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Depression prevalence among medical students concerning

Medical students have a higher overall rate of depression than the general population, according to study results published in JAMA. These findings emphasize that effective preventive efforts and improved access to care are needed for students in medical school.

“Studies have suggested that medical students experience high rates of depression and suicidal ideation,” Lisa S. Rotenstein, BA, of Harvard Medical School, and colleagues wrote. “However, estimates of the prevalence of depression or depressive symptoms among students vary across studies from 1.4% to 73.5% and those of suicidal ideation vary from 4.9% to 35.6%.”

“Reliable estimates of depression and suicidal ideation prevalence during medical training are important for informing efforts to prevent, treat, and identify causes of emotional distress among medical students, especially in light of recent work revealing a high prevalence of depression in resident physicians,” they added.

Rotenstein and colleagues conducted a systematic review and meta-analysis to investigate the prevalence of suicidal ideation, depression and depressive symptoms among medical students. They searched several databases for studies published prior to Sept. 17, 2016 that analyzed such prevalence using validated assessment methods. Utilizing random-effects meta-analysis, the researchers pooled estimates.

They extracted data for depression or depressive symptom prevalence data from 167 cross-sectional studies (n = 116,628) and 16 longitudinal studies (n = 5,728) from 43 countries, which primarily utilized self-reported instruments. These data indicated that medical students had an overall pooled crude prevalence of depression or depressive symptoms of 27.2% (95% CI, 24.7-29.9). This rate of depression among medical students is significantly higher than that of the general population — according to the National Institute of Mental Health, 6.7% of all US adults had at least one major depressive episode in the past year in 2015. There was a variation among summary prevalence estimates across assessment modalities, ranging from 9.3% to 55.9%. The prevalence of depressive symptoms remained fairly stable over the study duration from 1982 to 2015 with only a 0.2% increase per year.

The median absolute increase in depressive symptoms was 13.5%, ranging from 0.6% to 35.3%, according to findings from nine longitudinal studies (n = 2,432) that analyzed symptoms before and during medical school. The researchers found no significant difference in prevalence between studies of only preclinical students (23.7%) and studies of only clinical students (22.4%). Psychiatric treatment was pursued by 15.7% of medical students who displayed signs of depression (95% CI, 10.2-23.4).

Rotenstein and colleagues also extracted data for suicidal ideation prevalence from 24 cross-sectional studies (n = 21,002) from 15 countries, which primarily used self-reported instruments. These data showed an 11.1% overall pooled crude prevalence of suicidal ideation (95% CI, 9.0-13.7). There was a variation among summary prevalence estimates across assessment modalities, ranging from 7.4% to 24.4%.

“These findings are concerning given that the development of depression and suicidality has been linked to an increased short-term risk of suicide as well as a higher long-term risk of future depressive episodes and morbidity,” Rotenstein and colleagues concluded.

“Further research is needed to identify strategies for preventing and treating these disorders in this population,” they added.

In an accompanying editorial, Stuart J. Slavin, MD, MEd, of Saint Louis University School of Medicine, wrote that the report by Rotenstein and colleagues raises important questions that are essential to investigate and understand in order to address the mental health issues of medical students: What cultural factors of medicine and medicine education are contributing to this problem and what are the barriers to change that still remain?

“Medical schools need to step up to address the mental health crisis among medical students, and solutions cannot just come from the mental health side; the problem needs to be viewed as an environmental health issue,” Slavin concluded. “Medical school administrators must overcome any lingering indifference and institutional concerns and address this problem by concerted efforts to assess and monitor student well-being and to improve the culture and conditions in the educational environment.” – by Alaina Tedesco

Disclosure: Rotenstein and colleagues report funding by the National Institutes of Health and the US Department of State. Slavin reports no relevant financial disclosures.