IN BRIEF REPORT Cross-cultural Differences in Mental Health, Quality of Life, Empathy, and Burnout between US and Brazilian Medical Students Giancarlo Lucchetti 1 & Rodolfo Furlan Damiano 2 & Lisabeth F. DiLalla 3 & Alessandra Lamas Granero Lucchetti 1 & Ivana Lúcia Damásio Moutinho 1 & Oscarina da Silva Ezequiel 1 & J. Kevin Dorsey 4 Received: 14 November 2016 /Accepted: 17 July 2017 # Academic Psychiatry 2017 Abstract Objective This study aimed to compare mental health, quality of life, empathy, and burnout in medical students from a med- ical institution in the USA and another one in Brazil. Methods This cross-cultural study included students enrolled in the first and second years of their undergraduate medical training. We evaluated depression, anxiety, and stress (DASS 21), empathy, openness to spirituality, and wellness (ESWIM), burnout (Oldenburg), and quality of life (WHOQOL-Bref) and compared them between schools. Results A total of 138 Brazilian and 73 US medical students were included. The comparison between all US medical stu- dents and all Brazilian medical students revealed that Brazilians reported more depression and stress and US stu- dents reported greater wellness, less exhaustion, and greater environmental quality of life. In order to address a possible response bias favoring respondents with better mental health, we also compared all US medical students with the 50% of Brazilian medical students who reported better mental health. In this comparison, we found Brazilian medical students had higher physical quality of life and US students again reported greater environmental quality of life. Cultural, social, infrastructural, and curricular differences were compared be- tween institutions. Some noted differences were that students at the US institution were older and were exposed to smaller class sizes, earlier patient encounters, problem-based learning, and psychological support. Conclusion We found important differences between Brazilian and US medical students, particularly in mental health and well- ness. These findings could be explained by a complex interaction between several factors, highlighting the importance of consid- ering cultural and school-level influences on well-being. Keywords Cross-cultural . Medical education . Depression . Anxiety . Quality of life The medical profession is facing a challenging period with an increasing amount of burnout, mental disorders, stress, and dissatisfaction with work [1, 2]. A recent survey investigated 6880 US physicians and found burnout and satisfaction with work/life balance worsened from 2011 to 2014, while, in the same period of time, authors observed minimal changes in the same variables in other working US adults [1]. The same problem is also faced by medical residents and medical students, in which 20–50% screen positive for depression, 8–9% report suicidal ideation, and 30– 60% report burnout [3, 4]. This student distress is associ- ated with several sequelae in medical education, such as lower levels of empathy, higher levels of cynicism, worse academic performance, less professionalism, and subopti- mal patient care practices [3, 5, 6]. Several reasons are identified as possible causes of this distress. Adjustment to medical school, interpersonal conflicts between students and teachers, exposure to death and suffer- ing, personal life events, educational debt, and curricular fac- tors (e.g., new learning methods, exposure to patients) are * Giancarlo Lucchetti g.lucchetti@yahoo.com.br 1 School of Medicine, Federal University of Juiz de Fora, Av. Eugênio do Nascimento s/n, Juiz de Fora, Brazil 36038-330 2 School of Medicine, Pontifical Catholic University of Sao Paulo, São Paulo, SP, Brazil 3 Southern Illinois University School of Medicine, Carbondale, IL, USA 4 Southern Illinois University School of Medicine, Springfield, IL, USA Acad Psychiatry DOI 10.1007/s40596-017-0777-2