title: Risk factors at medical school for later severe depression: a 15-year longitudinal, nationwide study (NORDOC).
abstract: BACKGROUND
  Doctors have an increased risk of suicide, and depressive symptoms are prominent among young doctors. We lack prospective studies that identify risk factors to be targeted in medical schools.
  
  
  METHODS
  From 1993 to 2008, graduating medical students (n=631) from all four Norwegian universities participated in the Longitudinal Study of Norwegian Medical Students and Doctors (NORDOC). After their graduating term (T1), they were followed up 1 (T2), 4 (T3), 10 (T4), and 15 (T5) years later with postal surveys. Severe depressive symptoms were measured by the General Health Questionnaire-28 (T1, T2, T3, T4, and T5) and analyzed by generalized estimating equations.
  
  
  RESULTS
  At T1 and T5, 13.7% and 7.2%, respectively, of the doctors reported severe depressive symptoms; a significant reduction over time (p=0.001) in both genders (response rates 56-83%). Independent risk factors for future depressive symptoms were: young age (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.04-1.2, p=0.003); high neuroticism (OR 3.4, 95% CI 1.5-7.6, p=0.003); high reality weakness (OR 2.3, 95% CI 1.2-4.2, p=0.008); and severe depressive symptoms at T1 (OR 3.6, 95% CI 2.1-6.1, p<0.001).
  
  
  CONCLUSIONS
  Selection bias and concurrent life and work stress may have influenced the results.
  
  
  CONCLUSIONS
  In addition to low age, high neuroticism yielded a threefold increased risk over the 15-year follow-up, whereas high reality weakness, which is linked to personality pathology, doubled the risk. These factors are clinically relevant for identification of students at risk.
authors.affiliation: Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, PO Box 1111 Blindern, 0317 Oslo, Norway. k.s.grotmol@medisin.uio.no
authors.forename: Kjersti
authors.initials: K
authors.lastname: Støen Grotmol
authors.forename: Tore
authors.initials: T
authors.lastname: Gude
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Moum
authors.forename: Per
authors.initials: P
authors.lastname: Vaglum
authors.forename: Reidar
authors.initials: R
authors.lastname: Tyssen
mesh_terms: D000328:Adult; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D012307:Risk Factors; D012577:Schools, Medical; D012720:Severity of Illness Index; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult