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A mental health epidemic

Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation among Medical Students.  Rotenstein LS et al.  JAMA 2016; 316(21):2214-2236.

Reviewed by Elizabeth Christine Lee

Tags: medical students, mental health, systematic review

What was the study question?

What is the prevalence of depression and suicidal ideation among medical students? 

How was the study done?

The authors systematically searched EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO for studies published before September 17, 2016 that reported on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students.  Included studies were published in peer-reviewed journals and used validated assessment instruments.  The authors extracted data on the characteristics of study subjects, prevalence of depression or suicidal ideation, and percentage of students who screened positive for depression and also sought treatment.  Prevalence estimates were synthesized using random-effects meta-analysis. 

What were the results?

A total of 183 studies of depression in medical students (n= 122, 356) from 47 countries were included in the analysis.  The overall prevalence of depression or depressive symptoms was 27.2%.  In the 9 longitudinal studies (n= 2,432), the median increase in depressive symptoms after the onset of medical school was 13.5%.  Prevalence estimates in studies of solely preclinical students did not significantly differ from prevalence estimates in studies of solely clinical students.  Among medical students who screened positive for depression, 15.7% sought mental health treatment.  A total of 24 studies of suicidal ideation in medical students (n= 21,002) from 15 countries were analyzed.  The overall prevalence of suicidal ideation was 11.1%. 

What are the implications of these findings?

This study found that the overall prevalence of depressive symptoms among medical students was higher than that reported among individuals of similar age in the general population.  Considering the high prevalence estimates, the authors suggest that additional studies are warranted to identify the root causes of emotional distress and to identify strategies for prevention.  The authors suggest the need for increased access to care for medical students and efforts to reduce the stigma associated with depression.  

Editor’s Note: The study found no significant difference in rates by age, gender, year of medical school, geographic location or year the study was conducted, and the rates were similar to those reported for medical residents.  This is a pervasive problem for trainees at all levels and deserves our serious attention and effort. (JG)

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