Tolls of Med School

Medical students are more likely to suffer from depression than the general population is, and black students in medical school are particularly prone to frequent suicidal thoughts, according to a new study published in Academic Medicine.

Billed as the first large-scale study of its kind, the study examined surveys from more than 2,000 medical students and found some chilling results. The overall depression rate for medical students is 21.2 percent, more than double the commonly reported rate of about 10 percent for the general population.

The article, “Depressive Symptoms in Medical Students and Residents: A Multischool Study,” drew upon surveys distributed to medical students and residents at six sites in 2003-4. The authors picked sites with higher than average minority populations, aiming for a sample that would reflect the growing numbers of women and members of minority groups in medical school student bodies.

In addition to studying depression rates, the study examined the prevalence of suicidal thoughts among medical students and residents. Of the total sample, 5.7 percent reported having frequent suicidal thoughts. That figure is relatively consistent with the rate of suicidal thoughts in the general population, as reported in the National Comorbidity Study.

Suicidal thoughts were particularly prevalent among black students, 13 percent of whom reported “suicidal ideation.” Indigenous students, including American Indians, Pacific Islanders and Alaskan Natives, had an even higher rate -- 16.1 percent. The response rate for that cohort, however, was just 31 students -- half the size of the black student sample.

Deborah Goebert, the lead author of the article, said there are a number of factors inherent in the medical school experience that may contribute to the higher rates of depression the surveys detected.

“Certainly it’s a stressful time,” said Goebert, associate director of psychiatry research at the University of Hawaii’s John A. Burns School of Medicine. “There’s a lot of learning and responsibility not just for yourself, but then you’re also caring for others.

“A lot [of the stress], I think, is related to sleep cycles and expectations,” she added. “And the other thing is that the field is changing so rapidly, even while they’re there. I think that’s also an overwhelming aspect.”

Charles Reynolds, senior associate dean of the University of Pittsburgh School of Medicine, said the study is yet another indication that medical schools need to step up efforts to provide mental health resources to students. Reynolds co-wrote a commentary in the February issue of Academic Medicine, referring to the new study as a “clarion call to action on the part of leadership in the nations’ schools of medicine and academic health centers.”

“The time is right for strong leadership to change the culture of medicine,” Reynolds wrote, with co-author Dr. Paula Clayton, medical director of the American Foundation for Suicide Prevention.

The “culture” in medical schools is in many ways analogous to that of the military, another institution that has struggled to erase the stigma of seeking mental health care, Reynolds said in an interview Wednesday.

“We’re supposed to be strong, and to admit we may have a medical illness like depression just doesn’t come easily to us,” Reynolds said.

Future doctors may also have reservations about reporting symptoms of depression, fearing it might affect their careers. Most state medical boards, however, no longer specifically ask about mental health issues or substance abuse, Reynolds said. Instead, physicians are asked whether they have any condition that will permit them from functioning on the job. As such, it’s less likely that self-reporting mental health problems will impact a doctor’s career, Reynolds said.

“I wouldn’t say that it’s not a realistic concern at all,” he said. “My sense is that it’s less of a concern now than it used to be.”

Levels Differ By Year, Gender

The data collected for the article in Academic Medicine, which is the journal of the Association of American Medical Schools, may also give new evidence about the most risk-prone years in the medical student experience. For medical students, the highest rates of depression -- nearly 25 percent -- occurred in the second year of study. For residents, the third year proved the most perilous, with 14.6 percent reporting depression.

Over all, medical students reported rates of depression nearly twice as high as those of residents. Of the sample, nearly 22 percent of medical students exhibited signs of depression, compared with about 12 percent of residents.

There were also significant differences in responses based on gender. Women had a 21.6 percent depression rate, compared with a 15.6 percent rate for men.

To determine depression levels, the authors asked students to respond to surveys that included content from the Center for Epidemiologic Studies-Depression scale, a widely used self-reporting instrument to measure symptoms. The Primary Care Evaluation of Mental Disorders was also employed.