Prevalence and associated factors related to self-perceived depressive, anxiety and burnout symptoms in medical students of the University of Girona: a cohort study

Background Depressive, anxiety and burnout symptoms are highly prevalent in medical students compared to the general population, and little is known about how the curriculum contributes to such distress. Few studies have examined prevalence and associated factors in Spanish medical schools, and none with a problem-based learning (PBL) methodology. We aimed to assess the prevalence and correlates of depression, anxiety, and burnout in medical students enrolled in a PBL-based curriculum. Methods We invited all medical students at the University of Girona to complete a web-based survey during three waves in the 2021–22 academic year. The survey included sociodemographic data, validated self-report questionnaires (PHQ-9, GAD-7, MBI-SS, AUDIT-C, DAST-10, BFI-10), and an ad hoc questionnaire on PBL’s students perceptions. Prevalence estimates followed validated cut-off scores. We fitted multivariate logistic regression for depression, generalised anxiety disorder and burnout, including sociodemographic characteristics, alcohol and drug consumption, personality traits, and PBL opinion as independent variables. Results A total of 321, 209, and 174 students participated in December, February, and May, respectively (mean age 21.5 ± 3.0 years; 62–78% female). Across waves, 25.9–28.2% were at high risk for alcohol use disorder, and 14.9–15.3% exceeded the risk threshold for other drug consumption. Over half of participants reported clinically relevant depressive and anxiety symptoms in all three periods, and 25–30% exceeded the cut-off for clinically significant burnout symptoms. Positive associations between depressive with both anxiety and burnout symptoms were significant across all periods; but logistic regression showed no significant association between anxiety and burnout symptoms. Participants with significant depressive symptoms reported higher Emotional Exhaustion and Depersonalisation, and lower Academic Efficacy. Multiple sociodemographic features and personality traits influenced these symptoms, with a novel negative correlation between Conscientiousness and anxiety symptoms. PBL opinion score correlated positively with anxiety symptoms. Conclusions We found high prevalence rates of depression, anxiety, and burnout in a PBL-based medical school. Depressive symptoms showed the strongest associations with both anxiety and burnout. Sociodemographic and personality factors further shaped risk, highlighting the importance of identifying at-risk subgroups for preventive interventions. These findings underscore the need for systematic mental health support in medical curricula.