Rashi Hiranandani is a medical student in the Class of 2019 at the University of Ottawa
Medical school is a stressful time in students’ lives. There are emotional, physical, and mental stressors; particular daunting is the stress of being in new clinical environments on a weekly or even daily basis and having patients’ lives in our hands. Medical students are sleep deprived and over-worked. We have the stress of not matching to the residency of our choice or even not matching to a residency program at all. Medical students also experience significant burnout and compassion fatigue, with burnout rates ranging from 27 to 75% . It thus comes as no surprise that medical students suffer from rates of mental illness higher than the general population. This is not ideal for the health of the medical students, nor is it optimal for the health of the patients they care for.
A 2016 systematic review published in JAMA reported that, on average, 27.2% of medical students deal with depression or depressive symptoms . Among students who suffer from depression, only 16% receive help . The population of medical students who suffer from depression is astonishingly high in comparison to about 10% of the general population, and it is concerning that medical students are not getting help when they need it. Furthermore, in a study comparing rates of depression between medical students and residents, it was found that medical students have higher rates of depression . The same study highlighted that female medical students are more depressed than their male counterparts, and that second-year medical students have the highest rates of depression in comparison to their peers . The study also showed that there were differences in depression rates based on ethnicity, with African-American medical students having the highest rates of depression .
It has been shown that there are several factors and personality traits that predispose medical students to depression. For example, medical students with poor sleep quality report higher depressive symptoms, and personality traits such as high neuroticism also predispose medical students to have higher rates of depression . A longitudinal study investigated traits that might be related to burnout in medical students training at a Swedish medical school . Students were assessed in their first and third years of medical school. The study revealed that students with depressive symptoms, impulsivity traits, and financial stress in their first year of medical school were more likely to experience burnout. Twenty-seven students in the study were identified to have a psychiatric diagnosis, yet only six were receiving psychiatric help .
In addition to depression, other mental health disorders are also prevalent in the medical student population. A study conducted in an Iranian medical school revealed that 4.5% of their medical students had bipolar disorder . This is much higher than the general Iranian population, where the rate of bipolar disorder is only 0.8%. Medical students also have high rates of substance use disorders. In a survey of 133 U.S. medical students, it was found that 44% had smoked cigarettes, 96% had consumed alcohol, 57% had used marijuana, 22% had used amphetamines, 20% had used cocaine, 17% had used benzodiazepines, 15% had used hallucinogens, and 40% had used opioids at some point in their lives . The study also found that use of illicit substances was highest in students with depressive symptoms. Another study surveyed fourth-year students at 13 U.S. medical schools and found that 87% of students consumed alcohol, 17.3% consumed marijuana, 9% consumed cigarettes, 0.9% consumed opioids, and 1.2% consumed amphetamines in a time frame of 30 days before the survey .
The combination of stress of medical school and the poor mental health of medical students discussed above also puts medical students at risk of suicide. The 2016 JAMA systematic review found that, on average, 11.2% of medical students experience suicidal ideation . It has also been shown that the suicide rates of male physicians are 40% higher than the general male population, and the suicide rates of female physicians 300% higher than the general female population . This is reflected in trainees as well, with female medical students being 3-4 times more likely to complete suicide as compared to females of their age in the general population .
Though the rates of mental illnesses and suicide are staggeringly high among medical students, they rarely receive care for their mental health. It has been reported that time constraints, stigma, and confidentiality issues were significant barriers to medical students receiving care for their physical and mental problems . In a study conducted in an Indian medical school, stigma, confidentiality issues, and lack of awareness of where to receive care were reported more often for care of mental health issues when compared to to physical issues . Australian medical students also identified stigma (including peer judgment and disclosure of information), time issues, and affordability as barriers to receiving mental health services .
Medical education is filled with highly stressful environments. The rate of mental illnesses in medical students is high. Despite this, students do not access appropriate resources and barriers related to this should be addressed. It has been shown that increasing familiarity with mental health makes prejudices against mental illness decrease; psychiatrists have less stigma towards mental illness compared to clinical medical students, and clinical medical students who have completed their psychiatry rotation have less stigma than preclinical medical students . In addition, to address issues related to time constraints, medical students should be given flex days so that they have time to attend their healthcare appointments.
Ultimately, it is clear that the culture and stigma related to mental health among medical students needs to change. The first step is to increase awareness of the predominance of mental illness among medical students and let those struggling know they are not alone.
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