Did you know May is Mental Health Awareness Month? I know it’s nearly impossible to keep up with all the monthly themes (May is also Lupus Awareness Month and Bladder Cancer Awareness month, FYI) and holidays (Donut Day June 7th! Grandparents Day September 8th!), but we’re reminding you of this one in particular because mental health is a critical issue for medical students.
Mood disorders, anxiety, and suicide are common problems in the US, but they are even more common amongst medical professionals. Anxiety disorder affects about 18% of the adult US population every year and major depressive disorder affects 6.7% in a given year (2).
While these symptoms and conditions are common in the general population, they are rampant in medical professionals. Stress and depression are twice as common in medical students compared to all students (1). 28 percent of residents have a major depressive episode during their training (5, 7). 50% of all medical students reported symptoms of burnout in one study (5). If you have ever considered suicide, you are not alone. 10% of medical students reported experiencing suicidal ideation (4, 7). Medical students in particular are three times more likely to die from suicide than the general population of their age group (1). Physicians die by suicide at a higher rate than any other profession (28-40 per 100,000), and twice the rate of the general population (9).
So why are we plagued with these symptoms and conditions more than others? For anyone who has experienced medical training and understands the known the risks for these problems, this is probably not surprising. Medical school and training includes risks like sleep deprivation, poor work-life balance (8), excessive work demands, emotional trauma and stress, and large burdens of responsibility. Not to mention family pressures, the financial burden of school loans, exams, daily rounds that can be humiliating, and basically having a new job every 8 weeks while you are on clinical rotations. Don’t forget the stress of perhaps discovering medicine isn’t exactly what you thought it was going to be.
We all struggle at different periods in our training. For me, my third year was one of the hardest. I remember walking to the hospital in the dark, feeling lost, scared of messing up, and ignored all day, then coming home in the dark. I was lonely, I missed my family, and I felt really out of place most of the time. Any time I spent on anything other than the essentials was time I could be sleeping, so I didn’t really prioritize taking care of myself. On top of that, death, loss and tragedy were in my face in a way they never had been before. It was intense. It was lonely.
So what do we do? How do we sustain a lasting, rewarding career of this important, but admittedly HARD work, in an environment that puts us at very high risk for stress, burnout, depression, anxiety, PTSD, and suicide? Thankfully, there are people in the medical community who are looking for causes and solutions. Many focus on techniques and approaches doctors can employ to care for themselves and prioritize their own well-being, and well as systems we can have in place to support our physicians. These are great steps, but at the same time, it is important to address the root cause, which has a lot to do with the accepted pervasive culture of overwork, sleep deprivation, and abusive treatment in medical training. We lose one physician a day to suicide in the US alone, so there is no time to lose.
As you wind down this academic year and prepare for your next steps, here are some suggestions for immediate ways you can personally focus on your mental health, and how you can take needed care of yourself during some of the most challenging years of your life:
Get professional care
If you think you’re experiencing symptoms of depression, anxiety, PTSD or any other mental illness, you ARE NOT ALONE. Please treat this as you would any urgent medical issue that could be potentially fatal…don’t wait to seek appropriate professional care from a therapist or psychiatrist.
If you’re not sure, check out Mental Health America’s website…they have screening quizzes for conditions like depression, anxiety and PTSD, among others.
The AAMC has recommendations that schools provide all students with access to confidential, professional counseling. Many schools recognize the epidemic of depression, anxiety and suicide in medical students and have confidential systems in place to help you. Despite this, there still may be plenty of barriers to care such as stigma, lack of time, long wait times, and concerns about confidentiality and future employability or licensure.
If you are facing barriers to care, consider online resources while you get things figured out. In one study, web-based cognitive behavioral therapy decreased suicidal ideation in interns by 50% (11).
Just a few examples:
AMSA has partnered with Better Help to provide affordable and confidential online counseling.
Pamela Wible, MD has done incredible and exhaustive work on physician suicide, and her website includes a hotline for physicians in distress or considering suicide.
The National Suicide Prevention Lifeline is available 24/7, at 1-800-273-8255
2. Don’t accept abusive behavior
Unfortunately, the nature of medical training can lend itself to moments where you can feel belittled, humiliated or even abused. This isn’t right and you don’t deserve it.
You deserve the same amount of respect, care and happiness that you would want for your best friend, your child, your grandma, or whoever it is you love most in the world. Treat yourself with the same care and compassion you would extend to these beloved people in your life, or to your patients! Whether it means reporting the abuse or just refusing to internalize these feelings about yourself, try not to accept external hostility as appropriate or acceptable.
Despite what people may say, sleep deprivation, public shaming, denigration and belittling are not OK, and they don’t make you stronger.
3. Put yourself first
A career in medicine is a marathon, not a sprint, so on an individual level, it is important you invest in yourself and develop healthy habits to cope with stress and reduce your risk of mental illness from Day 1. Whatever form self-care takes for you, including eating healthy, regular exercise, meditation, limiting time on social media (12), getting outside, or just doing something you are really good at to boost your confidence, try to make just a little time for it. This may seem like one more thing to do on an already long list of things to do, but remember you can’t take care of anything without taking care of yourself first. As much as doctors want to believe we are superior and somehow superhuman, we are not. We need care, rest, nutrition and support to be healthy, happy and function at our peak, just like everyone else! Regarding sleep: while the rules of residency hours may tell us otherwise, you are a human being (no, getting into medical school did not exempt you from the rules of physiology), the research is clear that we need regular sleep to function properly. Prioritize sleep and fight for your right to sleep as much as you can.
4. Set realistic goals and boundaries
On a more philosophical level, self-care also means setting realistic goals and boundaries, knowing your limits, learning to say no when you don’t really want to do something.
Try to choose projects or extracurriculars based on what you are passionate about, not what you think will look good on your resume.
Remember, your worth is not measured by your productivity. Your worth is not based on a board score or where you match. You are not a number, you are not a list of accomplishments… you are a compassionate human being who probably got into this business because you were motivated to help your fellow human beings. That is pretty amazing and powerful.
5. Reach out to your community, friends and family
Strong bonds and regular communication with friends and family is very important for mental health. This is especially true in medical school, when different schedules, long hours and emotional stresses can leave you feeling incredibly isolated. Face-to-face social interaction has actually been shown to reduce risk of depression (13)!
You may medical school friends in the trenches with you, which is great because they understand what you are going through. But keeping in touch with people you knew before training can be very helpful too, as they can keep you grounded as you ride this medical school rollercoaster.
So remember the rest of this month of May, and the rest of the year, take care of yourself! The culture of medicine is changing little by little, and prioritizing your own health is an important part of that change.
4. Mental Health Services for Medical Students - A Time to Act. N Engl J Med 2018; 379:1196-1198
5. Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med 2008;149:334-341.
6. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. Rotenstein LS et al. JAMA. 2016 Dec 6;316(21):2214-2236.
8. Salary, Debt, Depression Issues Facing US Medical Residents. https://www.medscape.com/viewarticle/866364
11. Guille, C., Zhao, Z., Krystal, J., Nichols, B., Brady, K., & Sen, S. (2015). Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns. JAMA Psychiatry, 72(12), 1192.