Destigmatizing depression among medical (and graduate) trainees

The Clinical and Translational Science Network (CTSciNet) section of Science Careers has just published a superb article by Karyn Hede on the issues of depression precipitated during the rigors of medical education. Hede is a freelance writer in Chapel Hill and has contributed before to Science Careers, particularly with this article on the challenges of women MD-PhDs and another on why so many of us have crappy interpersonal and lab management skills.

The current article focuses primarily on the medical profession given its placement in the clinical/translational section but these issues are true for PhD trainees as well:

Depression among medical trainees is well-documented. A recent large-scale survey of medical students and residents at six major medical schools revealed that one in five have mild to severe depression, a rate 15% to 30% higher than the general public. One out of every 17 even said they had thought about suicide. The study, reported in the journal Academic Medicine in February, brought to the fore the problem of depression among students immersed in the rigors of medical training.

"Certainly, medical school, residency, Ph.D. training, all those kinds of advanced degrees are set up with a lot of expectations, and by and large the people that are doing them are driven," says Deborah Goebert, a psychiatrist at the University of Hawaii, Manoa, and lead investigator of the study. These stressors, along with lack of sleep, financial concerns, and family pressures, can push people into an episode of clinical depression, she says.

Michael Kerry O'Banion, director of the MD/PhD program at the University of Rochester points out the special issues of the trainee finishing their basic science years and going to the lab:

"As they are starting their graduate years, they see that they are no longer a part of the community of medical students who are continuing in their education," he says. "So after 4 years in the graduate program, you might be mired in figuring out your thesis work, but people who you became very close to in medical school are now graduating and departing. For some M.D.-Ph.D. students, there can be a significant loss of a support system that they may have developed."

I would argue a similar issue for PhD students in that one usually leaves a robust undergraduate environment with a huge, underappreciated support system and gets thrust into a program with maybe five to 15 students per year. The solitary nature of graduate training can certainly contribute to the feelings of isolation and questions of self-worth for those trainees already predisposed to depression.

Hede does a superb job in the remainder of the article discussing how to overcome the apprehension of seeking help and strategies for coping with and combatting minor depressive episodes. An interesting sidebar also discusses the specific features of depression in MD and PhD students that should be considered above and beyond typical depression warning symptoms amongst the general public:

Diagnosing depression among medical or doctoral students is often difficult because they "are all so tough and high-functioning," says Christine Moutier, a practicing psychiatrist and assistant dean for student affairs at the University of California, San Diego (UCSD), School of Medicine. "You can't use the usual standard of being disabled by symptoms. You have to use other measures such as how much distress there is, how much energy is this [depressed feeling] taking up, what's the severity of what they are dealing with internally, because usually it is hidden from their functional world."

Hede also talks about psychiatrist, Alice Flaherty, MD, PhD, whose own battles with major depressive illness and bipolar disorder were chronicled in her 2004 book, The Midnight Disease: The Drive to Write, Writer's Block, and the Creative Brain. A nice value-added feature of the article is that Dr Flaherty will be answering questions about depression throughout October on the CTSciNet discussion group, "Maintaining Your Mental Health."

This is an excellent article that raises awareness about a major, life-threatening illness that is underdiagnosed and undertreated in trainees in medicine and the biomedical research professions. Take a gander sometime over the weekend.