It is a well-known and yet rarely discussed occurrence among the global medical community, in large part due to the continuing stigma held by various cultures against frank conversations surrounding mental health in general, and suicide in particular. Yet the ever increasing rates of depression, anxiety and suicide among healthcare professionals and medical students demand immediate attention because it affects entire communities in devastating and lasting ways. 

Recently, there was renewed debate on this highly emotive topic in the U.S. following yet another tragic suicide of a bright medical student. Some senior doctors took the opportunity to courageously open up about their own struggles with depression, many of whom had battled mental health issues for decades in silence, for fear of being seen as less capable by their peers and patients. 

Mental health woes in Malaysian local universities

In Malaysia, public awareness and acceptance of mental health issues as legitimate and important topics is still lacking, despite several research papers that show higher rates of both depression and anxiety among public and private university medical students. In 2014, a student shared this stark anecdote on a portal for medical students: “The signs of depressions are getting more obvious each day but I would always try to deny. I am a medical student, I could not possibly have depression! If I am perceived as weak, how will my future patients trust me?

The anonymous student went on to describe how these feelings escalated into frequent thoughts of committing suicide, but luckily help was obtained in time - in this instance. 

A study in 2014 found that out of 358 students at International Medical University in Malaysia, 44% were anxious while 35% were depressed. Furthermore, female students were found to be more impacted by depression and anxiety than male students. 

While stress is a known predictor for depression and anxiety,a significant difference was found between depressed and non-depressed students' experience of stressors due to frustration, change, and their reaction to stressors. In essence, depressed and anxious students were found to experience more stress and react differently to stressors compared to non-depressed and non-anxious students.

The prevalence of depression among the local sample of students in the study was higher than those of medical students attending an American private university (19%) but lower than those of medical students attending private universities in India (49.1%) and Pakistan (60%). 

When compared tothose attending public universities, the prevalence of depression among private university students was still found to be higher than among thosein public universities in Greece (10.4%), the U.S. (15.2%), Malaysia (21.7%), UK (24%), India (29.1%) and Pakistan (43.8%). The researchers hypothesised that additional pressures may be placed on private university students due to high expectations from parents who have made a substantial financial investment in their child's private medical education. Moreover, expectations from faculty in private medical schools may be greater than expectations in public schools. 

However, public medical university students are often suffering, too. A 2003 study on Universiti Putra Malaysia medical students found that the prevalence of depression was significantly higher among with female students (41.4%) compared to males (27.0%), Malays (42.9%) compared to other races (26.5%) and in students who complained of pressure due to exams (42.7%) compared to those who did not complain of any pressure due to exams (27.9%).

Helping young doctors to stay strong

A study on medical students in Singapore also showed that medical students reported a higher level of stress and emotional disorders compared to students from other faculties. At least seven out of every ten medical students complained of stress related to academic pursuits, such as difficulty in keeping up with reading materials and increased academic workload. Issues related to academic stress were ranked in the top eight among the ten most common stressors for all students. 

While the medical and healthcare professions are indeed known as some of the most important and intense fields of work, the issue of how to combat the inevitable stress must be addressed not just at the scholarly level but also upon entering into the healthcare industry later on. 

Early detection of mental health concerns is crucial to prevent the build-up of long-term psychological morbidity and its unwanted effects in medical students and young doctors. However, until the stigmatisation of mental illness in general and depression in particular is reduced, professionals and students alike would not feel secure enough to seek the help that they need. 

Thus, the creation of more ‘safe spaces’ such as community portals and support groups could help to counter the isolation that often occurs with the typically long work and study hours of doctors and nurses. There is also a need for more counselling facilities in which both empathy and discretion are guaranteed. 

Whilst no easy solutions abound for what is undoubtedly a complex and murky matter, it is imperative that some urgent steps need to be taken to ensure that the healthcare profession is able to flourish and serve its community better in years to come.