New Studies Show Special Mental Health Risks for Certain Groups of New Doctors

Newswise: The first year of medical training after medical school comes with 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 special risk of developing mental health problems: those who are training to be 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 impacts of intense stress on mental health in general.

The data in both documents comes from the Internal Health Study, based on the Michigan Neuroscience Institute and directed 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 measures for the next 12 months through a wearable device and a smartphone app. Your life and medical history, and DNA samples, are also collected and analyzed.

The findings of the new studies:

Surgical interns and depression:

a new role published in J.A.M.A. Surgery by a team led by UM Department of Surgery assistant professor Tasha Hughes, MD, MPH, 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 with the experience of non-surgical residents. The study analyzed 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 internship, even if a physician will ultimately seek specialized training in a particular type of surgery. Hughes and his colleagues found that surgical interns actually started their 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 had 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 longer hours on average and those with a history of adverse 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 physicians new to other disciplines, except when work hours were taken into account.

Among those who showed signs of new-onset depression in at least one survey, 64% had continued signs of depression in a subsequent survey, suggesting persistent problems.

And only 26% of those who tested positive for depression reported seeking mental health care during their internship year, and even among those who scored especially high on their first test, only 39% sought help.

“Surgical training, especially in the United States, can be a period of intense stress, which we found to be linked to new-onset 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 mental health support readily available, and deliver special attention to those with characteristics that could put them at greater risk.”

LGBTQ doctors in training and depression:

The second study published in JAMA Health Forum, used data from more than 7,000 interns who began training in medical or surgical specialties between 2016 and 2018 and disclosed their sexual orientation as part of their intake questionnaire. Just over 7% said they were a member of a sexual minority group, including lesbian, gay, bisexual, or other non-heterosexual group.

Overall, depression scores were higher at the beginning of the internship year for members of sexual minorities compared to their heterosexual peers, and the gap grew as the year progressed, with the largest differences seen in the second half. of the year.

The study’s lead author is Tejal Patel, who will graduate from UM this week with a bachelor’s degree and a double major in cognitive science and biology, health and society. Director of the Intern Health Study, 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 major journal as an undergraduate is a rare feat. .

“These results indicate that interns who are part of sexual minority groups may experience unique workplace stressors that lead to a widening disparity in mental health,” says Patel. “This is important to keep in mind because as doctors become more depressed, this can lead to a higher risk of medical errors and medicine dropout. As a result, it can be difficult for sexual minority patients to find a doctor that they can relate to and that is right for them.”

Frank adds that the experience of LGBTQ+ medical trainees has not been widely studied, and that as many as one in five members of Generation Z 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 Frank, an assistant research scientist at MNI. “With our large national study, we realized that we were in a unique position to be able to provide insight into potential disparities in mental health experiences, and we are hopeful that our data will stimulate further research in this area and inform efforts.” specific to facilitate a healthier life. and a more inclusive educational environment for all doctors.”

The principal investigator of the Intern Health Study is Srijan Sen, MD, Ph.D., who in addition to directing the Eisenberg Family Depression Center is a member of the Institute of Health Policy and Innovation. Hughes and the lead author of the JAMA Surgery article, Amy Bohnert, Ph.D., MHS, are also members of the IHPI.

The Intern Health Study is funded by the National Institute of Mental Health (MH101459) and the American Foundation for Suicide Prevention.

New-onset depression among surgical interns, never surgery, doi:10.1001/jamasurg.2022.0618

Symptoms of depression due to sexual orientation during medical training, JAMA Health Forum, doi:10.1001/jamahealthforum.2022.0812