Purpose: To determine the prevalence of severe distress and its correlates among Cheju medical college students. Methods: Data were gathered in December 2005, and all medical college students were included. Of a total of 170 medical college students, 52 (30.6%), 41 (24.1%), 37 (21.8%), and 40 (23.5%) were 1st, 2nd, 3rd, and 4th year students, respectively. The questionnaire for sociodemographic information included age, sex, year, hometown, accommodation, education level of parents, socioeconomic status of parents, GPA (grade point average), and standing. Subjective sense of health status, level of health concern, smoking habit, drinking habit (CAGE), sleep pattern, degree of obesity, and body image satisfaction were included to reveal health habits and health behaviors of the subjects. CES-D for depression, Psychosocial Well-being Index (PWI) for stress level, State-Trait Anxiety Inventory (STAI) for level of anxiety, and SCL-90-R (Symptom Checklist 90 revised) for level of general psychopathology were used Results: 1st year students were 4.338 times (95% CI; 1.412-13.324) more likely than other years to experience severe distress. Students who felt that they had insufficient time for relaxation showed 5.027 times (95% CI; 1.489-16.969) higher prevalence of severe distress than those who felt they had sufficient time for relaxation. Those with poor self-esteem were 18.347 times (95% CI; 5.484-61.382) more likely to experience severe distress than those with ‘good’ self-esteem. Conclusion: Offering various programs for improving coping skills, advanced counseling program, or tutoring system and providing sufficient relaxation timeby various methods, such as modifying curriculum, are needed to ameliorate severe distress.