43
Análisis y Modicación de Conducta
2024, Vol. 50, Nº 183, 43-49
ISSN: 0211-7339
Depressive symptoms and suicidal ideation in
medical students
Síntomas depresivos e ideación suicida en
estudiantes de medicina
Letícia Duarte Cagol
Mariana Reversi
Degree in Psychology. FAG University Center. Brazil
Claudia Barbosa
PhD in Psychology. Unioeste. Brazil
Rafael Corrêa
PhD in Public Health and Health Education. Getúlio Vargas Foundation. – FGV. Brasil
Resumen
Introducción: Los síntomas depresivos afectan
a una gran parte de la población mundial, así como
a los profesionales de la salud, especialmente a los
estudiantes de medicina. Estos síntomas también
se consideran uno de los factores de riesgo de idea-
ción e intento de suicidio. Para ello, este estudio tiene
como objetivo identicar la prevalencia de síntomas
depresivos e ideación suicida entre los estudiantes
de medicina de una Universidad. Método: Estudio
descriptivo transversal realizado con una muestra
estraticada proporcional de 257 participantes. Se
utilizaron análisis descriptivos para analizar los datos
en la muestra general, por sexo y período, con un IC
del 95%. Resultados: Las mujeres estudiantes presen-
taron una mayor prevalencia de síntomas depresivos
en el primer ciclo de formación médica. Consideracio-
nes nales: Se destaca la importancia de implementar
estrategias dirigidas a la prevención y promoción de
la salud de los estudiantes en los últimos años de la
carrera de medicina.
PalabRas clave
Depresión; Ideación Suicida; Medicina.
abstRact
Introduction: Depressive symptoms aect a large
part of the world’s population as well as health profes-
sionals, especially medical students. These symptoms
are also considered to be one of the risk factors for
suicidal ideation and attempts. To this end, this study
aims to identify the prevalence of depressive symp-
toms and suicidal ideation among medical students
at the university. Method: A cross-sectional descrip-
tive study carried out using a proportional stratied
sample of 257 participants. Descriptive analyses
were used to analyze the data in the general sample,
by gender and period, with a 95% CI. Results: Fema-
le students had a higher prevalence of depressive
symptoms in the rst cycle of medical training. Final
considerations: The importance of implementing
strategies aimed at the prevention and promotion of
student health in the nal years of the medical course
is highlighted.
KeywoRds
Depression; Suicidal Ideation; Medicine.
Correspondencia: Rafael Soares Corrêa. Institution address: School of Public Policy and Government (EPPG). Getúlio Vargas Foundation. SGAN
(Setor de Grandes Áreas Norte Quadra 602 - Módulos A, B e C - Asa Norte, 70830-051. Brasília, Federal District, Brazil. E-mail: rafael.correa@fgv.br
Recibido: 23/02/2024; aceptado: 14/05/2024
44 DEPRESSIVE SYMPTOMS AND SUICIDAL IDEATION IN MEDICAL STUDENTS
Análisis y Modicación de Conducta, 2024, vol. 50, nº 183
Introduction
Depression is a psychiatric disorder that has
a high prevalence rate in the general popu-
lation, with a high morbidity and mortality
rate. 28% of Brazilians between the ages of
18 and 24 have depressive symptoms and in
70% of cases, this condition can lead to sui-
cide, especially in young people (Bolsoni-Silva
& Loureiro, 2016)and there is a gap in relation
to studies about social skills associated to de-
pression. The objective of this study was to
compare the social skills and the perceptions
of consequences in interactions of students
with depression (n=64. This disorder aects
more than 322 million people worldwide and
is characterized by changes in mood, interfer-
ing with family and social relationships (Santos
et al., 2011).
In this context, the clinical symptoms of
depression, according to the Diagnostic and
Statistical Manual of Mental Disorders - DSM-
5(APA, 2014) are: depressed mood, loss of in-
terest or pleasure in activities, deep sadness,
weight loss or gain, insomnia or hypersomnia,
agitation or psychomotor retardation, feel-
ings of worthlessness, loss of energy, excessive
guilt, suicidal ideation and attempts.
Depression also aects university students,
who because of the disorder experience nu-
merous symptoms that have a direct impact
on the way they see the world. It is estimated
that medical students are at greater risk of de-
veloping depressive symptoms than the gen-
eral population, due to factors to which they
are exposed throughout the course, such as
fatigue, a heavy study load, dealing with pa-
tients and recurrent contact with death (E. N.
de Oliveira, 2013).
In addition to the symptoms already identi-
ed in the DSM-5 (APA, 2014), some manifes-
tations considered milder, such as anguish,
irritability, constant tiredness, forgetfulness,
diculty concentrating and making decisions,
are also common among medical students,
which are called common mental disorders.
These are risk indicators for the development
of a more serious mental illness since the disor-
ders become incapacitating without adequate
medical and psychological follow-up (Dâmaso
et al., 2019).
Medical school is six years long and can
be divided into three phases: 1) the basic cy-
cle, which covers the rst and second years; 2)
the clinical cycle, which covers the third and
fourth years; and 3) the internship, which cor-
responds to the fth and sixth years. During
these six years, students can experience dif-
ferent psychic experiences, including: a) initial
euphoria, which is felt by the student when
they enter university; b) the high demands and
enormous challenge of the course can lead to
disappointment; c) in the nal phase, the in-
ternship, and the competitiveness in selection
processes for residency generate concern and
adaptation (Fiorotti et al., 2010).
The stress experienced during this period
aects students cognitively and physiologi-
cally, which compromises their learning and
can also inuence both their training and
their performance in internships (Oliveira &
Araujo, 2019). In this sense, symptoms such as
nervousness and excessive worry end up be-
ing frequent for medical students, generating
45
LETÍCIA DUARTE CAGOL · MARIANA REVERSI · CLAUDIA BARBOSA · RAFAEL CORRÊA
Análisis y Modicación de Conducta, 2024, vol. 50, nº 183
an adaptation - even if inappropriate - to the
phenomena experienced during the academic
period (Lima et al., 2016).
Due to the complexity of medical school,
students are exposed to consecutive stress fac-
tors throughout their training, facing changes
in their routine, such as little leisure time with
family and friends, emotional exhaustion,
and hopelessness (Oliveira & Araujo, 2019).
Such situations can generate a feeling of not
belonging, loneliness and low self-esteem
(Almeida, 2014).
Issues such as the stigma attached to the
illness, the fear of breaching the condenti-
ality of psychiatric treatment and the appre-
hension of possible negative repercussions
on their professional capacity, cause students
to silence their illness, serving as barriers that
prevent them from seeking specialized help
(Vasconcelos et al., 2015).
Depressive symptoms and suicidal idea-
tion are complex and wide-ranging phenom-
ena, requiring eorts to identify, track and
create strategies for the development of eec-
tive therapeutic support. The study therefore
sought to verify the prevalence of these symp-
toms among medical students to help develop
preventive health strategies.
Method
This is a descriptive, cross-sectional and
quantitative study. The research followed
ethical procedures with human beings (CAAE
54266021.6.0000.5219) and the Strengthening
the Reporting of Observational Studies in Epi-
demiology- STROBE protocol.
Participants were selected from a popula-
tion of 857 students enrolled between the 1st
and 8th terms in 2022 on the Medicine course
at the University, using a proportional strati-
ed sample by gender and term, resulting in a
nal sample of 257 participants.
For data collection, the participants were
contacted through the list of enrolled students,
Table 1
Description of the variables and measures involved in the study.
Study variables Measure
Gender 1 - Male; 2 - Female
Course period 1 - 1st period; 2 - 2nd period; 3 - 3rd period; 4 - 4th period; 5 - 5th period; 6 - 6th
period; 7 - 7th period and 8 - 8th period
Lack of appetite1
Poor sleep1
Feeling of sadness1
Constant crying1
Dissatisfaction with tasks1
Diculty making decisions1 1 – Yes; 2 – No
Disability in life1
Constant tiredness1
Suicidal ideation2
1- Variables considered for analyzing depressive symptoms.
2- Variable used to analyze suicidal ideation.
46 DEPRESSIVE SYMPTOMS AND SUICIDAL IDEATION IN MEDICAL STUDENTS
Análisis y Modicación de Conducta, 2024, vol. 50, nº 183
previously provided by the coordination of the
Medicine course. Data was collected through
rapport and application of the Common Men-
tal Disorders Identication Questionnaire (Self
Reporting Questionnaire - SRQ - 20, 1994)
(WHO, 1994), which has a Cronbach’s alpha
of 0.80 (Santos et al., 2011). The questionnaire
consists of 20 dichotomous questions aimed
at identifying symptoms of mental health risk,
acting as a screening for psychiatric morbidity.
Of the 20 questions, four assess physical symp-
toms and 16 assess psycho-emotional altera-
tions, among which questions assessing de-
pressive symptoms and suicidal ideation were
used, as shown in Table 1.
The data analysis method used was descrip-
tive analysis and the chi-square test for the
general group, by gender and period, using
the SPSS program, version 27, with a signi-
cance level of p<0.005.
Table 2
Distribution of depressive symptoms and suicidal ideation in medical students, by gender. Brazil, 2021.
Variables Total Male Female
%(n) %(n) %(n) p
Courseperiod 100(257) 39.3(101) 60.7(156) 0.222
BasicCycle 53.7(138) 22.9(59) 30.7(79)
ClinicalCycle 46.3(119) 16.3(42) 30(77)
Lackofappetite 0.046
Yes 22.3(57) 15.8(16) 26.5(41)
No 77.7(199) 84.2(85) 73.5(114)
Poorsleep 0.658
Yes 51.8(133) 53.5(54) 50.6(79)
No 48.2(124) 46.5(47) 49.4(77)
Feelingsad 0.295
Yes 40(102) 36(36) 42.6(66)
No 60(153) 64(64) 57.4(89)
Constantcrying <0.001
Yes 27.2(70) 13.9(14) 35.9(56)
No 72.8(187) 86.1(87) 64.1(100)
Dissatisfactionwithtasks 0.292
Yes 48.6(125) 44.6(45) 51.3(80)
No 51.4(132) 55.4(56) 48.7(76)
Dicultymakingdecisions 0.060
Yes 46.9(120) 39.6(40) 51.6(80)
No 53.1(136) 60.4(61) 48.4(75)
IDisabilityinlife
DYes 24.9(64) 17.8(18) 29.5(46) 0.035
No 75.1(193) 92.2(83) 70.5(110)
Constanttiredness 0.015
Yes 65.4(168) 56.4(57) 71.2(111)
No 34.6(89) 43.6(44) 28.8(45)
Suicidalideation 0.894
Yes 3.1(8) 3(3) 3.3(5)
No 96.9(246) 97(98) 96.7(148)
47
LETÍCIA DUARTE CAGOL · MARIANA REVERSI · CLAUDIA BARBOSA · RAFAEL CORRÊA
Análisis y Modicación de Conducta, 2024, vol. 50, nº 183
Results and discussions
Table 2 shows the distribution of depres-
sive symptoms and suicidal ideation among
the participants, by gender and period. Most
of the sample was made up of rst cycle stu-
dents (57.3%) and females (60.7%). The female
students showed a lack of appetite (26.5%),
feelings of sadness (42.6%), constant crying
(35.9%), dissatisfaction with tasks (51.3%), dif-
culty making decisions (51.6%), inability in
life (29.5%), feelings of uselessness (23.9%),
constant tiredness (71.2%) and suicidal idea-
tion (3.3%). Male students were more likely to
have diculty sleeping (53.5%).
Table 3 shows depressive symptoms and
suicidal ideation by period (cycle) of the medi-
cal course. Participants in the basic cycle had
a higher prevalence of poor appetite (24.8%),
diculty sleeping (54.3%) and dissatisfaction
with tasks (52.2%). In the clinical cycle, the
prevalence was higher for feelings of sadness
(43.2%), constant crying (32.8%), diculty in
making decisions (49.2%), incapacity in life
Table 3
Distribution of depressive symptoms and suicidal ideation in medical students, by period (cycles).
Brazil, 2021.
Variables Total%(n) BasicCycle%(n) Clicalcycle%(n) p
Lackofappetite 100(257) 100(138) 100(119) 0.292
Yes 22.3(57) 24.8(34) 19.3(23)
No 77.7(199) 75.2(103) 75.2(103)
Sleepsbadly 0.370
Yes 51.8(133) 54.3(75) 48.7(58)
No 48.29124) 45.7(63) 51.3(61)
Feelingofsadness 0.330
Yes 40(102) 37.2(51) 43.2(51)
No 60(153) 62.8(86) 56.8(67)
Constantcrying 0.064
Yes 27.2(70) 22.5(31) 32.8(39)
No 72.8(187) 77.5(107) 67.2(80)
Dissatisfactionwithtasks 0.222
Yes 48.6(125) 52.2(72) 44.5(53)
No 51.4(132) 47.8(66) 55.5(65)
Dicultymakingdecisions 0.500
Yes 46.9(120) 44.9(62) 49.2(58)
No 53.1(136) 55.1(76) 50.8(60)
Disabilityinlife 0.693
Yes 24.9(64) 23.9(33) 26.1(31)
No 75.1(193) 76.1(105) 73.9(88)
Constantfatigue 0.015
Yes 65.4(168) 56.4(57) 71.2(111)
No 34.6(89) 43.6(44) 28.8(45)
Suicidalideation 0.838
Yes 3.1(8) 2.9(4) 3.4(4)
No 96.9(246) 97.1(132) 96.6(114)
48 DEPRESSIVE SYMPTOMS AND SUICIDAL IDEATION IN MEDICAL STUDENTS
Análisis y Modicación de Conducta, 2024, vol. 50, nº 183
(26.1%), constant tiredness (71.2%) and sui-
cidal ideation (3.4%).
A higher prevalence of depressive symp-
toms was observed among medical students
in the clinical cycle. This data is conrmed in
another study and is attributed to the accumu-
lation of stress during the student’s academic
life (4).
A higher prevalence of depressive symp-
tom factors was also observed in female par-
ticipants; This has been attributed in other
studies to being up to twice as high as male
students (Oliveira, 2013).
In relation to the female sample in the study,
the highest frequency of depressive symp-
toms was identied as tiredness, constant cry-
ing, diculty in making decisions and feelings
of sadness. State that women nd it more dif-
cult to cope with everyday situations and are
more likely to develop depression (Aquino et
al., 2019).
As for the aspect of suicidal ideation, it was
observed that in both sexes and periods of the
medicine course they had a low prevalence in
the study.
Final considerations
In this study it was possible to identify that
at the end of the course - the clinical cycle of
medical training - students have a higher prev-
alence of depressive symptoms when com-
pared to students in the basic cycle, as well as
a higher prevalence in females. This highlights
the importance of implementing strategies
aimed at preventing and promoting student
health.
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