As though medical school wasn’t difficult enough, now new research suggests that internship is even more difficult.
In a study of 740 medical students who were on internship, researchers (Sen et al., 2010) found that nearly 4 percent of the students met the criteria for depression before their internship started.
That number jumped to over 25 percent of students when the researchers measured their depression level at four points over the course of the internship year. That’s right — 1 in 4 medical students on internship suffer from serious, clinical depression.
Most of the students who met criteria for depression were classified as moderately depressed. That’s in-between mild and severe depression, and in most people, means their daily functioning is significantly impacted by the feelings of depression.
Naturally you have to wonder — how well are people learning in an environment where depression shoots up 6x the amount seen before internship?
Stress does not inherently produce depression. What the researchers did find was a number of factors that are implicated in depression — many of which we already knew (but were confirmed in this study):
The baseline factors that were associated with the development of depression in this study include some that have been implicated in prior residency studies (female sex, difficult early family environment, neuroticism, and a prior history of depression) and other factors not previously identified (US medical education and lower baseline depressive symptoms).
It is also interesting to note that a number of factors, such as medical specialty and age, were not associated with the development of depression.
So enough cracks about psychiatrists having more depression than other medical specialties!
The researchers also found that medical errors were associated with greater depression. But the new finding is this — “depressive symptoms that are present before internship predicted reported errors during internship, indicating that depression results in increased medical errors.” In other words, a bad cycle gets reinforced on internship with people who are already mildly depressed creating more medical errors, which in turn exacerbates their depression.
But the most relevant and damning data from the new study indicates the flaws in current medical school education:
In addition to building on previous work exploring the relationship between medical errors and depression, this is the first study to demonstrate a direct association between the number of hours worked and risk of depression in medical interns. In contrast to our finding with medical errors, we found no evidence that depressive symptom score before internship predicted one’s work hours during internship. These findings suggest that increased work hours lead to increased depressive symptoms during internship.
Yes, you read that right. The more hours worked, the more depressed a medical student becomes on internship. If you want to churn out higher quality doctors and actually show that you understand and care about their mental health and well-being, medical schools would be wise to review their ethics when it comes to work hours.
The study was conducted in 2007 through 2009, five years after stricter limits on residency and internship hours went into effect. Those stricter standards, however, means that an intern can still work 80-hour work weeks. In most civilized societies, an 80-hour work week would be considered “slave labor” (and far more common in third-world countries). In other words, even these “strict” working hour standards do little to help future doctors have a sane life.
Of course, all of this has a direct effect on you if you ever need to go to a hospital (or, goodness forbid, a teaching hospital). Doctor training is still a throwback to the stone ages, and as this study demonstrates, results in poorer mental health for over a quarter of the doctors who undergo it. I think we can do better in this day and age.
Read our news article on the study: Stress of Internship Ups Physician Depression
Sen S., et al. (2010). A Prospective Cohort Study Investigating Factors Associated With Depression During Medical Internship. Arch Gen Psychiatry, 67(6). Doi:10.1001/archgenpsychiatry.2010.41