Academic Psychiatry

, Volume 40, Issue 1, pp 63–68 | Cite as

Experiences of Psychological Distress and Sources of Stress and Support During Medical Training: a Survey of Medical Students

  • Katherine M. MathesonEmail author
  • Tessa Barrett
  • Jeff Landine
  • Alan McLuckie
  • Nerissa Li-Weh Soh
  • Garry Walter
Empirical Report



The authors examine the prevalence of psychological distress, the stressors experienced, and the supports used by medical students and residents during their medical training at a Canadian university.


This study used an online survey that included a standardized instrument to evaluate psychological distress (Kessler-10) and Likert-based survey items that examined stress levels related to family relationships, living accommodations, commuting, finances, and program requirements. Depressive symptoms, substance use, and suicidal ideation were also measured, as were supports accessed (e.g., counseling) and students’ perceptions of the overall supportiveness of the university. Non-parametric descriptive statistics were used to examine the prevalence of psychological distress, sources of stress, and supports accessed.


Surveys were received from 381 students (37 % response). Most students (60 %) reported normal levels of psychological distress on the K10 (M = 19.5, SD = 6.25), and a subgroup reported high to very high levels of psychological distress. A small number also reported substance use, symptoms of depression, and/or suicidal ideation.


These results indicate that students experience psychological distress from a number of stressors and suggest that medical schools should act as key partners in supporting student well-being by promoting self-care, educating students on the risks of burnout, and developing programs to support at-risk students.


Medical students Psychological distress Burnout 



There are no conflicts of interest to report. Funding was provided by Dalhousie University, Department of Psychiatry.


  1. 1.
    Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81:354–73.CrossRefPubMedGoogle Scholar
  2. 2.
    Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: a cross-sectional study. Med Educ. 2005;39:594–604.CrossRefPubMedGoogle Scholar
  3. 3.
    Tyssen R, Vaglum P, Gronvold NT, et al. Factors in medical school that predict postgraduate mental health problems in need of treatment. A nationwide and longitudinal study. Med Educ. 2001;35:110–20.CrossRefPubMedGoogle Scholar
  4. 4.
    Spiegel DA, Smolen RC, Jonas CK. An examination of the relationships among interpersonal stress, morale and academic performance in male and female medical students. Soc Sci Med. 1986;23:1157–61.CrossRefPubMedGoogle Scholar
  5. 5.
    Stewart SM, Lam TH, Betson CL, et al. A prospective analysis of stress and academic performance in the first two years of medical school. Med Educ. 1999;33:243–50.CrossRefPubMedGoogle Scholar
  6. 6.
    Newbury-Birch D, Walshaw D, Kamali F. Drink and drugs: from medical students to doctors. Drug Alcohol Depend. 2001;64:265–70.3.CrossRefPubMedGoogle Scholar
  7. 7.
    Clark DC, Zeldow PB. Vicissitudes of depressed mood during four years of medical school. JAMA. 1988;260:2521–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Hojat M, Mangione S, Nasca T, et al. An empirical study of decline in empathy in medical school. Med Educ. 2004;38:934–41.CrossRefPubMedGoogle Scholar
  9. 9.
    Dyrbye LN, Thomas MR, Massie S, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149:334.CrossRefPubMedGoogle Scholar
  10. 10.
    Carson AJ, Dias S, Johnston A, et al. Mental health in medical students: a case control study using the 60 item General Health Questionnaire. Scott Med J. 2000;45:115–6.PubMedGoogle Scholar
  11. 11.
    Block L, Wu AW, Feldman L, et al. Residency schedule, burnout, and patient care among first-year residents. Postgrad Med J. 2013;89:495–500.CrossRefPubMedGoogle Scholar
  12. 12.
    Pagnin D, de Queiroz V, Carvelho YTMS, et al. The relationship between burnout and sleep disorders in medical students. Acad Psychiatry. 2014;38:438–44.PubMedGoogle Scholar
  13. 13.
    Dahlin M, Runeson B. Burnout and psychiatric morbidity among medical students entering clinical training: a three year prospective questionnaire and interview-based study. BMC Med Educ. 2007;7:6.PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Givens JL, Tjia J. Depressed medical students’ use of mental health services and barriers to use. Acad Med. 2002;77:918–21.CrossRefPubMedGoogle Scholar
  15. 15.
    Tjia J, Givens JL, Shea JA. Factors associated with under treatment of medical student depression. J Am Coll Health. 2005;53:219–24.CrossRefPubMedGoogle Scholar
  16. 16.
    Moutier C, Cornette M, Lehrmann J, et al. When residents need health care: stigma of the patient role. Acad Psychiatry. 2009;33:431–41.CrossRefPubMedGoogle Scholar
  17. 17.
    Toews JA, Lockyer JM, Dobson DJG, et al. Analysis of stress levels among medical students, residents and graduate students at four Canadian schools of medicine. Acad Med. 1997;72:997–1002.CrossRefPubMedGoogle Scholar
  18. 18.
    Toews JA, Lockyer JM, Dobson DJ, et al. Stress among residents, medical students, and graduate science (MSc/PhD) students. Acad Med. 1993;68:S46–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Kessler RC, Andrews G, Colpe LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32:959–76.CrossRefPubMedGoogle Scholar
  20. 20.
    Berle D, Starcevic V, Milicevic D, et al. The factor structure of the Kessler-10 questionnaire in a treatment-seeking sample. J Ner Ment Dis. 2010;198:660–4.CrossRefGoogle Scholar
  21. 21.
    Stallman H. Prevalence of psychological distress in university students: implications for service delivery. Aust Fam Physician. 2008;37:673–7.PubMedGoogle Scholar
  22. 22.
    Andrews G, Slade T. Interpreting scores on the Kessler Psychological Scale (K10). Aust NZ J Public Health. 2001;25:494–7.CrossRefGoogle Scholar
  23. 23.
    Soh N, Norgren S, Lampe L, et al. Mental distress in Australian medical students and its association with housing and travel time. J Contemp Med Edu. 2013;1:163–9.CrossRefGoogle Scholar
  24. 24.
    Ballie AJ. Predictive gender and education bias in Kessler’s psychological distress scale. Soc Psychiatry Psychiatr Epidemiol. 2005;40:743–8.CrossRefGoogle Scholar
  25. 25.
    Donker T, Comijs H, Cuijpers P, et al. The validity of the Dutch K10 and extended K10 screening scales for depressive and anxiety disorders. Psychiatry Res. 2010;176:45–50.CrossRefPubMedGoogle Scholar
  26. 26.
    Australian Bureau of Statistics. Information paper: use of the Kessler psychological distress scale in ABS health surveys, Australia 2001. Cat no. 4817.0. Canberra.Google Scholar
  27. 27.
    Furukawa TA, Kessler RC, Slade T, et al. The performance of the K6 and K10 screening scales for psychological distress in the Australian national survey of mental health and well-being. Psychol Med. 2003;33:357–62.CrossRefPubMedGoogle Scholar
  28. 28.
    Meehan PJ, Lamb JA, Saltzman LE, et al. Attempted suicide among young adults: progress toward a meaningful estimate of prevalence. Am J Psychiatry. 1992;149:41–4.CrossRefPubMedGoogle Scholar
  29. 29.
    Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry. 1999;56:617–26.CrossRefPubMedGoogle Scholar
  30. 30.
    Centers for Disease Control and Prevention. Youth risk behavior surveillance—United States, 2009. Surveillance summaries, June 4. MMWR. 2010;59:SS–5.Google Scholar
  31. 31.
    IBM Corp. Released IBM SPSS statistics for windows, version 21.0. Armonk: IBM Corp; 2012.Google Scholar
  32. 32.
    Paice E, Hamilton-Fairley D. Avoiding burnout in new doctors: sleep, supervision and teams. Postgrad Med J. 2013;2013(89):493–4.CrossRefGoogle Scholar
  33. 33.
    Dyrbye LN, Thomas MR, Huntington JL, et al. Personal life events and medical student burnout: a multicenter study. Acad Med. 2006;81:374–84.CrossRefPubMedGoogle Scholar
  34. 34.
    Stallman HM. Psychological distress in university students: a comparison with general population data. Aust Psychol. 2010;45:249–57.CrossRefGoogle Scholar
  35. 35.
    Shariati M, Yunesian M, Vash JH. Mental health of medical students: a cross sectional study in Tehran. Psychol Rep. 2007;100:346–54.CrossRefPubMedGoogle Scholar
  36. 36.
    Baldassin S, Alves TC, de Andrade AG, et al. The characteristics of depressive symptoms in medical students during medical education and training: a cross sectional study. BMC Med Educ. 2008;8:60.PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Cheng DR, Poon F, Nguyen TT, et al. Stigma and perception of psychological distress and depression in Australian-trained medical students: results from an inter-state medical school survey. Psychiatry Res. 2013.Google Scholar
  38. 38.
    Shah M, Hasan S, Malik S, et al. Perceived stress, sources and severity of stress among medical undergraduates in a Pakistani Medical School. BMC Med Educ. 2010;10:2.PubMedCentralCrossRefPubMedGoogle Scholar
  39. 39.
    Sreeramareddy CT, Shankar PR, Binu VS, et al. Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal. BMC Med Educ. 2007;7:26.PubMedCentralCrossRefPubMedGoogle Scholar
  40. 40.
    Eisenberg D, Golberstein E, Gollust SE. Help-seeking and access to mental health care in a university student population. Med Care. 2007;45:594–601.CrossRefPubMedGoogle Scholar
  41. 41.
    Stallman HM, Shochet I. Prevalence of mental health problems in Australian university health services. Aust Psychol. 2009;44:122–7.CrossRefGoogle Scholar
  42. 42.
    Verhaak PFM, Jozien MB, Brink-Muien AVD. GP mental health care in 10 European countries: patients’ demands and GPs’ responses. Eur J Psychiatry. 2007;21:7–16.CrossRefGoogle Scholar
  43. 43.
    Thomas NK. Resident burnout. JAMA. 2004;15:2880–9.CrossRefGoogle Scholar
  44. 44.
    Dyrbye LN, Power DV, Massie FS, et al. Factors associated with resilience to and recovery from burnout: a prospective, multi-institutional study of US medical students. Med Educ. 2010;44:1016–26.CrossRefPubMedGoogle Scholar
  45. 45.
    Peter T, Roberts LW, Buzdugan R. Suicidal ideation among Canadian youth: a multivariate analysis. Arch Suicide Res. 2008;12:263–75.CrossRefPubMedGoogle Scholar

Copyright information

© Academic Psychiatry 2015

Authors and Affiliations

  • Katherine M. Matheson
    • 1
    Email author
  • Tessa Barrett
    • 2
  • Jeff Landine
    • 3
  • Alan McLuckie
    • 4
  • Nerissa Li-Weh Soh
    • 5
  • Garry Walter
    • 5
  1. 1.University of OttawaOttawaCanada
  2. 2.University of TorontoTorontoCanada
  3. 3.University of New BrunswickFrederictonCanada
  4. 4.University of CalgaryCalgaryCanada
  5. 5.The University of SydneySydneyAustralia

Personalised recommendations