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Despite workplace improvements, US junior doctors have high depression risk

A 13-year effort to track the mental health of new doctors in their most stressful time of training shows that despite workplace improvements,  that first-year residents, or interns, still have a sizeable risk of developing depression. And many who do still don’t seek help.

The jump in depression scores over the course of the first post-medical school year has declined 25% from 2007 to 2019, according to the study of nearly 17,000 new doctors led by a team from the University of Michigan Medical School and published in the Annals of Internal Medicine.

To help understand potential drivers of the effect, the team explored individual and residency programme factors previously shown to be linked to depression among training doctors. The study suggests, but can’t prove, that reduced work hours, slightly increased sleep, more feedback from supervisors and increased use of mental health care contributed to the change in depressive symptoms over time.

Data from the participants showed significant changes in all of these measures.

The findings come from the Intern Health Study, which has used wearable activity trackers, mobile apps, surveys and genetic tests to study medical interns at hundreds of teaching hospitals.

In addition to tracking a group with a known high risk of depression, the study provides a way to study the effects of intense, prolonged stress more generally.

That’s why the results could have impact beyond medical training. Other stressful jobs and long-term stressful situations might also benefit from the increased attention to reducing depression-related stressors on which the graduate medical education community has focused in recent years.

“The Intern Health Study offers a unique dataset for us to study the trend of this population’s mental health over a long time span,” said Yu Fang, the study's first author and a researcher at the Michigan Neuroscience Institute. “The story we have learned from these data could help to make strategic plans in shaping a better medical internship experience in the future.”

Dr Srijan Sen, the leader of the Intern Health Study, added, “Given that depression rates are still very high, compared with the general population, we hope that the drivers of improvement over the past 13 years can help guide areas to focus on to catalyse even more improvement going forward.”

Sen is director of the U-M Frances and Kenneth Eisenberg and Family Depression Center, and a professor in MNI and the Department of Psychiatry at Michigan Medicine.

The reduction in the size of depression-score jump came despite the fact that interns in later years were more likely to have risk factors for depression, including a history of the condition.

The data show that interns’ work hours dropped by 11% over the 13-year period, sleep hours per day went up nearly 5%, and the percentage of residents with current depression who were getting professional help went from 14% to 38%.

Over the course of the 13 years studied, female interns experienced a more pronounced reduction in the magnitude of depression symptom increases across the intern year, and were much more likely to seek mental health care. The percentage of female interns also increased over the 13-year study period.

The same was true for interns in non-surgical fields compared with those pursuing training in surgery or another surgery-based specialty; the reduction in work hours was larger in non-surgical interns.

The study did not show any measurable difference between those whose intern year included the first months of the COVID-19 pandemic and those who trained before.

Other research from the Intern Health Study is looking at the impacts of the pandemic, including one already-published study about interns taking part in the study in China.

Study details
Trends in Depressive Symptoms and Associated Factors During Residency, 2007 to 2019

Yu Fang, Amy Bohnert, Karina Pereira-Lima, Jennifer Cleary, Elena Frank, Zhuo Zhao, Walter Dempsey, Srijan Sen.

Published in the Annals of Internal Medicine on 16 November 2021

Background
Efforts to address the high depression rates among training physicians have been implemented at various levels of the U.S. medical education system. The cumulative effect of these efforts is unknown.

Objective
To assess how the increase in depressive symptoms with residency has shifted over time and to identify parallel trends in factors that have previously been associated with resident physician depression.

Design
Repeated annual cohort study.

Setting
US healthcare organisations.

Participants
First-year resident physicians (interns) who started training between 2007 and 2019.

Measurements
Depressive symptoms (9-item Patient Health Questionnaire [PHQ-9]) assessed at baseline and quarterly throughout internship.

Results
Among 16 965 interns, baseline depressive symptoms increased from 2007 to 2019 (PHQ-9 score, 2.3 to 2.9; difference, 0.6 [95% CI, 0.3 to 0.8]). The prevalence of baseline predictors of greater increase in depressive symptoms with internship also increased across cohorts. Despite the higher prevalence of baseline risk factors, the average change in depressive symptoms with internship decreased 24.4% from 2007 to 2019 (change in PHQ-9 score, 4.1 to 3.0; difference, −1.0 [CI, −1.5 to −0.6]). This change across cohorts was greater among women (4.7 to 3.3; difference, −1.4 [CI, −1.9 to −0.9]) than men (3.5 to 2.9; difference, −0.6 [CI, −1.2 to −0.05]) and greater among nonsurgical interns (4.1 to 3.0; difference, −1.1 [CI, −1.6 to −0.6]) than surgical interns (4.0 to 3.2; difference, −0.8 [CI, −1.2 to −0.4]). In parallel to the decrease in depressive symptom change, there were increases in sleep hours, quality of faculty feedback, and use of mental health services and a decrease in work hours across cohorts. The decrease in work hours was greater for nonsurgical than surgical interns. Further, the increase in mental health treatment across cohorts was greater for women than men.

Limitation
Data are observational and subject to biases due to non-random sampling, missing data, and unmeasured confounders, limiting causal conclusions.

Conclusion
Although depression during physician training remains high, the average increase in depressive symptoms associated with internship decreased between 2007 and 2019.

 

Annals of Internal Medicine abstract – Trends in Depressive Symptoms and Associated Factors During Residency, 2007 to 2019 (Open access)

 

See more from MedicalBrief archives:

 

Forget 'resiliency training' for doctors – the entire system needs to change

 

GMC survey: COVID stress hammers Britain's trainee doctors

 

Solutions to physician burnout — US National Academy of Medicine report

 

Nationwide helpline for medical students

 

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