Mental health of medical students in culturally diverse learning environments: a cross-sectional study in Georgia

Vollständiger Abstract

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Background: Mental health is an increasing topic of concern among medical students worldwide. International medical students may face additional stressors related to academic pressure, cultural adjustment, language barriers, and social isolation. Despite Georgia's rapidly growing international student population, limited research has examined the mental well-being of international medical students within Georgian medical universities. Objective: To assess the prevalence and severity of depression and anxiety among international medical students in Georgia, and to explore key psychological and institutional factors contributing to psychological distress, including academic stress, language barriers, homesickness, and access to mental health support. Methods: An analytical cross-sectional study was conducted among international medical students enrolled at East-West University (EWU) and East European University (EEU) in Tbilisi, Georgia. An anonymous online questionnaire was distributed via university communication channels, yielding 396 valid responses (response rate: 31%). Depression and anxiety were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7) scales, respectively. Descriptive and inferential statistics were applied to quantitative data. A semi-structured interview with a university dean provided qualitative institutional context, analysed thematically and integrated with quantitative findings. Findings: Among 296 international medical students, 79.05% exhibited depressive symptoms (PHQ-9). Prevalence was higher at EEU (81.77%) than at EWU (74.78%), and significantly greater among preclinical (82.76%) than clinical students (70.97%). Anxiety was identified in 58.45% of participants (GAD-7), with 67.33% of affected students in the moderate-to-severe range. Female students demonstrated higher anxiety prevalence (62.01%) compared to males (52.99%). The majority of students had not accessed professional mental health services (77.0%), despite widespread functional impairment. Conclusions: International medical students in Georgia face exceptionally high rates of depression and anxiety, driven by academic overload, cultural displacement, language barriers, and limited institutional support. Urgent and coordinated action from universities, mental health professionals, and policymakers is required to strengthen mental health services, reduce stigma, and create a more supportive educational environment. Keywords: medical students; mental health; depression; anxiety; international students; Georgia; PHQ-9; GAD-7; cross-sectional study