Pam Harrison

October 11, 2016

WASHINGTON, DC — Medical school faculty seriously underestimate the amount of mental distress students are under, new research shows.

"I think the fact that students keep their mental health issues hidden is likely due to the stigma around having mental illness or even thinking you might have mental illness — people self-stigmatize, and as a psychiatrist, I know that even psychiatrists are stigmatized by our colleagues," study investigator Cheryl Kennedy, MD, assistant professor of psychiatry, Rutgers New Jersey Medical School, Newark, told Medscape Medical News.

"But we saw a striking difference between students' perception of their fellow students having mental health issues and faculty, and what worries us is that faculty really are the eyes and ears on students, and it's up to them to assess whether students are doing well, not just academically but emotionally, so we need faculty to be aware of these issues and not be too cavalier about students who may be struggling," she added.

Dr Kennedy presented the findings here at the Institute of Psychiatric Services (IPS): The Mental Health Services 2016 Conference.

Stressful Experience

Investigators circulated an anonymous electronic survey among current medical students and faculty at an urban academic medical center. The survey asked respondents about their personal experience with help-seeking and perceptions of the mental health of medical students.

A total of 176 students responded to the survey, as did 36 faculty.

Almost 40% of medical students thought that up to 40% of their classmates had or had had mental health problems.

This is in contrast to estimates from faculty, 61% of whom thought that from zero to 20% of students had mental health problems, Dr Kennedy and colleagues report (P < .001).

"But what is really curious about this is, even though the faculty didn't think more than 20% of their medical students had problems, 74% of these faculty members had already spoken to students about mental health issues — either students came to them or they noticed something. They were actually engaged with students on those issues, so it's interesting how people can compartmentalize knowledge they actually have," said Dr Kennedy.

More than two thirds of the students surveyed reported that since starting medical school, they felt "down," "depressed," or "hopeless" at some point, and 20% of the students who responded to the survey screened positive for depression on the Physicians Health Questionnaire–2.

Almost two thirds of student respondents also worried that their classmates might view them differently if they knew they were experiencing depression, and 41% of students said they would not use mental health services, presumably because of the stigma attached to admitting to feeling depressed.

The good news, added Dr Kennedy, is that at least 39% of the medical students surveyed acknowledged that they had talked with a mental health provider.

"Medical school is extremely stressful — there are very strong academic demands placed on students and expectations to succeed — but once you are in medical school and you find out that maybe it's not for you, that doesn't go over very well with anybody, including yourself, so it's very difficult," Dr Kennedy said.

"Most of our students make it through — at least 95% of them do ― so very few students leave medical school. But we know that some of them struggle along the way, and we need to be more open and receptive to that without stigmatizing them," she added.

Highly Demanding

Commenting on the findings for Medscape Medical News, Chantal Brazeau, MD, professor of family medicine and psychiatry, Rutgers New Jersey Medical School, Newark, concurred with Dr Kennedy that medical school is indeed very stressful.

"We were part of a multisite study in which we looked at mental health, burnout scores, quality of life, and depression in our own students and found that before students start medical school, they had better mental health scores, less burnout, and higher quality of life compared to other college students of the same age," said Dr Brazeau, who was not part of the current study.

However, any time after starting medical school, during residency, and even once they became physicians, "their scores have always been worse than the general population," she added.

"So the challenges and demands that students face in medical school are very high."

Making the experience of medical school more positive for students is not simply a question of faculty being solicitous and asking students how they are faring, Dr Brazeau suggested.

Rather, addressing medical student distress requires a multipronged effort in which students are taught about self-care and how to stave off burnout.

"We need to design a curriculum in ways to make it better and easier for students to apply self-care advice so we can teach them what to do with themselves personally, but we also have to educate faculty so they know about mental health issues," she said.

"But it has to be part of a bigger picture, because just to educate the faculty without making other environmental changes would not be sufficient," Dr Brazeau added.

Dr Kennedy and Dr Brazeau report no relevant financial relationships.

Institute of Psychiatric Services (IPS): The Mental Health Services 2016 Conference. Abstract 23. Presented October 6, 2016.

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