Nearly a third of med students suffer depression

A review of around 200 studies, which looked at 129,000 medical students in 47 countries, found that 27% were depressed.

A review and analysis of nearly 200 studies involving 129,000 medical students in 47 countries found that the prevalence of depression or depressive symptoms was 27%, that 11% reported suicidal ideation during medical school and only about 16% of students who screened positive for depression reportedly sought treatment, according to a study appearing in JAMA, a medical education theme issue.

In an ABC report, Dr Dov Degen talks about when he was first diagnosed with bipolar disorder in his second year of medical school.

"I thought I was Jesus at some stages," he said.

"I was clearly not myself, and yet even within a medical framework and amongst a medical community I was still unable to access resources.

"There was no one in particular that I could talk to. The medical world was unable to support me with that episode unfortunately."

Dr Degen is now a successful doctor and he is not surprised that experiences like his are shared by medical students around the world.

"Undoubtedly there are lots of stresses that face medical students," he said.

"There's work stresses, there's the pressure to succeed, a lot of us are type-A personalities by nature, that's often what draws us to the profession, we're perfectionists.

"All of those things along with competition from peers, lack of resources, high expectations from family and friends and from ourselves all culminate in personal stress."

Studies have suggested that medical students experience high rates of depression and suicidal ideation; however, prevalence estimates vary across studies. Reliable estimates of depression and suicidal ideation prevalence during medical training are important for informing efforts to prevent, treat and identify causes of emotional distress among medical students, especially in light of recent work revealing a high prevalence of depression in resident physicians.

Douglas A Mata, MD, MPH, of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues conducted a systematic review and meta-analysis of published studies of depression, depressive symptoms and suicidal ideation in undergraduate medical trainees. The researchers identified 195 studies that met criteria for inclusion in the analysis.

Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116,628) and 16 longitudinal studies (n = 5728) from 43 countries. The overall pooled crude prevalence of depression or depressive symptoms was 27% (37,933/122,356 individuals). Summary prevalence estimates ranged across assessment methods from 9% to 56%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982–2015). In the nine longitudinal studies that assessed depressive symptoms before and during medical school, the median absolute increase in symptoms was 14%. Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% vs 22.4%). The percentage of medical students screening positive for depression who sought psychiatric treatment was 16% (110/954 individuals).

Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21,002) from 15 countries. The overall pooled crude prevalence of suicidal ideation was 11% (2043/21,002 individuals). Summary prevalence estimates ranged across assessment methods from 7% to 24%.

“The present analysis builds on recent work demonstrating a high prevalence of depression among resident physicians, and the concordance between the summary prevalence estimates (27.2% in students vs 28.8% in residents) suggests that depression is a problem affecting all levels of medical training. Taken together, these data suggest that depressive and suicidal symptoms in medical trainees may adversely affect the long-term health of physicians as well as the quality of care delivered in academic medical centers,” the authors wrote.

“Possible causes of depressive and suicidal symptomatology in medical students likely include stress and anxiety secondary to the competitiveness of medical school. Restructuring medical school curricula and student evaluations might ameliorate these stresses. Future research should also determine how strongly depression in medical school predicts depression during residency and whether interventions that reduce depression in medical students carry over in their effectiveness when those students transition to residency. Furthermore, efforts are continually needed to reduce barriers to mental health services, including addressing the stigma of depression.

“Further research is needed to identify strategies for preventing and treating these disorders in this population,” the researchers concluded.