This article is more than 5 years old. Information may no longer be current.

Training physicians experience surge in depressive symptoms during internship

During the internship year, depressive symptoms rise significantly for both men and women, but women endure a greater increase, according to data published in JAMA Internal Medicine.

However, when accounting for work-family conflict, the sex disparity was reduced, according to the researchers.

“Depression is common among training physicians and may disproportionately affect women,” Constance Guille, MD, from the department of psychiatry and behavioral sciences at the Medical University of South Carolina, Charleston, and colleagues wrote. “The identification of modifiable risk factors is key to reducing this disease burden and its negative impact on patient care and physician career attrition.”

Guille and colleagues conducted a prospective longitudinal cohort study to investigate if depression and work-family conflict affects male and female training physicians differently during medical internship. The researchers recruited 3,121 interns (mean age, 27.5 years; 49.7% women) across all specialties who were training at one of 44 medical institutions during the 2015 to 2016 academic year.

Participants reported depressive symptoms and the magnitude of how work responsibilities hindered family life using the Patient Health Questionnaire-9 (PHQ-9) and Work Family Conflict Scale, respectively, both before and during their internship.

The researchers observed a pronounced elevation in depressive symptoms in both men and women during their internship. The increase in depressive symptoms was statistically significantly greater in women than men (mean increase in PHQ-9, 3.2; 95% CI, 2.97-3.43 vs. 2.5, 95% CI, 2.26-2.73). There was a 36% decline in the sex disparity in depressive symptoms after accounting for work-family conflict.

Mean work-family conflict scores did not significantly differ among women and men prior to their internship (19 vs. 18.6), but after 6 months of the internship, women had modestly, yet significantly higher scores than men (22.8 vs. 22.2; P = .01).

“Our study demonstrates that depressive symptoms increase substantially during the internship year for men and women, but that this increase is greater for women,” Guille and colleagues concluded. “The study also identifies work-family conflict as an important potentially modifiable factor associated with elevated depressive symptoms in training physicians. Interventions aimed at reducing work-family conflict may be an important step in reducing depressive symptoms in physicians.”

They added, “More explicit consideration of work and family responsibilities may be helpful in constructing a medical education system that allows for rigorous medical training and promotes good mental health.”

In a related editorial, Judy A. Shea, PhD, and Lisa M. Bellini, MD, both from the department of medicine at the Perelman School of Medicine at the University of Pennsylvania, wrote that this study calls attention to the need for solutions to physician burnout and offers “a thoughtful step forward” regarding effective interventions.

“We urge educators to engage researchers in order to more systematically study and use implementation strategies for optimal wellness and life-work integration,” Shea and Bellini concluded. “We have the energy and buy-in, but energy without evidence is not likely to be maximally effective.” – by Alaina Tedesco

Disclosure: All authors report no relevant financial disclosures.