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Acad Psychiatry. 2017 Aug 31. doi: 10.1007/s40596-017-0777-2. [Epub ahead of print]

Cross-cultural Differences in Mental Health, Quality of Life, Empathy, and Burnout between US and Brazilian Medical Students.

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School of Medicine, Federal University of Juiz de Fora, Av. Eugênio do Nascimento s/n, Juiz de Fora, Brazil, 36038-330.
School of Medicine, Pontifical Catholic University of Sao Paulo, São Paulo, SP, Brazil.
Southern Illinois University School of Medicine, Carbondale, IL, USA.
School of Medicine, Federal University of Juiz de Fora, Av. Eugênio do Nascimento s/n, Juiz de Fora, Brazil, 36038-330.
Southern Illinois University School of Medicine, Springfield, IL, USA.



This study aimed to compare mental health, quality of life, empathy, and burnout in medical students from a medical institution in the USA and another one in Brazil.


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.


A total of 138 Brazilian and 73 US medical students were included. The comparison between all US medical students and all Brazilian medical students revealed that Brazilians reported more depression and stress and US students 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 between 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.


We found important differences between Brazilian and US medical students, particularly in mental health and wellness. These findings could be explained by a complex interaction between several factors, highlighting the importance of considering cultural and school-level influences on well-being.


Anxiety; Cross-cultural; Depression; Medical education; Quality of life

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