Behavioral HealthORIGINAL ARTICLE

Identifying risk factors for burnout and self-harm thoughts among medical students: a multi-institutional survey study

Alexander J. Eddy, DO, DHA, MBA, MS; Natasha N. Bray, DO, MSEd; and Aaron J. Place, DO, PhD
Notes and Affiliations
Notes and Affiliations

Received: April 25, 2025

Accepted: January 12, 2026

Published: February 26, 2026

  • Alexander J. Eddy, DO, DHA, MBA, MS, 

    Resident, Internal Medicine Preliminary Program, The University of Kansas School of Medicine – Wichita, Wichita, KS, USA

  • Natasha N. Bray, DO, MSEd, 

    Dean, Clinical Professor of Rural Health, Associate Dean of Accreditation, Oklahoma State University College of Osteopathic Medicine – Cherokee Nation, Tahlequah, OK, USA

  • Aaron J. Place, DO, PhD, 

    Resident, Choctaw Nation Family Medicine Residency Program, Talihina, OK, USA

Abstract

Context: Burnout is a critical issue, with prevalence as high as 76 % among medical students. Associated with decreased empathy, cheating, withdrawal from medical school, and suboptimal patient care, burnout correlates with work hours (WH) and self-harm thoughts (SHT).

Objectives: This study analyzes the correlations of burnout, WH, SHT, and various socioeconomic, demographic, experiential, and behavioral factors among medical students.

Methods: A cross-sectional analysis was conducted utilizing a 60-question survey distributed to 12 osteopathic and 23 allopathic medical schools in six states (AR, KS, LA, MO, OK, and TX). Data from 137 medical students was analyzed utilizing the Copenhagen Burnout Inventory (CBI). Average burnout scores, weekly WH, and frequency of SHT were calculated for different demographic groups, with multiple linear regression analysis identifying significant predictors of burnout.

Results: Key findings include: (1) burnout and SHT rates increased from medical school year 1 (MS1) to MS3 years despite varying workloads; (2) female students reported higher burnout while male students had higher SHT rates; (3) married students showed significantly lower SHT rates (2.6 vs. 16.3 %); (4) students experiencing mistreatment had substantially higher burnout scores (48.8 vs. 38.0) and doubled SHT rates (19.3 vs. 7.8 %); (5) self-funded students reported higher burnout and SHT; and (6) religious affiliation was associated with lower SHT prevalence. Regression analysis identified male gender as protective against burnout, while depression/hopelessness, self-funded education, increased WH, and mistreatment were significant risk factors.

Conclusions: Medical student burnout varies significantly based on multiple factors, with concerning relationships between burnout, WH, and SHT. Medical schools should prioritize creating supportive learning environments and eliminating student mistreatment, with targeted interventions for vulnerable groups including female students, those with financial strain, and caregivers. Addressing these factors early in medical training may help mitigate burnout throughout physicians’ careers, ultimately improving healthcare delivery.

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