This medical student cohort had concerningly high levels of depression, anxiety and stress symptoms, and rumination is likely an important contributor to negative mental health outcomes.
Key Findings
Results
Medical students in this Christchurch-based sample reported high rates of moderate or greater depression, anxiety, and stress symptoms.
36% of respondents reported moderate or greater symptom levels of depression
45% reported moderate or greater symptom levels of anxiety
42% reported moderate or greater symptom levels of stress
These rates were measured using the Depression Anxiety Stress Scale 21 (DASS-21)
Meta-analyses report moderate or greater symptoms of depression in 27% and anxiety in 34% of medical students globally, suggesting this sample's rates were somewhat elevated
Results
All Ruminative Responses Scale subscales were significantly positively correlated with depression, anxiety, and stress symptoms.
The RRS includes subscales measuring brooding, reflection, and depression-related rumination symptoms
All RRS subscales showed significant positive correlations with all three mental health outcomes (depression, anxiety, stress)
Rumination had been previously identified as a transdiagnostic risk factor for anxiety and depression in medical student populations
This is described as the first study in New Zealand to examine rumination alongside mental health symptoms in tertiary students
Results
Female students reported significantly more symptoms of anxiety than male students.
76 of the 100 respondents identified as female
The gender difference was statistically significant for anxiety symptoms
No other gender-based differences were specifically reported in the abstract
Results
Asian students reported significantly higher levels of brooding and total rumination than Pākehā students.
Ethnic group comparisons were conducted between Asian students and Pākehā students
Differences were statistically significant for the brooding subscale and total rumination score on the RRS
The study included demographic questions on both gender and ethnicity
Methods
The survey response rate was 29.9%, with 100 out of a possible 335 medical students completing the online survey.
The survey was conducted online in 2023
The sample was drawn from a Christchurch-based medical student cohort
Instruments used included demographic questions (gender, ethnicity), the DASS-21, and the Ruminative Responses Scale (RRS)
76 of the 100 respondents were female
Background
Mental illness is the second-leading reason for tertiary students in Aotearoa New Zealand to consider dropping out of studies.
This statistic is cited in the background context for the study
It provides motivation for examining mental health specifically in the New Zealand tertiary student context
No prior New Zealand studies had examined rumination alongside mental health symptoms in this population
What This Means
This research suggests that medical students at a New Zealand university are experiencing high rates of mental health difficulties. More than a third reported significant depression symptoms, nearly half reported significant anxiety symptoms, and over 40% reported significant stress — rates that are notably higher than what has been found in global reviews of medical student mental health. The study also found that a thinking pattern called rumination (where people repeatedly dwell on negative thoughts or problems) was consistently linked to worse depression, anxiety, and stress scores across all students surveyed.
The study also found meaningful differences between groups of students. Female students reported significantly more anxiety than male students. Asian students showed significantly higher levels of 'brooding' — a particularly unhelpful form of rumination focused on dwelling on distress — and higher total rumination scores compared to Pākehā (New Zealand European) students. These findings point to the possibility that some student groups may face additional mental health challenges that are not being fully addressed.
This research suggests that rumination may be an important and modifiable factor contributing to poor mental health in medical students, and that interventions specifically targeting rumination could be beneficial. The authors call for further research to develop accessible, tailored support for students who engage in high levels of rumination, particularly given that mental illness is already a leading reason New Zealand tertiary students consider leaving their studies.
Ward J, Kew B, Jordan J, Porter R, Douglas K. (2026). Medical student mental health and the role of rumination.. The New Zealand medical journal. https://doi.org/10.26635/6965.7338