Is Internship Really that Depressing?

Steven Dubovsky, MD

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Comment

Some commentators might argue that these results justify further decreases in interns' hours to reduce depression and medical errors. However, the PHQ-9 was not designed for diagnosis, especially not in physicians; the endorsed items typically increase during internship (fatigue from being on call; thoughts of death from contact with dying patients); and symptoms might go away spontaneously. As an editorialist notes, long hours are not correlated with depression, but lack of control may contribute to feeling depressed. Some experts believe that many residents experience burnout, whereas other experts believe that such symptoms are developmental.

Study weaknesses include multiple hypotheses, uncorrected multiple post hoc comparisons, and lack of power in the genetics substudy. Perhaps the most relevant conclusion is that interns, and all physicians, should be taught to ameliorate common depressive feelings or distress (by helping each other and dealing with stress, bad outcomes, and worries about medical errors) and to use good clinical assessments to avoid overdiagnosis.

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