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To browse Academia. Skip to main content. By using our site, you agree to our collection of information through the use of cookies. To learn more, view our Privacy Policy. Log In Sign Up. Burnout and Suicidal Ideation among U. Medical Students Annals of Internal Medicine, Liselotte Dyrbye. Matthew A. David Power. William Harper. Steven Durning. Christine Moutier. Tait Shanafelt. Medical Students. Medical Students Liselotte N. Dyrbye, MD; Matthew R. Thomas, MD; F. Szydlo, BA; Paul J.

Novotny, MS; Jeff A. Sloan, PhD; and Tait D. In multivariable analysis, burnout and low mental Objective: To assess the frequency of suicidal ideation among quality of life at baseline were independent predictors of suicidal medical students and explore its relationship with burnout. Of the students who met Design: Cross-sectional and longitudinal to cohort criteria for burnout in , 99 Recovery from study.

Setting: 7 medical schools in the United States. Burn- out seems to be associated with increased likelihood of subsequent Results: Burnout was reported by In a sensitivity analysis that assumed all nonresponders did not have suicidal ideation, the prev- alence of suicidal ideation in the past 12 months would be 5. Ann Intern Med. D eath by suicide is a major occupational hazard for physicians 1.

The increased risk for suicide among We hypothesized that burnout would relate to suicidal physicians may begin during medical school 3. Available ideation among medical students.

We used a mixed longi- studies suggest that the suicide rate among medical stu- tudinal and cross-sectional study design to evaluate the dents is higher than in the age-matched population 3—5. Suicidal ideation life. Our objective was to assess the frequency of suicidal is a well-established predictor of suicidal planning and at- ideation among medical students and explore its relation- tempts. The National Comorbidity Survey found that ship with burnout. Web-Only Participation was elective, and responses were anonymized.

Each disorder 29, Pre- probability of current major depression. We We measured mental and physical quality of life by linked individual responses on the and surveys using the Medical Outcomes Study Short Form-8 SF-8 for longitudinal analysis by using unique identifiers and 31, 32 , an alternate version of the SF Norm-based stripped all data of identifiers before forwarding them to scoring methods of responses on this instrument are used study statisticians for analysis.

The mean mental and physical quality of life Study Measures summary scores for the U. Previous re- symptoms of depression, and quality of life on both the search has demonstrated acceptable reliability and test— and surveys. These surveys also included ques- retest reliability Several studies 31 have demon- tions about demographic characteristics, and the sur- strated content, construct, and criterion-related validity for vey included questions about suicidal ideation.

We evaluated used to assess suicidal ideation among medical students 9 , differences by reported suicidal ideation in the previous are similar to questions used in large U. We used the Wilcoxon rank-sum test rather than parametric tests to account for the interval level na- The Maslach Burnout Inventory is a item instru- ture of the psychological tests.

All tests were 2-sided, with ment that is considered the gold standard for measuring a type I error rate of 0. We performed collinearity test- burnout 19 — This instrument has separate subscales ing to determine whether multiple-way collinearity existed to evaluate each domain of burnout: emotional exhaustion, among the independent variables No variables had depersonalization, and low personal accomplishment.

Tests achieved a level of collinearity that would bias the model- of discriminant and convergent validity have been accept- ing process. We performed forward stepwise logistic regres- able, construct validity of the 3 dimensions has been dem- sion to evaluate independent associations of the indepen- onstrated 22, 23 , and predictive validity has been sug- dent variables with suicidal ideation.

We used a saturated gested by burnout score predicting risk for future sick leave model and backward stepping to confirm results of the absences The Maslach Burnout Inventory has also initial stepwise regression. In all cases, backward stepping been used extensively in studies of both physicians 20,21, produced the same model as the stepwise approach. All 25 and medical students 13, 14, 26 — Health professionals are con- This work was supported by an Education Innovation sidered to have a low score on the personal accomplishment award from the Mayo Clinic.

The Mayo Clinic played no role scale if their score is 33 or less. Normal scores for health care in the design and conduct of the study; collection, manage- professionals, including physicians, are Responders were less likely than www.

Participant Characteristics, ment. Compared with age-comparable individuals and the general U. More than one third of 25—30 Relationship status Married Age, mar- Divorced 31 1. Burnout, Quality of Life, and Depression Year in medical school 1st Yes Table 1 shows the demo- Mean personal accomplishment score SD Missing responses were excluded from the total before prevalence of suicidal ideation in the past 12 months percentages were calculated.

Among these students, ment. Missing responses were excluded from the total before percentages were calculated. We observed high emotional exhaustion odds ratio, 3. Students were 2- to accomplishment odds ratio, 2. Students with suicidal ideation had statistically sig- burnout odds ratio, 3. Because of the strong association of Figure 1. Prevalence of suicidal ideation, by degree of both burnout and depression with suicidal ideation, we depersonalization and emotional exhaustion and depressive explored the interactions between these variables.

The symptoms. Table 4 shows the relationship among burnout, qual- ity of life, and depressive symptoms at baseline with sui- 0 cidal ideation over the ensuing year spring to spring Low Medium High Depersonalization We observed a strong dose—response relationship between burnout and mental quality of life at baseline and Negative depression screen suicidal ideation in the subsequent year.

When we classified burnout according to the standard categorical thresholds low, intermediate, high 19 , high emotional exhaustion, 15 high depersonalization, and low personal accomplishment at baseline were associated with a 1. The prevalence of suicidal ideation increases as Physical score 1. Positive for symptoms on 3. Students with depressive symptoms were more likely ation associated with each 1-unit increase in emotional exhaustion and deperson- alization scores or each 1-unit decrease in personal accomplishment or mental or than those without depressive symptoms to endorse sui- physical quality-of-life score.

The odds ratio of suicidal ideation for those with a cidal ideation [ Screening positive for depression at baseline was time points. The saturated multi- 0. At baseline, medical students, with approximately 1 of 9 students hav- Seven ing thoughts of suicide in the past year.

The rate of suicidal hundred ninety-two of students in the longitudinal co- ideation among medical students in our study Of these individuals, U. Among the stu- symptoms and professional distress burnout. Although dents who were not burned out at baseline, This rela- either time point never burned out. Figure 2 shows the tionship is notable because burnout seems to be a much prevalence of suicidal ideation among these groups.

Students more common form of distress among medical students who recovered from burnout were less likely than students 12—14, The association is bio- burnout 7. Students who developed logically plausible and analogous to the association be- new burnout were as likely to report suicidal ideation in tween suicidal ideation and depression.

Burnout dem- as students with chronic burnout The association between burnout and sui- www.


Burnout and Suicidal Ideation among U.S. Medical Students

To browse Academia. Skip to main content. By using our site, you agree to our collection of information through the use of cookies. To learn more, view our Privacy Policy. Log In Sign Up.


Burnout and Suicidal Ideation Among U.S. Medical Students

Little is known about the prevalence of suicidal ideation among U. To assess the frequency of suicidal ideation among medical students and explore its relationship with burnout. Prevalence of suicidal ideation in the past year and its relationship to burnout, demographic characteristics, and quality of life. Burnout was reported by





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