Psychiatric and Medical Profile of Students at the Faculty of Medicine and Biomedical Sciences (FMSB) of the University of Yaoundé 1, Cameroon Volume 58- Issue 5

Sidonie Laeticia Ndjebet^1-3, Issack Biyong^3-5*, Marie José Essi^1,2, Ariane Ndjebet¹, Evelyn Mah^1,5, Harmonie Divine Aba A¹, Johanne A Abessolo¹, Adeline PELDA¹ and Félicien Ntone^1,6

• ¹Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
• ²Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Laboratory for Research in Medical Anthropology and Social Medicine, Cameroon
• ³Center of Psychotraumatology and Mediation (CPM), subsidiary of IPM-International, Cameroon
• ⁴Center for Psychotraumatology and Mediation (CPM), Trauma Clinic and Transcultural Psychiatry (CTPT), affiliated @ ISFM: Institut Suisse de Formation Médicale postgrade et continue, Switzerland
• ⁵Psy-Scan Institute, Neuchâtel (PSI), Clinic for Resilient Adolescents and Young Adults (CAJAR), Switzerland 5Gynaeco-obstetric and paediatric hospital, Cameroon
• ⁶Yaoundé University Hospital, Cameroon

Received: September 24, 2024; Published: October 04,2024

*Corresponding author: Issack BIYONG, Center de Psychotraumatologie et de Médiation (CPM), Clinique des Traumatismes et de Psychiatrie Transculturelle (CTPT), affiliated @ ISFM : Institut Suisse de Formation Médicale postgrade et continue, Neuchâtel, Switzerland

DOI: 10.26717/BJSTR.2024.58.009222

Abstract PDF

Introduction: It is recognized that medical studies lead to a disruption of life trajectories and lead to psychiatric disorders. Thus, it is important to assess their mental health status in order to anticipate possible psychopathological repercussions both individually and on the quality of care provided by these future doctors

Objectives: To evaluate the mental health profile of medical students at the University of Yaoundé

Methodology: This was a cross-sectional study with an analytical aim conducted among students of the Faculty of Medicine and Biomedical Sciences of Yaoundé (FMSB), over a period of two months (February to March 2021). The information was collected by level of study and medical field through a standardized tool, the General Health Questionnaire (GHQ- 28). The data obtained were processed in SPSS 24.0 software using proportions and Pearson's Chi2 test. Univariate and multivariate analyses were used to report the results.

Results: A total of 501 students were included with a sex ratio of 0.77. The age group of 20- 25 years was the most represented (67.3%). The sample consisted of 60.5% general medical students, 27.3.% odontostomatology students and 12.2% pharmacy students. The mean of the GHQ-28 was 12.05 (SD=1,87), and 86.4% of the population had a score above the threshold (pathological score > 5). Anxiety was the most represented form of distress (60.3%) followed by somatic disorders (53.7%), social maladjustment (30.3%), and depression (19.4%). However, 12.2% of the population already had problems before entering university and only 5% of these were under psychological assistance. Up to 47.1% of the students felt that their academic performance was good. Significant differences were found between the GHQ-28 and the medical program (p=0.019 OR=3.61 (1.22-10.68), and the master's program (p=0.027, OR=2.24(1.07-4.66)).

Conclusion: Medical students at the University of Yaoundé I face psychological distress that can prevent them from reaching their full potential. Students in the master's program and those in the medical program were the most exposed to psychological distress.

Keywords: Global Health; Preventive Medicine; Physical Health; Mental Health; GHQ; Medical Students

Abbreviations: FMSB: Faculty of Medicine and Biomedical Sciences of Yaoundé; WHO: World Health Organization; ASD: Autism Spectrum Disorder; ADHD: Attention Deficit Hyperactivity Disorder; CIER: Cross- Sectional Study After Obtaining Ethical; GHQ-28: General Health Questionnary; SGMP: Set Up a Global Health and Preventive Medicined

The issue of the psychiatric profile of medical students is complex, as it varies greatly from one individual to another. However, research has identified certain psychiatric disorders and mental health problems that may be more prevalent in medical students, often due to the high stress and rigorous academic demands they face. Here are some of the disorders and mental health problems often discussed in the scientific literature concerning this population: depression, anxiety, burnout, and sleep disorders. These disorders can affect not only their personal well-being, but also their academic and professional performance [1]. The mental health of medical students is a major focus of interest worldwide [1-10]. The World Health Organization (WHO) states that, to realize one's full potential and cope with life's challenges, a state of physical well-being must be combined with mental well-being [11]. Thus, there is a close link between the quality of care provided by these future doctors and their mental health. The presence of a mental disorder will have an impact on work, social and family relationships and adaptability [12]. Somatic, i.e. physical, health also remains a major concern, given the scale of psychosocial stress factors and the lack of facilities at student health centers equipped and open 24 hours a day for their training and the logically long hours of on-call duty.

Psychiatric Profile of Medical Students?

Stress and Anxiety: Medical students often report high levels of stress and anxiety, which can be linked to academic workload, exam pressure, peer competition, and concerns about their future career. Anxiety can manifest itself in many forms, including generalized anxiety disorder, panic disorder, and social phobia [13].

Depression: Depression is another psychiatric disorder frequently seen in medical students. It can be due to emotional exhaustion, chronic stress, social isolation, and fear of not meeting expectations. Symptoms of depression can include persistent depressed mood, loss of interest or pleasure in activities, changes in appetite or weight, sleep disturbances, and suicidal thoughts [14].

Burnout: Burnout is particularly prevalent in the healthcare professions, including among medical students. It is characterized by a feeling of exhaustion, cynicism or detachment from one's studies or future profession, and a sense of diminished self-efficacy. Burnout can result from prolonged exposure to high stress without adequate recovery [15].

Substance Use Disorder

Some medical students may resort to substance use (alcohol, illicit drugs, prescription medications) as a coping mechanism for stress and pressure. This can lead to substance use disorders, with potentially serious consequences for their health, well-being, and future careers.

Autism Spectrum Disorder and ADHD

Although less frequently discussed, conditions such as Attention Deficit Hyperactivity Disorder (ADHD) [16] and Autism Spectrum Disorder (ASD) can also affect medical students, influencing how they learn and interact in an academic and clinical environment [17]. Crucially, the presence of these disorders in no way diminishes students' ability to become excellent healthcare professionals. In fact, the appropriate recognition and treatment of these problems can lead to greater resilience and a better capacity to empathize with patients. Medical and educational institutions play a vital role in providing resources, support and interventions to promote the mental health and well-being of their students. Considering the medical profile of this academic population, medical students, like other populations, can be prone to a variety of physical health problems, some of which are related to their specific lifestyle and the demands of their training. Here are a few physical health problems frequently encountered by medical students.

Medical Profile (Physical Health Problems) of Medical Students Musculoskeletal Disorders

Long hours spent in a seated position, whether studying or on clinical placements, can lead to musculoskeletal disorders, particularly in the back, neck and shoulders. In addition, repeated carrying of heavy loads, such as books or medical equipment, can aggravate these conditions, leading to chronic pain or functional limitations [18].

Fatigue and Sleep Disorders

High workloads, stress and academic demands are common factors that can lead to sleep disorders, such as insomnia or poor-quality sleep. Chronic fatigue is also common among medical students, resulting from insufficient or disturbed sleep, which can affect their academic performance and general well-being [19].

Visual Problems

Long hours spent reading or working on computers can cause or exacerbate visual problems, such as eyestrain, dry eyes, or myopia. These problems can worsen if working conditions are less than optimal, such as inadequate lighting or insufficient breaks [20].

Eating and Nutritional Disorders

Irregular schedules, stress, and lack of time can lead to unhealthy eating habits in medical students, such as skipping meals or increased consumption of processed foods and caffeine. These behaviors can lead to nutritional deficiencies, unwanted weight gain or loss, and eating disorders [21].

Infections and Communicable Diseases

Due to their frequent exposure to hospital environments and patients, medical students are at increased risk of exposure to infections and communicable diseases, such as influenza, the common cold, tuberculosis, and more recently, COVID-19. This regular exposure calls for heightened vigilance regarding hygiene measures and personal protection [22].

Stress and Impact on Physical Health

Chronic stress, often encountered in the medical curriculum, can have a direct impact on physical health, contributing to conditions such as hypertension, heart problems, and a weakened immune system. This stress can make students more susceptible to illness and infection, in addition to affecting their overall well-being [23].

Problem Substance Use (PSU)

Under the pressure of stress and academic demands, some medical students may increase their consumption of substances such as nicotine, alcohol, and caffeine, or even resort to stimulant drugs. These practices can have detrimental consequences for their long-term physical and mental health [24]. It's crucial for medical students to recognize these risks and take steps to maintain a healthy balance between their studies, physical well-being, and mental health. This can include effective time management, regular exercise, a balanced diet, relaxation techniques, and seeking psychological support when necessary. Educational institutions also have a central role to play in providing resources and programs to support students' health and well-being. This can include time management, regular exercise, a balanced diet, relaxation techniques, and seeking psychological support when necessary. Educational institutions also have a role to play in providing resources and programs to support students' health and well-being.

Entering medical school requires a great deal of adaptability: a new environment, new learning strategies, the acquisition of a degree of autonomy that is not always desirable. At the other end of the scale, the national clinical synthesis exam generates a great deal of stress. Although this stress is seen as a driving force inherent to the medical curriculum, it is far from positive for everyone, and can lead to consequences such as anxiety, depression, a drop in academic performance or the abandonment of medical studies. Authors agree that the prevalence of mental disorders in medical students is higher than in the general population of the same age [25,26]. However, the literature contains little information on the mental health of medical students. The aim of this study was therefore to establish the mental health profile of medical students at the University of Yaoundé I.

We conducted a descriptive cross-sectional study after obtaining ethical (CIER) and administrative authorizations from the Yaoundé Faculty of Medicine and Biomedical Sciences (FMSB). Data collection lasted 02 months (February to March 2021) within the FMSB and was randomized. Students enrolled for the 2020-2021 academic year were included, regardless of course or level of study. Students meeting the inclusion criteria were approached as follows at the FMSB and in the Yaoundé hospitals where they were doing their academic internship, with a view to being interviewed. After having been informed of the objectives of this research, the sources of funding, the benefits, and their right to refuse to participate in the study without retaliation, their free and informed consent was obtained in writing. Then, depending on the students' availability, interviews were conducted using a short questionnaire containing socio-academic data and the French version of the General Health Questionnary (GHQ-28). The GHQ-28 assesses common aspects of psychiatric episodes: the inability to carry on normal daily activities and the appearance of recent symptoms leading to a state of psychological distress. We used the original scoring method in this study [27].

In this method, the response categories are assigned 0, 0, 1 and 1 respectively, giving a score ranging from 0 to 28. Values strictly above 5 indicated a high probability of psychological distress. Data were collected with the strictest respect for anonymity and confidentiality. We excluded all those who had not completed the evaluation tool. The information obtained was processed in Statistical Package for Social Sciences (SPSS 24.0). For quantitative variables, we used the median and interquartile range. For qualitative variables, we used proportions. Finally, the Chi-square test was used to look for significant associations between categorical variables. Values of p<0.05 were considered statistically significant.

During the study period, 600 students were invited to participate. Of these, 501 met our inclusion criteria, giving an acceptability rate of 89.3%. The sex ratio in this study was 0.77. The median age was 23 years and the interquartile range 3 years. Participants' ages ranged from 17 to 35, with 67.3% between 20 and 25. The socio-academic data of the participants are detailed in Table 1. The majority of the sample (77.6%) were in higher education. Academic performance was perceived as good and average by 47.1% and 40.3% of students respectively. It was also found that 17.8% had a family history of psychiatric problems. In addition, only 7.4% of students reported good mental health. The mean GHQ-28 was 12.05 (standard deviation=1.87), and 86.4% of the population had a score above the threshold (pathological score > 5). In fact, 14.4% had had suicidal thoughts during their university studies. However, before entering university, 12.2% had had suicidal thoughts and 2.2% had attempted to take their own lives. Figure 1 summarizes the different forms of psychological distress reported by the students.

Figure 1

Table 1: Basic characteristics of population distribution.

Up to 40.5% had experienced more sleep disturbances than usual since joining the FMSB. Only 5% of those who had a psychological problem benefited from follow-up. Follow-up was more frequent among males (7.3% vs. 3.5%). Table 2 shows psychological distress according to socio-academic characteristics. Although boys were better able to take care of themselves (p=0.034; OR=2.41 (1.04-5.56)), female students were 2 times more likely to develop anxiety (p=0.014, OR=1.57 (1.09-2.26)) and somatic disorders (p=0.001, OR=1.87 (1.30-2.67)). Significant differences were also found with the GHQ-28 according to level of study and medical stream. Medical students were 3 times more likely to attempt suicide (p=0.019 OR=3.61 (1.22-10.68). Clinically active students (Masters) were more prone to suicidal ideation (p=0.027, OR=2.24(1.07-4.66)). However, appeared to be better treated at undergraduate level (7% vs. 3.3% at master's level) (Figure 2, Table 3).

Table 2: T-test before and after PSM.

Table 3: Logistic regression analysis before and after PSM.

Figure 2

The aim of this study was to assess the mental health profile of students at the Faculty of Medicine and Biomedical Sciences (FMSB). At the end of the collection period, the acceptability rate was 89.83%, reflecting a good level of participation. However, it is possible that the refusal of some students to take part in the study reflects a fragility or reluctance to broach the subject of mental health, a phenomenon often observed in African societies where prejudices and traditionalist mentalities persist [26,27]. Almost 86% of students scored pathologically on the GHQ-28, indicating a high prevalence of mental health problems in this population. Anxiety, in particular, was the most prevalent pathology, with 60.3% of students showing significant symptoms. This high rate of anxiety may be explained by the transition to autonomy at an age when students have not yet fully mastered the management of their responsibilities. In addition, increasing academic demands, reduced sleep and leisure time, and the need to adapt to a new university environment contribute to this situation. These findings are consistent with those observed in Egypt and Morocco, where similar studies revealed anxiety rates of 64.3% and 54%, respectively [28,29].

Depression, although less frequent (19.4%), remains a significant problem. Compared to a study conducted in Cameroon in 2017, where the prevalence of depression among medical students was 30.6%, our results are lower. This difference can be attributed to the different measurement scales used. The GHQ-28, for example, does not provide a clinical diagnosis but rather assesses general state of mental well-being, which could explain the disparity in results. It is therefore crucial to consider these data as part of targeted preventive interventions for medical students, especially those in advanced levels where hospital placements can accentuate psychological distress. These observations are supported by studies carried out in Parakou, where hospital internships were identified as vulnerability factors for postgraduate students [30].

Despite worrying mental health indicators, academic performance was perceived as good or average by the students. This may indicate that, despite facing mental distress, students are finding mechanisms to maintain their academic performance. However, it is important to emphasize that this resilience may not be sustainable without adequate support. Indeed, doctoral students, who benefit from a less intense rhythm after hospital internships, seem to have better mental stability, enabling them to re-establish a balance between work and leisure. The study also highlighted a significant relationship between female gender and stress-related pathologies. Women were more likely to suffer from anxiety and somatic disorders, which could be due to greater exposure to stressful events and hormonal variations influencing their stress response [31]. Men, on the other hand, were more likely to seek psychological support, which could be explained by a tendency to externalize their unhappiness and seek support more actively. This difference in help-seeking behavior highlights the need for a differentiated approach to psychological support for men and women. Although this study provides valuable information on the mental health of students, it has certain limitations.

For example, it did not consider specific factors such as relationship-related depression, which can play an important role in the mental health of young adults. Moreover, as the GHQ-28 is sensitive to transient disorders, it does not detect long-term disorders, which could influence the interpretation of the results. Finally, these somatic data, while not exhaustive, should be integrated into the overall discussion and compared with the results of other studies conducted in Africa and around the world. Such a comparative analysis would enable us to better understand the cultural and contextual specificities influencing students' mental health, and to propose interventions tailored to their needs.

Students at the Faculty of Medicine and Biomedical Sciences (FMSB) of the University of Yaoundé 1 face psychological problems that can seriously hinder the achievement of their full academic potential. Psychological distress is particularly pronounced among master's students and those in the medicine stream, requiring urgent intervention [30]. It is imperative to set up a Global Health and Preventive Medicine (SGMP) service at the University of Yaoundé 1, within the faculty, offering a compulsory annual consultation. This initiative would enable early detection of neglected or sub-clinical psychological health problems, as well as somatic health problems, and propose a personalized treatment plan for each student, to be re-evaluated each academic year according to students' individual health status [31].

Such measures would not only help to improve students' mental well-being, but also ensure that they are able to reach their full academic potential. It is also recommended that good practice be established for future doctors and pharmacists, by assessing each student in his or her first year and first year of post-graduate studies. This would enable specific medical and psychiatric profiles to be compiled for each student, making it easier for university medical services to provide the best possible primary care [32]. Regular follow-up should be ensured where necessary, with early detection of serious health problems to guarantee effective triage and referral to specialist services [33]. Finally, to strengthen overall health care at the University of Yaoundé I, it is essential to introduce basic health insurance for all medical students from the first year onwards. This would ensure that all students have access to the necessary health care, thus reducing the risk of complications due to untreated health problems [34,35].

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