Substance Use and Perceived Hassles among Junior Medical Students with High Anxiety Levels in the Republic of Macedonia

Dear Editor-in-ChiefSeveral studies suggest that medical education does not prevent or reduce substance use, moreo- ver it could increase over time and it appears that the use of sedative drugs in medical students is comparatively widespread across the world (1-3). Higher rates of high anxiety and depression have also been reported for medical students in differ- ent countries worldwide and the contribution of different stressors has been suggested (2, 4, 5). The aim of the study was to estimate substance use habits and to identify hassles connected to medical education perceived by medical students with high anxiety at early stage of education in the Republic of Macedonia.We performed a cross-sectional study on a cohort of 157-second year medical students (61 males and 96 females) during the second semester of 2012-2013 year at the Medical Faculty in Skopje, the Republic of Macedonia. The students anony- mously fulfilled self-rating questionnaires regard- ing substance use (alcohol, nicotine, caffeine, sed- ative-hypnotics, and illicit drugs) and problem are- as connected to medical education (social and per- sonal problems) (4). The Beck Anxiety Inventory (BAI) was used to determine high anxiety symp- toms (6). BAI scores >25 were categorized as high anxiety symptoms for logistic regression analysis.Mean BAI score was 13.7±10.8. The prevalence of high anxiety was 15%. Twenty one percent of female students (n=20) and 6.5% of male students (n=4) showed high levels of anxiety (χ2 = 5.87, df=1, P= 0.0154). The results on substance use prevalence are shown on Table 1. Out of all stu- dents, 14.7% and 41, 4% of high anxiety group have used benzodiazepines (χ2 = 9.304, df=1, P= 0.002). The OR of BZD use was 7.16 (95% CI, 2.62-19.53, z=3.84, P=0.0001) in students with high anxiety levels. The prevalence of illicit sub- stance use was very low in second year medical students. The students with high anxiety did not report any illicit drug use (Table 1).Poor quality of the educational system was the most irritating problem for 66.4% of the student cohort and 79.1% of high anxiety students. Stu- dents with high anxiety identified disappointment as the second most irritating problem as opposed to those with low anxiety levels (χ2= 9.223, df=1, P=0.002) who identified inadequate social life and shortage of the facilities. The risk factors connect- ed to high anxiety symptoms were the existence of personal and social problems (R2 = 0.015, beta = 0.1475 and PFour of them were diagnosed with anxiety disor- der and treated adequately with antidepressant therapy.Our data confirm that the prevalence of high anx- iety levels is a stabile feature across several genera- tions of junior medical students in Macedonia who show high anxiety symptoms even during first as well as during the second year of training (3, 7). The drinking rates in our study (66% were "current drinkers" - who had drunk during past fortnight) are not in accordance with the preva- lence of 41.2 % of alcohol consumption obtained in our earlier study (3). It seems that the drinking rates in junior medical students in Macedonia have increased during last 6 years. Twenty percent of high anxiety students reported that they had used benzodiazepines during the past fortnight and al- most half of them had used BZD during last year, which suggests that they had felt symptoms of anxiety for a longer period. …