The December 8, 2015 issue of JAMA had a startling key clinical point; the prevalence of depression or depressive symptoms among resident physicians in training was 28.8%. The data was generated by meta-analysis of 31 cross-sectional and 23 longitudinal studies published in peer-reviewed journals involving 17,560 trainees. Two-thirds of the trainees were in North America, but the others were from Asia, Europe, South America, and one from Africa. Sensitivity-analysis confirmed that no individual study affected overall prevalence by more than 1% and that the incidence of depression was not influenced by study design, continent of origin, surgical vs nonsurgical program nor level of residency year.
The authors proposed that the causes of depressive symptoms “are common to the residency experience” and portends future depressive episodes detrimental not only to these physicians, but also patient care, as physician depression is associated with lower quality professional practice. Other commentary decried this extraordinarily and unacceptably high rate of mental disorder and demanded a national conversation to change the profound problems in graduate education.
But there is good news. First, 6 different instruments were used to determine depressive symptoms and depending on which one was utilized, the depression rate ranged from 20.9-42%. Also, it is critical to note that the participants were assessed by self-reporting, not gold-standard diagnostic clinical interviews for major psychiatric disorders. And finally, the 54 studies were published between 1963 and 2014. So, subjective, not objective, criteria were used in 5 continents over 50 years in hundreds of different residency systems differing by specialty, culture and healthcare delivery system and the take home message is common flaw in residency training, per se? And it is a crisis demanding national (why not international?) attention? My hope is that this is an aberration and not the result of an intrinsic problem in JAMA’s editorial process, which could be amenable. Alternatively, if the plaintiff’s bar ever sees this article, the consequences maybe intractable.
By Norman Silverman, MD, with Ryan McKennon, DO and Ren Carlton