{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:53:11Z","timestamp":1789865591862,"version":"4.0.1"},"reference-count":79,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T00:00:00Z","timestamp":1690416000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Physicians die by suicide at rates higher than the general population, with the increased risk beginning in medical school. To better understand why, this study examined the prevalence of mental distress (e.g., depressive symptoms and suicide risk) and behavioral and psychosocial risk factors for distress, as well as the associations between mental distress and risk factors among a sample of medical students in a pre\u2013COVID-19-era.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Students enrolled in a large California medical school in 2018\u20132019 (<jats:italic>N<\/jats:italic> = 134; 52% female) completed questionnaires assessing sociodemographic characteristics, depression and suicide family history, health behaviors, and psychosocial wellbeing. Assessment scores indexing mental distress (e.g., depressive symptoms, thoughts of suicide in the past 12 months, suicide risk, and history of suicidality) and risk factors (e.g., stress, subjective sleep quality, alcohol use, impostor feelings, and bill payment difficulty) were compared across biological sex using chi-squared tests, and associations between mental distress and risk factors were determined through logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Elevated mental distress indicators were observed relative to the general public (e.g., 16% positive depression screen, 17% thought about suicide in previous 12 months, 10% positive suicide risk screen, and 34% history of suicidality), as well as elevated risk factors [e.g., 55% moderate or high stress, 95% at least moderate impostor feelings, 59% poor sleep quality, 50% screened positive for hazardous drinking (more likely in females), and 25% difficulty paying bills]. A positive depression screen was associated with higher stress, higher impostor feelings, poorer sleep quality, and difficulty paying bills. Suicidal ideation in the previous 12 months, suicide risk, and a history of suicidality were independently associated with higher levels of impostor feelings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Higher scores on assessments of depressive symptoms and suicidal thoughts and behaviors were related to several individual-level and potentially modifiable risk factors (e.g., stress, impostor feelings, sleep quality, and bill payment difficulties). Future research is needed to inform customized screening and resources for the wellbeing of the medical community. However, it is likely that the modification of individual-level risk factors is limited by the larger medical culture and systems, suggesting that successful interventions mitigate suicide risk for medical providers need to address multiple socio-ecological levels.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1225254","type":"journal-article","created":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T15:28:18Z","timestamp":1690471698000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":17,"title":["Behavioral and psychosocial factors related to mental distress among medical students"],"prefix":"10.3389","volume":"11","author":[{"given":"Kathleen M.","family":"Carlos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hedyeh","family":"Ahmadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina A.","family":"Uban","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna L.","family":"Riis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fpsyt.2021.792925","article-title":"Suicide in healthcare workers: determinants, challenges, and the impact of COVID-19","volume":"12","author":"Awan","year":"2022","journal-title":"Front Psychiatry."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fpsyt.2022.791752","article-title":"COVID-19 and increased risk of physician suicide: a call to detoxify the US medical system","volume":"13","author":"Kakarala","year":"2022","journal-title":"Front Psychiatry."},{"key":"B3","doi-asserted-by":"publisher","first-page":"2295","DOI":"10.1176\/appi.ajp.161.12.2295","article-title":"Suicide rates among physicians: a quantitative and gender assessment (meta-analysis)","volume":"161","author":"Schernhammer","year":"2004","journal-title":"Am J Psychiatry."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0226361","article-title":"Suicide among physicians and health-care workers: a systematic review and meta-analysis","volume":"14","author":"Dutheil","year":"2019","journal-title":"PLoS ONE."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1520","DOI":"10.1097\/ACM.0000000000000482","article-title":"Distress among matriculating medical students relative to the general population","volume":"89","author":"Brazeau","year":"2014","journal-title":"Acad Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1097\/ACM.0000000000000134","article-title":"Burnout among us medical students, residents, and early career physicians relative to the general us population","volume":"89","author":"Dyrbye","year":"2014","journal-title":"Acad Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"334","DOI":"10.7326\/0003-4819-149-5-200809020-00008","article-title":"Burnout and suicidal ideation among US medical students","volume":"149","author":"Dyrbye","year":"2008","journal-title":"Ann Intern Med."},{"key":"B8","unstructured":"2019"},{"key":"B9","unstructured":"Park-LeeE, Hedden, SL, Lipari, RN,. 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