Over a quarter of physicians in training (28.8%) meet criteria for depression or suffer from depressive symptoms and prevalence is increasing, according to a meta-analysis published in the December 8, 2015 issue of the Journal of the American Medical Association. (JAMA).1
Douglas Mata, MD, MPH of Harvard University and colleagues extracted data from 31 cross-sectional studies (n= 9,447 subjects) and 23 longitudinal studies (n=8,113 subjects) conducted in North and South America, Europe, Asia, and Africa over a 50-year period.
Three studies used clinical interviews, while 51 used self-report instruments, including the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression Scale (CES-D), the 2-item Primary Care Evaluation of Mental Disorders questionnaire (PRIME-MD), the 9-item Patient Health Questionnaire (PHQ-9), the Zung Self-rating Depression Scale (SDS), and the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS).
The pooled prevalence of depression or depressive symptoms was 28.8%, with high between-study heterogeneity. Summary prevalence estimates ranged from 20.9% for the PHQ-9 to 43.2% for the 2-item PRIME-MD. There were no statistically significant differences between estimates made using the CES-D, PHQ-9, HANDS, BDI, or Zung SDS and no significant prevalence estimates between cross-sectional versus longitudinal studies.
Across all studies, the prevalence of depression or depressive symptoms significantly increased (slope = 0.5% per calendar-year increase) over the study period. The association persisted even when studies using the 2-item PRIME-MD were excluded.
The implications of these findings are far-reaching, since depression and depressive symptoms have been linked to long-term depressive morbidity. Repercussions of depression in residency go beyond the residents’ mental health and can also impact the wellbeing of patients, since physician depression contributes to lower-quality medical care and increased medical errors, the authors noted.
In an accompanying editorial,2 Thomas L Schwenk, MD, of the University of Nevada School of Medicine, recommends providing more and improved mental healthcare to depressed physicians and those in training, limiting residents’ exposure to the training environment, and considering more fundamental changes in the medical training system.
- Mata DA, Ramos MA, Bansal N, et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians. JAMA. 2015; 314(22):2373-2383.
- Schwenk TL. Resident depression: the tip of a graduate medical education iceberg. JAMA. 2015; 314(22):2357-2358.