Medical students' health-related quality of life: roles of social and behavioural factors

OBJECTIVES The long and demanding course of medical education may be accompanied by distress with serious consequences. This study was conducted to assess the multidimensional health-related quality of life (HR-QoL) in medical students in different stages of medical education and its associations with behavioural and social factors. METHODS A cross-sectional study was conducted in medical students at three medical schools at, respectively, Tehran University of Medical Sciences, Aja University of Medical Sciences and Baghiyatalah Medical School, in November and December 2011 using stratified sampling. Data were obtained on participants' characteristics, including gender, current education stage, living situation, smoking status, physical activity, and membership of associations or teams. Health-related QoL was measured using the Persian version of the 36-item Short Form Health Survey (SF-36), which generates a physical component score (PCS) and a mental component score (MCS). Logistic regression was applied to measure the adjusted associations between variables. RESULTS Of the 1350 students invited, 1086 individuals completed the survey to give a response rate of 80.4%. Logistic regression showed male gender (odds ratio [OR] = 2.88, p < 0.001), living with family versus in a dormitory (OR = 2.72, p < 0.001) and participation in daily physical activity (OR = 16.96, p < 0.001) to be significantly associated with a higher PCS. Being in an internship versus in the basic sciences stage of medical education showed a significant association with a lower PCS (OR = 0.12, p < 0.001). Similarly, male gender (OR = 1.67, p < 0.05), living with family rather than in a dormitory (OR = 16.91, p < 0.001), daily physical activity (OR = 25.36, p < 0.001), and membership of associations or teams (OR = 3.67, p < 0.001) were associated with a higher MCS. Likewise, studying in internship rather than in the basic sciences stage was accompanied by a lower MCS (OR = 0.12, p < 0.001). CONCLUSIONS This large, multi-institution study, despite its limitations, indicates that medical students in internships show lower scores in all domains of QoL. Social engagement is an important associate of higher HR-QoL. Further studies should address the efficacy of interventions, such as self-awareness programmes and initiatives to encourage students to be more physically and socially active, in improving students' health.