Ep 9. medice, cura te ipsum- mental health in medical school

*WARNING: This episode contains talk of depression and suicide.

Introduction

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The PHQ-9 (a questionnaire that screens for depression) looks for symptoms other than just mood. It asks about appetite, sleep, weight changes and other symptoms. During a lecture on depression and the PHQ-9, a friend turned to me and jokingly said “weight changes, changes in sleep, changes in mood, changes in appetite: med school has given us all depression!”

Sadly, his statement has more truth I had originally appreciated. To learn more about mental health throughout our training, I turned to Kelly Zerr and Jordan Yeo. Both are candidates for the class of 2019 and members of MIND team (Mental Illness Network for Destigmatization). Attached is a photo of them at the Mental Health Symposium at UBC in 2016.

Statistics

  1. Depression is more common among medical students, residents, and physicians than in the general population, though estimates of its prevalence vary (Schwenk, Davis & Wimsatt, 2010). A review of 200 studies involving 129,000 medical students in 47 countries found that the prevalence of depression or depressive symptoms was 27% among medical students (Rotensteinet al., 2016). 11% reported suicidal ideation during medical school, and only 16% of students who screened positive for depression sought treatment (Rotensteinet al., 2016).
    1. In contrast,  5.4% of the Canadian population aged 15 years and over reported symptoms that met the criteria for a mood disorder in the previous 12 months, including 4.7% for major depression and 1.5% for bipolar disorder (Public Heath Agency of Canada, 2016)
    2. In a survey of 1122 students in the UK, 30%  received treatment for a mental health condition while at medical school. From this group, 80% thought the level of support available to them was either poor or only moderately adequate. 15%  had considered committing suicide at some point during their studies (Billingsley, 2015).
    3.  In a survey of 4287 medical students at 7 medical schools, burnout was reported by 49.6%  of students (Dyrbye et al., 2008). Burnout is a measure that includes depersonalization, emotional exhaustion, and feelings of professional inadequacy (Dyrbye et al., 2008). Students with burnout are more likely to report having done something dishonest, like cheat, and are also more likely to seriously consider dropping out (Dyrbye et al., 2008)
  2. Medical students are less likely than the general population to receive appropriate treatment (Tjia, Givens, & Shea, 2005). Students may engage in potentially harmful methods of coping, such as excessive alcohol consumption, and may fail to recognize the need for treatment (Schwenk, Davis & Wimsatt, 2010)
    1. A web survey of  all students enrolled at the University of Michigan Medical School (N = 769) revealed some of the reasons medical students do not seek treatment. Some of these reasons included fellow medical students would respecting their opinions less,  faculty members may view them as being unable to handle their responsibilities and seeking help for depression would make them feel less intelligent  (Schwenk, Davis & Wimsatt, 2010)
  3. The problem does not seem to get better with more training. In fact, it seems to get worse.
    1. At the start of medical school, medical students have mental health profiles similar to their non-medical peers (Dyrbye, et al., 2006). Unfortunately, mental health worsens during medical school (Dyrbye, et al., 2006).
    2. In this systematic review, an estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8% (Mata et al., 2015). Sadly, the prevalence increased significantly over the course of the first year of training and increased progressively with subsequent years (Mata et al., 2015).
    3. The combined results of 25 studies suggest that the suicide rate among male doctors is 40 percent higher than that among men in general, whereas the rate among female doctors is 130 percent higher than that among women in general (Schernhammer & Colditz, 2004).
  4. Dyrbye et al., (2005, December) discusses some solutions including: mentorship programs, pass-fail grading systems, identifying and assisting struggling students, teaching stress management and promoting personal health.
    1. The MIND team works on removing stigma around mental health.
    2. UBC’s President, Dr Ono, has even spoken out about his own struggles with depression (Benrimoh, 2016).

Summary

This episode focused mostly on depression because it seems to be the most common mental illness among medical students. Students may also be affected by anxiety, bipolar disorder and psychosis- other important topics. My biggest “take-away” from this discussion is that mental illness is invisible. A couple things we can all do: be kind and check-in regularly with our peers.

Resources/Additional Reading

  1. Harvard Speak Up. http://www.harvardspeaksup.com/
  2. MIND speaks up at UBC. http://mindspeaksup.com/
  3. UBC student health http://students.ubc.ca/livewell/services/student-health-service
  4. Office of student affairs http://mdprogram.med.ubc.ca/student-resources/contact/

References

Benrimoh, S. (2016). President Ono participates in UBC “mental health literacy’’ talk. Retrieved from http://www.ubyssey.ca/news/ono-talks-mental-health-/

Billingsley, M. (2015). Student mental health survey. Student BMJ 2015;23:h4521

Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2005, December). Medical student distress: causes, consequences, and proposed solutions. In Mayo Clinic Proceedings (Vol. 80, No. 12, pp. 1613-1622). Elsevier.

Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Academic Medicine, 81(4), 354-373.

Dyrbye, L. N., Thomas, M. R., Massie, F. S., Power, D. V., Eacker, A., Harper, W., … & Sloan, J. A. (2008). Burnout and suicidal ideation among US medical students. Annals of internal medicine, 149(5), 334-341.

Mata, D. A., Ramos, M. A., Bansal, N., Khan, R., Guille, C., Di Angelantonio, E., & Sen, S. (2015). Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA314(22), 2373-2383.

Public Health Agency of Canada. (2016). What is depression. Retrieved from http://www.phac-aspc.gc.ca/cd-mc/mi-mm/depression-eng.php

Rotenstein, LS, Ramos, MA, Torre, M, Segal, JB, Peluso, MJ, Guille, C, Sen, S & Mata, DA. (2016). Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA.  316(21):2214-2236.

Schernhammer, E. S., & Colditz, G. A. (2004). Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). American Journal of Psychiatry, 161(12), 2295-2302.

Schwenk, T. L., Davis, L., & Wimsatt, L. A. (2010). Depression, stigma, and suicidal ideation in medical students. Jama, 304(11), 1181-1190.

Tjia, J., Givens, J. L., & Shea, J. A. (2005). Factors associated with undertreatment of medical student depression. Journal of American college health, 53(5), 219-224.

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