Subclinical depression and anxiety represent pervasive yet often unnoticed mental health challenges among medical students, particularly during clinical rotations when they transition from theoretical learning to patient care. The demanding environment of clinical training exposes students to stressors such as time pressure, sleep deprivation, emotional exhaustion, and fear of incompetence, making them highly vulnerable to internalized distress. Studies have consistently shown that psychological morbidity peaks during these years, with depression and anxiety significantly prevalent across various cohorts of medical trainees.[1] Globally, the prevalence of depression or depressive symptoms among medical students is estimated to be around 27%.[2] Across multiple countries, only a fraction of affected students—approximately 15%—seek professional help, largely due to stigma and fear of academic repercussions.[3] The magnitude of this problem echoes across stages of training, with similar rates noted among residents, suggesting that distress begins early in medical education and persists without intervention.[4] Subclinical depression, although less severe than major depressive disorder, can impair concentration, empathy, clinical judgment, and interpersonal relationships, thereby threatening both academic and professional outcomes.[5] Anxiety disorders demonstrate similarly concerning patterns, with global meta-analyses indicating a pooled prevalence of 33.8% among medical students.[6] Elevated anxiety levels correspond to the unique stressors of medical training—including exposure to death and suffering, the pressure of assessments, and the need to perform under supervision. Comparative research has observed slightly higher anxiety prevalence among students in clinical as opposed to preclinical years, likely due to increased patient contact and performance expectations.[7] Specific investigations have documented anxiety rates during clerkships reaching up to 59% in some contemporary cohorts, suggesting an upward trend post-pandemic.[8,9] The interplay between depression and anxiety during clinical rotations often manifests as subclinical symptomatology—persistent low mood, irritability, or somatic complaints masked as fatigue or academic pressure.[10] These symptoms, while subtle, may precede the development of major psychiatric disorders if left unaddressed. During clinical exposure, students also face identity-related stressors such as professional role confusion and imposter syndrome, exacerbating emotional burnout and decreasing resilience.Moreover, studies have shown that students’ perceived lack of support and ineffective coping strategies contribute to cumulative stress and reduced psychological wellbeing.[1] Addressing subclinical depression and anxiety within medical schools necessitates early detection and intervention strategies.[7] Programs that enhance resilience, mentorship, and peer support have shown measurable benefits in improving emotional regulation and stress management among medical trainees. Institutional policies promoting confidential mental health services and destigmatization of psychological distress are critically needed to cultivate a supportive training environment.[10] In essence, the clinical training stage represents both a risk period and an opportunity for early mental health intervention, ensuring that future physicians remain emotionally competent and empathetically grounded in their practice.[1]

This cross-sectional study was conducted at the Hind Institute of Medical Sciences, Sitapur, Uttar Pradesh, from January 2023 to April 2023. A total of 300 undergraduate medical students in their clinical years (third and fourth year) were included. Students who provided informed consent and were actively participating in clinical rotations during the study period were eligible for inclusion. Those with a prior diagnosis of clinically significant depression, anxiety, or other psychiatric disorders were excluded. Data collection was performed using a structured self-administered questionnaire comprising sections on demographic information, academic year, and psychosocial factors such as sleep quality and perceived academic stress. Standardized psychometric instruments were used to assess emotional symptoms: the Generalized Anxiety Disorder-7 (GAD-7) scale for anxiety and the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms. Students scoring within the subthreshold range on either or both scales were classified as having subclinical anxiety and/or depression. Coping strategies were evaluated using a modified coping inventory, which included categories such as social support, physical activity, mindfulness, and professional counseling. Data were tabulated and analyzed to determine the prevalence, pattern, and severity of subclinical symptoms. Descriptive statistics, including mean, standard deviation, and percentages, were calculated. Comparative analyses were performed between students with and without subclinical symptoms to explore associations with demographic and psychosocial variables.

The results of the study present a comprehensive overview of the demographic and clinical characteristics of medical students experiencing subclinical depression and/or anxiety during clinical rotations. Among 300 students surveyed, 50 (16.7%) exhibited subclinical symptoms, with a nearly equal gender distribution and similar mean age to those without symptoms, as detailed in Table 1. The subclinical group comprised primarily third and fourth-year students, reflecting the distribution of years in clinical rotations. Clinically, the majority displayed symptoms consistent with subclinical anxiety (56%) and depression (28%), while 16% had overlapping symptoms of both conditions. High rates of sleep disturbances and academic stress were prominent in this group, indicating significant psychosocial stressors during clinical years (Table 2). Symptom severity scales revealed mild to moderate anxiety and depressive symptoms with mean GAD-7 and PHQ-9 scores indicating subthreshold but impactful symptoms (Table 3). Coping strategies adopted were variable; most students sought social support and engaged in physical exercise, though a minority utilized professional counseling or mindfulness techniques (Table 4). These patterns highlight both the prevalence of emotional distress in clinical medical students and the need for accessible mental health resources. Together, these findings emphasize the burden of subclinical anxiety and depression among medical students amid the challenges of clinical rotations, underscoring a critical area for early identification and intervention to enhance student well-being and academic success. Table 1. Demographic Profile of Medical Students (n=300) Variable Subclinical Group (n=50) Normal Group (n=250) Statistical Significance Mean Age (years) 22.3 ± 1.9 22.7 ± 2.1 t=1.12, p=0.26 Gender (M/F) 26 / 24 (52% / 48%) 140 / 110 (56% / 44%) χ²=0.32, p=0.57 Year of Study χ²=2.05, p=0.36 - Third Year 30 (60%) 150 (60%) - Fourth Year 20 (40%) 100 (40%) Table 2. Clinical Profile of Medical Students with Subclinical Symptoms (n=50) Variable Frequency (%) Subclinical Anxiety Only 28 (56%) Subclinical Depression Only 14 (28%) Both Anxiety and Depression 8 (16%) Reported Sleep Disturbance 35 (70%) Reported Increased Academic Stress 38 (76%) Previous Mental Health History 5 (10%) Table 3. Symptom Severity Scores among Subclinical Group (Mean ± SD) Symptom Scale Mean Score ± SD Scale Range Generalized Anxiety Scale (GAD-7) 7.1 ± 2.5 0–21 Patient Health Questionnaire (PHQ-9) 6.3 ± 2.2 0–27 Perceived Stress Scale (PSS) 18.5 ± 4.7 0–40 Table 4. Coping Mechanisms Reported by Subclinical Group (n=50) Coping Strategy Frequency (%) Seeking Social Support 30 (60%) Physical Exercise 22 (44%) Mindfulness/Meditation 10 (20%) Professional Counseling 8 (16%) No Specific Coping Reported 12 (24%)

The findings of this study align with multiple prior investigations highlighting the prevalence of subclinical depression and anxiety symptoms among medical students during clinical training. The observed prevalence rate of 16.7% for subclinical symptoms corresponds closely with rates reported by Quek et al.,[4] who documented anxiety prevalence ranging from 15% to 30% in medical student populations globally. Similarly, Dyrbye et al.[11] found elevated depressive symptoms among students undergoing academic stress and clinical responsibilities, underscoring risk factors consistent with those noted here, such as sleep disturbances and increased academic pressure. The nearly equal gender distribution in the symptomatic group also mirrors findings by Rotenstein et al.,[1] who reported no consistent gender predilection for anxiety or depression in medical students, though individual variations exist. Symptom severity scores in this study reflected mild to moderate levels of distress, aligning with research from Kumar et al.,[12] who emphasized the subthreshold but functionally significant nature of anxiety and depression in medical students, which if unaddressed may progress to clinical disorders. The coping mechanisms reported—primarily social support and physical exercise—resonate with those described by Saeed et al.,[13] indicating a preference for informal support and lifestyle interventions over professional counseling, which remains underutilized due to stigma and accessibility barriers. Collectively, these findings reinforce the critical need for early mental health screening and tailored interventions within medical education to mitigate the impact of subclinical emotional distress on student well-being and performance. Integrating mental health resources and stress management training into curricula could facilitate better coping and reduce progression to more severe psychopathology during demanding clinical training phases.

Subclinical depression and anxiety are prevalent among medical students during clinical rotations, largely influenced by academic stress and sleep disturbances. Although most students adopt adaptive coping strategies, the underutilization of professional counseling highlights a gap in mental health support. Early detection, resilience training, and accessible mental health services within medical institutions are essential to safeguard students’ psychological well being. These measures can enhance both academic performance and long-term professional competence.

1. Rotenstein LS et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students. JAMA. 2016;316(21):2214‑36. 2. American Medical Association. One in four medical students worldwide shows depression signs. AMA News. 2025 Oct 19. 3. 2 Minute Medicine. Depression and suicidal ideation common among medical students. 2016 Dec 8. 4. Quek TTC et al. The global prevalence of anxiety among medical students: a meta-analysis. Int J Environ Res Public Health. 2019;16(15):2735. 5. Stanislawski ER et al. Longitudinal mental health outcomes of third-year medical students. Psychiatry Res. 2023;316:114974. 6. Mengesha AK et al. Identifying factors contributing to depression and anxiety among medical students: a global perspective. Sci Rep. 2025;15:99177. 7. Sanjaya A et al. A panacea for burnout in medical students during clinical training. BMC Med Educ. 2024;24:30965. 8. Pölczman L et al. Enhancing resilience through near-peer mentoring among medical students. Front Educ. 2025;10:1523310. 9. Sinval J et al. The impact of depression, anxiety, and stress on academic engagement among medical students. Psychiatry Res. 2025;324:116057. 10. Stirparo G et al. Is mental health worse in medical students than in the general population? J Affect Disord. 2024;364:118‑26. 11. Dyrbye LN et al. Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Acad Med. 2006;81(4):354-373. [doi:10.1097/00001888-200604000-00009]. 12. Kumar S et al. Prevalence and severity of depression, anxiety and stress in undergraduate medical students. Indian J Psychol Med. 2020;42(4):320-326. [PMC7463894]. 13. Saeed A et al. Stress management and coping strategies among medical students. Glob J Health Sci. 2015;7(3):262-269. [PMC4776938].