title: Mental health self-care in medical students: a comprehensive look at help-seeking.
abstract: OBJECTIVE
  The authors characterize medical student help-seeking behaviors and examine the relationship with stress, burnout, stigma, depression, and personal health behaviors.
  
  
  METHODS
  In 2013, the authors administered an electronic survey of all enrolled students at Yale School of Medicine (183 responders, response rate=35 %), inquiring about students' primary medical and mental health care, personal health behaviors, support systems, and help-seeking behaviors. Students completed the Attitudes to Mental Health Questionnaire, the Patient Health Questionnaire-2, and a modified Maslach Burnout Inventory. The authors analyzed the results with logistic regression, the Wilcoxon rank-sum test, the Kruskal-Wallis test, or a test for significance of Kendall rank correlation.
  
  
  RESULTS
  Most students reported having a primary care provider (PCP), yet few reported seeking care when sick (33 %). Nineteen percent of students reported having a mental health provider, fewer than reported having a PCP (p<0.0001). Twenty-five percent of students reported increased mental health needs since beginning medical school, and these students were more likely to agree that their needs were untreated. The majority of students endorsed stress, which correlated with increased and unmet mental health needs (p<0.001). Burnout peaked in second- and third-year students and correlated with stress and increased and untreated needs. Most students reported comfort with asking for academic help; those uncomfortable were more likely to have mental health needs for which they did not seek treatment (p=0.004). Mental health stigma was low.
  
  
  CONCLUSIONS
  Medical students had a significant unmet need for health care, influenced by barriers to accessing care, stress, burnout, and depression. Academic help seeking and supportive faculty relationships appear related to mental health treatment seeking. Targeted interventions for stress and burnout reduction, as well as incorporation of reflective practice, may have an impact on overall care seeking among medical students. Future studies should expand to other medical and professional schools.
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA, goldja@stanford.edu.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Gold
authors.forename: Benjamin
authors.initials: B
authors.lastname: Johnson
authors.forename: Gary
authors.initials: G
authors.lastname: Leydon
authors.forename: Robert M
authors.initials: RM
authors.lastname: Rohrbaugh
authors.forename: Kirsten M
authors.initials: KM
authors.lastname: Wilkins
mesh_terms: D000328:Adult; D002055:Burnout, Professional / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012577:Schools, Medical / Q000706:statistics & numerical data; D012648:Self Care / Q000706:statistics & numerical data*; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult