Psychological distress and preserved academic functioning among medical trainees in Kenya: a convergent mixed-methods cross-sectional study

Introduction: psychological distress is highly prevalent among health professional trainees, yet academic decline may inadequately identify psychologically vulnerable students. This study examined the association between psychological distress and academic functioning among medical trainees in Kenya. Methods: a convergent mixed-methods cross-sectional study was conducted among 266 medical trainees at Kenya Medical Training College, Kisumu Campus, selected through stratified random sampling. Psychological distress was assessed using the Global Mental Health Assessment Tool-Primary Care version (GMHAT/PC). Quantitative data were analyzed using descriptive statistics, Chi-square tests, and multivariable logistic regression, while qualitative data were analyzed thematically and integrated during interpretation. Results: psychological distress was highly prevalent, with 85.0% of participants reporting symptoms in at least one domain, while 77.8% maintained satisfactory academic functioning. Depressive symptoms (p = 0.038), adolescent onset of psychological difficulties (p = 0.029), and perceived genetic predisposition to mental illness (p = 0.011) showed significant crude associations with academic functioning. However, these associations were attenuated after multivariable adjustment, indicating no independent linear relationship between psychological distress and academic functioning, with depressive symptoms showing no independent association (AOR = 0.77, 95% CI: 0.53-1.11; p = 0.166). Qualitative findings indicated that self-regulation, peer support, spirituality, resilience, and achievement motivation buffered functional decline despite psychological distress. Conclusion: psychological distress may remain concealed despite preserved academic functioning among medical trainees. Academic performance alone is therefore an unreliable indicator of psychological wellbeing. Medical training institutions should implement proactive mental health screening and integrated support systems to enable early detection, strengthen trainee wellbeing, and promote resilient frontline health workforce development.