Study finds one-third of medical residents screen positive for depression or its symptoms

Nearly one-third of medical residents screened positive for depression or depressive symptoms, according to a meta-analysis of more than 17,000 physicians in training.

Researchers conducted the systematic review and meta-analysis of 54 studies involving 17,560 physicians. Included studies had information on the prevalence of depression or depressive symptoms among resident physicians, were published between January 1963 and September 2015, and used a validated method to assess for depression or depressive symptoms. Three studies used clinical interviews, and 51 used self-report instruments. Results appeared in the Dec. 8 Journal of the American Medical Association.

The overall pooled prevalence of depression or depressive symptoms was 28.8% (4,969 of 17,560 individuals; 95% CI, 25.3% to 32.5%), with high between-study heterogeneity. Prevalence estimates ranged from 20.9% according to the 9-item Patient Health Questionnaire with a cutoff of 10 or more (741 of 3,577 individuals; 95% CI, 17.5% to 24.7%) to 43.2% for the 2-item PRIME-MD (1,349 of 2,891 individuals; 95% CI, 37.6% to 49.0%). The prevalence of depression increased each baseline survey year (slope=0.5% increase per calendar year, adjusted for assessment modality; 95% CI, 0.03% to 0.9%, P=0.04).

In a secondary analysis of 7 longitudinal studies, the median absolute increase in depressive symptoms with the onset of residency training was 15.8% (range, 0.3% to 26.3%; relative risk, 4.5). No statistically significant differences were observed between cross-sectional versus longitudinal studies, studies of only interns versus only upper-level residents, or studies of nonsurgical versus both nonsurgical and surgical residents.

“Because the development of depression has been linked to a higher risk of future depressive episodes and greater long-term morbidity, these findings may affect the long-term health of resident doctors. Depression among residents may also affect patients, given established associations between physician depression and lower-quality care,” the authors wrote.

An editorial noted that the prevalence of depression in residents is a marker for deeper and more profound problems. “The solutions to this endemic can be classified into 3 categories: provide more and better mental health care to depressed physicians and those in training, limit the trainees' exposure to the training environment and system that are thought to contribute at least in part to poorer mental health and wellness, and consider the possibility that the medical training system needs more fundamental change,” the editorial stated.