Summary<\/p>\n
This study is the first in Germany to identify widespread financial concerns (55.7%) and financial debt (23.6%) among medical students, as well as significant associations between financial concerns and poor mental health at a private university in western Germany. In addition to women and students with a moderate to very poor general physical health status, those experiencing financial concerns had significantly higher odds of having below-average (aOR\u2009=\u20092.04; 95% CI: 1.33\u20133.14) or impaired mental health (aOR\u2009=\u20096.20; 95% CI: 3.19-12.00).<\/p>\n
Mental health of students<\/p>\n
As described in the background, university years are a critical period for mental health, where factors such as academic pressure, financial burdens, and social challenges could increase the risk. The portion of students reporting impaired mental health in our study (22.7%) is comparable to international findings from the World Health Organization (WHO) World Mental Health Surveys conducted in 21 countries, which reported that 20.3% of 1,572 college students met the criteria for a DSM-IV disorder [23<\/a>]. In the general German population, the 12-month prevalence of mental disorders was 27.7% in a representative national cohort aged 18 to 79 years, further highlighting the similarity to our findings [24<\/a>]. Adding the number of students with below-average mental health in our study, 67.4% were suffering, similar to the results of the best3-study in Germany for 2021, which reported 65% of university students with mental health issues [5<\/a>]. To improve the frequent mental health issues among students, particularly in the medical field, targeted measures like preventive approaches should be developed. Easily accessible information and counselling services could help identify and address mental health concerns in a timely manner. For medical students, who are particularly affected by the intense training and frequent emotional burdens, mental health should be more strongly integrated into the curriculum to encourage open discussion and facilitate access to professional support. Additionally, structures should be created to reduce overall stress for students. It is crucial to destigmatize mental health issues and establish a culture of openness and support. Closer collaboration with psychological and psychiatric professionals could help reduce students\u2019 reluctance to seek help when needed.<\/p>\n Prevalence of financial concerns among medical students<\/p>\n The prevalence of financial concerns (55.7%) and financial debt (23.6%) among medical students in this study are difficult to compare due to the lack of similar studies in Germany and differing tuition fee systems internationally. In Germany, most medical universities are tax-funded and, therefore, tuition-free, with the exception of private universities like the one in this study [25<\/a>]; there are 109 public universities in Germany, 39 of which offer programs in human medicine, while 9 private universities also offer medical studies.<\/p>\n In a study of 7,203 students from various fields conducted at five German universities during the fourth wave of the COVID-19 pandemic, 13.9% reported insufficient financial resources to cover their monthly expenses [26<\/a>]. High levels of financial concerns specifically among medical students can only be compared with international studies, where similar findings have been reported. A systematic review, predominantly based on studies from the USA, as well as some from Canada, New Zealand, Scotland, and Australia, indicated high levels of financial stress among medical students, which were correlated with debt. Finally, debt was also associated with poorer academic performance and negatively impacted mental well-being [14<\/a>]. International studies in the USA, UK and Australia also report financial difficulties as a common issue among medical students: Financial problems are a frequent reason for students to suspend or consider suspending their studies [27<\/a>]. In a UK study, 37.7%, of respondents stated that worrying about money affected their studies [28<\/a>]. In an US cross-sectional study, 16% of medical students reported education-related debt [29<\/a>], while another study found that 71% were concerned about the financial burden associated with medical school [30<\/a>]. The German student units (deutsche Studierendenwerke) point to the social polarization of student financing, as more than a third of students, for example, have less than 800 euros per month at their disposal [31<\/a>]. At the same time, rent expenses and living costs, e.g. for food and healthcare, are rising [8<\/a>]. BAf\u00f6G funding rates, the most important instrument of state student funding, have been steadily declining since 2016 [8<\/a>]. Increases in BAf\u00f6G rates and parental allowances are being demanded [31<\/a>].<\/p>\n In 2022, the average monthly BAf\u00f6G amount per student was 611 euros, according to the Federal Statistical Office in Germany. The exact amount depends on factors such as housing costs, as well as the income and assets of the student and their family members [32<\/a>].<\/p>\n BAf\u00f6G is a key source of financial support for students at both private and public universities. This is especially relevant for medical students, whose long and demanding studies leave little time for parttime jobs, especially during the low paid Practical Year. In addition, they also have to cover living and housing expenses.<\/p>\n Financial concerns and debt may be more prevalent in this study due to the private university setting with tuition fees and the extended duration of medical training. Further research on this topic is needed in Germany to gain a clearer picture.<\/p>\n Association between financial concerns and mental health<\/p>\n Although there are no studies examining the relationship between financial concerns and mental health among German medical students, some international studies have shed light on this association among students in general: A British study of 454 undergraduate students found that greater financial difficulties predicted poorer mental health and higher levels of anxiety, depression, stress and alcohol dependence [33<\/a>]. In a systematic review and meta-analysis by Sheldon et al. [10<\/a>], undergraduate students with financial difficulties had an increased risk of depression and suicide-related outcomes (pooled OR 1.83; 95% CI: 0.71\u20134.69). A German cross-sectional study, conducted at five German universities (n\u2009=\u20097,203), found that a worsened financial situation at the time of the survey, compared to prior to the COVID-19-pandemic, was associated with higher levels of anxiety and depressive symptoms [26<\/a>].<\/p>\n Increasing evidence suggests that the amount of stress about debt, rather than debt itself, may be the primary factor affecting mental health [34<\/a>, 35<\/a>]. Possible reasons could be that students anticipate future debt from tuition fees or that current concerns about living costs outweigh existing loan amounts. In a longitudinal study among UK students, greater subjective stress about debt worsened mental health over time, including anxiety and depression [12<\/a>]. Other British studies among students found that increased financial concerns were significantly associated with poorer mental and physical health [9<\/a>, 20<\/a>]. Another British study with similar results also highlights the negative impact of mental health problems on academic performance [11<\/a>]. The existing literature in this field is limited and warrants further investigation among students [33<\/a>]. The consequences of financial concerns and mental health issues during this important phase of life, as well as measures to counteract them, should urgently be investigated.<\/p>\n Sex, physical and mental health<\/p>\n Our findings, which show that women had higher odds of reporting mental health issues, align with the broader literature indicating a greater proportion of females experiencing common mental health difficulties [33<\/a>, 36<\/a>], as well as specific mental illnesses such as anxiety disorders [37<\/a>, 38<\/a>]. This is likely not attributable to sex itself, but rather to gender-specific differences in self-disclosure, help-seeking behaviour, and the utilization of health services [10<\/a>, 39<\/a>]. Female students may therefore be more inclined to discuss their problems and seek treatment. These findings underscore the importance of recent efforts to tailor services to those actively seeking help, while also creating proactive strategies to engage students who are less likely to seek support [40<\/a>]. It should be noted that our study only takes into account sex assigned at birth. The correlation between physical and mental health has been extensively researched in different contexts [41<\/a>,42<\/a>,43<\/a>], and our study supports this as well. Therefore, it will not be explored further.<\/p>\n Strengths and limitations<\/p>\n A key strength of this study is its sample size (n\u2009=\u2009564 medical students), as well as the high response rate. Additionally, the anonymity of the survey contributes to unbiased responses. The study benefits from the use of standardised measures for both financial and mental health variables. However, the potential for selection bias must be considered: On the one hand, students experiencing psychological distress and financial concerns may have been more likely to participate in order to express their situation. On the other hand, it is also conceivable that students with severe psychological distress and significant financial concerns refrained from participating due to a lack of energy, endurance, or because of feelings of shame. As a cross-sectional study, causality cannot be established. It remains unclear whether financial concerns are the cause of psychological distress or whether psychological distress, in turn, exacerbates financial concerns. Furthermore, our approach to missing data may have caused a bias in the risk estimators toward zero effect. A survey with a larger study population and complete data is desirable. Future research should employ longitudinal studies to examine causal relationships. Furthermore, the generalizability of the findings must be discussed. This study included only medical students from a private university. To assess generalizability, further research is needed, including both private and public universities and different subjects of study. Future studies could also consider the different admission criteria between public and private universities. Public ones typically select based on high school grades, while private institutions often use university specific procedures. Possible differences between private and public universities regarding financial concerns and mental health should be considered. At private universities, students may face higher financial burdens due to tuition fees, in addition to other debts such as BAf\u00f6G or student loans. While it is possible that private university students come from higher income families, this varies depending on the university\u2019s financing model for example the private University in this study offers income dependent repayment through a reversed generational contract. Without such models, reliance on family financial support may be greater. Private universities may have smaller cohorts and may offer more personalized support, which could benefit mental health. At the same time, tuition fees might increase the pressure to continue studying despite personal difficulties, as dropping out could feel like a financial loss.<\/p>\n It would be interesting to also collect data on social background as an aspect affecting students\u2019 financial resources, as well as household structure. Additionally, it would be valuable to examine whether students are employed alongside their studies and how such employment influences their financial situation and mental health. It would also be valuable to examine whether students are first-generation students, meaning they are the first in their family to attend university.<\/p>\n","protected":false},"excerpt":{"rendered":"Summary This study is the first in Germany to identify widespread financial concerns (55.7%) and financial debt (23.6%)…\n","protected":false},"author":2,"featured_media":98638,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[78],"tags":[6046,18,4611,62979,135,19,17,5461,96,12834,24103,13563],"class_list":{"0":"post-98637","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-debt","9":"tag-eire","10":"tag-financial-concerns","11":"tag-financial-toxicity","12":"tag-health","13":"tag-ie","14":"tag-ireland","15":"tag-medical-education","16":"tag-medicine","17":"tag-psyche","18":"tag-theory-of-medicine-bioethics","19":"tag-university"},"share_on_mastodon":{"url":"","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/98637","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/comments?post=98637"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/posts\/98637\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media\/98638"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/media?parent=98637"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/categories?post=98637"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/ie\/wp-json\/wp\/v2\/tags?post=98637"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}