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May 2015

Depression and Suicide Among Physician Trainees: Recommendations for a National Response

Author Affiliations
  • 1Department of Psychiatry, Columbia University Medical Center, New York, New York
  • 2New York State Psychiatric Institute, New York
  • 3Department of Psychiatry, New York University School of Medicine, New York
JAMA Psychiatry. 2015;72(5):411-412. doi:10.1001/jamapsychiatry.2014.3050

In the first 2 months of the 2014-2015 academic year, 2 New York City medical interns died in apparent suicides. In response, an intern from Yale School of Medicine wrote an op–ed in the New York Times highlighting the link between medical training and isolation, depression, and suicide among trainees. Physician suicide is a common occurrence. According to the American Foundation for Suicide Prevention, 300 to 400 physicians commit suicide each year, approximately 1 physician per day.1 Medical training involves numerous risk factors for mental illness, such as role transition, decreased sleep, relocation resulting in fewer available support systems, and feelings of isolation. A substantial body of evidence has demonstrated that trainees in particular are at high risk for depression and suicidal thinking, but many training programs have not been able to identify and provide treatment for these residents and fellows in a systematic way. National organizations, such as the Accreditation Council for Graduate Medical Education (ACGME), should address the mental health of residents and fellows by proposing strategies for comprehensive education, screening, and treatment.

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    2 Comments for this article
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    ? Vitamin D
    Kenneth M. Berc, MD | retired-formerly Columbia U Med School
    With the recent discovery that Vitamin D plays both a role in depression and is often low in residents of the Northern Hemisphere, and coupled with house staff's likely inability to ever get out into the sunshine, perhaps someone should do the mundane experiment of comparing all house staff Vit. D levels.
    CONFLICT OF INTEREST: None Reported
    Medical Trainees should be taught that this is a very real risk of practicing medicine
    Louise B. Andrew MD JD FACEP FIFEM | www.physiciansuicide.com
    It took several suicides of fellow trainees and faculty for me to realize how very common affective disorders are within our profession. My subsequent exposure to the regulatory environment through representation of a major specialty organization convinced me that these disorders are not only common, but very poorly addressed because of the very real and reasonable fear of loss of livelihood on the part of affected trainees/physicians if help is sought. My principal career focus has been addressing the stress of litigation. I see stark parallels between these threats. Just as we were never taught that malpractice litigation is part and parcel of a career in medicine in the U.S. and trained to deal with the stress engendered, we were never told that we might have entered medicine with a vulnerability to depression, and that we are at significantly increased risk for suicide because of that vulnerability coupled with knowledge of and access to lethal means. We need to both teach and believe that this is the reality, and be trained and prepared to address this very potentially lethal condition more effectively. Asking for help should not be an admission of inadequacy, and in fact students and house staff should be asked privately, routinely and as a matter of course, "How are you doing right now and could you use some support?" And then, of course confidential and effective support must be provided. As those most familiar with and also in the best position to respond, we the senior members of the medical profession are responsible for beginning to heal our replacement generations.

    CONFLICT OF INTEREST: The writer is owner of a non profit informational website for the education of physicians and family members who may be dealing with aspects of depression.
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