Medical School and Mental Health: Depression Among Doctors

A recent meta-analysis and systematic review of the literature from JAMA revealed that medical students were at unusually high risk of suicide, depressive ideations, and other related mood disorder issues. They also discovered that a full 11% of medical students reported having contemplated suicide, a rate much higher than that found among the general population. This is not the first review to find these results. Another from JAMA from last year also found that twenty-nine percent of medical residents experienced clinically significant depression.

Overall, it would appear that roughly 1 in 3 residents and medical students are depressed at some point during their medical training. That’s an incredibly high percentage, which suggests that something about medical school itself is contributing to this phenomenon. For reference, among the general population, lifetime prevalence of clinical depression in the United States is 17%.

It Doesn’t Always Get Better After Med School

The problem doesn’t always go away after physicians complete their training and begin practicing. In fact, doctors have alarming rates of suicide than the general population: 1.41% greater for males, and 2.27% times greater for females.

This problem is almost certainly something that extends beyond the psychology of individual physicians. It is suspected that there are systematic problems with medical school that are causing this. The exact factor at play here isn’t completely clear, but there are several possible contributors. Medical students and residents work long hours and overnight shifts, all which subjected to extreme psychological stress. They often lack time for self-care activities and for social interaction.

Most of all, medical school comes with an immense amount of pressure. Even getting in is a highly selective process. Only around 42% of applicants are accepted into medical schools, and once they’re in, there’s a lot of complex and intellectually challenging information that must be learned in a relatively short period of time.

Additional stress also comes from the bullying culture that exists in medical schools. A worrying 80% of students report ill treatment from their supervisors. Then, even more stress comes after medical school, when graduates begin to apply for their residencies. They don’t have much control over where they end up, and they often need to move across the country, leaving their social support system behind.

Changing the System to Help Medical Students

Addressing the underlying environmental problems that are present in medical school could help reduce the rates of mental health problems among medical students. Recent evaluations of the interventions in place to help has shown that they’re largely ineffective.

Several medical schools have been attempting to take a more systemic approach, rather than offering weak interventions like yoga classes that put the onus on the student but ignore the environmental underpinnings of depression. St. Louis has switched to a pass/fail grading system to help reduce pressures on medical students. It also started tracking anxiety and depression among its students. After these changes, it was found that not only did students’ academic performance improve, but they also became less likely to report mood disorder symptoms.

Offering more easily accessible mental health services may also be beneficial. In one review, it was found that among medical students who were diagnosed positive for depression, only 16% actually sought psychiatric treatment. The students may worry that seeking treatment could impact their future career prospects.  

Like Medical Students and Practicing Physicians, Nurses Also Hesitate to Seek Mental Health Treatment

Physicians aren’t the only ones who are suffering. Nurses are also prone to higher rates of depression than the general population. Working a stressful job with irregular hours and overnight shifts can take its toll, but many nurses hesitate to seek treatment because they’re worried about their jobs. A 2014 study confirms that many nurses find that the organizational culture in their workplace discourages them from seeking treatment, or even from acknowledging their own mental health problems. Psychiatric nurses, in particular, are quite hesitant to seek treatment if they suffer from anxiety or depression.

Just as addressing systemic environmental problems with medical school can help with medical students’ and physicians’ mental health, addressing issues of organizational attitudes toward mental health can help nurses seek treatment more effectively.
For both nurses and physicians, the “web of silence” that develops in healthcare facilities about mental health is extremely detrimental. Subjected to significant workplace stress, but afraid to seek treatment for its mental health consequences, many nurses and doctors are suffering in silence.