title: Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  Physicians in training are at high risk for depression. However, the estimated prevalence of this disorder varies substantially between studies.
  
  
  OBJECTIVE
  To provide a summary estimate of depression or depressive symptom prevalence among resident physicians.
  
  
  METHODS
  Systematic search of EMBASE, ERIC, MEDLINE, and PsycINFO for studies with information on the prevalence of depression or depressive symptoms among resident physicians published between January 1963 and September 2015. Studies were eligible for inclusion if they were published in the peer-reviewed literature and used a validated method to assess for depression or depressive symptoms.
  
  
  METHODS
  Information on study characteristics and depression or depressive symptom prevalence was extracted independently by 2 trained investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression.
  
  
  METHODS
  Point or period prevalence of depression or depressive symptoms as assessed by structured interview or validated questionnaire.
  
  
  RESULTS
  Data were extracted from 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals). Three studies used clinical interviews and 51 used self-report instruments. The overall pooled prevalence of depression or depressive symptoms was 28.8% (4969/17,560 individuals, 95% CI, 25.3%-32.5%), with high between-study heterogeneity (Q = 1247, τ2 = 0.39, I2 = 95.8%, P < .001). Prevalence estimates ranged from 20.9% for the 9-item Patient Health Questionnaire with a cutoff of 10 or more (741/3577 individuals, 95% CI, 17.5%-24.7%, Q = 14.4, τ2 = 0.04, I2 = 79.2%) to 43.2% for the 2-item PRIME-MD (1349/2891 individuals, 95% CI, 37.6%-49.0%, Q = 45.6, τ2 = 0.09, I2 = 84.6%). There was an increased prevalence with increasing calendar year (slope = 0.5% increase per year, adjusted for assessment modality; 95% CI, 0.03%-0.9%, P = .04). In a secondary analysis of 7 longitudinal studies, the median absolute increase in depressive symptoms with the onset of residency training was 15.8% (range, 0.3%-26.3%; relative risk, 4.5). No statistically significant differences were observed between cross-sectional vs longitudinal studies, studies of only interns vs only upper-level residents, or studies of nonsurgical vs both nonsurgical and surgical residents.
  
  
  CONCLUSIONS
  In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8%, ranging from 20.9% to 43.2% depending on the instrument used, and increased with calendar year. Further research is needed to identify effective strategies for preventing and treating depression among physicians in training.
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Mata
authors.affiliation: Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Ramos
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, England.
authors.forename: Narinder
authors.initials: N
authors.lastname: Bansal
authors.affiliation: Department of Medicine, Baylor College of Medicine, Texas Medical Center, Houston.
authors.forename: Rida
authors.initials: R
authors.lastname: Khan
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.
authors.forename: Constance
authors.initials: C
authors.lastname: Guille
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, England.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Di Angelantonio
authors.affiliation: Molecular and Behavioral Neuroscience Institute, Department of Psychiatry, University of Michigan, Ann Arbor.
authors.forename: Srijan
authors.initials: S
authors.lastname: Sen
mesh_terms: D003430:Cross-Sectional Studies / Q000706:statistics & numerical data; D003863:Depression / Q000453:epidemiology*; D003866:Depressive Disorder / Q000453:epidemiology*; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D015995:Prevalence