Year after year we read of young lives of budding physicians being taken intentionally in suicide attempts. This subgroup of medical students represent a bright and promising population who may simply lack the self awareness and societal support to overcome stressors which by default come along with the pursuit of a medical degree.

According to the American Foundation for Suicide Prevention, the depression rate in medical students is 15% to 30% greater than the general population. In Malaysia, this condition has been highlighted in several research papers showcasing the higher rates of both depression and anxiety among medical students.

A study in 2014 conducted in the International Medical University in Malaysia found that in the 358 students enrolled, 44% were anxious while 35% were depressed. A similar scenario is represented in Singapore whereby seven out of every ten medical students complained of academic related stressors.

More worryingly, research has found that students may arrive at medical school feeling less burnout and depression than other people of their age. Yet once in medical school, they go on to have greater risk of mental-health problems and suicidal thoughts.

The question of motive demands careful attention

An overly-competitive environment could have a detrimental effect on students’ health as Matthew Billingley, editor of Student BMJ, said that medicine had a reputation as one of the most intensive degrees.

“Only six in ten applicants manage to get a place at medical school, and students often have a relentless timetable of exams as well as having to balance the emotional strain of seeing sick patients and uphold high professional standards,” he writes.

JC, a final year Malaysian medical student aspiring to specialise in psychiatry spoke on the condition of anonymity about how the grueling environment of medical school feels. “I do not know whether we as medical students have a right to feel crazy, but yes I do question my existence a lot and while blaming it on the field of medicine may not paint a full picture, it does make me more afraid to reach out for help,” he said.

“Furthermore I have worked hard all my life to get into medical school, it just seems wrong to even conceive that this is not what makes me happy after all.”

Many factors lead to buildup of poor mental health among medical students

Many may attribute the life-and-death decisions, dealing with morbidity and mortality every day, and the anxiety inherent in having to learn a startling amount of information each day as mitigating causes of such sentiments in medical students. Yet, the fact remains that the stress starts in medical school, where students face pressure to master an overwhelming amount of material and competition with peers can be brutal.

Sleep deprivation is also not uncommon and students can face withering criticism from faculty who have little tolerance for ignorance, signs of weakness, or emotional displays.

These motives could all be accurate, or not at all, but the undeniable fact remains in that according to a study conducted in six medical schools, nearly one in four students reported clinically significant symptoms of depression. Almost 7% said they had thought of ending their lives in the last two weeks.

Rather than receiving support in these situations, these students often suffer humiliation from senior clinicians. Doctors work in a hierarchy, with attending physicians above residents, who are above interns. This tends to result in medical students being relegated to the bottom of the totem pole.

An unacknowledged problem for years, obscured by secrecy

A third year medical student from University Malaya who wishes to be identified only as AM shared: “The stigma associated with mental health issues especially when it boils down to us medical students can only be referred to as a weakness.”

The issues of suicide, death, and personal vulnerability ideally should not be delegated solely to departments of psychiatry, but dealt with by physician role models at all levels of the medical school hierarchy on a day to day basis.

Taking certain steps to encourage these students to ensure they have a more well-balanced life between work and school is crucial to prevent their stress levels from skyrocketing as they graduate. Reducing competition in the classroom may help. In the US, the majority of medical schools have embraced pass-fail grading systems for the first one to two years when students take classes, reforms shown to enhance well-being among students without affecting academic outcomes.

Team-based learning is another emerging trend in medical education. By encouraging collaboration, educators hope to increase cohesiveness among classmates and decrease social isolation while better preparing future doctors for team-based patient care. MIMS

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Doctors and Medical Students More Prone to Depression, Suicide