During vs. After Exams DSM-5 Depression Profiles, Coping, and Suicidal Ideation in Palestinian Medical Students: Cross sectional study

Background : Examination periods are high-stress intervals in medical school, yet it is unclear which depressive symptoms persist once exams end. Methods : Immediately after a major exam period (AY 2024–2025), 384 Palestinian medical students completed a paired, cross-sectional survey reporting DSM-5 depressive symptoms for two time points: retrospectively during exams and after exams (survey time). Probable MDE was defined as ≥5/9 DSM-5 symptoms including depressed mood or anhedonia for ≥2 weeks. Coping strategies were catalogued. Paired comparisons used McNemar’s test; group differences used χ²/Fisher’s tests; an exploratory Firth logistic regression examined correlates of suicidal ideation (SI) during exams. Results : During exams, 31.3% (120/384) met probable MDE criteria, declining to 22.4% (86/384) after exams. Most symptoms decreased significantly post-exams (paired p<0.01), including depressed mood (62.8%→51.6%), sleep disturbance (66.2%→48.7%), fatigue (71.6%→54.4%), and concentration problems (65.4%→54.2%). Two domains did not change: anhedonia (64.8%→64.8%, ns) and SI (36.7%→37.2%, ns). Social support (62.8%→66.1%), hobbies/relaxation (40.9%→44.5%), and physical activity (38.3%→39.3%) were common; smoking fell sharply as a coping method (40.4%→2.1%). ~55% of students who used any coping strategy perceived benefit. Women reported higher rates of several symptoms (e.g., fatigue, sleep problems, concentration difficulties), but SI did not differ by gender. SI peaked in first- and sixth-year students (~44% and ~50% during exams; χ² p=0.004). Conclusions : Depressive symptoms are widespread during exams and generally abate afterward; however, anhedonia and suicidal ideation persist at high levels, indicating risks not resolved by exam relief alone. Findings support systematic post-exam screening and rapid referral, alongside curricula-embedded supports (peer/social, activity-based) with targeted attention to first- and final-year trainees. Clinical trial number: not applicable.