Academic stress associated with probable eating disorder in medical students during their externship: post-pandemic cross-sectional study

Background: Previous research has explored the relationship between academic stress and eating disorders (ED) among medical students, yet studies specifically assessing this association during the externship training context are lacking after the impact of the COVID-19 pandemic on the medical education training. This study aimed to assess the association between academic stress and probable ED among medical students during their externship year at a university in Peru in 2022. Methods: A cross-sectional study was conducted involving medical students undertaking their externship training year during 2022 at a university in Lima, Peru. Probable ED and academic stress were assessed using the Eating Attitudes Test-26 and the SISCO Inventory questionnaires, respectively. Poisson regression analysis with robust variances was employed to calculate prevalence ratios (PR) and 95% confidence intervals (95% CI) to measure the effect of severe and moderate academic stress on probable ED compared to mild academic stress, adjusting for confounding variables like age, gender, previously diagnosed mental health disorder, has failed a previous course during medical school, and time between nighttime rest location and hospital. An interaction analysis was performed to assess the influence of gender as an effect modifier. Results: 193 participants were included, predominantly female (59.1%) with a median age of 21 years. Among the participants, 43.0% had failed a previous course during medical school, and 18.7% had a previously diagnosed mental health disorder. The prevalence of moderate and severe academic stress was 36.3% and 29.0%, respectively. 34.7% of the sample had a probable eating disorder. Medical students with moderate and severe academic stress had 150% (aPR: 2.50; 95% CI: 1.25 to 5.00) and 340% (aPR: 4.40; 95% CI: 2.32 to 8.37) higher prevalence of probable ED compared to those with mild academic stress. Gender did not act as an effect modifier variable of these associations. Conclusion: Moderate to severe academic stress was associated with a higher prevalence of probable ED among medical students during their externship training after the COVID-19 pandemic. However, unmeasured confounders and cross-sectional design limit causal inference. These findings highlight the importance of addressing stress management strategies within medical education to mitigate the risk of developing ED during critical training periods.