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Background: Mental distress during medical training is associated with academic performance, learning processes, and patient safety. This study aimed to quantify the mental health burden among medical students at Frankfurt University Hospital by estimating the prevalence of clinically relevant depressive symptoms and describing burnout, habitual well-being, and perceptions of the learning environment.

Methods: A pseudonymized online survey was conducted among medical students at Goethe University Frankfurt Medical Center. The survey used a standardized questionnaire developed within the ELMA study (University of Augsburg), funded by the Volkswagen Foundation. Data collection was embedded in a prospective longitudinal framework; the present analysis uses cross-sectional data from the first wave (November 7–December 8, 2025; response rate 32%). Depression (PHQ-9), burnout symptoms (MBI-SS), habitual well-being (FAHW-12) and the perceived learning environment (DREEM) were assessed. Descriptive statistics (M ± SD) and established cut-offs were applied.

Results: The final sample comprised 589 individuals (aged 18-40; M=23.3, SD=3.4). Of these, 73.7% were female, 25.6% male and 0.3% diverse. On the PHQ-9, 36.4% scored ≥10, indicating clinically relevant depressive symptoms. In the overall distribution, 22.8% were classified as “healthy” and 40.9% as “unremarkable”; among those with elevated symptom levels, 22.6% were categorized as “mild depression”, 9.2% as “moderate depression”, and 4.6% as “severe depression”. MBI-SS means (scale range 0-6) were: exhaustion M=3.09 (SD=1.33), loss of meaning M=1.38 (SD=1.46) and reduced sense of self-efficacy M=2.13 (SD=1.36). The FAHW-12 (scale range 1-5) showed M=3.82 (SD=0.62). In the DREEM assessment, 71.9% rated the learning environment as “more positive than negative”, whereas 20.8% reported “plenty of problems”. The lowest-rated domain was perception of teaching.

Discussion: Even though the learning environment was largely perceived as positive, a substantial proportion of students reported clinically relevant depressive symptoms and burnout. This discrepancy shows that a favorable overall climate does not eliminate significant individual strain and structural deficits. These findings underscore the importance of systematically addressing student well-being and identifying and addressing specific weaknesses within the curriculum.

Take-home messages: More than one-third of students reported clinically relevant depressive symptoms, and many exhibited elevated levels of emotional exhaustion. Despite positive overall ratings of the learning environment, these findings justify the implementation of systematic, low-threshold mental health support in medical education.