Cent Eur J Public Health 2025, 33(1):17-23 | DOI: 10.21101/cejph.a8222

Association of depressive symptoms and social determinants of health in medical students of four countries - Czechia, Iran, Kenya, and Venezuela

Anna Zimovjanová¹, Frederick Murunga Wekesah^{2, 3, 4}, Fatemeh Dehghani Firouzabadi^{5, 6, 7}, Jan Brož⁸, Jana Urbanová⁹, Jeffrey I. Mechanick¹⁰, Natalia Sulbarán¹¹, Andrea Medina¹¹, Geraldo A. Maranhao Neto¹², Ramfis Nieto-Martinez^{2, 13, 14}, Masih A. Babagoli¹⁰, Maritza Torres¹⁵, Monika Kunzová^{12, 16}, Martin Pešl^{12, 17, 18}, José Medina¹⁹, Eunice Ugel^{2, 13, 20}, Hesam Jahandideh⁶, Maryam Roomiani⁶, Niloofar Deravi^{5, 21}, Amirhossein Poopak⁵, Alireza Esteghamati⁵, Juan P. González-Rivas^{2, 12}

¹ Faculty of Medicine, Masaryk University, Brno, Czech Republic

² Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA

³ African Population and Health Research Centre, Nairobi, Kenya

⁴ Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands

⁵ Endocrinology and Metabolism Research Centre, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

⁶ ENT and Head & Neck Research Centre, Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran

⁷ Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, MA, USA

⁸ Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic

⁹ Department of Internal Medicine, Faculty Hospital Kralovské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic

¹⁰ Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA

¹¹ Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela

¹² International Clinical Research Centre, St Anne's University Hospital Brno, Brno, Czech Republic

¹³ LifeDoc Health, Memphis, TN, USA

¹⁴ School of Medicine, Faculty of Medicine, University of the Andes, Venezuela

¹⁵ Ministry of Public Health of Ecuador, Quito, Ecuador

¹⁶ Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic

¹⁷ First Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital Brno, Brno, Czech Republic

¹⁸ Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic

¹⁹ School of Medicine, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela

²⁰ Department of Social and Preventive Medicine, School of Medicine, Lisandro Alvarado Central Western University, Barquisimeto, Venezuela

²¹ Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Objectives: Medical students experience worse psychological well-being than the general population. Social determinants of health (SDOH) relate to conditions in which people live, work, and age and significantly influence mental health. This study examines the association between depressive symptoms and SDOH in medical students from four countries: Czechia, Iran, Kenya, and Venezuela.

Methods: An online cross-sectional survey was conducted in the spring of 2022. The questionnaire focused on depressive symptoms (using a validated psychiatric scale DASS-21 to assess mental health) and various SDOHs.

Results: A total of 2,033 medical students participated in the survey, with a median age of 23.0 years; 64.8% were females; 60.8% of respondents had some degree of depressive symptoms (mild-to-moderate 32.5%, severe-to-extremely severe 28.3%). Several SDOHs, such as low engagement in social life, low personal funds, and low social class, were strongly associated with severe-to-extremely severe depressive symptoms (p < 0.001), and the associations differed among countries. The prevalence of severe-to-extremely severe depressive symptoms varied significantly across the four countries, with Iran having the highest prevalence (OR = 2.1 compared to Czechia), followed by Czechia (OR = 1, reference value), Kenya (OR = 0.9), and Venezuela (OR = 0.6).

Conclusion: The study demonstrates the high prevalence of depressive symptoms among medical students from four global regions and the significant association with specific SDOH. Notably, the variation in prevalence across countries and differential relationships with SDOH underscore the importance of considering transcultural factors in research and management to improve mental health among medical students.

Klíčová slova: mental health, social determinants, medical students, depressive symptoms

Vloženo: 16. březen 2024; Revidováno: 12. prosinec 2024; Přijato: 12. prosinec 2024; Zveřejněno: 31. březen 2025  Zobrazit citaci