Over one quarter of medical school students report symptoms of depression, and roughly one out of 10 experience suicidal thoughts, a new study says. The meta-analysis of almost 200 studies, involving 129,000 medical students in 47 countries, found that only around 16 percent of students who screened positive for depression sought treatment.

Previous studies have put forward that medical students undergo high rates of depression and suicidal ideation. But prevalence estimates vary across studies.

Dependable estimates for depression and suicidal ideation prevalence in medical training are important for efforts to prevent, treat, and identify causes of emotional distress among medical students, especially in light of recent work revealing a high prevalence of depression in resident physicians.

Risk Of Future Depression

The authors, a team of researchers from Harvard, Yale, Brigham and Women’s Hospital, the University of Michigan, Ann Arbor, and the University of South Carolina, wrote:

“These findings are concerning given that the development of depression and suicidality has been linked to an increased short-term risk of suicide as well as a higher long-term risk of future depressive episodes and morbidity. The present analysis builds on recent work demonstrating a high prevalence of depression among resident physicians, and the concordance between the summary prevalence estimates (27.2 percent in students vs. 28.8 percent in residents) suggests that depression is a problem affecting all levels of medical training.”

Co-principle author Dr. Srijan Sen, a professor of depression and neurosciences at the University of Michigan, told CNN:

“When I was a medical student, a couple of people just a little bit older than me really suffered with depression and had serious suicide attempts, and one of them completed suicide,” said Sen. It hit home to me and made me realize how big a problem this was and was part of the reason why I got involved in this research.”

Depression or depressive symptom prevalence data came from 167 cross-sectional studies and 16 longitudinal studies from 43 countries. The overall pooled crude prevalence of depression or depressive symptoms was 27 percent - 37,933 out of 122,356.

Summary prevalence estimates ranged across assessment methods from 9 percent to 56 percent.

Depressive symptom prevalence remained relatively constant over the period studied of 1982-2015. In the 9 longitudinal studies that assessed depressive symptoms before and during medical school, the median absolute increase in symptoms was 14 percent.

Prevalence estimates did not significantly differ between studies of only pre-clinical students and studies of only clinical students (23.7 percent vs 22.4 percent). The percentage of medical students screening positive for depression who sought psychiatric treatment was 16 percent - 110 out of 954 individuals.

As for the possible causes of depression and suicidal symptoms in medical students, the authors point to stress and anxiety stemming from the competitiveness of medical school.

“Restructuring medical school curricula and student evaluations might ameliorate these stresses. Future research should also determine how strongly depression in medical school predicts depression during residency and whether interventions that reduce depression in medical students carry over in their effectiveness when those students transition to residency. Furthermore, efforts are continually needed to reduce barriers to mental health services, including addressing the stigma of depression.

“Further research is needed to identify strategies for preventing and treating these disorders in this population,” the researchers conclude.

Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, Sen S, Mata DA Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis JAMA. 2016;316(21):2214-2236. doi:10.1001/jama.2016.17324

Image: Dr.Farouk/Flickr

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