For many decades, there has been a persistent myth in medical schools about a condition known as Medical Students Syndrome, or Medical Students’ Disease, which affects young people completing medical degrees [15]. However, everyone agrees that the medical course is one of the most challenging, requiring students to focus their efforts, dedicate themselves to their studies, and face intense competition [16].
Demographics of the study students
Our participants had a median (IQR) age of 22.00 (22.00 to 23.00) years with most of them (72.0%) specializing in medicine and nearly half of them are males. Previous studies had disparities regarding the participating students’ characteristics. Abdullah et al. [17]. included participants with a mean age of 20.6 years, ranging from 17 to 25 years. Females comprised most of the sample at 71% (n = 335), while the nationalities of the participants included Arabs, Emiratis, and non-Arabs. The sample consisted of foundation-year students, preclinical students, and clinical students [17]. Furthermore, Shehata and Abdeldaim [18] included 500 medical students in the Tanta Faculty of Medicine with a mean age of 20.36 years with 43.8% of them being males. More than half of the students (58.2%) lived in rural areas compared to only 34% in our study. Around 60% of the students did not have a positive family history of chronic diseases [18] while only 20.67% did in our study.
Experience, and frequency of the medical field students with illness anxiety disorder
Regarding the frequency of MSS, among Egyptian medical field students who met the DSM-IV criteria for hypochondriasis, 20 (6.67%) had anxiety disorder. According to Abdullah et al.‘s (2023) study [17], 70.8% (334) of the study population had MSS; in Tanta Shehata and Abdeldaim’s (2022) research [18], 78.8% had hypochondriasis. However, in Santa Catarina, Brazil, in 2015, there was a prevalence of 35.5% and 32.8%, respectively, for anxiety symptoms and depression [19], and 66.8% for hypochondriasis, also known as MSS. In Vasconcelos et al., 2015 [20], anxiety prevalence was 19.7%, and depression prevalence was 5.6%. A 2017 study involving 700 medical students in economically developing countries like Egypt revealed a high prevalence of anxiety symptoms at 73% and depression at 65% [21]. In Turkey, they found a prevalence rate of 35.8% for symptoms of medium and moderate anxiety, 30.5% for medium and moderate depression, and 8.5% for severe depression [22].
The disparities in prevalence rates reported in the literature could have resulted from variations in the student body’s geographic and cultural backgrounds, as well as from the techniques and kinds of surveys employed to collect the data. The large number of common symptoms described in the literature could be due to several things, such as the use of different psychometric instruments (the Self-Reporting Questionnaire (SRQ-20), the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI), each with a different level of sensitivity and specificity). Of all the social groups, college students are more likely to develop anxiety and depression disorders. and the fact that students from different countries have very different ways of expressing and recognizing their emotions, both in terms of how strongly they are felt and how they are reported among medical students on several continents [23, 24].
The present study found that most students, 181 (60.33%), were aware of the medical student syndrome. Abdullah et al. (2023) [17] found that, among the students surveyed, 55.9% had previously heard about MSS (n = 264). Only 93 (31.00%) experienced preoccupation with fears of having or the idea that one has a serious disease based on the personal misinterpretation of bodily symptoms while 73 (24.33%) had preoccupation lasted for at least 6 months. In 94 students (31.33%), the preoccupation persisted despite appropriate medical evaluation and reassurance. The students had a median (IQR) score of 5.0 (3.0 to 7.0) for the health illness anxiety.
Of the students, 200 (66.67%) believed that their level of fear and anxiety was not commensurate with the actual risk involved, whereas only 105 (35.00%) felt that their feelings had a negative impact on them. Many theories explain this by suggesting that medical field students, who learn a lot about potentially fatal diseases during their training, may look for symptoms that affect them and worry that they have a serious illness or are exaggerating minor ones. This may prompt them to self-diagnose a specific somatic disease, a condition known as hypochondria. This makes them more likely to experience anxiety or anxiety disorder, which is a mental illness. However, a lack of experience and knowledge could lead to inaccurate diagnoses. Exposure to the symptoms of patients that students interact with, exposure to a stressful and competitive work environment, and students’ emotional responses could all be contributing factors to the emergence of this phenomenon [17].
The present study found that the most common anxiety symptoms were difficulty sleeping (50.00%), lack of productivity or difficulty concentrating (44.0%), and rapid heart rate (31.67%). The participants showed variable attitudes toward such conditions with 189 (63.00%) participants agreeing that medical student syndrome plays a major role in medical students’ lives. 209 individuals (69.67%) perceived a healthier lifestyle as the most effective preventive measure.
Differences in the illness anxiety score across the demographic variables
Age determinants
The current study’s results revealed a weakly negative correlation (r = -0.12, p-value = 0.04) between the health illness anxiety score and age. We found that students between the ages of 16 and 20 were 2.02 times less likely to have felt they had MSS compared to students in the age range of 21 to 25 (p = 0.001). In agreement with Abdullah et al. (2023) [17], this type of environment subjects young medical students to extreme stress. They are also more likely than their peers to experience anxiety, depression, and other mental health issues [18].
Sex as an MSS determinant
The current study revealed that females had higher illness anxiety scores (median of 6.00) than males (median of 4.00), with a p-value of less than 0.01. In agreement with the researcher, women were more likely than men to suffer from hypochondriasis [18]. Specifically, Backović et al. (2012) [25] Faravelli et al., (2013) [26]; Karger, (2014) [27], Moskalewicz et al., (2015) [28]; and Fawzy & Hamed (2017) [21] found that women are more likely than men to display morbid fear for their health among the 606 students from the Silesian region [29].
Studies hypothesize that there are several potential reasons for this gender dependence, including Neuroendocrine factors linked to hormonal cycles, as well as psychological and physiological factors, which may contribute to this gender dependence, given that women are more likely to claim specific illnesses. However, we must approach the diagnosis of anxiety disorder in this population with caution, considering the family history of somatic diseases and the patient’s past medical conditions. Compared to men, women respond faster to the first signs of disease, and they are more likely to focus on their bodies and any health issues they may be experiencing. Moreover, women are characterized by a greater need to talk about their health with others. They also more often decide to contact a specialist doctor, who can address their health worries. The stereotype of men presenting to health care professionals late and less often in our culture appears to hold [29]. In addition to environmental factors and social, work, and family stressors, females perform numerous social roles outside of the classroom, potentially contributing to their higher rates of burnout. These roles consume the energy and time required for learning and resting. Furthermore, female students tend to have a lower stress threshold, rather than experiencing more stressors than their male counterparts [30, 31].
Regarding the academic year
More than three-quarters of those with hypochondriasis (77.2%) were students whose parents did not work in the medical field. Furthermore, compared to their first- and fourth-year counterparts, sixth-year students (clinical year students, fourth to sixth medical year) have the highest prevalence across all burnout syndrome dimensions. This outcome is in line with the findings of Melaku et al. (2015) [32], who investigated and concluded that among 329 medical field students who move into more advanced stages of their education, their level of burnout rises. According to Santen et al. (2010) [33], among all the students in various years, there is not a statistically significant difference.
Regarding the academic year as an MSS determinant
More than three-quarters of hypochondriasis patients (77.2%) were students whose parents did not work in the medical field. Additionally, sixth-year students (clinical year students, fourth to sixth medical year) have the highest prevalence across all dimensions of burnout syndrome when compared to their first- and fourth-year counterparts. Melaku et al. (2015) [32] found that 329 medical students’ degree of burnout increases as they progress through higher educational stages, which is consistent with this result. Santen et al. (2010) [33] state that there is not a statistically significant difference between all of the students in different years.
A medical student’s academic path entails a demanding and drawn-out daily schedule of activities, which includes long journeys that interfere with socializing, unwinding, and even sleeping [34]. Bertani et al. (2020) [35] discovered that several academic factors could be responsible for this high level of stress and anxiety, including a heavy workload, the amount of time spent on hospital internships and curricular lessons, a competitive environment, difficult and remembered subjects, and frequent exams. Furthermore, intricate interactions with patients and their families may exacerbate the psychological and emotional strain of the degree course.
In addition, those from rural areas (55.6%, 51.5%, and 58.6%, respectively), and Egyptian students had higher scores (median of 5.00 compared to 4.00; p-value = 0.02) compared to other nationalities in agreement with Shehata and Abdeldaim, (2022) [18].
Comorbidities, and family history
Despite The majority of students (74.67%) did not have any long-term mental or organic health conditions. The most frequent conditions linked to illness anxiety among the participants in this study were tumors (7.00%), diabetes mellitus (5.33%), depression (5.00%), and obsessive-compulsive disorder (3.67%). 77.7% of medical students who were hypochondriacs had never taken sleep or psychiatric medication, and the majority of them (84.8%) had never seen a psychiatrist [18].
Contact with the patient’s anguish, pain, and even death events that also induce anxiety and stress in medical field students is another crucial component. Due to the students’ lack of time or the school’s negligence, it is difficult to take care of one’s health, which raises the risk of developing burnout syndrome and experiencing symptoms of anxiety and depression [36].
More than half of those with hypochondriasis (58.4%) did not have a family history of chronic illnesses. According to Szczurek et al. (2021) [13], students who received treatment for other mental disorders or had a family history of mental disorders indicated on the questionnaire were much more likely to report having hypochondria and a fear of getting sick. This could be the result of specific disorders coexisting [37].
Comparing medicine to dentistry
Participants specializing in medicine had the lowest anxiety scores (median of 4.00), while those in dentistry had the highest anxiety scores (median of 7.50) (p-value < 0.01). The environment places a great deal of stress on young medical students. Compared to their peers, they also have a higher likelihood of experiencing anxiety, depression, and other mental health issues. However, it is noteworthy to remember that some students’ well-being is not, and may never be, in danger [18].
Association between MSS and other mental (psychiatric) illnesses
Our results ensure that monitoring of anxiety and depression levels among medical students is important. Consistently, a multi-systemic and comprehensive approach with specific policies, should address increased levels of anxiety and depression. Examples of this approach include the VMS Wellness Program of the Vanderbilt School of Medicine and the Dutch 4T-CABS (Four-Tier Continuum of Academic and Behavioral Support). The integration of such programs in the university curriculum could potentially improve the psychophysical well-being of students, reduce burnout, and improve their performance [38].
Personality is a strong predictor of well-being
We detected the highest score for being sympathetic and warm, followed by dependable and self-disciplined. Conversly, the lowest score was for being critical and quarrelsome, followed by disorganized and careless. However, the effects of personality on students’ well-being are complex, integrating a combination of multiple traits and the situation. Well-being can be defined differently by everyone out of each person’s unique experiences and interests, however, all the components of health and well-being (i.e., physical, emotional, social, cognitive, and spiritual) are interdependent and influenced by personality [39].
We revealed a negative correlation between health anxiety illness and being dependable and self-disciplined (r = − 0.19, p-value < 0.01). On the other hand, the personality characteristic of being anxious and easily upset was positively correlated with the health anxiety score (r = 0.34, p-value < 0.01) which is in line with the literature. This association includes two personality dimensions belonging to the area of internalization, marked by depression, anxiety, anhedonia, and social withdrawal [27]. Our findings confirm the relationship between personality and anxiety symptoms and suggest the importance of early identification of maladaptive personality traits. Nevertheless, since the study is transversal, it does not allow the demonstration of a unilateral causal relationship; it could also prove how the onset of anxiety or mood disorders can lead to the development of maladaptive behavioral characteristics.
The impact of MSS on the student’s life
Although only a minority is fitting the criteria for illness anxiety disorder (3.67%) and hypochondriasis (6.67%), more than half of the participants (55%) react to the illness anxiety symptoms with 25.33% exhibiting care-avoidant type. Shehata and Abdeldaim [18] reported that more than half of the students with hypochondriasis (53.6%) experienced mild stimuli as they ignored them. In response to these stimuli, 33% of the students investigated further. These feelings lasted for days for 24.9% of students. On the other hand, Sadiq et al. [40] found that 13.9% of their medical students visited a psychiatrist, and 22.8% reported taking psychiatric medications before. Interestingly, nearly a third of our participants (30.33%) admitted experiencing such symptoms before the medical school. However, other studies on Saudi Arabian medical students revealed that 40.9% of them admitted to self-medicating for their symptoms [3]. Abdullah et al. [17]. reported that they asked participants who felt they had a disease they studied to elaborate on their feelings. Among all participants, 28% sought medical assistance (n = 92), and 37% mentioned a presumed disease diagnosis (n = 34).
While half of the study participants believed that MSS is a phase in the student’s life, most of them agree it has a negative effect and play a major role in their lives. The results of our study may have some implications for medical students’ health policy. The high frequency of mental health problems among medical filed students should raise the institutions’ and academicians’ attention. This is why some authors analyzing this problem postulate that mental health services should be available, accessible, and affordable at universities for every students on a regular basis [41, 42].
Strengths, and limitations
This study had many strengths, including being the first to highlight the interactions between medical students’ syndromes and personality types. Moreover, we analyze multiple determinants of MMS and its impact, paving the way for further research. Although we used three validated tools in this study, including the MSS questionnaire, which met al.l the criteria of DSM-IV and DSM-V, and the personality types questionnaire among medical field students (7, 9–10, 13, 14, 15), the condition still requires further clinical diagnosis. Moreover, the self-administered nature of the questionnaire ensures voluntary and transparent participation. This approach mitigates the potential influence of wish-related bias—the perception of mental health issues as social stigma—but is associated with all the drawbacks of cross-sectional studies, including self-recall biases in the results. Despite the potential impact of a single-setting study on generalizability, its relatively large size enhances its power. Finally, the study does not elaborate on the implications of MSS on the medical profession and patient care, despite briefly discussing the attitudes of medical field students regarding MSS and finding no correlation with their academic performance.
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