The first year of medical training after medical school brings intense stress, long work hours, irregular sleep schedules, and the risk of new or worsening symptoms of depression.
But two new studies identify two groups of first-year residents, also called interns, who may be at particular risk of developing mental health problems: those training to become surgeons and those who are members of sexual minorities.
The studies, both published this week by teams at the University of Michigan, add to the growing body of knowledge not only about mental health issues in medical training, but also about the health impacts of intense stress. mind in general.
Data for both articles come from the Intern Health Study, based at the Michigan Neuroscience Institute and led by the director of the Frances and Kenneth Eisenberg and Family Depression Center.
Each spring, the study recruits physicians who are about to begin their first year of residency to volunteer to track their mood, activity, sleep and other metrics over the next 12 months via a wearable device. and a smartphone app. Their medical and life histories, as well as DNA samples, are also collected and analyzed.
Residents in surgery and depression
A new article published in JAMA surgery by a team led by Assistant Professor Tasha Hughes, MD, MPH, of UM’s Department of Surgery, shows for the first time how the mental health of surgical residents changes over time during their first year of training and how it compares to the experience of non-surgical residents. The study looked at data from 12,400 interns, including 2,793 surgeons-in-training, between 2016 and 2020.
Training in most surgical disciplines begins with at least a year of general surgery residency, although a physician will eventually pursue specialty training in a particular type of surgery. Hughes and colleagues find that surgical interns actually began training with a lower rate of existing depressive symptoms than their age-matched peers in the general population.
But by the end of the internship year, 32% of those who started with no signs of depression had scored high enough on at least one mood survey to be considered depressed. Female surgeons, those with a sexual orientation other than heterosexual, those without a partner, those who worked the most hours on average, and those with a history of negative childhood experiences were more likely to develop signs of depression.
Even after adjusting for these factors, surgical interns were more likely to develop new-onset depression than new physicians in other disciplines, except when work hours were taken into account.
Of those who showed signs of new-onset depression on at least one survey, 64% had ongoing signs of depression on a subsequent survey, suggesting ongoing problems.
And only 26% of those who tested positive for depression actually said they had sought mental health care during their internship year, and even of those who had a particularly high score when first screened, only 39 % asked for help.
“Surgical training, especially in the United States, can be a time of intense stress, which we believe is linked to new onset of depression,” says Hughes. “These findings suggest the need for surgical program directors, leaders, and health systems to continue to find ways to mitigate the effects of surgical training, normalize help-seeking, make health support readily available mental health and to pay particular attention to those who exhibit characteristics that could put them at increased risk.”
Physicians in LGBTQ training and depression:
The second study, published in JAMA Health Forum, used data from over 7,000 interns who began training in medical or surgical specialties from 2016 to 2018 and disclosed their sexual orientation as part of their intake questionnaire. Just over 7% said they belonged to a sexual minority group, including lesbian, gay, bisexual or another non-heterosexual group.
In total, depression scores were higher at the start of the internship year for members of sexual minorities compared to their heterosexual peers, and the gap widened as the year progressed, with the largest differences observed in the second semester.
The study’s lead author is Tejal Patel, who will graduate from UM this week with his bachelor’s degree and a double major in cognitive science and biology, health, and society. The Health Study’s in-house director, Elena Frank, Ph.D., notes that the project was part of Patel’s honors thesis and that being the first author of a research letter in a premier journal cycle as an undergraduate is a rare feat.
“These results indicate that interns who are part of sexual minority groups may face unique stressors in the workplace, resulting in a growing disparity in mental health,” Patel says. “This is important to note because as physicians become more depressed, it can lead to an increased risk of medical errors and attrition from medicine. As a result, it can be difficult for sexual minority patients to find a doctor with whom they can identify, and who will suit them perfectly.”
Frank adds that the experience of LGBTQ+ medical trainees has largely been unstudied and that as many as one in five Gen Zers identify as a member of a sexual minority.
“Ensuring that we support the development of a diverse medical workforce that reflects our communities is increasingly critical,” says MNI Associate Researcher Frank. “Through our large national study, we realized we were in a unique position to be able to provide insight into potential disparities in mental health experiences and we hope our data will stimulate further research in this area and inform targeted efforts to facilitate healthier living and a more inclusive educational environment for all physicians.”
The principal investigator of the Internal Health study is Srijan Sen, MD, Ph.D., who, in addition to directing the Eisenberg Family Depression Center, is a Fellow of the Institute for Healthcare Policy and Innovation. Hughes and lead author of the JAMA surgery article, Amy Bohnert, Ph.D., MHS, are also members of IHPI.
The study was funded by the National Institute of Mental Health (MH101459) and the American Foundation for Suicide Prevention