title: Patterns of distress in US medical students.
abstract: BACKGROUND
  How multiple forms of psychological distress coexist in individual medical students has not been formally studied.
  
  
  OBJECTIVE
  To explore the prevalence of various forms of distress in medical students and their relationship to recent suicidal ideation or serious thoughts of dropping out of school.
  
  
  METHODS
  All medical students at seven US schools were surveyed with standardized instruments to evaluate burnout, depression, stress, mental quality of life (QOL), physical QOL, and fatigue. Additional items explored recent suicidal ideation and serious thoughts of dropping out of medical school.
  
  
  RESULTS
  Nearly all (1846/2246, 82%) of medical students had at least one form of distress with 1066 (58%) having ≥3 forms of distress. A dose-response relationship was found between the number of manifestations of distress and recent suicidal ideation or serious thoughts of dropping out. For example, students with 2, 4, or 6 forms of distress were 5, 15, and 24 fold, respectively, more likely to have suicidal ideation than students with no forms of distress assessed. All forms of distress were independently associated with suicidal ideation or serious thoughts of dropping out on multivariable analysis.
  
  
  CONCLUSIONS
  Most medical students experience ≥1 manifestation of distress with many experiencing multiple forms of distress simultaneously. The more forms of distress experienced the greater the risk for suicidal ideation and thoughts of dropping out of medical school.
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, MN 55906, USA. dyrbye.liselotte@mayo.edu
authors.forename: Liselotte N
authors.initials: LN
authors.lastname: Dyrbye
authors.forename: William
authors.initials: W
authors.lastname: Harper
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Durning
authors.forename: Christine
authors.initials: C
authors.lastname: Moutier
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Thomas
authors.forename: F Stanford
authors.initials: FS
authors.lastname: Massie
authors.forename: Anne
authors.initials: A
authors.lastname: Eacker
authors.forename: David V
authors.initials: DV
authors.lastname: Power
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Szydlo
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Sloan
authors.forename: Tait D
authors.initials: TD
authors.lastname: Shanafelt
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D002055:Burnout, Professional / Q000453:epidemiology / Q000523:psychology*; D003625:Data Collection; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005221:Fatigue; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D012577:Schools, Medical / Q000639:trends*; D012931:Social Environment; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology; D013337:Students, Medical / Q000523:psychology*; D059020:Suicidal Ideation; D014481:United States