., and van Noorden, M.S. (2015). Burnout, depression and anxiety in preclinical medical students: A cross-sectional survey. Int. J. Adolesc. Med. Health, 29.

Villacura, 2017, Evaluation of depressive and anxiety symptomatology in medical students at the University of Chile, Ment. Health Prev., 7, 45, 10.1016/j.mhp.2017.06.001

Wahed, 2017, Prevalence and associated factors of stress, anxiety and depression among medical Fayoum University students, Alex. J. Med., 53, 77

Waqas, 2015, Association of Ego Defense Mechanisms with Academic Performance, Anxiety and Depression in Medical Students: A Mixed Methods Study, Cureus, 7, e337

Waqas, A., Naveed, S., Aedma, K.K., Tariq, M., and Afzaal, T. (2018). Exploring clusters of defense styles, psychiatric symptoms and academic achievements among medical students: A cross-sectional study in Pakistan. BMC Res. Notes, 11.

Wolf, 1998, A four-year study of anxiety, depression, loneliness, social support, and perceived mistreatment in medical students, J. Health Psychol., 3, 125, 10.1177/135910539800300110

Zhang, Y., Xiong, Y., Dong, J., Guo, T., Tang, X., and Zhao, Y. (2018). Caffeinated Drinks Intake, Late Chronotype, and Increased Body Mass Index among Medical Students in Chongqing, China: A Multiple Mediation Model. Int. J. Environ. Res. Public Health, 15.

Henry, 2005, The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample, Br. J. Clin. Psychol., 44, 227, 10.1348/014466505X29657

Kader Maideen, S.F., Mohd Sidik, S., Rampal, L., and Mukhtar, F. (2015). Prevalence, associated factors and predictors of anxiety: A community survey in Selangor, Malaysia. BMC Psychiatry, 15.

Gillis, 1995, Normative values for the Beck Anxiety Inventory, Fear Questionnaire, Penn State Worry Questionnaire, and Social Phobia and Anxiety Inventory, Psychol. Assess., 7, 450, 10.1037/1040-3590.7.4.450

Lisspers, 1997, Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample, Acta Psychiatr. Scand., 96, 281, 10.1111/j.1600-0447.1997.tb10164.x

Enns, 2001, Adaptive and maladaptive perfectionism in medical students: A longitudinal investigation, Med. Educ., 35, 1034, 10.1046/j.1365-2923.2001.01044.x

Kawamura, 2001, Perfectionism, anxiety, and depression: Are the relationships independent?, Cognit. Ther. Res., 25, 291, 10.1023/A:1010736529013

Guthrie, 1995, Embarking upon a medical career: Psychological morbidity in first year medical students, Med. Educ., 29, 337, 10.1111/j.1365-2923.1995.tb00022.x

Wolf, 1988, Graduating medical students’ ratings of stresses, pleasures, and coping strategies, J. Med. Educ., 63, 636

Williams, 2005, Dying, death, and medical education: Student voices, J. Palliat. Med., 8, 372, 10.1089/jpm.2005.8.372

Richman, 1992, Mental health consequences and correlates of reported medical student abuse, JAMA, 267, 692, 10.1001/jama.1992.03480050096032

Abdullah, 2011, Mental illness stigma and ethnocultural beliefs, values, and norms: An integrative review, Clin. Psychol. Rev., 31, 934, 10.1016/j.cpr.2011.05.003

Littlewood, 2007, A cross-national study of the stigmatization of severe psychiatric illness: Historical review, methodological considerations and development of the questionnaire, Transcult. Psychiatry, 44, 171, 10.1177/1363461507077720

Rao, 2007, Racial and ethnic disparities in mental illness stigma, J. Nerv. Ment. Dis., 195, 1020, 10.1097/NMD.0b013e31815c046e

Baxter, 2013, Global prevalence of anxiety disorders: A systematic review and meta-regression, Psychol. Med., 43, 897, 10.1017/S003329171200147X

Wolf, 1986, Lifestyle characteristics during medical school: A four-year cross-sectional study, Psychol. Rep., 59, 179, 10.2466/pr0.1986.59.1.179

Niemi, 2006, Medical students’ distress–quality, continuity and gender differences during a six-year medical programme, Med. Teach., 28, 136, 10.1080/01421590600607088

Roberts, 2001, Perceptions of academic vulnerability associated with personal illness: A study of 1027 students at nine medical schools. Collaborative Research Group on Medical Student Health, Compr. Psychiatry, 42, 1, 10.1053/comp.2001.19747

Rogers, 2003, I wouldn’t want it on my CV or their records: Medical students’ experiences of help-seeking for mental health problems, Med. Educ., 37, 873, 10.1046/j.1365-2923.2003.01627.x

Rapaport, 2005, Quality-of-life impairment in depressive and anxiety disorders, Am. J. Psychiatry, 162, 1171, 10.1176/appi.ajp.162.6.1171

Sarnoff, 1961, Anxiety, fear, and social isolation, J. Abnorm. Soc.Psychol., 62, 356, 10.1037/h0046506

Sartorius, 1996, Depression comorbid with anxiety: Results from the WHO study on psychological disorders in primary health care, Br. J. Psychiatry, 168, 38, 10.1192/S0007125000298395

Vorspan, 2015, Anxiety and substance use disorders: Co-occurrence and clinical issues, Curr. Psychiatry Rep., 17, 4, 10.1007/s11920-014-0544-y

Krag, 1994, A blinded, controlled evaluation of anxiety and depressive symptoms in patients with fibromyalgia, as measured by standardized psychometric interview scales, Acta Psychiatr. Scand., 89, 370, 10.1111/j.1600-0447.1994.tb01531.x

Thieme, 2004, Comorbid depression and anxiety in fibromyalgia syndrome: Relationship to somatic and psychosocial variables, Psychosom. Med., 66, 837, 10.1097/01.psy.0000146329.63158.40

Wu, 2014, Misophonia: Incidence, phenomenology, and clinical correlates in an undergraduate student sample, J. Clin. Psychol., 70, 994, 10.1002/jclp.22098

Quek, T.C., Ho, C.S., Choo, C.C., Nguyen, L.H., Tran, B.X., and Ho, R.C. (2018). Misophonia in Singaporean Psychiatric Patients: A Cross-Sectional Study. Int. J. Environ. Res. Public Health, 15.

Lydiard, 2001, Irritable bowel syndrome, anxiety, and depression: What are the links?, J. Clin. Psychiatry, 62, 38

Fond, 2014, Anxiety and depression comorbidities in irritable bowel syndrome (IBS): A systematic review and meta-analysis, Eur. Arch. Psychiatry Clin. Neurosci., 264, 651, 10.1007/s00406-014-0502-z

Schroeder, 2009, Do state medical board applications violate the americans with disabilities act?, Acad. Med., 84, 776, 10.1097/ACM.0b013e3181a43bb2

Givens, 2002, Depressed medical students’ use of mental health services and barriers to use, Acad. Med., 77, 918, 10.1097/00001888-200209000-00024

Aaronson, 2018, Mental Health During Residency Training: Assessing the Barriers to Seeking Care, Acad. Psychiatry, 42, 469, 10.1007/s40596-017-0881-3

Puthran, 2016, Prevalence of depression amongst medical students: A meta-analysis, Med. Educ., 50, 456, 10.1111/medu.12962

Li, 2014, Efficacy of Williams LifeSkills training for improving psychological health: A pilot comparison study of Chinese medical students, Asia Pac. Psychiatry, 6, 161, 10.1111/appy.12084

Warnecke, 2011, A randomised controlled trial of the effects of mindfulness practice on medical student stress levels, Med. Educ., 45, 381, 10.1111/j.1365-2923.2010.03877.x

Vonnegut, M. (2019, June 15). A Doctor Shares His Story about Overcoming Mental Illness. Available online: KevinMD.com.