Is Internship Really that Depressing?

Steven Dubovsky, MD


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In This Article

Abstract and Introduction


A study of interns shows increased depressive symptoms but had multiple limitations.


Postgraduate medical education is stressful, but does it cause clinically significant depression? In a multicenter study of 740 medical interns in 2007–2009, researchers used computer-based, self-administered quarterly questionnaires and saliva samples to examine the prevalence of depression and its relationship to genetic polymorphisms in the serotonin transporter promoter (5-HTTP). The main instrument was the nine-item Patient Health Questionnaire (PHQ-9), typically used to screen primary-care patients for depression. Researchers also obtained information on demographics, neuroticism, resilience, perceived stress, social and family factors, and cognitive style.

The mean PHQ-9 score was 2.38 at baseline, as high as 6.70 during internship, and 6.26 at end of internship. The PHQ-9 criterion for major depression (score, ≥10) was met by 4% of interns at baseline and a mean of 25% during internship; 42% met this criterion at least once. Few interns (2.3% during internship) met the PHQ-9 criterion for severe depression (score, ≥20). Prevalence of all nine items, including sleeping difficulties and thoughts of death, increased significantly. Several baseline factors (past depression, lower initial PHQ-9 scores, female sex, neuroticism, difficult early family environment, and U.S. medical education) and within-internship factors (work hours, perceived medical errors, and outside stressful events) predicted increases in PHQ-9 scores. In whites, having one short 5-HTTP allele was associated with a greater increase in scores than having two long alleles.


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