According to previous research, resident physicians experience higher rates of depression than the general public.
Beyond the effects of depression on the individual, resident depression has also been linked to poor-quality care and higher rates of medical errors. “Data on the burden of depression on medical residents vary considerably across studies,” says Douglas A. Mata, MD, MPH.
“Getting a reliable estimate of the prevalence of this important mental health issue during medical training can help inform strategies and interventions that aim to prevent and treat depression among residents.”
A Closer Look
In a systematic review and meta-analysis that was published in JAMA, Dr. Mata and colleagues reviewed published studies of depression or depressive symptoms that were conducted in graduate medical trainees. After analyzing 54 studies involving more than 17,500 individuals, the research team found that the overall pooled prevalence of depression or depressive symptoms was 28.8%. Prevalence estimates, however, ranged widely based on the type of instrument used to assess depression, with rates as low as 20.9% in some analyses while rising to as high as 43.2% in others.
In a secondary analysis of seven longitudinal studies, the authors observed a median absolute increase of 15.8% in depressive symptoms with the onset of residency training (relative risk, 4.5). No statistically significant differences were observed in comparisons between interns and upper-level residents or in studies involving both non-surgical and surgical residents. “This finding suggests that the underlying causes of depressive symptoms are common among those in residency,” says Dr. Mata.
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The trends identified in the study may reflect the medical community’s increased awareness of depression or developments external to medical education. Dr. Mata says that it is important to note that the vast majority of participants were assessed through self-report inventories that measured depressive symptoms rather than gold-standard diagnostic clinical interviews for major depressive disorder. The sensitivity and specificity of these instruments can vary substantially.
Dr. Mata says findings of the study should be seen as a call to action to find effective interventions to help residents battle and overcome depression. “This is an important issue that should be addressed in graduate medical education,” he says. “Identifying factors that negatively affect the mental health of trainees may help inform future interventions for reducing the burden of depression.” He adds that the observed increases in depression rates are notable because they occurred despite recent efforts to limit trainee duty hours and improve work conditions.
Future studies should further explore specific factors that may explain the trends observed in the study, according to Dr. Mata. “Ultimately, we need this type of information to find effective strategies for preventing and treating depression among physicians in training. Efforts are needed to develop reactive interventions to deal with the aftermath of residents who become depressed during residency, but we also need proactive interventions that begin before residents begin their tenure so that depressive episodes can be addressed early and throughout residency.”
Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among resident physicians: systematic review and meta-analysis. JAMA. 2015;314:2373-2383. Available at: http://jama.jamanetwork.com/article.aspx?articleid=2474424.
Daskivich TJ, Jardine DA, Tseng J, et al. Promotion of wellness and mental health awareness among physicians in training: perspective of a national, multispecialty panel of residents and fellows. J Grad Med Educ. 2015;7:143-147.
Sen S, Kranzler HR, Didwania AK, et al. Effects of the 2011 duty hour reforms on interns and their patients: a prospective longitudinal cohort study. JAMA Intern Med. 2013;173:657-662.
Schwenk TL. Resident depression: the tip of a Graduate Medical Education iceberg. JAMA. 2015;314:2357-2358.
Mata DA, Ramos MA, Kim MM, Guille C, Sen S. In their own words: an analysis of the experiences of medical interns participating in a prospective cohort study of depression. Acad Med. 2016 May 10 [Epub ahead of print].
Goldman ML, Shah RN, Bernstein CA. Depression and suicide among physician trainees: recommendations for a national response. JAMA Psychiatry. 2015;72:411-412.