The mental health of new doctors during their first year of residency — called the intern year — may be significantly affected by the nature of the program they enter, according to a new study published in the journal Academic Medicine.
A research team from the University of Michigan (U-M) and Medical University of South Carolina analyzed the answers of year-long surveys taken by 1,276 interns in 54 programs across the country, who were taking part in the larger effort known as the Intern Health Study.
They found that medical interns were more likely to suffer from depression at certain programs compared with others. Previous research has shown that depression among medical students, residents and practicing physicians is associated with career burnout, medical errors, lower quality care, motor vehicle crashes and suicidal thoughts.
“While most of the focus on resident depression has been on the individual resident, in this paper we show that institutions and residency programs play a critical role,” said senior author Srijan Sen, M.D., Ph.D., leader of the Intern Health Study and the Eisenberg Professor of Depression and Neurosciences at U-M.
“Some programs have consistently high rates of depression year after year, while others have consistently low depression. We also find four factors that explain much of the difference between programs.”
The highest rates of intern depression were found in internal medicine residency programs that had the longest working hours, the least helpful feedback from faculty, and the least-valuable inpatient training rotation experiences.
High levels of depression were also found in programs that produced doctors who were likely to go on to research-focused careers.
Overall, depression symptoms tended to increase throughout the internship, as measured on a standard survey that each participant took before their intern year began, and four times during the year.
Sen and his colleagues, led by U-M Department of Psychiatry researcher Karina Pereira-Lima, M.Sc., looked at which factors predicted the largest rises in depression scores, and the highest percentage of interns whose scores were above 10, meaning that they met the criteria for having major depression. At least five, and as many as 101, interns from each program participated.
On average, one-third of interns met the criteria for major depression, a figure Sen has found in previous work. However, some programs had no interns meet the criteria for depression, while in others, three-quarters of those surveyed met the criteria.
Even when personal factors were taken into account — such as a history of past depression, childhood stress, a tendency toward neurotic behavior and female gender — the four residency program factors still stood out as making a difference in the likelihood of developing depressive symptoms during the intern year.
Overall, the four factors accounted for nearly half of the variation in depression symptoms found among those in the internship programs.
Poor timeliness and appropriateness of faculty feedback stood out as the most important factors, suggesting that efforts to improve the teaching skills of the physicians who supervise and mentor interns could affect interns’ mental health.
The impact of the research ranking of a residency program was noteworthy and suggests that some of our most prestigious institutions could most benefit from reform, says Sen.
“These findings suggest that the residency program environment plays a central role in the mental health of medical interns,” said Pereira-Lima, who is also a doctoral candidate at the Ribeirão Preto Medical School of the University of São Paulo in Brazil.
“These program-level factors can inform changes to residency programs that may reduce the risk of depression in resident physicians.”