Prevalence of reported harassment and associated mental health outcomes among medical students: a cross-sectional study in Sousse, Tunisia

Abstract

Harassment in academic settings is a global issue with serious psychological, emotional, and professional repercussions. In Tunisia, limited data exist regarding harassment in medical schools. This study aims to determine the prevalence of harassment among students at the Faculty of Medicine of Sousse and assess its effect on their mental health. A cross-sectional descriptive study was conducted during the 2022-2023 academic year among undergraduate medical students at the Faculty of Medicine of Sousse. A self-administered, anonymous questionnaire covering sociodemographic characteristics, experiences of harassment (moral, physical, sexual), responses to harassment, and mental health effects (assessed using the Hospital Anxiety and Depression Scale - HADS) was distributed. We collected 371 responses. Harassment was reported by 66.5% (95% CI [61.7%-71.3%]) of respondents. Moral harassment was most frequent (94.73%), followed by sexual (38.46%) and physical (25.1%) harassment. Victims were predominantly females (72.1%) and second-year students (36%). Only 39.27% of victims disclosed their experiences, with few (12.7%) reporting any action taken against perpetrators. Harassment was significantly associated with adverse outcomes: 29.5% of victims reported anxiety symptoms, 8.3% reported depressive symptoms, 6% reported suicidal ideation, and 6.5% reported suicide attempts. Increased rates of addictive behaviors (smoking, alcohol, cannabis use) as well as personal and professional difficulties (low self-esteem, social isolation, and changes in career orientation) were also observed among affected students. Harassment is highly prevalent among medical students in Sousse and has significant mental health, personal, and professional outcomes. The findings call for urgent preventive measures, structured support protocols, and institutional commitment to creating a safer academic environment.