Disillusionment mediates the associations between perceived stressors and affective symptoms in Thai medical students: a cross-sectional survey.

OBJECTIVES

This study aimed to explore the associations between stressors, disillusionment, and affective symptoms (including depressive symptoms and positive, anxious, and negative affects) among Thai medical students.

METHODS

Fourth-year medical students from rural and urban campuses of Srinakharinwirot University were purposively recruited to complete a self-administered online questionnaire. Perceived distress was assessed across different domains of stressors including intrafamilial and extrafamilial relationship difficulties, academic pressure and time mismatch, and achievement-related difficulties. Disillusionment related to medical training was assessed using a three-item scale. Affective symptoms were measured using the Thai version of the Patient Health Questionnaire-9 and the Thai adaptation of the Positive and Negative Affect Schedule.

RESULTS

In total, 49 male and 66 female fourth-year medical students completed the questionnaire. Of these, 14 reported remitted or stable mental illnesses. Eight students scored in the moderate-to-severe range on the Patient Health Questionnaire-9; three of these reported remitted or stable mental illnesses and five reported no prior diagnosis. From structural equation modelling, disillusionment was associated with intrafamilial relationship difficulties (β = 0.41, p < 0.001), academic pressure and time mismatch (β = 0.15, p < 0.001), as well as depressive symptoms (β = 0.31, p = 0.029) and positive affects (β = -0.89, p < 0.001). Through disillusionment, intrafamilial relationship difficulties was indirectly associated with depressive symptoms (β = 0.13, p = 0.048) and positive affects (β = -0.36, p = 0.005), whereas academic pressure and time mismatch was indirectly associated with positive affects (β = -0.13, p = 0.013). Achievement-related difficulties was associated with depressive symptoms (β = 0.25, p = 0.030) and anxious affects (β = 0.31, p < 0.001) without mediation by disillusionment.

CONCLUSION

Preliminary evidence shows that disillusionment mediates the associations between various stressors and affective symptoms, with differential effects, in Thai fourth-year medical students.