title: Stress, debt and undergraduate medical student performance.
abstract: BACKGROUND
  Against the background of current debate over university funding and widening access, we aimed to examine the relationships between student debt, mental health and academic performance.
  
  
  METHODS
  We carried out an electronic survey of all medical undergraduate students at the University of Aberdeen during May-June 2004. The questionnaire contained items about demographics, debt, income and stress. Students were also asked for consent to access their examination results, which were correlated with their answers. Statistical analyses of the relationships between debt, performance and stress were performed.
  
  
  RESULTS
  The median total outstanding debt was pound 7300 (interquartile range 2000-14 762.50). Students from lower socioeconomic backgrounds and postgraduate students had higher debts. There was no direct correlation between debt, class ranking or General Health Questionnaire (GHQ) score; however, a subgroup of 125 students (37.7%), who said that worrying about money affected their studies, did have higher debt and were ranked lower in their classes. Some of these students were also cases on the GHQ-12. Overall, however, cases on the GHQ had lower levels of debt and lower class ranking, suggesting that financial worries are only 1 cause of mental health difficulties.
  
  
  CONCLUSIONS
  Students' perceptions of their own levels of debt rather than level of debt per se relates to performance. Students who worry about money have higher debts and perform less well than their peers in degree examinations. Some students in this subgroup were also identified by the GHQ and may have mental health problems. The relationships between debt, mental health and performance in undergraduate medical students are complex but need to be appreciated by medical education policy makers.
authors.affiliation: Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, UK. s.ross@abdn.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Ross
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cleland
authors.forename: Mary Joan
authors.initials: MJ
authors.lastname: Macleod
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004504:Education, Medical, Undergraduate; D005382:Financing, Personal; D006801:Humans; D007182:Income; D008603:Mental Health; D012606:Scotland; D013315:Stress, Psychological / Q000191:economics / Q000209:etiology*; D013337:Students, Medical / Q000523:psychology*