‘Alarmingly high’: 28% MBBS students have mental disorders; over 60% face financial stress, finds NMC

NEW DELHI: As many as 16.2% undergraduate (UG) and 31.2% postgraduate (PG) medical students have experienced thoughts of self-harm or suicide in the last 12 months, according to an online survey conducted by a National Medical Commission (NMC) task force on mental health and well-being of medical students.

The survey included 25,590 undergraduate students, 5,337 postgraduate students, and 7,035 faculty members. The online mental health survey of medical students was conducted between April and May 2024.

The task force found that “an alarmingly high” 27.8% of UG students and 15.3% of PG students voluntarily indicated having a diagnosed mental health disorder.

“This degree of mental health disorders, and suicidal ideation combined with students with risk factors calls for an aggressive and rapid implementation of interventional programs,” the task force said in its report released on NMC’s official website on Thursday.

While 564 or 10.6% of PG students had thought of attempting suicide in the past year, a total of 237 or 4.4% of PG students made attempts. Data regarding suicide attempts among MBBS students was not gathered by the task force in the online survey.

According to the task force, the stress and reasons for stress experienced by UG and PG medical students vary considerably. At both UG and PG levels, large sections of students reported financial stress; MBBS students also reported considerable academic pressure while PG students reported punishingly-long hours, paltry stipends and exploitation and harassment by seniors. The report also reveals how inadequate existing systems in medical colleges are in helping students cope and how little faith they and the faculties inspire.

NMC had constituted a national task force on mental health and well-being of medical students in February 2024. The task force met in May to hear from students’ associations, students studying in medical colleges in India, and their parents.

During the in-person visits, faculties at medical colleges told the task force that some students fake mental illness, stress, and suicidal ideas claims to avoid clinical and academic responsibilities, raising concerns about the authenticity of their issues.

MBBS Students: Where they come from

A total of 25,590 undergraduate medical students responded to the online survey. A significant number of them are in their early years of study and their distribution across the years of the MBBS course was as follows:

• Year 1: 6,907 or 27%

• Year 2: 6,187 or 24.2%

• Year 3: 5,670 or 22.2%

• Year 4: 5,033 or 19.7%

• Year 5: 1,793 or 7%

Educational background of the UG medical students indicates that the majority come from urban areas and had English as their primary medium of instruction in school.

The distribution of NMC survey respondents by the medium of instruction in school and where they come from is given below.

NMC Survey Report: Where MBBS students come from

Finally, the primary medium of instruction in school was English for 21,643 or 84.6% of students, Hindi for 1,328 or 5.2%, and other languages for 2,619 or 10.2%.

A total of 19,812 or 77.4% out of 25,590 MBBS students who participated in the online survey are from medical colleges located in the same states they belong to, while 5,778 or 22.6% are studying in colleges outside their home states.

NMC: Over 40% MBBS students under stress

Medical curriculum-induced stress is a significant factor with 11,186 or 43.7% finding the MBBS syllabus and curriculum extremely or significantly stressful and 9,664 or 37.8% moderately stressful.

The frequency of exams is extremely or significantly stressful for 9,134 or 35.9% MBBS students and moderately stressful for 9,563 or 37.6%. “Furthermore, 10,383 or 40.6% students feel constant pressure to achieve top grades,” the task force found.

The fear of failure is a significant issue in more than half of MBBS students who participated in the online mental health survey. 51.6% strongly agreed that this fear “negatively impacts their performance”.

The fear of failure leads to various negative behaviours, including the thought of leaving the course among 738 or 2.9% of students and that of self-harm among 330 or 1.3% students. “These findings underscore the significant academic pressures and stresses faced by medical students,” the task force said.

Also read MBBS students are battling despair and depression in medical colleges

Financial stress among PG, MBBS students

A total of 22,019 or 86% MBBS students come from families with an annual income of Rs 1 to 20 lakh and two-parent households.

In its survey, the task force found that financial stress is a significant cause of mental health crises among MBBS students with 8,663 or 33.9% of students finding their finances extremely or significantly stressful and 6,971 or 27.2% moderately stressful.

That a quarter of students are studying on education loans and there is a financial penalty for exiting adds to the stress.

Here’s what the NMC found on the impact of finances on undergraduate medical students:

• 27.2% undergraduate medical students have education loans or debt; of them, 32.7% feel extreme or significant pressure about repayment

• 40.8% of students have financial dependents

• 32.9% of students feel “trapped” in the medical course due to the financial bond for exiting

Due to financial stress, thoughts of exiting the MBBS course were reported in more than half of the students surveyed.

As for postgraduate students, 85% of the respondents come from families with an annual income of less than Rs 20 lakh. About 60.1% feel that their stress and well-being are impacted by financial concerns. Postgraduate students are also staff and entitled to stipends which most, 72.2%, find inadequate.

“While a majority 3,115 or 58.4% receive their stipends regularly, a significant proportion of 2,222 or 41.6% do not, indicating potential areas for improvement,” says the report.

Half – 50.7% – of the PG students have financially-dependent families, adding to their financial stress.

Also read Mandatory reporting of suicides, e-Complaint portal, suggests NMC task force on medical student health

PG, MBBS students: Ragging, suicide, support

Among the survey respondents, 76.8% reported not experiencing or witnessing any form of ragging or harassment, while 9.7% accepted going through such an experience. That said, just 70.1% believe their college has adequate anti-ragging measures.

In fact, ragging continues to be prevalent even at the postgraduate level. 18% of PG students reported that ragging still existed among them; 27% reported harassment by senior PG students in clinical settings and, worryingly, 31% reported similar experiences from faculty and senior residents.

Relatively small sections of PG students reported being exploited. 12.7% said they were asked for “unreasonable favours” in exchange for passing marks in exams; 11.6% reported being exploited in exchange for signatures on their theses.

“Even this 12.74% …can severely undermine the educational institution’s integrity and potentially harm students’ overall educational experience. They may also lead to long-term detrimental effects on future medical practitioners' professional and ethical standards,” the task force said.

While one in 10 PG students “indicated making plans to attempt suicide within the last year”, 4.44% PG students admitted to attempting suicide, the taskforce found.

It also found that students, at least at the UG level, were largely reluctant to seek help or did not find services available to them very useful.

Only 13.4% of undergraduate students felt “very comfortable” about seeking professional help and just 31.1% – less than a third – felt comfortable about seeking help from faculty or mentors. Finally, less than half of the students – 43.3% – were aware of the mental health support services within their medical college and over 18% of those who were aware, rated the quality of the services as very poor.

NMC Report: PG working hours, weekly offs

A total of 5,337 postgraduate students participated in the online survey. Close to half – 45% – said they work for more than 60 hours a week with over 56% not getting weekly offs. A total of 38% of the PG students reported not having adequate time to rest, while 57% stated that they were denied their weekly off as per the NMC regulatory provisions.

As many as 1,123, or 21%, PG students said that they work for more than 80 hours a week.

Here’s the NMC working hours recommendations for resident doctors:

• No work more than 74 hours a week, with no more than 24 hours at a stretch.

• One day off per week, a 24-hour duty, and 10-hour shifts for the remaining five days

• Ensuring 7-8 hours of daily sleep

Also read 20 days of paid leave, NExT exam, parity in stipends: NMC regulations on PG medicine

Medical faculties

A total of 7,035 faculty members participated in the online survey; 78.66% of them said they have not encountered significant challenges in managing depression among students. However, there is still a significant minority – 21.34% – who said they had.

A substantial proportion of respondents – 42.66% – believe that their institutions lack a clear system for addressing depression among students.

More than half the respondents among medical faculties believe that students use mental stress “as an excuse”.

“This clearly indicates that there is a clear need for enhanced awareness and training on mental health issues for faculty and administrators, alongside the development of clear guidelines for handling claims of mental stress. Institutions should also bolster their mental health support systems, encourage open dialogues about mental health to reduce stigma, and regularly assess student well-being,” the task force said.

If you know someone – friend or family member – at risk of suicide, please reach out to them. Those in distress or having suicidal thoughts or tendencies could seek help and counselling by calling 9820466726 or visiting AASRA’s official website or can call iCALL on 9152987821. Here are some more helpline numbers of suicide prevention organisations that can offer emotional support to individuals and families.