The Silent Struggle: Depression During Residency

James A. Miller, MD

Disclosures

September 21, 2015

Despite all of the contributors to depression among medical trainees, we also have plenty of resources to prevent depression. At the institutional level, we need to advocate for policies that minimize conflicts between work and family life. Flexible work hours (when possible) and referrals for child-care services can go a long way toward improving the work/home interface.[5] Institutional policies can also help to balance effort and reward for medical residents. Waiving parking fees, providing high-quality cafeteria food, helping with gym memberships, and subsidizing child care are all small but significant steps toward alleviating the financial hardship faced by medical residents and their families.[8]

Residents also need opportunities to seek treatment for depression. This is complicated by the significant stigma associated with depression among medical professionals. Evidence suggests that treatment for depression is effective for residents. However, seeking treatment for depression is a difficult proposition during residency. Along with stigma, long and unpredictable work hours may thwart attempts to seek treatment.

Although changing the attitudes of medical professionals toward depression is a long-term goal, residency programs can make an immediate impact by planning for time off during business hours for residents to seek medical care, including treatment of depression.[10] Residency programs can provide mental health services as well. Efforts should be made to ensure that these services are easily accessed, and confidential.

Given the often crushing demands of medical residency, it is easy to forget that we can do a lot on our own to prevent depression. Although we typically have little influence on the policies of our respective residency programs and medical institutions, we do have control over our own attitudes and actions. Interviews with highly humanistic physicians indicate that the same traits that build compassionate care and lifelong learning can also help stave off depression. These physicians all made the point that maintaining humanistic attitudes requires conscious and deliberate effort. Cultivating our natural curiosity, working to meet our own standards of ethics, and maintaining humility will not only make us better physicians but also protect against depression.

As doctors in training, we all need to take time to remember what brought us to this profession in the first place. Applying the same principles of compassion and humanism to ourselves and our colleagues that we have cultivated for our patients may be our most effective tool in avoiding the clutches of depression.

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