Depression, Stigma, and Suicidal Ideation in Medical Students

Abstract

EDICAL STUDENTS EXPERIence depression, burnout, and mental illness at a higher rate than the general population, with mental health deteriorating over the course of medical training. [1][2][3][4][5][6] Medical students have a higher risk of suicidal ideation 7 and suicide, 8 higher rates of burnout, 6,9 and a lower quality of life than age-matched populations. 5,10 Burnout and depressive symptoms have been associated with suicidal ideation. 4,6,9,10 Medical students are less likely than the general population to receive appropriate treatment despite seemingly better access to care. [11][12][13] Students may engage in potentially harmful methods of coping, such as excessive alcohol consumption, and, despite their training, may fail to recognize that depression is a significant illness that requires treatment. 11 Stigma associated with depression and the use of mental health care services may represent a barrier to seeking treatment. 2,[12][13][14] One study identified stigma as an explicit barrier to the use of mental health services by 30% of first-and second-year medical students experiencing depression. In addition, 37% identified lack of confidentiality and 24% cited fear of documentation in their academic record as barriers to treatment. 2 Students may worry that revealing their depression will make them less competitive for residency training positions or compromise their education, 2,12,13 and physicians may be reluctant to disclose their diagnosis on licensure and medical staff applications. 15,16 The fear of professional sanctions may lead to inappropriate and possibly dangerous approaches to seeking care such as selfprescription of antidepressants. 17 No studies to our knowledge have addressed in more specific detail the perceptions of stigma by depressed medical students that may serve as barriers to receiving appropriate mental health care.We conducted a study of medical students at the University of Michigan Medical School to assess the prevalence of self-reported depression and suicidal ideation and to assess the per-See also pp 1173 and 1231.

Assessment of Mental Health among Iranian Medical Students : A Cross-Sectional Study

“…(17) Previous studies have assessed the reliability and validity of Persian form of the GHQ-28 and were of acceptable ranges from 0.73 to 0.89. (18)(19)(20) Through factor analysis, the GHQ-28 has been divided into four subscales, which are somatic symptoms (items 1-7); anxiety/insomnia (items [8][9][10][11][12][13][14]; social dysfunction (items [15][16][17][18][19][20][21], and depression (items 22-28).…”

“…(1,9,10) Mental problems in medical students are usually under diagnosed because of their concern for stigma and its unintended influence on their academic and career evaluation and reduction in hospital benefits. (11,12 ) So, medical student as future health care providers need special supports for improvement and protection of their mental health status.…”

Mistreatment in an academic setting and medical students' perceptions about their course in São Paulo, Brazil: a cross-sectional study

“…Overwhelming activities, along with contact with disease and death early in life, are among the factors that explain the high prevalence of depression and burn-out and the perception of poor quality of life that are commonly reported in medical student surveys. [28][29][30][31][32][33][34] According to Dyrbey et al, 35 unprofessional conduct and less altruistic professional values are more common among students with burn-out, thus suggesting that distress during medical education may compromise quality of care. Similar results were found in a study involving 1098 medical students in the United States, 36 in which distress and lack of wellbeing were shown to present connections with lack of empathy among medical students.…”

Stigma and Mental Health Challenges in Medical Students

“…Students with high scores would also be less likely to seek treatment if depressed than would students with low scores. 18 These findings may reflect a medical school environment in which depressed students are stigmatised because of their disease rather than on the basis of performance. 18 Mental illness in doctors and 'self-stigmatisation' Self-stigma describes the phenomenon whereby people adopt and internalise external social stigma and experience loss of selfesteem and self-efficacy.…”