On the surface, it’s a story loaded with irony. Dig deeper, however, and it’s something that has long been a problem.
And it calls into question: why hasn’t the issue of widespread mental health problems among medical students still not been addressed (a question that further adds to the irony)?
Why are more than one in four medical school students reporting depression or depressive symptoms, and even more alarming, why are more than one in 10 having suicidal thoughts?1
And among these depressed medical school students, why are only 16 percent seeking treatment? Perhaps that’s the only easy question to answer. Stigma, the biggest barrier to mental healthcare in America, is a force as powerful among medical students as it is among military veterans and anyone else.
The latest findings on the issue of medical school students and the brutal psychological distress they endure were released Dec. 6 in a special issue of JAMA. The entire issue focuses on the health issues of medical students.
A paper that reviews almost 200 studies of 129,000 medical students in 47 countries is accompanied by an editorial article titled “Medical School Mental Health” written by Dr. Stuart J. Slavin of St. Louis University School of Medicine.
In 33 Years, No Real Progress in Addressing Problem
The systematic review and meta-analysis found:
More than 27 percent of students reported depression or depressive symptoms. Of those, only 16 percent sought treatment. Eleven percent of medical students reported suicidal thoughts.
The analysis looked at studies spanning a 33-year period, 1982 to 2015. During that time, the prevalence of depression among medical students remained steady, suggesting that in more than three decades nothing has been done to effectively improve the situation.
Longitudinal studies showed thatthe increase in depressive symptoms before and during medical school was 14 percent.
There was very little difference in depression rates between medical students already in clinical work (rotations in a hospital, for example) and those who were pre-clinical students, with those not yet advancing to clinical work reporting slightly higher rates, 23.7 percent compared to 22.4 percent in studies that offered that comparison.
So why is this happening?
Barriers to Mental Health Treatment: Tear Down that Wall
“Possible causes of depressive and suicidal symptomatology in medical students likely include stress and anxiety secondary to the competitiveness of medical school,” wrote the authors, led by Dr. Douglas A. Mata of Brigham and Women’s Hospital and Harvard Medical School, Boston.2 “Restructuring medical school curricula and student evaluations might ameliorate these stresses. Future research also should determine how strongly depression in medical students carry over in their effectiveness when those students transition to residency. Furthermore, efforts are continually needed to reduce barriers to mental health services, including addressing the stigma of depression.”
In the accompanying editorial, Slavin notes that the first study of depression among medical students was published in 1936 – 80 years ago.
“When viewed together and within the context of eight decades of study and awareness of the problem, the reports by Rotenstein et al and Wasson et al lead to an important question: What is it about the culture of medicine and of medical education that has allowed this problem to remain so long unaddressed and for studies of interventions to lag so far behind the number of studies of the nature of the problem?” he writes.
“The first is the belief by some that medicine is a demanding profession and, therefore, medical school should also be extremely rigorous and demanding. If students are not ‘strong’ enough to handle the stress, then they should probably seek another profession. This sentiment has certainly diminished in recent decades but has not disappeared entirely. Some senior faculty and administrators still express dismay about the ‘softening’ of the culture and the students,” Slavin explains.
“A second aspect of medical culture is that mental health problems ordinarily have not been taken as seriously as physical problems, and treatment has generally been embraced over prevention. For years, psychiatry and psychology have been viewed by many in academic medicine as soft sciences,” he argues. “Coverage and payment for treatment of mental health problems has lagged that for ‘physical’ ailments. Considering that the U.S. health care system is better characterized as a disease-oriented system rather than one designed to promote wellness, it is not surprising that student mental health has also been neglected and preventive measures have been slow to evolve.”
Potentially Disastrous Consequences of Not Seeking Treatment
Consider what happens when medical students do not seek treatment for their symptoms: misery and potentially fatal health consequences at worst, an unsuccessful practice that results in diminished patient care and possibly even elevated risk of liability at best.
We also know that at least half of all people with mental health problems usually develop substance abuse problems, too. This is a particularly striking statistic given that medical students often have easy access to prescription drugs.
Not only is America’s opioid epidemic creeping into each corner of our society, including medical schools, but the use of Adderall, a stimulant, as a study drug has skyrocketed. It’s sure to become the next national conversation regarding America’s prescription drug crisis.
In yet another study in the medical school issue of JAMA, authors report that the prevalence of disabled students in medical school is higher than previously believed (yet still very low): 0.6 percent v. 0.3 percent.3
The reason for the higher numbers? This is the first study that looked at mental health disabilities. “The preponderance of students with ADHD (for which Adderall is prescribed), learning disabilities and psychological disabilities suggests that these disability subtypes should be included in future research efforts, such as studies assessing the performance of appropriately accommodated students,” the authors concluded.
1. Prevalence of Depression, Depressive Symptoms and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. (2016, Dec. 6). Retrieved Dec. 6 from http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2016.17324?utm_source=Silverchair_Information_Systems&utm_campaign=FTM_12012016&utm_content=news_releases&cmp=1&utm_medium=email
2. Slavin, S. (2016, Dec. 6). Medical Student Mental Health: Culture, Environment, and Need for Change. JAMA.
3. Meeks, L. et al. Prevalence of Self-Disclosed Disability Among Students in U.S. Allopathic Medical Schools. (2016, Dec. 6). JAMA http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2016.10544?utm_source=Silverchair_Information_Systems&utm_campaign=FTM_12012016&utm_content=news_releases&cmp=1&utm_medium=email
Written by David Heitz