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A Medical Student’s Depression Could Lead to a Medical Professional’s Suicide

November 1, 2010
Psychiatry, Medical Student, Medical School, Resident

Earlier this year one study estimated that ~400 physicians commit suicide annually, equivalent to an entire medical school class.(1). Overall, suicide rates in physicians are much higher than in the general population (40% higher in male doctors and a 130% higher in female doctors).(2) Because suicide can result from either untreated depression or inadequately treated depression, research has focused on depression prevalence rates for medical professionals as well as medical students.

The prevalence of depression among physicians is equal to that of the general population, with 12% of male physicians and 18% of female physicians suffering from depression.(1) Prevalence estimates of depression in medical students and residents range from 10% to 30% regardless of gender. Schwenk and colleagues recently conducted a survey of medical students at the University of Michigan Medical School and found that moderate to severe depression was prevalent in 18% of females and 9% of males.(3)

Chen and colleagues believe that a physician’s depression first manifests during medical school.(2) Overall, 25% of students suffer from depression, >50% suffer from professional distress (ie, burnout), and slightly >10% have suicidal ideation.(2) Suicide ideation rates increase as medical students enter their third and fourth years.(3) Alarmingly, suicide is the highest cause of death of medical students. By the time they become medical professionals, the suicide completion rates are 1.4–2.3 times higher than the rate of the general population.(1)

Most medical students do not disclose their depressive symptoms due to fear that other students would respect their opinion less or that the faculty would view them as unable to handle their work responsibilities. They also report that seeking treatment for depression would make them feel less intelligent than their peers.(3) This stigma can persist through medical school and affect a physician throughout their career.

When these medical students become medical professionals, their depression does not disappear. In some cases, it worsens, and the presence of other psychiatric disorders, such as bipolar disorder, anxiety disorders, substance abuse, etc., can also be present. These coexisting psychiatric disorders certainly do not help the physician’s depression or his/her ability to work effectively with other physicians or with their patients.

Physician suicide is not always related to mental illness. Some cases of physician suicide were linked to malpractice suits, employment discrimination after losing a malpractice case, or after performing expert testimony at a trial.(1)

Physicians most at risk for suicide are: >45 years of age for female physicians and >50 years of age for male physicians; white race; divorced, separated, or single; alcohol and/or drug abuse; workaholic tendencies; gambling problems, symptoms of depression and anxiety; symptoms of chronic pain or chronic debilitating illness; change in (or threat to) professional status; access to lethal medications; and access to firearms.(4) In fact, access to lethal medication overdoses and firearms are the two most common forms of suicide by physicians.(2)

There are a variety of resources you can contact if you think one of your classmates or your colleagues is in trouble and in need of assistance. Medical students should look into the types of programs their schools offer that recognize and treat depression, and other medical illnesses, in students. Physicians should realize that their depression is not untreatable and they should feel free to speak with colleagues, their partners, family members, clergyman, anyone they think will be able to make a difference.

Moving toward prevention is the way to go, however, until the stigma of depression in physicians is lifted, the road to prevention will be a long and arduous one. —Christopher Naccari

References

1. Physician suicide. Available at: http://emedicine.medscape.com/article/806779-overview. Accessed October 29, 2010.

2. Chen PW. Medical student distress and the risk of doctor suicide. The New York Times. October 7, 2010.

3. Schwenk TL, David L, Winsatt LA. Depression, Stigma, and Suicidal Ideation in Medical Students. JAMA. 2010;304(11):1181-1190.

4. Silverman MM. Physician suicide. In: Goldman LS, Myers MF, Dickstein LJ, eds. The Handbook of Physician Health. Chicago, Ill: American Medical Association; 2000.

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