The MD Blues: Under-Recognized Depression and Anxiety in Medical Trainees.
BACKGROUND
Mental health disease is under recognized in medical professionals.


OBJECTIVE
To screen medical students (MS), residents and fellows for major depressive disorder (MDD) and generalized anxiety disorder (GAD) under the new era of work hour reform with age-matched controls from a large representative cross-sectional survey.


METHODS
We conducted an anonymous online survey at a medical university in 2013-2014. We incorporated the Patient Health Questionnaire 2 (PHQ-2) to screen for MDD and the generalized anxiety disorder scale (GAD-7) to screen for GAD, along with additional questions on life stressors and academic performance. We compared these results to age-matched controls from the National Health and Nutrition Examination Survey (NHANES) database.


RESULTS
126 residents/fellows and 336 medical students participated voluntarily. 15.1% and 15.9% of postgraduates as well as 16.4% and 20.3% of MS screened positive for MDD and GAD, respectively. When compared to national estimates, the prevalence of a positive screen for MDD was over five-fold higher in medical trainees compared to age-matched controls (16% vs. 2.8%, p<0.0001). Similarly, the prevalence of a positive screen for GAD was over eight-fold higher in medical trainees (19% vs. 2.3%, p<0.0001).The prevalence was consistently higher within age strata. 33.3% of postgraduates and 32% of MS believe there is a significant impact of depression or anxiety on their academic performance. For stress relief, one fifth of residents/fellows as well as MS reported alcohol use.


CONCLUSIONS
The stresses of medical education and practice may predispose trainees to psychopathological consequences that can affect their academic performance and patient care. The current study showed a significantly higher rate of MDD and GAD positive screens in medical trainees than the prevalence in an age-matched U.S. population, despite significant work hour reform for medical trainees. Increased awareness and support services are required at all levels of medical training. We propose that the ACGME and the Institute of Medicine may consider these findings when implementing future changes to work hour regulations.
Department of Medicine, State University of New York-Upstate Medical University, Syracuse, New York, United States of America.
Omar Y
http://orcid.org/0000-0002-8411-3859
OY
Mousa
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
Mandip S
MS
Dhamoon
Department of Medicine, State University of New York-Upstate Medical University, Syracuse, New York, United States of America.
Sarah
S
Lander
Department of Medicine, State University of New York-Upstate Medical University, Syracuse, New York, United States of America.
Amit S
AS
Dhamoon
D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D003865:Major Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012959:Socioeconomic Factors; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014146:Training Support; D055815:Young Adult