A recent study published in the journal of BMC Medical Education gives an insight into the patterns and causes of medical school depression.
Depression is a mental illness that causes persistent low mood, and lack of interest and pleasure in daily life. Individuals with depression have feelings of worthlessness and disrupted concentration, sleep patterns, and appetite. In severe depression, sufferers may have suicidal thoughts. Depression is a very common condition, although the estimates of its lifetime prevalence vary widely between different countries – from 3% in Japan to 17% in the US.
Factors Influencing Medical School Depression Not Well Understood
The risk of depression may be increased in stressful environments, such as those experienced by combatant soldiers, or doctors and medical students. Despite the growing interest in stress during medical training, the factors influencing medical school depression are still not well understood. A study at the University of Minho in Portugal investigated the pattern of depression among its medical students. The results were recently published in the journal BMC Medical Education.
Medical students attending the University of Minho, in the admission years 2009, 2010, 2011 and 2012 (four student groups), were invited to complete a set of standardized mental health questionnaires. These four questionnaires were the Beck Depression Index (BDI) to measure depression, the State Trait Anxiety Inventory (STAI) to measure anxiety, Maslach Burnout Inventory (MBI), a “perceived difficulty” questionnaire, and a questionnaire to collect socio-demographic information such as age, gender, and motivation for enrolling in a medical degree. The participants completed these annually over a period of four years. Questionnaires were anonymous, but there was an individual identification code to allow analysis of data over time.
The average response rate was 86% (2,234 students). The prevalence of depression ranged from 21.5% (admission year 2009) to 12.7% (admission year 2012). This was higher than both the general population and their peers and similar to rates seen in other studies on medical students.
Medical School Depression Decreased Over Years Attended
Students who completed the questionnaires every year were included in a longitudinal analysis of over four years at medical school (238 students). There was a significant downward trend in BDI scores in the first three years at medical school, which indicated that depressive symptoms were generally decreasing over years attended. The BDI scores raised again slightly, but not significantly, in the fourth year. However, around 19% of medical students had persistently raised BDI scores over time, indicating persistent depressive symptoms in these students. On further analysis, these students were found to have high levels of anxiety and had chosen to study medicine for anticipated income and prestige. They also reported more problems with relationships and had decreased satisfaction with social activities. On the other hand students who had initially high BDI scores, but had low levels of anxiety and a primary interest in medicine as a career tended to improve their mood. These students also reported reduced burnout and increased satisfaction with social life by their final assessment. Researchers did not detect any difference between male or female students in their BDI scores over time.
Medical Schools Must Identify and Support Depressed Students As Early As Possible
The researchers concluded that personal factors (such as anxiety traits, factors influencing the choice to study medicine, relationship patterns, and academic burnout) were related to the persistence of high BDI scores during medical training. Evidence from other studies suggests that medical students who experience depressive symptoms are reluctant to seek help. Because of this, the researchers suggest that medical schools need to be aware of the risks and actively identify and support students who experience depression as early as possible.
Written by Julie McShane, Medical Writer
Reference: Silva V, Costa P, Pereira I, et al. Depression in medical students: insights from a longitudinal study. BioMed Central Medical Education (2017) 17:184. DOI: 10.1186/s12909-017-1006-0.