For the report, Douglas Mata, M.D., M.P.H., of Harvard Medical School and colleagues analyzed 195 studies that reported on the prevalence of depression, depressive symptoms, or suicidal ideation in 129,123 medical students in 47 countries.
According the analysis, 27.7% of students screened positive for depression—a percentage the authors noted is “higher than that reported in the general population.” A total of 11.1% reported suicidal ideation during medical school (prevalence estimates ranged from 7.4% to 24.2% depending on the screening instrument and cutoff score). Among the medical students who screened positive for depression, 15.7% reportedly sought psychiatric treatment, additional analysis revealed.
The authors outlined several limitations of the study, including the fact the analyzed data “were almost exclusively derived from self-report inventories of depressive symptoms that varied substantially in their sensitivity and specificity for diagnosing major depressive disorder.” Nonetheless, they wrote, “Combined with the finding that only 15.7% of medical students who screened positive for depression sought treatment, the high prevalence of suicidal ideation underscores the need for effective preventive efforts and increased access to care that accommodates the needs of medical students and the demands of their training.”
In September, APA President Maria A. Oquendo, M.D., Ph.D., wrote of the mental health challenges that some physicians face and the factors that may contribute to their hesitancy to seek mental health care in a Psychiatric News column. “[M]ost physicians have enormous personal strength, both emotional and intellectual ‘reserves.’ Accordingly, they often are able to compensate for the presence of psychiatric symptoms, which both makes it difficult to identify them so they can receive assistance and leads them to feel more isolated, since no one knows how they really feel,” she wrote.
In a related editorial also published Tuesday in JAMA, Stuart J. Slavin, M.D., M.Ed., of St. Louis University School of Medicine posed the following question in response to these and other findings: “What is it about the culture of medicine and of medical education that has allowed this problem to remain so long unaddressed and for studies of interventions to lag so far behind the number of studies of the nature of the problem?”
The stigma surrounding mental illness and an environment that holds “the firm belief that more pressure, more hours, and more demands must lead to better educational outcomes” are two of several factors Slavin suggests may have led to “the delayed and until recently muted response to the long-standing problem of poor mental health of medical students.”
Slavin concluded, “Medical schools need to step up to address the mental health crisis among medical students, and solutions cannot just come from the mental health side; the problem needs to be viewed as an environmental health issue.”