Newly minted doctors embarking on the intense clinical training known as residency are at unusually high risk for depression, according to a study released Wednesday.
Nearly 29 percent of residents worldwide will experience depression during their residencies, according to a meta-analysis published Wednesday in the Journal of the American Medical Association. That's four times higher than the rate of depression in all US adults.
"It's an open secret that depression and burnout are felt by a lot of people going through their training," said Dr. Douglas Mata, a physician at Brigham and Women's Hospital in Boston. He coauthored the new research, which reviewed 50 years of studies covering 18,000 physicians around the globe.
Residency can last three to five years, depending on the medical specialty. The meta-analysis found that the rate of depression during residency was much higher than in the general population across all countries and specialties.
Experts and residents both point to scheduling demands as a potential factor, with residents working upwards of 70 to 100 hours a week.
"Literally all your waking hours might be spent working," Mata said, noting that constant sleep deprivation can lead to depression.
Lengthy overnight shifts that keep residents on their feet for more than 24 hours at a time can be particularly problematic.
"That's the equivalent on your body of taking two trans-Atlantic flights in a week," Mata said.
Add that to the fact that residency often requires doctors to uproot their lives and move to a new city where they may not have a support system in place, Mata said, and you have a dangerous combination.
Dr. John Schumann, who supervised residents for more than a decade at a University of Oklahoma medical center, said residents typically follow the same emotional curve. They come into the program in the summer, excited to start. But as the days get shorter and the pressure increases, "there's this inevitable dip in emotions," he said.
Schumann, who was not involved with the study, said he's seen his fair share of residents struggling with mental health issues as they learn firsthand how to do things like pronounce a patient's death or counsel grieving families. The depression can become severe, with some residents attempting suicide.
"Is that from residency, or just residency exacerbating underlying issues? Probably a bit of both," Schumann said.
Experts said hospitals can and should do more to lighten the workload for residents, lower stress levels, and provide more resources for mental health. Dr. Srijan Sen, another author of the study and a University of Michigan psychiatrist, suggested medical centers hire more doctors, nurses, and physician assistants to off-load some of the work residents are asked to do.
"A lot of the extra work isn't really helping their education, it's just part of what hospitals need to get done," Sen said. He also urged that hospitals and medical centers need to enforce limits on how many hours each week a resident can work.
Mata suggested that at the beginning of a residency cycle, program directors take residents aside and let them know that mental health issues can crop up and resources are available if needed.
Schumann said that, more often than not, the residents he supervised could have benefited from a simple session to vent.
"Residents should be able to debrief about some of their experiences as much as they want or need to," he said.
Students should be supervised when they have to carry out the more difficult parts of their training, like speaking to relatives of patients who have died. And they need mentors to talk with about those experiences, he said.
Otherwise, Schumann said, "You are thrown in there and you just sink or swim."