Objectives: To explore mental health, burnout, and the factors associated with the level of empathy among Thai medical students. Background: Empathy is an important component of a satisfactory physician-patient relationship. However, distress, including burnout and lack of personal well-being, are recognized to affect a lower level of empathy. Material and methods: A cross-sectional study surveyed sixth-year medical students at three faculties of medicine in Thailand at the end of the 2020 academic year. The questionnaires utilized were: 1) Personal and demographic information questionnaire, 2) Thai Mental Health Indicator-15, 3) The Maslach Burnout Inventory-Thai version, and 4) The Toronto Empathy Questionnaire. All data were analyzed using descriptive statistics, and factors associated with empathy level were analyzed via the Chi-square test or Fisher’s exact test, logistic regression., and linear regression. Results: There were 336 respondents with a response rate of 70.3%. The majority were female (61.9%). Most participants reported a below-average level of empathy (61%) with a median score (IQR) of 43 (39–40). Assessment of emotion comprehension in others and altruism had the highest median empathy subgroup scores, whereas behaviors engaging higher-order empathic responses had the lowest median empathy subgroup score. One-third of participants (32.1%) had poor mental health, and two-thirds (62.8%) reported a high level of emotional exhaustion even though most of them perceived having a high level of personal accomplishment (97%). The multivariate analysis indicated that mental health was statistically significantly associated with the level of empathy. The participants with higher levels of depersonalization had statistically lower scores of demonstrating appropriate sensitivity, altruism, and behaviors engaging higher-order empathic responding. Conclusions: Most medical students had below-average empathy levels, and two-thirds of them had high emotional exhaustion levels, yet most of them reported having a high level of personal accomplishment and good mental health. There was an association between mental health and the level of empathy. Higher levels of depersonalization related to lower scores of demonstrating sensitivity, altruism, and behaviors responding. Therefore, medical educators should pay close attention to promoting good mental health among medical students.

This study was conducted to investigate the prevalence and associated factors of depression in medical students. This cross-sectional study investigated the prevalence and associated factors of depression in medical students from May 2018 to April 2019. Depression was diagnosed using the nine-item Patient Health Questionnaire. We evaluated the following potential predictors: demographic data, stressors, psychiatric comorbidities, emotional intelligence (EI), and perceived social support. The association between potential factors and depression was analyzed using multiple logistic regression analysis. The prevalence of depression was 149 of 706 students with 12.5% suicidality. Second- and fourth-year medical students were high-risk groups. Risk factors identified were insufficient income, physical illness, and previous psychiatric illness. Depression in medical students likely coincides with anxiety, internet addiction, sleep problems, and loneliness. Highly associated stressors were personal relationships, physical health, mental health, difficulties in social relationships, satisfaction with grades, and boredom with medical education. Protective EI factors included emotional self-control, problem-solving abilities, inner peace, and life satisfaction. Up to 21.1% of medical students had depression. In this study, among multiple known risk factors of depression, we found that EI is the novel protective factor against depression among medical students. EI training might be protective intervention for medical students in the future.

Background: The screening instrument for borderline personality disorder (SI-Bord) consists of a 5-item self-reported questionnaire on the key features of BPD from the DSM-5 using a 5-point Likert scale. This study investigated its validity and reliability in screening for BPD in university students. Methods: A cross-sectional study was conducted on a sample of university students in Thailand between November and December 2019. An online assessment gathered demographic data and results from the SI-Bord, the Perceived Stress Scale-10 (PSS-10) and the Patient Health Questionnaire-9 (PHQ-9). Participants whose SI-Bord scores were ≥ 1 were randomly selected to be interviewed and assessed for a BPD diagnosis by four psychiatrists using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) as a reference point. An intraclass correlation coefficient (ICC) of 0.925 (95% CI, 0.805–0.979) ensured inter-rater reliability between the four psychiatrists. The diagnostic sensitivity and specificity of the SI-Bord, as compared to that of the SCID-II, were determined to indicate the cut-off score. The Receiver Operating Characteristics (ROC) was analyzed to evaluate its diagnostic accuracy. Results: The study included 342 students aged 18–25 years (the mean age was 20.25 ± 1.4 years), 80.4% of whom were female. Among the 68 participants selected for an online interview, 16 were diagnosed with BPD. The cut-off score of the SI-Bord was > 9, as suggested by the Youden index, yielding a sensitivity of 56.3% and a specificity of 92.3%. It had a positive predictive value of 69.2% and negative predictive value of 87.3%. The SI-Bord had adequate discriminative power between cases and non-cases of BPD, with the area under the ROC curve being 0.83. Cronbach’s alpha for the SI-Bord was 0.76, indicating acceptable internal consistency. The SI-Bord score was positively correlated to PHQ-9 and PSS-10 scores (r = 0.67 and r = 0.69, p < 0.001, respectively) and negatively correlated to MSPSS (r = − 0.50, p < 0.001). The prevalence of BPD in the sample was 6.4%, according to the cut-off score > 9. Conclusion: The SI-Bord demonstrated good reliability and validity for screening BPD in university students. However, a study in non-Thai and other population groups should be warranted.

Purpose: The purpose of this study is to examine the prevalence, associated factors and quality of life associated with depressive disorder in cervical cancer patients. Patients and methods: This cross-sectional study was carried out in a gynecologic oncology clinic of a university hospital in Northern Thailand from October 2018 to August 2019. Two-hundred cervical cancer patients were screened for depressive disorder using the nine-item Patient Health Questionnaire (PHQ-9), and psychiatrists interviewed eligible patients to confirm diagnoses. We measured the quality of life using questionnaires from the European Organisation for the Research and Treatment of Cancer: Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Cervical Cancer Module 24 (EORTC QLQ-Cx24). Associated factors, including comorbidity, fatigue, and pain, were collected using the Charlson Comorbidity Index (CCI), the eleven-item Chalder Fatigue Scale (CFQ 11), and the visual analog scale (VAS) for pain, respectively. Results: Twenty-seven (13.5%) cervical cancer patients were diagnosed with depressive disorder by psychiatrists according to the DSM-5. Depressive disorder was related to a worse quality of life in these patients. A binary logistic regression analysis revealed that depressive disorder among these patients was linked with these factors: high fatigue score (aOR: 1.35; CI: 1.18–1.53), high pain score (aOR: 1.25; CI: 1.02–1.54), no perception of social support, (aOR: 3.12; CI: 1.11–8.81), and no previous surgical treatment for cervical cancer (aOR: 2.99; CI: 1.08–8.29). Conclusion: The depressive disorder prevalence was 13.5% in Northern Thai cervical cancer patients. In this demographic, cervical cancer patients—who reported high fatigue or pain scores, did not perceive social support, or had no previous cervical cancer surgery- were more likely to have depressive disorder.

Background: Attention deficit hyperactivity disorder (ADHD) is associated with depression among college students, while perceived social support is also associated with depression, especially among young adults. This study aimed to examine to what extent perceived social support mediated the relationship between ADHD symptoms and depressive symptoms. Methods: In total, 124 first year medical students completed the Adult ADHD Self-Report Scale Screener (ASRS), the Patient Health questionnaire-9 and the revised Thai Multidimensional scale of perceived social support reflecting ADHD symptoms, depressive symptoms, and perceive social support, i.e., family members, friends and other significant people, respectively. Structural equation modeling was used to investigate the hypothesized mediation model. Results: ADHD symptoms exhibited a significant indirect effect on depressive symptoms via perceived social support. ADHD symptoms initially had a direct effect on depression; thereafter, it reduced to a non-significance effect after perceived social support was added. The total variance explained by this model was 35.2%. The mediation model with family support as a mediator showed the highest effect size. Conclusions: The study highlighted the importance of perceived social support, particularly family support, on depressive symptoms among young medical students experiencing ADHD symptoms. The model suggests promising relationships for further research on ADHD-related depression and potential treatment in the future.

Suicidal ideation is a serious condition antecedent to suicidal attempts and is highly related not only to depression but also other psychosocial factors. This study aimed to examine the predictive effects of these potential factors for suicidal ideation among young adult university students. A cross-sectional survey was conducted on a sample of university students in Thailand. An online questionnaire employed the perceived stress scale-10 (PSS-10), the patient health questionnaire-8 (PHQ-8), the multidimensional scale of perceived social support (MSPSS), and a screening instrument for borderline personality disorder. An ordinal regression analysis was applied to determine the predictive effects of the independent variables. Of 336 students, the mean age was 20.26 ± 1.3 years, 80.4% of whom were female; 14.3% had suicidal ideation. The significant predictors of suicidal thoughts were perceived stress (AOR 1.11, 95% CI 1.01 to 1.22); depressive symptoms (AOR 1.16, 95% CI 1.05 to 1.22); borderline personality symptoms (AOR 1.19, 95% CI 1.01 to 1.40); and perceived social support (AOR 0.97, 95% CI 0.94 to 1.00). Not only did depressive symptoms contribute to suicidal ideation but they also constituted important variables. Therefore, they should be included in intervention plans to prevent suicidality among university students.