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.

MCI not to upload the minutes of any ethics committee meeting held

The Medical Council of India (MCI), has revised its working methodology and has decided not to make public the minutes of any ethics committee meetings, where the medical negligence cases and cases relating to professional misconduct of doctors are heard. Since October 2013, the MCI has not uploaded the minutes of any ethics committee meeting held, that is, after the current administration took over.

MCI said that the decision taken in each case would be respective to that particular case. The council further added that no consolidated minutes of the meetings of the ethics committee are now being maintained/prepared. This is done as the ethics committee of the council considers the matter before it in a quasi-judicial capacity and makes judgement upon the appeal/complaint. The committee has to decide upon the matter that affects the rights and duties of the contesting parties in accordance with the principles of natural justice and disclosing the proceedings prior to conclusion of a matter would serve no public interest.

The minutes of ethics committee meetings were uploaded regularly from May 2011 to May 2013 on the MCI website. The minutes of each committee meeting started with confirmation of the minutes of the previous meeting and all proceedings were absolutely transparent till the current council took over in November 2013.

However, some medico-legal experts have expressed their displeasure at this new turn of events and believe that minutes of hearings need to be public. It have also pointed out that this decision by MCI seems more like an attempt to hide the irregularities in the MCI that are being frequently reported. Many appeals seeking the minutes of meetings were met with stony silence till the applicants approached the chief information commissioner who had to force the MCI to hand over the specific minutes sought and threaten the public information officer with penalty.