Medical students face 'alarmingly high' rate of depression, study finds

In fact, medical students have an "alarmingly high depression prevalence" compared to what is seen in the general population, says study co-author, Dr. Douglas Mata, a resident physician at Brigham and Women's Hospital in Boston.

To conduct the study, researchers reviewed more than 180 studies involving 129,000 medical students worldwide, including those in Canada. They found the incidence of depression among this group was 27 per cent, compared to eight to nine per cent in the general population.

The incidence of medical students who had suicidal thoughts was 11 per cent. And only about 16 per cent of students who suffered from depression actually went to see a doctor about it.

Justin Cottrell is co-chair of the Ontario Medical Students Association (OMSA), which represents 3,500 medical students across the province. He says he isn't surprised by these numbers — unfortunately.

"Medical training is extremely demanding and stressful at times," he says. "There has been a growing body of evidence for years, demonstrating that this stress may exacerbate or lead to mental illness in some individuals."

Last year, the same researchers looked into the prevalence of depression among resident physicians. With this latest student-focused study, they went a step further, also looking into suicidal ideation in this group.

"Our study now completes the picture of depression and wellness throughout the life cycle of physicians in training, from day one of medical school, to the last day of residency, just prior to becoming a fully independent attending physician," Mata says.

Stigma as a barrier

Students often associate poor mental health with weakness, Cottrell says.

"Stigma remains a major barrier and leads to students feeling shame, embarrassment and social isolation, which creates an additional barrier to accessing necessary resources."

'Starting medical school is like being forced to drink from a firehose, in terms of the amount of information that you have to learn and synthesize.'- Dr. Douglas Mata, study co-author

The researchers say possible causes of depression and suicidal thoughts in medical students likely include stress and anxiety.

"Starting medical school is like being forced to drink from a firehose, in terms of the amount of information that you have to learn and synthesize," says Mata. "You can never stop studying.

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"If you go from surgery to medicine to obstetrics to neurology, you're always getting thrown into a new stressful situation where you have to be highly adaptable to do well there."

The high demands placed on medical students — including studying, working overnight shifts in hospitals and sleep deprivation — are contributing factors to the risk of suicide and depression, Mata says.  

'Multiple transatlantic flights a week'

He likens that kind of sleep deprivation and stress to the jet lag felt after long-haul airplane flights. "That's like taking multiple transatlantic flights a week, every month. That is going to have a big effect on your ability to deal with adversity."

The researchers acknowledge further investigation is needed to come up with strategies that could prevent and treat these mental health issues among medical students, including addressing the stigma attached to depression.

Solutions could include reducing student workloads, decreasing curricular hours or switching to a pass/fail grading system, rather than letter grades.

An editorial accompanying the JAMA study says concerns about the mental health of future physicians have existed for decades.

This research, it says, "highlights that the mental health of medical students is a global problem of significant proportion."

For years, the sentiment in medical schools would dictate that "if students are not 'strong' enough to handle the stress, then they should probably seek another profession."

That attitude, says the editorial, may have diminished over the years, but that it "certainly hasn't disappeared entirely."

"People who went into medical school actually had a more robust mental health than their peers when they were in college," says Mata. "Once they got into medical school, that reversed."