Kate Johnson

October 31, 2012

MONTREAL, Canada — Young, female medical students with specific personality traits and baseline depressive symptoms face a high risk for severe depression 15 years after graduating, new research shows.

"Problems start early, females seem to be at risk for more stress, and stress management and self-development interventions should be offered early," senior author Reidar Tyssen, MD, a psychiatrist and professor at the University of Oslo, in Norway, told delegates attending the 2012 AMA/CMA/BMA International Conference on Physician Health (ICPH).

Dr. Tyssen explained that in addition to young age, which increases the risk for later severe depression by 10%, the personality traits of "reality weakness" and neuroticism double and triple the risk, respectively.

"It is possible to modify maladaptive personality traits. The threshold for seeking help should be low," he said.

The trait of "reality weakness," the term for which was coined by Dr. Tyssen and his group, is "a very potent and very strong predictor of emotional problems in doctors, and we have also found this predicts doctors who do not seek help.... It is described as experiencing oneself being totally different at different points in time and feeling like being in a fog. It is linked to chronic delusions and paranoid traits and problems with relationships," he said.

Unpublished work by Dr. Tyssen's group comparing nonmedical students with medical students shows that although more women report mental distress than men overall, the sex difference is not statistically significant in nonmedical students (25% of women vs 17% of men), but it is significant in medical students (34% vs 20%, P = .006).

The study included 631 Norwegian medical students who graduated between 1993 and 2008. The participants were followed with postal surveys at 1, 4, 10, and 15 years to assess symptoms of severe depression.

By 15 years, the rate of severe depression was 7.2%, down from 13.7% at 1 year, said Dr. Tyssen.

Independent baseline risk factors for future depressive symptoms were as follows: young age (odds ratio [OR], 1.1; P = .003); high neuroticism (OR, 3.4; P = .003); high reality weakness (OR, 2.3; P = .008); and severe depressive symptoms (OR, 3.6; P < .001).

He recommended early attention by medical schools to the particular stresses of young medical students in order to prevent the onset of later problems.

"I think we have to get in really early," agreed Anna Reid, MD, president of the Canadian Medical Association, in an interview with Medscape Medical News.

"When I was in medical school, I was highly stressed. You may have no life experiences of death issues, of people your own age dying, and you're faced with lots of stuff."

"I was very lucky in medical school. We actually had a clinical professor who organized a peer support group for us as we rotated through all the different specialties. We met once a week, and she would come, and she didn't really say too much, but she just made sure it happened. That's what got me through medical school," she said.

"I think we have to make sure there are formalized peer support groups starting at day 1 in medical school as people are overwhelmed, and then continuing through residency. We need to make time in the curriculum. Rather than another lecture on the biochemistry of the eyeball, students should take an hour to meet with peers."

Dr. Tyssen and Dr. Reid have disclosed no relevant financial relationships.

2012 AMA/CMA/BMA International Conference on Physician Health (ICPH). Presented October 26, 2012.

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