Researchers analysing some 200 studies from 47 countries found a significant 27% of medical students either had depression or symptoms of it. The study, published in the Journal of the American Medical Association, reported that 11% of students had suicidal thoughts during medical school.

An earlier study among Malaysian medical students had also found an alarming 56% students were stressed. Although other studies have reported similar findings in the past, this study highlights the global nature of stress and depression among medical students.

The study also noted that medical students were just as depressed whether they were in their beginning years or their later years, when they practice in the hospital.

Study author Dr Douglas Mata emphasises the significance of this finding, especially when linked to a previous study he conducted that found high rates of depression among residents.

"Taken together, these two papers paint a full picture of the life cycle of mood disorder and wellness from the beginning of medical school to the end of residency. The two studies in combination serve as an impetus for educators and policy-makers to take this problem seriously," Mata said.

"What is it about the medical school environment that is leading to these adverse outcomes?"

So, what is it about the medical school environment?

Demanding entry requirements into medical school are there for a reason. Training impounds students’ personal lives, free time, and their physical and mental health.

“Once you’re there, the workload is so high it’s like drinking from a fire hose. Many people can’t adapt to that.’’ Mata said.

Students struggle to find time for socialising with friends and family, losing an important form of support. Furthermore, students often work with chronic sleep deprivation, in addition to having frequent depressing encounters with sick and dying patients.

Dr. Frances Southwick mentions hierarchy in the clinical environment as a source of stress. “Training to become a doctor requires a skill set that goes far beyond book smarts: You need to learn about hierarchy and psychology.”

The paradox of seeking help

Among students who were depressed in the study, “Only 16% actually saw someone,” said Mata, “It’s kind of paradoxical, given that they should recognise the signs better than anyone.”

“You would think someone so knowledgeable about mental health conditions, someone that convinces patients and their families that depression is not the patient’s fault, would recognise the condition in themselves and quickly seek help for it,” said local doctor Y, who wishes to remain anonymous.

“In reality, it is almost a taboo to own up to depression because of the sturdy, resilient front doctors must put up.”

Apart from the unwanted stigma from seeking mental health care, time constraints may also prevent students from seeking help.

Re-examining medical training

Mata notes that the focus is placed on individual students or residents when systemic issues are the root cause of depression among these groups.

As a method to improve students’ access to mental health services, it can be adopted onto medical school campuses, preferably with open-door policies and free of charge.

Also, a pass-fail system, abolishing letter grades, could make students less competitive and more collaborative. MIMS

Read also:
Most doctors with mental health issues do not seek treatment
Rising suicide rates among medical students rings alarm bells for profession
Doctors and Medical Students More Prone to Depression, Suicide
Should doctors be more transparent about their own mental illnesses?

Salam, Abdus et al. "Stress Among Medical Students In Malaysia: A Systematic Review Of Literatures". International Medical Journal, vol 20, no. 6, 2013.