Medical Students Keep Depression Under Wraps

For many medical school students, going through the educational process is a grind, and exceedingly difficult. But once they overcome hurdles in the fourth year, they are ready to go on to new levels, with their dream of practice becoming an evolving reality.

For students who are depressed, however, the potential difficulties of medical school are not only exacerbated, but also often put under wraps. Students may not want to talk about the extreme pain or sadness, or even concede the presence of their depression, because doing so reveals some cracks in their armor, meaning they aren't supermen, or superwomen, after all.

If you are a budding superman, why exposing yourself to Kryptonite?

That's what University of Michigan medical school researchers have found, saying that medical students who are depressed often don't bother confronting the situation. And the researchers say that medical students battling depression also fight a nagging stigma toward depression and concede a belief that colleagues and instructors have little use for it. So they stash their collective mental anxieties in a closet. As a result, they don't seek treatment when they should.

As Thomas L. Schwenk, MD, chairman of the University of Michigan family medicine department, sees it, something is very wrong with this picture, especially since it relates to the world of doctors, who are in the healing business, but too often not the business in healing themselves. Schwenk was the main author of the study, "Depression, Stigma, and Suicidal Ideation in Medical Students," in the Journal of the American Medical Association, which showed that 53.5% of medical students who reported high levels of depressive symptoms were worried that revealing their illness would be risky to their potential careers. In addition, about 62% who were depressed said they believed asking for help would mean their coping skills were not what they should be. The study's co-authors were Lindsay Davis, B.S. and Leslie A. Wimsatt, Ph.D. all of U-M Medical School.

Students feared they would be "viewed as less than adequate, that they would be viewed as less able to handle their responsibilities by faculty members, and that telling a counselor about depression would be risky," the study states.

Schwenk says the difficulties involve an "atmosphere and culture" that must be changed. It is no easy task, he admits. The problems are woven in and around a budding physician's sense of duty, a false sense of invulnerability, coupled with a lack of understanding about their depression and its impact on themselves and the reaction of others around them.

Overall, "there is this extreme sense of professional duty," he says. "Physicians will work while they are sick. They know everything, they can never be vulnerable, can never show any deficiency."

Of course, strong professional obligations are essentially good, he says. "But it gets carried way too far."

The study showed 14.3 % of the students reported moderate to severe depression, which is higher than the 10 to 12 % usually found in the general population, says Schwenk.  "These results show that students who are depressed feel highly stigmatized by their fellow students and faculty members," says Schwenk.

The report findings suggest that there is a perception by depressed students that "they are in fact viewed as less capable."  It adds: "The findings may reflect a medical school environment in which depressed students are stigmatized because of their disease rather than on the basis of performance. In such an environment, revealing depression to friends, faculty members and residency program directors could have real and adverse consequences."

Inevitably, students with moderate to severe depression are concerned that fellow students would respect them less, Schwenk says.

One of the problems of the study is the mix of perception and reality, Schwenk concedes. "Perception is reality: whether the students who are depressed just view their environment more negatively, or think other students are stigmatizing them—it doesn't really as much as students believe it."

Another significant problem is that there appears to be hesitancy on the part of colleagues to reach out and help their peers, says Schwenk. "Why is that we as physicians have a hard time reaching out and helping our colleagues? Is it because we are all scared—a there-but-for-the-grace-of-God kind of thing?"

From a patient's perspective, the study shows that medical students may have some intolerance toward patients with depressive symptoms, says Schwenk.

"If medical students are critical of each other about depression, how does that transfer to patients? We don't want the medical education experience to make them less tolerant of mental illness."

The study needs to be addressed by medical schools, and further research needs to be done, he says.  "We want to provide a medical education environment in which depression is treated like any other medical problem, worthy of treatment, detection and prevention," Schwenk says. "Most importantly, we want the medical students to be comfortable seeking help. Somehow we have to change the environment in which we are teaching future physicians."

Stigma over any mental illness "seems to be lessening among the general public," Schwenk says. For the medical profession? It seems certainly to be "lagging behind," he acknowledges.