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Original Investigation
December 6, 2016

Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical StudentsA Systematic Review and Meta-Analysis

Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Harvard Business School, Boston, Massachusetts
  • 3Yale School of Medicine, Yale University, New Haven, Connecticut
  • 4Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 5Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 6Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
  • 7Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor
  • 8Department of Psychiatry, University of Michigan, Ann Arbor
  • 9Division of MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 10Brigham Education Institute, Boston, Massachusetts
JAMA. 2016;316(21):2214-2236. doi:10.1001/jama.2016.17324
Key Points

Question  Are medical students at high risk for depression and suicidal ideation?

Findings  In this meta-analysis, the overall prevalence of depression or depressive symptoms among medical students was 27.2%, and the overall prevalence of suicidal ideation was 11.1%. Among medical students who screened positive for depression, 15.7% sought psychiatric treatment.

Meaning  The overall prevalence of depressive symptoms among medical students in this study was higher than that reported in the general population, which underscores the need for effective preventive efforts and increased access to care for medical students.

Abstract

Importance  Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies.

Objective  To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students.

Data Sources and Study Selection  Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included.

Data Extraction and Synthesis  Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression.

Main Outcomes and Measures  Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview.

Results  Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, −0.2% to 0.7%]). 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% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%.

Conclusions and Relevance  In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.

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