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

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Sen SrijanBackground
In our previous two Research Connections, we reviewed the first two parts in a research study examining the high rates of major depression and suicidal ideation (SI) in medical interns. In the first study, Dr. Srijan Sen determined just how high those rates were. In the second, we discovered that a decrease in hours did not, unfortunately, lessen the rates in depression and SI.

In this third and final study, Dr. Sen examined whether using web-based cognitive behavior therapy helped prevent depression and SI during the first year of internship.

The Study
A group of 199 interns from two hospitals were invited to participate in a randomized controlled trial (RCT) of free web-based cognitive behavior therapy (wCBT). The therapy included four 30-minute modules focused on the interplay between thoughts, emotions, and behavior in which the interns identified inaccurate and negative thoughts; restructured those cognitions; and learned about problem-solving skills.

In order to determine the effect of the web-based therapy, the wCBT group was compared with an attention control group (ACG) who, instead of the therapy, merely received information about mental health on a computer over four 30-minute sessions. Those participating in the therapy had the option of continuing on with it through their year of internship.

Results
88 percent of the interns invited to take part in the intervention completed at least one module of the wCBT. 51 percent went on to complete all four modules, and 82 percent completed at least one extra follow-up module during their internship year. This demonstrates the interns’ willingness to try mental health interventions when they are made available.

Interns in the wCBT group were 60 percent less likely to report suicidal ideation (SI) during their internship year than those in the attention control group (ACG; 12 percent vs. 21.2 percent), demonstrating the potential for internet interventions to prevent major depressive disorder (MDD) and SI during exposure to the high stress experience of medical internship.

Takeaway
Free web-based CBT before internship was helpful in reducing SI during the twelve months of medical training. If just four sessions of wCBT can have such an impact, imagine the possibilities for suicide prevention.

Publication from AFSP grant
Guille C, Zhao Z, Krystal J, Nichols B, Brady K, Sen S. Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2015.1880 Published online November 4, 2015.

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