The percentage of clinicians who meet criteria for depression appears to increase significantly during medical internship, according to a report posted online today that will appear in the June print issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Increased work hours, stressful life events, genetic predisposition and receiving a medical education in the United States are among the factors that appear to be associated with depressive symptoms among medical interns.
"Internship is known to be a time of high stress," the authors write as background information in the article. "New physicians are faced with long work hours, sleep deprivation, loss of autonomy and extreme emotional situations." Although some studies have assessed rates of depression among medical interns and found them higher than in the general population, few have explored the specific factors responsible.
Srijan Sen, M.D., Ph.D., of the University of Michigan, Ann Arbor, and colleagues studied 740 interns entering residency programs in 13 U.S. hospitals in 2007 or 2008. Participants completed a secure online survey to assess their symptoms of depression, along with personal and medical education factors and several psychological measures. After three, six, nine and 12 months, the interns completed follow-up surveys regarding depressive symptoms, internship variables (such as work hours and perceived medical errors) and other life stresses. A subgroup of 409 participants (63 percent) provided saliva samples for genetic analysis.
Average depression scores increased during internship; on a scale of zero to 27, where scores of 10 or greater indicate depression, the average score increased from 2.4 before internship to an average of 6.4 during internship. In addition, the proportion of participants who met criteria for depression increased from 3.9 percent before internship to an average of 25.7 percent during internship.
"A series of factors measured prior to internship (female sex, U.S. medical education, difficult early family environment, history of major depression, lower baseline depressive symptom score and higher neuroticism) and during internship (increased work hours, perceived medical errors and stressful life events) was associated with a greater increase in depressive symptoms during internship," the authors write.
"It is also interesting to note that a number of factors, such as medical specialty and age, were not associated with the development of depression," the authors write. "With effective interventions to help prevent the onset of depression now available, the predictive factors identified herein could allow at-risk interns to take steps before the onset of symptoms to lower their chances of developing depression."
- Srijan Sen; Henry R. Kranzler; John H. Krystal; Heather Speller; Grace Chan; Joel Gelernter; Constance Guille. A Prospective Cohort Study Investigating Factors Associated With Depression During Medical Internship. Arch Gen Psychiatry, 2010; 0 (2010): 2010. 41 [link]
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