Climate change worry, awareness and general anxiety in medical students: a multicentre cross-sectional study with implications for medical curricula

BACKGROUND: Climate change is an escalating public health threat with growing mental health impacts, including climate change worry. Medical students are both future health professionals and a learner group with high baseline stress and anxiety. Evidence from middle-income settings and disaster-affected regions remains limited. We examined general anxiety and its associations with climate change worry and awareness among Turkish medical students to inform undergraduate curricula. METHODS: We conducted a multicentre cross-sectional study (October 2024–April 2025) in two Turkish medical schools in the north (Giresun) and south (Hatay). Students completed an online survey with sociodemographic items and validated measures: Climate Change Awareness Scale (CCAwS), Climate Change Anxiety Scale (CCAS; Anxiety and Helplessness), and Anxiety Assessment Scale (AAS). Group comparisons used Mann–Whitney U and Kruskal–Wallis tests with Bonferroni–Dunn post hoc procedures. RESULTS: Overall, 443 students participated (mean age 21.81 ± 2.23 years; 50.8% female). Mean scores were 72.91 ± 13.73 (CCAwS total), 20.51 ± 6.37 (CCAS-Anxiety), 11.71 ± 2.34 (CCAS-Helplessness), and 29.64 ± 9.00 (AAS total); internal consistency was high (α = 0.907–0.934). Compared with clinical students, preclinical students reported higher climate change worry (CCAS-Anxiety; median 21 vs. 20; p = 0.017) and higher general anxiety (AAS total; median 30 vs. 29; p = 0.008), including higher AAS Physiological Tension (p = 0.004), Worry (p = 0.018), and Feeling Unsafe (p = 0.032). Regional differences were limited: Giresun students had higher CCAwS energy consumption awareness (median 13 vs. 12; p = 0.002), while Hatay students had higher AAS Feeling Unsafe (p = 0.040). By year, CCAwS Awareness of Causes was higher in Year 1 than Year 4 (p = 0.032), and CCAS-Anxiety was higher in Year 1 than Year 5 (p = 0.043). CONCLUSIONS: Climate change awareness was moderate to high, while climate change worry and general anxiety were more pronounced in preclinical years. Findings support early, balanced integration of climate–health and disaster-related mental health content into medical curricula, alongside coping and action-oriented supports to protect student wellbeing.