The Relationship Between Perfectionism, Depression, Anxiety, and Quality of Life in Medical Students: A Cross-sectional Study

Abstract

Background: Medical students face substantial academic and emotional pressures, placing them at high risk for psychological distress. Perfectionism, a common trait in this population, is often associated with mental health outcomes. Objectives: This study aimed to investigate associations between perfectionism and levels of depression, anxiety, and quality of life among medical students in Iran. Methods: This cross-sectional study was conducted in 2023 at Mashhad University of Medical Sciences. A total of 306 medical students from all academic years (basic sciences, physiopathology, externship, and internship) were selected using stratified random sampling. The response rate was approximately 70%. Participants completed an online survey consisting of a demographic questionnaire and four validated instruments: the Frost Multidimensional Perfectionism Scale (FMPS), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Previously validated Persian versions of these instruments were used. Data were analyzed using descriptive statistics and Pearson correlation coefficients. Results: The study included 306 students (52.9% male, 80.4% single, 57.8% in the internship year, 59.2% living with parents, and 71.9% with a family income > 100 million Iranian rials), with a mean age of 24.30 ± 1.94 years. The mean scores were 115.13 ± 14.85 for the FMPS, 46.19 ± 10.94 for the BDI-II, and 39.51 ± 8.28 for the BAI. Statistically significant, albeit weak, negative correlations were observed between the total perfectionism score (FMPS) and depression (BDI-II: r = -0.162, P = 0.005) and anxiety (BAI: r = -0.196, P = 0.001). A significant negative correlation was also observed between the FMPS and quality of life (WHOQOL-BREF: r = -0.118, P = 0.039). Conclusions: Higher overall perfectionism was associated with lower self-reported symptoms of depression and anxiety but also with lower quality of life, underscoring its nuanced role. Limitations include the cross-sectional design, which precludes causal inference; the single-center setting, which limits generalizability; and reliance on self-reported measures, which may introduce bias. These findings highlight the multidimensional nature of perfectionism and suggest that its adaptive and maladaptive components may have different implications for student well-being. Universities should consider implementing support programs that foster healthy striving while mitigating the detrimental aspects of perfectionism to improve student well-being.