Mental Health as a Determinant Factor in Academic Performance: A cross-sectional study among medical students of Mashhad University of Medical Sciences, Mashhad, Iran

Document Type : Original Article


1 Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran

2 Resident of cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Community and Family Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Background: Students' mental health has a strong relation to their quality of life and their academic success. This study aims to assess the mental health of medical students throughout different educational courses including pre-clinical, externship, and internship, and its association with students' academic performance at Mashhad University of Medical Sciences.
Methods: This cross-sectional analytical study was performed on all medical students studying in the first semester of pre-clinical course, at the beginning of the externship, and the beginning of the internship at Mashhad University of Medical Sciences in 2019. In this study, a general mental health questionnaire containing 12 questions (GHQ-12) was used. Data analysis was performed using chi-square and t-test using SPSS 16.
Results: The mean age of students was 22.61 + 1.79. In this study, approximately 40% of students scored higher than the threshold for the GHQ-12 questionnaire, indicating that they experienced more psychological distress than others. The highest score was related to the and the lowest score was related to externs. In addition, although students with higher academic scores have lower psychological stress and better mental health status than other students, these differences were not significant.
Conclusion: The results showed that overall nearly half of medical students based on the GHQ-12 questionnaire are subject to psychological stress. These stresses not only affect their mental health but also affect their academic performance.


  1. Ginawi I, Awdah A, Raja N, Abdalla ME. Do Study of Medicine leads to increase depression and anxiety, Study from Ha’il University, Saudi Arabia. Sud J of Public Health. 2014;9(1):7-13.
  2. Kessler RC, Sampson NA, Berglund P, Gruber M, Al-Hamzawi A, Andrade L, et al. Anxious and non-anxious major depressive disorder in the World Health Organization World Mental Health Surveys. Epidemiol Psychiatr Sci. 2015;24(3):210-26.
  3. Auerbach RP, Alonso J, Axinn WG, Cuijpers P, Ebert DD, Green JG, et al. Mental disorders among college students in the World Health Organization world mental health surveys. Psychol Med. 2016;46(14):2955-70.
  4. Sadock B, Ruiz P. Kaplan & Sadock's synopsis of psychiatry: Behavioral sciences: Walters Kluwer; 2015.
  5. Elliott DS, Huizinga D, Menard S. Multiple problem youth: Delinquency, substance use, and mental health problems: Springer Science & Business Media; 2012.
  6. Shariati M, Kaffashi A, Ghalehbandi M.F, Fateh A, Ebadi M. Mental health in medical students of the Iran University of Medical Sciences (IUMS). Payesh. 2002;1(3):29-37. Persian.
  7. Narimani A, Akbarzadeh M, Hamzeh M. Evaluation of general health in medical students of aja university of medical sciences, 2009. Annals of Military and Health Sciences Research. 2010;8(1 (serial number 29)):49-55. Persian.
  8. Firth J. Levels and sources of stress in medical students. Br Med J (Clin Res Ed). 1986;292(6529):1177-80.
  9. Lomis KD, Carpenter RO, Miller BM. Moral distress in the third year of medical school; a descriptive review of student case reflections. The American Journal of Surgery. 2009;197(1):107-12.
  10. Goebert D, Thompson D, Takeshita J, Beach C, Bryson P, Ephgrave K, et al. Depressive symptoms in medical students and residents: a multischool study. Acad Med. 2009;84(2):236-41.
  11. Rosal MC, Ockene IS, Ockene JK, Barrett SV, Ma Y, Hebert JR. A longitudinal study of students' depression at one medical school. Acad Med. 1997;72(6):542-6.
  12. Tayefi B, Eftekhar M, Tayefi M, Darroudi S, Khalili N, Mottaghi A, et al. Prevalence and Socio-Demographic Correlates of Mental Health Problems Among Iranian Health Sciences Students. Acad Psychiatry. 2020;44(1):73-7.
  13. Iqbal S, Gupta S, Venkatarao E. Stress, anxiety & depression among medical undergraduate students & their socio-demographic correlates. Indian J Med Res. 2015;141(3):354.
  14. Williams P, Goldberg D. A user's guide to the General Health Questionnaire. Berkshire: Nfer, Nelson. 1988.
  15. Goldberg D, Williams P. General health questionnaire (GHQ). Swindon, Wiltshire, UK: nferNelson. 2000.
  16. GOLDBERG D, Blackwell B. 0970) Psychiatric illness in general practice. A detailed study using a new method of case identification. Br Med J. ii.439-43.
  17. Montazeri A, Harirchi AM, Shariati M, Garmaroudi G, Ebadi M, Fateh A. The 12-item General Health Questionnaire (GHQ-12): translation and validation study of the Iranian version. Health Qual Life Outcomes. 2003;1(1):66.
  18. Moradian Sorkhkalaee M, Eftekhar H, Nejat S, Saeepour N, Esmaeel Shemirzadi S. The state of mental health of students of Tehran medical sciences university in the academic year 2010-2011. Jorjani Biomedicine Journal. 2012(1):16-22. Persian.
  19. Salama-Younes M, Montazeri A, Ismaïl A, Roncin C. Factor structure and internal consistency of the 12-item General Health Questionnaire (GHQ-12) and the Subjective Vitality Scale (VS), and the relationship between them: a study from France. Health Qual Life Outcomes. 2009;7(1):1-6.
  20. Zaid Z, Chan S, Ho J. Emotional disorders among medical students in a Malaysian private medical school. Singapore Med J. 2007;48(10):895.
  21. Carson AJ, Dias S, Johnston A, McLoughlin M, O'connor M, Robinson B, et al. Mental health in medical students a case control study using the 60 item general health questionnaire. Scott Med J. 2000;45(4):115-6.
  22. Yusoff MSB, Rahim AFA, Yaacob MJ. Prevalence and sources of stress among Universiti Sains Malaysia medical students. The Malaysian journal of medical sciences: MJMS. 2010;17(1):30.
  23. Aktekin M, Karaman T, Senol YY, Erdem S, Erengin H, Akaydin M. Anxiety, depression and stressful life events among medical students: a prospective study in Antalya, Turkey. Medical education. 2001;35(1):12-7.
  24. Shaikh B, Kahloon A, Kazmi M, Khalid H, Nawaz K, Khan N, et al. Students, stress and coping strategies: a case of Pakistani medical school. Educ Health. 2004;17(3):346-53.
  25. Supe A. A study of stress in medical students at Seth GS Medical College. J Postgrad Med. 1998;44(1):1.
  26. Saipanish R. Stress among medical students in a Thai medical school. Med teach. 2003;25(5):502-6.
  27. Sreeramareddy CT, Shankar PR, Binu V, Mukhopadhyay C, Ray B, Menezes RG. Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal. BMC Med educ. 2007;7(1):26.
  28. Borjalilu S, Mohammadi A, Mojtahedzadeh R. Sources and severity of perceived stress among Iranian medical students. Iran Red Crescent Med J. 2015;17(10).
  29. Jafari N, Loghmani A, Montazeri A. Mental health of medical students in different levels of training. Int J Prev Med. 2012;3(Suppl1):S107.
  30. Bíró É, Balajti I, Ádány R, Kósa K. Determinants of mental well-being in medical students. Soc Psychiatry Psychiatr Epidemiol. 2010;45(2):253-8.
  31. Shah M, Hasan S, Malik S, Sreeramareddy CT. Perceived stress, sources and severity of stress among medical undergraduates in a Pakistani medical school. BMC med educ. 2010;10(1):2.