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Depressed Medical Students Concerned About Stigma

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Survey Results Suggest Remedies

In an accompanying editorial, Dr. Laura Weiss Roberts suggested that the survey’s results on depression among medical students might not be all bad, and in fact, the results suggest some remedies (JAMA 2010;304:1231-33).

She noted that, compared with students in their first or second year of medical school, third- and fourth-year students “expressed less stigmatized views of depression in peers.” For example, advanced medical students in the study were less likely to see an ill student as being potentially dangerous to patients or as being depressed by choice. “These data suggest that the iterative experiences of medical training may inspire more accurate and empathetic understanding of the illness experience, whether in a patient or a colleague.”

Dr. Roberts is in the department of psychiatry and behavioral sciences at Stanford (Calif.) University. She reported receiving research funding from the National Institutes of Health, the U.S. Department of Energy, and the Medical College of Wisconsin in Milwaukee, as well as being the owner of Terra Nova Learning Systems.


 

A survey of more than 700 medical students found that 14% were moderately or severely depressed. Those depressed students were significantly more likely than students who were not depressed to express concern about stigmas associated with depression, according to the survey, published in the Sept. 15 issue of JAMA.

For example, 53% of the students with moderate to severe depression agreed with the statement, “Telling a counselor I am depressed would be risky,” compared with 17% of students with no or minimal depression.

The results come from a survey of all 769 students enrolled at the medical school of the University of Michigan, Ann Arbor, in September-November 2009. Of the students surveyed, 505 (66%) responded, reported Dr. Thomas L. Schwenk and his colleagues at the university (JAMA 2010;304:1181-90).

First- and second-year students were no more likely than third- or fourth-year students to report moderate to severe depression (13% vs. 15%). But significantly more women than men scored in the moderate to severe range (18% vs. 9%).

Third- and fourth-year students with moderate to severe depression were more likely to report suicidal ideation than were first- and second-year students (7.9% vs. 1.4%).

Significant differences were found between students with moderate to severe depression and those with no or minimal depression on several other stigma-related statements. For example, 62% of the students with moderate to severe depression, compared with 34% of those with no or minimal depression, agreed with the statement, “If I were depressed and asked for help, I would be admitting that my coping skills are inadequate.”

Depressed students also expressed significantly more concern about being less competitive in their residency applications.

On the other hand, 86% of students with moderate to severe depression disagreed with the statement, “Medical students with depression are dangerous to their patients,” compared with 74% of students with no or minimal depression who disagreed with that statement. The difference was statistically significant.

“These results suggest that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment,” the investigators wrote. “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 and professionalism.”

The study was funded by the department of family medicine at the University of Michigan. The authors reported no financial disclosures. Dr. Roberts reported receiving research funding from the National Institutes of Health, the U.S. Department of Energy, and the Medical College of Wisconsin in Milwaukee, as well as being the owner of Terra Nova Learning Systems.

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