Not only do medical students experience a higher rate of depression than the general population, but they also attach a higher degree of stigma to having the mental illness.
These are the findings of a recent study conducted at the University of Michigan and led by Thomas L. Schwenk, M.D.
Outcomes of the study revealed that 14.3 percent of the students were identified as having moderate to severe depression — higher than the 10- to 12 percent range found in the population at large.
The results also revealed that 53.3 percent of medical students who reported high levels of depressive symptoms were worried that revealing their illness would be risky. Almost 62 percent of the same students said asking for help would mean the student’s coping skills were inadequate.
“These results show that students who are depressed feel highly stigmatized by their fellow students and faculty members,” says Schwenk, who also is a professor of family medicine.
“Medical students are under extraordinary demands. They feel they are making life and death decisions and that they can never be wrong. There is such tremendous pressure to be perfect that any sense of falling short makes them very anxious.”
The higher stigma also contributes to the likelihood that medical students will not seek out treatment for depression because they are concerned about perceptions that would limit future options. Researchers write that “students may worry that revealing their depression will make them less competitive for residency training positions or compromise their education, and physicians may be reluctant to disclose their diagnosis on licensure and medical staff applications.”
Schwenk noted that the high level of intolerance to depression may cause students to equate the illness with performance problems. “We want to provide a medical education environment in which depression is treated like any other medical problem, worthy of treatment, detection and prevention. Most importantly, we want the medical students to be comfortable seeking help,” he said.
The study was conducted in the fall of 2009 covering all students enrolled at the University of Michigan Medical School. A little more than 65 percent participated in the survey—505 students of 769 enrolled.
The degree of stigma felt followed a plane of severity, according to researchers, who wrote that “students with higher depression scores felt more strongly than did those with no to minimal depression that telling a counselor would be risky and that asking for help would mean the student’s coping skills were inadequate.”
Many more women than men were characterized by moderate to severe depression—18 percent compared to 9 percent, and those in their third and fourth year of medical school reported suicidal ideation more frequently than those in their first two years.
First- and second-year students reported that they would feel less intelligent for seeking help than their third- and fourth-year counterparts—a difference of 34.1 percent and 22.9 percent respectively. Also, 36.3 percent of men compared to 20.1 percent of women believed that depressed students could endanger patients.
Authors suggested that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment. “The effective care of mental illness, the maintenance of mental health and effective emotional function, and the care of professional colleagues with mental illness could be taught as part of the ethical and professional responsibilities of the outstanding physician and become a critical component of the teaching, role modeling, and professional guidance that medical students receive as part of their curriculum in professionalism,” the authors write.
The study can be found in September 15 issue of JAMA, a theme issue on medical education.