F.I ., 31, is in her final year at the University of California, San Diego School of Medicine. She’s studying to be an emergency department doctor, and come March 17, or “Match Day, ” she and thousands of other medical students across America will find out if they got matched to a hospital residency program after graduation.
F.I. has something else in common with many of her medical school colleagues: She’s struggled with depression and suicidal thoughts. These are issues she’s dealt with since she was 10 years old, but F.I ., who would like to request that we use her initials due to concerns about mental health stigma in her field, said her symptoms get worse when she was applying to medical school.
When F.I. got into a top-2 0 medical school, she thought her problems were over. But soon, the relentless rivalry and insecurities about not being smart or prepared enough re-triggered her old depression symptoms.
“I still remember the day I got the acceptance letter, ” said F.I. “I was actually shocked and I was unbelievably happy, and I guessed all those impressions of inadequacy would be gone.”
“But then after I started, they all returned, and it’s never-ending, ” she continued. “Then you have to apply for residency, and it’s like the same thing all over again.”
F.I. isn’t alone in her struggle, and American medical students aren’t unique in their unusually high rates of depression and suicidal guess. A large-scale analysis of 195 examines involving over 120,000 students in 47 countries found that 27 percent of medical students experience depression or depression symptoms, with more than 1 in ten reporting suicidal thoughts. To set that in view, this means that medical students are five times more likely than the general population to have depression.
The study, published this month in the Journal of the American Medical Association, found that, on average, students experienced a 13 percent increase in depression symptoms when they started medical school. Students in both the beginning and later years of their programs are similarly at risk, and medical residents, too, face comparably high rates of depression.
How Medical School Raises The Hazard For Depression
The study doesn’t delve into why medical students would have elevated depression rates and suicidal ideation. But there are a few possibilities, says Dr. Douglas Mata, a pathology resident at Brigham and Women’s Hospital and clinical fellow at Harvard Medical School who was the study’s senior corresponding editor.
There are times when she said, like, Some things you say are stupid, or You should have already known that’ … She just really guessed I was bad, and she made sure I knew it. F.I ., student at the University of California, San Diego School of Medicine
Medical school is notorious for its long hours, demanding course loadings, competitive atmosphere and high rates of stress and burnout. While it’s well-known that this pressure-cooker environment can take a toll on students’ mental health, new research suggests that depression among medical students may be even more widespread than is usually recognise.
Lack of sleep is a known risk factor for depression, and students’ chronic sleep deprivation from analyse and running overnight shifts at hospitals could increase depression rates, Mata said. Plus, the amount of financial indebtednes that students take on in order to graduate could stimulate them feel mentally and emotionally trapped. Medical students who graduated with indebtednes in 2014 owed an average of $180,000, according to the Association of American Medical Colleges.
“Sometimes people feel trapped by that, because in addition to not having enough fund to do everyday things, if, God forbid, you decide that maybe you built the incorrect decision and that medication is not actually what you want to do, you’re pretty much locked in just for monetary reasons, ” said Mata. “You really don’t have a selection of discontinuing and starting anew if you’ve gotten yourself into that much debt.”
F.I. is confident that she wants to become a doctor, but she does identify strongly with all the other risk factors Mata outlined. Her worst bouts of depression passed during her pediatrics rotation, when she had to work a 30 -hour shift every five days, and during a surgery rotation, when she felt her attending supervisor communicated daily that she didn’t belong in the rotation, in the hospital or even in medical school.
“There are times when she said, like,’ Some things you say are stupid, ’ or’ You should have already known that, ’” F.I. remembered. “She just really guessed I was bad, and she made sure I knew it.”
Finally, while she receives financial aid to go to school, the money doesn’t covering F.I.’s everyday expenses like groceries and bills. She is in debt, and to attain extra money, she lately started driving for Uber and Lyft whenever her busy schedule allows.
What Schools Are Doing To Protect Their Students
To cope with the pressure on multiple fronts, F.I. took advantage of her school’s free counselors. She found help from professionals she liked and trusted, calling it “one of the best experiences” she’s ever had in her life. But when a friend and fellow medical school student committed suicide in 2015, she found herself fantasizing about death as a type of liberty or escape. That’s when F.I. realized she needed to start considering a psychiatrist, who then went on to prescribe her antidepressant medication.
Too many students like F.I ., as well as full-fledged doctors, are struggling with med school and hospital life. An estimated 300 to 400 physicians commit suicide every year, and the medical profession is scrambling to come to terms with how to change so it can protect physicians from this risk.
F.I. feels she is now getting the help she needs. While she still struggles with depression symptoms, she’s looking forward to Match Day and enjoys spending time with her patients.
Some schools offer mental health services through their psychiatry departments and others offer free counseling for students, but these programs expressed the view that students will seek help, and they may not be enough to address the structural the specific characteristics of medical school that increase depression. For instance, Mata’s meta-analysis found that merely 16 percent of the students who screened positive for depression sought treatment.
Examples of institutional change, on the other hand, include Saint Louis University School of Medicine’s recent decision to adopt a pass/ fail system and reduce class time by 10 percent, which resulted in improved academic performance and fewer students reporting symptoms of anxiety and depression.
While Mata says that it’s a good sign more medical schools are taking the mental health and well-being of their students seriously and offering services like free counseling, yoga or mindfulness meditation, organizations need to take a more structural approach to change.
“Both of these things put the onus on the student, and I don’t think get to the root causes of depression, which are more system-based issues, ” he said. “There are a couple of big changes that can be made.”
The Culture Around Mental Health Needs To Change
There are certain deeply ingrained aspects of medicine culture that make it difficult to fix this problem, Dr. Stuart Slavin argues in an editorial also published in JAMA.
If you satisfy criteria for major depressive disorder, you shouldnt stay home, dig your heels in and try to tackle it on your own. Dr. Douglas Mata
“The first is the faith by some that medicine is a demanding profession and, hence, medical school should also be extremely rigorous and demanding. If students are not’ strong’ enough to handle the stress, then they should probably attempt another profession, ” wrote Slavin, who is the associate dean for curriculum and a pediatrics professor at Saint Louis University School of Medicine. “A second aspect of medical culture is that mental problems commonly have not been taken as seriously as physical problems.”
Mental illness stigma is particularly rampant in the medical community, Slavin indicates, and likely prevents students from trying help.
Mata hopes that his examine and similar research serve as a wake-up call for both medical schools and medical students. Merely as a person with an infection would go to a doctor for antibiotics, or a person with diabetes would take a pill or insulin, people with depression should seek medical treatment, he concluded.
“If you fulfill criteria for major depressive disorder, you shouldn’t stay home, excavate your heels in and try to tackle it on your own, ” Mata said. “You should go assure somebody, because both medication and therapy are equally effective, and it’s not a sign of weakness for people to get treated for their illness. It’s an illness just like any other.”
If you or someone you know requires help, call 1-800-273-8255 for the National Suicide Prevention Lifeline . Outside of the U.S ., please visit the International Association for Suicide Prevention for a database of resources.
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