Mental Health Crisis in Medical Education: A Global Systematic Review and Meta-Analysis of Medical Students on Depression, Anxiety, and Stress

Abstract

Background: Medical education is inherently demanding and has been increasingly associated with significant psychological distress among students. Depression, anxiety, and stress are widely reported, raising concerns about the well-being of future healthcare professionals and the quality of patient care. Objective: To systematically review and meta-analyze the global prevalence of depression, anxiety, and stress among medical students and to explore associated demographic and regional variations. Methods: A systematic search of PubMed, Scopus, Web of Science, and Google Scholar was conducted for studies published between January 2000 and March 2025. Observational studies reporting prevalence of depression, anxiety, or stress among medical students using validated assessment tools (PHQ-9, GAD-7, DASS-21) were included. Two independent reviewers performed study selection and data extraction. Study quality was assessed using the Newcastle–Ottawa Scale. A random-effects model was used to estimate pooled prevalence with 95% confidence intervals (CI). Heterogeneity was evaluated using the I² statistic, and publication bias was assessed through funnel plots and Egger’s test. Results: A total of 120 studies encompassing approximately 150,000 medical students across more than 50 countries were included. The pooled prevalence was 37.5% (95% CI: 34.0–41.0) for depression, 41.2% (95% CI: 37.5–45.0) for anxiety, and 47.0% (95% CI: 43.0–51.0) for stress. Subgroup analyses revealed higher prevalence among female students, those in preclinical years, and students from low- and middle-income countries. Significant heterogeneity was observed across studies (I² > 90%). Funnel plot asymmetry suggested mild publication bias. Conclusion: Depression, anxiety, and stress are highly prevalent among medical students worldwide, indicating a substantial and growing mental health crisis in medical education. Urgent, multi-level interventions including institutional support systems, curricular reforms, and policy-level strategies are essential to promote student well-being and ensure a resilient healthcare workforce.