Med Student Suicide, Depression: National Response Needed

Megan Brooks

March 31, 2015

Depression and suicide among doctors in training are well-known concerns in the medical community but have yet to be adequately addressed, experts say.

In an article published online March 4 in JAMA Psychiatry, three psychiatrists, led by Matthew L. Goldman, MD, of Columbia University Medical Center and New York State Psychiatric Institute, New York City, call for a national response to combat high levels of depression and suicide among physician trainees, and they offer guidelines on appropriate education, screening, and treatment.

"First steps would be to educate the academic community about these issues, encourage mental health screening, and foster help-seeking behavior and access to care for trainees," they write. "A national commitment to support residents and fellows throughout the challenges of medical training will help ensure the well-being of future generations of physicians and their patients," they add.

According to the American Foundation for Suicide Prevention, each year in the United States, 300 to 400 physicians die by suicide ― about one physician per day. Medical training involves several risk factors for mental illness, including decreased sleep, relocation resulting in fewer available support systems, and feelings of isolation.

Foot-Dragging

A recent study of 740 interns across 13 US hospitals found that the incidence of depression rose from 3.9% to 27.1% in the first 3 months of their intern year and that interns' thoughts of death increased by 370% (Arch Gen Psychiatry. 2010;67:557-566.) There are no clear data on rates of trainee suicide. However, among all physicians, men are 1.41 times more likely and women 2.27 times more likely to die by suicide than their counterparts in the general population.

A consensus statement published in JAMA in 2003 noted that the culture of medicine accords "low priority to physician mental health despite evidence of untreated mood disorders and an increased burden of suicide." It recommended "transforming professional attitudes and changing institutional policies to encourage physicians to seek help."

More than a decade later, these proposed interventions have not been widely adopted, Dr Goldman and coauthors note.

Currently, the Accreditation Council for Graduate Medical Education requires that programs assess fatigue and burnout among trainees and provide access to confidential counseling, "but these regulations should go further to require specific strategies to promote mental health among all trainees," Dr Goldman and colleagues write.

They would like to see curricular time (grand rounds, didactic conferences) devoted to educating trainees about the "continuum of distress, from burnout to depression to suicide." They also recommend screening trainees to identify those most at risk for mental health problems and making sure they have access to confidential counseling and treatment.

Dr Goldman and colleagues add that more research is needed to pinpoint the specific elements of medical training that may contribute to the development of mental illness and the increased risk for physician suicide. Identifying evidence-based interventions that curb the incidence of depression among physicians is also "critically important."

An Epidemic

Colin P. West, MD, PhD, codirector of the Mayo Clinic Department of Medicine Physician Well Being Program, in Rochester, Minnesota, agrees that there needs to be a national response to the problem of maintaining physician trainee and practicing physician mental health.

"Training to become a physician and the work of a physician are very stressful, and we know that the well-being of physician trainees and physicians is not as good as it should be," he told Medscape Medical News.

"I think for many, many years, there really wasn't a great deal of attention to physician well-being, because of the culture of medicine. The almost boot-camp philosophy, so to speak, prevented these issues from being talked about and created a great deal of stigma such that physicians struggling with some of these issues would be very fearful of raising these issues to their own leadership or colleagues," Dr West said.

But times are changing. "Finally, in the last 10 years or so, we are starting to get good national data on how common these issues are. In terms of burnout, we are looking at national rates of burnout among physicians of 50%, whether it's residents or practicing physicians. That's certainly not something you can say, 'Well, it's just a handful of physicians who can't deal with the stresses of the profession. Maybe they picked the wrong field.' It's an epidemic, and I think that has changed the dialogue," Dr West said.

The authors and Dr. West report no relevant financial relationships.

JAMA Psychiatry. Published online March 4, 2015. Abstract

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