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

Abstract

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.