Mental Health in Medicine:

By the numbers

Mental health in medicine is a complex topic worthy of our time and attention. Medical students, physicians, and other healthcare professionals face unique stressors to their mental health and experience mental health symptoms at rates higher than that of the general population, making them a special risk group for mental illness and suicidality.

Prevalence

  • Globally, rates of depression and anxiety among medical students are estimated to be 27% and 34-38%, respectively. Additionally, previous studies have found that 34% of medical students reported low mental quality of life. One study found a significant proportion of depressed medical students reported symptoms severe enough to warrant treatment.

    (Rotenstein et al., 2016; Quek et al., 2019; Thuma et al., 2020; Talmi, 2021; Anderson, 2018)

  • In a similar age group, 13.6% of adults aged 18-25 had serious thoughts of suicide.

    (Rotenstein et al., 2016; Cooper et al., 2022).

  • In one study, 31.4% of residents experienced severe emotional exhaustion, 25.6% of residents experienced severe depersonalization, and 46.5% of residents experienced low personal accomplishment. Factors contributing to burnout included dealing with difficult cases and extensive work hours.

    (American Foundation for Suicide Prevention; Nurikhwan et al., 2022)

  • This is 28 to 40 per 100,000 physicians compared to 12.3 per 100,000 non-physicians. About 400 physicians take their own lives each year in the United States.

    (Anderson, 2018; Hankir et al., 2014)

Effects

  • Medical students tend to begin medical school with similar mental health to their non-medical peers. However, they notice a decline in their mental health when medical school begins. In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5%.

    (Hansell et al., 2019; Rotenstein et al., 2016)

  • Additionally, 25% of medical students in the United States are considering dropping out due to mental health concerns. Even for students who do not drop out, they report that mental health issues negatively impacted their academic performance.

    (Advisory Board, 2023; Hefny et al., 2024)

  • After residency, 62.8% of physicians had at least one manifestation of burnout in 2021, compared with 38.2% in 2020, 43.9% in 2017, 54.4% in 2014 and 45.5% in 2011.

    (Hansell et al., 2019; Thuma et al., 2020; Shanafelt et al., 2022)

  • This may be due to the multitude of challenges including academic pressure, financial struggles, and a lack of control.

    (Nair et al., 2023; Dyrbye et al., 2006)

Stigma

  • According to data collected and analyzed by The 2023 Survey of America’s Current and Future Physicians.

    (Physicians Foundation, 2023)

  • Of the 24% of medical students who were depressed in a study conducted on first and second-year medical students, only 22% were utilizing counseling services. Barriers to using these services included stigma (30%), cost (28%), lack of time (48%), and fear of documentation on academic record (24%).

    (Givens & Tija, 2002)

  • In the same study, approximately half of physicians (48%), residents (48%), and students (55%) said they know a physician/colleague/peer who said they would not seek mental health care.

    (Physicians Foundation, 2023)

  • In this study, first- and second-year students also agreed with the statement, "if I were depressed, fellow medical students would respect my opinions less", and that seeking help for depression would make them feel less intelligent.

    (Schwenk et al., 2010)

  • This reluctance was due to the fear of stigma, which poses a major barrier to seeking treatment. Physicians who end their own lives often struggle with untreated mental health issues, which highlights the urgent need for change.

    (Anderson, 2018)

Interventions & Treatment

  • Studies show that medical students are more likely to seek help after hearing physicians further along in their careers share their own stories about mental health struggles in medicine. Sharing stories about mental health challenges can create a healthy narrative about mental health in the medical field, while reminding us that we are not alone and deserve support when we are struggling.

    (Coverdale et al., 2021)

  • Social support within the workplace has been shown to demonstrate a buffering effect when dealing with stressors such as workload and conflict.

    (Rospenda et al., 1994)

  • Utilizing peer support strategies can improve mental health among individuals, as well as healthcare provider teams as a whole.

    (Nair et al., 2023)

  • Having a social support network accessible has been shown to increase resilience when faced with a stressful situation. Resilient individuals are also thought of as able to have healthy coping mechanisms.

    (Abrams et al., 2022; Ozbay et al., 2007)

Stethos[Cope] Homepage

References

  1. Abrams, M. P., Salzman, J., Espina Rey, A., & Daly, K. (2022). Impact of Providing Peer Support on Medical Students’ Empathy, Self-Efficacy, and Mental Health Stigma. International Journal of Environmental Research and Public Health, 19(9), 5135. https://doi.org/10.3390/ijerph19095135

  2. Anderson P. Physicians experience highest suicide rate of any profession. Medscape. May 7, 2018. Accessed May 12, 2024. https://www.medscape.com/viewarticle/896257?form=fpf.

  3. Cooper, M., Gyawali, S., Smith, T., & Yan, J. (2022). Key Substance Use and Mental Health Indicators in the United States: Results from the 2022 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-nsduh-nnr.pdf

  4. Coverdale J, West CP, Roberts LW. Courage and Mental Health: Physicians and physicians-in-training sharing their personal narratives. Academic Medicine. 2021;96(5):611-613. doi:10.1097/acm.0000000000004006

  5. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian Medical Students. Academic Medicine. 2006;81(4):354-373. doi:10.1097/00001888-200604000-00009

  6. Givens JL, Tjia J. Depressed medical studentsʼ use of mental health services and barriers to use. Academic Medicine. 2002;77(9):918-921. doi:10.1097/00001888-200209000-00024

  7. Hankir AK, Northall A, Zaman R. Stigma and mental health challenges in medical students. Case Reports. 2014;2014 (sep02 1). doi:10.1136/bcr-2014-205226

  8. Hansell MW, Ungerleider RM, Brooks CA, Knudson MP, Kirk JK, Ungerleider JD. Temporal trends in medical student burnout. Family Medicine. 2019;51(5):399-404. doi:10.22454/fammed.2019.270753

  9. Kihumuro, R. B., Kaggwa, M. M., Nakandi, R. M., Kintu, T. M., Muwanga, D. R., Muganzi, D. J., Atwau, P., Ayesiga, I., Acai, A., Najjuka, S. M., Najjuma, J. N., Frazier-Koussai, S., Ashaba, S., & Harms, S. (2022). Perspectives on mental health services for medical students at a Ugandan medical school. BMC Medical Education, 22(1). https://doi.org/10.1186/s12909-022-03815-8

  10. Nair M, Moss N, Bashir A, et al. Mental health trends among medical students. Baylor University Medical Center Proceedings. 2023;36(3):408-410. doi:10.1080/08998280.2023.2187207

  11. Nurikhwan PW, Felaza E, Soemantri D. Burnout and quality of life of medical residents: A mixed-method study. Korean Journal of Medical Education. 2022;34(1):27-39. doi:10.3946/kjme.2022.217

  12. Ozbay, F., Johnson, D. C., Dimoulas, E., Morgan, C. A., Charney, D., & Southwick, S. (2007). Social Support and Resilience to stress: from Neurobiology to Clinical Practice. Psychiatry (Edgmont), 4(5), 35–40. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/

  13. Quek T, Tam W, Tran B, et al. The global prevalence of anxiety among medical students: A meta-analysis. International Journal of Environmental Research and Public Health. 2019;16(15):2735. doi:10.3390/ijerph16152735

  14. Rospenda KM, Halpert J, Richman JA. Effects of social support on Medical Studentsʼ performances. Academic Medicine. 1994;69(6):496-500. doi:10.1097/00001888-199406000-00018

  15. Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students. JAMA. 2016;316(21):2214. doi:10.1001/jama.2016.17324

  16. Schwenk TL, Davis L, Wimsatt LA. Depression, stigma, and suicidal ideation in medical students. JAMA. 2010;304(11):1181. doi:10.1001/jama.2010.1300

  17. Shanafelt TD, West CP, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVID-19 pandemic. Mayo Clinic Proceedings. 2022;97(12):2248-2258. doi:10.1016/j.mayocp.2022.09.002

  18. Talmi YP. Quality of Life. Surgery of the Salivary Glands. Published online 2021:364-367. doi:10.1016/b978-0-323-67236-8.00056-0

  19. The Physicians Foundation. 2023 Survey of America’s Current and Future Physicians. Published online 2023.

  20. Thuma T, Lawandy M, Lotfalla A, Terrell M, Lomiguen C. Mental health matters: Mental health and overall well-being among first- and second-year medical students. Health Professions Education. 2020;6(4):516-521. doi:10.1016/j.hpe.2020.07.003