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Table 1.  Characteristics of 74 Responding Medical Schools
Characteristics of 74 Responding Medical Schools
Table 2.  Frequency of Students Registered With Psychological Disability, 2019 Data From 74 Allopathic Medical Schools
Frequency of Students Registered With Psychological Disability, 2019 Data From 74 Allopathic Medical Schools
1.
Meeks  LM, Case  B, Herzer  K, Plegue  M, Swenor  BK.  Change in prevalence of disabilities and accommodation practices among US medical schools, 2016 vs 2019.   JAMA. 2019;322(20):2022-2024. doi:10.1001/jama.2019.15372PubMedGoogle ScholarCrossref
2.
Mata  DA, Ramos  MA, Bansal  N,  et al.  Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis.   JAMA. 2015;314(22):2373-2383. doi:10.1001/jama.2015.15845PubMedGoogle ScholarCrossref
3.
Rotenstein  LS, Ramos  MA, Torre  M,  et al.  Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis.   JAMA. 2016;316(21):2214-2236. doi:10.1001/jama.2016.17324PubMedGoogle ScholarCrossref
4.
Meeks  LM, Jain  NR.  Accessibility, Inclusion, and Action in Medical Education: Lived Experiences of Learners and Physicians With Disabilities. Association of American Medical Colleges; 2018.
5.
Slavin  SJ.  Medical student mental health: culture, environment, and the need for change.   JAMA. 2016;316(21):2195-2196. doi:10.1001/jama.2016.16396PubMedGoogle ScholarCrossref
6.
Dyrbye  LN, West  CP, Sinsky  CA, Goeders  LE, Satele  DV, Shanafelt  TD.  Medical licensure questions and physician reluctance to seek care for mental health conditions.   Mayo Clin Proc. 2017;92(10):1486-1493. doi:10.1016/j.mayocp.2017.06.020PubMedGoogle ScholarCrossref
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    1 Comment for this article
    EXPAND ALL
    Psychological disabilities among US medical students with special reference to depression, anxiety and suicide
    Tomoyuki Kawada, MD | Nippon Medical School
    Meeks et al. assessed disclosure of psychological disabilities in medical students (1). Overall, 1.4% of all students reported at least 1 psychological disability. Prevalence (95% confidence interval [CI]) of students with a primary diagnosis of anxiety and depression were 0.8% (0.7%-0.9%) and 0.3% (0.2%-0.3%), respectively. The authors considered factors regarding disclosing psychological disabilities in medical students, and concluded that recognizing psychological disability, removing barriers to disclosure, and ensuring appropriate supporting system should be established. I have some concerns.

    First, Rotenstein et al. conducted a meta-analysis and estimated the prevalence of depression/depressive symptoms and suicidal ideation among medical students being
    27.2% and 11.1%, respectively (2). There is a big difference between the prevalence and disclosure percentage of depression. I suspect that disclosure percentage of psychological disabilities might be differed from the prevalence of them. But gender difference would exist in disclosure percentage of depression as it was observed in the prevalence of depression (3).

    Second, the global prevalence rate (95% CI) of anxiety among medical students was 33.8% (29.2-38.7%) (4). Anxiety was most prevalent among medical students, and disclosing percentage of anxiety was also higher than that of depression. I suspect that overlapping of anxiety and depression would be existed in medical students.

    Finally, suicide prevention is effective by screening stages of suicide ideation. Health care of depression and anxiety in medical students should be conducted in combination with suicide prevention.


    References
    1. Meeks LM, Plegue M, Case B, et al. Assessment of Disclosure of Psychological Disability Among US Medical Students. JAMA Netw Open. 2020;3(7):e2011165. doi:10.1001/jamanetworkopen.2020.11165
    2. Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016;316(21):2214-2236. doi:10.1001/jama.2016.17324
    3. Pacheco JPG, Silveira JB, Ferreira RPC, et al. Gender inequality and depression among medical students: A global meta-regression analysis. J Psychiatr Res. 2019;111:36-43. doi:10.1016/j.jpsychires.2019.01.013
    4. Quek TT, Tam WW, Tran BX, et al. The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis. Int J Environ Res Public Health. 2019;16(15):2735. doi:10.3390/ijerph16152735
    CONFLICT OF INTEREST: None Reported
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    Research Letter
    Medical Education
    July 23, 2020

    Assessment of Disclosure of Psychological Disability Among US Medical Students

    Author Affiliations
    • 1Department of Family Medicine, The University of Michigan Medical School, Ann Arbor
    • 2Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
    • 3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    • 4Michigan Neuroscience Institute, The University of Michigan Medical School, Ann Arbor
    JAMA Netw Open. 2020;3(7):e2011165. doi:10.1001/jamanetworkopen.2020.11165
    Introduction

    According to a 2019 study,1 medical student disclosure of disability increased by 69% from 2016 to 2019. In a comparison of data from schools that responded both years, the largest gain was in psychological disability. To better understand whether a meaningful proportion of students with mental health diagnoses disclose their disability, we assessed the proportion of MD students reporting psychological disabilities and examined subcategories of psychological disability.

    Methods

    This survey study was conducted between September 2018 and March 2019. A survey assessing the number of students reporting disabilities was sent to 140 fully accredited US allopathic medical schools’ disability offices or the school’s primary contact for disability disclosure. The study followed the American Association for Public Opinion Research (AAPOR) reporting guideline. Given the deidentified nature of the data, the University of Michigan Medical School institutional review board considered the study exempt. Aggregate data were used to estimate the proportion of medical students reporting a psychological disability and the prevalence of subcategories of psychological disability. Descriptive analyses were conducted in R version 3.5.1 (R Project for Statistical Computing). No prespecified level of statistical significance was set.

    Results

    Of the 140 schools surveyed, 89 (63.6%) responded with overall categorical data for registered students with disability.1 Characteristics of responding schools are outlined in Table 1. Seventy-four medical schools (52.8%) provided data on primary psychological diagnosis (eg, depression, anxiety, bipolar disorder). Responding schools represented 46 635 MD students with 2189 (4.7%; 95% CI, 4.5%-4.9%) registering as having a disability. Overall, 675 MD students reported at least 1 psychological disability, which accounted for 30.8% ( 95% CI, 28.9%-32.8%) of all individuals who reported any disability and 1.4% of all students in the sample. The most frequently reported diagnoses were anxiety and depression (17.3% [379 students] and 5.8% [128 students] of all reported disabilities, respectively). MD students with a primary diagnosis of anxiety accounted for 0.8% (95% CI, 0.7%-0.9%) of the overall student population, and students with a primary diagnosis of depression accounted for 0.3% (95% CI, 0.2%-0.3%) of the total population (Table 2).

    Discussion

    Research indicates that 30.8% of reported disabilities among MD students are psychological,1 representing an 11.9% increase in psychological disabilities during the past 3 years. While recent meta-analyses suggest that 25% to 30% of all MD students meet the criteria for depression,2,3 our survey estimates that only 0.3% of students disclose depression as a disability. Therefore, the proportion of disclosures is considerably lower than the expected prevalence of psychological disability among MD students, indicating a gap in mental health support–seeking among students.

    Multiple factors may be driving the lower percentage of students disclosing psychological disabilities, including: (1) lack of engagement between MD students and mental health services, reducing opportunities for referral; (2) lack of stakeholder awareness that mental health diagnosis may be eligible for accommodation under the Americans with Disabilities Act4; (3) lack of accommodation of psychological disability in favor of placing students on a leave of absence; (4) stigma surrounding psychological disabilities4,5; (5) timing of diagnosis (ie, before or during medical school); (6) access to and cost of an evaluation; and (7) concerns regarding mandatory disclosure requirements on state board licensing.6

    Limitations of this study include the exclusion of osteopathic schools in the reporting of disability, which affects the generalizability of our results to all medical students. Additionally, our survey only captured students who required accommodation. Not all students who screen positive for or are diagnosed with a psychological disability required accommodation.

    While our data indicate a substantial percentage increase in disclosure of psychological disability, the number of students who disclosed psychological disabilities remained small. This suggests that many students who may benefit from accommodation are going without this support. Failure to identify, support, and address psychological disabilities may have wide-ranging implications for students. Therefore, a comprehensive commitment to the mental health of medical students must in part include recognizing psychological disability, removing barriers to disclosure, and ensuring appropriate support through accommodation.

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    Article Information

    Accepted for Publication: May 11, 2020.

    Published: July 23, 2020. doi:10.1001/jamanetworkopen.2020.11165

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Meeks LM et al. JAMA Network Open.

    Corresponding Author: Lisa M. Meeks, PhD, Department of Family Medicine, The University of Michigan, 1018 Fuller St, Ann Arbor, MI 48104-1213 (meeksli@med.umich.edu).

    Author Contributions: Dr Meeks had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Meeks, Swenor.

    Acquisition, analysis, or interpretation of data: Meeks, Plegue, Case, Sen.

    Drafting of the manuscript: Meeks, Plegue, Case, Swenor.

    Critical revision of the manuscript for important intellectual content: Meeks, Plegue, Swenor, Sen.

    Statistical analysis: Meeks, Plegue.

    Administrative, technical, or material support: Case, Swenor.

    Supervision: Meeks, Sen.

    Conflict of Interest Disclosures: None reported.

    References
    1.
    Meeks  LM, Case  B, Herzer  K, Plegue  M, Swenor  BK.  Change in prevalence of disabilities and accommodation practices among US medical schools, 2016 vs 2019.   JAMA. 2019;322(20):2022-2024. doi:10.1001/jama.2019.15372PubMedGoogle ScholarCrossref
    2.
    Mata  DA, Ramos  MA, Bansal  N,  et al.  Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis.   JAMA. 2015;314(22):2373-2383. doi:10.1001/jama.2015.15845PubMedGoogle ScholarCrossref
    3.
    Rotenstein  LS, Ramos  MA, Torre  M,  et al.  Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis.   JAMA. 2016;316(21):2214-2236. doi:10.1001/jama.2016.17324PubMedGoogle ScholarCrossref
    4.
    Meeks  LM, Jain  NR.  Accessibility, Inclusion, and Action in Medical Education: Lived Experiences of Learners and Physicians With Disabilities. Association of American Medical Colleges; 2018.
    5.
    Slavin  SJ.  Medical student mental health: culture, environment, and the need for change.   JAMA. 2016;316(21):2195-2196. doi:10.1001/jama.2016.16396PubMedGoogle ScholarCrossref
    6.
    Dyrbye  LN, West  CP, Sinsky  CA, Goeders  LE, Satele  DV, Shanafelt  TD.  Medical licensure questions and physician reluctance to seek care for mental health conditions.   Mayo Clin Proc. 2017;92(10):1486-1493. doi:10.1016/j.mayocp.2017.06.020PubMedGoogle ScholarCrossref
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