Are Medical Students Really More Depressed? What Our Study of Pakistani University Students Found

The short answer is no—not in our sample. Although medical education is widely associated with psychological pressure, our study of 602 university students in Lahore, Pakistan, found that non-medical students reported higher depressive symptoms than medical students. They also reported higher anxiety symptoms after adjustment for measured factors, while the difference in stress was not statistically significant. The broader message is more important than deciding which academic group is “more depressed”: mental-health difficulties affect students across disciplines, and academic major alone explains only a small part of the variation in symptoms.

Our study, published in BMC Psychology in August 2026, examined both symptom differences and the measurement properties of two commonly used mental-health questionnaires: the Patient Health Questionnaire-9 (PHQ-9) and the 21-item Depression Anxiety Stress Scales (DASS-21). Readers interested in the complete methods, statistical analyses, and results can read the full BMC Psychology study on PHQ-9 and DASS-21 symptom profiles among Pakistani university students.

The findings challenge a simple narrative in which medical students are automatically assumed to be the university population with the greatest depressive burden. At the same time, they should not be interpreted as evidence that medical training is psychologically harmless or that non-medical education itself causes depression. The study was cross-sectional, and the differences between groups were modest. What the results support is a more inclusive approach to campus mental health.

Why ask whether medical students are more depressed?

Medical students have long attracted attention in mental-health research. The reasons are understandable. Medical training can involve demanding examinations, a large academic workload, exposure to illness and death, long study hours, uncertainty about career progression, competition, and pressure to perform. These experiences can contribute to psychological distress, and research on medical students remains important.

However, focusing almost exclusively on medical students creates another problem: students in other disciplines also face substantial pressures. Financial uncertainty, family expectations, academic competition, employment concerns, relationship difficulties, limited social support, poor sleep, and uncertainty about the future are not unique to medical schools.

If researchers examine only medical students, a high level of depressive symptoms can easily be interpreted as evidence that medicine is uniquely responsible. A direct comparison with students studying other subjects provides a more informative test of that assumption.

That was one reason our study compared medical and non-medical university students rather than examining medical students in isolation.

What our Pakistani university student study examined

We conducted a cross-sectional survey involving 602 undergraduate university students in Lahore, Pakistan. Of these, 424 were medical students and 178 were non-medical students. Participants completed established self-report measures of psychological symptoms, including the PHQ-9 and DASS-21.

The study had two closely connected objectives. First, we wanted to compare depressive and related psychological symptoms between medical and non-medical students. Second, we wanted to examine how well the PHQ-9 and DASS-21 functioned psychometrically in this student population.

That second question matters because mental-health research should not simply calculate questionnaire totals and assume that every instrument performs identically in every population. Reliability, factor structure, item behavior, and measurement comparability can influence how confidently researchers interpret observed scores.

Our analyses therefore extended beyond simple averages. They included descriptive statistics, group comparisons, multivariable regression, confirmatory factor analysis, item response theory, symptom network analysis, reliability assessment, and testing of measurement invariance across academic discipline.

So, were medical students more depressed?

No. The observed pattern went in the opposite direction.

Non-medical students had a median PHQ-9 score of 10, compared with 9 among medical students. In adjusted regression analyses, non-medical students also showed higher PHQ-9 depressive symptom scores.

The difference was not limited to the PHQ-9. In adjusted DASS-21 models, non-medical students had higher depression and anxiety scores than medical students. The difference in DASS-21 stress scores, however, did not reach statistical significance.

This distinction is useful. Depression, anxiety, and stress are related constructs, but they are not interchangeable. Our results did not show a uniform pattern in which one academic group scored higher across every possible measure of psychological distress.

Key group findings

• Non-medical students had a median PHQ-9 score of 10 compared with 9 among medical students.
• After adjustment, non-medical students had higher PHQ-9 depressive symptom scores.
• Non-medical students also had higher adjusted DASS-21 depression scores.
• DASS-21 anxiety scores were higher among non-medical students in the adjusted model.
• The adjusted difference in DASS-21 stress scores was not statistically significant.

These findings challenge the assumption embedded in the question “Are medical students more depressed?” The answer can depend on the population being studied, the comparison group, the instrument used, and the social and academic context.

Academic discipline explained only a small part of the picture

One of the most important findings can be missed if attention is focused only on whether the medical versus non-medical difference reached statistical significance.

The regression models explained only a small proportion of the overall variation in symptom scores. In other words, knowing whether a student was studying medicine was not enough to meaningfully explain most individual differences in depression, anxiety, or stress.

This is a crucial point for interpreting the study responsibly. A statistically detectable average difference between two groups does not mean that academic discipline determines an individual student’s mental health. There can be substantial overlap between groups. Some medical students may experience severe distress, while many non-medical students may have few symptoms, and vice versa.

Student mental health is influenced by multiple interacting factors. Academic discipline is only one potential component.

Female students reported higher psychological symptom scores

Gender showed a more consistent relationship with symptoms in our analyses. Female students had higher scores across the psychological domains examined in the adjusted models.

This finding should be interpreted as an association within the study rather than evidence that gender itself directly causes depression or anxiety. Cross-sectional questionnaires cannot identify the biological, social, cultural, academic, or economic mechanisms responsible for an observed difference.

Possible influences in university populations can include differences in social expectations, perceived safety, family responsibilities, exposure to stressors, coping opportunities, willingness to report symptoms, and access to support. Our study was not designed to establish which mechanisms account for the observed gender pattern.

For universities, however, the practical implication is that aggregate academic-discipline comparisons should not obscure potentially important demographic and social differences within the student population.

Sleep was also associated with depressive symptoms

Another notable result involved sleep. Each additional reported hour of sleep was associated with a lower PHQ-9 score in the adjusted analysis.

This does not establish that increasing sleep by a particular amount will automatically reduce depression by a predictable amount. Because the data were cross-sectional, the direction of the relationship cannot be determined. Poor sleep may contribute to emotional difficulties, depressive symptoms may disturb sleep, and both may reflect other underlying stressors.

Nevertheless, the association is relevant to university life. Students frequently sacrifice sleep during examinations, assignments, clinical rotations, employment, commuting, or late-night digital activity. Sleep health therefore deserves attention in broader student-wellbeing programs rather than being treated solely as a lifestyle issue.

Previous depression treatment was strongly associated with current symptoms

Among the variables examined, a history of previous depression treatment showed a strong association with higher current symptom scores. This is clinically plausible because individuals who have previously required treatment may remain vulnerable to recurrent or persistent symptoms.

Again, this is an association rather than a causal finding. The study cannot determine whether earlier treatment influenced current symptoms or reconstruct individual clinical histories. It does reinforce an important principle for student support services: students with a history of mental-health difficulties may benefit from accessible pathways to continued professional care when needed.

What did we learn about the PHQ-9 and DASS-21?

Our research was not simply a comparison of medical and non-medical students. We also investigated whether two widely used questionnaires performed adequately in this population.

Reliability was acceptable

Internal-consistency estimates were within an acceptable range across the scales, with Cronbach’s alpha values from approximately 0.82 to 0.88. This suggests that items within the measures showed reasonable consistency in this sample.

Reliability alone, however, does not prove that a questionnaire diagnoses a disorder or that its theoretical structure works perfectly. That is why additional psychometric analyses were performed.

The DASS-21 showed adequate overall model fit, but its dimensions were highly correlated

Confirmatory factor analysis of the DASS-21 produced adequate fit indices. At the same time, correlations between its latent depression, anxiety, and stress dimensions were extremely high, particularly between depression and stress and between anxiety and stress.

This raises a useful measurement question. If supposedly separate psychological dimensions are almost perfectly correlated in a particular population, researchers should consider whether the subscales are functioning as clearly distinguishable constructs or are capturing a broader common dimension of emotional distress.

This does not mean the DASS-21 is unusable. Rather, it illustrates why psychometric evaluation should accompany substantive interpretation, especially when instruments developed or validated in one setting are applied in another cultural or linguistic context.

Measurement invariance supported the discipline comparison

Our analyses supported measurement invariance across medical and non-medical students. This is important because group comparisons are more meaningful when there is evidence that the instrument measures the underlying construct in a comparable way across the groups being contrasted.

Without such testing, an apparent difference in total scores could theoretically reflect differences in how questionnaire items function rather than differences in the underlying symptoms themselves.

Which depressive symptoms appeared especially informative?

The item-level analyses added another layer to the findings. Item response theory suggested that symptoms involving self-worth, concentration, feeling down, and appetite were among the more discriminating PHQ-9 items in this population. The loss-of-interest item showed comparatively lower discrimination.

Network analysis similarly highlighted self-worth, concentration, and downheartedness as relatively central symptoms within the observed symptom network.

These findings should not be interpreted as a new diagnostic hierarchy or as evidence that other depressive symptoms are unimportant. Network centrality and item discrimination are statistical properties, and their estimates can vary across datasets. Stability estimates in our network analysis were moderate rather than uniformly strong.

Still, the convergence of several analyses suggests that cognitive and self-evaluative symptoms deserve further investigation in Pakistani university populations.

Why the findings matter beyond medical schools

The most practical lesson from this study is that universities should avoid designing mental-health strategies around the assumption that distress belongs primarily to one professional discipline.

Medical students undoubtedly deserve mental-health support. But so do students in business, science, engineering, social sciences, arts, and other programs. In our sample, non-medical students actually reported somewhat higher depressive and anxiety symptoms.

A campus-wide approach could include:

• confidential and accessible psychological counselling;
• clear referral pathways for students requiring professional assessment;
• mental-health literacy and stigma-reduction initiatives;
• reasonable academic support during periods of significant illness or distress;
• attention to sleep and workload patterns;
• training for faculty to recognize when a student may need additional support;
• special consideration of groups showing consistently elevated symptom burden; and
• routine evaluation of whether support services are actually reaching students who need them.

Such programs should be evaluated rather than assumed to work. Universities differ considerably in resources, student populations, culture, academic demands, and access to specialist mental-health services.

What the study does not prove

Several limitations are essential when interpreting these results.

It was a cross-sectional study

All variables were assessed at a particular period rather than followed longitudinally. Therefore, we cannot determine temporal direction or causality. For example, the association between sleep and depression does not tell us whether poor sleep preceded depressive symptoms or resulted from them.

Questionnaire symptoms are not the same as a clinical diagnosis

The PHQ-9 and DASS-21 are self-report symptom measures. A higher questionnaire score should not automatically be interpreted as a confirmed depressive or anxiety disorder. Clinical diagnosis requires appropriate assessment using relevant diagnostic criteria and professional judgment.

The sample does not represent every Pakistani university student

The participants were university students in Lahore. Pakistan has considerable geographic, socioeconomic, linguistic, educational, and cultural diversity. Results from one sample should not be assumed to describe every institution or province.

The groups were not equal in size

There were substantially more medical than non-medical participants. Although statistical modelling was used, future studies would benefit from larger, more diverse, and more balanced samples across academic disciplines.

Unmeasured factors probably matter

The low proportion of variance explained by the regression models indicates that many influences on student mental health were not captured. Financial stress, family relationships, academic performance, social support, personality, physical health, trauma exposure, substance use, employment, housing, and other contextual factors may contribute.

Should we stop worrying about medical student mental health?

Absolutely not. That would be the wrong conclusion.

The finding that non-medical students reported higher average depressive symptoms does not make psychological distress among medical students unimportant. Nor does a group average tell us whether an individual student requires support.

The better conclusion is that mental-health policy should not become a competition over which degree program suffers most. Medical students face real pressures, but psychological distress can also be substantial among students outside medicine.

Instead of asking only, “Are medical students more depressed?”, a more useful set of questions is: Which students are struggling? What factors are associated with their difficulties? Are our screening tools functioning appropriately? Can students obtain help without stigma or unnecessary barriers? And which interventions improve outcomes?

The larger message from our research

Our study adds evidence from Pakistan to a broader conversation about university mental health. In this sample, the common assumption that medical students necessarily experience the greatest depressive burden was not supported. Non-medical students reported higher depressive and anxiety symptom scores, although differences were modest and academic discipline explained little of the overall variation in psychological symptoms.

The psychometric findings also remind researchers that measuring mental health is not merely a matter of administering a questionnaire and reporting a score. Reliability, factor structure, item performance, measurement invariance, and cultural context all affect interpretation.

Future research should follow students over time, recruit from multiple universities and regions, investigate a wider range of social and academic determinants, and examine whether differences persist across educational settings. Longitudinal research would be particularly valuable for understanding how symptoms evolve during university education and which factors precede improvement or deterioration.

For now, the most defensible conclusion is straightforward: student mental health deserves attention across the entire university, not only within medical schools.

Frequently asked questions

Are medical students more depressed than non-medical students?

Not necessarily. In our sample of 602 Pakistani university students, non-medical students had higher depressive symptom scores than medical students. Results can differ between populations, institutions, countries, and measurement methods, so this finding should not be generalized to every university.

How many students participated in the study?

The study included 602 undergraduate students in Lahore, Pakistan: 424 medical students and 178 non-medical students.

Which mental-health questionnaires were used?

The study used the Patient Health Questionnaire-9 (PHQ-9) and the 21-item Depression Anxiety Stress Scales (DASS-21). Both are symptom-assessment instruments rather than substitutes for a complete clinical evaluation.

Did non-medical students also report more anxiety?

Yes. In the adjusted analysis, non-medical students had higher DASS-21 anxiety scores as well as higher depression scores. The adjusted difference in DASS-21 stress was not statistically significant.

Can a high PHQ-9 score diagnose depression?

No. The PHQ-9 is widely used to assess depressive symptom burden and support screening, but a questionnaire score alone does not establish an individual psychiatric diagnosis. Appropriate clinical assessment is needed when diagnosis or treatment decisions are being considered.

Medical disclaimer

This article is intended for educational and research communication purposes and does not provide individual medical or mental-health advice. Screening questionnaires such as the PHQ-9 and DASS-21 do not replace evaluation by a qualified healthcare professional. Anyone experiencing persistent psychological distress, thoughts of self-harm, or significant impairment in daily functioning should seek appropriate professional assessment or urgent assistance when necessary.