Medical vs Non-Medical Students: Who Reports More Depression and Anxiety?

Direct answer: In our cross-sectional study of 602 university students in Lahore, Pakistan, non-medical students reported higher depressive and anxiety symptoms than medical students. The difference remained statistically significant after adjustment for measured covariates, while the difference in stress was not statistically significant. However, academic discipline explained only a small proportion of the overall variation in mental-health scores. The findings therefore do not mean that medical students have little psychological distress; instead, they challenge the assumption that medical students must automatically be the most distressed group on campus.

Medical education is frequently associated with demanding schedules, examinations, clinical responsibilities, competition, and concerns about future careers. These pressures have understandably made medical students a prominent population in mental-health research. Yet university students outside medicine face their own combinations of academic, financial, social, employment, family, and career pressures. Direct comparisons between medical and non-medical students are therefore important if universities want to understand where psychological distress actually occurs rather than relying on stereotypes.

Our recently published BMC Psychology study, Psychometric properties and symptom profiles of the PHQ-9 and DASS-21 among medical and non-medical university students, examined this question while also evaluating how well two widely used symptom measures performed in the study population.

Medical vs Non-Medical Students: What Did the Study Find?

The study included 602 undergraduate university students in Lahore, Pakistan. Of these, 424 were medical students and 178 were non-medical students. Participants completed two established self-report instruments: the Patient Health Questionnaire-9, or PHQ-9, and the Depression Anxiety Stress Scales-21, commonly called the DASS-21.

The comparison produced a result that may be surprising to readers who expect medical students to report the greatest psychological burden. Non-medical students had a median PHQ-9 score of 10.0, compared with 9.0 among medical students. The difference was not limited to an unadjusted comparison. In multivariable models, academic discipline remained associated with PHQ-9 depression scores as well as the DASS-21 depression and anxiety domains.

According to the published results, non-medical students had higher adjusted scores on the PHQ-9, DASS Depression, and DASS Anxiety measures. The corresponding differences were statistically significant. By contrast, the adjusted difference in DASS Stress scores did not reach conventional statistical significance.

This distinction matters. The findings do not support a simplistic statement that non-medical students were worse on every psychological measure. They specifically indicate higher reported depressive and anxiety symptoms in this sample, whereas evidence for a difference in stress was weaker.

How Large Was the Difference in Depression?

The median PHQ-9 score was 10.0 among non-medical students and 9.0 among medical students. In the adjusted PHQ-9 model, the reported coefficient corresponding to academic discipline represented an approximately 1.43-point difference between the groups, with a p-value of 0.004.

Statistical significance should not automatically be interpreted as a large or clinically decisive difference. The study itself provides an important qualification: the regression models explained relatively little of the total variation in symptom scores. Reported model R-squared values ranged from approximately 0.029 to 0.041. In practical terms, measured variables in these models accounted for only a modest fraction of why one student reported more symptoms than another.

That is one of the most important messages from the research. Being a medical or non-medical student may contribute some information about symptom patterns at a group level, but academic discipline alone is a poor summary of an individual student’s mental health.

What About Anxiety?

The same general pattern appeared for anxiety. After statistical adjustment, non-medical students had higher DASS Anxiety scores than medical students, with a reported coefficient corresponding to a difference of approximately 2.31 points and a p-value of 0.001.

Again, this should be interpreted as a group-level association within the sampled students rather than evidence that every non-medical student is more anxious than every medical student. The distributions of symptoms inevitably overlap. Some medical students will have substantial anxiety, while many non-medical students will have low symptom scores.

The more useful interpretation is that universities should not assume that psychological support should be concentrated primarily in medical schools. Students from other disciplines may experience an equally important, and in some settings potentially greater, burden of depression or anxiety symptoms.

Did Medical and Non-Medical Students Differ in Stress?

Not convincingly in the adjusted analysis. The reported DASS Stress difference was smaller than the differences observed for depression and anxiety and was not statistically significant at the conventional 0.05 threshold. The study reported a coefficient corresponding to approximately 0.89 points and a p-value of 0.089.

This result illustrates why depression, anxiety, and stress should not automatically be treated as interchangeable concepts. They often correlate strongly, but a factor associated with one domain may not have exactly the same relationship with another.

Interestingly, the psychometric component of the study also found very high correlations among the latent DASS-21 factors. The reported correlations between Depression and Stress and between Anxiety and Stress were approximately 0.94 and 0.95, respectively. Although the conventional three-factor DASS-21 model showed adequate overall fit, these very high correlations raise questions about how distinctly the three subscales separate psychological distress in this particular population.

Why Might Non-Medical Students Report More Depression and Anxiety?

The study was cross-sectional, so it cannot establish why the observed difference occurred. Any explanation should therefore be treated as a hypothesis rather than a demonstrated cause.

There are several plausible possibilities worth considering. Non-medical students encompass diverse fields with different academic structures, career pathways, financial prospects, institutional resources, and support systems. Medical schools, despite their demanding environment, may also provide more structured cohorts, clearer professional pathways, closer peer networks, or greater exposure to health information. Whether any of those mechanisms explains the observed difference cannot be determined from this study.

Likewise, the result should not be interpreted as evidence that medical education protects students from depression or anxiety. The study was designed to compare symptom levels and examine measurement properties, not to identify a protective effect of studying medicine.

Future longitudinal studies could examine whether differences develop before university entry, emerge during particular academic years, vary around examinations, or reflect socioeconomic and career-related factors. More detailed information on finances, academic workload, social support, living circumstances, employment, physical health, and previous psychiatric history could also clarify why symptom patterns differ across disciplines.

Academic Discipline Was Not the Whole Story

Perhaps the strongest lesson from the analysis is that the label attached to a student’s degree program tells us relatively little about their complete psychological situation.

The study identified other variables associated with symptom scores. Female gender predicted higher scores across the measured mental-health domains, with all reported associations reaching statistical significance. Previous treatment for depression was particularly strongly associated with PHQ-9 scores. The study reported prior depression treatment as the strongest predictor in that model, with a coefficient of 4.15 and a p-value below 0.001.

Sleep also mattered. Each additional reported hour of sleep was associated with an approximately 0.37-point lower PHQ-9 score after adjustment, with a p-value of 0.010. Because the data were collected at one point in time, this association cannot establish whether shorter sleep contributed to depressive symptoms, depressive symptoms disrupted sleep, or both were influenced by other factors.

Still, the result reinforces a broader methodological point: comparisons such as “medical versus non-medical” are only one part of the mental-health picture. Student well-being is likely shaped by multiple overlapping influences rather than one academic category.

What Do PHQ-9 and DASS-21 Scores Actually Mean?

Understanding the instruments is essential when interpreting the findings. The PHQ-9 is a nine-item self-report questionnaire measuring the frequency of depressive symptoms over the preceding two weeks. It provides a symptom-severity score. The DASS-21 contains 21 items divided into depression, anxiety, and stress domains.

Neither questionnaire should be treated as equivalent to a comprehensive psychiatric assessment. A high questionnaire score can identify elevated symptoms and may indicate that further evaluation is appropriate, but a research survey does not by itself establish an individual psychiatric diagnosis.

This distinction is particularly important when discussing prevalence or comparing groups. Saying that one group has a higher average or median symptom score is different from claiming that more members of that group have a clinically confirmed depressive or anxiety disorder.

Were the Questionnaires Reliable in This Study?

Reliability and measurement quality were major components of the research rather than secondary details. Internal consistency estimates were acceptable, with Cronbach’s alpha values ranging from 0.82 to 0.88 across the scales examined.

The DASS-21 confirmatory factor analysis also showed adequate overall model fit. The published results reported a Comparative Fit Index of 0.954, Tucker-Lewis Index of 0.948, and root mean square error of approximation of 0.052 for the reported model.

The researchers additionally evaluated measurement invariance across academic discipline. Support for invariance is important because group comparisons become more defensible when a questionnaire appears to measure the underlying constructs in a sufficiently comparable way across the groups being contrasted.

At the same time, the very high correlations between the DASS-21 latent factors suggest that depression, anxiety, and stress responses were closely intertwined in this sample. That finding encourages careful interpretation of precise subscale distinctions.

Which Symptoms Appeared Most Informative?

The study went beyond total questionnaire scores by applying item response theory and symptom network analysis. These approaches can provide information about which individual symptoms are especially informative or structurally prominent within the observed symptom pattern.

Items related to self-worth, concentration, feeling down, and appetite showed comparatively high discrimination in the item-response analysis. The interest or anhedonia item showed the lowest reported discrimination in the PHQ-9 analysis.

Network analysis similarly highlighted symptoms involving self-worth, concentration, and downheartedness as central nodes. However, the reported network stability coefficients ranged from approximately 0.31 to 0.44, so these exploratory symptom-level findings should be interpreted with appropriate caution rather than turned into firm clinical rules.

For research, the results suggest that total symptom scores may conceal meaningful differences in how psychological distress is expressed. Two students with similar total scores can reach them through very different combinations of symptoms.

Does This Mean Non-Medical Students Have a Mental-Health Crisis?

The study does not justify that conclusion. It identifies differences in self-reported symptoms within a specific cross-sectional sample. It cannot establish population-wide prevalence for every university student in Pakistan, demonstrate a temporal increase in mental illness, or prove that academic discipline causes psychological symptoms.

The participants were undergraduate students from universities in Lahore, and the medical and non-medical groups were unequal in size. Results from this setting may not generalize directly to every institution, city, province, country, postgraduate population, or educational system.

Cross-sectional research also cannot determine the direction of associations. For example, although sleep duration was associated with PHQ-9 scores, the study cannot determine from these data alone whether sleep changes preceded depressive symptoms or vice versa.

Self-report instruments introduce additional limitations. Responses may be influenced by interpretation of questionnaire wording, willingness to disclose symptoms, current circumstances, recall, or cultural differences in expressing psychological distress.

Does This Mean Medical Students Are Doing Well?

No. A comparison between two groups is relative. If one group reports a somewhat lower score than another, that does not demonstrate that its absolute level of distress is negligible.

The more appropriate conclusion is that student mental-health programs should avoid designing services around the presumption that one academic discipline necessarily carries the greatest burden. Medical students deserve appropriate support, but so do students in business, engineering, social sciences, humanities, technology, and other disciplines.

Restricting attention to traditionally identified “high-risk” faculties could overlook students elsewhere who experience substantial depression or anxiety symptoms.

What Should Universities Learn From These Findings?

The findings support a campus-wide approach to student mental health. A practical university strategy could include several complementary elements:

• Make support accessible across disciplines. Mental-health resources should not be concentrated exclusively in medical or other traditionally demanding programs.
• Use screening responsibly. Questionnaires can help identify symptom burden, but elevated scores should lead to appropriate assessment rather than automatic diagnostic labels.
• Pay attention to sleep and daily routines. Sleep duration was associated with depressive symptom scores in the study, although the direction of causation cannot be established.
• Recognize demographic and clinical history. Gender and previous depression treatment were more informative in some models than a simple medical-versus-non-medical classification.
• Investigate local patterns. Universities differ in student demographics, workload, socioeconomic circumstances, available support, and campus culture. Institutions should gather evidence relevant to their own students.
• Reduce barriers to seeking care. Support is most useful when students can access it confidentially and without fear that seeking help will damage their academic or professional prospects.

Why the Result Challenges a Common Assumption

Much discussion of university mental health focuses on medical students, and there are understandable reasons for doing so. Medical training can involve heavy coursework, repeated high-stakes examinations, clinical exposure, long training pathways, and substantial professional expectations.

But prominence in the research literature should not be confused with proof that medical students always experience the highest symptom burden. In this Pakistani sample, the opposite pattern appeared for depression and anxiety: non-medical students reported higher scores.

The finding encourages researchers to broaden comparisons rather than repeatedly studying one discipline in isolation. Without a comparison group, it is difficult to determine whether an observed level of distress is specific to medical education or reflects a broader university-student phenomenon.

Why Cross-Disciplinary Studies Matter in Pakistan

Research findings from universities in North America, Europe, or other regions should not automatically be assumed to represent Pakistani students. Educational systems, financial pressures, family expectations, career uncertainty, availability of mental-health services, stigma, and cultural understandings of psychological symptoms can differ substantially between settings.

Cross-disciplinary research conducted locally helps build a more context-specific evidence base. It can also reveal unexpected patterns that would be missed if researchers assumed beforehand which group should have the highest scores.

The current findings suggest that future Pakistani student mental-health research should include broader university populations and should examine socioeconomic, academic, behavioral, and clinical factors simultaneously. Longitudinal designs would be particularly valuable because they could track how symptoms change over semesters, examination periods, clinical rotations, graduation, and entry into employment.

The Most Important Interpretation

The question “Who is more depressed or anxious: medical or non-medical students?” sounds as though it should have a simple answer. The study provides a specific answer for this sample: non-medical students reported higher depression and anxiety scores. Yet the more meaningful conclusion is more nuanced.

The difference between disciplines was real enough to be detected statistically, but discipline explained only a small amount of the overall variation. Individual students differed for many reasons that cannot be captured by whether they studied medicine.

That distinction matters for researchers, university administrators, clinicians, students, and families. Mental-health support should respond to symptoms and individual circumstances, not to assumptions based on a person’s degree program.

Conclusion

Among 602 undergraduate students studied in Lahore, Pakistan, non-medical students reported higher depressive and anxiety symptoms than medical students on the PHQ-9 and DASS-21. The adjusted difference in stress was not statistically significant. Female gender, prior depression treatment, and sleep duration were also associated with symptom scores, while academic discipline accounted for only a relatively small proportion of overall variation.

The findings challenge the widespread assumption that medical students will necessarily be the most psychologically distressed students on a university campus. They do not diminish concerns about medical-student mental health. Instead, they broaden the focus: depression and anxiety are student-health issues that can affect people across academic disciplines.

For universities, the implication is straightforward. Mental-health strategies should be inclusive, evidence-informed, and accessible across faculties. For researchers, the findings underline the value of comparison groups, careful measurement, and cautious interpretation of self-reported symptom scores.

Medical disclaimer: This article is for educational and research communication purposes only. The PHQ-9 and DASS-21 are symptom-assessment tools and do not replace an individualized evaluation by a qualified healthcare or mental-health professional. Anyone experiencing persistent psychological distress, significant impairment, thoughts of self-harm, or concerns about their mental health should seek appropriate professional assessment or urgent assistance when necessary.