Depression, anxiety, and lifestyle behaviors in Ecuadorian medical students: a multivariable approach

Background: Medical students face intense academic and clinical pressures, increasing their risk for depression, anxiety, and maladaptive coping behaviors such as hazardous alcohol use. In Latin America—particularly in Ecuador—research on these issues remains limited, especially regarding the role of health-promoting behaviors. This study aimed to assess the prevalence and correlations of psychological distress, alcohol use, and lifestyle habits among Ecuadorian medical students. Methods: A cross-sectional study was conducted among 393 medical students from a private university in Quito using an online survey. Depression (PHQ-9), anxiety (GAD-7), hazardous drinking (AUDIT), and health-related behaviors (Health Behavior Inventory, HBI) were assessed using validated instruments. Clinical thresholds (PHQ-9 ≥ 10, GAD-7 ≥ 10, AUDIT ≥ 8) were applied to estimate prevalence, and associations were examined using correlation analyses, group comparisons, and mixed-effects logistic regression models. Results: The prevalence of moderate-to-severe depression, anxiety, and hazardous drinking was 54.71%, 52.93%, and 20.36%, respectively. Depression and anxiety were strongly correlated and negatively associated with HBI scores. The Positive Mental Attitude (PMA) subscale showed the strongest negative correlation. Higher HBI scores were associated with lower odds of depression (OR = 0.49) and anxiety (OR = 0.55). Comorbidities and earlier training stages increased mental health risks. Hazardous drinking was associated with tobacco use and older age but not with HBI scores. Conclusions: Ecuadorian medical students face a high burden of psychological distress. Health-promoting behaviors, particularly a positive mental attitude, were associated with lower odds of depression and anxiety. These findings underscore the need for targeted interventions and longitudinal research, especially in resource-constrained educational settings.