Burnout among medical students was strongly associated with alcohol use, according to a study published in Academic Medicine.

For the study, led by researchers from Mayo Medical School and the American Medical Association, a national survey of 4,402 medical students was conducted to determine alcohol abuse/dependence, burnout, depression, suicidality, quality of life, and fatigue.

The results revealed that approximately one-third of the students met criteria for alcohol abuse/dependence. Specifically, 80% had burnout, alcohol abuse/dependence, or depressive symptoms at the time of the survey, and 70% of students had burnout, alcohol abuse/ dependence, and/or suicidal ideation present at the time of the survey. “In comparison, only 15.6% of a sample of U.S. college-educated 22- to 34-year-olds met similar criteria,” the authors wrote. “Furthermore, the rate observed in our sample was almost twice what was previously reported among participating surgeons, a national sample of U.S. physicians, and that found in U.S. adult population.”

Of those students with alcohol abuse/dependence, they were more likely to be younger, single, and have higher educational debt. Of note, alcohol abuse/dependence appeared to be more common during the first two years of medical school.

Furthermore, the study’s findings suggesting that educational debt may increase the risk of alcohol abuse/ dependence are particularly concerning considering that medical educational debt has risen sharply over the past several decades. “The escalating cost of medical school needs to be more effectively addressed, especially if health care reform and reimbursement changes lead to reduced earning potential in some specialty areas,” the authors wrote. “If educational debt continues to rise in the face of lower earnings, the psychological toll of educational debt may become even more severe.”

In light of these findings, the researchers suggested that schools implement wellness curricula to help students understand the prevalence and consequences of mental health problems among physicians in-training and in-practice, self-assess their well-being, develop strategies to enhance their resilience, manage educational debt and seek help when needed. “Our study provides further evidence that distress among medical students warrants serious attention,” the authors concluded. “A multifaceted approach to reducing alcohol use, ameliorating burnout, and reducing the cost of medical education is needed.”