Medical student depression, anxiety and distress outside North America: a systematic review

Med Educ. 2014 Oct;48(10):963-79. doi: 10.1111/medu.12512.


Context: North American medical students are more depressed and anxious than their peers. In the UK, the regulator now has responsibility for medical students, which may potentially increase scrutiny of their health. This may either help or hinder medical students in accessing appropriate care. The prevalences of anxiety, depression and psychological distress in medical students outside North America are not clear. A better understanding of the prevalence of, risk factors for and results of psychological distress will guide the configuration of support services, increasingly available for doctors, for medical students too.

Objectives: The aim of this study was to examine the prevalences of depression, anxiety and psychological distress in students in medical schools in the UK, Europe and elsewhere in the English-speaking world outside North America.

Methods: A systematic review was conducted using search terms encompassing psychological distress amongst medical students. OvidSP was used to search the following databases: Ovid MEDLINE (R) from 1948 to October 2013; PsycINFO from 1806 to October 2013, and EMBASE from 1980 to October 2013. Results were restricted to medical schools in Europe and the English-speaking world outside North America, and were evaluated against a set of inclusion criteria including the use of validated assessment tools.

Results: The searches identified 29 eligible studies. Prevalences of 7.7-65.5% for anxiety, 6.0-66.5% for depression and 12.2-96.7% for psychological distress were recorded. The wide range of results reflects the variable quality of the studies. Almost all were cross-sectional and many did not mention ethical approval. Better-quality studies found lower prevalences. There was little information on the causes or consequences of depression or anxiety.

Conclusions: Prevalences of psychological distress amongst medical students outside North America are substantial. Future research should move on from simple cross-sectional studies to better-quality longitudinal work which can identify both predictors for and outcomes of poor mental health in medical students.

Publication types

  • Comparative Study
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Anxiety Disorders / epidemiology*
  • Cross-Sectional Studies
  • Depressive Disorder / epidemiology*
  • Europe / epidemiology
  • Humans
  • Male
  • North America / epidemiology
  • Prevalence
  • Risk Factors
  • Sex Factors
  • Stress, Psychological / epidemiology*
  • Students, Medical / psychology
  • Students, Medical / statistics & numerical data*
  • United Kingdom / epidemiology
  • Young Adult