Introduction
Medical students face greater mental health issues than the general population, largely as a result of sustained academic pressure, demanding schedules, and emotional strain associated with medical training. Many large-scale surveys (eg, the World Health Organization World Mental Health Surveys in college students)1 suggest that 1 in 3 or more university students screen positive for some common mental disorders during their university education. In Poland, data from the EZOP II (Epidemiology of Psychiatric Disorders and Availability of Psychiatric Health Care) study2 indicate that slightly more than one-fourth of the adult population have experienced a mental disorder at some point in their lives, while among student populations, the prevalence ranges from 19.2% to 67.4%,3 indicating a substantially increased burden in academic settings.
Psychiatric medications (eg, antidepressants, anxiolytics, or mood stabilizers) are commonly prescribed to alleviate symptoms of depression, anxiety, and other mental illnesses, but may also influence cardiovascular parameters—including heart rate, blood pressure, and rhythm disturbances—as highlighted in earlier reviews.4,5 On the other hand, psychiatric disorders themselves are often accompanied by vegetative or somatic symptoms, such as palpitations, dizziness, chest discomfort, syncope, and orthostatic hypotension, which may reflect dysregulation of the autonomic nervous system. Autonomic nervous system dysfunction is a putative underlying mechanism of an increased cardiovascular disease (CVD) risk in individuals with psychiatric disorders.6
Since CVD is rare in young and otherwise healthy populations, such as students, this group offers a relatively “clean” context to examine how psychiatric drugs may influence the occurrence of cardiovascular symptoms.
The aim of this study was to assess the impact of psychiatric medication on cardiovascular complaints reported by medical university students and compare the prevalence of symptoms before and after initiation of pharmacotherapy.
Methods
Study design and data collection
The study was conducted in February and March 2024 on students of the Medical University of Lodz, Poland, using an online survey consisting of 22 questions. Given the anonymous nature of the survey and voluntary participation of the respondents, approval from the Bioethics Committee was not required. The complete list of questions and corresponding response options are provided in Supplementary material. The questionnaire was distributed among the students from the following fields of study: medicine, military medicine, dentistry, nursing, midwifery, emergency medical services, pharmacy, physiotherapy, dietetics, medical laboratory science, and electroradiology. Invitations were sent via the university’s internal email system, ensuring that responses were submitted exclusively by individuals with active student email accounts. The data collection process was fully anonymous; the authors had access only to the submitted responses, with no personal or identifying information attached.
The presence of mental disorders was assessed based on the participants’ self-reports. No clinical interviews were conducted, and the authors did not have access to medical records. The respondents who declared that they had been diagnosed with CVD were excluded from the study. Cardiovascular symptoms whose occurrence was checked in the participants included dizziness, syncope, palpitations, chest pain, abnormal bleeding, prolonged bleeding, orthostatic hypotension, and cold hands and feet. Prolonged bleeding was defined as a self-reported tendency toward longer or heavier bleeding episodes (eg, during minor injuries or menstruation), without clinical verification or laboratory assessment. Cold hands and feet were understood as a subjective peripheral vasomotor symptom potentially related to autonomic regulation rather than indicating structural cardiovascular pathology.
Psychiatric medication use was assessed via an open-ended survey question in which the participants were asked to list the medications they were currently taking for mental health conditions. All responses were manually reviewed and verified by the authors to ensure appropriate classification.
Group classification
The study cohort was divided into 4 groups. Group I included healthy individuals without diagnosed mental illness. Group II encompassed individuals with a diagnosed mental disorder, on psychiatric medications, who, despite treatment, had symptoms of the diagnosed mental disorder. Group III comprised students with a diagnosed mental disorder, on psychiatric medications and without symptoms of the diagnosed mental disorder. Group IV included individuals with a diagnosed mental disorder, not taking psychiatric medications. The incidence of circulatory system complaints was compared in study groups II and III before and after the initiation of psychiatric treatment.
Statistical analysis
Statistical analysis was performed using Statistica software, version 13.1 (TIBCO Software Inc., Palo Alto, California, United States). Categorical variables were presented as absolute numbers and percentages. The normality of the data distribution was assessed using the Shapiro–Wilk test. To evaluate differences between individual groups, the χ2 test was used for categorical data, and the Mann–Whitney test was applied for non-normally distributed continuous variables. The McNemar test was employed to compare the prevalence of cardiovascular symptoms within the same group of participants before and after the initiation of psychiatric treatment. To identify independent predictors of cardiovascular symptoms, a multivariable logistic regression model was used. Predictors for the multivariable logistic regression model were selected based on variables that showed a significant association with cardiovascular symptoms in univariate analyses, such as female sex, daily stress level, and mental disorder diagnosis, and on variables of primary clinical interest for this study, specifically the use of psychiatric medications. The model was constructed using the “enter” method to evaluate the independent impact of these factors while controlling for confounders. The results were presented as odds ratios (ORs) with 95% CIs. A P value below 0.05 was considered significant.
Results
We received 1132 completed surveys. The prevalence of CVDs among the respondents was 6.36% (n = 72). As the participants with diagnosed CVDs were excluded from the analysis, the final cohort comprised 1060 students. Self-reported mental disorders were present in 27.83% of the respondents (n = 295). Baseline characteristics of the study population, including age, sex, and the prevalence of cardiovascular symptoms according to mental health status, are summarized in Table 1.
Characteristic | Total (n = 1060) | Without mental disorders (n = 765) | With mental disorders (n = 295) | P value | |
|---|---|---|---|---|---|
Age, y | 18–20 | 412 (38.9) | 310 (40.5) | 102 (34.6) | 0.08 |
21–23 | 569 (53.7) | 400 (52.3) | 169 (57.3) | ||
24–26 | 64 (6) | 43 (5.6) | 21 (7.1) | ||
27–29 | 15 (1.4) | 12 (1.6) | 3 (1) | ||
Sex | Women | 839 (79.2) | 584 (76.3) | 255 (86.4) | 0.07 |
Men | 221 (20.8) | 181 (23.7) | 40 (13.6) | ||
Year of study | I | 361 (34.1) | 263 (34.4) | 98 (33.2) | 0.31 |
II | 254 (24) | 191 (25) | 63 (21.4) | ||
III | 252 (23.8) | 175 (22.9) | 77 (26.1) | ||
IV | 145 (13.7) | 102 (13.3) | 43 (14.6) | ||
V | 42 (4) | 30 (3.9) | 12 (4.1) | ||
VI | 6 (0.6) | 4 (0.5) | 2 (0.7) | ||
Field of study | Medicine | 427 (40.3) | 286 (37.4) | 141 (47.8) | 0.003 |
Military medicine | 57 (5.4) | 41 (5.4) | 16 (5.4) | ||
Dentistry | 69 (6.5) | 50 (6.5) | 19 (6.4) | ||
Nursing | 111 (10.5) | 93 (12.2) | 18 (6.1) | ||
Midwifery | 45 (4.2) | 32 (4.2) | 13 (4.4) | ||
Emergency medical services | 26 (2.5) | 17 (2.2) | 9 (3.1) | ||
Pharmacy | 88 (8.3) | 71 (9.3) | 17 (5.8) | ||
Physiotherapy | 137 (12.9) | 107 (14) | 30 (10.2) | ||
Dietetics | 38 (3.6) | 21 (2.7) | 17 (5.8) | ||
Medical laboratory science | 31 (2.9) | 24 (3.1) | 7 (2.4) | ||
Electroradiology | 31 (2.9) | 23 (3) | 8 (2.7) | ||
Cardiovascular symptoms | No symptoms | 300 (28.26) | 237 (31) | 63 (21.4) | 0.001 |
At least 1 symptom | 760 (71.74) | 528 (69) | 232 (78.6) | 0.001 | |
Dizziness | 348 (32.8) | 231 (30.2) | 117 (39.7) | 0.004 | |
Syncope | 74 (7) | 42 (5.5) | 32 (10.8) | 0.003 | |
Palpitations | 359 (33.9) | 226 (29.5) | 133 (45.1) | <0.001 | |
Chest pain | 303 (28.6) | 199 (26) | 104 (35.3) | 0.004 | |
Abnormal bleeding | 95 (9) | 69 (9) | 26 (8.8) | >0.99 | |
Prolonged bleeding | 46 (4.34) | 26 (3.4) | 20 (6.8) | 0.02 | |
Orthostatic hypotension | 403 (38) | 284 (37.1) | 119 (40.3) | 0.37 | |
Cold hands and feet | 540 (50.94) | 381 (49.8) | 159 (53.9) | 0.25 | |
Data are presented as number (percentage). | |||||
In our study, 59.66% of the students (n = 176) with diagnosed mental disorders reported taking psychiatric medications, and 30.11% of them (n = 53) took more than 1 psychiatric drug. The most frequently taken psychiatric medication was sertraline, followed by escitalopram. A detailed classification and frequency of the specific medications reported by the participants are presented in Table 2. No difference in the prevalence of cardiovascular symptoms was observed between the students on 1 psychiatric medication and those on polypharmacy (72.57% vs 66.67%; P = 0.17).
Type of medication | Total value | Specific medication | Value |
|---|---|---|---|
SSRIs | 102 (57.95) | Sertraline | 51 (28.98) |
Escitalopram | 32 (18.18) | ||
Fluoxetine | 7 (3.98) | ||
Citalopram | 6 (3.41) | ||
Paroxetine | 5 (2.84) | ||
Fluvoxamine | 1 (0.57) | ||
SNRIs | 49 (27.84) | Venlafaxine | 26 (14.77) |
Duloxetine | 23 (13.07) | ||
Other antidepressants | 39 (22.16) | Trazodone | 24 (13.64) |
Bupropion | 10 (5.68) | ||
Mianserin | 2 (1.14) | ||
Wortioxetine | 2 (1.14) | ||
Tianeptine | 1 (0.57) | ||
Anxiolytics | 37 (21.02) | Pregabalin | 26 (14.77) |
Hydroxyzine | 8 (4.55) | ||
Opipramol | 2 (1.14) | ||
Buspirone | 1 (0.57) | ||
Benzodiazepines | 13 (7.39) | Alprazolam | 10 (5.68) |
Diazepam | 1 (0.57) | ||
Chlordiazepoxide | 1 (0.57) | ||
Clonazepam | 1 (0.57) | ||
Mood stabilizers | 19 (10.8) | Lamotrigine | 16 (9.09) |
Valproic acid | 2 (1.14) | ||
Carbamazepine | 1 (0.57) | ||
Antipsychotics (neuroleptics) | 17 (8.52) | Quetiapine | 10 (5.68) |
Sulpiride | 3 (1.7) | ||
Perazine | 1 (0.57) | ||
Others (aripiprazole, flupentixol, and clozapine) | 3 (1.7) | ||
ADHD medications | 14 (7.95) | Methylphenidate | 13 (7.39) |
Atomoxetine | 1 (0.57) | ||
Hypnotics (Z-drugs) | 2 (1.14) | Zolpidem / zopiclone | 2 (1.14) |
Data are presented as number (percentage). Abbreviations: ADHD, attention deficit hyperactivity disorder; SNRI, serotonin–norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor | |||
A total of 71.74% of the respondents (n = 760) reported experiencing at least 1 cardiovascular symptom. The most common cardiovascular symptom reported by the students in all groups was cold hands and feet (50.94%; n = 540), and the least common one was prolonged bleeding (4.34%; n = 46).
Female students reported cardiovascular symptoms more frequently than male students (71.66% vs 54%; P <0.001); both sexes most often reported the occurrence of cold hands and feet.
In group I (n = 765), cardiovascular symptoms occurred in 69.23% of the participants (n = 530). In this group, 11.89% of the individuals declared a very high level of stress on a daily basis, and 30.75% declared a high daily level of stress. In group II (n = 138), cardiovascular symptoms were reported by 84.06% of the students (n = 116), in group III (n = 38) by 57.89% (n = 22), and in group IV (n = 119) by 86.55% (n = 103). Details regarding cardiovascular symptoms across all study groups are presented in Table 3.
Symptom | Group I (n = 765) | Group II (n = 138) | Group III (n = 38) | Group IV (n = 119) | P value |
|---|---|---|---|---|---|
Any cardiovascular symptoms | 530 (69.23) | 116 (84.06) | 22 (57.89) | 103 (86.55) | <0.001 |
Dizziness | 228 (29.8) | 62 (44.93) | 6 (15.79) | 51 (42.86) | <0.001 |
Syncope | 39 (5.1) | 13 (9.42) | 1 (2.63) | 15 (12.61) | 0.004 |
Palpitations | 214 (27.97) | 63 (45.65) | 6 (15.79) | 55 (46.22) | <0.001 |
Chest pain | 183 (23.92) | 46 (33.33) | 6 (15.79) | 48 (40.34) | <0.001 |
Abnormal bleeding | 70 (9.15) | 10 (7.25) | 0 | 12 (10.08) | 0.21 |
Prolonged bleeding | 26 (3.4) | 9 (6.52) | 5 (13.16) | 6 (5.04) | 0.02 |
Orthostatic hypotension | 282 (36.86) | 71 (51.45) | 8 (21.05) | 44 (36.97) | 0.001 |
Cold hands and feet | 379 (49.54) | 72 (52.17) | 14 (36.84) | 75 (63.03) | 0.01 |
Data are presented as number (percentage). | |||||
Among the participants from group I who declared a very high or high level of stress on a daily basis, 82.59% reported the occurrence of at least 1 symptom related to the circulatory system, as compared with 62.23% of the individuals who reported lower levels of daily stress.
The comparative analysis of cardiovascular symptoms before and after the initiation of psychiatric medication was conducted among the group II and III participants (n = 176). We found a significant dicrease in the frequency of most of the analyzed cardiovascular signs and symptoms, such as dizziness, syncope, palpitations, chest pain, abnormal bleeding, prolonged bleeding, orthostatic hypotension, and cold hands and feet, after the administration of psychiatric medications. Specific values are detailed in Table 4.
Symptom | Before initiating psychiatric treatment | After initiating psychiatric treatment | P value |
|---|---|---|---|
None | 51 (28.98) | 121 (68.75) | <0.001 |
Dizziness | 95 (53.98) | 51 (28.98) | <0.001 |
Syncope | 37 (21.02) | 9 (5.11) | <0.001 |
Palpitations | 101 (57.39) | 57 (32.39) | <0.001 |
Chest pain | 65 (36.93) | 34 (19.32) | <0.001 |
Abnormal bleeding | 15 (8.52) | 2 (1.14) | 0.001 |
Prolonged bleeding | 14 (7.95) | 3 (1.7) | 0.007 |
Orthostatic hypotension | 95 (53.98) | 43 (24.43) | <0.001 |
Cold hands and feet | 117 (66.47) | 51 (28.98) | <0.001 |
Data are presented as number (percentage). | |||
The assessment of independent contributors to cardiovascular symptoms showed that high or very high daily stress levels were the most prominent factor, nearly tripling the odds of reporting cardiac complaints. Furthermore, the presence of a confirmed mental disorder diagnosis and female sex were both associated with a markedly higher likelihood of occurrence of symptoms. Notably, while the use of psychiatric medication also emerged as a significant predictor, its association with cardiovascular manifestations was less pronounced than that of high stress levels or an underlying psychiatric condition. Detailed results of the multivariable model, including ORs and 95% CIs, are presented in Table 5.
Variable (independent) | Odds ratio | 95% CI | P value |
|---|---|---|---|
High daily stress level | 2.75 | 1.98–3.82 | <0.001 |
Mental disorder diagnosis | 1.92 | 1.4–2.65 | <0.001 |
Psychiatric medication use | 1.45 | 1.05–2.02 | 0.02 |
Female sex | 1.58 | 1.18–2.1 | 0.003 |
Discussion
The results of our study show that the use of psychiatric medications by medical university students is associated with a reduced incidence of cardiovascular symptoms. The observed reduction in symptoms, such as palpitations and dizziness, could indicate normalization of autonomic function, as mental health stabilizes under pharmacological treatment. Previous studies have demonstrated that effective management of anxiety and depression can alleviate both psychological and physical symptoms, including cardiovascular manifestations.7 Antidepressant therapies targeting serotonergic and noradrenergic systems can alleviate somatic symptoms in clinical populations, presumably via modulation of neurohormonal balance and reducing sympathetic overactivity.7
Stratification of the participants into 4 groups enabled exploration of the differential impact of psychiatric medications on cardiovascular symptom reporting. In particular, the comparison between group II (students with diagnosed mental disorders on psychiatric medications but still experiencing symptoms) and group III (students on psychiatric medications with full symptom remission) provides insight into the interplay between symptom control and somatic manifestations. The students in group III reported a lower incidence of cardiovascular complaints, as compared with those in group II, suggesting that effective pharmacological management of psychiatric disorders may contribute to a reduction in somatic and autonomic symptoms.
We observed no difference in the prevalence of cardiovascular symptoms between the students on more than 1 psychiatric medication and those on a single drug (66.67% vs 72.57%; P = 0.17). Although polypharmacy is often associated with an increased risk of adverse effects, our findings did not show an escalation of cardiovascular complaints in the individuals on combined therapy. This numerical trend could suggest that the students receiving combination therapy might benefit from better overall psychiatric symptom control, potentially leading to a stabilization of autonomic dysregulation. However, as this observation did not reach significance, it should be interpreted with caution and warrants further investigation in larger cohorts.
A high percentage of students without diagnosed mental disorders reported cardiovascular symptoms, which may be attributed to elevated stress levels, fatigue, and insufficient recovery. Medical students are known to experience high psychological burden, and chronic stress can dysregulate the hypothalamic–pituitary–adrenal axis and autonomic function, leading to somatic manifestations. Indeed, empirical studies have demonstrated that stress related to the examination period causes autonomic imbalance (increased heart rate, elevated blood pressure, and reduced heart rate variability) in medical student populations.8 Moreover, burnout in medical university students correlates with poorer autonomic nervous system measures and cardiovascular dysregulation.9
Among the group I participants who declared a very high or high level of daily stress, 82.59% reported at least 1 cardiovascular symptom, as compared with 62.23% of the participants reporting lower stress levels. These findings suggest that stress plays a major role in the occurrence of cardiovascular complaints, which may represent early manifestations of burnout that begin during medical training, even before students enter the workforce.
Several studies focusing on health care professionals report high prevalence of burnout and work overload. For instance, in a large Polish cross-sectional survey, 74.9% of the oncologists and 67% of the physicians of various specialties met burnout criteria.10,11 In addition, approximately 19% of the medical students in Poland reported high or very high levels of burnout.12 These data underscore that the elevated stress levels and somatic symptoms observed in our student cohort may signal early stages of a process leading to occupational burnout—a risk factor that should be acknowledged already at the stage of education.
International studies also confirm that medical professions are among the groups at the highest risk of burnout. In a study comparing the general working population and physicians, burnout prevalence was substantially higher in the latter group.13 These findings highlight that preventive interventions at the university level are crucial. Structured programs, including mindfulness-based stress reduction, resilience training, and cognitive-behavioral stress management, have been shown to reduce stress, emotional exhaustion, and burnout risk among medical students and physicians.14-16
In light of the high prevalence of stress and somatic complaints observed in our study, it is crucial for medical universities to implement preventive strategies and provide accessible psychological support. Structured interventions at the institutional level may help mitigate the development of stress-related cardiovascular symptoms and prevent progression to more severe burnout or mental health disorders.
Interestingly, female students in our study reported cardiovascular symptoms more frequently than their male peers. This finding aligns with previous observations that women tend to report physical or cardiovascular complaints more often, even in the absence of structural abnormalities. For instance, in a study of healthy teenage athletes undergoing echocardiographic screening, 43.8% of the female participants reported physical symptoms, as compared with 25.9% of the men, despite normal cardiac findings.17 Several explanations for these sex-related differences have been proposed. Biological factors, such as hormonal influence on autonomic regulation and vascular tone, may partly account for the increased frequency of symptoms in women.18,19 Additionally, psychosocial factors—higher somatic awareness and differences in coping with stress—have been shown to contribute to higher rates of symptom reporting among women.20-22
The multivariable logistic regression model further reinforced these findings, showing that high stress levels and the presence of a mental disorder were stronger independent predictors of cardiovascular symptoms than the use of psychiatric medication. This suggests that the somatic burden in this population is primarily driven by psychological distress rather than pharmacological adverse effects.
Limitations
Several limitations of our study should be acknowledged. First, the data were obtained via self-report surveys, which introduces the possibility of response bias, recall bias, and subjectivity. Second, there is potential selection bias, as the study relied on voluntary participation. Students who decided to complete the survey may not be fully representative of the entire student population at of the Medical University of Lodz. The individuals with a greater interest in mental health or those experiencing more significant cardiovascular symptoms might have been more likely to participate (self-selection bias), which could have influenced the reported prevalence of symptoms. Additionally, we lacked objective cardiovascular measurements, such as blood pressure, heart rate variability, or electrocardiography findings. Moreover, diagnoses and medication were not clinically verified. Another limitation is the sex imbalance of the sample, with a clear predominance of female participants. Given the known sex-related differences in symptom perception, stress responses, and health reporting, this disproportion may have influenced overall pattern of the results. Consequently, the generalizability of the findings, particularly to male student populations, may be limited. The use of a sample involving medical students may represent an additional limitation, as this population may be more prone to heightened symptom perception and reporting. Finally, the multivariable analysis was based on cross-sectional data; therefore, while strong associations were identified, causal relationships between stress level, medications, and symptoms could not be definitively established. Future prospective studies incorporating physiological monitoring and repeated measurements are warranted.
Conclusions
Our study demonstrates that the use of psychiatric medications among medical university students is associated with a reduction in the frequency of self-reported cardiovascular symptoms. Effective treatment of psychiatric disorders not only alleviates emotional distress but may also contribute to the reduction of somatic and cardiovascular complaints through improved autonomic regulation. Our study showed that the students who reported cardiovascular symptoms were more likely to report high or moderate levels of daily stress. The multivariable analysis indicated that cardiovascular manifestations in this population were primarily driven by high levels of daily stress and an underlying mental disorder, rather than pharmacological treatment. Regular screening for cardiovascular symptoms and stress levels among students may help detect high-risk individuals and guide targeted interventions aimed at improving both psychological well-being and cardiovascular health.
Robert Morawiec, MD, PhD, Emergency Medicine and Disaster Medicine Department, Medical University of Lodz, ul. Pomorska 251, 92-213 Łódź, Poland, phone: +48 42 272 57 59, email: robert.morawiec@umed.lodz.pl
February 3, 2026.
April 20, 2026.
April 24, 2026.
None.
None.
All authors contributed to the conception and design of the study, literature analysis, interpretation of the data, and drafting of the manuscript. All authors reviewed and approved the final version of the manuscript.
None declared.
Artificial intelligence was not used in the preparation of this manuscript.
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