Physical activity may play an important role in the management of mild-to-moderate mental health diseases, especially depression and anxiety. Although people with depression tend to be less physically active than non-depressed individuals, increased aerobic exercise or strength training has been shown to reduce depressive symptoms significantly. However, habitual physical activity has not been shown to prevent the onset of depression. Anxiety symptoms and panic disorder also improve with regular exercise, and beneficial effects appear to equal meditation or relaxation. In general, acute anxiety responds better to exercise than chronic anxiety. Studies of older adults and adolescents with depression or anxiety have been limited, but physical activity appears beneficial to these populations as well. Excessive physical activity may lead to overtraining and generate psychological symptoms that mimic depression. Several differing psychological and physiological mechanisms have been proposed to explain the effect of physical activity on mental health disorders. Well controlled studies are needed to clarify the mental health benefits of exercise among various populations and to address directly processes underlying the benefits of exercise on mental health.

EDICAL STUDENTS EXPERIence depression, burnout, and mental illness at a higher rate than the general population, with mental health deteriorating over the course of medical training. [1][2][3][4][5][6] Medical students have a higher risk of suicidal ideation 7 and suicide, 8 higher rates of burnout, 6,9 and a lower quality of life than age-matched populations. 5,10 Burnout and depressive symptoms have been associated with suicidal ideation. 4,6,9,10 Medical students are less likely than the general population to receive appropriate treatment despite seemingly better access to care. [11][12][13] Students may engage in potentially harmful methods of coping, such as excessive alcohol consumption, and, despite their training, may fail to recognize that depression is a significant illness that requires treatment. 11 Stigma associated with depression and the use of mental health care services may represent a barrier to seeking treatment. 2,[12][13][14] One study identified stigma as an explicit barrier to the use of mental health services by 30% of first-and second-year medical students experiencing depression. In addition, 37% identified lack of confidentiality and 24% cited fear of documentation in their academic record as barriers to treatment. 2 Students may worry that revealing their depression will make them less competitive for residency training positions or compromise their education, 2,12,13 and physicians may be reluctant to disclose their diagnosis on licensure and medical staff applications. 15,16 The fear of professional sanctions may lead to inappropriate and possibly dangerous approaches to seeking care such as selfprescription of antidepressants. 17 No studies to our knowledge have addressed in more specific detail the perceptions of stigma by depressed medical students that may serve as barriers to receiving appropriate mental health care.We conducted a study of medical students at the University of Michigan Medical School to assess the prevalence of self-reported depression and suicidal ideation and to assess the per-See also pp 1173 and 1231.

Despite the availability of safe and efficacious treatments, mood disorders remain a significant health care issue for the elderly and are associated with disability, functional decline, diminished quality of life, mortality from comorbid medical conditions or suicide, demands on caregivers, and increased service utilization. Discriminatory coverage and reimbursement policies for mental health care are a challenge for the elderly, especially those with modest incomes, and for clinicians. Minorities are particularly underserved. Access to mental health care services for most elderly individuals is inadequate, and coordination of services is lacking. There is an immediate need for collaboration among patients, families, researchers, clinicians, governmental agencies, and third-party payers to improve diagnosis, treatment, and delivery of services for elderly persons with mood disorders.

Objective Physician suicide is an important public health problem as the rate of suicide is higher among physicians than the general population. Unfortunately, few studies have evaluated information about mental health comorbidities and psychosocial stressors which may contribute to physician suicide. We sought to evaluate these factors among physicians versus non-physician suicide victims. Methods We used data from the United States National Violent Death Reporting System to evaluate demographics, mental health variables, recent stressors, and suicide methods among physician versus non-physician suicide victims in 17 states. Results The dataset included 31,636 suicide victims of whom 203 were identified as physicians. Multivariable logistic regression found that having a known mental health disorder or a job problem which contributed to the suicide significantly predicted being a physician. Physicians were significantly more likely than non-physicians to have antipsychotics, benzodiazepines, and barbiturates present on toxicology testing but not antidepressants or antipsychotics. Conclusions Mental illness is an important comorbidity for physicians who complete a suicide but postmortem toxicology data shows low rates of medication treatment. Inadequate treatment and increased problems related to job stress may be potentially-modifiable risk factors to reduce suicidal death among physicians.