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Potential predictors of psychological distress and

well-being in medical students: a cross-sectional
pilot study
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Advances in Medical Education and Practice
2 March 2016
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Miles Bore 1 Purpose: Research has consistently found that the proportion of medical students who
Brian Kelly 2 experience high levels of psychological distress is significantly greater than that found in the
Balakrishnan Nair 2 general population. The aim of our research was to assess the levels of psychological distress
more extensively than has been done before, and to determine likely predictors of distress and
1
School of Psychology, 2School of
For personal use only.

Medicine and Public Health, University well-being.

of Newcastle, Newcastle, NSW, Subjects and methods: In 2013, students from an Australian undergraduate medical school
Australia
(n=127) completed a questionnaire that recorded general demographics, hours per week spent
studying, in paid work, volunteer work, and physical exercise; past and current physical and
mental health, social support, substance use, measures of psychological distress (Kessler
Psychological Distress Scale, depression, anxiety, stress, burnout); and personality traits.
Results: Females were found to have higher levels of psychological distress than males. However,
in regression analysis, the effect of sex was reduced to nonsignificance when other variables
were included as predictors of psychological distress. The most consistent significant predictors
of our 20 indicators of psychological distress were social support and the personality traits of
emotional resilience and self-control.
Conclusion: The findings suggest that emotional resilience skills training embedded into the
medical school curriculum could reduce psychological distress among medical students.
Keywords: medical student, well-being, psychological distress, personality

Introduction
The findings of research into the mental health of university students generally, and
medical students in particular, are of concern. For example, 30% of a large sample of
students from an Australian university were found to be depressed, be anxious, have
an eating disorder, or engage in harmful drinking.1 High-to-very high levels of psy-
chological distress in medical students were found in Sweden,2 Norway,3 Australia,4,5
Spain,6 and the US and Canada in a review of 40 articles.7
Poor mental health is also seen after graduation from medical schools, and there
has been a long-standing call for the development of strategies to improve the health of
doctors.8 This has included a focus on reducing the psychological stress of medical train-
ing and medical practice.9 In a longitudinal study, from graduation year to fourth-year
Correspondence: Miles Bore residency, a 17% prevalence of mental health problems was found. The best predictors
School of Psychology, University of
Newcastle, University Drive, Callaghan,
were previous stress in medical school and prior mental health problems.10 Studies to
Newcastle, NSW 2308, Australia date indicate that doctors experience higher rates of mental health problems, such as
Tel +61 2 4921 6585
Fax +61 2 4921 6980
depression and substance use, than the general population.11 Nevertheless, doctors are
Email Miles.Bore@newcastle.edu.au less likely to seek health care for such problems when it is needed.10,12 The most severe

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and tragic of the consequences of these unaddressed mental endogenous and exogenous variables should have some power
health needs is that doctors have higher rates of suicide than to predict individual differences in the level of psychological
the general population.11 distress experienced in the medical education context. This
In Australia, a national mental health survey of doctors in turn could suggest what to target in order to manage and
and medical students13 found higher rates of psychological minimize psychological distress.
distress and suicide attempts compared to Australian popula- A consistent finding in the literature is that of sex differ-
tion norms and to other Australian professionals. This was ences on measures of psychological distress, with females
particularly pronounced for young doctors and female doc- typically reporting greater distress that males.1,13 It is for this
tors. Very high levels of psychological distress, as indicated reason that we included sex as an endogenous variable in our
by a score of 30 or more on the Kessler Psychological Dis- model of protective vs vulnerability factors.
tress Scale14 (K10), were found in 9.2% of medical students The literature on personality and psychological distress
compared to 3.1% found in the general population and 4.4% is substantial, but the typical finding is that emotional sta-
of interns. A greater proportion of female medical students bility (vs neuroticism) and self-control (vs disorderliness)
(10.4%) had high levels of psychological distress than male are negatively related to psychological distress. 19,20 For
medical students (7.1%). the research reported here, we used a three-trait “resilient
It would seem clear that more work is needed to develop well-being” model developed from previous work in medi-
effective prevention and early intervention programs that cal student selection21 and empirical research with medical
address the stress of medical training and the transition to early and other allied health students.22 The model consists of the
years of clinical practice.15 Early medical training provides a traits of involvement, emotional resilience, and self-control
critical opportunity to address barriers to appropriate attention (see Figure 1).
to health care needs among doctors. One study found that it A measure of psychological distress that has been used
was not the personal problems but medical training issues that in medical student research is the K10, as just noted. Student
were the stressors among students. Introduction of increased burnout has also been examined,2,23 and could be considered
student feedback, guidance, and the provision of adequate an indicator of distress level in response to the demands
learning resources were suggested as stress-reduction strate- of medical education and each individual’s ability to self-
gies.16 In another study, second-year medical students who manage in that context.24 Other distress indicators might be
were given an elective in “mind–body skills” had reduced use of health services, substance use, days off due to mental
anxiety scores compared to the baseline.17 health, levels of stress, anxiety and depression, self-esteem,
While awareness is growing that intervention in the form and general satisfaction with life.
of mental health skill building is needed within the medical The aim of this study was to investigate the psychologi-
school curriculum, research based on a more comprehensive cal health and well-being among a representative sample of
psychologically based model of protective and vulnerability medical students enrolled in an Australian undergraduate
factors is required. Such research has the potential to show medical program. We sought to assess more extensively the
more clearly where intervention might be aimed. To study levels of psychological distress than had been done before,
this, we developed a model similar to one proposed by Dunn and to examine likely predictors of distress and well-being.
et al18 of protective vs vulnerability factors to psychological The expectations were that a significant proportion of stu-
distress as the foundation of our research. The pilot study is dents would be experiencing psychological distress, and that
reported here. endogenous and exogenous variables would significantly
Each student brings into the medical education context predict psychological distress and related indicators.
(and any other context) their endogenous trait, eg, their sex
and their personality traits. Exogenous variables are those Subjects and methods
that make up the individual’s medical education context, and Participants
might include such factors as hours per week required for The sample consisted of 127 students (from a total of 709 stu-
study (including lectures, tutorials, and reading), access to dents; response rate 18%) enrolled in a 5-year medical program
health services, living arrangements, relationship status, level in 2013 at an Australian university. Recruitment targeted years
of social support, year of study within the medical program, 1, 3, and 5, although participation was open to all students.
paid and/or volunteer work, physical exercise undertaken, Participant numbers in each year were 33, six, 36, four, and 46,
leisure time, and financial concerns. A combination of respectively (two unrecorded). There were 32 males, 93 females

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Resilient well-being

Emotional
Involved Self-controlled
resilience

Empathic, confident with Emotionally stable, calm, Conscientious, orderly,

others, cooperative, engaged, grounded restrained, industrious
agreeable
vs vs vs
Aloof, narcissistic, Neurotic, volatile, anxious,
disagreeable, withdrawn, unreality of Permissive, antisocial,
uncomfortable with others thoughts unrestrained
Emotional
Detached Disorderly
reactivity

Susceptibility to
psychological distress

Figure 1 Three personality traits of the health professional resilience model.

Note: Based on the findings reported in Munro et al.22

(two unrecorded), and the mean age was 23 (standard deviation on a modified version of a survey of student experiences of
5.6, median 22, range 17–49) years. All enrolled were full-time support services,25 asked about awareness of health-support
students, and 28 had tertiary qualifications. services at the university.

Instruments Exercise and leisure

The questionnaire battery consisted of nine sections. Hours of exercise and other physical activities in a typical
week, how satisfying (5-point scale, not satisfying to highly
General demographics satisfying) these are, other leisure/hobbies, and how satisfy-
Information on sex, age, accommodation during semester ing (5-point scale) these are were recorded.
and other times (with parents, friends, partner, alone, other),
relationships (married, partnered, single [in relationship], Social support
single [no current relationship], separated, or divorced), year Participants completed the Duke Social Support Index
of current degree, intended area of medical practice, and (DSSI),26 which comprises eleven questions, such as “How
previous tertiary qualifications was gathered. many times did you talk to someone – friends, relatives or
others – on the phone in the last week (either they called you
Work and study or you called them)?” with eight response options (0–7 or
Average weekly hours of study (lectures, tutorials, reading, more) and “Do you feel useful to your family and friends (ie,
studying), hours of paid work during and outside semester, people important to you)?” with answer options of “hardly
hours of volunteer work during and outside semester, and ever”, “some of the time”, and “most of the time”. Three
concern about day-to-day finances (not concerned, somewhat, scores are derived from the DSSI: social interaction with
very) were assessed. others over the past week, satisfaction with relationships
with others, and overall social support.
Health
Questions on physical health over the past 5 years, current Substance use
physical health, mental health over the past 5 years, and The ten-item Alcohol Use Disorders Identification Test27
current mental health were all answered on a 5-point scale and ten-item Cannabis Use Disorders Identification Test28
of very poor to excellent. A further nine questions, based were used.

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Psychological distress (low scores indicating aloofness and narcissistic behavior),

The 21-item short form of the Depression, Anxiety, and emotional resilience (high scores indicating emotional stabil-
Stress Scale (DASS)29 with items such as “In the past week, ity and low scores indicating neuroticism), and self-control
I felt scared without any good reason” (4-point scale, “did (orderly, conscientious, restrained) vs disorderliness (messy,
not apply to me at all” to “applied to me very much, or most impulsive, permissive). High scores on all three traits indicate
of the time”. Included in the battery was the ten-item K10,14 psychological resilience, while low scores indicate suscepti-
with such questions as “In the last 4 weeks, about how often bility to psychological distress. The items (eg, “I don’t waste
did you feel depressed?”, answered using five response my time on people who have caused their own problems”)
options (“none of the time” to “all of the time”). The K10 are answered using a 4-point scale: “never true about you”
also includes four additional questions that ask about time to “always true about you”.
away from work or study due to the feelings reported in
questions 1–10 of the scale. Participants also completed Procedure
the Satisfaction with Life Scale,30 which consists of five The research proposal was approved by the University of
items, such as “I am satisfied with my life” answered on a Newcastle Human Research Ethics Committee. Participants
7-point scale (“strongly disagree” to “strongly agree”), and were recruited by email, in which the research was described
the ten-item Rosenberg Self-Esteem Scale,31 eg, “I wish I and an invitation given to complete the questionnaire bat-
could have more respect for myself ”, reverse-scored, with tery, which was made available online from a secure server
a 4-point response scale of “strongly agree” to “strongly internal to the university. Participants could log in and
disagree”. complete the battery at a time and location of their choice.
The time taken to complete the battery was not recorded,
Student burnout but was estimated to take approximately 40 minutes from
The Maslach and Jackson Burnout Inventory32 was adapted pilot testing. In order to recognize the time and effort
for a tertiary-level student context by the researchers using involved, participants who completed the battery had a
the same subscale structure as the original. Emotional one in ten chance of receiving a AU$20 shopping voucher.
exhaustion was measured using nine items, eg, “I feel Data were collected over the period of semester 1 (March
I can’t cope anymore”, eight items for lack of personal to May 2013). No identifying information was recorded
accomplishment, eg, “I feel like I’ve lost my purpose in my with the data. Participants were advised that completion
studies”, and six items for depersonalization eg, “I worry of the questionnaire would be taken as consent. Data were
that my studies are hardening me emotionally”, with all items then downloaded, and descriptive and statistical analyses
answered using a 5-point scale from “strongly disagree” to performed. Missing-item data were replaced with the mid-
“strongly agree”. range of the item’s response scale. The analyses utilized
two-tailed t-tests, correlation, and regression techniques.
Personality The level of statistical significance used in all instances
Participants completed the 100-item Health Professional Val- was P,0.05, two-tailed.
ues Survey (HPVS),33 which measures three personality traits
that form a model of psychological resilience. The traits are Results
involvement with others (high scores indicating empathy and Responses to questions concerning general demographics,
confidence in dealing with others) vs detachment from others study, work, leisure activities, and health were collated and

Table 1 Accommodation, relationships, study, work, health, finances, and intended specialization
Accommodation During semester, % (n) Outside semester, % (n) Relationship status % (n)
With friends 50.4 (64) 11.0 (14) Single, no current relationship 48.0 (61)
Partner 12.6 (16) 9.4 (12) Single, in steady relationship 25.2 (32)
Parents or relatives 10.2 (13) 68.5 (87) Partnered 18.1 (23)
Alone 9.4 (12) 3.9 (5) Married 3.9 (5)
University college 8.7 (11) 0 Separated or divorced 1.6 (2)
Shared house 7.1 (9) 1.6 (2) No response 3.1 (4)
Other/no response 1.6 (2) 5.5 (7)
(Continued)

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Table 1 (Continued)
Work and health n Mean hours SD Median Range
Study per week 122 38 17.7 40 3–120
Paid work in semester 43 8 6.3 8 1–35
Paid work outside semester 58 23.2 15.1 20 1–60
Volunteer work in semester 39 3.8 2.5 4 0.2–10
Volunteer work outside semester 36 5 4.1 4 0.1–15
Exercise/physical activity in semester 126 4.5 3.1 4 0–15
Exercise/physical activity outside semester 120 5.7 4.2 5 0–20
Satisfied with exercise/physical activities 119 4.1 1.0 4 1–5
Satisfied with other leisure activities 100 4.4 0.8 5 1–5
Mean rating SD Median Range
Physical health, past 5 years 126 3.9 0.7 4 1–5
Mental health, past 5 years 127 3.5 1.0 4 1–5
Current physical health 127 4.0 0.7 4 1–5
Current mental health 127 3.6 0.9 4 1–5
Intended specialization % (n) Use of health services Yes, % (n)
Not sure yet 40.9 (52) Aware of University Health support 81 (103)
General practice 15.7 (20) Services promoted adequately 38 (49)
Surgery 13.4 (17) Know someone who has used service 46 (59)
Psychiatry 4.7 (6) Were they satisfied? 63 (37)
Pediatrics 4.7 (6) Have you used health services? 33 (42)
Physician/emergency medicine 3.9 (5) Were you satisfied? 71 (30)
Obstetrics 3.1 (4) Comfortable seeking university services 67 (85)
Anesthetics 3.1 (4) Comfortable seeking services outside university 65 (82)
Forensics 0.8 (1) Do you have a GP you can see? 63 (80)
Hematology 0.8 (1)
Oncology 0.8 (1) Finances n (%)
Ophthalmology 0.8 (1) Concerned about finances: no 25 (19)
Pathology 0.8 (1) Somewhat 79 (62)
No response 6.3 (8) Very 23 (18)
Abbreviation: SD, standard deviation.

examined to provide a profile of the student sample (see As is also shown in Table 1, physical and mental health
Table 1). During the semester, 50.4% of students lived over the past 5 years and currently were rated on average (on
with friends, while outside semester time 68.5% lived a 5-point scale) between 3 (minor problems) and 4 (generally
with parents or other relatives. The majority of students good). However, mental health over the past 5 years was rated
were single (73.2%), with 48% of these having no current significantly lower (P,0.05) than physical health over the
relationship. Responses to the question of how many hours past 5 years (t=3.77, P,0.001), and current mental health was
of lectures, tutorials, reading, and studying students did in rated significantly lower than current physical health (t=3.19,
a typical semester week ranged widely from 3 hours (one P=0.002). The majority of the sample (81%) were aware of
respondent) to 120 hours (two respondents), with the median the university general practice and student-counseling health
being 40 hours per week. Of the 127 students in the sample, services, with 33% having used the services; 63% had a
43 (33.8%) undertook an average of 8 hours a week paid general practitioner they could see as needed.
work during semester. An average of 3.8 hours per week was Measures of psychological distress and personality were
spent on volunteer work during the semester by 39 (30.1%) scored, the α-reliabilities examined, and the means and
students. A further 4.5 hours were taken up with exercise standard deviations calculated for males and females (see
or other physical activity, and most found this satisfying Table 2). All measures showed acceptable-to-high internal
and enjoyable. A large proportion of students (79%) were reliability, with the exception of the social interaction sub-
somewhat concerned about their finances, while 23% of scale of the DSSI. With regard to sex differences, compared
these were very concerned. General practice was the most to males, females had significantly higher mean scores for
popular intended specialization, although 40.9% of students depression, anxiety, and stress as measured by the DASS,
responded “not sure yet”. higher psychological distress scores as indicated by the K10,

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Table 2 Mean and standard deviation for males and females

Scale Variable Males Females
n Mean SD n Mean SD α
DSSI Social interaction 32 7.7 1.5 91 7.3 1.4 0.22
Satisfaction 32 18.7 2.1 91 18.5 2.1 0.70
Social support, total 32 26.4 2.7 91 25.9 2.7 0.43
DASS Depression 32 7.6 5.8 92 11.2* 10.4 0.88
Anxiety 32 4.3 3.7 92 8.5* 9.4 0.86
Stress 32 11.7 6.5 92 14.7* 9.6 0.84
K10 Psychological distress 31 16.8 4.3 91 20.6* 7.2 0.88
AUDIT Alcohol use, total 31 6.7* 5.0 91 4.5 4.3 0.75
CUDIT Cannabis use, last 6 months 7 – – 5 – – –
RSES Self-esteem 30 30.6* 3.6 91 28.4 5.8 0.87
SWLS Satisfaction with life 30 22.7 7.3 91 23.3 7.6 0.91
Burnout Emotional exhaustion 27 26.3 6.1 82 28.0 7.3 0.87
Lack of personal accomplishment 27 21.9 5.7 82 22.4 6.5 0.86
Depersonalization 27 11.6 3.7 82 12.8 4.7 0.79
Burnout total 27 59.8 12.5 82 63.2 15.6 0.92
HPVS Involved vs detached 25 127.8 11.0 82 134.9* 13.3 0.85
Emotional resilience 25 71.3 7.9 82 68.2 12.9 0.91
Self-control 25 70.3 9.5 82 75.3* 8.9 0.86
Note: *Differences between sex mean scores is significant at P,0.05.
Abbreviations: SD, standard deviation; DSSI, Duke Social Support Index; DASS, Depression, Anxiety, and Stress Scale; K10, Kessler Psychological Distress Scale; AUDIT,
Alcohol Use Disorders Identification Test; CUDIT, Cannabis Use Disorders Identification Test; RSES, Rosenberg Self-Esteem Scale; SWLS, Satisfaction with Life Scale; HPVS,
Health Professional Values Survey.

and lower self-esteem. Males reported significantly higher adult population, and compared to medical student and all-
rates of alcohol consumption than females. In response to student norms, the scores showed less psychological distress.
the Cannabis Use Disorders Identification Test, seven (22%) The proportion of females in the high and very high ranges
males and five (5.4%) females reported using cannabis over was similar to the medical student and all-student norms, but
the past 6 months (given this small number of users, no greater than the all-adult norms.
frequency-of-use analysis was conducted). For the HPVS In order to produce manageable and meaningful regres-
measure of personality, females were significantly more sion models, we selected eleven variables as predictors based
involved with others and had higher self-control compared to on an initial examination of the correlation matrix of all
males. No sex differences were observed for social support, variables. Sex and the personality variables of involvement,
satisfaction with life, burnout, or emotional resilience. emotional resilience, and self-control were selected as endo­
The sample’s mean scores on the DASS were compared genous predictors. Exogenous predictor variables were: year of
to the published norms.29 The male mean depression, anxi- study (1, 3, or 5); hours per week of study (including lecture
ety, and stress scores were no different to the male norms. and tutorial attendance), paid work during semester, volunteer
However, females were significantly more depressed, anxious, work during semester, and exercise or other physical activity;
and stressed compared to the female norms (all P,0.001). concern about finances; and level of social support as mea-
The DASS norms also provide severity ratings by sex, with sured by the DSSI. The variable of hours per week of study
scores distributed from “normal” to “extreme severity”. As was considered a predictor variable, as it included lecture and
shown in Table 3, 19% of the males in the sample were in the tutorial attendance, as well as reading and studying, and so
moderate range of depression scores and 13% in the moderate provided a surrogate measure of the demands of a medical
range for anxiety and for stress. The proportion of females in degree. Hours per week studying was also examined as an
the severe and extremely severe range was much higher for outcome variable on the basis that the time devoted to study
depression, anxiety, and stress. K10 psychological distress was an indicator of engagement with one’s degree.
scores were compared to the national mental health survey of The other outcome variables examined were the use of
doctors and medical students13 and the 2007 National Survey the university health services, alcohol use, cannabis use, K10
of Mental Health and Wellbeing34 findings. The distribution psychological distress score, DASS scores, burnout scores
of males’ K10 scores was the same as found in the general (total score and the three subscores), self-esteem, and satis-

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Table 3 Sample DASS and K10 scores compared to norm distributions

DASS Male, % (n) Female, % (n)
Depression Anxiety Stress Depression Anxiety Stress
Normal 72 (23) 75 (24) 75 (24) 54 (50) 60 (55) 61 (56)
Mild 6 (2) 13 (4) 9 (3) 14 (13) 7 (6) 9 (8)
Moderate 19 (6) 13 (4) 13 (4) 12 (11) 12 (11) 13 (12)
Severe 3 (1) 0 3 (1) 7 (7) 7 (6) 13 (12)
Extremely severe 0 0 0 12 (11) 15 (14) 4 (4)
K10 Sample Male norms, % Sample Female norms, %
% (n) Medical All students All adults % (n) Medical All students All
students students adults
Low (10–19) 77 (24) 51 63 75 48 (44) 41 57 67
Moderate (20–24) 19 (6) 31 32 19 24 (22) 34 31 23
High (25–29) 3 (1) 11 4 4 13 (12) 16 8 7
Very high (30–50) 0 7 1 2 14 (13) 10 5 4
Notes: K10 norms for medical students from Beyond Blue.13 “All students” and “all adults” norms from the National Survey of Mental Health and Wellbeing (2007) report,
given in Beyond Blue.13
Abbreviations: DASS, Depression, Anxiety, and Stress Scale; K10, Kessler Psychological Distress Scale.

faction with life. Included as outcome variables were two of being more emotionally resilient, being in an earlier year
the four additional K10 questions: days unable to work, study, of study, and having lower financial concerns. However,
or manage your day in the last 4 weeks due to these feelings emotional resilience was found to be the only significant
(feelings being responses to items 1–10 of the K10), and days unique predictor.
you cut down on what you did due to these feelings. The four Lower self-control and higher hours in paid work per
questions that asked participants to rate their physical health week were significant predictors of alcohol use (Alcohol
and mental health over the past 5 years and currently were Use Disorders Identification Test scores) and cannabis use
also included as outcome variables. in the last 6 months. Eight of the predictors were related to
The procedure for each multiple linear regression run psychological distress, with three being significant negative
was to correlate the eleven predictor variables against an predictors (low emotional resilience, self-control, and study
outcome variable. Only variables that were found to be sig- hours per week), the model in total accounting for 57.2% of
nificantly related to the outcome were then included in the the variance in psychological distress.
regression model for that outcome. As shown in the first row Of note was that while sex was significantly related to
of Table 4, study hours per week was significantly and posi- 12 of the 20 outcome variables, it was not found to be a
tively correlated with self-control (r=0.24) and year of study significant unique predictor in any of the regression models.
(r=0.19): participants who spent more time studying tended to Emotional resilience was a significant predictor in 16 of the
have higher self-control and were more likely to be in a higher 20 models, self-control in seven models, and social support
year. Study hours per week was then regressed against self- in five models. The burnout regression model had the largest
control and year of study. Standardized β-weights are shown number of significant unique predictors: high burnout scores
in Table 4 (to the right of the correlation coefficients), where were predicted by low involvement, low emotional resilience,
the predictor variable reached significance in the regression low exercise hours per week, and low social support.
model. For study hours per week, the standardized β-weight
for self-control was 0.21 and for year of study was 0.25. In Discussion
this model, these two variables accounted for 10.4% of the Our expectation that a significant proportion of students
variance in study hours per week. All regression models would be experiencing psychological distress was partly
shown in Table 4 were statistically significant. supported. Males in our sample were generally no more
The results given in Table 4 show that higher use of distressed than the general population, although 13%–19%
the university health services was related to being female, of males scored in the moderate range on both the DASS and
having lower emotional resilience, being in a higher year the K10. Females were significantly more distressed than
of study, and having greater financial concerns. Conversely, males, and more distressed when compared to other students
lower use of the health services was related to being male, and the general population.

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Table 4 Significant correlations and regression models
Outcomes Predictors
Sex Involvement Emotional Self-control Year of Study/ Paid Volunteer Exercise/ Finance Social R2
resilience study, university, work, work, physical concern support (adjusted)
1–5 HPW HPW HPW activity,

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HPW
Study/university, HPW 0.24/0.21 0.19/0.25 10.0 10.4
Used health services 0.27 –0.34/–0.30 0.23 0.18 13.3
AUDIT score –0.22 –0.33/–0.31 0.24/0.23 17.4
Cannabis use, last 6 months –0.26 –0.29/–0.25 0.31/0.29 17.4
K10 – psychological distress 0.24 –0.23 –0.68/–0.56 –0.34/–0.19 –0.25/–0.21 –0.28 0.27 –0.34 57.2
K10 – days not working/ 0.19 –0.24 –0.33/–0.25 –0.28 –0.24 19.3
studying
K10 – days cut down 0.21 –0.38/–0.29 –0.23 –0.21 0.27/0.22 –0.23 19.6
Depression 0.17 –0.20 –0.60/–0.48 –0.36/–0.25 –0.24/–0.18 –0.20 0.21 –0.35 44.2
Anxiety 0.22 –0.62/–0.64 0.19/0.22 0.21 44.2
Stress –0.67/–0.64 0.24/0.22 –0.19 0.26 –0.20 46.8
Emotional exhaustion –0.31 –0.59/–0.43 –0.26 0.19 –0.30 –0.44/–0.22 42.0
Lacking personal –0.34 –0.38/–0.20 –0.42/–0.27 –0.25 –0.22 –0.32 26.1
accomplishments
Depersonalization –0.53/–0.48 –0.34/–0.18 –0.19 –0.20 –0.43/–0.19 36.1
Burnout total –0.45/–0.23 –0.54/–0.35 –0.36 –0.29/–0.15 –0.48/–0.22 44.8
Self-esteem 0.20 0.69/0.57 0.27 0.22 –0.22 0.47/0.30 56.6
Satisfaction with life 0.22 0.48/0.32 0.33/0.21 –0.27 0.43/0.29 33.2
Physical health, past 5 years –0.19 0.40/0.37 0.23 17.4
Current physical health –0.19 0.33 0.26/0.20 –0.19/–0.21 0.21 17.2
Mental health, past 5 years –0.19 0.65/0.60 –0.18 0.30 41.8
Current mental health –0.19 0.20 0.64/0.53 0.22 0.23 –0.24 0.34 42.7
Notes: Blank, not significant; single coefficient, significant correlation; two coefficients, correlation/standardized β-value of significant unique predictor. Sex coded 1 for male, 2 for female.
Abbreviations: HPW, hours per week; AUDIT, Alcohol Use Disorders Identification Test; K10, Kessler Psychological Distress Scale.
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 Dovepress Psychological distress in medical students

The exogenous variables, which indicate each individual’s have been a significant predictor of more of the indica-
medical education context, of accommodation, relationship tors of distress.
status, and intended specialization were not significantly With regard to personality, low self-control was predictive
related to any of the psychological distress or well-being of alcohol use, cannabis use, K10 scores, depression, lack
measures, although there was a trend toward those living of personal accomplishment, and low satisfaction with life.
alone to be more psychologically distressed. However, being However, the strongest predictor of 14 of the 20 indicators
in a higher year of study, spending more hours studying and of psychological distress measured was the personality trait
attending university, and having more hours of paid work of emotional resilience. In earlier unpublished research,35
and volunteer work were associated with higher psychologi- with a sample of 427 Australian undergraduate students,
cal distress. Greater financial concern was also associated a correlation of –0.86 between emotional resilience (as mea-
with greater distress, as has been found by others.1 Exercise sured by the HPVS) and neuroticism (vs emotional stability,
hours per week and social support were associated with lower as measured by the NEO PI-R [Neuroticism–Extroversion–
psychological distress. Openness Personality Inventory – revised])36 was found
Significant sex differences were found with a number strongly, suggesting that both scales are measuring the same
of variables, and to a large extent replicated the differences personality trait. In the present study, the trait of emotional-
reported by many others. Of note, however, was that while ity was a significant predictor of use of the health services,
females were significantly more involved and self-controlled, K10 scores, days not at work/study, or cut down on work/
they were no different to males in their emotional resilience study due to psychological distress, depression, anxiety and
scores: females typically scored lower than males on the stress scores, burnout, past physical health, past and current
personality trait of emotional stability. No sex differences mental health, self-esteem, and satisfaction with life. Given
were observed for burnout scores, nor on self-esteem or the strength of the relationships between emotional resilience
satisfaction with life scores. and these outcome variables, which ranged from –0.33 to
As noted, the relatively small number of males in the –0.69 with significant regression standardized β-weights
sample means these findings need the support of replication ranging from –0.18 to –0.64, it would seem clear that this
with a large and more balanced sample. Why males were is an important and relevant trait in the context of medical
more reluctant to participate than females is not clear. The student well-being.
smaller proportion of males that we found reporting high The findings overall suggest that greater social support
psychological distress compared to the norm might suggest and high emotional resilience are key factors in minimiz-
that distressed males were less willing to participate than ing and managing psychological distress and enhancing
distressed females. We note that the proportion of male well-being. Put another way, medical students with low
respondents in the Beyond Blue national survey13 of medical social support and low emotional resilience are at risk of
students and the Said et al1 university student study (37.4% experiencing high levels of psychological distress, including
and 34%, respectively) reflected to some degree the smaller depression, anxiety, stress, and burnout. While there has been
proportion (25%) of male students willing to participate in some research into embedding general resilience training into
our study. university courses,37 our findings suggest a more targeted
Although sex correlated significantly with 12 of our approach could help avoid the development of psychologi-
20 outcome variables, it was not found to be a unique cal distress. Self-knowledge of one’s level of social support
significant predictor in any of the regression models. and emotional resilience and training in strategies (such as
This is a finding of some importance, as it suggests that physical exercise, as found here) and skills that improve the
while sex is related to various indicators of psychological management of one’s emotions could be worthwhile incor-
distress, the effect becomes nonsignificant when other porating into the medical school curriculum.
more strongly related variables, such as personality traits A limitation of this study is the small sample size and
and social support, are considered. Interpretations of particularly the small proportion of males in the sample, and
the findings regarding social support need to be made further research is clearly required. The study was cross-
with some caution, given the low α-reliability found sectional, and so lacks the predictive ability of a longitudinal
for social interaction. It could be that a more reliable study. However, the strength of the relationships found here
measure of social support would have produced stronger does suggest the potential for the findings to be replicated.
relationships with the outcome variables and perhaps Further consideration could be given to possible other trait

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 Bore et al Dovepress

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