Why are medical students and residents at higher risk for physician suicide?

Updated: Aug 01, 2018
  • Author: Louise B Andrew, MD, JD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Prospective medical students and residents are extremely unlikely to report a history of depression during highly competitive selection interviews. The prevalence of depression in these populations and in medical student and postgraduate trainees is unknown, but it is estimated to range from 15-30%. [5, 6, 7, 8, 9, 52]  After accidents, suicide is the most common cause of death among medical students. In one study, 9.4% of fourth-year medical students and interns reported having suicidal thoughts in the previous two weeks. [6]

One report has suggested that depression is not uncommon in pediatric residents (up to 20% self reported in 3 programs). This preliminary study found that residents who experienced depression may be as much as 6 times more likely than nonaffected controls to make medication errors. [53] Other studies have confirmed the association of depression with self-perceived medication and other errors. [54] Recently skyrocketing rates of burnout being reported among physician trainees and physicians have garnered attention [55] . Although burnout does not necessarily lead to depression, some of the symptoms are similar; and burnout probably contributes to the development or onset of depression in those who are predisposed. 

Stressful aspects of physician training—such as long hours, having to make difficult decisions while being at risk for errors due to inexperience, learning to deal with death and dying, frequent shifts in workplace, and estrangement from supportive networks, such as family—could add to the tendency toward depressive symptoms in trainees.

Harassment and belittlement by professors, higher-level trainees, and even nurses contribute to mental distress of students and development of depression in some. [56] Even positive workplace changes, such as translocations to secure further training or job advancement, can contribute to job-related stress. Suicide in medical trainees is most likely to occur just prior to beginning clinical rotations, or prior to or at the beginning of residency. 

A few schools are implementing programs to recognize and deal with depression and other stresses in medical trainees. [57, 58, 7, 59, 60, 9] The American Foundation for Suicide Prevention has created a video on the topic for physicians and other medical trainees. [61]

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