More than 25% of medical interns have depression during their internships, and depressed interns are more likely to make medical errors, according to the largest prospective study of depression during medical internship to date.
In addition, interns who commit frequent medical errors may be more likely to become depressed than their colleagues who commit fewer, Dr. Srijan Sen of the University of Michigan, Ann Arbor, and colleagues wrote (Arch. Gen. Psychiatry 2010;67[doi:10.1001/archgenpsychiatry.2010.41
“Depressive symptoms that are present before internship predicted reported errors during internship, indicating that depression results in increased medical errors,” they said. “Controlling for the baseline level of depressive symptoms, a strong correlation between errors and depression persisted, indicating that errors may also cause depression and that the association between depression and reported medical errors is bidirectional.”
The authors assessed 740 interns for depressive symptoms and genetic risk prior to internship and then for symptoms and potential stressors at 3-month intervals throughout their internships.
There was a dramatic increase—from less than 4% prior to internship to an average of more than 25% during the internship year, according to Dr. Sen and associates.
Most subjects who met the criteria for depression were moderately depressed, and few subjects met the standards for moderately severe or severe depression, the investigators noted.
Women, and interns of either gender with history of depression, neuroticism, and a difficult early family environment, were more likely to suffer from depression, they found.
The study was funded by grants from the Donaghue Foundation, the Department of Veterans Affairs, the American Foundation for Suicide Prevention, and the Substance Abuse and Mental Health Services Administration. Two study authors reported consulting arrangements with a variety of pharmaceutical manufacturers, and one of these reported he also is a cosponsor on pending patents related to new drugs for psychiatric disorders, including depression.
My Take
System Needs to Build Resilience
This issue of depression among medical interns is not an individual problem, but a system one. If the 25% prevalence of depression among medical interns reported by Dr. Srijan Sen and colleagues is correct, there is something about our medical education system that is imbalanced. Medical training will always be stressful, which is why there needs to be a corresponding emphasis on building resilience and mental stability in the face of that distress.
One way to build resilience is to help physicians develop mindfulness skills. These skills fall into two categories. The first set emphasizes the development of self-awareness, so that the individual learns to be more attuned to the early stages of stress and so can attenuate the effects of that stress before it gets out of hand.
The second set of skills focuses on interpersonal mindfulness, that is, one's ability to read others, sense when they are in stress or reacting during the heat of the moment. This interpersonal mindfulness is at the heart of being able to be supportive.
In a before-after study, our mindful practice research group at the University of Rochester demonstrated that an intervention aimed at strengthening that sense of mindfulness among 70 primary care physicians successfully produced sustained improvements in well-being (JAMA. 2009;302:1284–93).
RONALD M. EPSTEIN, M.D., is professor of family medicine, psychiatry and oncology at the University of Rochester (N.Y.) School of Medicine and Dentistry.
