Interventions on medical students' psychological health: A meta-analysis

Introduction: Three systemic reviews reported that, although many studies echoed the importance of stress management programs in medical curricula, yet very few high quality studies provided convincing evidence of their effectiveness. So far, none of meta-analysis study was done to appraise their effectiveness on medical students' psychological health. Objective: The author conducted a meta-analysis to quantitatively appraise and summarize all studies of stress management interventions on medical students' psychological health that include general psychological distress, stress, anxiety and depression symptoms. Method: The author planned, conducted and reported this study according to the PRISMA standard of quality for reporting meta-analyses. Result: The author yielded 23,921 relevant articles based on search terms and eventually, after critical appraisal, only 13 articles were included in the meta-analysis. Stress management interventions were associated with moderate, statistically significant improvement of medical students' psychological health [-0.335 (95% CI, -0.423, -0.246), P < 0.001] with low inconsistency among the studies (I-2 = 30.46%). Subgroup analyses demonstrated there were consistent interactions with the duration of intervention (Q-value (df) = 15.56 (3), p = 0.001) and research design (Q-value (df) = 4.93 (1), p = 0.026). Sensitivity analyses did not change the study conclusions. Conclusion: Stress management interventions were associated with moderate effects on medical students' psychological health compared with no intervention. Brief to medium-duration intervention demonstrated significant larger effects than long-duration intervention. Likewise, RCT studies showed larger effects than non-RCT studies. Future research with RCT design should directly compare different types of stress management interventions based on a sound theoretical basis.