title: Depression and suicidal ideation in medical students in China: a call for wellness curricula.
abstract: OBJECTIVE
  To investigate rates of depression and suicidal ideation in medical students in mainland China and to explore wellness curricula and mental health services available to students.
  
  
  METHODS
  Second and third year medical students (N=348) at one medical school in mainland China completed the Patient Health Questionnaire-9 (PHQ-9). Based on responses to the PHQ-9, students were labeled as depressed, with suicidal ideation, and/or impaired. Additionally, students' feedback from a focus group (N=30) evaluating the current state of the school's wellness curricula and mental health services was thematically analyzed.
  
  
  RESULTS
  A total of 348 students responded (response rate = 99%) to the survey. Forty-seven of 348 (13.5%) students had moderate-severe depression. The mean PHQ-9 score was 6.02 (SD=3.44). Seven and a half percent of students reported suicidal ideation. The frequency of depression and suicidal ideation did not differ between second and third year medical students (p = 0.52). Nearly 30% of depressed students reported suicidal ideation. Depression and suicidal ideation were strongly correlated (r = 0.42, p=0.001). Students with depression (p =0.0001) or suicidal ideation (p = 0.004) were more likely to be impaired compared to students who were not. Focus group participants reported only off-campus student counseling services available to medical students in distress. No wellness curricula were established.
  
  
  CONCLUSIONS
  Rates of depression and suicidal ideation are high in medical students in mainland China. Mental health services are deficient and unlikely to address distress in students. Chinese medical schools should offer mental health support and treatment at an early stage, such as wellness curricula and proactive student counseling.
authors.affiliation: Pritzker School of Medicine, The University of Chicago, USA.
authors.forename: Kunmi
authors.initials: K
authors.lastname: Sobowale
authors.affiliation: Pritzker School of Medicine, The University of Chicago, USA.
authors.forename: Ning
authors.initials: N
authors.lastname: Zhou
authors.affiliation: Department of Pediatrics, Zhongnan Hospital of Wuhan University, China.
authors.forename: Jingyi
authors.initials: J
authors.lastname: Fan
authors.affiliation: Child/Adolescent Psychiatry, North Shore University Health System, USA.
authors.forename: Ni
authors.initials: N
authors.lastname: Liu
authors.affiliation: Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago, USA.
authors.forename: Renslow
authors.initials: R
authors.lastname: Sherer
mesh_terms: D002681:China; D003430:Cross-Sectional Studies; D003479:Curriculum; D003863:Depression / Q000453:epidemiology*; D004501:Education, Medical / Q000379:methods; D017144:Focus Groups; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration*; D013337:Students, Medical / Q000523:psychology*; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires
keywords: China; depression; medical student; suicidal ideation; wellness