Learning Environment, Academic Stressors, and Institutional Aspects as Determinants of Mental Health Outcomes in...

Examine associations between learning environment, academic stressors, and mental health among Brazilian medical students across different institutional contexts.

Cross-sectional study of 1,026 medical students from 74 public and private universities. Participants completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Johns Hopkins Learning Environment Scale (JHLES), and Medical Student Stressor Factor Scale (MSSF). Analyses included group comparisons, multiple regression, random forest modeling, and latent class analysis.

Private university students reported significantly better learning environments than public university counterparts (M = 84.6 vs. 81.9, p < 0.001). Quota students, those admitted to universities through affirmative action policies, demonstrated higher depression scores (M = 14.2 vs. 12.8, p = 0.007) and academic stress levels (M = 134.0 vs. 129.1, p = 0.018). Academic stressors demonstrated significant associations with both depressive (β=0.103; p<0.001) and anxiety symptoms (β=0.103; p<0.001), while higher learning environment quality was associated with lower depressive symptom severity (β=-0.105; p=0.043). Latent classes identified high-risk (53.7%), moderate-distress (32.7%), and high-functioning (13.6%) profiles, with affirmative-action students overrepresented in higher-risk classes.

Students admitted via affirmative action in public universities face compounded vulnerabilities. Interventions should focus on reducing academic stress and improving learning environments, especially in public institutions serving disadvantaged groups.