Medical Student Mental Health

Abstract

Concerns about the mental health of future physicians have existed for decades. For example, in 1936, Strecker et al 1 described 4 levels of impairment of psychologic functioning of medical students. In this issue of JAMA, 80 years later, the studies by Rotenstein and colleagues 2 and by Wasson and colleagues 3 shed new light on the issue of poor mental health of medical students by examining 2 different aspects of the problem.The meta-analysis by Rotenstein et al 2 of 195 studies of medical student depression and suicidality highlights that the mental health of medical students is a global problem of significant proportion. Based on data from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries, the estimated overall pooled prevalence of depression or depressive symptoms was 27.2% and ranged from 9.3% to 55.9% across assessment modes. Based on prevalence data from 24 cross-sectional studies (n = 21 002) from 15 countries, the authors also found that the estimated overall pooled prevalence of suicidal ideation was 11.1% and ranged from 7.4% to 24.2% depending on assessment modes.Wasson and colleagues 3 focused on solutions to the problem in their systematic review of 28 interventions designed to promote medical student well-being. The authors found that limited evidence suggests that some specific learning environment interventions (such as a pass/fail grading system, mental health programs, mind-body skills programs, curriculum structure, multicomponent program reform, wellness programs, and advising/mentoring programs) were associated with improved emotional well-being among medical students. However, the authors acknowledge that the overall quality of the evidence was low and suggest that high-quality medical education research addressing student well-being is needed.When viewed together and within the context of 8 decades of study and awareness of the problem, the reports by Rotenstein et al and Wasson et al lead to an important question: What is it about the culture of medicine and of medical education that has allowed this problem to remain so long unaddressed and for studies of interventions to lag so far behind the number of studies of the nature of the problem? If the training of future physicians is to improve, it is important to understand the culture, know its history and its legacy, and then consider how to address the factors that may still remain as barriers to change.Several aspects of the culture of medicine and medical education have likely contributed to the delayed and until re- Related articles pages 2214 and 2237Opinion EDITORIAL

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“…Could such separation and learning space silos contribute towards the influence of the hidden curriculum? We are also concerned about whether students are subject to unnecessary mental health stressors that relate to their management of the liminal identity linked to this enforced separation. Medical students experience higher rates of depression than the general population . Might this be related to the very location of medical learning spaces?…”

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“…This approach can be a more effective strategy than limiting the scope to interventions at the individual level that tend to foster the augmentation of the individual resilience, but, in many cases, ignore some of the causes. 7,8,28 It is well established that the work environment plays an important role in subjects' well-being and/or distress. However, the aspects of the institutional All rights reserved.…”

“…Several authors have emphasized that changing the culture within institutions may be the most efficient way to stem the rising rates of emotional distress among health professionals. 7 In the case of health professionals, a recent paper All rights reserved. No reuse allowed without permission.…”

“…Several authors have observed that health professionals as a group have been intensely affected by changes in the administrative structure of hospitals and the decline of physician autonomy in the current culture of health institutions. [5][6][7] In fact, a recent meta-analysis revealed a significantly smaller effect of interventions aimed at the individual level compared to those geared to the institutional level. 8,9 Rates of exhaustion and mental health concerns are currently affecting 30-60% of all doctors and physicians in training in North America.…”

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“…This study focuses on medical students, who experience a stressful environment characterized by an increasing study load due to the demanding medical curriculum [18]. In Japan, increasing numbers of students are dropping out of medical school, which is an important issue [19].…”