What depression, medical school and gender have in common?

Esther Serman

After years of studying hard, you finally are accepted into medical school. Nonetheless, what should be a dream, becomes a nightmare: stress, grades, competitive ambience and feeling that you’re not good enough makes you feel like medicine isn’t the right career for you. Then, you start to feel sad, your appetite changes, you have trouble sleeping and loss of energy. This is what depression looks like.

Depression is considered a public health problem and is expected to be the principal contributor to mental health disorders in 2030 [1], but an important situation that should be discussed is the level of depression in medical school.

According to a study published in the Journal of the American Medical Association, 27.2% of medical students from 43 countries had depression and 11.1% had suicidal ideation [2] and other studies in different countries showed that depression is increased in medical students. Furthermore, another research showed that 83% of medical students think that their studies are an important source of stress [3]. Emotional disorders compromise the academic performance and can be associated with alcohol and drugs abuse. For example, 30% of medical students in Europe are suffering from depression or anxiety [4]. This is a really worrying situation because these people will graduate and become doctors and those who need mental support are taking care of their patients’ lives and, sometimes, forget that they need help too.

And what makes this scenario worse? Besides all the stress, grades, and competitive ambience there are other situations that can worse:

· Exposure to death: medical students are constantly exposed to death but not much is talked about it, so many of them do not know how to deal with it.

· Student abuse: students can suffer from sexual harassment, verbal abuse and physical abuse from hospital staff, doctors, nurses etc.

And what about gender? In our society, women conquer important achievements like the right to vote and study, but they are still victims of a patriarchal society, accumulating professional activities, motherhood, home and social responsibilities which can relate to higher levels of depression in women medical students than men. According to a study in Brazil, women had a 1.83 times higher chance to have depression than men [5]. This is not only in medical school, but in the general population, female sex is a risk for depression [6].

It is important to talk about depression because it is still a taboo in the medical field. We need to be more open about it and stop the stigma of people seeking mental support. According to a 2018 Canadian Medical Association survey, female doctors in Canada have 31% higher odds of suicidal ideation than male doctors [7]. Also, some specialties such as general surgery and anesthetics have a greater risk of suicide than others.

And what should we do about it? To overcome the mental health stigma, we need to discuss more about mental health/depression within the medical community so people can know that they are not alone. It is also important to do further research to understand why this system makes people, especially women, more vulnerable to having depression. In terms of building mental resilience, we need to integrate more self-care daily activities, including: take time for ourselves, talking to friends and family and having a good sleep hygiene. Furthermore, society needs to put less emphasis on grades, and more on competency. This will overcome the competitive atmosphere within the medical field and encourage more doctors to work effectively with each other. Finally, we need to encourage each other to reach out and ask for help when we need it!

As the first step is telling someone…

References:

1. Global burden of disease: 2004 update. Geneva: World Health Organization; 2008. [accessed on August 23, 2021]. World Health Organization. Available from: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf

2. Rotenstein LS, Ramos MA, Torre M, et al. 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

3. Wilkes C, Lewis T, Brager N, Bulloch A, MacMaster F, Paget M, Holm J, Farrell SM, Ventriglio A. Wellbeing and mental health amongst medical students in Canada. Int Rev Psychiatry. 2019 Nov-Dec;31(7-8):584-587. doi: 10.1080/09540261.2019.1675927. Epub 2019 Oct 22. PMID: 31638441.

4. Haldorsen H, Bak NH, Dissing A, Petersson B. Stress and symptoms of depression among medical students at the University of Copenhagen. Scand J Public Health. 2014; 42(1):89-95

5. Paula, Juliane dos Anjos de, Borges, Ada Maria Farias Sousa, Bezerra, Louise Rayra Alves, Parente, Helena Vieira, Paula, Rafael César dos Anjos de, Wajnsztejn, Rubens, Carvalho, Alzira Alves de Siqueira, Valenti, Vitor Engrácia, & Abreu, Luiz Carlos de. (2014). Prevalence and factors associated with depression in medical students. Journal of Human Growth and Development, 24(3), 274-281.http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S0104-12822014000300006&lng=pt&tlng=en.

6. Albert P. R. (2015). Why is depression more prevalent in women?. Journal of psychiatry & neuroscience : JPN, 40(4), 219–221. https://doi.org/10.1503/jpn.150205

7. Renkas, Rebecca. “Female Doctors Are Good for Your Health, but They Experience a Gender Pay Gap, Discrimination, Burnout and Depression”. The Conversation http://theconversation.com/female-doctors-are-good-for-your-health-but-they-experience-a-gender-pay-gap-discrimination-burnout-and-depression-125485