Monday, December 14, 2015

Nearly One-Third Of Interns, Residents May Experience Depressive Symptoms During Their Training, Analysis Suggests

The Los Angeles Times (12/9, Kaplan) reports in “Science Now” that “nearly one-third of interns and residents experience depressive symptoms or full-blown depression at some point during their training,” an analysis published Dec. 8 in the Journal of the American Medical Association suggests. After analyzing “data from 54 earlier studies involving 17,560 physicians in training,” then pooling results, investigators found that “the prevalence of depression or depressive symptoms was 29%.”
        The Washington Post (12/9, Sun) points out in “To Your Health” that “researchers said the prevalence of depression was much higher among medical residents than the general population.” In comparison, “the National Institute of Mental Health has said that in 2013, about 6.7 percent of all US adults had at least one major depressive episode during the previous year.”
        TIME (12/9, Oaklander) reports that the reasons for higher rates of depression among new physicians “are complex, ranging from long hours and sleep deprivation to bullying by attending physicians to a stigmatized attitude against mental illness.” Not only are the physicians suffering, but their patients too, as evidenced by the fact that “medical literature links untreated mental health problems in this population of young doctors to more medical errors and worse patient care.”

        According to MedPage Today (12/9, Bender), an accompanying editorial observed that even though “the medical profession is obligated to provide the best medical and mental healthcare to its members, ‘best efforts fall short, mostly because of the high levels of stigma attached to seeking mental health care.’” The editorial suggested that “perhaps an overhaul of the graduate medical education training system is in order.” 

The summary of the study is given below
The study was done to provide a summary estimate of depression or depressive symptom prevalence among resident physicians.
Information on study characteristics and depression or depressive symptom prevalence was extracted independently by 2 trained investigators. The estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression.
The data were extracted from 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals). Three studies used clinical interviews and 51 used self-report instruments. The overall pooled prevalence of depression or depressive symptoms was 28.8% (4969/17 560 individuals, 95% CI, 25.3%-32.5%), with high between-study heterogeneity (Q = 1247, τ2 = 0.39, I2 = 95.8%, P < .001). Prevalence estimates ranged from 20.9% for the 9-item Patient Health Questionnaire with a cutoff of 10 or more (741/3577 individuals, 95% CI, 17.5%-24.7%, Q = 14.4, τ2 = 0.04, I2 = 79.2%) to 43.2% for the 2-item PRIME-MD (1349/2891 individuals, 95% CI, 37.6%-49.0%, Q = 45.6, τ2 = 0.09, I2 = 84.6%). There was an increased prevalence with increasing calendar year (slope = 0.5% increase per year, adjusted for assessment modality; 95% CI, 0.03%-0.9%, P = .04). In a secondary analysis of 7 longitudinal studies, the median absolute increase in depressive symptoms with the onset of residency training was 15.8% (range, 0.3%-26.3%; relative risk, 4.5). No statistically significant differences were observed between cross-sectional vs longitudinal studies, studies of only interns vs only upper-level residents, or studies of nonsurgical vs both nonsurgical and surgical residents.
The study revealed  the summary estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8%, ranging from 20.9% to 43.2% depending on the instrument used, and increased with calendar year. Further research is needed to identify effective strategies for preventing and treating depression among physicians in training.

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