title: In Their Own Words: An Analysis of the Experiences of Medical Interns Participating in a Prospective Cohort Study of Depression.
abstract: To compare the subjective experiences of interns with and without symptoms of depression using a mixed-methods approach.
  
  
  
  In 2007-2008, interns from six institutions were screened for depression before and during internship using an online survey that included the Patient Health Questionnaire (PHQ-9). At the end of internship, participants were asked what made the year difficult, easy, and memorable, and how they had changed. Computerized lexical and qualitative thematic analyses were performed to analyze their free-text responses.
  
  
  
  Sixty-three percent (244/388) of invited interns participated in the original cohort study. Of those, 42% (103/244) answered the open-ended questions for this analysis. Thirty-five percent (36/103) screened positive for clinically significant depression (i.e., PHQ-9 score ≥ 10) during their intern year. Respondents with symptoms of depression were more likely to report problems with cynicism, exhaustion, and stress, while those without them were more likely to mention positive patient care and educational experiences. Respondents with symptoms of depression preferentially described experiences that "broke" their confidence, sense of well-being, and belief in the medical profession, while those who did not described profoundly positive, life-changing experiences regarding interactions with patients and supportive colleagues, through which they grew personally and professionally.
  
  
  
  Depression during internship affects not only objective outcomes like medical errors but also how interns value the profession and themselves, with potentially profound consequences for their future career decisions. Residency programs should implement reactive interventions targeting depression and proactive interventions promoting resilience and well-being to address the issues that lead to depression.
authors.affiliation: D.A. Mata is a resident physician in anatomic and clinical pathology, Brigham and Women's Hospital, and clinical fellow in pathology, Harvard Medical School, Boston, Massachusetts. M.A. Ramos is an MD/PhD candidate, Yale School of Medicine, New Haven, Connecticut. M.M. Kim is a resident physician in genitourinary surgery, Massachusetts General Hospital, and clinical fellow in surgery, Harvard Medical School, Boston, Massachusetts. C. Guille is assistant professor, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina. S. Sen is research associate professor, Molecular and Behavioral Neuroscience Institute, and associate professor, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Mata
authors.forename: Marco A
authors.initials: MA
authors.lastname: Ramos
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Kim
authors.forename: Constance
authors.initials: C
authors.lastname: Guille
authors.forename: Srijan
authors.initials: S
authors.lastname: Sen
mesh_terms: D000328:Adult; D001569:Benzodiazepines; D015331:Cohort Studies; D003863:Depression / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008016:Life Change Events; D008297:Male; D033262:Narration; D009511:New England; D011446:Prospective Studies; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: C531941:PWZ-029; D001569:Benzodiazepines