A Quantitative Analysis of Mandatory Wellness Assessments for 1st and 3rd Year Medical Students at the University of Ottawa

A Quantitative Analysis of Mandatory Wellness Assessments for 1st and 3rd Year Medical Students at the University of Ottawa | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Quantitative Analysis of Mandatory Wellness Assessments for 1st and 3rd Year Medical Students at the University of Ottawa Kay-Anne Haykal, Ines Zombre, Selena Laprade, Miryam Duquet, Joseph Joseph This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3970771/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background An alarming prevalence of burnout among medical students has been reported in many countries, including Canada. To design resilience and wellness programs, it is important to explore individual risk factors. This article presents an example of a Wellness Assessment Program for medical students at the University of Ottawa. The overall goal was to identify risk factors for poorer mental health outcomes among medical students at the University of Ottawa. Methods We conducted a quantitative study to determine risk factors for mental health, among MD-A (1st year only), MD-B (1st year only), MD-C (1st and 3rd year) and MD-D (1st and 3rd year). Results Risk factors that significantly impacted the mental health of 1st and 3rd year medical students at the University of Ottawa were physical health, sleep/fatigue, social support, education and career, stress, and drug and/or alcohol use. Students who were originally from Ottawa had more social support and less stress and drug and/or alcohol use (p < 0.001;p = 0.009). Being in the Francophone cohort had a positive effect on physical health, but a negative effect on psychological/emotional health (p = 0.039;p = 0.004). There was a statistically significant difference (p = 0.021) between the psychological/emotional health of 1st year students (M = 0.7895) and 3rd year students (M = 0.8923) when co-variates (risk factors) were not considered. Conclusion In the current context of the limited effectiveness of measures to address the negative impacts of medical education on student well-being, this study showed that efficient use of the wellness program data can identify risk factors that have a significant impact on wellness. medical student wellness program mental health training undergraduate BACKGROUND It is well known that medical schools are considered stressful environments, as the academic expectations are extreme ( 1 ). However, it is only recently that the epidemic of burnout related to medical training has been studied ( 1 ). Medical students are facing several stressors that place them at high risk for burnout and poor mental health ( 2 , 3 ). Several studies have shown the negative impacts of medical education on student well-being in several countries, including Canada ( 1 , 4 , 5 ). It is therefore not surprising that the prevalence of psychological distress among medical students is significantly higher than in the general population ( 6 , 7 ). When compared to individuals with professional degrees or Doctoral degrees in other fields, physicians experience higher rates of emotional exhaustion and burnout and report more dissatisfaction with work-life balance ( 8 ). The more years a physician has been in practice, the more positive the perception of well-being, whereas physicians with fewer years (< 5 years) of practice reported greater burnout and lower resilience ( 9 ). Females had higher odds of having low resilience and they reported more burnout, depression and suicidal ideation when compared to men ( 9 ). The alarming condition of medical students’ well-being has prompted several institutional organizations, including medical schools, to develop and implement various wellness programs for burnout prevention and resiliency ( 10 , 11 ). However, the targeted risk factors and overall quality of these programs are inconsistent, and there is limited evidence about their effectiveness ( 11 ). Despite the increasing number of evidence on the worrying state of medical students' well-being, few systematic studies have addressed different risk factors reported to date ( 11 ). Understanding the factors that contribute to medical student distress and how to address them requires identifying risk factors for poor mental health ( 11 ). The overall goal of this study is to identify risk factors for mental health among undergraduate medical students at the University of Ottawa. Specific objectives are: 1) define the variation of these risk factors according to demographic variables; 2) determine if there is a change in the mental health of students during the 1st and 3rd year of their undergraduate program. METHODS Study design and setting Students from 4 different cohorts were invited to complete the Wellness Assessment Questionnaire. For the purpose of anonymizing the participating years, cohorts were identified with numbers: MD-A(1st year only), MD-B(1st year only), MD-C (1st and 3rd year) and MD-D (1st and 3rd year). We used a quantitative approach to analyze the Wellness Assessment questionnaire results among 1st and 3rd year students. The responses were converted to numerical values and analyzed statistically. Description of the University of Ottawa's Wellness Assessment Program The health and well-being of students are a priority for the Faculty of Medicine at the University of Ottawa. The Wellness Assessment Program aims to promote and ensure the health and well-being of students while fostering academic success. It offers a full range of services to undergraduate students, such as personal wellness, psychological health, financial and career planning, including support for the residency application process ( 12 ). The Wellness Assessment Questionnaire is part of the program, and it is based on the Medical Students Well-Being Index, the Perceived Wellness Survey and the Burns Depression Inventory ( 11 , 13 , 14 ). The questionnaire has the following headings: demographic information, mental health and risk factors such as physical health, sleep, social support, financial stress, education and career, stress and drug use and/or alcohol. Open-ended questions are also asked about any concerns the student may have, as well as a list of suggestions for the medical program. The wellness check is a mandatory assessment of the student wellness conducted in year 1 and year 3 of their undergraduate training. The Wellness Check Program was established in 2010–2011 but has not been validated ( 12 ). Students complete an online 15-minute Wellness Assessment Questionnaire on Survey Monkey prior to their appointment followed by an individual virtual 30-minute meeting with a counsellor. During and following these sessions, students are oriented to the different resources provided in relation to the pillars of Student Affairs Office services. As of the 2017–2018 academic year, the Wellness Check Program became a mandatory program for 1st year students, and since then all students must complete the questionnaire. Students in year 3 of clerkship are also invited to participate in the Wellness Check Program on a voluntary basis. An email is sent to all students at the end of April of each year to complete the survey online, accompanied by an invitation to follow up with an in-person visit with a counsellor to address any concerns or to build on strengths. Counsellors communicate with students if they identify specific concerns or red flags upon reviews of the completed surveys as well. As of the academic year 2017–2018, the 3rd year wellness check became mandatory as well. Data analysis We analyzed the responses to questions with Likert scales and converted to numbers to perform a statistical analysis addressing different questions. A multiple linear regression analysis was performed to identify independent predictors of psychological/emotional health. Independent sample t-test was used to compare various risk factors of mental health between gender, study cohort (francophone vs. anglophone) and residence. Linear mixed model repeated measures were performed to determine if time (1st year to 3rd year) has an effect on the psychological/emotional health of the students. A second linear mixed model with covariates was also performed to determine if time still has an effect on psychological/emotional health. Data were converted from the Likert scale to a numerical scale (Strongly Disagree = -2, Disagree = -1, Neutral = 0, Agree = 1, Strongly Agree = 2). The data for some questions were also reversed so that a high score in each category was considered "healthy" and a low score was therefore considered "unhealthy". For example, for question 13: In general, I have good eating habits , a Strongly Disagree has a low score (-2) while a Strongly Agree response has a high score ( 2 ). Therefore, the healthier the student is physically, the higher the score and vice versa. On the other hand, question 38: I rarely engage in exercise and/or physical activities was reversed. Therefore, a student who answered Strongly Disagree had a score of 2 (they are in better physical health) and a student who answered Strongly Agree had a score of -2 (they are in poor physical health). Due to the different number of questions by categories in the 1st - and 3rd year questionnaire, we had to use the average of the responses to the questions in each category for each student. SPSS 22.0 for Windows was used to perform statistical analyses. Results are expressed as means ± standard deviation and standardized beta coefficient with a 95% confidence interval. A p-value ≤ 0.05 was considered statistically significant. RESULTS What are the risk factors for mental health in medical students? These analyses were done on three groups: 1st year students only, 3rd year students only, and all responses combined (1st year responses from MD-A, MD-B, MD-C, and MD-D, and 3rd year responses from MD-C and MD-D). At the time of conducting this study, only two cohorts had completed both year 1 and year 3 assessments. A multiple linear regression was calculated to determine predictors of the psychological/emotional health score. The model was a significant predictor explaining 56% (R square = 0.556; p < 0.001), 73% (R square = 0.726; p < 0.001) and 59% (R square = 0.594; p < 0.001) for 1st year, 3rd year and both years, respectively. Significant predictors are presented in Table 1 . Table 1 Mental health risk factors for 1st, 3rd and all responses (1st and 3rd year) B Standard Error 95% Confidence Interval Standardized coefficient Beta p value Lower Limit Upper limit Year 1 Sleep/fatigue 0.18 0.03 0.125 0.237 0.24 < 0.001 Social support 0.30 0.04 0.226 0.375 0.28 < 0.001 Education and Career 0.19 0.05 0.098 0.285 0.14 < 0.001 Stress and drug and/or alcohol use 0.31 0.05 0.219 0.394 0.24 < 0.001 Year 3 Physical health 0.13 0.04 0.056 0.197 0.13 < 0.001 Sleep/fatigue 0.20 0.03 0.138 0.267 0.27 < 0.001 Finance -0.06 0.02 -0.108 -0.014 -0.09 0.011 Education and Career 0.33 0.05 0.233 0.431 0.30 < 0.001 Stress and drug and/or alcohol use 0.36 0.05 0.252 0.465 0.30 < 0.001 Year 1 & 3 Physical health 0.05 0.03 0.005 0.102 0.06 0.030 Sleep/fatigue 0.21 0.02 0.162 0.249 0.27 < 0.001 Social support 0.17 0.03 0.116 0.228 0.17 < 0.001 Education and Career 0.30 0.03 0.229 0.363 0.24 < 0.001 Stress and drug and/or alcohol use 0.30 0.04 0.226 0.363 0.24 < 0.001 B = Unstandardized Coefficient. Regression method. Variables entered in the model for each group year: Are you new to Ottawa; MD program stream (French or English); Gender; Physical health; Sleep/fatigue; Social support; Finance; Education and career; Stress and drug and/or alcohol use. Do risk factors and mental health vary by gender, cohort (Francophone vs. Anglophone) and whether the student is coming from Ottawa or out-of-town? Table 2 Difference between gender on well-being. Average for female(N = 519) Average for male (N = 386) p value Physical health 0.87 ± 0.65 0.99 ± 0.63 0.007 Sleep/fatigue 0.11 ± 0.83 0.38 ± 0.81 < 0.001 Social support 0.87 ± 0.61 0.93 ± 0.62 0.133 Finance 0.47 ± 0.86 0.62 ± 0.88 0.009 Education and Carreer 0.52 ± 0.48 0.66 ± 0.55 < 0.001 Stress and drug and/or alcohol use 0.84 ± 0.51 0.99 ± 0.52 < 0.001 Psychological/emotional health 0.72 ± 0.62 0.92 ± 0.63 < 0.001 N = number Data are presented as mean ± standard deviation. Table 3 Difference between cohorts on well-being. Average for the Francophone cohort (N = 296) Average for the Anglophone cohort (N = 609) p value Physical health 0.99 ± 0.63 0.89 ± 0.65 0.039 Sleep/fatigue 0.17 ± 0.85 0.25 ± 0.82 0.186 Social support 0.91 ± 0.62 0.89 ± 0.61 0.570 Finance 0.47 ± 0.90 0.56 ± 0.85 0.160 Education and Career 0.55 ± 0.50 0.59 ± 0.52 0.297 Stress and drug and/or alcohol use 0.88 ± 0.50 0.91 ± 0.52 0.428 Psychological/emotional health 0.72 ± 0.65 0.85 ± 0.62 0.004 N = number Data are presented as mean ± standard deviation. Table 4 Difference related to students’ residence on well-being. Average for students coming from Ottawa (N = 486) Average for students coming out-of-town (N = 419) p value Physical health 0.91 ± 0.64 0.94 ± 0.65 0.552 Sleep/fatigue 0.23 ± 0.83 0.23 ± 0.83 0.992 Social support 0.97 ± 0.60 0.81 ± 0.62 < 0.001 Finance 0.57 ± 0.85 0.48 ± 0.89 0.135 Education and Career 0.58 ± 0.50 0.58 ± 0.52 0.885 Stress and drug and/or alcohol use 0.95 ± 0.53 0.86 ± 0.5 0.009 Psychological/emotional health 0.81 ± 0.64 0.79 ± 0.63 0.638 N = number Data are presented as mean ± standard deviation. Is mental health better in the 1st or 3rd year of medical school? The linear mixed model repeated measures analysis conducted for this question showed a statistically significant difference (p = 0.021) between 1st year students (0.79 ± 0.63) and 3rd year students (0.89 ± 0.59) on psychological/emotional health. Summary of the main results of the study The results from Table 1 show that the higher the standardized coefficient, the more impact it has on mental health. For every 1 unit increase of the risk factor, there is an impact (increase in this case) on the mental health value corresponding to the standardized coefficient. Table 2 shows a significant difference between genders in physical health, sleep/fatigue, finance, education and career, stress and drug and/or alcohol use and psychological/emotional health. Compared to males, females have a poorer outcome in terms of physical health, sleep/fatigue, finances, education and career stress and drug/alcohol use, and psychological/emotional health. Table 3 shows a significant difference between the language cohort on physical health and psychological/emotional health. Results showed that being in one cohort or the other partially explains the higher (and therefore healthier) scores in these categories. Therefore, being in the Francophone cohort showed a higher positive effect on physical health and a lower psychological/emotional health compared to Anglophones. Table 4 shows a significant difference between students’ origin on social support and stress and drug and/or alcohol. Coming from Ottawa partially explains the higher (and therefore healthier) scores for these risk factors. This means that students who come from Ottawa have more social support and less stress and drug and/or alcohol use when compared to students coming from out of town. Finally, the mental health of the 1st year students is poorer when compared to the 3rd year students. However, when considering the co-variates (physical health, sleep/fatigue, social support, finances, education and career, and stress and substance use), the difference is no longer significant. DISCUSSION Our study used a Wellness Assessment Questionnaire, which is part of the University of Ottawa Wellness Check Program, to determine risk factors for mental health among medical students. It is acknowledged that poor mental health of medical students is a ‘’disease condition that is endemic to medical schools’’ ( 15 ). A systematic overview of risk factors for suicidal ideation and suicide attempts among medical students indicated that poor mental health outcomes such as burnout and depression are the strongest risks. Female gender was significantly associated with an increased risk of suicidal ideation, compared with males ( 15 ). Additionally, strong evidence on the wellness of medical students shows that their well-being is deteriorating throughout training, and it is becoming a growing problem ( 16 , 17 ). In 2016, Canadian medical students reported burnout and suicidal ideation rates of 37% and 6%, respectively ( 18 ). An increase in the prevalence of mood disorders, anxiety disorders, suicidal ideation, and psychological distress in Canadian medical students compared to age-matched controls from the general population was observed in 2019 ( 18 ). It is well documented that physicians who demonstrate a high level of resilience report better well-being that promotes fulfillment in their work environment ( 19 ). It is then favorable to support the development of resilience wellness programs in medical training, to equip and prepare students for the challenges of the clinical environment ( 16 , 20 ). However, the lack of enthusiasm for resilient programs in medical education remains. The culture that "doctors are invincible" persists (p.6–7) ( 18 ). A first systematic review conducted on the effectiveness of resilient programs in medical education indicates an improvement in resilience and well-being across several studies, however, no standardized resilient program has been evaluated ( 21 ). In the current context of limited effectiveness of resources (wellness programs, access to tertiary care services) implemented to address the negative impacts of medical education on student well-being ( 15 ), this study shows that thoughtful use of the wellness program can identify risk factors that have a significant impact on medical students’ mental health. Wellness programs could also tailor effective interventions to address these risk factors for poor mental health ( 22 ). In addition to thoughtful use of wellness programs, it is also required to have a comprehensive approach to address the systemic and structural factors in which students live and learn ( 23 ). Most wellness and resilience programs implemented to date tend to focus on teaching self-care to students when the main problem often comes from the work environment ( 24 ). Further studies are needed to explore the influence of the work environment on poor mental health among medical students to evaluate the outcomes of wellness and resilience programs targeting risk factors identified by medical students. This study data was gathered in pre-covid context, further studies could consider the impact of COVID-19 on the program. The lack of homogeneity in responses across student cohorts may have affected the results of the study. There was significant variability in responses regarding risk factors on mental health, as the percentage of impact of risk factors on psychological and emotional health was unequally distributed among students. Also, there were more responses from first-year students considered. Furthermore, given that there is no data on the psychometric properties of the instrument currently used, it is difficult to determine whether the differences arise from real differences among students or from artifacts due to the instrument (e.g. problem loyalty). In addition, this questionnaire is a mixture of statements from several English instruments which makes it less reliable for administration to French-speaking students, the translated version does not give rise to a back-translation or validation. This absence of using a reliable and valid tool for assessing the psychological health of medical students supports further research in this area. CONCLUSION The alarming condition of medical students’ well-being prompted medical schools to develop and implement various wellness programs for burnout prevention and resilient trainees. However, resilience training and wellness programs are unlikely to make a difference if they are not used efficiently. This study shows that wellness programs may be relevant to identifying risk factors related to poor mental health among medical students and implementing interventions that are more effective. Declarations ETHICAL APPROVAL AND CONSENT TO PARTICIPATE This research received an ethics exemption from the Ottawa Health Science Network Research Ethics Board as it was determined in the category of quality improvement. Informed consent to participate has been also waived by the Ethics committee ( see exemption letter) CONSENT TO PUBLICATION Not applicable DATA AVAILABILITY STATEMENT All data generated or analysed during this study are included in this published article. They are available from the corresponding author on reasonable request. CONFLICT OF INTERESTS There is no conflict of interest to declare. FUNDING SOURCES This project was funded by the AMUHM (Association médicale universitaire Hôpital Montfort) and the Department of Family Medicine New Innovator Award (University of Ottawa). ACKNOWLEDGEMENT All authors revised it critically for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work. Kay-Anne Haykal and Ines Zombre share senior authorship. AUTHOR CONTRIBUTION Kay-Anne Haykal was the PI of this project, she designed the study, and contributed to data acquisition. Ines Zombre drafted the manuscript with the support of Dr Haykal, Miryam Duquet Miryam Duquet coordinated the manuscript and contributed to different drafts Selena Laprade contributed to data analysis and reviewed the final draft of the manuscript Joseph Abdulnour contributed to data analysis and reviewed the different drafts of the manuscript References Seo C, Corrado M, Fournier K, BaileyT, Haykal KA. Addressing the physician burnout epidemic with resilience curricula in medical education: a systematic review. BMC medical education.2021; 21(1): 1-25. Baste VS, Gadkari JV. 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Finding solutions to the problem of burnout. Consult. Psychol. J.: Pract. Res . 2017 Jun;69(2):143-152. Slavin SJ. Medical Student Mental Health: Culture, Environment, and the Need for Change. JAMA.2016; 316(21):2195. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3970771","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":276083079,"identity":"565687eb-8d95-4cb2-a1cd-96a6525c274a","order_by":0,"name":"Kay-Anne Haykal","email":"","orcid":"","institution":"University of Ottawa","correspondingAuthor":false,"prefix":"","firstName":"Kay-Anne","middleName":"","lastName":"Haykal","suffix":""},{"id":276083080,"identity":"4a25a67c-2f35-46fa-a8a7-c9f5cf0332bb","order_by":1,"name":"Ines Zombre","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIie3OIQvCQBTA8RsHt3K6egYdfoONgU38Kh6DSwZtC4ZLZxGt81sMBuaTw1lmH1wRBPOS0Tm7bLMZ7g+vvR/vAWAy/WGoHgi8auT8SCIYDDiwuOzKIMghTWRX0nfUOV0JRNMivNzLtXKBrW4tj2VMHwQOjgWjXGbK55h5zcTaTnRPkOGxWPhcIm1xAloIxB/iWWn8IS8948QumwmqCc7n44TU5CQ05QS3XMGI6TiSAckfNL7uqlDgxbKRuHuV6aUnR84mlGX0ZNO9fUkayZe7P+6bTCaT6UtvKldKnEvA1nkAAAAASUVORK5CYII=","orcid":"","institution":"Institut du Savoir Montfort, Hôpital Montfort) Hôpital Montfort","correspondingAuthor":true,"prefix":"","firstName":"Ines","middleName":"","lastName":"Zombre","suffix":""},{"id":276083081,"identity":"e0ac0ed7-53e4-4b5f-bc3f-34523b3cdee5","order_by":2,"name":"Selena Laprade","email":"","orcid":"","institution":"University of Ottawa","correspondingAuthor":false,"prefix":"","firstName":"Selena","middleName":"","lastName":"Laprade","suffix":""},{"id":276083082,"identity":"159330ed-6e51-4ecd-88f6-e4ef13ff79dc","order_by":3,"name":"Miryam Duquet","email":"","orcid":"","institution":"Institut du Savoir Montfort, Hôpital Montfort) Hôpital Montfort","correspondingAuthor":false,"prefix":"","firstName":"Miryam","middleName":"","lastName":"Duquet","suffix":""},{"id":276083083,"identity":"58fb03c6-25c9-4bd2-9697-6103dee4295c","order_by":4,"name":"Joseph Joseph","email":"","orcid":"","institution":"Institut du Savoir Montfort, Hôpital Montfort) Hôpital Montfort","correspondingAuthor":false,"prefix":"","firstName":"Joseph","middleName":"","lastName":"Joseph","suffix":""}],"badges":[],"createdAt":"2024-02-19 19:42:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3970771/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3970771/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83980915,"identity":"af6060ec-c6b1-4e00-a166-a31acc9ee451","added_by":"auto","created_at":"2025-06-05 10:02:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":850764,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3970771/v1/2878f1ad-0cd3-4154-91b6-1c60965051f8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Quantitative Analysis of Mandatory Wellness Assessments for 1st and 3rd Year Medical Students at the University of Ottawa","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eIt is well known that medical schools are considered stressful environments, as the academic expectations are extreme (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). However, it is only recently that the epidemic of burnout related to medical training has been studied (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Medical students are facing several stressors that place them at high risk for burnout and poor mental health (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Several studies have shown the negative impacts of medical education on student well-being in several countries, including Canada (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). It is therefore not surprising that the prevalence of psychological distress among medical students is significantly higher than in the general population (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). When compared to individuals with professional degrees or Doctoral degrees in other fields, physicians experience higher rates of emotional exhaustion and burnout and report more dissatisfaction with work-life balance (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The more years a physician has been in practice, the more positive the perception of well-being, whereas physicians with fewer years (\u0026lt;\u0026thinsp;5 years) of practice reported greater burnout and lower resilience (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Females had higher odds of having low resilience and they reported more burnout, depression and suicidal ideation when compared to men (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe alarming condition of medical students\u0026rsquo; well-being has prompted several institutional organizations, including medical schools, to develop and implement various wellness programs for burnout prevention and resiliency (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, the targeted risk factors and overall quality of these programs are inconsistent, and there is limited evidence about their effectiveness (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Despite the increasing number of evidence on the worrying state of medical students' well-being, few systematic studies have addressed different risk factors reported to date (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Understanding the factors that contribute to medical student distress and how to address them requires identifying risk factors for poor mental health (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The overall goal of this study is to identify risk factors for mental health among undergraduate medical students at the University of Ottawa. Specific objectives are: 1) define the variation of these risk factors according to demographic variables; 2) determine if there is a change in the mental health of students during the 1st and 3rd year of their undergraduate program.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eStudents from 4 different cohorts were invited to complete the Wellness Assessment Questionnaire. For the purpose of anonymizing the participating years, cohorts were identified with numbers: MD-A(1st year only), MD-B(1st year only), MD-C (1st and 3rd year) and MD-D (1st and 3rd year).\u003c/p\u003e \u003cp\u003eWe used a quantitative approach to analyze the Wellness Assessment questionnaire results among 1st and 3rd year students. The responses were converted to numerical values and analyzed statistically.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDescription of the University of Ottawa's Wellness Assessment Program\u003c/h2\u003e \u003cp\u003eThe health and well-being of students are a priority for the Faculty of Medicine at the University of Ottawa. The Wellness Assessment Program aims to promote and ensure the health and well-being of students while fostering academic success. It offers a full range of services to undergraduate students, such as personal wellness, psychological health, financial and career planning, including support for the residency application process (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The Wellness Assessment Questionnaire is part of the program, and it is based on the Medical Students Well-Being Index, the Perceived Wellness Survey and the Burns Depression Inventory (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The questionnaire has the following headings: demographic information, mental health and risk factors such as physical health, sleep, social support, financial stress, education and career, stress and drug use and/or alcohol. Open-ended questions are also asked about any concerns the student may have, as well as a list of suggestions for the medical program.\u003c/p\u003e \u003cp\u003eThe wellness check is a mandatory assessment of the student wellness conducted in year 1 and year 3 of their undergraduate training. The Wellness Check Program was established in 2010\u0026ndash;2011 but has not been validated (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Students complete an online 15-minute Wellness Assessment Questionnaire on Survey Monkey prior to their appointment followed by an individual virtual 30-minute meeting with a counsellor. During and following these sessions, students are oriented to the different resources provided in relation to the pillars of Student Affairs Office services. As of the 2017\u0026ndash;2018 academic year, the Wellness Check Program became a mandatory program for 1st year students, and since then all students must complete the questionnaire.\u003c/p\u003e \u003cp\u003eStudents in year 3 of clerkship are also invited to participate in the Wellness Check Program on a voluntary basis. An email is sent to all students at the end of April of each year to complete the survey online, accompanied by an invitation to follow up with an in-person visit with a counsellor to address any concerns or to build on strengths. Counsellors communicate with students if they identify specific concerns or red flags upon reviews of the completed surveys as well. As of the academic year 2017\u0026ndash;2018, the 3rd year wellness check became mandatory as well.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eWe analyzed the responses to questions with Likert scales and converted to numbers to perform a statistical analysis addressing different questions.\u003c/p\u003e \u003cp\u003eA multiple linear regression analysis was performed to identify independent predictors of psychological/emotional health. Independent sample t-test was used to compare various risk factors of mental health between gender, study cohort (francophone vs. anglophone) and residence. Linear mixed model repeated measures were performed to determine if time (1st year to 3rd year) has an effect on the psychological/emotional health of the students. A second linear mixed model with covariates was also performed to determine if time still has an effect on psychological/emotional health.\u003c/p\u003e \u003cp\u003eData were converted from the Likert scale to a numerical scale (Strongly Disagree = -2, Disagree = -1, Neutral\u0026thinsp;=\u0026thinsp;0, Agree\u0026thinsp;=\u0026thinsp;1, Strongly Agree\u0026thinsp;=\u0026thinsp;2).\u003c/p\u003e \u003cp\u003eThe data for some questions were also reversed so that a high score in each category was considered \"healthy\" and a low score was therefore considered \"unhealthy\". For example, for question 13: \u003cem\u003eIn general, I have good eating habits\u003c/em\u003e, a Strongly Disagree has a low score (-2) while a Strongly Agree response has a high score (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Therefore, the healthier the student is physically, the higher the score and vice versa.\u003c/p\u003e \u003cp\u003eOn the other hand, question 38: \u003cem\u003eI rarely engage in exercise and/or physical activities\u003c/em\u003e was reversed. Therefore, a student who answered Strongly Disagree had a score of 2 (they are in better physical health) and a student who answered Strongly Agree had a score of -2 (they are in poor physical health). Due to the different number of questions by categories in the 1st - and 3rd year questionnaire, we had to use the average of the responses to the questions in each category for each student.\u003c/p\u003e \u003cp\u003eSPSS 22.0 for Windows was used to perform statistical analyses. Results are expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and standardized beta coefficient with a 95% confidence interval. A p-value\u0026thinsp;\u0026le;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eWhat are the risk factors for mental health in medical students?\u003c/h2\u003e \u003cp\u003eThese analyses were done on three groups: 1st year students only, 3rd year students only, and all responses combined (1st year responses from MD-A, MD-B, MD-C, and MD-D, and 3rd year responses from MD-C and MD-D). At the time of conducting this study, only two cohorts had completed both year 1 and year 3 assessments.\u003c/p\u003e \u003cp\u003eA multiple linear regression was calculated to determine predictors of the psychological/emotional health score. The model was a significant predictor explaining 56% (R square\u0026thinsp;=\u0026thinsp;0.556; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), 73% (R square\u0026thinsp;=\u0026thinsp;0.726; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 59% (R square\u0026thinsp;=\u0026thinsp;0.594; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) for 1st year, 3rd year and both years, respectively. Significant predictors are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMental health risk factors for 1st, 3rd and all responses (1st and 3rd year)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStandard Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStandardized coefficient Beta\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLower Limit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUpper limit\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYear 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep/fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation and Career\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress and drug and/or alcohol use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.394\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYear 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep/fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation and Career\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.431\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress and drug and/or alcohol use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYear 1 \u0026amp; 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep/fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation and Career\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress and drug and/or alcohol use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eB\u0026thinsp;=\u0026thinsp;Unstandardized Coefficient. Regression method. Variables entered in the model for each group year: Are you new to Ottawa; MD program stream (French or English); Gender; Physical health; Sleep/fatigue; Social support; Finance; Education and career; Stress and drug and/or alcohol use.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDo risk factors and mental health vary by gender, cohort (Francophone vs. Anglophone) and whether the student is coming from Ottawa or out-of-town?\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDifference between gender on well-being.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage for female(N\u0026thinsp;=\u0026thinsp;519)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAverage for male (N\u0026thinsp;=\u0026thinsp;386)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep/fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation and Carreer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress and drug and/or alcohol use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological/emotional health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eN\u0026thinsp;=\u0026thinsp;number\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDifference between cohorts on well-being.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage for the Francophone cohort (N\u0026thinsp;=\u0026thinsp;296)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAverage for the Anglophone cohort (N\u0026thinsp;=\u0026thinsp;609)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep/fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.570\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation and Career\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.297\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress and drug and/or alcohol use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.428\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological/emotional health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eN\u0026thinsp;=\u0026thinsp;number\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDifference related to students\u0026rsquo; residence on well-being.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage for students coming from Ottawa (N\u0026thinsp;=\u0026thinsp;486)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAverage for students coming out-of-town (N\u0026thinsp;=\u0026thinsp;419)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep/fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.992\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation and Career\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.885\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress and drug and/or alcohol use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological/emotional health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eN\u0026thinsp;=\u0026thinsp;number\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eIs mental health better in the 1st or 3rd year of medical school?\u003c/h2\u003e \u003cp\u003eThe linear mixed model repeated measures analysis conducted for this question showed a statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.021) between 1st year students (0.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63) and 3rd year students (0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59) on psychological/emotional health.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSummary of the main results of the study\u003c/h2\u003e \u003cp\u003eThe results from Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e show that the higher the standardized coefficient, the more impact it has on mental health. For every 1 unit increase of the risk factor, there is an impact (increase in this case) on the mental health value corresponding to the standardized coefficient. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows a significant difference between genders in physical health, sleep/fatigue, finance, education and career, stress and drug and/or alcohol use and psychological/emotional health. Compared to males, females have a poorer outcome in terms of physical health, sleep/fatigue, finances, education and career stress and drug/alcohol use, and psychological/emotional health.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows a significant difference between the language cohort on physical health and psychological/emotional health. Results showed that being in one cohort or the other partially explains the higher (and therefore healthier) scores in these categories. Therefore, being in the Francophone cohort showed a higher positive effect on physical health and a lower psychological/emotional health compared to Anglophones.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows a significant difference between students\u0026rsquo; origin on social support and stress and drug and/or alcohol. Coming from Ottawa partially explains the higher (and therefore healthier) scores for these risk factors. This means that students who come from Ottawa have more social support and less stress and drug and/or alcohol use when compared to students coming from out of town.\u003c/p\u003e \u003cp\u003eFinally, the mental health of the 1st year students is poorer when compared to the 3rd year students. However, when considering the co-variates (physical health, sleep/fatigue, social support, finances, education and career, and stress and substance use), the difference is no longer significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur study used a Wellness Assessment Questionnaire, which is part of the University of Ottawa Wellness Check Program, to determine risk factors for mental health among medical students. It is acknowledged that poor mental health of medical students is a \u0026lsquo;\u0026rsquo;disease condition that is endemic to medical schools\u0026rsquo;\u0026rsquo; (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). A systematic overview of risk factors for suicidal ideation and suicide attempts among medical students indicated that poor mental health outcomes such as burnout and depression are the strongest risks. Female gender was significantly associated with an increased risk of suicidal ideation, compared with males (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Additionally, strong evidence on the wellness of medical students shows that their well-being is deteriorating throughout training, and it is becoming a growing problem (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In 2016, Canadian medical students reported burnout and suicidal ideation rates of 37% and 6%, respectively (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). An increase in the prevalence of mood disorders, anxiety disorders, suicidal ideation, and psychological distress in Canadian medical students compared to age-matched controls from the general population was observed in 2019 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). It is well documented that physicians who demonstrate a high level of resilience report better well-being that promotes fulfillment in their work environment (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). It is then favorable to support the development of resilience wellness programs in medical training, to equip and prepare students for the challenges of the clinical environment (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). However, the lack of enthusiasm for resilient programs in medical education remains. The culture that \"doctors are invincible\" persists (p.6\u0026ndash;7) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). A first systematic review conducted on the effectiveness of resilient programs in medical education indicates an improvement in resilience and well-being across several studies, however, no standardized resilient program has been evaluated (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the current context of limited effectiveness of resources (wellness programs, access to tertiary care services) implemented to address the negative impacts of medical education on student well-being (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), this study shows that thoughtful use of the wellness program can identify risk factors that have a significant impact on medical students\u0026rsquo; mental health. Wellness programs could also tailor effective interventions to address these risk factors for poor mental health (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In addition to thoughtful use of wellness programs, it is also required to have a comprehensive approach to address the systemic and structural factors in which students live and learn (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Most wellness and resilience programs implemented to date tend to focus on teaching self-care to students when the main problem often comes from the work environment (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Further studies are needed to explore the influence of the work environment on poor mental health among medical students to evaluate the outcomes of wellness and resilience programs targeting risk factors identified by medical students. This study data was gathered in pre-covid context, further studies could consider the impact of COVID-19 on the program.\u003c/p\u003e \u003cp\u003eThe lack of homogeneity in responses across student cohorts may have affected the results of the study. There was significant variability in responses regarding risk factors on mental health, as the percentage of impact of risk factors on psychological and emotional health was unequally distributed among students. Also, there were more responses from first-year students considered. Furthermore, given that there is no data on the psychometric properties of the instrument currently used, it is difficult to determine whether the differences arise from real differences among students or from artifacts due to the instrument (e.g. problem loyalty). In addition, this questionnaire is a mixture of statements from several English instruments which makes it less reliable for administration to French-speaking students, the translated version does not give rise to a back-translation or validation. This absence of using a reliable and valid tool for assessing the psychological health of medical students supports further research in this area.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe alarming condition of medical students\u0026rsquo; well-being prompted medical schools to develop and implement various wellness programs for burnout prevention and resilient trainees. However, resilience training and wellness programs are unlikely to make a difference if they are not used efficiently. This study shows that wellness programs may be relevant to identifying risk factors related to poor mental health among medical students and implementing interventions that are more effective.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eETHICAL APPROVAL AND CONSENT TO PARTICIPATE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received an ethics exemption from the Ottawa Health Science Network Research Ethics Board as it was determined in the category of quality improvement. Informed consent to participate has been also waived by the Ethics committee ( see exemption letter)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCONSENT TO PUBLICATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eDATA AVAILABILITY STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article. They are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTERESTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no conflict of interest to declare.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFUNDING SOURCES\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was funded by the AMUHM (Association m\u0026eacute;dicale universitaire H\u0026ocirc;pital Montfort)\u0026nbsp;and the Department of Family Medicine New Innovator Award (University of Ottawa).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors revised it critically for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.\u0026nbsp;Kay-Anne Haykal\u0026nbsp;and Ines Zombre share senior authorship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAUTHOR CONTRIBUTION\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eKay-Anne Haykal was the PI of this project, she designed the study, and contributed to data acquisition.\u003c/li\u003e\n \u003cli\u003eInes Zombre drafted the manuscript with the support of Dr Haykal, Miryam Duquet\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMiryam Duquet coordinated the manuscript and contributed to different drafts\u003c/li\u003e\n \u003cli\u003eSelena Laprade contributed to data analysis and reviewed the final draft of the manuscript\u003c/li\u003e\n \u003cli\u003eJoseph Abdulnour contributed to data analysis and reviewed the different drafts of the manuscript\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSeo C, Corrado M, Fournier K, BaileyT, Haykal KA. Addressing the physician burnout epidemic with resilience curricula in medical education: a systematic review. BMC medical education.2021; 21(1): 1-25.\u003c/li\u003e\n\u003cli\u003eBaste VS, Gadkari JV. Study of stress, self-esteem and depression in medical students and effect of music on perceived stress. Indian J Physiol Pharmacol. 2014;58(3):298\u0026ndash;301.\u003c/li\u003e\n\u003cli\u003eVoltmer E, Rosta J, Aasland OG, Spahn C. Study-related health and behavior patterns of medical students: a longitudinal study. Med Teach. 2010;32(10): e422\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eKealy D, Halli P, Ogrodniczuk JS, Hadjipavlou G. Burnout among Canadian psychiatry residents: a national survey. Can J Psychiatry. 2016;61(11):732\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eBourcier D, Far R, King LB, Cai G, Mader J, Xiao MZ, Christopher S,Taylor M, Flynn L. Medical student wellness in Canada: time for a national curriculum framework. Canadian Medical Education Journal.2021;12(6):103-107.\u003c/li\u003e\n\u003cli\u003eMaser B, Danilewitz M, Gu\u0026eacute;rin E, Findlay L, Frank E. Medical student psychological distress and mental illness relative to the general population: a Canadian cross-sectional survey. Canadian Medical Education Journal. 2019;94(11):1781-1791.\u003c/li\u003e\n\u003cli\u003ePuthran R, Zhang MW, Tam WW, Ho RC. Prevalence of depression amongst medical students: a meta-analysis. Med Educ. 2016 ;50(4):456-68.\u003c/li\u003e\n\u003cli\u003eShanafelt TD, Sinsky C, Dyrbye LN, Trockel M, West CP. Burnout Among Physicians Compared With Individuals With a Professional or Doctoral Degree in a Field Outside of Medicine. \u003cem\u003eMayo Clin Proc\u003c/em\u003e.2019; 94(3):549\u0026ndash;551.\u003c/li\u003e\n\u003cli\u003eCanadian Medical Association. CMA national physician health survey: A national Snapshot. 2018. https://www.cma.ca/sites/default/files/2018-11/nph-survey-e.pdf . Accessed Dec 2023.\u003c/li\u003e\n\u003cli\u003eShiralkar MT, Harris TB, Eddins-Folensbee FF, Coverdale JH. A Systematic Review of Stress-Management Programs for Medical Students\u003cem\u003e. \u003c/em\u003eAcad Psychiatry. 2013; 37(3):158.\u003c/li\u003e\n\u003cli\u003eBeck A. T, Beamesderfer A. Assessment of Depression: The Depression Inventory: Psychological Measurements in Psychopharmacology. Mod Trends Pharmacopsychiatry. Basel, Karger.1974; 7: 151-169.\u003c/li\u003e\n\u003cli\u003eUniversit\u0026eacute; d\u0026rsquo;Ottawa. Bureau des services aux \u0026eacute;tudiants, facult\u0026eacute; de m\u0026eacute;decine Universit\u0026eacute; d\u0026rsquo;ottawa; n.d. https://med.uottawa.ca/premier-cycle/etudiants/bureau-services-etudiant/qui-nous-sommes. Accessed Dec 2023.\u003c/li\u003e\n\u003cli\u003eDyrbye LN1, Satele D, Sloan J, Shanafelt TD. Utility of a brief screening tool to identify physicians in distress. J Gen Intern Med. 2013;28(3):421-7.\u003c/li\u003e\n\u003cli\u003eAdams, Troy, The Conceptualization and Measurement of Perceived Wellness: Integrating Balance Across and Within Dimensions. American journal of health promotion: AJHP.1997; 11(3):208-18 \u003c/li\u003e\n\u003cli\u003eD\u0026apos;Eon M, Thompson G, Stacey A, Campoli J, Riou K, Andersen M, Koehncke N. The alarming situation of medical student mental health. Can Med Educ J. 2021 Jun 30;12(3):176-178.\u003c/li\u003e\n\u003cli\u003eHope V, Henderson M. Medical student depression, anxiety and distress outside North America: a systematic review. Med Educ. 2014;48(10):963-979.\u003c/li\u003e\n\u003cli\u003eMaser B, Danilewitz M, Gu\u0026eacute;rin E, Findlay L, Frank E. Medical student psychological distress and mental illness relative to the general population: a Canadian cross-sectional survey. Acad Med. 2019;94(11):1781-1791.\u003c/li\u003e\n\u003cli\u003eHenderson M, Brooks SK, Del Busso L, et al. Shame! Self-stigmatisation as an obstacle to sick doctors returning to work: a qualitative study. BMJ Open. 2012;2(5).\u003c/li\u003e\n\u003cli\u003eWalsh K. An economic argument for investment in physician resilience. Acad Med. 2013;88(9):1196.\u003c/li\u003e\n\u003cli\u003eEpstein RM, Krasner MS. Physician resilience: what it means, why it matters, and how to promote it. Acad Med. 2013;88(3):301\u0026ndash;3.\u003c/li\u003e\n\u003cli\u003eLeppin AL, Bora PR, Tilburt JC, Gionfriddo MR, Zeballos-Palacios C, Dulohery MM, Sood A, Erwin PJ, Brito JP, Boehmer KR, Montori VM. The efficacy of resiliency training programs: a systematic review and meta-analysis of randomized trials\u003cem\u003e. \u003c/em\u003ePLoS One. 2014 Oct 27;9(10).\u003c/li\u003e\n\u003cli\u003eHodges BD, Kuper A. Education reform and the hidden curriculum: The Canadian journey. In The hidden curriculum in health professional education. 2014:41-50.\u003c/li\u003e\n\u003cli\u003eMaslach C. Finding solutions to the problem of burnout. \u003cem\u003eConsult. Psychol. J.: Pract. Res\u003c/em\u003e. 2017 Jun;69(2):143-152.\u003c/li\u003e\n\u003cli\u003eSlavin SJ. Medical Student Mental Health: Culture, Environment, and the Need for Change. JAMA.2016; 316(21):2195.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"medical student, wellness program, mental health, training, undergraduate","lastPublishedDoi":"10.21203/rs.3.rs-3970771/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3970771/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAn alarming prevalence of burnout among medical students has been reported in many countries, including Canada. To design resilience and wellness programs, it is important to explore individual risk factors. This article presents an example of a Wellness Assessment Program for medical students at the University of Ottawa. The overall goal was to identify risk factors for poorer mental health outcomes among medical students at the University of Ottawa.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a quantitative study to determine risk factors for mental health, among MD-A (1st year only), MD-B (1st year only), MD-C (1st and 3rd year) and MD-D (1st and 3rd year).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eRisk factors that significantly impacted the mental health of 1st and 3rd year medical students at the University of Ottawa were physical health, sleep/fatigue, social support, education and career, stress, and drug and/or alcohol use. Students who were originally from Ottawa had more social support and less stress and drug and/or alcohol use (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001;p\u0026thinsp;=\u0026thinsp;0.009). Being in the Francophone cohort had a positive effect on physical health, but a negative effect on psychological/emotional health (p\u0026thinsp;=\u0026thinsp;0.039;p\u0026thinsp;=\u0026thinsp;0.004). There was a statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.021) between the psychological/emotional health of 1st year students (M\u0026thinsp;=\u0026thinsp;0.7895) and 3rd year students (M\u0026thinsp;=\u0026thinsp;0.8923) when co-variates (risk factors) were not considered.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn the current context of the limited effectiveness of measures to address the negative impacts of medical education on student well-being, this study showed that efficient use of the wellness program data can identify risk factors that have a significant impact on wellness.\u003c/p\u003e","manuscriptTitle":"A Quantitative Analysis of Mandatory Wellness Assessments for 1st and 3rd Year Medical Students at the University of Ottawa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-04 15:35:19","doi":"10.21203/rs.3.rs-3970771/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2cbf1e33-243e-4565-bfce-40b3a5df5ea9","owner":[],"postedDate":"March 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-05T09:53:50+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-04 15:35:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3970771","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3970771","identity":"rs-3970771","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}