‘I wouldn’t want it on my CV or their records’: medical students’ experiences of help-seeking for mental health problems Carolyn A Chew-Graham, 1 Anne Rogers 1 & Nuha Yassin 2 Background Medical education is reported to be demanding and stressful and previous work with doc- tors suggests that there is a resistance within the pro- fession to help-seeking and an ad hoc approach to dealing with stress and distress. Aim To explore the attitudes of medical students at the University of Manchester, UK to the causes of stress and to examine their views on help-seeking. Study design A qualitative study using semistructured interviews, with analysis of the data using the technique of constant comparison. Methods Medical students at the University of Man- chester were invited to participate in the study. Sampling made the research representative of medical students in terms of gender, ethnicity and UK ⁄ over- seas students. Semistructured interviews, with open questions, were conducted and audio-taped with consent. The tapes were transcribed verbatim. The schedule was revised in the light of the emerging themes. Results Medical students recognised that studying medicine contributes to stress, as experienced in their undergraduate careers. Students reported that percep- tions of stigma associated with mental illness, including stress, were prevalent in the student body and were perceived to continue throughout the medical profes- sion. Avoidance of appropriate help-seeking behaviour starts early and is linked to perceived norms which dictate that experiencing a mental health problem may be viewed as a form of weakness and has implications for subsequent successful career progression. Conclusion The preparation of medical students for life as doctors involves more than facilitation of the acquisition of knowledge and skills, so that new doctors can conform to the principals of professional conduct. Support and mentoring are required so that stress can be identified early and dealt with appropriately. Keywords medical students, help-seeking, stress, mental health. Medical Education 2003;37:873–880 Background Mortality statistics have shown the increased risk to doctors of cirrhosis, accidents and poisoning since the 19th century. These elevated rates have persisted for cirrhosis and suicide and apply to doctors from all specialties 1 and are likely to arise in part from training and pre-training influences. There has been debate 2,3 about whether doctors develop mental health problems as a result of working in medicine or because they are more likely to have psychologically vulnerable person- alities before selection to medical school. Medical students may be motivated to study medicine by unconscious neurotic drives and unresolved conflicts dating from their childhood in an attempt to improve their own well-being by healing others. 2 Previous work investigating management of stress by doctors suggests that there is a resistance to help- seeking and an ad hoc approach to dealing with stress and distress. 4,5 Medical education itself is reported to be demanding and stressful 6,7 and the psychological and physical care issues are increasingly recognised as both prevalent and complex. 8 There are many publications reporting psychological ill health in medical students 3,9,10 and research in the UK has suggested that the prevalence of depression and alcohol-related problems is higher among doctors than in the general population. 11 Causes of stress vary according to the stage medical students are at in their career: emotional causes tend to be reported by first year students, while academic 1 School of Primary Care, University of Manchester, UK 2 University of Manchester, UK Correspondence: Carolyn A Chew-Graham BSc (Hons), MB, ChB, MD, FRCGP, School of Primary Care, Rusholme Health Centre, Walmer Street, Manchester M14 5NP, UK. Tel.: 00 44 161 256 3015; Fax: 00 44 161 256 1070; E-mail: cchew@man.ac.uk Diversity Ó Blackwell Publishing Ltd MEDICAL EDUCATION 2003;37:873–880 873