Students with moderate-to-severe depression were more likely than those without depression or with minimal symptoms to believe that telling a counselor would be risky (53.3% versus 16.7%, 95% CI for difference 23.2 to 50.1, P<0.001), according to Thomas L. Schwenk, MD, and colleagues from the University of Michigan in Ann Arbor.
In addition, significantly more depressed students believed that other students and faculty would view them as unable to handle the responsibilities of medical school (83.1% versus 55.1%, 95% CI for difference 16.1 to 39.8, P<0.001), the researchers reported in the Sept. 15 Journal of the American Medical Association.
Medical students experience depression at a higher rate than the general population, and the stigma associated with the use of mental health services may be a barrier to their seeking appropriate treatment.
Because the perception and effects of this have not been explored in detail, Schwenk and colleagues conducted an anonymous survey in which they invited all medical students at their university to answer questions about their own symptoms as well as attitudes about depression.
Among the more than 500 students who participated, 14.3% scored in the moderate-to-severe range of depression, with more women scoring in this range (18% versus 9%, 95% CI for difference −14.8 to −3.1, P<0.001).
The overall participation rate was 65.7% but was higher for first- and second-year students compared with third- and fourth-year students.
A total of 4.4% reported suicidal ideation at some point during their training, more often during the third and fourth years. Almost all of those who had thoughts of suicide acknowledged feeling severely depressed but not seeking treatment.
In addition, far more students with moderate-to-severe depression considered dropping out of school compared with those with minimal to no symptoms (43.1% versus 5.6%).
A significantly higher percentage of students who were moderately to severely depressed reported feeling that fellow students would respect their opinions less (56% versus 23.7%, 95% CI for difference 17.3 to 47.3, P<0.001).
Moreover, more depressed students felt that asking for help would mean their coping skills were inadequate (61.7% versus 33.5%, 95% CI for difference 14.4 versus 42,P<0.001).
And compared with third- and fourth-year students, more first- and second-year students felt that depressed medical students would provide inferior patient care (79.3% versus 66.9%, 95% CI for difference 3.3 to 21.5, P=0.007).
In an editorial accompanying the study, Laura Weiss Roberts, MD, of Stanford University in California, wrote, "The report by Schwenk et al issues a clear invitation to intervene with depressed and at-risk students, particularly during the transition between the second and third years of medical school when suicidal thoughts and the wish to leave medical training may be greatest."
The study authors observed that their findings about the stigmatization of depression could represent either cognitive distortion associated with depression or the actuality of the medical school environment that "could have real and adverse consequences."
Roberts agreed. "Whether the stigma perceived by depressed medical students is a sign of illness (i.e., a negative cognitive distortion), as the authors suggest as a possibility, or an accurate 'read' of the culture of medicine, it is important to deconstruct stigmatized attitudes toward mental illness."
She argued in favor of the provision of "secure, affordable, and confidential pathways to mental healthcare," and with adequate safeguards for students who agree to participate in research concerning their experiences and perspectives.
"Indeed, the future of medicine rests on the shoulders of today's medical students, and the care with which medical school administrators and faculty attend to their learning and well-being may bring good to them as well as to the patients of tomorrow," Roberts concluded.
Schwenk and colleagues noted that the study was limited to a single center, by the participation of significantly more women than men, and may have been biased because depressed students might have been less or more willing to participate.
