Empowering Medical Students to Improve Their Mental Health

Abstract

Aims: Medical students have relatively high rates of depression and anxiety. Interventions to improve mental health and resistance to stress in this population are needed. This thesis includes three intervention studies and a systematic review that address this issue. The Computer Assisted Learning for the Mind (CALM) study aimed to develop and assess the use of a self-help web-based intervention to improve mental health amongst medical students. The Systematic Review aimed to assess the effectiveness of peer-led interventions to improve mental health in secondary and tertiary students. The Peer Intervention Pilot and Randomised Controlled Trial (RCT) aimed to assess the feasibility, acceptability and effectiveness of peer-support and peer-taught mindfulness interventions to improve mental health and wellbeing in medical students. Methods: The CALM study was a before-after intervention study that also assessed website utilization patterns. It identified the number and proportion of medical students in years 2 and 3 who accessed the web-based CALM site, and compared the characteristics of those who used the website with those who did not. Outcome measures included depression (PHQ-9) and anxiety (GADS-7), recorded at baseline, online during the 5-week website trial and at 12-week follow-up. Sub-sites visited were monitored and acceptability was assessed. The Peer Intervention Pilot developed and assessed three peer-led interventions versus control over 8 weeks. The Peer Intervention RCT was a 2-arm trial conducted over 6 months. Outcome measures included depression (PHQ-9), anxiety (GAD-7), quality of life (LASA), resilience (15 item resilience scale), academic self-concept (PCL) and motivation to learn (MSLQ). Results: The CALM website was accessed by 80/321 (25%). In comparison to the whole class, a higher percentage of those who visited the website had high PHQ-9 scores and GAD-7 scores (≥10). Those who accessed the website and could be linked by unique identifier (n=49) had significantly higher anxiety scores (p=0.01) but not higher depression scores (p=0.07) at baseline, than those who did not access the site (n=230). The Systematic Review found good evidence for the effectiveness of peer-led interventions for improving mental health amongst secondary students, and moderate evidence amongst tertiary students. The Peer Intervention Pilot showed that peer-led interventions were feasible and acceptable but the RCT was not able to show a significant improvement in outcomes compared with control. Conclusions: The level of evidence for peer-led interventions in students to improve mental health and wellbeing is promising but higher quality trials are needed. Peers are capable of delivering effective interventions and peer-led approaches are acceptable.