Prevalence, characteristics and measurement of somatic symptoms related to mental health in medical students: a scoping review

Abstract

Introduction

Somatic symptoms related to mental health in medical students are under-researched, with nothing on the topic being published in the United States in over three decades. This scoping review is the first of its kind to explore the prevalence, type and severity of somatic symptoms induced by stress, anxiety, depression and burnout amongst medical students, with the objective of describing the significance and breadth of this issue.

Methods

PRISMA-ScR guidelines were used to guide this review. A comprehensive search was performed of 22 databases, followed by bibliographic and hand searching. Inclusion criteria were published, peer-reviewed articles with a sample of medical students and at least one measure of somatic symptoms related to mental health, in English or with an English-language translation. Excluded were review, companion and editorial articles. Coding was done by an experienced coder trained in systematic review techniques. Two authors reviewed each article.

Results

Twenty-nine articles met inclusion criteria, representing 16 countries, 31 schools/teaching hospitals and 9,887 medical students. The prevalence of somatic symptoms ranged from 5.7 to 80.1%, and somatic symptoms were overwhelmingly found to be significantly correlated with mental ill-health. Somatic symptoms included back pain, neck pain, headaches, sleep disturbances and functional gastrointestinal disorders. Eleven different outcome measures were used, with varying degrees of validity and reliability, which were compared and assessed.

Conclusions

Somatic symptoms appear strongly correlated with mental ill-health in medical students, and are likely highly prevalent. This review highlights the need for further research on somatic symptoms of mental ill-health in medical students, particularly in the United States, and the addition of larger, multi-institutional cohorts to expand our understanding of prevalence, incidence and inciting factors of somatic symptoms. Longitudinal studies tracking somatic symptoms’ effect on career trajectory and professional burnout levels are also needed. Finally, future research should explore interventions for reducing physical symptom burden in medical students.

KEY MESSAGES

• This scoping review is the first of its kind to explore the breadth and depth of knowledge on the presence, prevalence, type and severity of somatic symptoms related to stress experienced by medical students across the globe, and if or how physical symptoms of stress have been addressed thus far.

• Medical students are known to have chronically high levels of stress, but somatic symptoms of stress are not well researched in this population, particularly in the United States, where no research has been done on this topic in over three decades.

• This scoping review finds that across many different countries, medical students consistently report high rates of physical symptoms, including musculoskeletal pain and gastrointestinal disorders, which are highly correlated with stress and other mental health conditions.

• This review provides the first initial assessment of the outcome measures used for somatic symptoms related to mental health.

• Further research on the impact of physical symptoms in medical students, and how this might relate to medical students’ mental health and eventual career burnout, is warranted.