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| Journal of the New Zealand Medical Association,
26-August-2011, Vol 124 No 1341
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Chinthaka B Samaranayake, Antonio T Fernando
Satisfaction with life is an important contributor to the
quality of life and subjective wellbeing.1, 2
Even though it is a broad and non-specific subjective perception, life
satisfaction is a predictor of mortality3 as
well as psychiatric morbidity.4 Furthermore,
life dissatisfaction has a significant effect on the long-term risk of suicide
in the general adult population.4 Subjective
wellbeing also impacts on a person’s ability to function and thus predicts
subsequent work disability among healthy
adults.5
University students are increasingly recognised as a
population group experiencing stressors that can contribute to psychological
disorders.6 The academic demands and lifestyle
choices, easy access to alcohol and other
substances7 as well as minimal adult
supervision are some of the contributing factors.
Medical students in particular are a subgroup of students
with a significant level of stressors during undergraduate
training.8 The aim of this study was to assess
the satisfaction with life among undergraduate medical and other students in
Auckland and identify associations with depression and anxiety disorders.
MethodThe study was conducted at The University of Auckland,
New Zealand in 2008 and 2009. The surveyed medical students were from two third
year classes (2008 and 2009 cohort). This was the final preclinical year in the
programme and the students were starting to get clinical exposure through their
weekly visits to the wards.
A sample of other undergraduate students was also
surveyed from nursing, health science and architecture courses in 2009. These
students were also in the third year in their respective courses, which was the
final year for the nursing and health science students and the final basic
training year for the architecture students in their two tiered programme. There
were no exclusion criteria for participation in the study.
The five item Satisfaction with Life Scale (SWLS)
developed by Diener et al9 was used to measure
the participants’ life satisfaction. Other questionnaires including the
Patient Health Questionnaire10 (PHQ) for
depression and Generalised Anxiety Disorder
Questionnaire11 (GAD) were administered to the
whole class of the selected course year groups at the beginning of a lecture
with prior consent of the lecturers and participants. Ethical approval for this
study was granted by the Northern Regional Ethics Committee
(NTX/07/05/038).
Demographic details and the scores for the above
questionnaires were recorded for the responded students. Subgroup analyses
between medical and other students were also carried out. The unpaired
t-test was used for comparing subgroups. Proportions between groups
were compared using the chi-squared test. Pearson correlation was used to
quantify associations between SWLS, PHQ and GAD scores. The 95% confidence
intervals (95% CI) were calculated for prevalence rates. The reported
differences were significant at p value <0.05. The analyses were carried out
using Statistical Package for the Social Sciences 2010 (SPSS for Windows,
release 19.0.0, IBM Corporation, Somers, NY, USA).
ResultsDescription of study sample—A total
of 778 students were eligible, and 594 (76.4%) students (255 (80.7%) medical,
208 (77.6%) health science, 36 (50.0%) nursing and 95 (77.9%) architecture)
completed the questionnaires. The median age was 20 years (range 17-45) and
women represented 67.2% (n=399) of the total group. A statistically significant
difference (p<0.0001) was observed in the gender between medical and other
students, which was caused by the disproportionate number of female students in
health science (81.7%) and nursing (91.7%) classes. A significant difference in
the rate of New Zealand-European students between medical and other students was
observed as a result of the health science class having a low number of students
of that ethnicity (26.9%). Other characteristics were similar in the two sub
groups.
Table 1 summarises the demographic details of the
participants.
Table 1. Demographic details of the
participants
* Statistically significant difference between medical
students and other students group (p<0.05).
Satisfaction with life, depression and
anxiety—The mean SWLS score for the total group was 24.9 (SD
6.4). Table 2 summarises the mean scores for the three questionnaires and table
3 provides a breakdown of the SWLS categories for medical and other students. In
the total surveyed sample, the rates of depression and anxiety were 20.7% (95%CI
17.4-24.0) and 20.0% (95%CI 16.8-23.3) respectively.
Medical students had an average SWLS score of 26.4 (SD 6.4),
which is within the range for being satisfied with life (see Table 3). The rate
of depression (PHQ score ≥ 10) among medical students was 16.9% (95% CI
12.2-21.5). Significant anxiety symptoms (GAD score ≥ 8) were present in
13.7% (95%CI 9.5-18.0) of medical students.
In subgroup analysis, medical students on average had a
higher level of satisfaction with life. Medical students overall had a lower
rate of depression compared to others (16.9% vs 23.6%; p=0.045). The rate of
anxiety was also less in medical students than other students (13.7% and 24.8%;
p=0.001).
In gender groups analysis, there was no difference in the
SWLS scores between female and male students, however females had a
significantly higher rate of depression (23.6% vs 14.9% in males; p=0.01) and
anxiety (22.8% vs 14.4% in males; p=0.02). There was no difference between the
rate of depression among female medical students compared to other female
students (20.4% vs 25.1%; p=0.15).
Table 2. Average scores for total group,
medical students and other students
SWLS = Satisfaction with Life Scale.
PHQ = Patient Health Questionnaire for
depression.
GAD = Generalised Anxiety Disorder Questionnaire.
SD = Standard deviation.
* Statistically significant difference between medical
and other students (p<0.05).
Table 3: Rates of satisfaction with life
categories in medical and other students
SWLS = Satisfaction with Life Scale.
* Statistically significant difference between medical
and other students (p<0.05).
Regression analysis revealed a statistically significant
moderate correlation between SWLS score and PHQ score [r = -0.37 (p<0.001)]
and SWLS score and GAD score (r = - 0.23 [p<0.001)]. Cronbach’s alpha
coefficient for the five parts of the SWLS was 0.89, indicating good reliability
and internal consistency of the SWLS scores.
DiscussionThis study aimed to assess the satisfaction with life among
undergraduate medical students and identify associations between depression and
anxiety. The study also compared the satisfaction with life among medical and
other students. In the sampled University of Auckland population, 15.4% of
medical and 19.5% of other students reported dissatisfaction with life. These
students were more likely to have depression and/or anxiety compared to students
who reported to be neutral or satisfied with life. A significant proportion of
students were also found to be having clinically significant depression and
anxiety symptoms.
An interesting finding of this study is that medical
students had a higher mean SWLS scores compared to other students surveyed. One
possible explanation for this is the greater career and job certainty in medical
students.
The survey was carried out during the 2007-2010 financial
crisis, where job opportunities were limited for many university graduates
including health science and architecture graduates; majority of the non-medical
students in this study were doing these two courses.
The uncertainty of getting into a limited entry course after
the undergraduate degree may have also contributed to the lower SWLS scores in
health science students. Alternatively, higher life satisfaction among medical
students may be caused by the fact that they are already accepted into their
desired programme. Another explanation is that the selection process of students
into the medical programme from the premedical courses (including health
sciences) results in selection of students with better mental health and coping
strategies.
The results also suggest that poor mental wellbeing is
common to all tertiary students rather than limited to medical students alone.
This is in line with other researchers12 and
was highlighted by a recent study of tertiary students in Adelaide, Australia
which found that students from non-health disciplines were significantly more
distressed than health disciplines13.
The overall rate of depression among medical students was
lower than other students in our survey. However this is most likely to be due
to the significantly lower number of female students in the medical students
group compared to the other students surveyed. There was no difference in the
rate of depression among female medical students compared to other female
students. The rate of depression among female students overall was significantly
higher than the male students and this is in accordance with the rates from the
general population14.
A strength of this study is that it was conducted in a large
group of students at a similar stage of their undergraduate courses allowing
comparison between subgroups. The high response rate (76.4%) was achieved by
administering the questionnaire at the start of lectures and the study
investigators being present to encourage students to complete the questionnaire.
The inclusion of a large sample of medical students allowed
comparison between medical and other students. The lack of random selection and
wider sampling of students is a shortcoming and prevents the authors from making
strong conclusion on the mental health among medical students compared to other
university students as a whole; however resources of the project were limited.
Acute stressors (such as upcoming assignments, tests or
exams) may have contributed to some of the reported SWLS scores.
Re-administering the questionnaire to the same group of students at different
times of the year to use the individual students as their own control would have
eliminated the impact of acute stressors on the scores.
The SWLS scores in The University of Auckland sample are
very similar to other literature on undergraduate
students.1 A study of American college students
found a mean SWLS score of 23.7 (SD 6.4).15 The
association between SWLS scores and depression in medical students was assessed
by Swami et al, and the results (r = -0.38) are very similar to our
study.16
The rates of depression and anxiety in our sample are
similar to the New Zealand population rates for the 16 to 24 years age group
(20.7% and 23.9% for mood and anxiety disorders
respectively)17 and other literature on
university students.18
In conclusion, dissatisfaction with life is associated with
depression and anxiety. One possible way of reducing the depressive and anxiety
symptoms in university students is to promote positive wellbeing and improve
satisfaction with life. The results further emphasise the evidence required for
developing frameworks for identifying and prioritising interventions for
students who are suffering from mood disorders and dissatisfaction with life.
Competing interests: None.
Author information: Chinthaka B
Samaranayake, Medical Student (Trainee Intern); Antonio T Fernando, Senior
Lecturer, Psychiatrist; Department of Psychological Medicine, Faculty of Medical
and Health Sciences, The University of Auckland
Correspondence: Dr Antonio Fernando,
Department of Psychological Medicine, School of Medicine, The University of
Auckland, Faculty of Medical and Health Sciences, Private Bag 92019, Auckland,
New Zealand. Fax: +64 (0)9 373 7641; email: a.fernando@auckland.ac.nz
References:
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