title: Resilience Among Medical Students: The Role of Coping Style and Social Support.
abstract: BACKGROUND
  Although medical students begin medical school with better mental health than their peers, during medical school students have a higher prevalence of psychological distress. Medical students often do not seek help for mental health concerns. The use of approach coping strategies and social support has been shown in other populations to be related to mental health resiliency.
  
  
  OBJECTIVE
  The rates of depression and burnout in this medical student population are expected to be high, with the majority not seeking help for their psychological distress in accordance with studies of medical students across the nation. Perceptions of stigma are hypothesized to be a potential source of this lack of care-seeking behavior. Approach coping strategies and social support are speculated to have an inverse relationship with the prevalence of depression and burnout in the medical student population.
  
  
  METHODS
  Validated measures of depression and burnout along with items pertaining to diagnosis and treatment of mental health issues, specific coping strategies used during stressful times, and perceptions of social support were used in a cross-sectional study of students at the University of North Dakota School of Medicine and Health Sciences (UND SMHS).
  
  
  RESULTS
  The overall survey response rate was 64%. Seventeen percent had moderate to severe depression, and 49% had burnout. Of depressed respondents, 81% were undiagnosed. When asked why depression develops, 23% responded that it was due to an inability to cope. A significantly greater risk of depression was associated with inadequate support from family and friends (p = .002), fellow medical students (p = .01), and the UND SMHS (p = .003). Greater use of approach-oriented coping strategies than avoidant-oriented strategies was associated with significantly decreased risk of burnout (p = .02) and was inversely correlated with depression (rs = -0.27, n = 153, p = .001).
  
  
  CONCLUSIONS
  This study outlines associations among approach-oriented coping strategies, social support, and resiliency to mental health issues among medical students. This study also supports the existing literature that stigma regarding mental health issues is present in the medical community. Further multi-institutional, longitudinal research to delineate whether interventions that promote approach coping style and utilization of social support lead to decreased rates of mental health issues is necessary. The development of these interventions will need to be a multifaceted approach that includes promotion of care-taking behaviors but also focuses on institutional cultural change in order to empower students to participate in these resiliency strategies.
authors.affiliation: a Faculty Affairs , University of North Dakota School of Medicine and Health Sciences , Grand Forks , North Dakota , USA.
authors.forename: Gwen
authors.initials: G
authors.lastname: Thompson
authors.affiliation: b Department of Family Medicine , University of North Dakota School of Medicine and Health Sciences , Grand Forks , North Dakota , USA.
authors.forename: Rosanne B
authors.initials: RB
authors.lastname: McBride
authors.affiliation: c Education Resources , Medicine, University of North Dakota School of Medicine and Health Sciences , Grand Forks , North Dakota , USA.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Hosford
authors.affiliation: b Department of Family Medicine , University of North Dakota School of Medicine and Health Sciences , Grand Forks , North Dakota , USA.
authors.forename: Gwen
authors.initials: G
authors.lastname: Halaas
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D002055:Burnout, Professional / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009658:North Dakota; D055500:Resilience, Psychological; D012944:Social Support; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: burnout; coping; depression; medical students; resiliency