This study demonstrated that the prevalence of depression among preclinical medical students at the Faculty of Medicine Siriraj Hospital was 25.8%, which was 8.6 times higher than the prevalence of depression in normal Thai population (3%). This result corresponded to the findings from a study performed at Midwestern University, United States, where the prevalence of depression in medical students was 23.7%,18 and also corresponded with a study at the Medical College, New Delhi, India, where 21.5% of medical students were reported to have depression.5 Compared with the study of the prevalence of depression in medical students in the Faculty of Medicine Siriraj Hospital published in 2007, which showed a prevalence of 19.6%, the current prevalence of depression was significantly higher by 31.6%.6
The present study also highlights the factors associated with depression among Thai medical students. Having a personal counselor or peer support was found to be correlated with a lower PHQ-9 score. This finding corresponds to a study in Germany on in-patients at a psychiatric department with depression, which revealed a significant improvement in the self-rated mood of the participants after they received counseling.19 Another factor that was found to be associated with a lower PHQ-9 score in our study was the autonomy in the medical student’s decision to study medicine. To the best of our knowledge, there has been no previous study on the association between this factor and depression in medical students.
In terms of family factors, having trust in parents helps fulfill the basic needs of children, including a sense of safety and connectedness to others; while if children’s needs cannot be fulfilled, they might develop inappropriate coping strategies, such as rumination.20 Many studies21,22,23 have revealed that parental support is a protective factor against adolescent’s developing depression. Despite only showing a small magnitude in this study, getting a higher score in the questionnaire for the family relationship significantly indicated that the student would be at lower risk of developing depression. This result corresponded with data from a study performed with Thai high-school students, which revealed that parent–child relationship problems were significantly associated with depression.21 A study on United States adolescents also showed that poor parental support, meaning a lack of caring, sympathizing, and accommodating, significantly predicted depressive symptoms in adolescents.22 Parent–child connectedness also predicted a decrease in the depressive symptoms of both male and female United States adolescents.23
Mindfulness has received a great deal of interest in the past decades. Several studies have revealed that mindfulness interventions, such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), have positive outcomes with chronic pain and psychopathology, e.g., depression.24 The Philadelphia Mindfulness Scale (PHLMS) was developed as a two-factor trait measure of mindfulness, acceptance, and awareness, which can be measured independently with minimal inter-factor correlation.17 Cardaciotto differentiated mindfulness into acceptance and awareness components.17 Awareness is characterized as a continuous monitoring of experience with a focus on current experience rather than a preoccupation with past or future events.25,26 Acceptance has been defined as experiencing events fully and without defense, as they are.27 In our study, higher Thai-version PHLMS acceptance scores were associated with lower PHQ-9 scores. This result corresponded with a study on undergraduate students in Pennsylvania, in which higher PHLMS acceptance scores were found to be correlated with lower scores on measures of psychopathology.17 In this study, awareness did not show a significant correlation with depression, which is similar to several other studies. In particular, awareness and its analogues did not appear to have a significant relationship with pathology.17,28 On the other hand, in some populations, e.g., meditators, awareness often appears to be associated with reduced pathology.28 These inconsistent findings suggest that there might be a role played by mediating variables, including meditation experience28, and demographics.29