Medical students' perceptions on depression may point to stigma prevention

NEW YORK - Medical students tend to admit that depression is a medical condition, but they often eschew treatment for themselves, according to new research.

They also view a depression diagnosis as a cause for stigmatization and a career barrier. Researchers point to three variables as causes of much of the stigma: perceiving depression as a personal weakness, fearing social/professional discrimination, and fearing public devaluation.

These stigma domain findings from a survey of medical students can help to inform development of preventive and educational approaches reducing stigma, and, speculatively, reducing the high suicide rate among medical students and physicians, the researchers said online July 2 in the American Journal of Preventive Medicine.

"We need to look closely at the nature of our medical education environment to understand if we are contributing to that stigmatization through a hidden curriculum that tells students to not be vulnerable, to not seek help, to not disclose their difficulties to teachers and role models," Dr. Thomas Schwenk, dean of the University of Nevada School of Medicine, told Reuters Health by email.

"Our response to students in trouble will determine to a considerable extent their comfort in further disclosure and in seeking help," Dr. Schwenk said.

Dr. Schwenk and colleagues evaluated surveys of 505 medical students representing more than 65% of those enrolled at the University of Michigan Medical School in 2009. Of those respondents, 14.7% reported having been previously diagnosed with depression.

The surveys found that more than 95% of responding students agreed with the statement that depression is a medical disease. But 62% said they would feel embarrassed if they were depressed and only about 55% said that they would seek treatment.

U.S. physicians kill themselves at a rate of 28-40 per 100,000, compared to 12.3 per 100,000 among the general population, the researchers wrote. Untreated depression is a major risk factor for suicidal thoughts.

The new survey can't confirm whether high rates of depression and stigma among medical students can explain the high suicide rate, but it does try to tease out determinants of stigma, Dr. Eva Schernhammer, of Harvard Medical School in Boston, who was not involved in the study, told Reuters Health by email.

"The paper highlights depression in this profession as a problem that ought not to be taken lightly and, because of its stigma, may be undertreated," Dr. Schernhammer said.

There may be two other contributors to the high suicide rate among doctors.

One is that students who go on to become doctors are selected for traits that emphasize independence, sacrifice, and autonomy, which are admirable qualities in healthy practitioners, but they can isolate people who become mentally ill, Dr. Schwenk said.

And the other is that doctors choose effective means of killing themselves.

"The combination of means and isolation is very deadly," Dr. Schwenk said.

The authors reported no financial disclosures. One coauthor is statistics editor for the American Journal of Preventive Medicine.


Am J Prev Med 2015.

References: Reuters Health
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