Prevalence of Depression and Depressive Symptoms Among Resident Physicians

Abstract

IMPORTANCE Physicians in training are at high risk for depression. However, the estimated prevalence of this disorder varies substantially between studies. OBJECTIVE To provide a summary estimate of depression or depressive symptom prevalence among resident physicians. DATA SOURCES AND STUDY SELECTION Systematic search of EMBASE, ERIC, MEDLINE, and PsycINFO for studies with information on the prevalence of depression or depressive symptoms among resident physicians published between January 1963 and September 2015. Studies were eligible for inclusion if they were published in the peer-reviewed literature and used a validated method to assess for depression or depressive symptoms. DATA EXTRACTION AND SYNTHESIS Information on study characteristics and depression or depressive symptom prevalence was extracted independently by 2 trained investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression. MAIN OUTCOMES AND MEASURES Point or period prevalence of depression or depressive symptoms as assessed by structured interview or validated questionnaire. RESULTS Data were extracted from 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals). Three studies used clinical interviews and 51 used self-report instruments. The overall pooled prevalence of depression or depressive symptoms was 28.8% (4969/17 560 individuals, 95% CI, 25.3%-32.5%), with high between-study heterogeneity (Q = 1247, τ2 = 0.39, I2 = 95.8%, P < .001). Prevalence estimates ranged from 20.9% for the 9-item Patient Health Questionnaire with a cutoff of 10 or more (741/3577 individuals, 95% CI, 17.5%-24.7%, Q = 14.4, τ2 = 0.04, I2 = 79.2%) to 43.2% for the 2-item PRIME-MD (1349/2891 individuals, 95% CI, 37.6%-49.0%, Q = 45.6, τ2 = 0.09, I2 = 84.6%). There was an increased prevalence with increasing calendar year (slope = 0.5% increase per year, adjusted for assessment modality; 95% CI, 0.03%-0.9%, P = .04). In a secondary analysis of 7 longitudinal studies, the median absolute increase in depressive symptoms with the onset of residency training was 15.8% (range, 0.3%-26.3%; relative risk, 4.5). No statistically significant differences were observed between cross-sectional vs longitudinal studies, studies of only interns vs only upper-level residents, or studies of nonsurgical vs both nonsurgical and surgical residents. CONCLUSIONS AND RELEVANCE In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8%, ranging from 20.9% to 43.2% depending on the instrument used, and increased with calendar year. Further research is needed to identify effective strategies for preventing and treating depression among physicians in training.

Mental health in medical residents: relationship with personal, work-related, and sociodemographic variables

“…1,2 A series of studies has shown high prevalence of mental health problems in medical residents in different cultural contexts, including Latin America, [3][4][5][6] as well as an increased incidence of these problems throughout the residency years. 2,7 Anxiety, depression, and problematic alcohol use are among the mental health issues experienced by medical residents.…”

“…2,7 Anxiety, depression, and problematic alcohol use are among the mental health issues experienced by medical residents. A recent systematic review and meta-analysis 6 including 54 studies from five continents identified an overall pooled prevalence of depression or depressive symptoms of 28.8% among medical residents, ranging from 20.9 to 43.2%, depending on the instrument used. Such rates are much higher than the prevalence of lifetime depression in the general population verified by a study evaluating more than 37,000 participants from 10 countries -showing prevalence rates ranging from 3 to 16.9%, or from 8 to 12% in most countries.…”

Enhancing Resident Well-being: Illuminating the Path Forward

“…Numerous studies have documented a high prevalence of burnout and symptoms of depression among residents. 1,2 Despite starting medical school with mental health profiles better than similarly aged college graduates who pursued other careers, residents are more likely to have burnout and depression symptoms than age-similar peers. 1,2 A 2012 national study of 1701 residents found 50% had burnout symptoms in comparison to 31% among age-matched college graduates not studying medicine.…”

“…3 Although less common than burnout symptoms, nearly a third (28.8%) of residents have substantial symptoms of depression, and the prevalence of depression increases during training. 1 The prevalence of burnout and depression among residents is alarming as the potential personal and professional consequences can be profound. Residents with burnout are more likely to report difficulty concentrating at work, 2 and differences in in-training examination scores across levels of emotional exhaustion (a domain of burnout) are as large as differences across years of training for internal medicine residents.…”

Deciding to Refer Residents for Psychiatric Evaluation

“…1 The exact prevalence of mental illness among physicians is unknown, but the existing, limited studies indicate that rates of depression are higher among medical students and residents than the general population. [2][3][4] Suicide rates among practicing physicians are significantly higher than the general population, especially for female physicians. 5 A recent study found that the factors contributing to suicidal ideation may differ between residents and physicians in academic practice, 6 but that all physicians are less likely to seek help.…”