Background
Methods
Study design, setting, and participants
Sample size and sample procedure
Outcome variables
Independent variables
Socio-demographic factors
Behavioral and clinical factors
Methods of data collection
Statistical analysis
Ethical considerations
Results
Participants
Characteristics of study participants
Socio-demographic features | n, (%) |
---|---|
Male | 495 (76) |
Mean age (SD) | 25 (4) |
Medical students | 378 (58.1) |
First-year | 66 (10.1) |
Second-year | 68 (10.4) |
Third-year | 71 (10.9) |
Fourth-year | 63 (9.7) |
Fifth-year | 63 (9.7) |
Interns | 47 (7.2) |
Clinical medical students | 244 (37.63) |
Non-clinical medical students | 134 (20.58) |
Residents | 273 (41.9) |
First-year | 97 (14.9) |
Second-year | 93 (14.3) |
Third-year | 83 (12.7) |
Clinical residents | 245 (37.63) |
Non-clinical residents | 28 (4.3) |
18–24 years | 314 (48.2) |
25–29 years | 211 (32.4) |
30–34 years | 122 (18.7) |
35–39 years | 4 (0.6) |
Religion | |
Hindu | 611 (93.9) |
Buddhist | 7 (1.1) |
Muslim | 28 (4.3) |
Christian | 2 (0.3) |
Sikh | 2 (0.3) |
Yumanism | 1 (0.2) |
Nationality | |
Nepalese | 566 (86.9) |
Indian | 67 (10.3) |
Sri Lankan | 6 (0.9) |
Maldivian | 12 (0.18) |
Relationship status | |
Married | 135 (20.8) |
Non-married partner | 122 (18.8) |
Single | 392 (60.3) |
Divorced | 1 (0.2) |
Socio-economic status | |
Upper | 215 (33.1) |
Upper-middle | 302 (46.5) |
Lower-middle | 121 (18.6) |
Upper-lower | 11 (1.7) |
Lower | 0 (0) |
Current residence | |
Home | 224 (34.4) |
Rented room | 240 (36.9) |
Hostel | 185 (28.4) |
Relative | 1 (0.2) |
Quarter | 1 (0.2) |
Features | n (%, 95 CI) a |
---|---|
Suicidal thoughts | 41 (6.3, 4.6–8.4) |
Thoughts of dropping out | 79 (12.1, 9.7–14.9) |
Previous history of mental disorders | 35 (5.4, 3.8–7.4) |
Currently receiving treatment for mental health disorders | 5 (0.8, 0.2–1.8) |
Family history of mental health problems | 55 (8.4, 6.4–10.9) |
Sleep hours, mean (SD) | 7 (1) |
Adequate, n (%) | 441 (67.7, 64–71.3) |
Inadequate | 210 (32.3, 28.7–36) |
Not satisfied with career choice | 145 (22.31, 19.1–25.7) |
Not satisfied with academic performance | 307 (47.23, 43.2–51.1) |
Involvement in extracurricular activities | 221 (34, 30.3–37.7) |
Alcohol | 393 (60.4, 56.5–64.1) |
Cigarette | 241 (37.1, 33.3–40.9) |
Marijuana | 100 (15.4, 12.7–18.4) |
Substance use | 398 (61.14, 57.3–64.9) |
Depression | 202 (31, 27.5–34.7) |
Anxiety | 295 (45.3, 41.4–49.2) |
Burnout | 318 (48.8, 44.9–52.7) |
Personal burnout | 266 (40.8, 37.1–44.7) |
Work-related burnout | 210 (32.3, 28.7–36) |
Patient-related burnout | 105 (16.1, 13.4–19.2) |
Domains of stressors | Mild, n (%) | Moderate, n (%) | High, n (%) | Severe, n (%) | Mean score | Grade |
---|---|---|---|---|---|---|
ARS | 93 (14.3) | 264 (40.6) | 213 (32.7) | 81 (12.4) | 2.05 | High |
IRS | 231 (35.5) | 236 (36.3) | 141 (21.7) | 43 (6.6) | 1.58 | Moderate |
TLRS | 261 (40.1) | 280 (43) | 83 (12.8) | 27 (4.1) | 1.47 | Moderate |
SRS | 262 (40.2) | 275 (42.2) | 97 (14.9) | 17 (2.6) | 1.45 | Moderate |
DRS | 367 (56.4) | 201 (30.9) | 62 (9.5) | 21 (3.2) | 1.2 | Moderate |
GARS | 225 (34.6) | 263 (40.4) | 133 (20.4) | 30 (4.6) | 1.45 | Moderate |
Stressor groups | Depression, χ2, P-value n (%) | Anxiety, χ2, P-value n (%) | Burnout, χ2, P-value n (%) |
---|---|---|---|
ARS | 9.69, 0.002 | 13.19, P < 0.001 | 15.25, P < 0.0001 |
Present (n = 558) | 186 (33.3) | 269 (48.2) | 290 (52) |
Absent (n = 93) | 16 (17.2) | 26 (28) | 28 (30.1) |
IRS | 8.72, 0.003 | 15.18, P < 0.0001 | 15.26, P < 0.0001 |
Present (n = 420) | 147 (35) | 214 (51) | 229 (54.5) |
Absent (n = 231) | 55 (23.8) | 81 (35.1) | 89 (38.5) |
TLRS | 26.87, P < 0.0001 | 32.11, P < 0.0001 | 55.32, P < 0.0001 |
Present (n = 390) | 151 (38.7) | 212 (54.4) | 237 (60.8) |
Absent (n = 261) | 51 (19.5) | 83 (31.8) | 81 (31) |
SRS | 7.93, 0.005 | 9.04, 0.003 | 8.27, 0.004 |
Present (n = 389) | 137 (35.2) | 195 (50.1) | 208 (53.5) |
Absent (n = 262) | 65 (24.8) | 100 (38.2) | 110 (42) |
DRS | 19.54, P < 0.0001 | 7.55, 0.006 | 63.17, P < 0.0001 |
Present (n = 284) | 114 (40.1) | 146 (51.4) | 189 (66.5) |
Absent (n = 367) | 88 (24) | 149 (40.6) | 129 (35.1) |
GARS | 32.12, P < 0.0001 | 29.78, P < 0.0001 | 37.03, P < 0.0001 |
Present (n = 426) | 164 (38.5) | 226 (53.1) | 245 (57.5) |
Absent (n = 225) | 38 (16.9) | 69 (30.7) | 73 (32.4) |
Independent correlates of depression-related symptoms
Participant’s characteristics | Depression χ2, P-value n (%) | Anxiety χ2, P-value n (%) | Burnout χ2, P-value n (%) |
---|---|---|---|
Gender | 7.28, 0.007 | 16.93, P < 0.0001 | 3.93, 0.05 |
Male (n = 495) | 140 (28.3) | 202 (40.8) | 231 (46.7) |
Female (n = 156) | 62 (39.7) | 93 (59.6) | 87 (55.8) |
Trainee type | 1.57, 0.21 | 0.35, 0.55 | 45.92, P < 0.0001 |
Medical Students (n = 378) | 110 (29.1) | 175 (46.3) | 142 (37.6) |
Residents (n = 273) | 92 (33.7) | 120 (44) | 176 (64.5) |
Years in training | 10.81, 0.21 | 21.57, 0.006 | 77.63, P < 0.0001 |
Medical student | |||
First-year (n = 66) | 22 (33.3) | 40 (60.6) | 28 (42.4) |
Second-year (n = 68) | 12 (17.7) | 26 (38.2) | 12 (17.6) |
Third-year (n = 71) | 23 (32.4) | 41 (57.8) | 25 (35.2) |
Fourth-year (n = 63) | 20 (31.8) | 23 (36.5) | 18 (28.6) |
Fifth-year (n = 63) | 21 (33.3) | 31 (49.2) | 39 (61.9) |
Interns (n = 47) | 12 (25.5) | 14 (29.8) | 20 (42.6) |
Residents | |||
First-year (n = 97) | 37 (38.1) | 47 (48.5) | 68 (70.1) |
Second-year (n = 93) | 25 (26.9) | 35 (37.6) | 60 (64.5) |
Third-year (n = 83) | 30 (36.1) | 38 (45.8) | 48 (57.8) |
Clinical or non-clinical med student or resident | 6.57, 0.09 | 1.10, 0.78 | 58.78, P < 0.0001 |
Clinical med std (n = 244) | 76 (31.2) | 109 (44.7) | 102 (41.8) |
Non-clinical med std (n = 134) | 34 (25.4) | 66 (49.3) | 40 (29.9) |
Clinical res (n = 245) | 87 (35.5) | 108 (44.1) | 165 (67.3) |
Non-clinical res (n = 28) | 5 (17.9) | 12 (42.9) | 11 (39.3) |
Age category | 0.13 a | 0.75 a | P < 0.0001 a |
18–24 years (n = 314) | 88 (28) | 148 (47.1) | 109 (34.7) |
25–29 years (n = 211) | 65 (30.8) | 92 (43.6) | 130 (61.6) |
30–34 years (n = 122) | 48 (39.3) | 54 (44.3) | 76 (62.3) |
35–39 years (n = 4) | 1 (25) | 1 (25) | 3 (75) |
Satisfied with academic performance | 43.2, P < 0.0001 | 50.1, P < 0.0001 | 12, P < 0.001 |
Satisfied (n = 344) | 68 (19.8) | 111 (32.3) | 146 (42.4) |
Dissatisfied (n = 307) | 134 (43.6) | 184 (59.9) | 172 (56) |
Satisfied with career choice | 28, P < 0.0001 | 22.9, P < 0.0001 | 28.2, P < 0.0001 |
Satisfied (n = 506) | 131 (25.9) | 204 (40.3) | 219 (43.3) |
Dissatisfied (n = 145) | 71 (49) | 91 (62.8) | 99 (68.3) |
Extracurricular involvement | P < 0.001a | 0.12a | 36.9, P < 0.0001 |
Always (n = 56) | 16 (28.6) | 31 (55.4) | 15 (26.8) |
Often (n = 166) | 36 (21.7) | 65 (39.2) | 70 (42.2) |
Sometimes (n = 240) | 70 (29.2) | 112 (46.7) | 111 (46.3) |
Rarely (n = 177) | 75 (42.4) | 79 (44.6) | 111 (62.7) |
Never (n = 12) | 5 (41.7) | 8 (66.7) | 11 (91.7) |
Adequacy of sleep | 2.9, 0.09 | 1.7, 0.19 | 22.7, P < 0.0001 |
Adequate (n = 441) | 127 (28.8) | 192 (43.5) | 187 (42.4) |
Inadequate (n = 210) | 75 (35.7) | 103 (49) | 131 (62.4) |
Substance use | 0.37, 0.54 | 1.41, 0.23 | 6.29, 0.01 |
Using (n = 398) | 127 (31.9) | 173 (43.5) | 210 (52.8) |
Not using (n = 253) | 75 (29.6) | 122 (48.2) | 108 (42.7) |
Predictor | β | SE | P | OR (95% CI) |
---|---|---|---|---|
Intercept | −1.690 | 0.240 | < 0.001 | 0.18 (0.114–0.291) |
Anxiety | – | – | – | – |
Absent a | – | – | – | – |
Present | 1.412 | 0.232 | < 0.001 | 4.129 (2.639–6.574) |
Personal burnout | – | – | – | – |
Absent a | – | – | – | – |
Present | 0.534 | 0.258 | 0.04 | 1.706 (1.026–2.831) |
Work-related burnout | – | – | – | – |
Absent a | – | – | – | – |
Present | 0.576 | 0.267 | 0.03 | 1.780 (1.054–3.009) |
Satisfied with academic performance | – | – | – | – |
Dissatisfied a | – | – | – | – |
Satisfied | −0.666 | 0.224 | 0.003 | 0.514 (0.330–0.796) |
Test | χ2 | df | P | |
Hosmer and Lemeshow test | 4.09 | 8 | 0.85 | |
Likelihood ratio test | 4 | 97.68 | < 0.001 |
Independent correlates of anxiety-related symptoms
Predictor | β | SE | P | OR (95% CI) |
---|---|---|---|---|
Intercept | 1.051 | 0.534 | 0.049 | 2.860 (1.019–8.309) |
Gender | – | – | – | – |
Male a | – | – | – | – |
Female | 0.604 | 0.251 | 0.016 | 1.830 (1.122–3.010) |
Year of study | – | – | – | – |
Med1 a | – | – | – | – |
Med2 | −0.605 | 0.458 | 0.186 | 0.546 (0.220–1.331) |
Med3 | −0.075 | 0.411 | 0.855 | 0.928 (0.413–2.077) |
Med4 | −0.901 | 0.486 | 0.064 | 0.406 (0.154–1.043) |
Med5 | −0.628 | 0.463 | 0.175 | 0.534 (0.214–1.319) |
Med6 | −0.810 | 0.533 | 0.129 | 0.445 (0.153–1.248) |
PGY1 | −0.873 | 0.452 | 0.053 | 0.418 (0.170–1.005) |
PGY2 | −1.229 | 0.462 | 0.008 | 0.293 (0.116–0.716) |
PGY3 | −0.787 | 0.451 | 0.081 | 0.455 (0.186–1.096) |
Depression | – | – | – | – |
Absent a | – | – | – | – |
Present | 1.396 | 0.247 | < 0.001 | 4.039 (2.509–6.620) |
Personal burnout | – | – | – | – |
Absent a | – | – | – | – |
Present | 0.526 | 0.247 | 0.033 | 1.693 (1.043–2.755) |
Patient-related burnout | – | – | – | – |
Absent a | – | – | – | – |
Present | 0.594 | 0.312 | 0.056 | 1.810 (0.990–3.370) |
Satisfied with academic performance | – | – | – | – |
Dissatisfied a | – | – | – | – |
Satisfied | −0.516 | 0.225 | 0.022 | 0.597 (0.383–0.928) |
TLRS | – | – | – | – |
Absent a | – | – | – | – |
Present | 0.555 | 0.229 | 0.015 | 1.743 (1.114–2.733) |
Past history of mental illness | – | – | – | – |
Absent a | – | – | – | – |
Present | 0.943 | 0.450 | 0.036 | 2.568 (1.092–6.480) |
Extracurricular involvement | – | – | – | – |
Always a | – | – | – | – |
Often | −1.003 | 0.401 | 0.012 | 0.367 (0.165–0.799) |
Sometimes | −0.761 | 0.340 | 0.051 | 0.467 (0.215–0.995) |
Rarely | −1.317 | 0.446 | 0.003 | 0.268 (0.110–0.634) |
Never | −0.268 | 0.862 | 0.756 | 0.765 (0.151–4.745) |
Sleep adequacy | – | – | – | – |
Inadequate sleep a | – | – | – | – |
Adequate sleep | −0.650 | 0.269 | 0.016 | 0.522 (0.306–0.882) |
Test | χ2 | df | P | |
Hosmer and Lemeshow test | 8.49 | 8 | 0.387 | |
Likelihood ratio test | 128.22 | 20 | < 0.001 |
Independent correlates of burnout-related symptoms
Predictor | β | SE | P | OR (95% CI) |
---|---|---|---|---|
Intercept | −2.595 | 0.684 | < 0.001 | 0.075 (0.019–0.277) |
Year of study | – | – | – | – |
Med1 a | – | – | – | – |
Med2 | −0.605 | 0.473 | 0.201 | 0.546 (0.211–1.362) |
Med3 | −0.370 | 0.402 | 0.357 | 0.691 (0.312–1.515) |
Med4 | −0.626 | 0.482 | 0.194 | 0.535 (0.204–1.359) |
Med5 | 0.138 | 0.450 | 0.758 | 1.149 (0.475–2.782) |
Med6 | 0.173 | 0.523 | 0.741 | 1.189 (0.423–3.312) |
PGY1 | 0.868 | 0.437 | 0.047 | 2.382 (1.021–5.690) |
PGY2 | 0.587 | 0.455 | 0.197 | 1.799 (0.741–4.438) |
PGY3 | −0.027 | 0.439 | 0.952 | 0.974 (0.411–2.309) |
Depression | – | – | – | – |
Absent a | – | – | – | – |
Present | 0.709 | 0.243 | 0.004 | 2.031 (1.263–3.285) |
Anxiety | – | – | – | – |
Absent a | – | – | – | – |
Present | 0.864 | 0.232 | < 0.001 | 2.374 (1.510–3.753) |
Satisfied with career choice | – | – | – | – |
Dissatisfied a | – | – | – | – |
Satisfied | −0.499 | 0.262 | 0.057 | 0.607 (0.362–1.014) |
Extracurricular involvement | – | – | – | – |
Always a | – | – | – | – |
Often | 0.591 | 0.413 | 0.152 | 1.806 (0.817–4.145) |
Sometimes | 0.449 | 0.401 | 0.263 | 1.567 (0.724–3.519) |
Rarely | 0.996 | 0.446 | 0.025 | 2.709 (1.145–6.618) |
Never | 2.324 | 1.165 | 0.046 | 10.215 (1.446–6.618) |
ARS | – | – | – | – |
Absent a | – | – | – | – |
Present | 0.760 | 0.394 | 0.054 | 2.137 (1.009–4.768) |
IRS | – | – | – | – |
Absent a | – | – | – | – |
Present | 0.412 | 0.245 | 0.092 | 1.511 (0.936–2.446) |
DRS | – | – | – | – |
Absent a | – | – | – | – |
Present | 0.723 | 0.236 | 0.002 | 2.061 (1.299–3.282) |
Substance use | – | – | – | – |
Not using a | – | – | – | – |
Using | 0.450 | 0.236 | 0.057 | 1.568 (0.989–2.502) |
Test | χ2 | df | P | |
Hosmer and Lemeshow test | 12.7 | 8 | 0.12 | |
Likelihood ratio test | 145.9 | 19 | < 0.001 |