rends in Depressive Symptoms and Associated Factors During Residency, 2007 to 2019 A Repeated Annual Cohort Stud

Author(s)

Fang, Yu ^[1] ; Bohnert, Amy S. B. ^{[2, 3, 4]} ; Pereira-Lima, Karina ^{[5, 6]} ; Cleary, Jennifer ^{[1, 7]} ; Frank, Elena ^[1] ; Zhao, Zhuo ^[1] ; Dempsey, Walter ^{[8, 9]} ; Sen, Srijan ^{[6, 1]}

Affiliation

^[1] Univ Michigan, Michigan Neurosci Inst, 205 Zina Pitcher Pl, Ann Arbor, MI 48109 - USA

^[2] Univ Michigan, Dept Anesthesiol, Ann Arbor, MI 48109 - USA

^[3] Univ Michigan, Dept Epidemiol, Ann Arbor, MI 48109 - USA

^[4] VA Ctr Clin Management Res, Ann Arbor, MI - USA

^[5] Univ Fed Sao Paulo, Dept Psychiat, Sao Paulo - Brazil

^[6] Univ Michigan, Dept Psychiat, Ann Arbor, MI 48109 - USA

^[7] Univ Michigan, Dept Psychol, Ann Arbor, MI - USA

^[8] Univ Michigan, Inst Social Res, Ann Arbor, MI - USA

^[9] Univ Michigan, Dept Biostat, Ann Arbor, MI 48109 - USA

• Document type: Journal article
• Source: Annals of Internal Medicine; NOV 2021.
• Web of Science Citations: 0

Abstract

Background: Efforts to address the high depression rates among training physicians have been implemented at vari-ous levels of the U.S. medical education system. The cumula-tive effect of these efforts is unknown. Objective: To assess how the increase in depressive symp-toms with residency has shifted over time and to identify parallel trends in factors that have previously been associ-ated with resident physician depression. Design: Repeated annual cohort study. Setting: U.S. health care organizations. Participants: First-year resident physicians (interns) who started training between 2007 and 2019. Measurements: Depressive symptoms (9-item Patient Health Questionnaire {[}PHQ-9]) assessed at baseline and quarterly through-out internship. Results: Among 16 965 interns, baseline depressive symptoms increased from 2007 to 2019 (PHQ-9 score, 2.3 to 2.9; difference, 0.6 {[}95% CI, 0.3 to 0.8]). The prevalence of baseline predictors of greater increase in depressive symptoms with internship also increased across cohorts. Despite the higher prevalence of base -line risk factors, the average change in depressive symptoms with internship decreased 24.4% from 2007 to 2019 (change in PHQ-9 score, 4.1 to 3.0; difference,-1.0 {[}CI,-1.5 to -0.6]). This change across cohorts was greater among women (4.7 to 3.3; difference, -1.4 {[}CI,-1.9 to-0.9]) than men (3.5 to 2.9; difference,-0.6 {[}CI, -1.2 to -0.05]) and greater among nonsurgical interns (4.1 to 3.0; difference,-1.1 {[}CI,-1.6 to-0.6]) than surgical interns (4.0 to 3.2; difference,-0.8 {[}CI,-1.2 to -0.4]). In parallel to the decrease in depressive symptom change, there were increases in sleep hours, quality of faculty feedback, and use of mental health services and a decrease in work hours across cohorts. The decrease in work hours was greater for nonsurgical than surgical interns. Further, the increase in mental health treatment across cohorts was greater for women than men. Limitation: Data are observational and subject to biases due to nonrandom sampling, missing data, and unmeasured confounders, limiting causal conclusions. Conclusion: Although depression during physician training remains high, the average increase in depressive symptoms asso-ciated with internship decreased between 2007 and 2019. Primary Funding Source: National Institute of Mental Health. (AU)

• FAPESP's process: 18/21480-4 - Online training to prevent suicidal ideation and depressive symptoms in Medical students: a randomized controlled trial
• Grantee: Karina Pereira Lima
• Support Opportunities: Scholarships in Brazil - Post-Doctoral