Stress, which affects individuals' behaviors, communications, and efficiency, is not only a factor in the workplace, but also in educational environments (1). Previous studies in many countries have shown that medical students have high levels of depression, anxiety, and stress during their training (2–5). Many research findings suggest that the mental health of students becomes worse after starting medical school, and this situation continues throughout training (6, 7). Furthermore, studies have shown that mental disorders in medical students have not been properly diagnosed and treated. Failure to detect these disorders will lead to increased morbidity, with unwanted effects throughout students' careers and lives (8).

In this study, we aimed to examine the psychiatric morbidity among last-year medical students at the Erciyes School of Medicine by using the Turkish version of Depression Anxiety Stress Scale (DASS) (9). The institutional ethics committee of Erciyes University approved this study. All last-year medical students were asked to take part in the study. Verbal informed consent was obtained, and students willing to participate filled out the questionnaire. The questionnaire was distributed to the students and collected. A total of 193 students of 222 (86.9%) filled out the questionnaire.

The first part of the questionnaire included questions about students' demographics, and the second part included the Turkish version of the DASS. The reliability coefficients (Cronbach α) of DASS–42 in our study were found to be 92.8, 83.5, and 92.3 for depression, anxiety, and stress, respectively. The presence of either depression, anxiety, or stress was accepted as “emotional disorder.” Statistical analyses were conducted with SPSS Version 15.0 for Windows (SPSS Inc., Chicago, IL, U.S.) and Sigma Stat 3.5. The Kruskal-Wallis analysis of variance and Mann-Whitney U test were used to compare the differences in DASS scores among various groups. Dunn's test was used for all pairwise multiple-comparison procedures. Spearman's correlation analysis was used to determine the relation between the length of internship and DASS scores. Chi-square analysis was used to determine the differences among categorical variables, and p values <0.05 were considered statistically significant. The mean age of the group was 24.5 (SD: 1.5) years (range: 23–31 years); 55.4% were men; 4.2% were married. Nineteen students reported that they had previously had psychiatric or chronic illness. The overall prevalence of depression, anxiety, and stress among last-year medical students in our study was 58%. Mean scores for depression, anxiety, and stress were found to be 8.3 (8.1), 9.1 (6.6), and 14.2 (8.9), respectively. The distribution of last-year students regarding depression, anxiety, and stress symptoms of mild severity-or-above were 29.5%, 50.3%, and 39.9%, respectively. These percentages and mean scores were similar to the results of other studies, which were conducted on students, but scores were higher than the studies conducted on the general population and physicians (10–14).

Emotional disorders in medical students not only cause unwanted effects throughout their lives, but also affect patient care (15). A study has reported an association between increased levels of interns' stress and medical errors (16)—a finding that renders the results of this group even more important. Students who were unhappy about becoming physicians and who worried about their future had higher scores on depression and anxiety than the rest of their class.

Individuals use an ever-increasing variety of psychoactive substances to help them cope with their increasing amounts of stress. Studies show that, in university students, cigarettes and alcohol are used generally as tools for coping with stress (17, 18). In our study, we have found that more depressed and more stressed students were using cigarettes at a higher rate than their non-depressed and non-stressed peers.

The level of emotional morbidity was high among last-year students at Erciyes Medical School. Since this study has only been carried out on only one school during one year, the results should be evaluated carefully. If these studies were carried out on more of the students and followed long-term, the results would be more reliable; however, we need to be aware of the stressors and should undertake some interventions, such as organizing services for counseling or organizing social activities for students.