Right now, aspiring doctors around the country are waiting to hear if they've been accepted into the medical schools of their dreams.
MORE FROM THE LAB: Subscribe to our weekly newsletter
If they are, they'll set off on the road to becoming a physician — a path that will teem with pressure, anxiety and stress.
A new study from a team at Brigham and Women's Hospital and the University of Michigan Medical School shows just how much of a toll that path can take.
One in four med students may develop depression, nearly twice the prevalence of others their age, the study found. And nearly one in 10 will contemplate suicide during medical school.
In a recent issue of JAMA, the team reports the results from their exhaustive review of nearly 200 studies of medical student mental health. They combined data from the studies, which included more than 129,000 students in 47 countries, and calculated rates of depression and suicidal thinking.
The strain of medical training is well known — and since depression and suicidal ideation can be triggered by intense and prolonged stress, the risk has been studied from many angles. The new analysis boils down the evidence from all those studies. Some data suggest that even compared with students in other elite professional training courses, such as law, their risk of depression is higher.
We need to reduce stigma so more students feel comfortable seeking help.Srijan Sen, M.D., Ph.D.
Addressing stigma
But many of these students aren't getting the help they need, perhaps because of stigma around mental health issues in demanding professions.
Just 16 percent of the students who screened positive for depression on standard surveys said they had sought mental health care.
Medical schools, including U-M, offer comprehensive support for the well-being of their students, with confidential counseling and care available around the clock. But such services only work if students take advantage of them, says Srijan Sen, M.D., Ph.D., co-author of the new study.
"We need to reduce stigma so more students feel comfortable seeking help," he says. "We also need to make changes to our medical education system so that a much smaller percentage of medical students develop depression and suicidal thoughts in the first place."
In an editorial accompanying the JAMA paper, Stuart J. Slavin, M.D., M.Ed., writes that "student mental health outcomes must be viewed as critical program outcomes, as important as board scores and residency placements."
Depression in other stages
Sen, who is the Eisenberg Professor of Depression and Neurosciences in the U-M Department of Psychiatry, teamed with Brigham and Women's Hospital colleague Douglas Mata, M.D., on the new study.
SEE ALSO: 1 in 4 First-Year Residents May Meet Criteria for Clinical Depression
The pair has worked together on previous studies of mental health among medical residents, and Sen is leading a study tracking depression symptoms and other factors among first-year residents.
Sen has also shown through previous research that a simple website can help interns manage their stress. He's continuing to study mobile and wearable options in the Intern Health Study.
For now, the new meta-analysis of studies of depression and suicidal thinking among medical students sounds an alarm for better studies of this population that span from the start of medical training through physicians in practice, the authors conclude.
"As more medical schools ramp up their support infrastructure for students who are struggling with stress," says Sen, "systematic efforts to identify the most effective will be needed."