{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T19:12:16Z","timestamp":1790190736916,"version":"4.1.0"},"reference-count":62,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T00:00:00Z","timestamp":1607558400000},"content-version":"unspecified","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,10,29]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Although there is much focus on burnout and psychological distress among doctors, studies about stress and well-being in medical students are limited but could inform early intervention and prevention strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>The primary aim of this mixed-method, cross-sectional survey was to compare objective and subjective levels of stress in final-year medical students (2017) and to explore their perspectives on the factors they considered relevant to their well-being.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>University College Dublin, the largest university in Ireland.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>161 of 235 medical students participated in this study (response rate 69%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>65.2% of students scored over accepted norms for the Perceived Stress Scale (34.8% low, 55.9% moderate and 9.3% high). 35% scored low, 28.7% moderate and 36.3% high on the Subjective Stress Scale. Thematic analysis identified worry about exams, relationships, concern about the future, work\u2013life balance and finance; one in three students reported worry, irritability and hostility; many felt worn out. Cognitive impacts included overthinking, poor concentration, sense of failure, hopelessness and procrastination. Almost a third reported sleep and appetite disturbance, fatigue and weariness. A quarter reported a \u2018positive reaction\u2019 to stress. Positive strategies to manage stress included connection and talking, exercise, non-study activity and meditation. Unhelpful strategies included isolation and substance use. No student reported using the college support services or sought professional help.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Medical students experience high levels of psychological distress, similar to their more senior doctor colleagues. They are disinclined to avail of traditional college help services. Toxic effects of stress may impact their cognition, learning, engagement and empathy and may increase patient risk and adverse outcomes. The focus of well-being in doctors should be extended upstream and embedded in the curriculum where it could prevent future burnout, improve retention to the profession and deliver better outcomes for patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-040245","type":"journal-article","created":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T21:18:51Z","timestamp":1607635131000},"page":"e040245","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":36,"title":["Worried, weary and worn out: mixed-method study of stress and well-being in final-year medical students"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6860-4586","authenticated-orcid":false,"given":"Abbie","family":"Lane","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Mental Health Research, St. Vincent\u2019s University Hospital and School of Medicine and Health Sciences, University College Dublin, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"McGrath","sequence":"additional","affiliation":[{"name":"Cardiff University School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eimear","family":"Cleary","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Mental Health Research, St. Vincent\u2019s University Hospital and School of Medicine and Health Sciences, University College Dublin, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allys","family":"Guerandel","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Mental Health Research, St. Vincent\u2019s University Hospital and School of Medicine and Health Sciences, University College Dublin, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin M","family":"Malone","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Mental Health Research, St. Vincent\u2019s University Hospital and School of Medicine and Health Sciences, University College Dublin, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,12,10]]},"reference":[{"key":"2025121600245536000_10.12.e040245.1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000134"},{"key":"2025121600245536000_10.12.e040245.2","unstructured":"Hayes B , Walsh G , Prihodova L . National study of wellbeing of hospital doctors in Ireland. Royal College of physicians of Ireland, 2017. Available: https:\/\/rcpi-live-cdn.s3.amazonaws.com\/wp-content\/uploads\/2017\/05\/Wellbeing-Report-web.pdf"},{"key":"2025121600245536000_10.12.e040245.3","unstructured":"BMA . Caring for the mental health of the medical workforce, 2019. Available: https:\/\/www.bma.org.uk\/collective-voice\/policy-and-research\/education-training-and-workforce\/supporting-the-mental-health-of-doctors-in-the-workforce"},{"key":"2025121600245536000_10.12.e040245.4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0140-6736(16)30934-5","article-title":"When the doctor is sick too","volume":"388","year":"2016","journal-title":"The Lancet"},{"key":"2025121600245536000_10.12.e040245.5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.12777"},{"key":"2025121600245536000_10.12.e040245.6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.15845"},{"key":"2025121600245536000_10.12.e040245.7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.17324"},{"key":"2025121600245536000_10.12.e040245.8","unstructured":"Beyond Blue . The National depression initiative: a systematic review of the literature, 2010."},{"key":"2025121600245536000_10.12.e040245.9","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1111\/medu.12512","article-title":"Medical student depression, anxiety and distress outside North America: a systematic review","volume":"48","author":"Hope","year":"2014","journal-title":"Med Educ"},{"key":"2025121600245536000_10.12.e040245.10","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1300"},{"key":"2025121600245536000_10.12.e040245.11","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1080\/09638237.2018.1521922","article-title":"Distress and resilience associated with workload of medical students","volume":"28","author":"Kiziela","year":"2019","journal-title":"J Ment Health"},{"key":"2025121600245536000_10.12.e040245.12","doi-asserted-by":"crossref","unstructured":"Sheepers a systematic review of the impact of physicians occupational well-being on the quality of patient care. International Journal of Behavioural Medicine 2015.","DOI":"10.1007\/s12529-015-9473-3"},{"key":"2025121600245536000_10.12.e040245.13","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1001\/jamainternmed.2018.3713","article-title":"Association between physician burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysis","volume":"178","author":"Panagioti","year":"2018","journal-title":"JAMA Intern Med"},{"key":"2025121600245536000_10.12.e040245.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-018-2927-y","article-title":"Failing to retain a new generation of doctors: qualitative insights from a high-income country","volume":"18","author":"Humphries","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"2025121600245536000_10.12.e040245.15","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1001\/jamapediatrics.2015.0684","article-title":"Reasons why physicians and advanced practice clinicians work while sick: a mixed-methods analysis","volume":"169","author":"Szymczak","year":"2015","journal-title":"JAMA Pediatr"},{"key":"2025121600245536000_10.12.e040245.16","unstructured":"NHS Employers . Supporting staff who are experiencing mental health problems, 2019."},{"key":"2025121600245536000_10.12.e040245.17","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-010-1422-x"},{"key":"2025121600245536000_10.12.e040245.18","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-010-1487-6"},{"key":"2025121600245536000_10.12.e040245.19","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291714000129"},{"key":"2025121600245536000_10.12.e040245.20","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3999(96)00392-3"},{"key":"2025121600245536000_10.12.e040245.21","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2012.3199"},{"key":"2025121600245536000_10.12.e040245.22","unstructured":"WHO . Available: https:\/\/www.who.int\/occupational_health\/topics\/stressatwp"},{"key":"2025121600245536000_10.12.e040245.23","doi-asserted-by":"crossref","unstructured":"Hull prevalence of health related behaviours among physicians and medical trainees academic psychiatry 2008.","DOI":"10.1176\/appi.ap.32.1.31"},{"key":"2025121600245536000_10.12.e040245.24","doi-asserted-by":"crossref","DOI":"10.1186\/s12909-017-0931-2","article-title":"\"A steep learning curve\": junior doctor perspectives on the transition from medical student to the health-care workplace","volume":"17","author":"Sturman","year":"2017","journal-title":"BMC Med Educ"},{"key":"2025121600245536000_10.12.e040245.25","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s11845-017-1688-7","article-title":"Burnout and stress amongst interns in Irish hospitals: contributing factors and potential solutions","volume":"187","author":"Hannan","year":"2018","journal-title":"Ir J Med Sci"},{"key":"2025121600245536000_10.12.e040245.26","doi-asserted-by":"publisher","DOI":"10.1136\/postgradmedj-2016-134626"},{"key":"2025121600245536000_10.12.e040245.27","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0b013e3181c46aad"},{"key":"2025121600245536000_10.12.e040245.28","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1318"},{"key":"2025121600245536000_10.12.e040245.29","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0b013e3181637837"},{"key":"2025121600245536000_10.12.e040245.30","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31279-X"},{"key":"2025121600245536000_10.12.e040245.31","unstructured":"Eleanor B , Clare G , Lisa P . Doctors need to be supported, not trained in resilience. British Medical Journal 2015;351."},{"key":"2025121600245536000_10.12.e040245.32","unstructured":"Bowman B , Dyrbye L , Sinsky CA , et al . Physician well-being: the reciprocity of practice efficiency, culture of wellness, and personal resilience. NEJM Catalyst 2017."},{"key":"2025121600245536000_10.12.e040245.33","doi-asserted-by":"publisher","DOI":"10.2307\/2136404"},{"key":"2025121600245536000_10.12.e040245.34","unstructured":"Cohen S , Williamson G . Perceived Stress in a Probability Sample of the United States. In: Spacapan S , Oskamp S , eds. The Social Psychology of Health. Newbury Park, CA: Sage, 1988."},{"key":"2025121600245536000_10.12.e040245.35","doi-asserted-by":"publisher","DOI":"10.5271\/sjweh.3081"},{"key":"2025121600245536000_10.12.e040245.36","unstructured":"Ibm SPSS statistics for windows, version 24 (IBM Corp. NY, USA) 2016."},{"key":"2025121600245536000_10.12.e040245.37","doi-asserted-by":"publisher","DOI":"10.7748\/nr2011.01.18.2.52.c8284"},{"key":"2025121600245536000_10.12.e040245.38","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2025121600245536000_10.12.e040245.39","unstructured":"Cohen D , Winstanley S , Palmer P , et al . Factors that impact on medical student wellbeing \u2013 perspectives of risk. In: Individual support programme. School of Medicine, Cardiff University, 2013."},{"key":"2025121600245536000_10.12.e040245.40","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-030209"},{"key":"2025121600245536000_10.12.e040245.41","unstructured":"Price A , Smith HA . USI national report on student mental health in third level education. Dublin: Union of Students in Ireland, 2019."},{"key":"2025121600245536000_10.12.e040245.42","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2923.2003.01627.x"},{"key":"2025121600245536000_10.12.e040245.43","unstructured":"Royal medical Benevolent fund: practitioner health programme."},{"key":"2025121600245536000_10.12.e040245.44","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/kqs179"},{"key":"2025121600245536000_10.12.e040245.45","doi-asserted-by":"publisher","DOI":"10.1097\/YCO.0b013e3283477a09"},{"key":"2025121600245536000_10.12.e040245.46","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1016\/S2215-0366(19)30275-5","article-title":"Mental health care for university students: a way forward?","volume":"6","author":"Duffy","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"2025121600245536000_10.12.e040245.47","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00579-1"},{"key":"2025121600245536000_10.12.e040245.48","unstructured":"UCD strategy 2015-2020; University College Dublin;2015."},{"key":"2025121600245536000_10.12.e040245.49","unstructured":"Safety, health and welfare at work act 2005."},{"key":"2025121600245536000_10.12.e040245.50","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6963-14-134","article-title":"The new South Wales allied health workplace learning study: barriers and enablers to learning in the workplace","volume":"14","author":"Lloyd","year":"2014","journal-title":"BMC Health Serv Res"},{"key":"2025121600245536000_10.12.e040245.51","doi-asserted-by":"crossref","DOI":"10.1080\/10872981.2019.1603526","article-title":"Medical students' perceptions of stress due to academic studies and its interrelationships with other domains of life: a qualitative study","volume":"24","author":"Bergmann","year":"2019","journal-title":"Med Educ Online"},{"key":"2025121600245536000_10.12.e040245.52","doi-asserted-by":"publisher","DOI":"10.2147\/AMEP.S137384"},{"key":"2025121600245536000_10.12.e040245.53","doi-asserted-by":"publisher","DOI":"10.1007\/s10926-007-9096-x"},{"key":"2025121600245536000_10.12.e040245.54","unstructured":"Southerland VJ , Cooper CL . Strategic stress management: an organizational approach. New York: Pargrave, 2000."},{"key":"2025121600245536000_10.12.e040245.55","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/S2215-0366(18)30057-9","article-title":"Preventive strategies for mental health","volume":"5","author":"Arango","year":"2018","journal-title":"Lancet Psychiatry"},{"key":"2025121600245536000_10.12.e040245.56","unstructured":"Institute for Public Policy Research 2017 . Not by Degrees: Improving Student Mental Health in the UK\u2019s universities. London: IPPR."},{"key":"2025121600245536000_10.12.e040245.57","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/S2215-0366(18)30509-1","article-title":"Interventions to reduce symptoms of common mental disorders and suicidal ideation in physicians: a systematic review and meta-analysis","volume":"6","author":"Petrie","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"2025121600245536000_10.12.e040245.58","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1001\/jamainternmed.2016.7674","article-title":"Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis","volume":"177","author":"Panagioti","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2025121600245536000_10.12.e040245.59","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-023297"},{"key":"2025121600245536000_10.12.e040245.60","doi-asserted-by":"publisher","DOI":"10.1097\/YCO.0b013e32816ebc8c"},{"key":"2025121600245536000_10.12.e040245.61","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.chc.2016.12.017","article-title":"The transitional age brain: \"the best of times and the worst of times\"","volume":"26","author":"Chung","year":"2017","journal-title":"Child Adolesc Psychiatr Clin N Am"},{"key":"2025121600245536000_10.12.e040245.62","doi-asserted-by":"publisher","DOI":"10.4065\/80.12.1613"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-040245","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T08:25:08Z","timestamp":1765873508000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-040245"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":62,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,10]]},"published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1136\/bmjopen-2020-040245"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-040245","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12]]}}}