Skip to main content

Medical Student Suicide: An Assessment of Risk Factors and Prevention Strategies

  • Chapter
  • First Online:
Suicide Prevention

Abstract

Throughout their careers, medical caregivers face high levels of stress and are at increased risk of depression, burnout, and suicide. Even early in medical training, medical students have been shown to have increased prevalence of mental health concerns and mental distress. Rates of suicide completion in medical students have been in decline since the 1950s. However, as detailed by David Muller and other colleagues, lives continue to be tragically lost to suicide, leaving a resounding impact on families and students, schools, and the medical community. The prevalence of risk factors associated with suicide, including depression, anxiety, burnout, and substance abuse, remains high. Interventions can be made to reduce the burden of mental distress. Familial support and marital status may serve as protective factors against the development or exacerbation of psychopathology in this population. Additionally, the majority of medical schools have begun to implement a wide variety of curricular wellness programs and suicide risk-reduction strategies to ensure identification and treatment of at-risk students, as well as continued wellness for others.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Schernhammer E. Taking their own lives: the high rate of physician suicide. N Engl J Med. 2005;352(24):2473–6.

    Article  CAS  PubMed  Google Scholar 

  2. Simon HJ. Mortality among medical students, 1947–1967. J Med Educ. 1968;43(11):1175–82.

    PubMed  CAS  Google Scholar 

  3. Hays LR, Cheever T, Patel P. Medical student suicide, 1989–1994. Am J Psychiatry. 1996;153(4):553–5.

    Article  CAS  PubMed  Google Scholar 

  4. Cheng J, Kumar S, Nelson E, Harris T, Coverdale J. A national survey of medical student suicides. Acad Psychiatry. 2014;38(5):542–6.

    Article  PubMed  Google Scholar 

  5. Hawton K. Suicide in doctors while under fitness to practise investigation. BMJ. 2015;350:h813.

    Article  PubMed  Google Scholar 

  6. Centers for Disease Control and Prevention, National Center for Health Statistics: underlying cause of death 1999–2015 on CDC WONDER online database. 2017. http://wonder.cdc.gov/ucd-icd10.html. Accessed 3 Mar 2017.

  7. Baca-Garcia E, Perez-Rodriguez MM, Oquendo MA, Keyes KM, Hasin DS, Grant BF, et al. Estimating risk for suicide attempt: are we asking the right questions? Passive suicidal ideation as a marker for suicidal behavior. J Affect Disord. 2011;134(1):327–32.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the Scale for Suicide Ideation. J Consult Clin Psychol. 1979;47(2):343–52.

    Article  CAS  PubMed  Google Scholar 

  9. Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: a cross-sectional study. Med Educ. 2005;39(6):594–604.

    Article  PubMed  Google Scholar 

  10. Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149(5):334–41.

    Article  PubMed  Google Scholar 

  11. Clark DC, Zeldow PB. Vicissitudes of depressed mood during four years of medical school. JAMA. 1988;260(17):2521–8.

    Article  CAS  PubMed  Google Scholar 

  12. Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA. 2016;316(21):2214–36.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Goebert D, Thompson D, Takeshita J, Beach C, Bryson P, Ephgrave K, et al. Depressive symptoms in medical students and residents: a multischool study. Acad Med. 2009;84(2):236–41.

    Article  PubMed  Google Scholar 

  14. Carson AJ, Dias S, Johnston A, McLoughlin MA, O’connor M, Robinson BL, et al. Mental health in medical students: a case control study using the 60 item General Health Questionnaire. Scott Med J. 2000;45(4):115–6.

    Article  CAS  PubMed  Google Scholar 

  15. Dyrbye LN, Thomas MR, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, et al. Personal life events and medical student burnout: a multicenter study. Acad Med. 2006;81(4):374–84.

    Article  PubMed  Google Scholar 

  16. Rosal MC, Ockene IS, Ockene JK, Barrett SV, Ma Y, Hebert JR. A longitudinal study of students’ depression at one medical school. Acad Med. 1997;72(6):542–6.

    Article  CAS  PubMed  Google Scholar 

  17. Saravanan C, Wilks R. Medical students’ experience of and reaction to stress: the role of depression and anxiety. Sci World J. 2014. https://doi.org/10.1155/2014/737382.

  18. Aktekin M, Karaman T, Senol YY, Erdem S, Erengin H, Akaydin M. Anxiety, depression and stressful life events among medical students: a prospective study in Antalya, Turkey. Med Educ. 2001;35(1):12–7.

    Article  CAS  PubMed  Google Scholar 

  19. Inam SB. Anxiety and depression among students of a medical college in Saudi Arabia. Int J Health Sci (Qassim). 2007;1(2):295–300.

    Google Scholar 

  20. Stewart SM, Betson C, Marshall I, Wong CM, Lee PW, Lam TH. Stress and vulnerability in medical students. Med Educ. 1995;29(2):119–27.

    Article  CAS  PubMed  Google Scholar 

  21. Bassols AM, Okabayashi LS, Silva AB, Carneiro BB, Feijó F, Guimarães GC, et al. First- and last-year medical students: is there a difference in the prevalence and intensity of anxiety and depressive symptoms? Rev Bras Psiquiatr. 2014;36(3):233–40.

    Article  PubMed  Google Scholar 

  22. Lloyd C, Gartrell NK. Psychiatric symptoms in medical students. Compr Psychiatry. 1984;25(6):552–65.

    Article  CAS  PubMed  Google Scholar 

  23. Tyssen R, Vaglum P, Grønvold NT, Ekeberg O. Suicidal ideation among medical students and young physicians: a nationwide and prospective study of prevalence and predictors. J Affect Disord. 2001;64(1):69–79.

    Article  CAS  PubMed  Google Scholar 

  24. Noyes R. Suicide and panic disorder: a review. J Affect Disord. 1991;22(i):1–11.

    Article  PubMed  Google Scholar 

  25. Schmidt N, Woolaway-Bickel K, Bates M. Evaluating panic specific factors in the relationship between suicide and panic disorders. Behav Res Ther. 2001;39(6):635–49.

    Article  CAS  PubMed  Google Scholar 

  26. O’Rourke SR, Bray AC, Anastopoulos AD. Anxiety symptoms and disorders in college students with ADHD. J Atten Disord. 2017. https://doi.org/10.1177/1087054716685837.

  27. Tuttle J, Schuerich N, Ranseen J. Prevalence of ADHD diagnosis and nonmedical prescription stimulant use in medical students. Acad Psychiatry. 2010;34(3):220–3.

    Article  PubMed  Google Scholar 

  28. Mazzone L, Ducci F, Scoto MC, Passaniti E, D’arrigo VG, Vitiello B. The role of anxiety symptoms in school performance in a community sample of children and adolescents. BMC Public Health. 2007;7(1):347.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Esch P, Bocquet V, Pull C, Couffignal S, Lehnert T, Graas M, et al. The downward spiral of mental disorders and educational attainment: a systematic review on early school leaving. BMC Psychiatry. 2014;14(1):237.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Blair-West GW, Cantor CH, Mellsop GW, Eyeson-annan ML. Lifetime suicide risk in major depression: sex and age determinants. J Affect Disord. 1999;55(2–3):171–8.

    Article  CAS  PubMed  Google Scholar 

  31. Pepitone-Arreola-Rockwell F, Rockwell D, Core N. Fifty-two medical student suicides. Am J Psychiatry. 1981;138(2):198–201.

    Article  CAS  PubMed  Google Scholar 

  32. Vitaliano PP, Maiuro RD, Russo J, Mitchell ES. Medical student distress: a longitudinal study. J Nerv Ment Dis. 1989;177(2):70–6.

    Article  CAS  PubMed  Google Scholar 

  33. Richman JA, Flaherty JA. Gender differences in medical student distress: contributions of prior socialization and current role-related stress. Soc Sci Med. 1990;30(7):777–87.

    Article  CAS  PubMed  Google Scholar 

  34. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354–73.

    Article  PubMed  Google Scholar 

  35. Lloyd C, Gartrell NK. Sex differences in medical student mental health. Am J Psychiatry. 1981;138(10):1346–51.

    Article  PubMed  CAS  Google Scholar 

  36. Jeon HJ, Roh MS, Kim KH, Lee JR, Lee D, Yoon SC, et al. Early trauma and lifetime suicidal behavior in a nationwide sample of Korean medical students. J Affect Disord. 2009;119(1):210–4.

    Article  PubMed  Google Scholar 

  37. Hardeman RR, Przedworski JM, Burke SE, Burgess DJ, Phelan SM, Dovidio JF, et al. Mental well-being in first year medical students: a comparison by race and gender. J Racial Ethn Health Disparities. 2015;2(3):403–13.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Fan AP, Kosik RO, Mandell GA, Tran DT, Cheng HM, Chen CH, et al. Suicidal ideation in medical students: who is at risk? Ann Acad Med Singap. 2012;41(9):377–82.

    PubMed  Google Scholar 

  39. Haglund ME, aan het Rot M, Cooper NS, Nestadt PS, Muller D, Southwick SM, et al. Resilience in the third year of medical school: a prospective study of the associations between stressful events occurring during clinical rotations and student well-being. Acad Med. 2009;84(2):258–68.

    Article  PubMed  Google Scholar 

  40. Meehan PJ, Lamb JA, Saltzman LE, O’carroll PW. Attempted suicide among young adults: progress toward a meaningful estimate of prevalence. Am J Psychiatry. 1992;149(1):41–4.

    Article  CAS  PubMed  Google Scholar 

  41. Pyskoty CE, Richman JA, Flaherty JA. Psychosocial assets and mental health of minority medical students. Acad Med. 1990;65(9):581–5.

    Article  CAS  PubMed  Google Scholar 

  42. Dyrbye LN, Thomas MR, Huschka MM, Lawson KL, Novotny PJ, Sloan JA, et al. A multicenter study of burnout, depression, and quality of life in minority and nonminority US medical students. Mayo Clin Proc. 2006;81(11):1435–42.

    Article  PubMed  Google Scholar 

  43. Katz J, Monnier J, Libet J, Shaw D, Beach SR. Individual and crossover effects of stress on adjustment in medical student marriages. J Marital Fam Ther. 2000;26(3):341–51.

    Article  CAS  PubMed  Google Scholar 

  44. Coombs RH, Fawzy FI. The effect of marital status on stress in medical school. Am J Psychiatry. 1982;139(11):1490–3.

    Article  CAS  PubMed  Google Scholar 

  45. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96.

    Article  CAS  PubMed  Google Scholar 

  46. Baldwin DC, Hughes PH, Conard SE, Storr CL, Sheehan DV. Substance use among senior medical students: a survey of 23 medical schools. JAMA. 1991;265(16):2074–8.

    Article  PubMed  Google Scholar 

  47. Jackson ER, Shanafelt TD, Hasan O, Satele DV, Dyrbye LN. Burnout and alcohol abuse/dependence among U.S. medical students. Acad Med. 2016;91(9):1251–6.

    Article  PubMed  Google Scholar 

  48. Wasserman JA, Fitzgerald JE, Sunny MA, Cole M, Suminski RR, Dougherty JJ. Nonmedical use of stimulants among medical students. J Am Osteopath Assoc. 2014;114(8):643–53.

    Article  PubMed  Google Scholar 

  49. Conard S, Hughes P, Baldwin DC, Achenbach KE, Sheehan DV. Substance use by fourth-year students at 13 U.S. medical schools. J Med Educ. 1988;63(10):747–58.

    PubMed  CAS  Google Scholar 

  50. Bucher JT, Vu DM, Hojat M. Psychostimulant drug abuse and personality factors in medical students. Med Teach. 2013;35(1):53–7.

    Article  PubMed  Google Scholar 

  51. Frank E, Elon L, Naimi T, Brewer R. Alcohol consumption and alcohol counselling behaviour among US medical students: cohort study. BMJ. 2008;337:a2155.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Shoukat S, Anis M, Kella DK, Qazi F, Samad F, Mir F, et al. Prevalence of mistreatment or belittlement among medical students: a cross sectional survey at a private medical school in Karachi, Pakistan. PLoS One. 2010;5(10):e13429.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  53. Dumitrascu CI, Mannes PZ, Gamble LJ, Selzer JA. Substance use among physicians and medical students. Med Student Res J. 2014;3:26–35.

    Google Scholar 

  54. Shiralkar MT, Harris TB, Eddins-Folensbee FF, Coverdale JH. A systematic review of stress-management programs for medical students. Acad Psychiatry. 2013;37(3):158–64.

    Article  PubMed  Google Scholar 

  55. Thompson D, Goebert D, Takeshita J. A program for reducing depressive symptoms and suicidal ideation in medical students. Acad Med. 2010;85(10):1635–9.

    Article  PubMed  Google Scholar 

  56. Kiessling C, Schubert B, Scheffner D, Burger W. First year medical students’ perceptions of stress and support: a comparison between reformed and traditional track curricula. Med Educ. 2004;38(5):504–9.

    Article  PubMed  Google Scholar 

  57. Drolet BC, Rodgers S. A comprehensive medical student wellness program: design and implementation at Vanderbilt School of Medicine. Acad Med. 2010;85(1):103–10.

    Article  PubMed  Google Scholar 

  58. Moutier C, Norcross W, Jong P, Norman M, Kirby B, McGuire T, et al. The suicide prevention and depression awareness program at the University of California, San Diego School of Medicine. Acad Med. 2012;87(3):320–6.

    Article  PubMed  Google Scholar 

  59. Downs N, Feng W, Kirby B, McGuire T, Moutier C, Norcross W, et al. Listening to depression and suicide risk in medical students: the Healer Education Assessment and Referral (HEAR) Program. Acad Psychiatry. 2014;38(5):547–53.

    Article  PubMed  Google Scholar 

  60. Rohe DE, Barrier PA, Clark MM, Cook DA, Vickers KS, Decker PA. The benefits of pass-fail grading on stress, mood, and group cohesion in medical students. Mayo Clin Proc. 2006;81(11):1443–8.

    Article  PubMed  Google Scholar 

  61. Bloodgood RA, Short JG, Jackson JM, Martindale JR. A change to pass/fail grading in the first two years at one medical school results in improved psychological well-being. Acad Med. 2009;84(5):655–62.

    Article  PubMed  Google Scholar 

  62. Ghodasara SL, Davidson MA, Reich MS, Savoie CV, Rodgers SM. Assessing student mental health at the Vanderbilt University School of Medicine. Acad Med. 2011;86(1):116–21.

    Article  PubMed  Google Scholar 

  63. Hassed C, De lisle S, Sullivan G, Pier C. Enhancing the health of medical students: outcomes of an integrated mindfulness and lifestyle program. Adv Health Sci Educ Theory Pract. 2009;14(3):387–98.

    Article  PubMed  Google Scholar 

  64. Erogul M, Singer G, Mcintyre T, Stefanov DG. Abridged mindfulness intervention to support wellness in first-year medical students. Teach Learn Med. 2014;26(4):350–6.

    Article  PubMed  Google Scholar 

  65. Dunn LB, Iglewicz A, Moutier C. A conceptual model of medical student well-being: promoting resilience and preventing burnout. Acad Psychiatry. 2008;32(1):44–53.

    Article  PubMed  Google Scholar 

  66. Austenfeld JL, Paolo AM, Stanton AL. Effects of writing about emotions versus goals on psychological and physical health among third-year medical students. J Pers. 2006;74(1):267–86.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carol Swetlik B.A. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Swetlik, C., Franco, K.N. (2018). Medical Student Suicide: An Assessment of Risk Factors and Prevention Strategies. In: Falcone, T., Timmons-Mitchell, J. (eds) Suicide Prevention. Springer, Cham. https://doi.org/10.1007/978-3-319-74391-2_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74391-2_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74390-5

  • Online ISBN: 978-3-319-74391-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics