Recent studies have highlighted a problem that many medical students know about all too well: the prevalence of depression and burnout in medical training. On student discussion boards, the stories put a human face on this troubling issue.
One medical student writes that she experienced severe depression during exams a few years ago. "I couldn't stop crying, couldn't sleep, I stopped seeing all my friends, I just used to sit and stare at books with nothing going in, it was horrible," she notes in a comment on Medscape's student blog, The Differential. After going to counseling, she was able to look objectively at her abilities and stop putting so much pressure on herself.
Medical students are exposed to a host of new, stressful experiences during their training, and they often process these moments in isolation. Although it has been studied considerably, the effects of depression and burnout on attitudes and actions are still being realized.
Depression is more common among medical students, residents, and physicians than in the general population, though estimates of its prevalence vary. About 14% of medical students have symptoms of moderate to severe depression, according to a study published last September in JAMA. In addition, roughly 5% of the 505 students surveyed revealed that they had suicidal thoughts at some point during training. A survey published inEpidemiology and Health last November found that 40% of 120 medical students in Seoul, Korea, appeared to have depression.
"Medical students are stubborn," writes Joshua Batt, a student at Touro University Nevada College of Osteopathic Medicine in Las Vegas. "We want to put forth the image that we can hold up the world even when everything inside is falling apart." That blog post prompted more than 75 readers to comment, many of them sharing their own experiences during medical school.
"Sometimes it is weird and worrisome to think that soon, I'll be responsible for others when I can hardly take care of myself," one medical student writes.
The anonymity of discussion boards seems to lower the barriers to honest conversation, but medical students still seem to attach a stigma to depression. In an informal poll accompanying his post, Batt asked medical students whether they've experienced depression during training, and 84% said they had. However, about half of them noted that they would not tell anyone about their emotional struggles.
Medical students with more severe depression also may be less likely to seek treatment, the JAMA study suggests. In particular, compared with their healthier peers, students with depression more frequently agree that "if I were depressed, fellow medical students would respect my opinions less" and that faculty members would view them as being unable to handle their responsibilities. Attitudes differ between class years, with first- and second-year depressed students more often agreeing that seeking help for depression would make them feel less intelligent, the study found.
Several students note that it is difficult to stay emotionally healthy during medical school, partly because there's little extra time to dedicate to counseling. "Unfortunately, we don't have time to schedule appointments, wait for a few weeks to see a therapist, and then have to schedule an appointment every week for a few months, just so that we can get a prescription or diagnosis," writes one medical student. Others also expressed fear that having a record of their depression could jeopardize their medical careers.
Even medical students who don't have depression could be suffering from burnout, a measure that includes depersonalization, emotional exhaustion, and feelings of professional inadequacy. According to a survey of about 2500 students from 7 US medical schools, about 53% of students met those criteria. In addition, students with burnout are more likely to report having done something dishonest, like cheat, and are also more likely to seriously consider dropping out.
In another post on The Differential, medical student Alex Folkl openly admits that he has burnout, and in an informal poll accompanying his post, 92% of voters (N=648) say they have experienced burnout during medical training.
How are educators thinking about this issue? In response to the JAMA study, an independent group of researchers raised the possibility that first- and second-year students may by anxious about their upcoming clinical experiences and suggested integrating clinical experiences into the first 2 years of training. However, the study authors found this suggestion inadequate. Rather, they wrote, the key step will be to change the "cultures and values of medical education, with a focus on support, role modeling, and mentorship by both faculty members and fellow students."
Indeed, students who feel they lack a social support system are 10 times more likely to be depressed compared with students who say they have good support, according to the Epidemiology and Health study. One student commenter recommends finding at least 2 people with whom you can discuss your toughest moments.
Another medical student who has battled depression off and on for the past 4 years writes, "If there was one thing I could implement in medical schools it is that there would be more attention paid to the mental health of students, because I believe that it is only when we ourselves are healthy that we can begin to treat others."
Kelly Chi, MS