Prevalence of empathy, anxiety and depression, and their association with each other and with sex and intended specialty in medical students

Brunfentrinker, Camila; Gomig, Regina Pinho; Grosseman, Suely

doi:10.1590/1981-5271v45.3-20210177.ING

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ORIGINAL ARTICLE • Rev. bras. educ. med. 45 (03) • 2021 • https://doi.org/10.1590/1981-5271v45.3-20210177.ING copy

Prevalence of empathy, anxiety and depression, and their association with each other and with sex and intended specialty in medical students

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Introduction:

Empathy and mental health are crucial for medical students’ self-care and performance as well as for patient care.

Objective:

to assess the prevalence of empathy, anxiety and depression, and their association with each other and sex, intended specialty and course semester.

Method:

Cross-sectional study with 405 of 543 students (74.6%) from odd semesters and from the 12^th semester of the medical course of two universities in southern Brazil. Data were collected using a self-administered questionnaire containing information on age, sex, medical course semester, intended specialty, Jefferson Scale of Empathy (JSE) and Beck Anxiety and Depression Inventories (BAI and BDI). The data were analyzed using descriptive statistics, Student’s t-tests, Chi-square, and bidirectional ANOVA between groups. The level of significance was set at p < 0.05.

Results:

The mean JSE score was 120.2 (SD = 10.6) [116.9 (SD = 11.0) in men and 123.4 (SD = 9.2) in women, p = 0.000], being higher among students who wanted to follow medical areas aimed at people [123.1 (SD = 10.1)], than among those whose intended areas aimed at techniques and procedures [118.5 (SD = 11.2)], p = .003. There was no difference between the course periods. The anxiety and depression mean rates were, respectively, 16.2 (SD = 11.3) and 11.9 (SD = 9.0) [13.1 (SD = 10.3) and 9.9 (SD = 8.3) in men and 19.1 (SD = 11.4), and 13.8 (SD = 9.4) in women, p = .000 for both]. The prevalence rate of moderate and high anxiety was 33.8% and, when including mild anxiety, it was 59%. The prevalence rate of dysphoria (BDI = 16 - 20) and depression (BDI > 20) was 26.4%, and 11.9% for suicidal ideation. An association was observed between severe anxiety and the JSE subscale ‘Walking in patient’s shoes’, more related to empathic stress.

Conclusions:

Empathy is high and stable throughout the medical course at the studied institutions and higher in women and students who want to follow people-oriented specialties. Anxiety and depression have higher prevalence rates in women. Severe anxiety is associated with the JSE subscale ‘Walking in patient’s shoes’.

Keywords:
Medical Students; Empathy; Anxiety; Depression; Medical Education

University	Semester	n	Empathy (JSE)^a a. Two-way between groups Analysis of Variance - University: F(1) = 2.77, p = 0.097; semester course: F(6) = 1.63, p = 0.138; University*Semester Interaction: F(6) = 2.72, p = 0.013, partial Eta2 = 0.040 [University B: mean in the 12th semester was lower than means in the 3rd (p = 0.041) and 5th (p = 0.029) semesters] .	Anxiety (BAI)^b b. Two-way between groups Analysis of Variance - University: F(1) = 7.03, p = 0.008, partial Eta2 = 0.018, Semester: F(6) = 1.77, p = 0.104, University*Semester Interaction: F(6) = 4.29, p = 0.000, partial Eta2 = 0.062 (University B with a higher mean in the 11th semester than in all other semesters).	Depression (BDI)^c c. Two-way between groups Analysis of Variance - University: F(1) - 1.17, p = 0.28, Semester: F(6) = 3.39, p = 0.02, partial Eta2 = 0.037 (University B: higher mean in the 11th semester than in the 12th semester), University*Semester Interaction: F(6) = 3.39, p = 0.003, partial Eta2 = 0.049.
University	Semester	n	Mean (SD)	Mean (SD)	Mean (SD)
A	1^st	43	116.2 (12.0)	19.0 (11.8)	11.1 (8.8)
	3^rd	42	118.9 (10.0)	18.4 (13.5)	15.0 (10.0)
	5^th	37	118.9 (10.1)	14.5 (7.8)	12.0 (7.8)
	7^th	33	122.2 (8.5)	13.6 (10.1)	12.0 (9.0))
	9^th	34	119.4 (10.4)	12.4 (7.3)	10.6 (7.3)
	11^th	11	116.7 (10.3)	10.5 (7.4)	9.8 (10.3)
	12^th	34	121.2 (10.9)	14.7 (12.8)	9.8 (7.7)
	Total	234	119.2 (10.5)	15.4 (11.0)	11.8 (8.7)
B	1^st	24	122.2 (10.8)	15.4 (13.7)	11.7 (13.2)
	3^rd	28	125.0 (10.2)	17.3 (11.8)	11.6 (6.7)
	5^th	34	125.1 (8.6)	12.6 (7.5)	9.6 (5.5)
	7^th	28	121.5 (10.4)	18.3 (10.9)	11.4 (6.4)
	9^th	23	118.6 (9.7)	17.8 (12.0)	11.6 (8.9)
	11^th	18	119.1 (9.5)	28.8 (11.7)	23.1 (13.2)
	12^th	16	115.1 (14.8)	14.5 (7.3)	8.4 (7.4)
	Total	171	121.6 (10.7)	17.3 (11.6)	12.1 (9.5)
Total^a a. Two-way between groups Analysis of Variance - University: F(1) = 2.77, p = 0.097; semester course: F(6) = 1.63, p = 0.138; University*Semester Interaction: F(6) = 2.72, p = 0.013, partial Eta2 = 0.040 [University B: mean in the 12th semester was lower than means in the 3rd (p = 0.041) and 5th (p = 0.029) semesters] .	1^st	67	118.4 (11.9)	17.7 (12.5)	11.3 (10.5)
	3^rd	70	121.3 (10.5)	17.9 (12.8)	13.7 (9.0)
	5^th	71	121.9 (9.8)	13.6 (7.7)	10.9 (6.8)
	7^th	61	121.9 (9.3)	15.8 (10.7)	11.7 (7.8)
	9^th	57	119.1 (10.1)	14.6 (9.7)	11.0 (8.0)
	11^th	29	118.2 (9.7)	21.9 (13.6)	18.1 (13.7)
	12^th	50	119.2 (12.5)	14.6 (11.2)	9.4 (7.5)
	Total	405	120.2 (10.6)	16.2 (11.3)	11.9 (9.0)

Disorders	Sex ^a a Four participants did not fill out this variable, resulting in 401 students in this variable.		Ӽ²(df) p (Eta, if p<0.05)	Sex	University (U)		Ӽ²(df) p (Eta, if p<0.05)	U
Disorders	Male n (% in the sex)	Female n (% in the sex)	Ӽ²(df) p (Eta, if p<0.05)	Total n (%)	A n (% at U)	B n (% at U)	Ӽ²(df) p (Eta, if p<0.05)	Total n (%)
Anxiety ^b b Classification according to the Manual of the Portuguese version of the Beck Scales 47.
Minimal (BAI ≤ 10)	104 (53.6)	61(29.5)	Ӽ²(3) = 32,9 p = 0,000 (0,29)	165 (41.1)	99 (42.3)	67 (39.2)	Ӽ²(3) = 3,7 p = 0,294	166 (41.0)
Mild (BAI:11 to 19)	48 (24.7)	52 (25.1)		100 (24.9)	61 (26.1)	41 (24.0)		102 (25.2)
Moderate (BAI: 20 to 30)	32 (16.5)	59 (28.5)		91 (22.7)	54 (23.1)	38 (22.2)		92 (22.7)
Severe (BAI: ≥31)	10 (5.2)	35 (16.9)		45 (11.2)	20 (8.5)	25 (14.6)		45 (11.1)
Depression ^b b Classification according to the Manual of the Portuguese version of the Beck Scales 47.
Minimal (BDI: 0 a 11)	130 (67.0)	100 (48.3)	Ӽ²(3) = 19.4 p = 0.000 (0.21)	230 (57.4)	134 (57.3)	99 (57.9)	Ӽ²(3) = 0.8 p = 0.844	233 (57.5)
Mild (BDI:12 to 19)	46 (23.7)	58 (28.0)		104 (25.9)	61 (26.1)	44 (25.7)		105 (25.9)
Moderate (BDI: 20 to 35)	15 (7.7)	43 (20.8)		58 (14.5)	35 (15.0)	23 (13.5)		58 (14.3)
Severe (BDI: >35)	3 (1.5)	6 (2.9)		9 (2.2)	4 (1.7)	5 (2.9)		9 (2.2)
Depression and dysphoria ^c c. Classification of the Brazilian version of the BDI used by Gorenstein et al.49 for non-clinical subgroups.
Normal to minimal (BDI up to 15)	157 (80.9)	137 (66.2)	Ӽ²(2) = 14.1 p = 0.001 (0.19)	294 (73.3)	171 (73.1)	127 (74.3)	Ӽ²(2) = 0.1 p = 0.94	298 (73.6)
Dysphoria (BDI between 16 and 20)	20 (10.3)	25 (12.1)		45 (11.2)	27 (11.5)	18 (10.5)		45 (11.1)
Depression (BDI > 20)	17 (8.8)	45 (21.7)		62 (15.5)	36 (15.4)	26 (15.2)		62 (15.3)
Suicidal Ideation
Yes	19 (9.8)	29 (14.0)	Ӽ²(1) = 1.7 p = 0.194	48 (12.0)	26 (11.1)	22 (12.9)	Ӽ²(1) = 0.3 p = 0.59	48 (11.9)
No	175 (90.2)	178 (86.0)	Ӽ²(1) = 1.7 p = 0.194	353 (88.0)	208 (88.9)	149 (87.1)	Ӽ²(1) = 0.3 p = 0.59	357 (88.1)
Total	194 (100.0)	207 (100.0)	Ӽ²(3) = 32.9 p = 0.000 (0.29)	401^a(100.0)	234 (100)	171 (100)	Ӽ²(3) = 3.7 p = 0.294	405 (100.0)

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