Prevalence of empathy, anxiety and depression, and their association with each other and with sex and intended specialty in medical students

Abstract: Introduction: Empathy and mental health are crucial for medical students’ self-care and performance as well as for patient care. Objective: to assess the prevalence of empathy, anxiety and depression, and their association with each other and sex, intended specialty and course semester. Method: Cross-sectional study with 405 of 543 students (74.6%) from odd semesters and from the 12th semester of the medical course of two universities in southern Brazil. Data were collected using a self-administered questionnaire containing information on age, sex, medical course semester, intended specialty, Jefferson Scale of Empathy (JSE) and Beck Anxiety and Depression Inventories (BAI and BDI). The data were analyzed using descriptive statistics, Student’s t-tests, Chi-square, and bidirectional ANOVA between groups. The level of significance was set at p < 0.05. Results: The mean JSE score was 120.2 (SD = 10.6) [116.9 (SD = 11.0) in men and 123.4 (SD = 9.2) in women, p = 0.000], being higher among students who wanted to follow medical areas aimed at people [123.1 (SD = 10.1)], than among those whose intended areas aimed at techniques and procedures [118.5 (SD = 11.2)], p = .003. There was no difference between the course periods. The anxiety and depression mean rates were, respectively, 16.2 (SD = 11.3) and 11.9 (SD = 9.0) [13.1 (SD = 10.3) and 9.9 (SD = 8.3) in men and 19.1 (SD = 11.4), and 13.8 (SD = 9.4) in women, p = .000 for both]. The prevalence rate of moderate and high anxiety was 33.8% and, when including mild anxiety, it was 59%. The prevalence rate of dysphoria (BDI = 16 - 20) and depression (BDI > 20) was 26.4%, and 11.9% for suicidal ideation. An association was observed between severe anxiety and the JSE subscale ‘Walking in patient’s shoes’, more related to empathic stress. Conclusions: Empathy is high and stable throughout the medical course at the studied institutions and higher in women and students who want to follow people-oriented specialties. Anxiety and depression have higher prevalence rates in women. Severe anxiety is associated with the JSE subscale ‘Walking in patient’s shoes’.

摘要：引言：共情与心理健康对医学生的自我关怀、学业表现及患者照护均具有重要意义。研究目的：评估共情、焦虑与抑郁的患病率，及其与性别、意向专业和就读学期的关联。方法：本研究为横断面研究，纳入巴西南部两所高校医学课程奇数学期及第12学期的543名学生中的405名，应答率为74.6%。数据通过自填式问卷收集，问卷内容涵盖年龄、性别、医学课程学期、意向专业、杰弗逊共情量表（Jefferson Scale of Empathy, JSE）以及贝克焦虑量表（Beck Anxiety Inventory, BAI）与贝克抑郁量表（Beck Depression Inventory, BDI）。采用描述性统计、学生t检验、卡方检验及组间双向方差分析对数据进行分析，检验水准设定为p<0.05。结果：杰弗逊共情量表得分均值为120.2（标准差SD=10.6），其中男性得分116.9（SD=11.0），女性得分123.4（SD=9.2），p=0.000；意向从事面向人群的医学领域的学生得分（123.1，SD=10.1）高于意向从事侧重技术与操作领域的学生（118.5，SD=11.2），p=0.003。不同就读学期间未观察到显著差异。焦虑与抑郁的平均得分分别为16.2（SD=11.3）与11.9（SD=9.0），其中男性焦虑得分13.1（SD=10.3）、抑郁得分9.9（SD=8.3），女性焦虑得分19.1（SD=11.4）、抑郁得分13.8（SD=9.4），两项指标的组间差异均为p=0.000。中重度焦虑的患病率为33.8%，若纳入轻度焦虑则总患病率达59%。心境恶劣（BDI得分16~20）与抑郁（BDI得分>20）的患病率分别为26.4%，自杀意念的患病率为11.9%。研究发现重度焦虑与杰弗逊共情量表子维度“换位思考（Walking in patient’s shoes）”存在关联，该子维度与共情压力相关性更高。结论：本次研究涉及的两所高校中，医学生的共情水平整体偏高且在整个医学就读阶段保持稳定，女性及意向从事面向人群导向专业的学生共情水平更高。女性的焦虑与抑郁患病率更高。重度焦虑与杰弗逊共情量表子维度“换位思考”存在关联。