Estresse, ansiedade, depressão e qualidade de vida ao longo da graduação médica: estudo longitudinal

Introduction: The literature has many studies on the mental health and quality of life of medical students, but they lack long-term follow-up. Objectives: The present study has two objectives, one of which, to investigate associated factors and changes in the quality of life and mental health of four classes of medical students followed up for three years, and the other, to evaluate associated factors and changes in the quality of life and mental health of the same class of medical students followed up during the six-year undergraduate program. Methods: An observational, prospective cohort study. The first objective was analyzed on four classes followed up during the first three years of the medical program. The second was analyzed on a class followed up during the six-year undergraduate program. The evaluated data included sociodemographic data, mental health using the DASS-21 scale, and quality of life using the WHOQOLBREF scale. Linear regression models were used to analyze the three-year follow-up, and Generalized linear mixed models (GLMM) were used to analyze health and quality of life changes in the six-year follow-up cohort. Results: In the three-year follow-up, 304 (91.8%) students responded to the baseline collection and 201 (66.1%) responded to both data collection waves after three years of follow-up. Depressive symptoms (p < 0.001), anxiety (p = 0.037), and stress (p < 0.001) increased. On the other hand, physical (p < 0.001), psychological (p < 0.001), and social (p = 0.003) quality of life decreased. Worse mental health at baselineand being a woman were associated with worse mental health after three years, while higher income at baseline was associated with better quality of life after three years. In the six-year follow-up, 80 students were included, 63.7% being women with an average age of 19.6 years. Mental health, happiness, and quality of life levels tended to be better in the first and last semesters, being worse in the middle of the program. However, satisfaction from becoming a doctor decreased in the second semester and remained low throughout the program, never reaching baseline levels. Conclusions: Considering the relevance of this results, educators and managers must be aware of these factors, promoting preventive actions and approaching the students to continuously take care of their mental health and quality of life to minimize distress during their medical training.Introdução: Apesar dos muitos estudos sobre a saúde mental e qualidade de vida do estudante de medicina, ainda são carentes acompanhamentos à longo prazo. Objetivos: O presente estudo possui dois objetivos, sendo, um deles, investigar os fatores associados e as mudanças na qualidade de vida e na saúde mental de quatro turmas de estudantes de medicina seguidos por três anos e, o outro, avaliar os fatores associados e as mudanças na qualidade de vida e na saúde mental de uma mesma turma de estudantes de medicina seguida pelos seis anos da graduação. Métodos: Trata-se de estudo observacional, tipo coorte prospectivo. Para o primeiro objetivo, quatro turmas foram acompanhadas durante os três primeiros anos do curso de medicina. Enquanto para o segundo, uma turma foi seguida ao longo dos seis anos da graduação. Foram avaliados dados sociodemográficos, saúde mental pela escala DASS-21 e qualidade de vida pelo WHOQOL-BREF. Para análise do seguimento de três anos, foram utilizados modelos de regressão linea, e, para a análise da coorte de seguimento de seis anos, foram usados modelos mistos lineares generalizados para avaliar as mudanças da saúde mental e qualidade de vida ao longo do tempo. Resultados: Em relação ao seguimento de três anos, 304 (91.8%) estudantes responderam à coleta no baseline e 201 (66.1%) responderam ambas as ondas da coleta após três anos de acompanhamento. Observou-se um aumento na sintomatologia depressiva (p<0.001), ansiedade (p=0.037) e estresse (p<0.001), enquanto houve uma diminuição na qualidade de vida física (p<0.001), psicológica (p