Depression among medical students and the role of academic stress and coping strategies: A cross-sectional study in Bangladesh

Abstract

Objectives: Depression is highly prevalent among medical students, especially in resource-constrained settings like Bangladesh, where academic stress serves as a prominent contributing factor. This study aims to explore the predictors of depression among medical students, with a specific focus on academic stress and coping mechanisms, while also evaluating the influence of behavioral and sociodemographic factors on depression in Bangladeshi medical students. Methods: This cross-sectional study, conducted from October to December 2022, involved 1,072 undergraduate medical students from six public medical colleges in Bangladesh, selected through simple random sampling. Depression was measured using the PHQ-9, while academic stress, anxiety, insomnia, self-esteem, coping strategies, and internet addiction were assessed using the ASS-40, GAD-7, ISI, RSES, SCSI, and IAT, respectively. Data were analyzed by SPSS and Jamovi software employing chi-square tests, Mann-Whitney U tests, and binary logistic regression. The predicted probabilities were presented as beta coefficients, including crude and adjusted odds ratios (AOR), 95 confidence intervals, and p-values. Results: Over half of the participants experienced moderate to severe depression. Key predictors of depression included academic stress, coping strategies, and various sociodemographic and behavioral factors. Inadequate study facilities (OR: 1.32, 95 CI: 1.21-1.44) and feelings of personal inadequacy (OR: 1.33, 95 CI: 1.23-1.43) significantly increased the likelihood of depression. Among coping strategies, passive problem-focused coping was associated with higher odds of depression (OR: 1.17, 95 CI: 1.08-1.26), whereas passive emotion-focused coping slightly reduced the risk (OR: 0.91, 95 CI: 0.85-0.98). Active emotional coping had a marginal effect (OR: 1.07, 95 CI: 1.00-1.15). Sociodemographic factors also played a significant role. Females were less likely to experience depression than males (OR: 0.35, 95 CI: 0.19-0.68), and urban residents had lower odds than rural counterparts (OR: 0.40, 95 CI: 0.19-0.86). Higher paternal education was protective (OR: 0.09, 95 CI: 0.04-0.21), while maternal education beyond the secondary level was linked to increased risk (OR: 4.07, 95 CI: 1.61-10.33). Among behavioral factors, insomnia significantly increased the odds of depression (OR: 1.38, 95 CI: 1.29-1.48), while moderate internet use showed a protective effect compared to no use (OR: 0.26, 95 CI: 0.13-0.52). Anxiety emerged as a strong predictor (OR: 1.78, 95 CI: 1.61-1.97). Economically, having a personal income reduced the risk of depression by 49 (OR: 0.51, 95 CI: 0.27-0.96). Conclusions: Depression among medical students is significantly associated with academic stress, ineffective coping strategies, insomnia, and anxiety, which may further intensify among high-risk groups such as males, rural residents, and those facing financial challenges. Effective interventions should focus on reducing stress, developing adaptive coping skills, ensuring equitable access to academic resources, and enhancing mental health screening and support services. © 2025 the author(s), published by De Gruyter, Berlin/Boston.