Table 1 Observational/correlational studies on somatization in healthcare students
From: A scoping review of somatization: characteristics and implications among health profession students
Study/ Location | Design | Objectives | Participant Characteristics | Primary outcome measures & resultsa |
|---|---|---|---|---|
Adhikari et al., 2017 [20] Nepal | Cross-sectional | Prevalence of mental disorders among medical students | n = 343 medical students all years; Mean age: NR; 49% female | PHQ-15a, PHQ-9, suicidal ideations, smoking, marijuana use; 30.4% females and 14.9% males reported medium to severe somatization (45% total); significantly higher in females (p < .001). Headaches were common amongst both genders; menstrual cramps most common in females. Panic syndrome 5.8% prevalence, other anxiety 5%, suicidal ideation 4.7%, binge eating disorder 5%. |
Algarni et al., 2017 [21] Saudi Arabia | Cross-sectional | Determine the prevalence of neck, shoulder, low-back musculoskeletal pain (MSP) and depression. | n = 469 medical students; Mean age: 21.4 (1.3); 60.6% female | SNQ; MSP associated with medical school-related depression (OR 2.93, CI 1.73–4.98, p < .001) and other mental health-related somatic symptoms (OR 2.93, CI 1.37–5.27, p = .004). |
Alkozi et al., 2024 [22] Saudi Arabia | Cross-sectional | Examine the potential relationship between anxiety, depression, and eye health. | n = 112 medical students; Mean age: 21.9 (1.7); 58.9 % female | TMAS, BDI, Ocular Surface Disease Index, cortisol in tears; 67% had anxiety, 56% depression. Ocular surface health was associated with symptoms of anxiety (r = .22, p < .05) and depression (r = .20, p < .05); cortisol and anxiety were also significantly associated (r = .33, p < .05). |
Alshagga et al., 2013 [23] Malaysia | Cross-sectional | Find the prevalence, location, and factors associated with MSP. | n = 232 medical students; Mean age: 20.6 (2.2); 72.9% female | SNQ; Higher MSP in past week in clinical students (OR 2.0, CI 1.15–3.67, p = .015), individuals with a history of physical trauma (OR 2.6, CI 1.22–5.29, p = .011), and those with family history of MSP (OR 2.6, CI 1.22–5.29, p = .011). Higher in past year for same populations. |
Angelone et al., 2011 [24] Italy | Cross-sectional | Determine prevalence of various kinds of sleep issues and correlations of sleep issues with demographic factors, physical symptoms, lifestyle factors, and mood | n = 364 nursing students years 1-3; Mean age: 24.0 (5.4) 70.3 % female | MHI-5, S&DHQ; 26.7% prevalence of insomnia, insomnia disorders of various kinds were significantly associated with depression (OR 2.6, p = .004), lower QOL (OR = 1.8, p = .02), and headaches (OR = 2.0, p = .04). |
Antoniadou et al., 2024 [18] Greece | Cross-sectional | Examine stress, somatization, and coping strategies. | n = 271 nursing and dentistry students (n = 145 dentistry and n = 126 nursing), mixed graduate and undergraduate; Mean age: NR; 68.6% female | Self-developed somatization scalea; Prevalence of somatization 41% in dental students and 28.2% in nursing students. Females reported higher stress somatization (M = 10.22, SD = 5.23) than males (M = 7.94, SD = 6.14; Cohen’s d = .412, p < .05). Nursing students who perceived stress as the “inability to manage unexpected or difficult situations, insecurity, panic” had increased likelihood of stress somatization symptoms; in dentistry students, stress somatization was related to “pressure to meet daily obligations/long-term goals” |
Badawy et al., 2023 [25] Saudi Arabia | Cross-sectional | Assess the predictability of risk factors for insulin resistance. | n = 272 medical students; Mean age: 21.51 (2.18); 100 % female | SQS, ISMA questionnaire, postprandial blood glucose, BP, height, weight, waist circumference; 64.7% were “prone to stress”; 72.8% had insomnia. Those with more stress were significantly more likely to have a higher waist circumference (X2 = 6.2, p = .01) |
Behera et al., 2020 [26] India | Cross-sectional | Prevalence of neck pain and the associated factors such as academic stress | n = 331 medical students; Mean age: 20.5 (1.7); 33.2% female | Web-based questionnaire developed using the Kobo Toolbox (Harvard Humanitarian Initiative); 2.9× greater odds of neck pain in 3rd and 4th-year students than 1st-year students. Students who attributed neck pain to academic stress had 3.5× greater odds of having neck pain (p < .001). |
Bolatov et al., 2022 [27] Kazakhstan | Cross-sectional | Assess potential factors associated with academic burnout including both mental and physical health markers. | n = 736 medical students; Mean age: 20.3 (2.74); 75.0% female | OLBI-S, CBI, GAD-7, PHQ-9; Having academic burnout was associated with somatization: headache (p < .001), fatigue (p < .001), and insomnia (p < .001). Burnout levels correlated with somatization (r = .313-.624, p < .001). |
Cheung et al., 2016 [28] China | Cross-sectional | Prevalence of stress, anxiety, and depression, and their association with related factors such as sleep, work situation, and finances. | n = 661 undergraduate nursing students, years 1-4; Age: between 18-22; 72.5% female | DASS-21, lifestyle (diet, exercise, hobbies, quiet time, sleep); Depression was found to be significantly associated with lack of balanced diet, exercise, entertainment, hobbies, and quiet time, sleep problems, and self-perceived physical and mental health (all p < .05, cOR ranged from .4 to 1.6). Students with poor lifestyles were more likely to report anxiety. Those with lack of sleep, exercise, entertainment, hobbies or alone time showed increased stress (cOR .36–1.44, 95% CI .24–2.29) |
Chinawa et al., 2016 [29] Nigeria | Cross-sectional | Determine prevalence of somatization. | n = 385 medical students; Mean age: 23.55 (3.33); % female not reported | ESSa; Prevalence of mental health-related somatic disorder: 14.3% overall; males 14.2% and females 14.4%. |
Clarvit, 1988 [30] USA | Cross-sectional | Prevalence of oligomenorrhea, amenorrhea, and dysmenorrhea in female medical students. | n = 159 medical students; Mean age: 26.8; 100% female | Questionnaire, unspecified; Prevalence of oligomenorrhea 8.4% during and 10.9% prior to medical school; amenorrhea 1.9 and 2.6% respectively; dysmenorrhea 73.2 and 71.1% respectively. No significant correlation with stress. |
Cohen & Khalaila, 2014 [31] Israel | One-group pre/post | Assess the relationship between exam stress and salivary pH. | n = 83 nursing students; Mean age: 21.9 (3.0); 61.4% female | Salivary pH, challenge and threat appraisal self-developed scale, test anxiety scale, exam grade; Levels of salivary pH were higher in the post exam period compared to the exam period (t = -4.33, p < 0.001) and associated with lower threat appraisal (t = 5.55, p < .001), stress (t = 2.05, p < .05), and test anxiety (t =2.50, p < .05) levels post-exam |
Diebig et al., 2021 [32] Germany | Longitu-dinal | Discover the relationship between learning and family responsibilities and the impact on personal health. | n = 128 medical students; Mean age: 20.7 (3.47); 70.0% female | COPSOQ, PHQ-15a; Long-term commuting is associated with poor health and somatic symptoms, with commuting strain predicting somatic symptoms. Conflicts between learning and family responsibilities affected the relationship between commuting strain and somatic symptoms (indirect effect estimate between = .13, SE = .05, 95% CI [.05; ∞). |
Dighriri et al., 2019 [33] Saudi Arabia | Cross-sectional | Prevalence of neck, shoulder, and low-back pain and association with stress, depression, and history of trauma. | n = 440 medical students; Mean age: 22.4 (1.6); 50.0% female | Questionnaire, unspecified; History of trauma (OR = 2.59; 95% CI: 1.54–5.64) and history of depression (OR = 2.95, 95% CI: 1.54–5.64) were significantly correlated with MSP. Participants with history of trauma had a 2.7x higher likelihood of reporting MSP (OR = 2.70; 95% CI: 1.36–5.36). Depressive symptoms associated with studying resulted in 2x higher chance of MSP (OR = 1.94; 95% CI: 1.03–3.66). Students with mental health-related somatic symptoms had 3x greater likelihood MSP (OR = 2.98; 95% CI: 1.71–5.18). |
Dodin et al., 2024 [34] Jordan | Cross-sectional | Prevalence of stress, anxiety, depression, somatization, and thoughts of self-harm. | n = 618 medical students; Median age: 22; 68.6% female | PHQ-9, SCOFF, GAD-7, PHQ-15a, MSSQ, SLIQ, PIRS, perceived health; Females had significantly higher odds of severe somatization over males (ORs 2.54 - 6.07); individuals with moderate to high stress were 2.44 to 3.17 times (respectively) more likely have greater somatization. Having a higher insomnia score, reporting an eating disorder, and being a cigarette smoker or other forms of tobacco smoker were significantly associated with a 1.31, 1.55, 2.78 and 1.65 times (respectively) greater odds of having higher somatization; having a higher insomnia score, reporting an eating disorder, and being a cigarette smoker were associated with a 1.34, 1.93 and 1.8 times (respectively) greater odds of higher depression; having a higher insomnia score, reporting an eating disorder, and being a cigarette smoker were significantly associated with a 1.37, 1.67 and 2.51 times (respectively) greater odds of anxiety. |
El-Gilany et al., 2019 [35] Egypt | Cross-sectional | Find the prevalence of mental disorders and associated factors. | n = 900 medical students; Age: n = 491 under age 20, n = 409 age 20 or above; 53.2% female | SCL-90-Ra; Prevalence of somatization 21.7%. Being younger than 20 years old, a man, pre-clinical, living off campus, coming from a rural background, and very low or low social class were independent predictors of somatization (AORs of 1.8, 1.6, 1.5, 8.3, 1.8, and 2.5 respectively). |
Esquerda et al., 2023 [36] Spain | Cross-sectional | Describe the national educational climate and how it relates to psychopathological symptoms. | n = 4,374 medical students, all years; Mean age: 21.5 (3.52); 74.9 % female | DREEM, SA-45a; Mean somatization score was 5.6 (5.1) in females and 3.7 (4.4) in males (t = 10.8, p < .001). Somatization was significantly negatively correlated with all students’ rating of all aspects of the learning environment (perceptions of learning, teachers, atmosphere, and academic and social self-perceptions (r = -0.3 to -0.2, p all < .001). |
Feizy et al., 2020 [37] Iran | Cross-sectional | Examine relationship between internet addiction and psychosomatic disorders. | n = 300 undergraduate nursing students; Mean age: 23.3 (3.02); 57.9% female | YIAT, PCQa; Prevalence of moderate or severe psychosomatic symptoms 25%. Significant positive correlation between internet addiction and psychosomatic disorders (p < .05, r = .132) |
Fernandes Azevedo et al., 2017 [38] Brazil | Cross-sectional | Prevalence of TMD and its relationship to anxiety. | n = 105 dental students; Mean age: NR; NR % female | RDC/TMD-Axis 1, STAI; 36.2% prevalence of temporomandibular disorder (TMD), no statistical relationship between TMD and anxiety (p >.05). |
Feussner et al., 2022 [19] Germany | Cross-sectional | Prevalence and severity of somatization, and associated risk and resilience factors. | n = 271 mental and dental students (n = 142 medical, n = 129 dental); Mean age: 23.2 (3.4) medical, 23.8 (4.2) dental; 70.4 % female medical, 66.7% female dental | SOMS-2a, BDI-II, NEO-FFI; 50.7% of medical and 63.6% of dental students had critical somatization scores. Somatization index mean of 9.12 symptoms (1.2 SD higher than the reported norm), dental higher (M = 9.65, SD = 7.00; SEM 0.62) compared to medical (n = 142): M = 8.64, SD = 7.27; SEM = .61). Resilience (r = -.21, p < .001) correlated with somatization, as did psychiatric illness (r = .22, p < .01), female sex (r = .27, p < .01), mental overload (r = .20, p < .001), pressure to perform (r = .24, p < .001), and emotional support (r = -.24, p < .001), among others. |
Fino et al., 2021 [39] Italy | Longitu-dinal | Examine if or how trait mindfulness mitigates the effects of stress, mental health-related somatic symptom burden, and sleep-wake quality. | n = 305 medical students; Mean age: 20.47 (1.9); 50.4% female | STAI-Y, FFMQ, PSS, PPSa, MSQ; Total prevalence of mental health-related somatic symptoms = 19.81%. Trait anxiety was strongly associated with stress, mental health-related somatic symptoms, and sleep quality at the beginning and end of the first trimester. Mental health-related somatic symptoms also significantly increased (Z = −3511, p < .0001). |
Gallas et al., 2022 [40] Tunisia | Cross-sectional | Prevalence of functional gastro-intestinal disorders (FGIDs) and their association with anxiety. | n = 343 medical students; Mean age: 30.2 (0.8); 68.5% female | Rome III, PSCa, HAD; Probable or definite anxiety was an risk factor for functional gastrointestinal disorders (FGIDs) (OR = 2.5, 95% CI= 1.1–5.8). Probable or definite anxiety was correlated to somatic symptoms (OR = 2.5, 95% CI= 1.1–5.8). Anxiety resulted in 2x greater risk of having a FGID (OR= 2.5; 95% CI: 1.1–5.8). |
Glaser et al., 1992 [41] USA | Longitu-dinal | Effect of academic stress and anxiety on immune response to Hep B vaccine. | n = 48 medical students; Mean age: 23.31 (SEM 0.20); 47.9% female | SSS-8a, PSS, biomarkers; People who seroconverted after one vaccine significantly less anxious than those who seroconverted later (F(l,44) = 6.28, p < .02). Significant differences between antibody positive and antibody negative groups for stress levels, with antibody negative group having higher stress (F(l,43) = 4.22, p < .05). Social support was significantly correlated with antibodies to HBsAg and blastogenic response to SAg for the third injection (t = 2.21, p < .05). |
Gorter et al., 2008 [42] England, Ireland, Finland, and Netherlands | Repeated measures observa-tional | Compare health-related indicators in year 1 vs. year 5 in same cohort of students | n = 132 dental students, 5th years, at five schools in four European countries; Mean age: NR; 58% female | MBI, PSQ, GHQ, DES; Burnout and physical health significantly correlated (Chi2 = 0.38, p = .04); stress of dental training and physical health significantly correlated (Chi2 = .52, p = .01). |
Goweda et al., 2021 [43] Saudi Arabia | Cross-sectional | Prevalence and type of somatic symptom disorder (SSD). | n = 374 medical students; Mean age: not reported; 44.9% female | SSD diagnostic criteriaa; 20.3% had very high risk for somatic symptom disorder (SSD), 18.7% had high risk, 19.8% medium risk, 24.6% low risk, 16.6% had none to minimal risk. Prevalence of SSD estimated at 39%. Females had higher risk than males (p = .002). Most commonly reported symptoms were fatigue, insomnia, and gastrointestinal issues. |
Hulsman et al., 2010 [44] Netherlands | One-group pre/ during | Assess the effect of delivering bad news vs history-taking with simulated patients on stress and cardiovascular markers. | n = 20 4th and 5th-yr medical students; Mean age: 23.7 – 25.8; 50% female | STAI, HR, MAP, CO, SVR, visual stress scale; participants had a significant increase in HR, MAP and CO compared to baseline in both scenarios, implying that both the history-taking and bad news tasks induced a cardiovascular stress response; bad news induced a significantly larger cardiovascular stress response than the history-taking on HR (t = 3.19; p < .01), SVR (t = 2.20; p < .05) and CO (t = 3.08; p < .01); stress correlated significantly in both the history (r = 0.80; p < .001) and bad news consultations (r = .78; p < .001). |
Inshyna & Chorna, 2024 [45] Ukraine | Cross-sectional | Quantify the impact of the COVID-19 pandemic on mental health of medical students. | n = 230 medical students, 2nd and 4th year, from Ukraine, India, and “African countries” (undefined); Mean age: 20.4 (1.1); 54 % female | GHQ-28a; 34% prevalence of psychosomatic symptoms. Indian and African students had a higher incidence of depression than students from Ukraine. |
Ivashchenko et al., 2013 [46] Russia | Cross-sectional | Investigate changes of state anxiety and autonomic symptoms before and after exams. | n = 54 medical students; Mean age: not reported; 51.85% female | STAI, VASQa; Correlation between autonomic symptoms and gender was found one day before exams (r = .46; p = .003) and after exams (r = .901; p < .001), but not two weeks before exams. |
Jamil et al., 2024 [47] Turkey | Cross-sectional | Prevalence of somatization and related mental-health variables in males vs. females. | n = 92 final-year medical students; Mean age: 24.0 (1.18); 60.9% female | Somatisation Scalea; 23.9% met criteria for somatisation. Females exhibited significantly higher somatisation scores than males (t = 2.4, p = .018); somatisation significantly associated with worse sleep (t = 3.9, p < .001). |
Kurokawa et al., 2011 [48] Japan | One-group pre/post | The effect of anxiety and depression on salivary cortisol and other biomarkers before and after the national licensure exam. | n = 26 medical students; Mean age: 25.0 (1.2); 34.6% female | STAI, SDS, salivary cortisol, glucocorticoid receptor α and β isoforms expression; Anxiety (p < .001), depression (p < .01 – .05), and salivary cortisol levels (p < .01 – .05) were consistently higher during the pre-examination period, all these measures significantly decreased to baseline levels at 1 month post-exam. Real-time reverse transcription PCR showed no change in expression of the functional GRa mRNA isoform in peripheral leukocytes before exam, though reduced expression of the GRb isoform two days before the examination. There was no significant correlation between psychological measures and salivary cortisol levels at each time point. |
Le et al., 2024 [49] USA | Cross-sectional | Association of stress and skin-picking disorder. | n = 75 medical students; Mean age: NR; 89.3% female | PSS-10, Skin-Picking Scale; Perceived stress and skin picking were significantly correlated (r = .351, p = .002). Positive correlations between coping difficulty in the last month and frequency of urges to pick skin (r = .325, p = .004), coping difficulty in the last month and emotional distress from skin-picking (r = .418 p < .001), feeling difficulties were “piling up with inability to overcome them” and inability to stop picking (r = .373, p < .001), and feeling difficulties were “piling up with inability to overcome them” and intensity of urges to pick skin (r = .353, p = .001). |
Lei et al., 2015 [50] China | Cross-sectional | Quantify stressful effects of the clinical learning environment. | n = 92 nursing students; Mean age: 20.35 (1.44); 100% female | STAI, PSQI, immune-endocrine panel, RBC count, plasma cortisol; Anxiety related to poor sleep and significantly lower % of CD3 and CD4 cells. |
Lloyd & Gartrell, 1984 [51] USA | Cross-sectional | Examine presence of psychiatric symptomatology | N = 285 medical students; Mean age: 25.8l 36.5% female | HSCL; Medical students were two SDs > than general population in Interpersonal Sensitivity and Obsessive-Compulsive Disorder (OCD) and one SD > on the Depression and Anxiety subscales. Symptoms highest in 2nd year. Overall higher scores in females (t = 3.37, p < .001). From Somatization subscale, headaches (t = 4.82, p < .01) and loss of sexual interest/pleasure (3.30, p < .01), were sig different between genders and higher in females. |
Lloyd & Musser, 1989 [52] USA | Cross-sectional | Assess psychiatric symptomology in dental students. | n = 298 dental students, all years; Mean age: 26.0 (4.0); 23.3% female | HSCL; Dental students had significantly higher somatization than medical students in a previous study (t = 3.49, p < .001). Females had significantly higher somatization (t = 3.10, p < .05). Stress and somatization were significantly correlated (r = .61, p < .001). |
Lv et al., 2023 [53] China | Cross-sectional | Assess the relationship between negative life events and somatic symptoms as mediated by self-esteem and depression. | n = 3,219 medical students; Mean age: 20.9 (0.94); 56.5% female | PHQ-15a, PHQ-9, RSES; 29.8% had moderate or severe somatization |
Majeed et al., 2023 [54] Pakistan | Cross-sectional | Determine the correlation of stress with cardiorespiratory markers. | n = 72 medical students; Mean age: 19.6; 61.1% female | BP, MAP, VC, FVC, FEV, BMI, HR, PSS; diastolic BP (p = 0.008), mean arterial blood pressure (p = .006), vital capacity (p < .001), forced vital capacity (p = .006), forced expiratory volume (p = .003) all negatively correlated with perceived stress scale in the participants |
Medisauskaite et al., 2023 [55] United Kingdom | Longitu-dinal cohort | Determine prevalence of various mental ill-health symptoms and what contributes to them. | n = 792 medical students at baseline, 407 at follow-up, all years; Mean age: 21.5 (3.2); 73.9% female | MBI, ISI, SSS-8a, PHQ-4, SLEQ; 50.8% reported moderate to high somatization, obsessive-compulsive disorder (48.5%), schizoid personality disorder symptoms (46.7%) anorexic tendencies (44.6%), burn-out (33%), had moderate/severe symptoms of anxiety/ depression (38.5%), or clinical insomnia (19.2%). Somatisation was sig. associated with perceived stigma (.15, p < .01, 95% CI 0.05 – 0.26) and feeling underprepared for COVID (.07, p < .05, 95% CI .01 – .13). |
Mosley et al., 1994 [56] USA | Cross-sectional | Prevalence and correlations between stress, coping strategies, depression, and somatic symptoms. | n = 69 medical students; Mean age: 26; 32.0% female | MEHS-R, CSI, CESD-R, WPSIa; 57% had high levels of somatic distress (mean = .66 (.42)). 23% clinically depressed (mean = 11.48 (7.13)). Frequency of stress correlated with depression (.54, p < .001) and somatic symptoms (0.71, p < .001). Stress intensity also correlated with somatic symptoms (0.31, p < .01). |
Neubauer et al., 2024 [57] Austria | Cross-sectional | Assess occupational stress factors associated with mental health issues. | n = 430 veterinary med students; Mean age: 23.1 (3.7); 85.8% female | WHO-5, PHQ-9, GAD-7, PSS-4, ISI-2; Students’ insomnia was related to stressful communication with supervisors (r = .19, p < .05), working overtime (r = .16, p < .05) and public pressure on social media (r = .18, p < .05). |
Olvera Alvarez et al., 2019 [58] USA | Prospec-tive cohort | Investigate social, behavioral, and environmental factors’ impact on stress in new nurses (beginning with nursing students). | n = 436 nursing students; Mean age: 25.2 (2.3); 80% female | BP, fasting triglyceride levels, cholesterol, A1c, carotid intima-media thickness, HRV, retinal BP, PHQ-9, environmental sensitivities, lifestyle, SES, cytokines; IL-8 was positively associated with stress exposure across the lifespan, F(1, 208) = 4.37, p = .038, as well as with lifetime exposure to life-threatening situation stressors, F(1, 209) = 4.09, p =.045. IL-6 was negatively associated with lifetime exposure to housing, F(1, 209) = 3.57, p = .060; education, F(1, 207) = 3.37, p = .068. TNF-α was negatively associated with lifetime exposure to housing, F(1, 209) = 3.61, p = .059; education, F(1, 207) = 4.66, p = .032; work, F(1, 208) = 3.11, p = .079; and possessions stressors, F(1, 206) = 3.69, p = .056. (Many more). |
Pikó, 1997 [59] Hungary | Cross-sectional | Describe the frequency of common mental health-related somatic symptoms. | n = 691 medical students; Age range: 18–31; 60.6% female | SPHQ; Men: backache (9.2% often, 15.8% sometimes), sleeping problems (5.5% often, 13.2% sometimes) and chronic fatigue (3.3% often, 10.7% sometimes). Female: Chronic fatigue (3.3% often, 16.9% sometimes), backache, tension headaches, and poor sleep. Women more likely than men to have experienced mental health-related somatic symptoms (p < .0001), and prevalence of tension headaches and chronic fatigue were significantly higher in women (p < .0001). |
Rocha et al., 2017 [60] Brazil | Cross-sectional | Prevalence of TMD and association with general health, quality of life, and anxiety. | n = 90 dental students, all years; Mean age: 21.2 (2.1); 52.2% female | Fonesca TMD questionnaire, GHQ, WHOQOL, STAI; 58.9% of dental students had TMD. Psychological stress (t = 2.65, p = .01), distrust in their performance (t = 2.56, p = 0.01), and psychosomatic disorders (t = 2.37, p = .02) had statistically significant differences with the presence of TMD. |
Ruzhenkova et al., 2018 [61] Russia | Cross-sectional | Development of differentiated approaches to psychopharmacotherapy in autonomic dysfunction. | n = 166 medical students; Mean age: 18 (0.9); 77.1% female | PSS, Diagnostic research criteria ICD-10 for SADa; 80.1% had symptoms of autonomic instability. 9% reached clinical levels of somatoform autonomic dysfunction (SAD). Symptoms of autonomic instability worse during exams. Prevalence of symptoms of SAD: tachycardia 86%, palpitations 37%, shortness of breath 57%, difficulty breathing 33%, poor inspiration 43%, muscle tension 52.3%, muscle tremors 67%, rapid urination 19%, headaches 67%, anxiety 90%, difficult falling asleep 71%, and unpleasant dreams 33%. Anxiety prevalence 86%, 62% reached clinical levels. |
Samarah et al., 2023 [62] Jordan | Cross-sectional | Prevalence of neck, shoulder, and low back pain. | n = 593 medical students; Mean age: 20.9 (2.1); 62.2% female | NMQa; 85.2% of students reported psychosomatic symptoms of some kind in the past year. 66.8% of students who had psychosomatic symptoms (p < .001 difference) and 62.3% of those with depressive symptoms in past week (p < .001) difference) had MSK pain compared to those without psychosomatic symptoms or depression. More hours of study was significant for higher MSK pain, as was more computer use. |
Scheuch et al., 1988 [63] Germany | Quasi-experim-ental repeated measures | Explore changes to physiological and biochemical parameters with mental stress. | n = 64 medical students; Mean age: 24.3 exp group; 43.8% female | Immunological parameters, physical and mental task performance, max ergometry, mental health-related somatic complaints; Delayed reactions improved after exams (5.2% (3) to 4.4 (3), p < .001) as did false reactions (2.3% (2) to 1.4 (2), p < .001). Trends in somatic complaints went up (2.3 (3.2) to 4.1 (3.7)) and psychological complaints went down (3.8 (3.6) to 1.8 (2.5)) pre/post exams. No significant changes in leucocytes, eosinophil granulocytes, lymphocytes, or cortisol pre/post exams. |
Sekas & Wile, 1980 [64] USA | Cross-sectional | Determine prevalence and incidence of stress-associated illnesses and possible sources of stress among students enrolled in MD, PhD, or MD-PhD programs (MD only used here). | n = 334 medical students; Mean age: not reported; 3.0% female | Frequency of stress-related illnessesa, stress questionnaire unspecified; Reported frequency of stress-related illnesses decreased from before medical school to during medical school (retrospectively). In men: episodes of depression 50% prior, 18.8% during, and insomnia 24.5% prior, 13.8% during. In women: depression 72.7% prior, 23.6 during, headaches 45.5% prior, 13.6% during, insomnia 30% prior, 15.5% during. |
Smith et al., 2005 [65] China | Cross-sectional | Determine prevalence and distribution of MSP. | n = 207 medical students; Mean age: not reported; % female not reported | SNQ; 67.6% had MSP in any body site in past 1 year, 46.9% in past week, 31.9% currently. Mental pressure was significantly correlated with low back pain (OR 2.9, CI 1.4–5.9, p = .0030). |
Sohrabi et al., 2015 [66] Iran | Cross-sectional | Explore prevalence of probable mental disorders during the internship period. | n = 404 medical students; Mean age: 24.7 (2.01); 53.8% female | SCL-90-Ra; Prevalence of somatization 16.3%. Depression prevalence 16.8% and anxiety 18.8%. |
Srivastava et al., 2021 [67] Saudia Arabia | Cross-sectional | Prevalence and risk factors for TMD including associations with demographic, academic, and psychosocial factors. | n = 246 dental students; Age: Mainly 20-25; 44.3% female | Diagnostic Criteria for Temporomandibular Disorders Axis I and II; Prevalence of TMD 37%; clinical students had higher risk of TMD (OR = 1.65; p = .03); anxiety increased risk of TMD (OR = 1.55; p = .04). |
Tan et al., 2003 [68] Malaysia | Cross-sectional | Determine the prevalence of IBS and symptom subgroups. | n = 533 medical students; Mean age: 22 (1.8); 57.0% female | Rome I, psychological and somatic questionnaire unspecified; The psychological and mental health-related somatic symptoms of anxiety (OR = 2.0, CI [1.1,3.5], p = .02), depression (OR = 2.1, CI [1.3,3.7], p = .002), insomnia (OR = 2.3, CI [1.3,4.1], p = .006), headache (OR = 1.7, CI [1.0,2.8], p = .04), and backache OR = 2.0, CI [1.2,3.4], (p = .006) were all more common in the participants who had IBS. |
Tang et al., 2020 [69] China | Cross-sectional | Examine associations of suicidality with psychological distress, somatic symptoms, and stressors. | n = 662 medical students; Mean age: 19.85 (1.6); 59.4% female | Three Qs from the Chinese NCS; K6, PHQ-15a, ASLEC; Prevalence of somatic symptoms: 5.7% medium or high. General pain/fatigue correlated with suicidal ideation (OR 6.11, 95% CI 2.99–12.48, p < .001) and suicidal planning (OR 18.83, 95% CI 2.75–128.89, p = .003). |
Tecles et al., 2014 [70] Spain | Two-group non-random pre/post | Assess the effect of 5-min oral presentation on stress and biomarkers compared to a control group; participants volunteered for presenting or not. | n = 20 veterinary students (15 speakers, 5 controls) Mean age: 20.6/20.9 % Female: 60 | Questionnaire based on the ASI, salivary cortisol and testosterone; No significant associations of salivary cortisol or testosterone with intensity of the self-rated stress response. Cortisol was significantly higher among the oral presenters compared to controls who did not present (p < .05 just after speech, p < .01 20 mins after speech). I.e., cortisol peaked just after to 20 mins after the presentation but this is not when presenters felt the most stressed. 20 mins post-speech, testosterone significantly decreased in females but not males (p < .05). |
Tocto-Solis et al., 2023 [71] Peru | Cross-sectional | Association between level of anxiety and level of psychosomatic features. | n = 352 medical students; Mean age: 23.2 (3.7); 56.5% female | PHQ-15a; Over 75% of students reported psychosomatic features. Females (RPa = 1.45, CI 95% [1.23, 1.71], p ≤ .001), and having mild (RPa = 1.11, CI 95% [1.20, 1.63], p ≤ .001) and moderate anxiety levels (RPa = 1.7, CI 95% [1.24, 2.34], p = .001) were associated with more psychosomatic features |
Vage et al., 2024 [72] United Kingdom | RCT | Students were randomized to blocks of low-complexity and high-complexity medical simulation with venipuncture tasks and their stress levels and biomarkers were assessed. | n = 10 medical students; Mean age: 25 (1.5); 80% female | STAI, serum cortisol, plasma metanephrine/normetanephrine; Anxiety scores were higher before the high-complexity simulation (p = .007) than afterwards, and before the low-complexity simulation (p = .05) compared to afterwards. Cortisol showed a trend largely reflective of changes in STAI scores but not significant (p = .33). |
Vitaliano et al., 1988 [73] USA | Cross-sectional two cohorts | Examine distribution and pattern of stress in first-year medical students at the beginning and end of the year. | n = 175 medical students per cohort; Mean age: 25.0 (3.2) male; 26.7 (4.1) female; 37% female | SCAS, BDI, LES, FTASa, AES, biomarkers, WCCL, SNL; Increased depression in men (t(194) = −3.42, p < .001) and women (t(107) = −3.38, p < .001); increased stress in men (t(194) = −5.13, p < .001) and women (t(107) = −4.07, p < .001), all during first year of medical school. Problem-focused coping, and seeking of social support, resulted in less distress. |
Weber et al., 2024 [74] Germany | One-group pre/post | virtual reality-Trier Social Stress Test, then 3 days of ECG monitoring | n = 60 medical students; Mean age: 22.27 (2.13); 70% female | PSRS, TSST, BP, HRV, ECG, A1c; Self-reported stress was not significantly associated with physical activity, BP, HRV, or A1c. |
Wege et al., 2016 [75] Germany | Cross-sectional two cohorts | Prevalence of common mental health issues and the use of psychotropic substances. | n = 590 medical students; Mean age: 21.13 (3.91); ∼70% female over two cohorts | PHQa; Total prevalence of moderate to high somatization 15.7%, with women having higher rates (19.9%) vs. men (5.2%, p < .005). Prevalence of major depression 4.7%, prevalence of ‘other depressive symptoms’ (subthreshold) 5.8%, panic disorders 4.4%,‘other anxiety disorders’ 1.9%. |
Xu et al., 2020 [76] China | Longitu-dinal | Explore relationship of sleep disturbance and depressive symptoms and assess emotional exhaustion and sleep-related worry as mediators. | n = 856 undergraduate nursing students; Mean age: 17.8; 100% female | APSQa, PSQI, PHQ-9, MBI emotional exhaustion subscale; Depressive symptoms were significantly correlated to health condition (r = -.18, p < .001), weekly exercise (r = -.13, p < .01), and emotional exhaustion (r = .47, p < .001) at timepoint 2. |