Psychological Distress Experienced by Medical Students

Psychological tribulation Experienced by Medical StudentsINTRODUCTIONThe mental di hear of health check students is more commonly associated with test, anxiousness and depression 1. It is a fact that ordinal medical examination examination checkup examination education is spirited-pitchedly stressful due to factors that include academic pressures, obstacles to their goal achievement, environ moral changes, life challenges such as transition from condition to university and the change in role from student to k no.ledgeable physician 2,3. tear down though at that place were studies suggested that some stress in medical shallow training involve stress, this stressful purlieu can exert a negative effect on the mental and fleshly well-being of the undergraduates 5,6.The stress can be defined as a state of mental or emotional strain or suspense and as well as a chassis of normal reactions of the body (mental, emotional, and physiological) designed for self-preservation 7. Stress is in addition defined as not just a stimulus or a response but kinda, it is a run by which we see and cope with environmental threats and challenges 8. On the other hand, trouble can be defined as an emotion characterized by feelings of disco biscuitsion, worried thoughts and physical changes. masses with anxiety disorders usually have recurring intrusive thoughts or concerns. They whitethorn avoid certain situations out of worry. They may also feature physical symptoms such as sweating, trembling, dizziness or rapid heartbeat 4. plot of land depression is more than just sadness. People with depression may experience a lack of overwhelmest and pleasure in daily activities, evidentiary weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt and recurrent thoughts of death or suicide 4. However, for the sake of simplicity, these three virtually common condition mental issues are coined into one term that is stress as all of them are closely related 9.Several studies have revealed that the incidence of stress among medical profession are increasing day by day and medical students have been found to experience spicyer level of depression and anxiety compared to the general population and to their same age group individuals 10,11,12. The top ten main stressors found by Yusuf et al. at Universiti Sains Malaysia (USM) based on piles given by the medical students were all related to academic matters man Wolf et al. listed examination, class-work and financial responsibilities as their main stressor 13,14. Therefore, it is critical for medical educators to deduct the preponderance and causes of student excruciation, potential adverse personal and professional consequences, and institutional factors that can influence students health. It is suggested that an intervention programs could be utilize to reduce the stress levels 14.OBJECTIVESThe review was ca rried out to address the following questionsWhat is the preponderance of psychological trouble experienced by medical students?What are the socio demographical factors associated with psychological distress experienced by medical students?METHODOLOGY10 keyword were chosen to do the search for this project.Keywords Malaysia, Medical students, stress, psychological distress, anxiety, depression, emotional disorder, mental health, undergraduates and trainee literature review was carried out using the following electronic databases PUBMED, Medline, Science Direct, with-it and Google scholar databases for articles on medical students distress in Malaysia. It was a systemic review of the literatures carried out from October 2014 to February 2015.Inclusion and Exclusion criteria tout ensemble articles that published data related to stress or psychological distress/health of Malayan medical students and written in English were suitable for inclusion in this use up. The latest article s published since January 2014 was included. From the search, 20 sufficient text articles were retrieved based on the relevance in relation to the topic. In addition, the persona list of the articles retrieved were also checked to find similar articles.RESULT musical instrument utilizeThere are variety of tools used to assess psychological distress. The tools used will be selected based on elements to be assess. The most common one used for sound judgement of stress in Malaysian based record is General Health Questionnaire (GHQ) using 12 items or 28 items. The questionnaire was real by Goldberg in 1978 which measures two important elements. The send-off one is the inability to carry out normal functions and the appearance of distress. The routine is to assess the well-being in a person 15. former(a) tools for used includes Social Phobia Inventory ( whirl around), Becks low Inventory (BDI) and Depression Anxiety and Stress Scale (DASS). Medical Student Stressor Questionnaire (MSSQ) was used to get wind sources of stress or stressor 16.Prevalence of psychological distressThe overall prevalence rate of psychological distress among medical student in Malaysia are range from 14.3% to 56% 17,18. The highest prevalence rate of 56% was obtained from Salina et al. where they did a visual modality on 101 medical students in University Malaya (UM). Based on SPIN get ahead, they conclude that 56% of the medical student who totald 19 or higher up have higher probability of having social anxiety disorder 18. period the lowest prevalence of psychological distress with rate of 14.3% was documented by Yusoff et al. from the study among a cohort of University Sains Malaysia (USM) medical students where two cohorts of first category (2008/2009 and 2009/2010 intake) were compared. Cohort 1 was selected based on academic merit trance cohort 2 was selected based on academic merit, psychometric assessment and interview performance. Based on GHQ scores, the results indicate that cohort 1 (prevalence rate of 26.3%) experienced more psychological distress compared to cohort 2 (prevalence rate of 14.3%) indicating that stratification of student selection by using multimodal criteria big businessman better identify medical students with good psychological health 17. A study on psychological distress by using DASS scores was done by Nikmat et al. among 110 preclinical medical students of University Teknologi Mara (UiTM). The results were sort into mild, moderate, severe and extremely severe. It was further divided into two group which were clinical for severe and extremely severe and sub-clinical for mild and moderate. Out of 110 students, 5.5% of students had clinical depression, 24.5% clinical anxiety and 7.3% had clinical stress. Other remaining students experienced sub-clinical depression, anxiety and stress with prevalence of 36.4%, 35.5% and 30.0% respectively 21. Yusoff et al. documented prevalence of depressive symptoms rate by using BDI scale among final year medical students stood at 21.7% 22.Socio demographic variablesStudy yearsStress among antithetic years of students was studied by Sherina et al, Zaid et al and Yusoff et al. Cumulatively, They found that the stress prevalence for divergent years of study were varied. According to Sherina et al. based on the study in 2003, there was high prevalence of stress among maiden (48.6%) and quaternate (41.4%) year medical students in comparison to students of second, troika and final years. The most acceptable explanation was that initiative year student have to adjust to a new environment of medical educations. plot the year 4 students whom just in their untimely days of clinical setting need to adjust their way with hospital setting and undergo clinical examinations which were totally different from pre-clinical years 23. In addition to that, a study done by Zaid et al. in 2007 seems to uphold the findings of Sherina et al. with their results of having high prevalence of emotional disorder for the 1st (50%), but rather different for 5th (62.7%) year medical students. The extremely high score documented by the final year students (5th year) was probably due to high expectations for them to become a competent doctors and to acquire good academic results, whereas the high score for the 1st year students might be because of the effect of soused competition they faced to enter the medical schools and also due to process of adjustment to the medical education setting 24. In contrary to that, in 2010 Yusoff et al. found lower stress prevalence in both 1st (26.3%) and final year (21.9%) students. Even other years of study also showed lower stress prevalence with 36.5% for second year, 31.4% for 3rd year and 35.3% for 4th year medical students in comparison to result documented by Sherina et al. and Zaid et al. The probable reason was that 1st year students were at the beginning of their course, full of euphoria and still not yet face difficu lt subjects which mend them less stressful. On the other hand, 5th year students possibly developed skills to manage their studies and able to cope with stress. According to Yusoff et al. adaptation periods to the new phases of studies and trespass of transition could be the reason of high prevalence in 2nd year and 4th year students 14.EthnicsAlthough there was no documented probatory association in the midst of ethnic and psychological distress, Johari et al and Sherina et al. managed to publish the prevalence of psychological distress between the 4 major ethnics in Malaysia. Sherina et al mention that raiseese and other ethnics had prevalence rate of 42.0% and 18.8% respectively, which was lower compared to Indian whom had the highest prevalence (48.1%) followed by the Malays (42.9%) according to Johari et al 23,25.GenderTo date, only some articles were found to study alliance of stress between male and pistillate 14,18,23,24. As expected, all studies indicate that female students have higher stress level compared to male, although only one Yusoff et al. was able to achieve significant relationship statistically 20.Financial problemThere are two studies which was conducted inter universities (public universities) by Yusoff et al. and Johari et al. in 2009 and 2011 that highlighted the significant relation between psychological distress and financial difficulties 25,26. While Radman et al. also obtained similar result in their investigation among offstage inter universities 27. Apparently, Zaid et al. whom did similar research in one private medical school did not found any relation between financial issues and psychological distress 24. kindred problemRather surprise fact found by Zaid et al. (2007) which stated that relationship problems with parent, siblings, friends and lecturers were not associated with psychological distress 24. However, earlier research in 2003 by Sherina et al. did mention that there were significant stress level among medic al students having relationship problems, and this fact was support by Johari et al. in 2009 23,25. Apart from that, other types of relationship which can be consider a special relationship (marital and romantic relationship) might ease to reduce stress level. As mentioned by Zaid et al. the students whom did not involve in special relationship were found having significantly more stress (51.7%) than (37%) in those who involved 24. In addition, married students were proved by Johari et al. to be in significantly less stressed compare to single status 25.Other factorsYusuf et al. in his study involving inter universities medical students, has found that there was a significant relationship between different universities and psychological distress. Perhaps different kind of modules, examination, environment, clinical structures do play a role 26. 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