Mental Health Trajectories in Medical Students: The Impact of Academic Repetition on Depressive Symptoms and Self-Rated Health.

Background: Medical students are at high risk for depressive symptoms, but few longitudinal studies have examined changes over time, especially among those repeating academic years. The aim of this study was to assess the prevalence and temporal trends of depressive symptoms and self-rated health among Hungarian medical students, examining the influence of demographic and lifestyle factors and the independent impact of academic repetition on mental health risk. Methods: In a four-year cohort study at the University of Pécs Medical School, students were classified as original-entry cohort (progressing according to the standard curriculum) or repeaters (those who began studies before 2016). Sample size was N = 196 in the first semester of the first year, N = 192 in the second semester of the first year, N = 157 in the second year, N = 147 in the third year, and N = 155 in the fourth year. Data were collected at five time points on lifestyle factors and depressive symptoms using the Beck Depression Inventory and a self-rated health questionnaire. Multivariate logistic regression identified risk and protective factors. Results: In the original-entry cohort, depressive symptoms peaked in the first two years (up to 52.6%), then declined to 24.6% by year four. Compared to age-matched peers, students had 3.1-fold higher odds of depressive symptoms at entry (OR = 3.10, CI: 2.007-4.773; p < 0.001), rising to 5.2-fold after the first exam period (OR = 5.20, CI: 3.375-8.000; p < 0.001). Among repeaters, odds of depressive symptoms remained over threefold higher than the general population (OR = 3.64, CI: 1.888-7.022, year IV/1), and self-rated health was significantly lower (p < 0.001). Financial hardship increased risk, while regular physical activity was protective. Conclusions: This study highlights the elevated and persistent mental health risks among repeaters and medical students with financial difficulties. Stratifying by academic progression reveals unique vulnerabilities, underscoring the need for targeted support in medical training.