Changes in Mental Well-Being, Lifestyle Behaviors, and Medication Use Before and During Medical School

Medical training is commonly associated with increased psychological stress, yet changes in mental health from before to during medical school are not consistently evaluated using within-participant comparisons. This study aimed to assess whether mental health indicators and related behaviors worsen during medical school compared to premedical school status.

We conducted a cross-sectional, anonymous survey of current U.S. medical students and recent graduates between April 2025 and January 2026. Using a self-developed questionnaire, we assessed recalled mental health status before medical school and current experiences during medical school via adaptations of the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), and Social Functioning Scale (SFS). Additional self-developed items evaluated medication use, caffeine and nicotine use, physical activity, and perceived stressors. Paired ordinal outcomes were analyzed using Wilcoxon signed rank tests, and categorical variables were analyzed using McNemar tests.

A total of 118 respondents completed all survey items. Participants reported significant increases in frequent mental and physical exhaustion (+62, 52.5%, P < 0.001) and frequent self-doubt (+33, 28.0%, P < 0.001) during medical school compared to before enrollment. Physical activity declined (P < 0.001), with a decrease of 31 (26.3%) in frequent exercise and a 3.4-fold increase in respondents reporting no regular exercise. Use of prescribed antidepressants and attention-deficit/hyperactivity disorder (ADHD) medications did not significantly differ before versus during medical school (P = 0.68 and P = 0.38, respectively). Caffeine use was common (103, 87.3%), and use during medical school increased for 68 (57.6%) of students, while nicotine use was uncommon (105, 89% never used). Academic workload, lack of free time, and difficulty balancing personal well-being were the most frequently reported stressors.

Medical school was associated with worsening self-reported mental health symptoms and declines in health promoting behaviors, without a corresponding increase in prescribed psychiatric medication use. These findings suggest that psychological distress during medical training may not be adequately addressed through formal treatment pathways, highlighting the need for preventive and supportive institutional interventions.