Exploring the impact of depression, anxiety, stress, academic engagement, and dropout intention on medical students' academic performance: A prospective study

Background: Depression, anxiety, and stress (DAS) have been linked to poor academic outcomes. This study explores the relationships among DAS, academic engagement, dropout intentions, and academic performance — measured by Grade Point Average (GPA) — in medical students. It aims to understand how these factors relate to each other and predict academic performance. Methods: Data were collected from 351 medical students (74.9 % female) through an online survey. The average age was 20.2 years. Psychometric instruments measured DAS, academic engagement, and dropout intentions. Structural equation modeling was used to test the relationships between these variables and their prediction of GPA. Results: DAS was negatively associated with academic engagement β̂=−0.501p<0.001 and positively associated with dropout intentions β̂=0.340p<0.001. Academic engagement positively predicted GPA β̂=0.298p<0.001 and negatively associated with dropout intentions β̂=−0.367p<0.001. DAS had a nonsignificant direct effect on GPA β̂=−0.008p=0.912. However, the indirect effect of DAS — via academic engagement — on GPA and dropout intention was statistically significant. Limitations: The study's limitations include the use of a convenience sample and the collection of all variables, except GPA, at the same time point, which may affect the generalizability of the results. Conclusions: The study supports the important role of DAS in its association with academic engagement and dropout intentions, which can predict GPA. Addressing DAS could enhance academic engagement and reduce dropout rates, leading to better academic performance.