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Medical Students and Depression/Suicide: I am not astounded to read this article from the JAMA stating the relationship between medical students and higher rates of suicide, depression and suicidal ideation. For decades the literature has cited higher rates of suicide in doctors and dentists, even naming certain subspecialties to be at a higher risk (psychiatry, for example). The literature exemplifies the relationship between professions where addictive drugs are prescribed or ease to access as those professionals having higher rates of mental health illnesses. The link between the prevalence/incidence of depression in medical students longitudinally will be carried with the individual upon graduation and into the daily life that demands a functioning doctor. Evidence illustrates the trend that stress triggers autoimmune disease and mental health illness at alarming rates. Mentioned in the article are many of the top items on the Hans Selye stress scale that in any lay person the doctor would tell the patient that their health is at risk, yet that same doctor will overwork students and 'pimp' them into the late evening hours under the auspice of medical education! This behavior is an oxymoron of the profession of helping and bettering lives. In comparison, the nursing profession clearly labels this behavior where the profession is not supportive to students as "eating their young." Nursing students have papers to read in their professional practice class titled, "Why do nurses eat their young?"

My recommendation: The American Medical Association should develop guidelines for the behaviour of 'pimping' medical students. Often, the badgering of questions without a break may be considered by psychologists to be defined as abuse. Certainly there is room for emotional abuse to occur. My concern is that students that may have come from abusive childhood backgrounds or from childhood trauma will be more affected by this emotional bullying called "pimping." The connotation of the word pimp is negative and supports the negative behaviors evidenced in extreme pimping. I recommend we change the name from pimping to quizzing and that there be general guidelines developed and recommended by expert psychologists as to what level of questioning will not induce trauma nor trigger emotional stress. This may be one factor that could decrease the rates of depression in medical students.

Commenting on the stigma of depression in medical students and other health care providers: Health care professionals are trying to lift the stigma of depression in society but by not addressing the extreme stress levels in medical students and the devastating outcomes of this stress the health profession is failing to evaporate the stigma. For example, in British Columbia, Canada; to renew licensure as a nurse practitioner the NP has to click a button to state whether or not she has a mental health diagnosis or is taking medications for a mental health condition. It does not necessarily mean the NP cannot practice but it goes into a file with the regulatory body to keep that diagnosis in check in the event of a complaint against the practitioner.

We have developed so far in advancements in medicine but the medical profession remains in the 'dinosaur age' when it comes to addressing and treating mental health illness in medical students and doctors.

This article was an informative read. Thank-you.

I have been seeing more and more articles and blogs on the subject of depression and suicidality in the medical profession – and that’s comforting. In my own medical school (SGU), lunch-time talks and workshops on stress management and mindfulness/meditation classes are routinely offered to first and second year students. I don’t know how long that’s been going on, but it was nice to see during my first two years. Occasionally, our professors might mention the importance of self-care, good nutrition, managing the stress and weighty sense of responsibility that becoming a physician entails – but, it usually fell on the psychological services department to convey this message.

I recall an 'Office of Career Guidance' talk we had in first year, when the speaker referred to the Step 1 exam as “the most important exam of your life.” I often felt in medical school that one of the benefits of being an older student was having a little perspective when it came to statements like that. That day, I thought to myself (and with no small amount of irritation) “no, it’s not the most important exam of my life - my medical career, perhaps – but my life? Most certainly not.” I know for a fact, however, that more than a few of my classmates took the speaker’s words to heart in a less than healthy way and it showed in the comments and fear they expressed after the talk was over, and in the weeks and months that followed with the number of meals they skipped, hours of sleep they lost, smoking habit they picked up, and the energy drinks and coffees they consumed without restraint. If one’s entire sense of self-worth is wrapped up in a collection of grades and exams, how can depression NOT set in? Unfortunately, the stoic, ‘pressure-cooker’ mentality still reigns supreme among many of the medical school faculty and staff and if it were not for a few professors and the psychological services department I think there would be very little awareness or consideration of mental and emotional well-being. Just hoping that the next 10-20 years will see even greater change and improvement in addressing this issue...

This is a frustrating topic to discuss. Partly because it's a complicated problem and that means the solution isn't likely to be simple. It's also frustrating because it's not a new problem, we just seem to be talking about it more. I've commiserated a lot over the past 3 years with me fellow students about what we see as unnecessary stress in the process of becoming a physician. To an outside ear, it may sound like we are just blaming our problems on anyone up the hierarchical ladder, but in my experience, students do everything in their power to reduce stress and stay mentally healthy. As a result, it's the things outside of our control that we tend to complain about. And I feel like this makes having a discussion about how to fix the problem difficult as no one wants to sit down at the table and hear a list of things they are doing wrong. So the short answer is, I'm not sure, from a systematic viewpoint, what we can do to solve this problem. My current plan is to remain attentive to it as I move up the ladder and effect change on a local level.

Medicine is a high stress profession, and as such many of its members suffer from myriad of psychological problems, depression being one of such problems. Nearly 200 studies of 129, 000 medical students from 47 different countries found that 27% of these students suffered from depression, and about 11% of them considered suicide. That is a very unsurprising statistic to me as this profession is so highly competitive with minimal amount of support. The profession makes you so insulated and isolated that not even family members are able to understand the stress and hardships you go through. Then there is always that pressure to do better and be better than the rest of your colleagues. It is unsurprising that the relentless competition and insecurities about not being smart or prepared enough brings on the depression symptoms. I believe that we should be more understanding of what the others are going through, because we've probably gone through, and had the same thoughts ourselves.

While this is an eye opening article, it is, unfortunately, not particularly surprising. I have seen first hand how colleagues who are medical students, and even those who are residents or who have become attending physicians, have suffered in both mental as well as physical health due to the inherently stressful nature of this particular career path. A friend of mine who is an attending internal medicine physician back in Canada recently described his job as having "a chronic low grade stress". Part of the problem is, yes, the path to becoming a doctor is inherently difficult and requires a very large degree of determination and hard work, but the article also touched on widely accepted practices such as 'pimping'. Some of it is indeed for medical education purposes, and I would even further assert that some students who have large egos could benefit from this practice, but there certainly is a hierarchy that is reinforced time and time again. This, again, is something which friends of mine who are doctors have consistently attested to. I commend the authors of the study for bringing much needed attention to the issues of depression and suicide in our particular portion of the population (medical students, residents, etc.) and I like the fact that medical students from countries from around the world were sampled, so as to show that it is not simply a North American phenomenon.

This article does not shock me in the least bit. We have all heard the stories and read the articles about medical students being depresses, I just did not know the numbers were that high. I can see why students would be afraid of asking for help or seeing someone about their depression as this could blemish their medical career. The choice to pursue the medical field is one fraught with physical, emotional, mental, and financial hardships. All of these hardships add up to large amounts of stress that can eventually turn to depression and then lead to far worse things such as suicide. It is very challenging for a medical student to balance a normal daily life, as the article mentioned our choice of career often puts enormous strains on personal relationships and support systems. The countless number of sleepless nights and the endless hours of studying after finishing a shift can be enough to drive anyone insane, but medical students power through. Society reads these articles and judge, but one cannot truly understand what it is like to walk in our shoes. They can say that they understand why we are stressed or depressed but they really don't. In our quest to be the perfect doctor/student we consume extensive amounts of caffeine, skip meals, forgo the gym, lose sleep, and many other things to destroy our minds and bodies. So the question is not will depression set in, but when. The medical community as a whole needs to help fix this problem together, for how can we treat patients if we cannot even take care of ourselves. This article and many more like it are helping to bring to light the darkness that surrounds our profession.

There is no easy solution to medical student depression but I feel that this topic is just brushed off by many as part of the job. What struck me in this article is when they talked about fear of failure and if you are kicked out of your program you could be left with $250,000 in debt. In my opinion, medical schools should require students to talk to a counselor once every month/2 months especially as the workload and stress increases. Currently I have peers that have sought outside counseling assistance since my school does not have great assistance available. During this past year I, myself, have experienced high levels of stress and symptoms of depression. Medical educators tend to remind you that every student experiences stress instead of treating you as an individual. However I have found that dealing with my own stress allows me to better appreciate my own social support but it also allows me to better empathize with the patient.