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Almost 1/3 Of Med Students Are Depressed!


s2MD

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http://www.cbc.ca/beta/news/health/medical-students-medicine-mental-health-depression-suicide-1.3883935

 

I saw it on CBC today, too! Very interesting read. I'm not in medical school, but I can definitely see how the demands can wreak havoc on your mental health. I hope that more resources will be implemented to help students in that regard.

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http://www.cbc.ca/beta/news/health/medical-students-medicine-mental-health-depression-suicide-1.3883935

 

I saw it on CBC today, too! Very interesting read. I'm not in medical school, but I can definitely see how the demands can wreak havoc on your mental health. I hope that more resources will be implemented to help students in that regard.

 

When you can see residency has even more hours, more call, and more directly consequences of screwing up you can see there is a long stretch where people are quite vulnerable. it is important to be aware and look after yourself and those around you. 

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It's unfortunately not that surprising. Med school is hard and while there's a lot of attention paid to the need to ensure self-care, the nature of the training simply doesn't always make it possible to prioritize ourselves. I'm finding there's a bit of a "suck it up" attitude that I don't think does anyone any good, but it seems to permeate the culture of medicine. This wasnt terribly surprising to discover since I'd read ahead of starting med school that this was the case, but it was still disappointing to come up against it.

 

(To be fair, I say this as someone who only took a week off after having a baby because "suck it up" is basically my motto for myself, so I'm really not so great about improving the overall put-yourself-last culture.)

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"Almost a third of medical school students report depressive symptoms or depression".

 

They mostly mean the former. There is a big difference between having depressive symptoms and actually being clinically depressed. If 1 in 3 medical students had clinical depression; absenteeism would be rampant, medications would be flying off the shelves, and it would literally be impossible to not notice. 

 

Medical training involves a lot of years, a lot of work, and being in environments that aren't always pleasant. In fact, it would be very unusual if people didn't experience depressive symptoms (i.e., sadness / burn-out / wtf-why-am-I-here?) during at least some part of it.

 

Bottom line. Nothing truly new is being said here. I see it as part of a worthy, ongoing effort to acknowledge that these feelings are normal, and that help is available so it doesn't evolve into depression, suicidality and death. It's also why schools put so much effort into selecting academically strong, well-adjusted individuals. If they didn't, this issue would be even worse.

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"Almost a third of medical school students report depressive symptoms or depression".

 

They mostly mean the former. There is a big difference between having depressive symptoms and actually being clinically depressed. If 1 in 3 medical students had clinical depression; absenteeism would be rampant, medications would be flying off the shelves, and it would literally be impossible to not notice. 

 

Medical training involves a lot of years, a lot of work, and being in environments that aren't always pleasant. In fact, it would be very unusual if people didn't experience depressive symptoms (i.e., sadness / burn-out / wtf-why-am-I-here?) during at least some part of it.

 

Bottom line. Nothing truly new is being said here. I see it as part of a worthy, ongoing effort to acknowledge that these feelings are normal, and that help is available so it doesn't evolve into depression, suicidality and death. It's also why schools put so much effort into selecting academically strong, well-adjusted individuals. If they didn't, this issue would be even worse.

 

This is a great point, I was gonna say the same thing.

 

What percentage of people in the real working world have "depressive symptoms?"  If clinical major depression is ~10%, I bet endorsing some depressive symptoms is well over 20% in the general population. 

 

On a personal note, I found most of med school to be ok, but the "depression-inducing" parts were pretty brutal.  Mostly in clerkship, the core surgery and medicine blocks were really bad.  No sleep, you feel like you know nothing and you feel stupid, you are worried at times about failing, no time for friends and family.  Luckily, unless you do electives in these areas, I found times like this to be only about 6 months of med school.  I'm wondering if others agree.

 

Edit: about half of the first year of residency is "depression-inducing" as well; I found for the most part things improved after that.  I am a neuro resident, and while I still do nights/call, it is far less bad eventually once you feel confident and comfortable, and realize you are close to staffing where life is way better

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Not very surprising. I saw quite a few people in my class crash during preclerkship or clerkship, even though we started clerkship only 4 months ago. During surgery, a friend on the same service started crying out of the blue because of the horrible hours we had and the fact that she was stressed. The hours are just awful. For residents, it's even worse. Depressive symptoms during these times are simply to be expected.

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On my psych rotation one of the preceptors put it like this: "you can't have a disorder without some negative effects to ability to function".

 

I couldn't separate symptoms from true pathology; everyone has depressive symptoms but not everyone is able to continue to function through them.

 

Don't know how helpful that is but it puts in context for me. Many people had/are having difficulties with residency/med school around me, including myself. Some people I know have sought professional help, others have less appropriate coping skills and some are not coping at all but I would say that those who are unable to handle things and are depressed to a point it is affecting their function are a minority smaller than 1/3rd. 

 

That is not to say this isn't a issue that needs correcting, and I am not trying to minimize things for the people who are able to cope through it, I know it is difficult and things need to change, I just suspect the 1/3rd figure needs a more precise definition or adjusting.

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"Almost a third of medical school students report depressive symptoms or depression".

 

They mostly mean the former. There is a big difference between having depressive symptoms and actually being clinically depressed. If 1 in 3 medical students had clinical depression; absenteeism would be rampant, medications would be flying off the shelves, and it would literally be impossible to not notice. 

 

Medical training involves a lot of years, a lot of work, and being in environments that aren't always pleasant. In fact, it would be very unusual if people didn't experience depressive symptoms (i.e., sadness / burn-out / wtf-why-am-I-here?) during at least some part of it.

 

Bottom line. Nothing truly new is being said here. I see it as part of a worthy, ongoing effort to acknowledge that these feelings are normal, and that help is available so it doesn't evolve into depression, suicidality and death. It's also why schools put so much effort into selecting academically strong, well-adjusted individuals. If they didn't, this issue would be even worse.

 

Depends on what your cutoff between depressive symptoms and clinical depression to be. Depression is a spectrum, not a binary state. Some of the included studies used some fairly well-validated tools and still put the rate of clinical depression at around 20%, though parsing through the results, it seems much more likely to be moderate depression than severe depression.

 

Anecdotally, I'd say these numbers are pretty accurate. Part of the problem with having academically strong, well-adjusted individuals is that they tend to be very good at hiding their symptoms if they want to. Depressive signs are there though.

 

I'm going to quibble with the words used - these feelings are common, but definitely not normal. Medical training shouldn't involve this kind of harm to trainees on such a regular basis. 

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The medical field emphasizes a lot on hierarchy. Many higher up on the ladder can make people on the lower rung feel like dirt. In most rotations, the attending and seniors are too busy to teach and doesn't matter how much you read up ahead (if you have any time to read up ahead), you still feel like you're not good enough in the team. So you're constantly in a stressed mode until the end of each rotation you are told you actually did an excellent job.  :huh:  This cycle repeats itself, rotation after rotation, year after year, until you finish your residency! The extremely long hour shifts also wear you down a lot. Lack of sleep can easily lead to depression!

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I think a good way to prevent unhappiness or get through rough times is to have a good circle of friends to talk/complain to. Its amazing how just complaining to friends and family can make you feel better and get you through rough times.

 

Also, humor works so well. Make light of everything and it gets you through those rough times. Sometimes letting loose is what we really need. Instead of always being super serious about everything, crack a few jokes about your issues. Very cathartic.

 

But its rough, especially in clerkship due to all the staff interaction, stress of being involved in such serious circumstances and long hours. Find people who understand you and the times you are going through. 

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I think a good way to prevent unhappiness or get through rough times is to have a good circle of friends to talk/complain to. Its amazing how just complaining to friends and family can make you feel better and get you through rough times.

 

Also, humor works so well. Make light of everything and it gets you through those rough times. Sometimes letting loose is what we really need. Instead of always being super serious about everything, crack a few jokes about your issues. Very cathartic.

 

But its rough, especially in clerkship due to all the staff interaction, stress of being involved in such serious circumstances and long hours. Find people who understand you and the times you are going through. 

 

I think this misses the point here. Depression isn't just unhappiness or going through rough times. It's deeper than that, fare more persistent and pervasive.

 

Talking with friends and family, using humour, connecting with those in similar situations - these are all great things to use when feeling down, but they're best for people who aren't actually depressed. Ever try to joke with a truly depressed person? It's not overly effective...

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I think this misses the point here. Depression isn't just unhappiness or going through rough times. It's deeper than that, fare more persistent and pervasive.

 

Talking with friends and family, using humour, connecting with those in similar situations - these are all great things to use when feeling down, but they're best for people who aren't actually depressed. Ever try to joke with a truly depressed person? It's not overly effective...

 

I was referring to depressive symptoms as well, since that was what the study included. I think there is a difference between the depressive symptoms and depression and also feeling down that isn't effectively managed could very well eventually lead to depression. 

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I was referring to depressive symptoms as well, since that was what the study included. I think there is a difference between the depressive symptoms and depression and also feeling down that isn't effectively managed could very well eventually lead to depression.

Fair point on the prevention aspect.

 

However, depressive symptoms shouldn't be equated with simple unhappiness either. They may not be as severe as full-blown depression, but they're not the transient emotions that might be ameliorated by a quick laugh or chat with a loved one. When someone is experiencing or getting close to depression, these normally-helpful approaches often stop being effective.

 

I'd endorse your advice for every medical trainee, but I think it's ill-tailored to the problem at hand. Worse, I worry it continues a trend towards putting the onus on individual trainees to improve their own situations - which, of course, the vast majority are already trying to do - rather than pushing for schools and residency programs to address the root causes as to why their trainees experience depression at such high rates. Medical students don't start medical school with higher rates of depression than the general population, but that changes rather quickly.

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That's really a good point!!! Instead of telling us, when you feel down, seek professional help at the faculty and take care of yourself.

Instead, medical schools could make changes to the residency curriculum, cutting down cruel long hour, the same goes for clerks.

When you were berated or belittled by your senior resident in surgery, it was so difficult to complain...because he or she would end up evaluating you and make your life miserable. Perhaps implementing completely confidential complaint system and make sure that the actors involved would not be involved in our final evaluation.

When I was in call in surgery, I arrived at 6h30 and went home after midnight, with my senior resident constantly yelling at me and telling me that I was stupid...It was hard to complain to my preceptors..Instead, I complained to my friends and family, it did help and I successfully passed my surgery rotation B)

When you are a medical clerk, you really feel at the bottom of the chain, and some preceptors and residents do not care about you at all. 

But the root of problems need to be addressed, IMO :)

Fair point on the prevention aspect.

However, depressive symptoms shouldn't be equated with simple unhappiness either. They may not be as severe as full-blown depression, but they're not the transient emotions that might be ameliorated by a quick laugh or chat with a loved one. When someone is experiencing or getting close to depression, these normally-helpful approaches often stop being effective.

I'd endorse your advice for every medical trainee, but I think it's ill-tailored to the problem at hand. Worse, I worry it continues a trend towards putting the onus on individual trainees to improve their own situations - which, of course, the vast majority are already trying to do - rather than pushing for schools and residency programs to address the root causes as to why their trainees experience depression at such high rates. Medical students don't start medical school with higher rates of depression than the general population, but that changes rather quickly.

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Feeling exhausted, stressed, worried, and worn out are normal responses to long hours under high pressure, but feeling hopeless, worthless, and unable to enjoy things you normally enjoy is unhealthy, and should not be mistaken as normal outcomes of intense challenges.

 

 

 

Systematic disprespect, dehumanization, constant fear of being humiliated for not already knowing what you are there to learn, disregard for the physical and psychological drain of long hours, representing you as "weak" if you show the toll it is taking on you.

These are all things I saw in med/dent.

 

I didn't find it was the pressure that made medical and dental students depressed, it was the learned helplessness from the toxic environment that teaches you that you cannot avoid humiliation and disrespect through any amount of effort and preparedness. There's a huge difference between the embarrassment of legitimate failure and being humiliated unnecessarily.

 

I felt it all actually took away from the professional learning. It was the abusive instructors who made learning from them so unpleasant that most students reverted to just trying to make it through a session without being embarrassed as opposed to maximizing the learning experience. This then reinforced to the faculty the erroneous notion that the students weren't self motivated and needed to be force-fed their learning.

 

I expected better. I expected excellence in teaching and management and I saw pettiness and institutionalized abuse and lack of leadership.

 

Also, I'm not saying that these programs don't produce great doctors and dentists, I'm saying I don't see the culture as *necessary* for producing great doctors and dentists.

I don't believe that hopelessness and humiliation are productive in crafting future professionals. Even if the model has "worked" for decades.

 

 

Very well said Malkynn!!!  They emphasized empathy when selecting applicants but you don't see much empathy when they grilled/humiliated their med students or residents in front of everyone!  To be fair, there are some very good attendings and senior residents who are kind and encouraging and willing to teach, but the disrespect and dehumanization from other ones are totally unnecessary. All med students they meticulously picked (with high academics and other achievements and empathy) are actually more motivated and eager to learn than they know!  Ever got called a "prince" or "princess" when you get to go home after a 30-hour shift because the culture in that specialty don't get a post call day? Any human being will not function normally or alertly without a shut eye after staying awake for 30 hours (this could happen on a busy night). Their state of mind is equivalent to driving drunk! How could you expect these people to save lives when they can't even think straight??? The seniors do what they do because they know they can! Nobody speaks up because they all see the light at the end of the tunnel even though the tunnel could be long. They know that this torture will end so they all just say that's the way things are. Suck it up!

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That's really a good point!!! Instead of telling us, when you feel down, seek professional help at the faculty and take care of yourself.

Instead, medical schools could make changes to the residency curriculum, cutting down cruel long hour, the same goes for clerks.

When you were berated or belittled by your senior resident in surgery, it was so difficult to complain...because he or she would end up evaluating you and make your life miserable. Perhaps implementing completely confidential complaint system and make sure that the actors involved would not be involved in our final evaluation.

When I was in call in surgery, I arrived at 6h30 and went home after midnight, with my senior resident constantly yelling at me and telling me that I was stupid...It was hard to complain to my preceptors..Instead, I complained to my friends and family, it did help and I successfully passed my surgery rotation B)

When you are a medical clerk, you really feel at the bottom of the chain, and some preceptors and residents do not care about you at all.

But the root of problems need to be addressed, IMO :)

Cutting down long hours risks prolonged residency. You already don't have enough time in residency to see all the stuff you want to see in order to be comfortable (or at least semi comfortable) when you are staff. Cutting back hours means you will be looking an extra year or two.

 

Residents, especially senior residents, shouldn't be belittling or degrading med students. Even if the med student is blatantly underperforming (like skipping out on work or lacking basic skills/knowledge that are required) there is a way to address that. Freakong out at the med students just shows:

 

A. Your own weakness as a resident

B. You're a loser

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Thanks for your input :)

My senior resident was quizzing me on Gardner Syndrome, and I just had a blank at 12 AM....Then my resident started to yell and told me that I am dumb..I didn't take it personal, but it was still harsh on my self-esteem. It was just a very long call in surgery with a grumpy and mad senior resident.

I think that all med schools need to make sure that complaints are 100% confidential, and that the actors involved SHOULD NOT be involved in the evaluation process.

I did not report those incidents during my surg rotation, because I knew that my senior resident will be doing my final eval and that my preceptor did not give a damn about how residents interact with us. Well, it was just a long excruciating rotation :rolleyes:

 

Cutting down long hours risks prolonged residency. You already don't have enough time in residency to see all the stuff you want to see in order to be comfortable (or at least semi comfortable) when you are staff. Cutting back hours means you will be looking an extra year or two.

Residents, especially senior residents, shouldn't be belittling or degrading med students. Even if the med student is blatantly underperforming (like skipping out on work or lacking basic skills/knowledge that are required) there is a way to address that. Freakong out at the med students just shows:

A. Your own weakness as a resident
B. You're a loser

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Cutting down long hours risks prolonged residency. You already don't have enough time in residency to see all the stuff you want to see in order to be comfortable (or at least semi comfortable) when you are staff. Cutting back hours means you will be looking an extra year or two.

 

Residents, especially senior residents, shouldn't be belittling or degrading med students. Even if the med student is blatantly underperforming (like skipping out on work or lacking basic skills/knowledge that are required) there is a way to address that. Freakong out at the med students just shows:

 

A. Your own weakness as a resident

B. You're a loser

haha

It reminded me of an incredibly insecure R1 me and a few of my friends worked with.

He kept acting as if he was WAAYYYYY above us. He even introduced himself as Dr. [his last name] to one of my friends on another service, knowing my friend was a med student. And yes, he's an R1. 

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My senior resident was quizzing me on Gardner Syndrome, and I just had a blank at 12 AM....Then my resident started to yell and told me that I am dumb..I didn't take it personal, but it was still harsh on my self-esteem. It was just a very long call in surgery with a grumpy and mad senior resident.

I think that all med schools need to make sure that complaints are 100% confidential, and that the actors involved SHOULD NOT be involved in the evaluation process.

I did not report those incidents during my surg rotation, because I knew that my senior resident will be doing my final eval and that my preceptor did not give a damn about how residents interact with us. Well, it was just a long excruciating rotation :rolleyes:

 

Yes, surgery is one of the most brutal ones! The team deals with life and death and is under a lot of stress. I can accept they skip the "please" and "thanks" to save time but shouting out insults to the juniors is simply an exploitation of their power.

 

You thought those who'd gone through this pain would know how hurtful it is and would not want to do it to the ones below them. Turns out, once they have the power, they become one of them and pay it forward! Fake it till you make it? Or are they simply burnt out and don't want to bother with basic manners to human anymore? I bet they had a very empathetic face on when they were being interviewed while applying to medical schools.

 

Forgive them and try to remember not to fall into this dark abyss when you have the power one day! Hope we can end this toxicity!

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Fair point on the prevention aspect.

 

However, depressive symptoms shouldn't be equated with simple unhappiness either. They may not be as severe as full-blown depression, but they're not the transient emotions that might be ameliorated by a quick laugh or chat with a loved one. When someone is experiencing or getting close to depression, these normally-helpful approaches often stop being effective.

 

I'd endorse your advice for every medical trainee, but I think it's ill-tailored to the problem at hand. Worse, I worry it continues a trend towards putting the onus on individual trainees to improve their own situations - which, of course, the vast majority are already trying to do - rather than pushing for schools and residency programs to address the root causes as to why their trainees experience depression at such high rates. Medical students don't start medical school with higher rates of depression than the general population, but that changes rather quickly.

 

Fair point, yeah i do intend my advice not as something for someone who may actually be depressed, but more for every medical student.

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Hey there, thank you for your kind word!!!

I found it ironic, because my resident was humane in front of chief nurses and the staff physicians, and became so demeaning and mad in front of me. I simply moved on after my gen surg rotation :)

I could never imagine doing that to a medical student, even when I become a staff physician. I really hope that we could end this "suck it up and live with it" attitude in the medical training culture!

Yes, surgery is one of the most brutal ones! The team deals with life and death and is under a lot of stress. I can accept they skip the "please" and "thanks" to save time but shouting out insults to the juniors is simply an exploitation of their power.

 

You thought those who'd gone through this pain would know how hurtful it is and would not want to do it to the ones below them. Turns out, once they have the power, they become one of them and pay it forward! Fake it till you make it? Or are they simply burnt out and don't want to bother with basic manners to human anymore? I bet they had a very empathetic face on when they were being interviewed while applying to medical schools.

 

Forgive them and try to remember not to fall into this dark abyss when you have the power one day! Hope we can end this toxicity!

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