August 12, 2016 6:00 AM

1 in 4 First-Year Residents May Meet Criteria for Clinical Depression

As research paints a clearer picture of the depression risks among newly minted doctors, researchers and educators are trying to help.

Nearly 27,000 of them arrived in early summer, fresh-faced and ready to start their careers in medicine in teaching hospitals all across the U.S.

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But just a few months later, they may already be feeling the effects of long days, erratic sleep schedules, intense professional pressure and the humbling experience of being the lowest-ranking member of a team.

They’re interns: first-year doctors, just out of medical school. They’ve just started on the training journey called residency that will prepare them to practice on their own.

And one in four may be so stressed and sleep-deprived, they meet diagnostic criteria for clinical depression. That’s four to five times the rate in the general population.

As you might expect, research has shown that this can get in the way of their ability to care for patients and avoid making medical errors. A new study, based on detailed surveys of more than 100 individuals, shows that the intern year can even change how they value the profession of medicine and themselves.

This could have profound consequences for their future career decisions, and their patients, says Srijan Sen, M.D., Ph.D., a University of Michigan Medical School psychiatrist and the senior author of the paper in Academic Medicine. In response, residency programs across the country should recognize the serious problem of depression among medical trainees and implement evidence-based changes to their programs to address the issues that lead to depression, Sen and his colleagues say.

“There is a strong link between depression in doctors and the quality of care that they provide for their patients,” Sen says. “Improving the mental health of residents may be an important way to improve the health of our patients.

"Improving the mental health of residents holds great promise for improving the care that our patients receive."
Srijan Sen, M.D., Ph.D.

One year with ‘a profound impact’

In a separate paper published last year, Sen and Douglas Mata, M.D., MPH, reviewed research on more than 17,500 residents collected over the past 50 years and estimated that 29 percent meet criteria for depression. As part of the ongoing Intern Health Study, the team built on this work to explore qualitative differences between depressed and nondepressed residents in the new paper.

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Interns who showed signs of depression were more likely to report problems with cynicism, exhaustion and stress while those without depressive symptoms were more likely to mention positive patient care and educational experiences in surveys.

Those with symptoms of depression also had a higher chance of describing experiences that “broke” their confidence, their sense of well-being and their belief in the medical profession. Those without symptoms mainly described profoundly positive, life-changing experiences from their interactions with patients and supportive colleagues that helped them grow personally and professionally.

“These findings underscore the importance of mental health during the internship year, as these negative experiences may have a profound impact on physicians’ sense of self and future practice, patient care and career decisions,” the authors write.

“Physicians should emerge from their internship year feeling capable, confident and enthusiastic about their careers in medicine. Regret and cynicism during internship — a critical time in the development of the physician — may manifest later as burnout, a problem that disproportionately affects physicians compared with other workers in the United States.”

Sen, who helps lead the team that helps interns and residents at the U-M Health System handle depression and other mental health concerns, says the growing body of work showing interns’ special vulnerability should spur immediate action by all teaching hospitals.

He’s also recently recorded two podcasts aimed at physicians on this topic, for a series that addresses physician burnout issues and for an American Medical Association ethics journal. His work was also cited by an AMA blog post that points physicians to resources available from the AMA and the accreditation body that oversees residency training.

Sen’s research has shown that a free mobile app called Mood Gym can help interns stave off depression through regular mood checks and other tools. (He reports no financial interest in the app.)

Interns and residents also need to be reassured they can get help for depression without jeopardizing their careers, the researchers say.

“Destigmatization of mental illness among medical trainees and making screening and treatment for depression more accessible are important steps to addressing this issue,” they write.

“Proactive, resilience-based strategies also may help interns retain the enthusiasm that brought them to the medical profession in the first place so that they may emerge from training as capable, confident and forward-looking practitioners.”