Rates of depression are high among medical students in the United States and around the world, according to a systematic review and meta-analysis of nearly 200 studies involving 129,000 medical students in 47 countries.
More than a quarter of medical students suffer from depression or depressive symptoms, and more than 1 in 10 report suicidal ideation during medical school, the review found. Yet, only a minority of students who screen positive for depression seek help.
The study was published in December 6 issue of Journal of the American Medical Assocation (JAMA), which is a theme issue on medical education.
This analysis “provides the most comprehensive look at prevalence of depression and suicidal ideation and psychiatric treatment in medical students that has ever been published. Our study is now kind of the bottom-line answer on this topic at this point in time,” Douglas A. Mata, MD, MPH, of Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, told Medscape Medical News.
The study shows that “depression and suicidal thinking are highly elevated in medical students compared to people around the same age in the general population who are not students. Basically, what we have is kind of a hidden epidemic on our hands that is hiding right in front of our noses, and we need to figure out how we are going to tackle this,” Dr Mata said.
On the basis of data from 167 cross-sectional and 16 longitudinal studies from 43 countries, the estimated overall pooled prevalence of depression or depressive symptoms was 27.2% and ranged from 9.3% to 55.9%, the researchers report. The prevalence of depressive symptoms remained relatively constant during the study period (1982-2015).
The nine longitudinal studies that assessed depressive symptoms before and during medical school found a median absolute increase in symptoms of 13.5%. Prevalence estimates did not differ markedly between studies of only preclinical students and studies of only clinical students (23.7% vs 22.4%).
Among medical students who screened positive for depression, only 15.7% sought psychiatric treatment.
On the basis of data from 24 cross-sectional studies from 15 countries, the estimated overall pooled prevalence of suicidal ideation was 11.1% and ranged from 7.4% to 24.2%.
“A lot of work on this in the past has been kind of reactive instead of proactive. When the student becomes depressed, they plugged in with treatment resources, but I think there needs to be more proactive wellness interventions promoted among students, where we try to prevent people from becoming depressed in the first place,” said Dr Mata.
Dr Mata believes the overall system of training medical students “needs to change, and that might involve decreasing work hours and pressure on the students, which would actually allow them to perform better. That’s been shown in some prior studies.
“People have focused on teaching wellness and self-care, but that ignores the environmental issues that are in the medical school and hospital that cause these issues in the first place, like chronic sleep deprivation,” he added.
In an accompanying editorial, Stuart Slavin, MD, MEd, Office of Curricular Affairs, Saint Louis University School of Medicine, in Missouri, notes that the analysis shows that the mental health of medical students is a “global problem of significant proportion.”
He adds that several aspects of the culture of medicine and medical education have likely contributed to the “delayed and until recently muted response to the long-standing problem of poor mental health of medical students.”
One aspect is the belief by some that medicine is a demanding profession, and therefore medical school also must be extremely demanding. This sentiment has diminished in recent decades but has not disappeared entirely, Dr Slavin notes.
Another aspect of medical culture is that mental health problems have not been taken as seriously as physical problems, and treatment has generally been embraced more than prevention.
Dr Slavin believes student mental health outcomes “must be viewed as critical program outcomes, as important as board scores and residency placements.”
Although some schools are appointing “wellness” deans or directors, the responsibility for student well-being should not be limited to one office and one administrator; “student wellness must be everyones concern,” Dr Slavin writes.
“Medical schools need to step up to address the mental health crisis among medical students,” he concludes.
Reached for comment, Darrell G. Kirch, MD, president and CEO of the Association of American Medical Colleges (AAMC), said, “The nation’s medical schools and teaching hospitals are extremely concerned about the growing problem of student and physician burnout, depression, and suicide.
“As a psychiatrist by training, this is a topic I am passionate about both personally and professionally. This study’s findings confirm that we must continue to do all that we can to support and aid members of our community,” Dr Kirch told Medscape Medical News.
He noted that the AAMC and member medical schools and teaching hospitals are working to “improve the learning environment, and are helping learners and trainees develop skills to strengthen their resilience as they encounter the challenges of a transforming healthcare system.
“To combat this growing crisis in our community, students and physicians must be trained at every stage of their educational career to address stress and burnout and to know when to ask for help,” said Dr Kirch.
Earlier this year, the AAMC hosted a leadership forum to convene medical school deans, teaching hospital CEOs, faculty, and others to discuss strategies for strengthening resilience and promoting well-being, he said.
“We have also engaged with the National Academy of Medicine on a collaborative effort to promote resilience and well-being for clinicians throughout their careers.
“To further support medical students, residents, and others across academic medicine, the AAMC has created an online resource (aamc.org/wellbeing) that offers a collection of literature, upcoming learning opportunities, an index of well-being programs available at medical schools and teaching hospitals, and other related content,” Dr Kirch said.