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• Posted November 16, 2021

Better Work Conditions Bringing Better Mental Health to Resident Doctors: Study

Medical training may be taking less of a mental health toll on young doctors than it used to, but depression remains common, a new study suggests.

Medical residency -- the training that new doctors undergo at hospitals or clinics -- is infamous for its grueling schedule, high pressure and relatively low pay. Research has shown that residents also have fairly high depression rates.

Now the new study offers some good news: Residency may not be as much of a drain on mental well-being as it was 15 years ago.

But there's still plenty of room for improvement, researchers said.

The study tracked nearly 17,000 U.S. interns (first-year residents) who entered residency programs between 2007 and 2019.

Overall, interns in 2019 did show an increase in depression symptoms during that first year of training, but it was about one-quarter less, compared to their counterparts in 2007.

That's despite the fact that, in the United States as a whole, depression increased among young adults during that period, said researcher Dr. Srijan Sen.

"Our findings suggest there has been some real improvement," said Sen, a professor at the University of Michigan Medical School.

And that improvement, his team found, might be related to changes made in the "medical culture."

On average, interns in 2019 were working a little less, getting a little more sleep and giving higher ratings to their interactions with senior doctors, compared to those in 2007.

One of the biggest changes, though, was that more interns started seeking mental health care: 38% of those with depression symptoms sought help in 2019, compared to 14% in 2007.

Sen said that finding is striking and likely reflects better access to mental health services -- as well as greater willingness on interns' part to get care.

Even in the world of medicine, Sen said, there remains stigma around mental health conditions. And in a field with so much performance pressure and scrutiny from superiors, people may feel reluctant to acknowledge needing help.

"There may be less stigma about seeking care now, which is great to see," Sen said.

However, he added, there's still room for improvement. The study suggests that is particularly the case for certain groups: Surgical interns, for instance, showed a smaller decline in depression symptoms than those not in surgery programs.

Work hours could be one reason, Sen said.

Over the years, non-surgical interns saw their average work week decline from 68 hours to 59 hours. Surgical interns have seen a much smaller change, with the average work week dipping from 74 hours to 72.

As for sleep, there was a small improvement among non-surgical interns. But on average, interns were still getting 6 to 6.5 hours of sleep per day in 2019.

Dr. Jessica Gold co-wrote an editorial published with the study Nov. 16 in the Annals of Internal Medicine.

She said that resources vary among medical centers, but in recent years many have set up mental health services specifically for residents.

Access to services, though, is only one factor, Gold said. Residents also need the time to use them and the mindset.

"The 'medical culture' piece is huge," said Gold, an assistant professor of psychiatry at Washington University School of Medicine in St. Louis.

"There's this normalized belief that we're supposed to be infallible," she said.

More is being done to address the stigma around mental health conditions, Gold said, starting in medical school. Like Sen, she said more work remains.

That's, in part, to support better patient care. Doctors who are uncomfortable with mental health struggles, Gold noted, "may also stigmatize them in their patients."

"If they see this as a weakness in themselves," she said, "they may see it as a weakness in others."

Plus, Gold and Sen said, research shows that providers' burnout and depression can affect patient care more generally -- making medical errors more likely, for example, or limiting their capacity for empathy.

One critical question is how the pandemic has affected any progress made in improving residents' mental health.

The study included some doctors whose intern year included the first months of the pandemic. No clear difference emerged between them and interns from previous years.

But, Gold said, much remains to be learned: As the pandemic has dragged on, how have loneliness, isolation and other stressors -- on top of the work hours and lack of sleep -- affected residents' mental health?

A potential silver lining, Gold noted, is that the pandemic has spurred more discussion of the importance of health care providers' mental health.

"People are at least talking about it more now," she said.

More information

Mental Health America has more on depression in the workplace.

SOURCES: Srijan Sen, MD, PhD, professor, depression and neurosciences, and research professor, Michigan Neuroscience Institute, University of Michigan Medical School, Ann Arbor; Jessica Gold, MD, MS, assistant professor, psychiatry, Washington University School of Medicine in St. Louis; Annals of Internal Medicine, Nov. 16, 2021, online