Longitudinal Relationship Between Medical Students’ Stressors and Mental Health Outcomes: A Structural Equation Modeling Analysis

Paula de Moura e Silva Toledo, Giancarlo Lucchetti, Sabrine Teixeira Ferraz Grunewald, Oscarina da Silva Ezequiel and Alessandra Lamas Granero Lucchetti

International Journal of Social Psychiatry, 2026, vol. 72, issue 4, 841-850

Abstract: Background: Further research is crucial to clarify the factors associated with mental disorders that directly impact the well-being of medical students. Aims: To investigate the various stressors experienced by medical students and the longitudinal association between these stressors and mental health outcomes (depression, anxiety, and stress). Method: A two-year longitudinal study was conducted with medical students completing questionnaires at baseline and after 2 years of follow-up. Mental health outcomes (depression, anxiety, and stress) were assessed using the depression, anxiety, and stress scale – 21 items, while stressors were assessed using the Medical Student Stress Factor Scale. Structural equation modeling (SEM) was employed for statistical analyses. Results: The study included 231 participants, of which 45.9% reported depression in 2016, rising to 48.9% in 2018. Anxiety decreased from 52.8% to 48.9%, whereas stress increased from 56.7% to 59.7% over the same period. The most prevalent stressors were related to “lack of time†and “learning environment/academic performance.†SEM analyses revealed that follow-up depression was linked to the “learning environment/academic performance,†baseline depression, and “relationships†; follow-up anxiety was associated with “learning issues,†“health,†and baseline anxiety; and follow-up stress correlated with “learning environment/academic performance,†“learning issues,†“health,†and baseline stress. Conclusions: The high prevalence of mental health symptoms and the identification of specific stressors associated with these symptoms call for urgent action by medical schools. Interventions should focus on establishing psychological support programs, promoting a balance between academic and personal lives, and reducing the stigma surrounding mental health help-seeking.

Keywords: mental health; stress; depression; medical students; structural equation modeling (search for similar items in EconPapers)
Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:sae:socpsy:v:72:y:2026:i:4:p:841-850

DOI: 10.1177/00207640251384081

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