Psychological Distress and its Effect on Academic Performance and Attendance of Undergraduate Medical Entrants: A Longitudinal Study

Introduction: Globally, the prevalence of psychological distress is alarmingly high and increasing among medical students at different phases of their training. Signs and symptoms of mental distress have also been observed in first-year entrants. Psychological distress can significantly hinder students’ ability to retain and apply knowledge. Aim: To assess changes in stress levels and academic performance among undergraduate medical students after the first term of medical education, compared with their levels at entry into the medical course. Materials and Methods: A longitudinal, observational study was conducted from July 2015 to February 2016 at the Department of Physiology, Maulana Azad Medical College, New Delhi, India. A total of 168 newly admitted students (97 male, 71 female) participated voluntarily. Data were collected using self-reported questionnaires, including a sociodemographic profile and the General Health Questionnaire (GHQ-12), in two sessions: the baseline session (at the end of the first week in medical college) and the follow-up session (at the end of the first-term exams). Academic performance was assessed at baseline by the percentage of marks secured in the best four subjects in the Class 12 examination, and at follow-up by the percentage of marks secured in combined Physiology theory and practical. Attendance was calculated as the percentage of theory and practical classes attended in Physiology. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 20.0; Student’s t-test, Pearson’s correlation and Multivariate Analysis of Variance (MANOVA) were employed. For all analyses, p<0.05 was considered significant. Results: The mean age of students was 18.51±0.90 years. There was a significant increase (p<0.001) in GHQ-12 scores at followup compared with baseline. The prevalence of stress was 14.3% at baseline and 64.3% at follow-up. Stress levels increased significantly at follow-up compared with baseline (p<0.001). Academic performance decreased significantly at follow-up compared with baseline (p<0.001), where the baseline measure was the percentage secured in Class 12. The mean attendance at the end of the first-term examination was 86.12±5.44%. There was a significant correlation between attendance and academic performance at both baseline (r=0.236; p<0.01) and follow-up (r=0.444; p<0.001). MANOVA revealed an overall significant effect of gender (p<0.01) and exercise (p<0.05) on the combined dependent variables. There was a significant main effect of gender on the percentage of marks secured in both Class 12 (p<0.001) and the first-term exam (p<0.05). Conclusion: There was an overall deterioration in general psychological well-being, as indicated by a significant increase in mean GHQ-12 scores at follow-up. The prevalence of psychological distress and stress levels increased significantly, whereas academic performance declined significantly at followup. Continuous counselling is required to identify stressors and promote coping strategies to help students manage stress more effectively