OBJECTIVES: Medical students experience worse psychological well-being than the general population. Social determinants of health (SDOH) relate to conditions in which people live, work, and age and significantly influence mental health. This study examines the association between depressive symptoms and SDOH in medical students from four countries: Czechia, Iran, Kenya, and Venezuela. METHODS: An online cross-sectional survey was conducted in the spring of 2022. The questionnaire focused on depressive symptoms (using a validated psychiatric scale DASS-21 to assess mental health) and various SDOHs. RESULTS: A total of 2,033 medical students participated in the survey, with a median age of 23.0 years; 64.8% were females; 60.8% of respondents had some degree of depressive symptoms (mild-to-moderate 32.5%, severe-to-extremely severe 28.3%). Several SDOHs, such as low engagement in social life, low personal funds, and low social class, were strongly associated with severe-to-extremely severe depressive symptoms (p < 0.001), and the associations differed among countries. The prevalence of severe-to-extremely severe depressive symptoms varied significantly across the four countries, with Iran having the highest prevalence (OR = 2.1 compared to Czechia), followed by Czechia (OR = 1, reference value), Kenya (OR = 0.9), and Venezuela (OR = 0.6). CONCLUSION: The study demonstrates the high prevalence of depressive symptoms among medical students from four global regions and the significant association with specific SDOH. Notably, the variation in prevalence across countries and differential relationships with SDOH underscore the importance of considering transcultural factors in research and management to improve mental health among medical students.

1st Department of Internal Medicine Cardioangiology St Anne's University Hospital Brno Brno Czech Republic

African Population and Health Research Centre Nairobi Kenya

Boston Children's Hospital Harvard Medical School Harvard University Boston MA USA

Department of Biology Faculty of Medicine Masaryk University Brno Czech Republic

Department of Global Health and Population Harvard T H Chan School of Public Health Harvard University Boston MA USA

Department of Internal Medicine 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Internal Medicine Faculty Hospital Kralovske Vinohrady and 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Public Health Faculty of Medicine Masaryk University Brno Czech Republic

Department of Social and Preventive Medicine School of Medicine Lisandro Alvarado Central Western University Barquisimeto Venezuela

Endocrinology and Metabolism Research Centre Vali Asr Hospital School of Medicine Tehran University of Medical Sciences Tehran Iran

ENT and Head and Neck Research Centre Five Senses Institute Iran University of Medical Sciences Tehran Iran

Faculty of Medicine Masaryk University Brno Czech Republic

Foundation for Clinic Public Health and Epidemiology Research of Venezuela Caracas Venezuela

International Clinical Research Centre St Anne's University Hospital Brno Brno Czech Republic

Julius Global Health Julius Centre for Health Sciences and Primary Care University Medical Centre Utrecht Utrecht University Utrecht The Netherlands

Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart Icahn School of Medicine at Mount Sinai New York NY USA

LifeDoc Health Memphis TN USA

Ministry of Public Health of Ecuador Quito Ecuador

School of Medicine Faculty of Medicine University of the Andes Venezuela

School of Medicine Faculty of Medicine University of Zulia Maracaibo Venezuela

Student Research Committee School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran

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