There appears to be a lack of support for medical students with mental health problems.
An online survey of 1,122 medical students was carried out recently by the Student BMJ. Of these, 30% had experienced or received treatment for a mental health condition. Nearly 15% had considered committing suicide while at medical school.
Among these respondents, 80% thought the level of support available to them was either poor or only moderately adequate.
One student said, “As a postgraduate student studying undergraduate medicine, I worry for my younger colleagues. I know many of them suffer with depression, self-esteem issues, and various other problems, and I am stunned by the amount who take prescription medication during exam time.”
A second respondent reported, “The stigma with mental health issues especially comes into focus when exposed to consultants and tutors who refer to it as a weakness.” This respondent had also encountered several consultants who believed that depression “isn’t a real illness,” so the responded asked, “is it any wonder that students struggle to come forward?”
Matthew Billingsley, editor of the Student BMJ, believes the reasons for these high rates of mental health problems in medical students are complex. “Students often have a relentless timetable of exams as well as having to balance the emotional strain of seeing sick patients and uphold high professional standards,” he writes. “The demands of the course can cause an over competitive environment that can have a detrimental effect on the health of students.”
Twishaa Sheth, chair of the British Medical Association’s student’s welfare committee, adds, “The number of students reporting mental illness or considering suicide is shocking. What is more concerning is the lack of independent support available for students.”
The results are in line with previous research carried out by Dr. Deborah Cohen of Cardiff University, UK, in which 15% of 557 respondents from two large UK medical schools had substantial levels of depression. In this study, 52% reported substantial levels of anxiety.
Chair of the Medical Schools Council, Professor Iain Cameron, stated, “Medical schools take the mental well-being of their students seriously. The Student BMJ survey highlights key issues and similar concerns have been raised previously. It is crucial that students who have concerns about their health are able to make this known so that they can be provided with the necessary advice and support.”
The American Medical Student Association is well aware of the growing concern of mental health in medical students. They state, “The cycle of stress, anxiety, and depression takes root during medical school since students frequently lack time for enough sleep, healthy eating, regular exercise, and smaller support systems.”
The AMSA quote a study published by Academic Medicine in 2014 on distress among matriculating medical students. Results showed that medical students had similar or better mental health than the rest of the population before they began training.
“Therefore, the high rates of distress reported in medical students and residents support concerns that the training process and environment contribute to the deterioration of mental health in developing doctors,” the authors state. “Interventions targeting physicians, therefore, should take place early in training during the first year of medical school.”
In terms of the changes medical schools can make, the AMSA suggests they try to provide opportunities to discuss mental health issues on campus “by promoting candid discussions and opening up to classmates about our own struggles.”
Others have suggested changing medical school curricula to pass or fail grading, reducing the volume of material covered in classes, and lowering the number of classroom hours to reduce stress and anxiety over grades.
New programs for promoting student wellness have increased over the past few years, including activities that focus on community building among medical students or courses to teach coping methods and stress management. In addition, colleges can target specific issues that medical students face, such as the challenges of individual clerkships during the third year of medical school.
Dr. Scott Rodgers, the associate dean of student affairs at Vanderbilt University School of Medicine, comments, “You don’t want to lose your humanity by becoming a doctor. Students should participate in activities outside of medicine, maintain personal connections, and make their own physical health a priority.”
More than 80% of medical students with mental health issues feel under supported, says Student BMJ survey. Student BMJ, September 2015, pp. 34-36.
Brazeau, C. M. et al. Distress among matriculating medical students relative to the general population. Academic Medicine, November 2014 doi: 10.1097/ACM.0000000000000482.
Stressed Out Medical Student picture from Shutterstock.