We Expected Medical Students to Have Worse Mental Health. The Data Told a Different Story

Medical students are often treated as the obvious high-risk group when university mental health is discussed. Their workload, examinations, clinical exposure, long study hours, and competitive training make that assumption understandable. Yet when we compared medical and non-medical university students in Pakistan, the pattern was not what we expected: non-medical students reported higher depressive symptoms, and the difference remained after accounting for several measured characteristics. Anxiety showed a similar pattern, while stress did not differ clearly between the groups.

This does not mean that medical students have good mental health, nor does it overturn decades of evidence showing substantial psychological distress in medical education. Instead, it highlights a more useful lesson: mental-health risk cannot be inferred reliably from a student’s degree programme alone. University students outside medicine may face equally serious, and sometimes greater, psychological burdens that receive much less attention.

By Taimoor Asghar

Why we expected medical students to score worse

There is a strong research-based reason to pay attention to medical-student mental health. Medical training combines demanding academic schedules with examinations, competition, changing clinical responsibilities, exposure to illness and suffering, uncertainty about future careers, and limited time for recovery. These pressures have generated an extensive international literature on depression, anxiety, burnout, sleep problems, and suicidal ideation among medical students.

A widely cited systematic review and meta-analysis published in JAMA in 2016 synthesized data from more than 100,000 medical students across dozens of countries and estimated that 27.2% experienced depression or depressive symptoms. The researchers also reported substantial heterogeneity between studies, an important reminder that prevalence varies considerably depending on the population, instrument, setting, and methodology.

Because medical students have been studied so intensively, however, an unintended impression can emerge: that they must necessarily have worse mental health than students in other disciplines. That is a different claim, and it requires direct comparison.

University life creates pressures far beyond medicine. Non-medical students can experience academic competition, financial uncertainty, employment concerns, family expectations, social isolation, relationship difficulties, disrupted sleep, questions about career direction, and limited access to psychological support. Some may also have fewer structured institutional support systems than students enrolled in professional programmes.

So the scientifically useful question is not simply, “Are medical students distressed?” We already know that many are. A better comparative question is: when medical and non-medical students are measured in the same setting using the same instruments, do their symptom profiles actually differ?

What our 602-student study examined

Our cross-sectional study included 602 undergraduate university students in Lahore, Pakistan: 424 medical students and 178 non-medical students. Participants completed two widely used psychological symptom measures, the Patient Health Questionnaire-9 (PHQ-9) and the 21-item Depression Anxiety Stress Scales (DASS-21).

The PHQ-9 measures nine depressive symptoms over the preceding two weeks. The DASS-21 provides separate symptom scores for depression, anxiety, and stress. These are screening and symptom-severity instruments rather than stand-alone clinical diagnostic interviews.

The study went considerably beyond simply reporting average questionnaire scores. Analyses included group comparisons, multivariable regression, confirmatory factor analysis, item response theory, reliability assessment, measurement evaluation, and symptom network analysis. Readers interested in the complete methodology and results can consult the published BMC Psychology study of PHQ-9 and DASS-21 symptom profiles among Pakistani university students.

For the question in this article, however, one result is especially important: the comparison between medical and non-medical students did not follow the intuitive expectation that the medical group would report greater psychological distress.

The first surprise: PHQ-9 depression scores were higher outside medicine

Medical students had a median PHQ-9 score of 9, while non-medical students had a median score of 10. The unadjusted group difference was statistically significant.

A one-point difference in medians should not be exaggerated. Individual mental-health experiences vary far more than a single point on a questionnaire, and statistical significance is not synonymous with large clinical importance. What made the finding more interesting was what happened after adjustment.

In multivariable analysis, academic stream remained associated with PHQ-9 scores. Non-medical students had approximately 1.4 points higher adjusted PHQ-9 scores than medical students, with a p-value of 0.004.

That result challenges a simple hierarchy in which medical students automatically occupy the highest-risk position. It suggests that, within this sample and after accounting for the variables included in the model, non-medical students were experiencing a greater measured depressive-symptom burden.

The pattern extended beyond the PHQ-9

If the PHQ-9 result had appeared in isolation, it would have been reasonable to wonder whether it reflected peculiarities of one instrument. But the DASS-21 produced a related pattern.

In adjusted models, non-medical students had higher DASS depression scores by approximately 1.82 points and higher DASS anxiety scores by approximately 2.31 points. Both differences were statistically significant. The adjusted difference in DASS stress was smaller, approximately 0.89 points, and was not statistically significant at the conventional 0.05 threshold.

This distinction matters. Depression, anxiety, and stress are correlated forms of psychological distress, but they are not interchangeable. The findings did not indicate that non-medical students were simply “worse on everything.” Rather, group differences appeared more clearly for depressive and anxiety symptoms than for stress.

That is exactly why multidimensional measurement can be informative. A single total score can obscure meaningful differences in how psychological difficulties are expressed.

What the result does not mean

Unexpected findings are especially vulnerable to overinterpretation. Several conclusions would go beyond what this study can establish.

It does not mean medical students are psychologically healthy

A lower average score relative to another group does not imply absence of distress. The medical students in the study still reported meaningful levels of depressive, anxiety, and stress symptoms. International research also consistently documents substantial mental-health difficulties among medical trainees.

The correct interpretation is comparative: the non-medical group had higher scores on several measured outcomes in this particular sample. It is not a declaration that medical education is psychologically benign.

It does not prove that studying a non-medical subject causes depression

The study was cross-sectional. Exposure and outcome were measured at one period rather than followed prospectively over time. Therefore, the analysis can identify associations but cannot establish that academic stream caused the observed differences.

Students also do not enter university programmes randomly. Medical and non-medical populations may differ in socioeconomic conditions, family expectations, career pathways, admission processes, coping resources, social networks, institutional environments, or unmeasured characteristics. Statistical adjustment can address measured variables, but it cannot eliminate every possible source of confounding.

It does not establish a national ranking of disciplines

The participants came from universities in Lahore, and the sample should not be treated as a perfectly representative survey of every university student in Pakistan. Different institutions, cities, academic programmes, and cohorts could produce different estimates.

Replication across universities and regions would therefore be valuable, ideally using probability-based sampling and longitudinal designs.

Why might non-medical students have reported more symptoms?

The study identifies an association; it does not provide a definitive causal explanation. Still, the unexpected direction raises several hypotheses worth testing in future research.

1. Career uncertainty may matter

Professional programmes often provide a comparatively visible occupational pathway, even when that pathway is demanding. Students in broader academic fields may face greater uncertainty about employment, postgraduate training, income, or how their degree will translate into a career.

In settings where graduate employment is competitive and economic uncertainty is substantial, career ambiguity could contribute to anxiety and depressive symptoms. This explanation is plausible but should be tested directly rather than assumed from the present data.

2. Medical schools may provide more structured peer environments

Medical programmes often involve stable cohorts, repeated contact with the same classmates, structured timetables, clinical teams, societies, mentoring structures, and frequent interaction with faculty. Those features do not eliminate psychological stress, but they may provide forms of social organization that are less consistent in other programmes.

Whether stronger peer cohesion or institutional support explains part of the observed difference remains an empirical question.

3. The burdens affecting different student groups may simply be different

Medical students may face heavy academic and clinical demands, while non-medical students may face a different mixture of economic pressure, uncertainty, family expectations, academic concerns, and social stressors. Two groups can both experience substantial distress for different reasons.

This is one reason broad university mental-health strategies should be complemented by programme-specific assessment rather than relying on assumptions about which discipline is inherently most vulnerable.

4. Selection factors could influence group differences

Admission to medical education is highly competitive. Students who successfully enter and remain in medicine may differ from other student populations in academic preparation, socioeconomic background, family support, coping patterns, or other characteristics.

Such selection effects could contribute to observed differences. Again, a cross-sectional comparison cannot determine whether this occurred, but future research could measure these factors directly.

Gender emerged as an important finding across outcomes

Academic stream was not the only variable associated with psychological symptom scores. Female gender was associated with higher scores across the PHQ-9 and all three DASS-21 domains in the adjusted analyses.

This consistency is relevant because it illustrates why interpreting student mental health through a single variable, such as degree programme, is inadequate. Psychological distress is shaped by overlapping personal, social, academic, and environmental factors.

The gender association also should not be reduced to biological assumptions. Differences in symptom reporting, social pressures, safety concerns, family expectations, discrimination, economic opportunity, and many other contextual factors may contribute. The study establishes an association, not a mechanism.

Sleep also mattered

Each additional reported hour of sleep was associated with a 0.37-point lower PHQ-9 score in the adjusted model. Because the study was cross-sectional, this association cannot determine direction of causality.

Poor sleep can worsen mood, concentration, and emotional regulation, while depression and anxiety can themselves disrupt sleep. The relationship is often bidirectional. Nevertheless, the result reinforces the value of considering everyday behavioural and environmental factors when studying university mental health rather than focusing only on academic discipline.

For universities, this can have practical implications. Timetabling, late-night academic demands, commuting burdens, workload organization, hostel conditions, digital habits, and expectations around all-night studying may all influence students’ opportunities for adequate sleep. Interventions should be based on local assessment rather than assuming that telling students simply to “sleep more” solves a structurally influenced problem.

The bigger issue: attention can create blind spots

Medical-student mental health deserves serious attention. But intense research focus on one visible population can unintentionally make other populations less visible.

A global meta-analysis of college students published in 2022 estimated high pooled prevalences of both depressive and anxiety symptoms across university populations. The exact prevalence differed considerably across settings and study methods, reinforcing the broader point that mental-health difficulties are not confined to medical education.

The policy danger is straightforward. If university administrators assume medical students are automatically the group with the greatest need, resources may be allocated according to reputation rather than current local evidence. Students in engineering, social sciences, business, humanities, computing, law, or other programmes may experience substantial distress while receiving comparatively little attention.

The better approach is not to remove support from medical students. It is to widen the lens.

What universities can learn from an unexpected result

The most practical lesson from these findings is that student mental-health programmes should be needs-based rather than stereotype-based.

• Screen across disciplines. Universities should avoid limiting mental-health surveillance to programmes already known for heavy workloads.
• Measure multiple domains. Depression, anxiety, and stress may show different patterns, so one generic distress measure may not capture the full picture.
• Investigate programme-specific pressures. Career uncertainty, financial strain, assessment systems, workload, discrimination, commuting, social support, and sleep may vary substantially between faculties.
• Make support accessible. Counselling and referral pathways should be clearly communicated to students across the institution rather than concentrated in selected schools.
• Use data repeatedly. A one-time survey provides a snapshot. Repeated or longitudinal assessment can show whether patterns change during examinations, clinical placements, economic disruption, or transitions between academic years.

Most importantly, institutions should avoid turning comparative findings into a competition over which students suffer most. Mental-health services do not become more effective by ranking distress. The purpose of comparison is to identify overlooked needs and understand how risks differ between groups.

Why the measurement work matters too

The study was not designed merely to compare two medians. A central aim was to evaluate how the PHQ-9 and DASS-21 behaved psychometrically in this university population.

This matters because every comparison depends on measurement. If an instrument performs poorly, group differences can be misleading. Reliability analysis, confirmatory factor analysis, item response theory, and symptom network analysis therefore contribute to a deeper understanding of what questionnaire scores represent.

Psychometric evaluation is particularly important when instruments developed or initially validated in other settings are used in South Asian populations. A questionnaire being popular does not remove the need to examine whether its structure and items function adequately in the population being studied.

This also changes how we think about student mental health. A total depression score is useful, but it is not the entire story. Two students can achieve similar totals through different symptom combinations. One may primarily experience low mood and loss of interest; another may report concentration problems, sleep disturbance, low energy, and feelings of worthlessness. Item-level approaches can help researchers investigate those differences.

Unexpected findings are often the most useful findings

Research becomes less valuable when it is used mainly to confirm what researchers already believe. We had good reasons to expect greater symptom burden among medical students. The existing literature makes that hypothesis entirely reasonable.

But the observed data pointed in another direction.

That should not be treated as an inconvenience to explain away. Nor should it be exaggerated into a claim that medical students are somehow protected from mental-health difficulties. The scientifically productive response is to ask what the result reveals about the limitations of our assumptions.

In this case, the answer is important: non-medical university students can carry substantial psychological burden, and their needs may be underestimated when institutional attention is organized around familiar high-risk groups.

The next generation of student mental-health research in Pakistan would benefit from larger multisite studies that include diverse academic disciplines, socioeconomic measures, career uncertainty, financial strain, social support, sleep, living arrangements, academic performance, help-seeking, and longitudinal follow-up. Such designs could begin to explain not only which groups differ, but why.

A broader way to think about student mental health

The central message is not that one group has replaced another as the group we should worry about. Medical students still deserve evidence-based mental-health support, and their training exposes them to genuine pressures.

The more important lesson is that university mental health should be understood as a campus-wide issue. Programme labels are imperfect proxies for lived experience. Students’ psychological wellbeing reflects a combination of academic demands, economic circumstances, social relationships, future prospects, sleep, personal vulnerabilities, institutional culture, and access to support.

Our data challenged an expectation. That is precisely what useful data sometimes do.

Instead of asking only why medical students struggle, universities and researchers should also ask a broader question: which students are struggling here, what pressures are affecting them, and what support do they actually need?

Frequently asked questions

Did non-medical students have higher depression scores than medical students?

Yes. In this sample of 602 Pakistani university students, non-medical students had a median PHQ-9 score of 10 compared with 9 among medical students. Academic stream remained associated with PHQ-9 scores after adjustment, with non-medical students scoring approximately 1.4 points higher.

Were anxiety and stress also higher among non-medical students?

Adjusted DASS-21 anxiety scores were significantly higher among non-medical students. DASS depression scores were also higher. The adjusted difference in DASS stress scores did not reach conventional statistical significance.

Does this prove that medical school is better for mental health?

No. The study was cross-sectional and cannot establish causation. Medical students also experienced psychological symptoms. The findings show a group difference within this sample, not that medical education protects against depression or anxiety.

Can PHQ-9 or DASS-21 scores diagnose depression or anxiety disorders?

Not by themselves. These questionnaires measure symptom burden and can support screening and research, but a clinical diagnosis requires appropriate professional assessment and consideration of the individual’s broader clinical context.

Why is comparing medical and non-medical students useful?

Direct comparison helps test assumptions about which university populations experience the greatest symptom burden. It can reveal overlooked groups and encourage institutions to allocate mental-health support according to measured needs rather than stereotypes about particular academic programmes.

Medical disclaimer: This article is for educational and research communication purposes only. PHQ-9 and DASS-21 scores are not substitutes for an individual clinical assessment. Anyone experiencing persistent psychological distress, thoughts of self-harm, or difficulty functioning should seek appropriate professional healthcare or urgent assistance when necessary.