Tackling High Rates of Depression and Suicidal Ideation in Medical Interns: Part 1 of 3

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Sen SrijanBackground
Medical interns are known to have higher rates of major depression and suicidal ideation (SI) than the general population. To give you some idea, in the U.S. each year, male physicians die by suicide at a rate 1.41 times higher than male non-physicians; female physicians 2.27 times more often than female non-physicians. Combinations of high stress, lack of sleep, limited independence in decision-making, and exposure to emotional situations are thought to contribute.

To find out more, Dr. Srijan Sen conducted three separate studies. For the first study, he followed first-year medical interns over time to document any change in either depression or SI.

The Study
In 2008 and 2009, Dr. Sen invited almost 1,400 medical interns who were starting internships at 13 hospitals to participate in the study. Interns from all medical disciplines (e.g., internal medicine, surgery, pediatrics) were included. Of those, 740 of them agreed to participate. In order for Dr. Sen to conduct a genetic analysis of a serotonin gene that has been found to be related to depression — the 5-HTTLPR (rs 24431) — 409 of the interns provided saliva samples.

The interns completed the commonly used Patient Health Questionnaire (PHQ-9) to assess depression and SI during the two months before their internship. In addition, Dr. Sen included measures of neuroticism, resilience, perceived stress, social support, family functioning, cognitive styles, and demographic characteristics to see if these contributed to the outcomes.

The team assessed changes over time by having the interns complete the PHQ-9 and questions about perceived medical errors, hours of sleep, and stress at three, six, nine, and 12 months.

Results
Over the first three months, the rate of major depression in the interns increased from 3.9 percent to 27.1 percent…about nine times higher than before beginning their internships. The rate of SI increased an astounding 370 percent. These rates remained high at each assessment period, with 42 percent meeting the PHQ-9 criterion of major depressive disorder (MDD) at some time during their first year of internship. Higher depression was associated with more hours of work, more perceived medical errors, and increased stress.

Of significant interest, while the average depression score increased over time, the presence of the “s allele” in the 5-HTTLPR gene was associated with greater increase in depression scores on the PHQ-9. Thus, the serotonin gene did make a difference regarding the level of depression experienced.

Takeaway
During the physical and emotional stress of internship, medical interns often experience MDD and SI, and those experiencing these mental health conditions were likely to report medical errors.

COMING UP NEXT WEEK:
In the second of our three studies, we’ll find out if a reduction in work hours had any effect on the rates of depression and suicidal ideation. Stay tuned!

Publication from AFSP grant
Sen S, Kranzler HF, Krystal JH, Speller H, Chan G, Gelernter J, Guille D. (2010) A prospective cohort study investigating factors associated with depression during medical internship. Arch Gen Psychiatry 67(6), 557-565.

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