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Examining Burnout, Depression, and Attitudes Regarding Drug Use Among Lebanese Medical Students During the 4 Years of Medical School

Academic Psychiatry volume 42, pages 288–296 (2018)Cite this article

Abstract

Objectives

This study aims to evaluate the prevalence of burnout, depressive symptoms, and anxiety symptoms and attitudes toward substance use in medical students as well as their evolution during the 4 years of medical school.

Methods

A cross-sectional study was carried out at the American University of Beirut Medical Center (AUBMC) between September and December 2016. In total, 176 out of 412 eligible medical students responded. The survey was anonymous and administered via e-mail link to an electronic form. The study included general socio-demographic questions and standardized validated tools to measure depressive symptomatology (PHQ-9), burnout (Burnout Measure), anxiety (GAD-7), alcohol use (AUDIT), and substance abuse (DAST-10) as well as questions pertaining to attitudes toward recreational substance use.

Results

Overall, 23.8% of medical students reported depressive symptomatology, with 14.5% having suicidal ideations. Forty-three percent were found to have burnout. Those who screened positive for burnout were more likely to be males, to be living away from their parents, and to have experienced a stressful life event during the last year. With the exception of burnout, there was no significant difference in the prevalence of depression or anxiety among the 4 years of medical school. There was a significant difference in alcohol use, illicit substance use, and marijuana use during the four medical school years.

Conclusions

The results of this study show high rates of depression, burnout, and suicidal ideation among medical students from the Middle East region. Increased rates of substance use were detected as well as a more tolerant attitude toward substance use in general, specifically cannabis. It is crucial that medical educators and policymakers keep tackling the complex multifactorial mental health issues affecting medical students and design effective solutions and support systems.

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References

  1. Prins JT, Hoekstra-Weebers JE, Gazendam-Donofrio SM, et al. Burnout and engagement among resident doctors in the Netherlands: a national study. Med Educ. 2010;44(3):236–47. https://doi.org/10.1111/j.1365-2923.2009.03590.x.

    Article  PubMed  Google Scholar 

  2. Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, et al. Burnout among US medical students, residents, and early career physicians relative to the general US population. Acad Med. 2014;89(3):443–51. https://doi.org/10.1097/ACM.0000000000000134.

    Article  PubMed  Google Scholar 

  3. Dyrbye LN, Massie FS, Eacker A, Harper W, Power D, Durning SJ, et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA. 2010;304(11):1173–80. https://doi.org/10.1001/jama.2010.1318.

    Article  CAS  PubMed  Google Scholar 

  4. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52(1):397–422. https://doi.org/10.1146/annurev.psych.52.1.397.

    Article  CAS  PubMed  Google Scholar 

  5. Dahlin ME, Runeson B. Burnout and psychiatric morbidity among medical students entering clinical training: a three year prospective questionnaire and interview-based study. BMC Med Educ. 2007;7(1):6. https://doi.org/10.1186/1472-6920-7-6.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Acad Med. 2006;81(1):82–5. https://doi.org/10.1097/00001888-200601000-00020.

    Article  PubMed  Google Scholar 

  7. Center C, Davis M, Detre T, Ford DE, Hansbrough W, Hendin H, et al. Confronting depression and suicide in physicians: a consensus statement. JAMA. 2003;289(23):3161–6. https://doi.org/10.1001/jama.289.23.3161.

    Article  PubMed  Google Scholar 

  8. Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatr. 2004;161(12):2295–302. https://doi.org/10.1176/appi.ajp.161.12.2295.

    Article  PubMed  Google Scholar 

  9. Hays LR, Cheever T, Patel P. Medical student suicide, 1989–1994. Am J Psychiatry. 1996;153(4):553–5. https://doi.org/10.1176/ajp.153.4.553.

    Article  CAS  PubMed  Google Scholar 

  10. Pepitone-Arreola-Rockwell F, Rockwell D, Core N. Fifty-two medical student suicides. Am J Psychiatry. 1981;138(2):198–201. https://doi.org/10.1176/ajp.138.2.198.

    Article  CAS  PubMed  Google Scholar 

  11. Tyssen R, Vaglum P, Grønvold NT, Ekeberg Ø. Suicidal ideation among medical students and young physicians: a nationwide and prospective study of prevalence and predictors. J Affect Disord. 2001;64(1):69–79. https://doi.org/10.1016/S0165-0327(00)00205-6.

    Article  CAS  PubMed  Google Scholar 

  12. Clark DC, Zeldow PB. Vicissitudes of depressed mood during four years of medical school. JAMA. 1988;260(17):2521–8. https://doi.org/10.1001/jama.1988.03410170069036.

    Article  CAS  PubMed  Google Scholar 

  13. Tjia J, Givens JL, Shea JA. Factors associated with undertreatment of medical student depression. J Am Coll Heal. 2005;53(5):219–24. https://doi.org/10.3200/JACH.53.5.219-224.

    Article  Google Scholar 

  14. Talih F, Warakian R, Ajaltouni J, Tamim H. Correlates of depression and burnout among residents in a Lebanese Academic Medical Center: a cross-sectional study. Acad Psychiatry. 2016;40(1):38–45. https://doi.org/10.1007/s40596-015-0400-3.

    Article  PubMed  Google Scholar 

  15. Eva Schernhammer MDD. Taking their own lives—the high rate of physician suicide. N Engl J Med. 2005;352(24):2473–6. https://doi.org/10.1056/NEJMp058014.

    Article  PubMed  Google Scholar 

  16. Baldwin DC, Hughes PH, Conard SE, Storr CL, Sheehan DV. Substance use among senior medical students: a survey of 23 medical schools. JAMA. 1991;265(16):2074–8. https://doi.org/10.1001/jama.1991.03460160052028.

    Article  PubMed  Google Scholar 

  17. Knight JR, Wechsler H, Kuo M, Seibring M, Weitzman ER, Schuckit MA. Alcohol abuse and dependence among US college students. J Stud Alcohol. 2002;63(3):263–70. https://doi.org/10.15288/jsa.2002.63.263.

    Article  PubMed  Google Scholar 

  18. Dunn D. Substance abuse among nurses—defining the issue. AORN J. 2005;82(4):572–96. https://doi.org/10.1016/S0001-2092(06)60028-8.

    Article  Google Scholar 

  19. Bennett J, O’donovan D. Substance misuse by doctors, nurses and other healthcare workers. Curr Opin Psychiatry. 2001;14(3):195–9. https://doi.org/10.1097/00001504-200105000-00006.

    Article  Google Scholar 

  20. Spitzer RL, Kroenke K, Williams JB, Group PHQPCS. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA. 1999;282(18):1737–44. https://doi.org/10.1001/jama.282.18.1737.

    Article  CAS  PubMed  Google Scholar 

  21. Malach-Pines A. The burnout measure, short version. Int J Stress Manag. 2005;12(1):78–88. https://doi.org/10.1037/1072-5245.12.1.78.

    Article  Google Scholar 

  22. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7. https://doi.org/10.1001/archinte.166.10.1092.

    Article  PubMed  Google Scholar 

  23. Saunders JB, Aasland OG, Babor TF, De la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x.

    Article  CAS  PubMed  Google Scholar 

  24. Skinner HA. The drug abuse screening test. Addict Behav. 1982;7(4):363–71. https://doi.org/10.1016/0306-4603(82)90005-3.

    Article  CAS  PubMed  Google Scholar 

  25. Sawaya H, Atoui M, Hamadeh A, Zeinoun P, Nahas Z. Adaptation and initial validation of the Patient Health Questionnaire–9 (PHQ-9) and the Generalized Anxiety Disorder–7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample. Psychiatry Res. 2016;239:245–52. https://doi.org/10.1016/j.psychres.2016.03.030.

    Article  PubMed  Google Scholar 

  26. Almarri TS, Oei TP, Amir T. Validation of the alcohol use identification test in a prison sample living in the Arabian Gulf region. Subst Use Misuse. 2009;44(14):2001–13. https://doi.org/10.3109/10826080902848533.

    Article  PubMed  Google Scholar 

  27. Dyrbye LN, Thomas MR, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, et al. Personal life events and medical student burnout: a multicenter study. Acad Med. 2006;81(4):374–84. https://doi.org/10.1097/00001888-200604000-00010.

    Article  PubMed  Google Scholar 

  28. Backović DV, Ilić Živojinović J, Maksimović J, Maksimović M. Gender differences in academic stress and burnout among medical students in final years of education. Psychiatr Danub. 2012;24(2):175–81.

    PubMed  Google Scholar 

  29. Galán F, Sanmartín A, Polo J, Giner L. Burnout risk in medical students in Spain using the Maslach Burnout Inventory-Student Survey. Int Arch Occup Environ Health. 2011;84(4):453–9. https://doi.org/10.1007/s00420-011-0623-x.

    Article  PubMed  Google Scholar 

  30. Costa EF, Santos SA, Santos AT, Melo EV, Andrade TM. Burnout Syndrome and associated factors among medical students: a cross-sectional study. Clinics. 2012;67(6):573–80. https://doi.org/10.6061/clinics/2012(06)05.

    Article  PubMed  Google Scholar 

  31. Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, et al. Burnout and suicidal ideation among US medical students. Ann Intern Med. 2008;149(5):334–41. https://doi.org/10.7326/0003-4819-149-5-200809020-00008.

    Article  PubMed  Google Scholar 

  32. Abushaikha L, Saca-Hazboun H. Job satisfaction and burnout among Palestinian nurses. East Mediterr Health J. 2009;15(1):190–7.

    CAS  PubMed  Google Scholar 

  33. Ilhan MN, Durukan E, Taner E, Maral I, Bumin MA. Burnout and its correlates among nursing staff: questionnaire survey. J Adv Nurs. 2008;61(1):100–6. https://doi.org/10.1111/j.1365-2648.2007.04476.x.

    Article  PubMed  Google Scholar 

  34. Sabbah I, Sabbah H, Sabbah S, Akoum H, Droubi N. Burnout among Lebanese nurses: psychometric properties of the Maslach burnout inventory-human services survey (MBI-HSS). Health. 2012;4(09):644–52. https://doi.org/10.4236/health.2012.49101.

    Article  Google Scholar 

  35. Győrffy Z, Birkás E, Sándor I. Career motivation and burnout among medical students in Hungary—could altruism be a protection factor? BMC Med Educ. 2016;16(1):182. https://doi.org/10.1186/s12909-016-0690-5.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Cecil J, McHale C, Hart J, Laidlaw A. Behaviour and burnout in medical students. Med Educ Online. 2014;19(1):25209. https://doi.org/10.3402/meo.v19.25209.

    Article  Google Scholar 

  37. Fares J, Saadeddin Z, Al Tabosh H, Aridi H, el Mouhayyar C, Koleilat MK, et al. Extracurricular activities associated with stress and burnout in preclinical medical students. J Epidemiol Global Health. 2016;6(3):177–85. https://doi.org/10.1016/j.jegh.2015.10.003.

    Article  Google Scholar 

  38. Muzafar Y, Khan HH, Ashraf H, Hussain W, Sajid H, Tahir M, et al. Burnout and its Associated Factors in Medical Students of Lahore, Pakistan. Muacevic A, Adler JR, eds. Cureus. 2015;7(11):e390. https://doi.org/10.7759/cureus.390.

  39. Youssef FF. Medical student stress, burnout and depression in Trinidad and Tobago. Acad Psychiatry. 2016;40(1):69–75. https://doi.org/10.1007/s40596-015-0468-9.

    Article  PubMed  Google Scholar 

  40. Prins JT, Gazendam-Donofrio SM, Dillingh GS, Van De Wiel H, Van Der Heijden FM, Hoekstra-Weebers JE. The relationship between reciprocity and burnout in Dutch medical residents. Med Educ. 2008;42(7):721–8. https://doi.org/10.1111/j.1365-2923.2008.03041.x.

    Article  PubMed  Google Scholar 

  41. Dyrbye LN, Thomas MR, Harper W, Massie FS Jr, Power DV, Eacker A, et al. The learning environment and medical student burnout: a multicentre study. Med Educ. 2009;43(3):274–82. https://doi.org/10.1111/j.1365-2923.2008.03282.x.

    Article  PubMed  Google Scholar 

  42. Durmer JS, Dinges DF. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2005;25(1):117–29. https://doi.org/10.1055/s-2005-867080.

    Article  PubMed  Google Scholar 

  43. Dorrian J, Rogers NL, Dinges DF. Psychomotor vigilance performance: neurocognitive assay sensitive to sleep loss. New York: Marcel Dekker; 2005.

    Google Scholar 

  44. Rogers NL, Dorrian J, Dinges DF. Sleep, waking and neurobehavioural performance. Front Biosci. 2003;8(6):s1056–67. https://doi.org/10.2741/1174.

    Article  PubMed  Google Scholar 

  45. Seo J-H, Kim HJ, Kim B-J, Lee S-J, Bae H-O. Educational and relational stressors associated with burnout in Korean medical students. Psychiatry Investig. 2015;12(4):451–8. https://doi.org/10.4306/pi.2015.12.4.451.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Assadi SM, Nakhaei MR, Najafi F, Fazel S. Mental health in three generations of Iranian medical students and doctors. Soc Psychiatry Psychiatr Epidemiol. 2007;42(1):57–60. https://doi.org/10.1007/s00127-006-0130-7.

    Article  PubMed  Google Scholar 

  47. Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: a cross-sectional study. Med Educ. 2005;39(6):594–604. https://doi.org/10.1111/j.1365-2929.2005.02176.x.

    Article  PubMed  Google Scholar 

  48. Mehanna Z, Richa S. Prévalence des troubles anxio-dépressifs chez les étudiants en médecine: Étude transversale chez les étudiants en médecine de l’Université Saint-Joseph de Beyrouth. L’Encéphale. 2006;32(6):976–82. https://doi.org/10.1016/S0013-7006(06)76276-5.

    Article  CAS  PubMed  Google Scholar 

  49. Karam EG, Mneimneh ZN, Dimassi H, Fayyad JA, Karam AN, Nasser SC, et al. Lifetime prevalence of mental disorders in Lebanon: first onset, treatment, and exposure to war. PLoS Med. 2008;5(4):e61. https://doi.org/10.1371/journal.pmed.0050061.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Farhood LF, Dimassi H. Prevalence and predictors for post-traumatic stress disorder, depression and general health in a population from six villages in South Lebanon. Soc Psychiatry Psychiatr Epidemiol. 2012;47(4):639–49. https://doi.org/10.1007/s00127-011-0368-6.

    Article  PubMed  Google Scholar 

  51. El-Gilany A-H, Amr M, Hammad S. Perceived stress among male medical students in Egypt and Saudi Arabia: effect of sociodemographic factors. Ann Saudi Med. 2008;28(6):442–8. https://doi.org/10.4103/0256-4947.51666.

    Article  PubMed  Google Scholar 

  52. Karam EG, Mneimneh ZN, Karam AN, Fayyad JA, Nasser SC, Chatterji S, et al. Prevalence and treatment of mental disorders in Lebanon: a national epidemiological survey. Lancet. 2006;367(9515):1000–6. https://doi.org/10.1016/S0140-6736(06)68427-4.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Kimhi S, Shamai M. Community resilience and the impact of stress: adult response to Israel’s withdrawal from Lebanon. J Comm Psychol. 2004;32(4):439–51. https://doi.org/10.1002/jcop.20012.

    Article  Google Scholar 

  54. Saeed AA, Bahnassy AA, Al-Hamdan NA, Almudhaibery FS, Alyahya AZ. Perceived stress and associated factors among medical students. Journal of Family & Community Medicine. 2016;23(3):166–171. https://doi.org/10.4103/2230-8229.189132.

    Article  Google Scholar 

  55. Saipanish R. Stress among medical students in a Thai medical school. Med Teacher. 2003;25(5):502–6. https://doi.org/10.1080/0142159031000136716.

    Article  Google Scholar 

  56. Bunevicius A, Katkute A, Bunevicius R. Symptoms of anxiety and depression in medical students and in humanities students: relationship with big-five personality dimensions and vulnerability to stress. Int J Soc Psychiatry. 2008;54(6):494–501. https://doi.org/10.1177/0020764008090843.

    Article  PubMed  Google Scholar 

  57. Mancevska S, Bozinovska L, Tecce J, Pluncevik-Gligoroska J, Sivevska-Smilevska E. Depression, anxiety and substance use in medical students in the Republic of Macedonia. Bratislavske lekarske listy. 2008;109(12):568–72.

    CAS  PubMed  Google Scholar 

  58. Karam E, Melhem N, Mansour C, Maalouf W, Saliba S, Chami A. Use and abuse of licit and illicit substances: prevalence and risk factors among students in Lebanon. Eur Addict Res. 2000;6(4):189–97. https://doi.org/10.1159/000052045.

    Article  CAS  PubMed  Google Scholar 

  59. Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA. 2016;316(21):2214–36. https://doi.org/10.1001/jama.2016.17324.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Zahlan L, Ghandour L, Yassin N, Afifi R, Martins SS. Double trouble: exploring the association between waterpipe tobacco smoking and the nonmedical use of psychoactive prescription drugs among adolescents. Drug Alcohol Depend. 2014;145:217–23. https://doi.org/10.1016/j.drugalcdep.2014.10.020.

    Article  PubMed  Google Scholar 

  61. Ghandour LA, El Sayed DS, Martins SS. Prevalence and patterns of commonly abused psychoactive prescription drugs in a sample of university students from Lebanon: an opportunity for cross-cultural comparisons. Drug Alcohol Depend. 2012;121(1):110–7. https://doi.org/10.1016/j.drugalcdep.2011.08.021.

    Article  PubMed  Google Scholar 

  62. Ford JA, Ong J. Non-medical use of prescription stimulants for academic purposes among college students: a test of social learning theory. Drug Alcohol Depend. 2014;144:279–82. https://doi.org/10.1016/j.drugalcdep.2014.09.011.

    Article  PubMed  Google Scholar 

  63. Dumitrascu CI, Mannes PZ, Gamble LJ, Selzer JA. Substance use among physicians and medical students. Med Student Res J. 2014;3:26–35.

    Google Scholar 

  64. Conard S, Hughes P, Baldwin D Jr, Achenbach KE, Sheehan DV. Substance use by fourth-year students at 13 US medical schools. Acad Med. 1988;63(10):747–58. https://doi.org/10.1097/00001888-198810000-00002.

    Article  CAS  Google Scholar 

  65. Hughes PH, Brandenburg N, Baldwin DC, et al. Prevalence of substance use among US physicians. JAMA. 1992;267(17):2333–9. https://doi.org/10.1001/jama.1992.03480170059029.

    Article  CAS  PubMed  Google Scholar 

  66. Organization WH. Cannabis: a health perspective and research agenda. 1997.

    Google Scholar 

  67. Bargagli AM, Hickman M, Davoli M, Perucci CA, Schifano P, Buster M, et al. Drug-related mortality and its impact on adult mortality in eight European countries. Eur J Public Health. 2005;16(2):198–202. https://doi.org/10.1093/eurpub/cki168.

    Article  PubMed  Google Scholar 

  68. Kumar P, Basu D. Substance abuse by medical students and doctors. J Indian Med Assoc. 2000;98(8):447–52.

    CAS  PubMed  Google Scholar 

  69. Naskar NN, Bhattacharya SK. A study on drug abuse among the undergraduate medical students in Calcutta. J Indian Med Assoc. 1999;97(1):20–1.

    CAS  PubMed  Google Scholar 

  70. Gjeruldsen S, Myrvang B, Opjordsmoen S. Risk factors for drug addiction and its outcome. A follow-up study over 25 years. Nordic J Psychiatry. 2003;57(5):373–6. https://doi.org/10.1080/08039480310002714.

    Article  Google Scholar 

  71. Baker D, Pryce G, Giovannoni G, Thompson AJ. The therapeutic potential of cannabis. Lancet Neurol. 2003;2(5):291–8. https://doi.org/10.1016/S1474-4422(03)00381-8.

    Article  CAS  PubMed  Google Scholar 

  72. Fiz J, Durán M, Capellà D, Carbonell J, Farré M. Cannabis use in patients with fibromyalgia: effect on symptoms relief and health-related quality of life. PLoS One. 2011;6(4):e18440. https://doi.org/10.1371/journal.pone.0018440.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Levine RE, Breitkopf CR, Sierles FS, Camp G. Complications associated with surveying medical student depression. Acad Psychiatry. 2003;27(1):12–8. https://doi.org/10.1176/appi.ap.27.1.12.

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank the medical students at the American University of Beirut (AUB) Faculty of Medicine for their participation in this study.

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Authors and Affiliations

  1. American University of Beirut Medical Center, Beirut, Lebanon

    Farid Talih, Michel Daher & Jean Ajaltouni

  2. American University of Beirut, Beirut, Lebanon

    Dayane Daou

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  1. Farid Talih
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Correspondence to Farid Talih.

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The AUB institutional review board (IRB) reviewed and approved all aspects of this study. The authors complied with all the recommendations of the IRB to maintain confidentiality and anonymity of the participants. All enrolled medical students at the AUBFM were invited to participate.

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The IRB committee at AUB approved this research project.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Talih, F., Daher, M., Daou, D. et al. Examining Burnout, Depression, and Attitudes Regarding Drug Use Among Lebanese Medical Students During the 4 Years of Medical School. Acad Psychiatry 42, 288–296 (2018). https://doi.org/10.1007/s40596-017-0879-x

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Keywords

  • Medical students
  • Mental health
  • Suicide
  • Burnout
  • Depression