Chronic, unrelenting stress can expedite psychological distress in the form of anxiety disorders and major depressive disorder (18). Medical school produces a number of stressors for students. Medical students are often living away from their families and support systems (19), They are under high levels of financial strain (20), They are often not in control of their schedules and often medical students were the top of their class in college, but struggle to keep up with the coursework in medical school (Maria et al., 2013). High workloads can keep medical students from engaging in healthy lifestyle factors that reduce stress, like exercise, healthy diets, sleep quality, and relationships (5, 19, 21–24). Medical schools have made significant efforts to support students and provide stress management and relief. Many schools like UofSC SOMG offer in-house success coaches, and non-affiliated psychotherapy. Despite the availability of mental health support, many medical students do not use the resources provided (5). Several studies have identified that medical professionals and students will not seek therapy due to self-stigma (2, 3, 13–16).
Mental health stigma and self-stigma (internalized public stigma) are higher in the medical community than the general population (5). Physicians have higher rates of mental health stigma, and many report that they will not seek help for mental health (2, 3, 13–16). Medical students report fear that disclosing a mental health problem will decrease their chances of getting a residency position (25). Medical board licensing exams in many states ask directly if a candidate has been treated for a mental health disorder (13).
In this study, we surveyed students at the UofSC SOMG to screen for generalized anxiety disorder using the GAD7. 33% of UofSC SOMG students surveyed scored in the moderate-severe anxiety range on the GAD7. This is a similar rate to previous studies that have screened medical students for anxiety (31%), but much higher than aged-matched peers from the general population in 2021 (15.3%) (26). To protect medical students’ mental health, it is important to pursue further interventions.
We surveyed students about their feelings of self-stigma and compared their anxiety levels to responses. Students with higher levels of anxiety had reported stronger disagreement with self-stigma questions, which argues that students with higher levels of anxiety may carry less self-stigma than those with lower anxiety levels. Stigma perceptions did not differ by gender or class year.
To elucidate student perception of barriers to mental health care in medical school, students were asked the open-ended question, “If you were suffering from a mental health disorder, what would be the largest barrier to seeking mental health care for yourself?” Answers were then categorized into “Time”, “Cost”, “Stigma”, and “Difficulty”. Students listed time (47%), cost (27%), stigma (60%), and difficulty (21%) (some students listed more than one answer, and both answers were categorized separately.) Students with moderate-severe anxiety reported cost as a barrier more often than those with none-mild anxiety. It is possible that students with lower financial support may be more likely to have higher levels of anxiety in medical school. Financial worries are one of the largest stressors (20). It also may be that students with higher levels of anxiety are more likely to worry about finances, noting that the therapy and psychiatry sessions provided by the school are free. Furthermore, students in preclinical years also answered cost more than students in clinical years. We suggest that as students get further along in their education, the “light at the end of the tunnel” might relieve some anxiety towards paying off high levels of medical school debt, and students may feel less burdened by their debts. Further work should be done to elucidate financial stress in medical students, and how it could be relieved in the earlier years. Interestingly, students in clinical years were more likely to answer “stigma” than students in preclinical years. This may be due to impending residency applications, or due to experiences, students encounter working in a clinical setting around others that carry mental health stigma.
There were several limitations of this study; the 2020 COVID-19 pandemic was reported to increase anxiety levels at different rates in different populations. Due to this, the impact of increased stressors was not able to be controlled. Furthermore, the high level of stigma responses in the open-ended questions may be due to the order of questions asked, with the open-ended questions coming after the stigma survey. And finally, this survey was only given to one medical school at one point in time. To better understand the barriers to mental health care in medical students, it would be better to compare multiple medical schools over multiple years and to follow students throughout their medical education.