BackgroundPharmacological neuroenhancement (PNE) is discussed as coping strategy in academic and work-related contexts. Depending on the definition of PNE and sample population, different prevalence rates for various groups have been reported. In the three parts of the study, prevalence rates for work and student populations in Germany are detected and the reasons for PNE and possible causal associations between PNE, stress and resilience are investigated.MethodsIn part 1 of the study, 152 occupational physicians (OPs) were surveyed about prevalence rates and reasons for PNE. In part 2 of the study, 1,077 German students reported on their PNE behavior. 704 students were then longitudinally considered to draw conclusions on causal associations between PNE, stress, and resilience.ResultsThe OPs' estimated prevalence rate of 10.9% in a working population is higher than the prevalence rate of 5.4% for prescription and illicit substances found in the student sample in part 2 of the study. The reason suspected by OPs to be most important for PNE with prescription drugs were performance pressure and long working hours. Using soft enhancers, such as caffeine, is most common with a prevalence rate of 76.8% in the student sample. Stress predicts a higher (β = 0.179, p < 0.001) and resilience a lower use of PNE (β = −0.13, p = 0.001). Resilience predicts a lower (β = −0.35, p < 0.001) and PNE a higher level of stress (β = 0.11, p < 0.001).ConclusionOPs suspect a prevalence rate of 10.9% among the working population, while we found a prevalence rate of 5.4% among students. Caffeine is the most used substance for PNE, while the use of prescription and illicit substances remains low. Higher levels of stress and lower levels of resilience result in a higher use of PNE. Universities should therefore include the promotion of resilience and methods for dealing with study stress in health programs to reduce PNE.

A longitudinal study on the causal relationship between study-related stress, depressive symptoms and cognitive neuroenhancement among medical students in NRW Objectives: Medical students report high levels of study-related stress. They are also subject to an increased risk of depression. Study-related stress may lead to the consumption of a range of different substances in order to meet study requirements (pharmacological neuroenhancement = PN). This study therefore investigates the causal links between study-related stress, depression and PN. Methods: In total, 204 medical students in NRW (North Rhine-Westphalia) participated in the online survey [age: M(SD) = 24.1 (3.6); 20.1% male]. A longitudinal design with two measuring points was used with a 4-week interval. In order to measure PN, we asked how often different substances were consumed in the last four weeks to improve performance or reduce stress. The substances in question were divided and weighted according to soft enhancers, prescription drugs and illegal substances. Depressive symptoms were measured with the PHQ9 and study-related stress with the “Higher Education Stress Inventory”. Cross-lagged regression analysis (CLA) was used in order to determine causality. Results: The prevalence rates of depression were very high at 22.5% (t1) and 15.4% (t2). With regard to the causal relationship, study-related stress is a predictor of depressive symptoms but depression is not a predictor of study-related stress. Study-related stress is also a predictor of PN, but PN is not a predictor of stress. Both CLA effects were equally significant for depressive symptoms and PN. Conclusions: Study-related stress is a predictor of depressive symptoms and performance-enhancing PN. No clear causality could be found for depressive symptoms and PN, as they influence each other. Lecturers and university medical institutions should be made aware of the effects of study-related stress and be given appropriate advice in order to prevent depression and PN. Keywords: cognitive neuroenhancement – study-related stressors – medical students – depressive symptoms