A National Epidemiologic Mixed-methods Study on Depression, Anxiety, Substance Use, Treatment Needs and Barriers and Facilitators to Treatment Among Medical Students in Paraguay

Background: Research on the mental health of medical students enrolled in Paraguayan universities has mainly examined the prevalence of anxiety and depression, with limited exploration of treatment access, barriers, and facilitators. Additionally, substance use, such as alcohol and other substances, is of significant concern because of its association with mental health issues. This study aimed to assess the prevalence of depression, anxiety, and substance use disorders, as well as to identify barriers and facilitators influencing medical students’ access to mental health and substance use treatment in the Republic of Paraguay. Methods: A national mixed-methods cross-sectional study was conducted with 532 medical students from public and private universities across the Republic of Paraguay. Data were collected via an online survey in 2024 using validated tools to measure mental health conditions, including alcohol and other substance use. Qualitative responses regarding barriers to and facilitators of treatment were categorized and analyzed. Results: The findings revealed high rates of anxiety (76.8%) and depression (39.3%). Substance use was also concerning, with 11.1% reporting alcohol-related problems and 1.9% reporting other substance-related problems. Barriers to seeking treatment included confidentiality concerns, stigma, and financial constraints, while facilitators included trust in the mental health system, emotional distress, and accessibility. Despite the availability of these services, many students felt unsupported by their universities. Conclusions: Paraguayan universities must urgently address the stigma surrounding mental health and substance use, improve service accessibility, and build trust in the academic environment. Tackling these issues is crucial for safeguarding medical students’ mental health and future.