Article

A Prospective Cohort Study Investigating Factors Associated With Depression During Medical Internship

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Abstract

Although the prevalence of depression among medical interns substantially exceeds that of the general population, the specific factors responsible are not well understood. Recent reports of a moderating effect of a genetic polymorphism (5-HTTLPR) in the serotonin transporter protein gene on the likelihood that life stress will precipitate depression may help to understand the development of mood symptoms in medical interns. To identify psychological, demographic, and residency program factors that are associated with depression among interns and to use medical internship as a model to study the moderating effects of this polymorphism. A prospective cohort study. Thirteen US hospitals. Seven hundred forty interns entering participating residency programs. Subjects were assessed for depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9), a series of psychological traits, and the 5-HTTLPR genotype prior to internship and then assessed for depressive symptoms and potential stressors at 3-month intervals during internship. The PHQ-9 depression score increased from 2.4 prior to internship to a mean of 6.4 during internship (P < .001). The proportion of participants who met PHQ-9 criteria for depression increased from 3.9% prior to internship to a mean of 25.7% during internship (P < .001). A series of factors measured prior to internship (female sex, US medical education, difficult early family environment, history of major depression, lower baseline depressive symptom score, and higher neuroticism) and during internship (increased work hours, perceived medical errors, and stressful life events) was associated with a greater increase in depressive symptoms during internship. In addition, subjects with at least 1 copy of a less-transcribed 5-HTTLPR allele reported a greater increase in depressive symptoms under the stress of internship (P = .002). There is a marked increase in depressive symptoms during medical internship. Specific individual, internship, and genetic factors are associated with the increase in depressive symptoms.

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... Of these articles, nine did not conduct statistical analyses to determine whether the reported changes in sleep, mental health, or physical health across timepoints were significant [27,31,48,49,[52][53][54][55][56][57]. Thirty studies investigated longitudinal changes in healthcare workers (nurses and medical residents/interns) [21,22,25,27,29,31,[52][53][54][55][56][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76], and nine studies examined emergency personnel (police, paramedics, and firefighters) [23,26,28,30,47,50,57,77,78]. Most of the included studies (26 studies) investigated workers who completed rotating shift work, which included night shifts [22,23,[25][26][27][28][29][30][31][48][49][50][51][52]57,58,61,62,64,66,67,[77][78][79][80]. ...
... Thirty-three (73%) studies looked at mental health outcomes. Most studies (93%) investigating depression found depressive symptoms increased with the onset of shift work [22,28,53,[58][59][60][61]65,69,70,73,74,76]. Further detail is available in Table S3 and supplementary material. ...
... In addition to changes in mental health symptoms, several studies (n = 13) reported the onset of a mental health condition in new shift workers. Between 9.0% and 41.8% of new shift workers met a screening criterion for depression at some point during shift work [58][59][60]63,65,69,71,[74][75][76]. One study in medical interns found the prevalence of self-reported depression decreased after starting shift work (7%) compared to pre-shift work (11%) [55]. ...
... In addition, the rapidly increasing number of cases with morbidity and mortality has faced healthcare workers worldwide under enormous pressure (11,12). This shows that the medical staff experience higher levels of anxiety and depression compared to the general population, with a prevalence of 20.9% to 43.2% (13)(14)(15). High levels of depression and anxiety along with personal distress result in a low quality of patient care and elevated levels of medical errors. (16)(17)(18). ...
... Descriptive statistics in terms of frequency, mean, and standard deviation (SD) were used to describe the data. An independent-sample t-test was run to determine if there were differences in working hours per week and the number of shifts per month between the depressive or anxiety symptoms group (HADS [11][12][13][14][15][16][17][18][19][20][21] and no depressive or anxiety group (HADS < 11). Categorical variables such as having or not having depressive or anxiety symptoms (HADS 11-21) were compared with those without depressive or anxiety symptoms (HADS < 11) and differences between the two groups in terms of demographic information were conducted using the Chi-square test. ...
... Internal medicine (IM) residency is well-recognized as a challenging period of time generally characterized by long work hours, adjustment to new roles and responsibilities, and a steep clinical learning curve [1]. Multiple studies have established that depression and burnout are highly prevalent among IM trainees and are even higher during the intern year, the first year of post-graduate training [1][2][3]. One study estimated the burnout rate among internal medicine residents to be as high as 63% based on responses to the Maslach Burnout Inventory [4]. ...
... One study estimated the burnout rate among internal medicine residents to be as high as 63% based on responses to the Maslach Burnout Inventory [4]. Other studies have found that up to 49% of residents screen positively for major depression with by PHQ-9 criteria [1,2]. Suicide is the second most common cause of death among residents in programs accredited by the Accreditation Council of Graduate Medical Education (ACGME), second only to all forms of cancer combined [5]. ...
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Background Internal medicine (IM) residency is a notoriously challenging time generally characterized by long work hours and adjustment to new roles and responsibilities. The COVID-19 pandemic has led to multiple emergent adjustments in training schedules to accommodate increasing needs in patient care. The physician training period, in itself, has been consistently shown to be associated with vulnerability with respect to mental well-being. The impact of the COVID-19 pandemic on the experience of IM trainees is not well established. Objective Characterize the impact of the COVID-19 pandemic on trainee clinical education, finances, and well-being. Methods We developed a survey composed of 25 multiple choice questions, 6 of which had an optional short-answer component. The survey was distributed by the American College of Physicians (ACP) to 23,289 IM residents and subspecialty fellows. We received 1,128 complete surveys and an additional 269 partially completed surveys. Results The majority of respondents reported a disruption in their clinical schedule (76%) and a decrease in both didactic conferences (71%) and protected time for education (56%). A majority of respondents (81%) reported an impact on their well-being with an increase in their level of burnout and 41% of respondents reported a decrease in level of direct supervision. Despite these changes, the majority of trainee respondents (78%) felt well prepared for clinical practice after graduation. Conclusions These results outline the vulnerable position of internal medicine physicians in training. Preserving educational experiences, adequate supervision, and humane work hours are essential in protecting trainees from mental illness and burnout during global emergencies.
... Therefore, ensuring appropriate and wellsupported internship training is important for health workforce production and health systems. We previously conducted a scoping review on quantitative studies that measured internship experience and summarised three major and interconnected areas frequently examined by these studies, 7 including (1) well-being which encompasses overall health and wellness, that is, the physical, mental and social health outcomes of interns including burn-out, [8][9][10][11][12][13] stress, [14][15][16][17] depression 14 16 18-20 etc; (2) educational environment encompassing aspects which primarily influence where and how interns learn, that is, focused on the educational approach, 21-23 supervision and mentorship 2 24 25 and teamwork [26][27][28][29][30] and (3) work conditions and environment aspects that primarily impact how interns work including terms and conditions of employment such as work hours, workload, 31 safety, 32 bullying and harassment 33 and resources. 21 Our review also highlighted the scarcity of studies focusing on interns in low-income and middle-income countries (LMICs) where resources, education and working conditions are poor. ...
... Therefore, ensuring appropriate and wellsupported internship training is important for health workforce production and health systems. We previously conducted a scoping review on quantitative studies that measured internship experience and summarised three major and interconnected areas frequently examined by these studies, 7 including (1) well-being which encompasses overall health and wellness, that is, the physical, mental and social health outcomes of interns including burn-out, [8][9][10][11][12][13] stress, [14][15][16][17] depression 14 16 18-20 etc; (2) educational environment encompassing aspects which primarily influence where and how interns learn, that is, focused on the educational approach, 21-23 supervision and mentorship 2 24 25 and teamwork [26][27][28][29][30] and (3) work conditions and environment aspects that primarily impact how interns work including terms and conditions of employment such as work hours, workload, 31 safety, 32 bullying and harassment 33 and resources. 21 Our review also highlighted the scarcity of studies focusing on interns in low-income and middle-income countries (LMICs) where resources, education and working conditions are poor. ...
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Objective Medical interns are an important workforce providing first-line healthcare services in hospitals. The internship year is important for doctors as they transition from theoretical learning with minimal hands-on work under supervision to clinical practice roles with considerable responsibility. However, this transition is considered stressful and commonly leads to burn-out due to challenging working conditions and an ongoing need for learning and assessment, which is worse in countries with resource constraints. In this study, we provide an overview of medical doctors’ internship experiences in Kenya and Uganda. Methods Using a convergent mixed-methods approach, we collected data from a survey of 854 medical interns and junior doctors and semistructured interviews with 54 junior doctors and 14 consultants. Data collection and analysis were guided by major themes identified from a previous global scoping review (well-being, educational environment and working environment and condition), using descriptive analysis and thematic analysis respectively for quantitative and qualitative data. Findings Most medical interns are satisfied with their job but many reported suffering from stress, depression and burn-out, and working unreasonable hours due to staff shortages. They are also being affected by the challenging working environment characterised by a lack of adequate resources and a poor safety climate. Although the survey data suggested that most interns were satisfied with the supervision received, interviews revealed nuances where many interns faced challenging scenarios, for example, poor supervision, insufficient support due to consultants not being available or being ‘treated like we are nobody’. Conclusion We highlight challenges experienced by Kenyan and Ugandan medical interns spanning from burn-out, stress, challenging working environment, inadequate support and poor quality of supervision. We recommend that regulators, educators and hospital administrators should improve the resource availability and capacity of internship hospitals, prioritise individual doctors’ well-being and provide standardised supervision, support systems and conducive learning environments.
... The proposed study builds up on the Intern Health Study which is a prospective longitudinal cohort study of stress and depression among training physicians in the USA and China [6,7]. This model allows for the same individuals to be followed, first under normal conditions and then under high-stress conditions [8]. The Intern Health Study employs a unique mobile app platform, the Intern App, specifically designed for healthcare workers to collect and integrate active and passive data on mood, sleep, and activity. ...
... Intern Health Study has demonstrated that mobile monitoring can facilitate the prospective, real-time monitoring of continuous, passive measures and effectively predict short-term risk for depressive episodes in a large group of individuals (See Tables 1and Fig. 1). Mobile technology coupled with predictive models can help in triggering early warning systems e.g., signs of depression [8]. We would like to adapt the App and make it contextually relevant and deploy it among healthcare workers within Kenyan urban and semi-urban settings. ...
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Objective This study proposes to identify and validate weighted sensor stream signatures that predict near-term risk of a major depressive episode and future mood among healthcare workers in Kenya. Approach The study will deploy a mobile application (app) platform and use novel data science analytic approaches (Artificial Intelligence and Machine Learning) to identifying predictors of mental health disorders among 500 randomly sampled healthcare workers from five healthcare facilities in Nairobi, Kenya. Expectation This study will lay the basis for creating agile and scalable systems for rapid diagnostics that could inform precise interventions for mitigating depression and ensure a healthy, resilient healthcare workforce to develop sustainable economic growth in Kenya, East Africa, and ultimately neighboring countries in sub-Saharan Africa. This protocol paper provides an opportunity to share the planned study implementation methods and approaches. Conclusion A mobile technology platform that is scalable and can be used to understand and improve mental health outcomes is of critical importance.
... An Indian study investigating suicide-related deaths among medical students between 2010 and 2014 found that stress due to poor academic performance was a factor in 56% of cases (28). The incidence of depression was reported to increase fourfold during medical internships, especially within the first four months of the year (29). Another study suggested that the first three years are a particularly vulnerable period for suicidality in medical students (26). ...
... Moreover, some students may become emotionally affected by the suffering of their patients. A study demonstrated that the incidence of depression quadrupled during medical internships, especially in the first four months of the year (29). In a study conducted with 1,306 medical students in Turkiye, being in the fourth year was found to predict scores on both The Center for Epidemiologic Studies Depression Scale and Perceived Stress Scale (27). ...
Article
Objective: Among physicians, men are 1.41 times, and women are 2.27 times more likely to die by suicide than the general population. Physician suicide exhibits a double peak, with the highest incidence occurring in late middle age, and the second peak during the training years. There is a limited number of studies on physician suicides in Turkiye. This study aims to examine completed physician and medical student suicides and explore the associated socio-demographic, professional, and suicidological parameters over a 16-year period. Method: The research involves an explanatory study of medical student and physician suicide deaths in Turkiye from 2006 to 2021, based on data from the Google database and online news sites. In the initial stage, specific keywords were used to search Google for news related to the topic. This process yielded 892 results, from which 133 relevant cases were identified. Subsequently, the study extended to searching 32 online national newspapers and 28 online news sites using the same keywords, leading to the discovery of an additional 33 cases. Furthermore, 32 cases were obtained from four widely used social media sites and seven health workers' news portal. Results: The study evaluated 138 cases as definite/probable suicide deaths. The mean age of individuals was 38.64±12.80. Most of the subjects were specialists (39.9%). Drug intoxication (27.9%) was the most common method of suicide, followed by jumping from height (21.7%). Familial problems were cited most frequently (26.5%), followed by occupational/academic problems (22.1%). Regarding the specialties, anesthesiology (12.5%), gynecology and obstetrics (10.2%), and psychiatry (10.2%) had the highest occurrences among the suicide cases. Conclusion: The study revealed that academic problems among medical students and marital discord among specialists emerged as the key reasons for suicide. These issues are preventable and warrant further investigation through focused research. How to cite this article: Unler M, Ekmekci Ertek I. Completed physician and medical student suicides in Turkiye (2006-2021): An explanatory internet-based study. Dusunen Adam J Psychiatr Neurol Sci 2023;36:00-00.
... Studies have shown that healthcare workers (HCWs) are more likely than the general population to be exposed to depression due to the demanding nature of their occupations [5][6][7]. The prevalence of depression among HCWs varies from 21.53% to 32.77% in developed nations [8][9][10][11][12]. A meta-analysis and systematic review utilizing 57 cross-sectional studies conducted between 2019 and 2020 found that the pooled prevalence rate of depression among HCWs was 24% [13]. ...
Article
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Background Depression is a common mental disorder that affects 3.8% of the general population and 24% of healthcare workers globally. Healthcare professionals are more susceptible to depression because they face higher amounts of professional stress in their jobs and academic lives. However, there is limited knowledge regarding health professionals’ level of depression in Ethiopia. This study aimed to assess the prevalence of depression and associated factors among health professionals, at Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods We conducted an institution-based cross-sectional study among 439 randomly selected healthcare workers using interviewer-administered patient health questionnaire-9 from April to May 2023. Ordinal logistic regression was performed to identify predictors of depression. Reported p-values < 0.05 or a 95% Confidence Interval of Odds Ratio excluding one was considered statistically significant. Result The overall prevalence of depression among healthcare workers was 21.9% (95%CI: 18%, 27.76%). There were reports of mild (35%), moderate (13%) and severe (9%) depression, respectively. Marital status of being single (AOR = 7.78, 95%CI: 1.123, 49.01), history of childhood abuse (AOR = 2.57, 95%CI:1.49, 4.42), history of suicidal attempt (AOR = 2.66, 95%CI:1.25,5.67), having a history of stressful life event (AOR = 1.527, 95%CI: 1.02,2.3), back pain over the past 30 days (AOR = 2, 95%CI: 1.30,3.11), working for more than 8 hours (AOR = 3.03, 95%CI: 1.12,8.24), and having experience of 5–10 year (AOR = 4, 95%CI: 1.05,15.27) and 10–15 years (AOR = 4.24, 95%CI: 1.08,16.58) and poor social support (AOR = 2.09, 95%CI: 1.09,3.99) were statistically associated with increased level of depression. Conclusion Healthcare professionals’ higher rate of depression was due to the higher workload, childhood abuse, history of stressful life, back pain, and poor social support. Thus, the hospital should give special attention to early screening and treatment for depression for those healthcare workers who have a high workload, childhood abuse, back pain, a history of stressful life and poor social support. Similarly, the Ministry of Health should also design strategies to screen, detect and treat depression among healthcare workers.
... The first year of postgraduate medical training engages physicians in long duty hours and overnight shifts that negatively impact sleep and neurocognitive function, as well as physical and mental health. [3][4][5][6][7][8][9][10] To reduce physician workload while preserving educational and patient care goals, alternative schedules have been designed. [11][12][13][14][15][16] On a traditional call schedule, interns work 24-hour or longer shifts (overnight call) in addition to regular daytime work. ...
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Importance Extended work hours and night shifts are essential in health care, but negatively affect physician sleep, well-being, and patient care. Alternative schedules with shorter work hours and/or reduced irregularity might mitigate these issues. Objective To compare sleep, well-being, and cognition between interns working irregular, extended shifts (call schedule), and those working a more regular schedule with restricted hours (float schedule). Design, Setting, and Participants In this observational longitudinal cohort study, interns in a Singapore-based teaching hospital were studied for 8 weeks from January 2022 to July 2023. Data were analyzed from July 2023 to July 2024. Exposure Participants worked either regular approximately 10-hour workdays, interspersed with 24 hour or more overnight calls 4 to 5 times a month, or a float schedule, which included regular approximately 10-hour workdays, and 5 to 7 consecutive approximately 12-hour night shifts every 2 months. Exposure was based on departmental training and operational needs. Main Outcomes and Measures Sleep was measured with wearable sleep trackers and an electronic diary. Day-to-day well-being and cognitive assessments were collected through a smartphone application. Assessments included the Sleep Regularity Index (SRI; determines the probability of an individual being in the same state [sleep or wake] at any 2 time points 24 hours apart, with 0 indicating highly random sleep patterns and 100 denoting perfect regularity) and Pittsburgh Sleep Quality Inventory (PSQI; scores ranges from 0 to 21, with higher scores indicating poorer sleep; a score greater than 5 suggests significant sleep difficulties). Results Participants (mean [SD] age, 24.7 [1.1] years; 57 female participants [59.4%]; 41 on call schedule [42.7%]; 55 on float schedule [57.3%]) provided 4808 nights of sleep (84.2%) and 3390 days (59.3%) of well-being and cognition assessments. Participants on a float schedule had higher SRI scores (mean [SD] score, 69.4 [6.16]) and had better quality sleep (PSQI mean [SD] score, 5.4 [2.3]), than participants on call schedules (SRI mean [SD] score, 56.1 [11.3]; t 91 = 6.81; mean difference, 13.3; 95% CI, 9.40 to 17.22; P < .001; PSQI mean [SD] score, 6.5 [2.3]; t 79 = 2.16; 95% CI, 0.09 to 2.15; P = .03). Overnight call shifts, but not night float shifts, were associated with poorer mood (−13%; β = −6.79; 95% CI, −9.32 to −4.27; P < .001), motivation (−21%; β = −10.09; 95% CI, −12.55 to −7.63; P < .001), and sleepiness ratings (29%; β = 15.96; 95% CI, 13.01 to 18.90; P < .001) and impaired vigilance (21 ms slower; β = 20.68; 95% CI, 15.89 to 25.47; P < .001) compared with regular day shifts. Night shifts with naps were associated with better vigilance (16 ms faster; β = −15.72; 95% CI, −28.27 to −3.17; P = .01) than nights without naps. Conclusions and relevance In this cohort study, 24-hour call schedules were associated with poorer sleep, well-being, and cognition outcomes than float schedules. Naps during night shifts benefited vigilance in both schedules.
... Additional factors, including lack of sleep, limited social interactions, and the emotional burden of patient care, exacerbate these conditions (Dyrbye et al., 2011) highlighting the urgent need for awareness and better mental health resources tailored specifically for medical students (Edwin et al., 2024). These mental health issues can be the precursors of long-term professional repercussions, including burnout and decreased quality of patient care, further emphasizing the importance of addressing DAS among medical students early and effectively (Dahlin and Runeson, 2007;Sen et al., 2010). ...
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Background Depression, anxiety, and stress (DAS) have been linked to poor academic outcomes. This study explores the relationships among DAS, academic engagement, dropout intentions, and academic performance — measured by Grade Point Average (GPA) — in medical students. It aims to understand how these factors relate to each other and predict academic performance. Methods Data were collected from 351 medical students (74.9 % female) through an online survey. The average age was 20.2 years. Psychometric instruments measured DAS, academic engagement, and dropout intentions. Structural equation modeling was used to test the relationships between these variables and their prediction of GPA. Results DAS negatively associated academic engagement (β =-0.501; p<0.001) and positively connected to dropout intentions (β =0.340; p<0.001). Academic engagement positively predicted GPA (β =0.298; p<0.001) and negatively associated with dropout intentions (β =-0.367; p<0.001). DAS had a nonsignificant direct effect on GPA (β =-0.008; p=0.912). However, DAS indirect effect — via academic engagement — on GPA and dropout intention was statistically significant. Limitations The study’s limitations include the use of a convenience sample and the collection of all variables — except GPA — at the same time point, which may affect the generalizability of the results. Conclusions The study supports the important role of DAS in associating with academic engagement and dropout intentions, which can predict GPA. Addressing DAS could enhance academic engagement and reduce dropout rates, leading to better academic performance.
... Poor sleep quality is closely related to poor mental health as increased risk of depression and anxiety among medical intern's, further affecting their overall well-being and career satisfaction. 9 Various interventions can help to improve the quality of sleep and thereby prevent health consequences in intern's. 10,11 Providing education on sleep hygiene practices and the importance of sleep for physical and mental health can help intern's prioritize sleep and recognize signs of sleep disorders. ...
Article
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Background: Medical professionals are often subjected to long working hours and intensive academic teaching programs. This leads to altered sleep timings, duration, and quality. This study was carried out to assess the quality of sleep in medical intern’s at a tertiary care teaching hospital. Methodology: This was a cross-sectional, observational, descriptive study conducted among medical intern’s who were posted in various departments of a medical college in North India. A prestructured, pretested questionnaire incorporated into Google Forms was designed and circulated, containing questions on the Pittsburgh Sleep Quality Index (PSQI). All the data were collected in a single day. Results: A total of 130 intern’s participated in the study, where the mean global score (PSQI) was 6 with ± 2.82 values, and the global score ranged from 0 to 16. More than 70% of the students had a bad sleep quality (score 6–21). A majority of intern’s (70%) slept late at night (12–2.59 a.m.), and most (73%) woke up between 7 and 9 a.m. Around half of the people could fall asleep within 15 minutes of lying in bed, which increased to three-quarters within 30 minutes. Conclusion: A large proportion of medical intern’s have poor sleep quality and delayed sleep phase syndrome, which can increase their morbidity and also affect the quality of patient care.
... For example, in Malaysia, a recent study revealed that 28.6% of medical officers experience anxiety, 10.7% report depression, and 7.9% face stress. These figures align with the psychological distress rates observed in Western nations, which range from 7 to 29% (Sen et al., 2010). Nordin et al. (2022) found that individuals working in hospitals face a significantly higher risk of depression and anxiety than those working in peripheral healthcare services, with factors, such as extended working hours and 24-h on-call duties, contributing to this disparity. ...
Article
Every year, more than one million people worldwide die from suicide, which is attributed to depression in 6.7% of cases. These incidents often stem from life-related stresses that can progress into more severe mental health challenges, potentially leading to mental disorders. High levels of depression, anxiety, and stress are prevalent mental health issues that quietly infiltrate various aspects of people's lives, eroding their well-being. Early recognition and detection are essential for gaining a better understanding and implementing timely interventions to prevent further deterioration into mental disorders and associated complications. However, early recognition and detection alone are insufficient to prevent mental disorders. Effective therapeutic sessions are necessary to address and manage these conditions. Nonetheless, evaluating a patient's progress in therapy can be a challenging and somewhat ambiguous task, influenced by the biases and theoretical training of the clinicians involved, often yielding uncertain or unmeasured results. Therefore, this research aims to investigate how patients respond to therapy using data from electroencephalography (EEG) and heart rate variability (HRV) signals. This study introduces a therapeutic approach using sensational oil derived from the Gelam tree. Therapy sessions and consultations will be conducted for workers in the Kuala Terengganu region. During these sessions, EEG and HRV signals will help detect the levels of alpha and beta waves, enabling the recognition of physical signs and symptoms of stress and anxiety by interpreting visual and auditory cues using a mind-body technique. The findings from questionnaires, EEG, and HRV data will be combined and analysed using statistical methods. This combination of quantitative, qualitative, experimental, and statistical methods is expected to yield the following results: 1) predicting responses to therapy, 2) determining the timing and extent of response to therapy, and 3) assessing the suitability of the therapy approach. Overall, aroma therapy has been found to demonstrate great efficacy in inducing deep relaxation. Ultimately,
... Um fenômeno que tem se observado é o aumento do número de suicídio nas variadas profissões, e os médicos, profissionais de saúde e estudantes de medicina receberam destaque (Meleiro, 1998;Millan & Arruda, 2008), principalmente nos Estados Unidos, país que apresenta em suas estatísticas elevada taxa de suicídio. Cerca de 300-400 médicos morrem por suicídio a cada ano (AFSP, 2015;Gold, Sen & Schwenk, 2013;Sen, Kranzler, Krystal, Speller & Chan, 2010), no qual 1 médico morre por suicídio a cada dia. Nos artigos científicos relacionados a suicídio em médicos, como profissão isolada, as referências mostram que a taxa é maior do que em outras profissões (American Foundation for Suicide Prevention (AFSP), 2015, 2018Gunter, 2016;Hawton, Malmberg & Simkin, 2004;Sheikhmoonesi & Zarghami, 2014). ...
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O objetivo deste estudo foi realizar uma revisão sistemática da literatura para identificar e analisar as estratégias de prevenção do suicídio utilizadas em médicos. A classe médica é uma das que mais cometem suicídio, é um problema mundial e de saúde pública. A Organização Mundial da Saúde-OMS e outras organizações internacionais têm trabalhado juntas para reduzir o suicídio, no entanto, esse fenômeno não foi reduzido entre os médicos. A revisão sistemática foi realizada em cinco base de dados (PubMed, LILACS, SciELO, PsycINFO, Cochrane) com estudos publicados referentes à prevenção do suicídio em médicos nos últimos 11 anos (2008-2018). Foram encontrados apenas 05 artigos que atenderam os critérios de inclusão. Observou-se que não há homogeneidade ou sistematização clara nas intervenções, houve pouca participação dos médicos nos programas de prevenção do suicídio devido ao estigma do transtorno mental e ao suicídio, mas que foram eficazes para aqueles que procuraram por ajuda. Palavras-chave: médico; suicídio; prevenção do suicídio.
... These disturbances can impact personal life, academic performance, and the quality of healthcare service to patients. 2,3 A study conducted in Brazil revealed that out of 606 resident doctors, depression symptoms appeared in 19% of residents and had a significantly negative correlation with quality of life. 4 This is also consistent with the prevalence of depression among resident doctors in Indonesia. ...
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Introduction: A resident doctor is a doctor who has graduated from medical school, has earned the title of "doctor" and is currently undergoing a specific specialization postgraduate program. Resident doctors are at high risk of experiencing stress and depression. Depression greatly affects the quality of medical services provided by residents. Objective: This study aimed to determine the prevalence of depression, its relationship with various sociodemographic factors and several environmental factors, and its relation to the residency level of resident doctors in the Neurology Study Program, Faculty of Medicine, Universitas Indonesia. Material and Methods: This research was an analytic observational study with a cross-sectional design. All neurology resident doctors of Universitas Indonesia had filling out a questionnaire containing sociodemographic data and the Beck Depression Inventory-II (BDI-II) via Google Form platform. Then, the data were analyzed using chi-square and regression analysis. Result: In this study, 53 (66.2%) participants were females and 16 (33.8%) were males. Sixty-five participants were analyzed with 4 participants excluded. The overall prevalence of depression was 18.2%, with mild depression at 9.2% and moderate depression at 9.2%. Depression was more common in females than males (10.8% vs 7.7%). The residency level and supervisor support have a significant association with the incidence of depression. Conclusion: Our study found that 18.4% of neurology resident doctors had depression. Residency level and senior/supervisor support were significantly associated with depression among resident doctors.
... During the COVID-19 pandemic, poor psychological health was associated with multiple factors [1][2][3][4], including insomnia [16,17], among healthcare workers. As a common form of psychological distress during clinical training, depression can have bidirectional effects with medical errors [18]. With changes in clinical training, AHTs and PGY doctors may have experienced even greater psychological distress than normal, which may have subsequently negatively impacted care of their patients. ...
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Background Clinical training for allied health trainees (AHTs) and postgraduate-year (PGY) doctors needed to go online during the outbreak of coronavirus disease 2019 (COVID-19), which may have caused academic stress and consequent outcomes among this cohort. Material/Methods To evaluate academic-related stress, clinical confidence, psychological distress, and insomnia, an online survey-based study was conducted among Taiwanese AHTs and PGY doctors between July and December, 2022, during the COVID-19 pandemic. The survey included the 21-item Depression, Anxiety, and Stress Scale (DASS-21), the Insomnia Severity Index (ISI), and self-designed questions. It was distributed using convenience sampling and snowball sampling and was completed by 522 participants. Results Structural equational modelling showed that academic stress was negatively associated with clinical confidence (standardized coefficient [β]=−0.382, p<0.001). Clinical confidence was negatively associated with psychological distress (β=−0.397, p<0.001), which was associated with insomnia (β=0.648, p<0.001). Additionally, clinical confidence and psychological distress were the significant mediators. Results indicated that higher academic stress was associated with higher level of insomnia via the mediation of clinical confidence and psychological distress. Conclusions Academic stress related to changes in clinical training may have led to insomnia among AHTs and PGY doctors during the pandemic. Factors to reduce academic stress should be investigated to promote good mental health while providing sufficient clinical training, especially during events that can cause increased stress (eg, epidemics, pandemics).
... Some studies found higher rates of depression compared to the general population [5], which have been associated with the delivery of low-quality care and an increase in errors during healthcare practices [10,11]. In this context, research also emphasizes variances among different specialties, different years of training, or in relation to gender [12][13][14]. The importance of proactively addressing this issue is evident, especially considering that residents have been found to be less prone to seek help through mental health services [15]. ...
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Medical residents constitute a vulnerable population susceptible to mental health disorders. In Italy, this was evident during the COVID-19 pandemic, when medical residents served on the front line and provided significant support to healthcare services. Therefore, the working group on “Public Mental Health” of the Medical Residents’ Council of the Italian Society of Hygiene, Preventive Medicine, and Public Health (S.It.I.) designed the “Residents’ mental health investigation, a dynamic longitudinal study in Italy” (ReMInDIt). This longitudinal study aims to assess the mental status of medical residents and to explore potential cause–effect relationships between risk/protective factors (identified among sociodemographic, residency program, and lifestyle characteristics) and mental health outcomes (anxiety and depressive symptoms). Data will be collected from a study population of 3615 residents enrolled in Italian residency programs in public health, occupational medicine, and forensic medicine through an online questionnaire that includes validated tools, requires 10 min for completion, and is disseminated by the residents’ Councils. It will be followed by a follow-up administration after 12 months. The ReMInDIt study will play a significant role in generating evidence crucial for enhancing mental health services and promoting protective factors for the mental well-being of this important segment of healthcare professionals.
... The combination of these factors can have adverse consequences on their mental health (Papp et al., 2004;Sen et al., 2010;Ogawa et al., 2018;Zhou et al., 2020;Awan et al., 2022). International reviews suggest that the prevalence of burnout among medical residents ranges from 35.7% (Rodrigues et al., 2018) to 51% (Low et al., 2019), and depression or depressive symptoms from 20.9% to 43.2 (Mata et al., 2015), respectively. ...
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Introduction The mental health of residents is a growing significant concern, particularly with respect to hospital and university training conditions. Our goal was to assess the professional, academic, and psychological determinants of the mental health status of all residents of the academy of Lyon, France. Materials and methods The Health Barometer of Lyon Subdivision Residents (BASIL) is an initiative which consists in proposing a recurrent online survey to all residents in medicine, pharmacy, and dentistry, belonging to the Lyon subdivision. The first of these surveys was conducted from May to July 2022. Participants should complete a series of validated questionnaires, including the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), and the Kessler Psychological Distress Scale (K6), respectively, and ad-hoc questions assessing their global health and hospital and academic working conditions. A Directed Acyclic Graph (DAG) analysis was conducted prior to multivariable analyses, to explore the determinants associated with low wellbeing (WEMWBS <43) and high psychological distress (K6 ≥ 13). Results A total of 904 residents (response rate: 46.7%) participated in the survey. A low level of wellbeing was observed in 23% of participants, and was significantly associated to job strain (OR = 2.18; 95%CI = [1.32–3.60]), low social support (OR = 3.13; 95%CI = [2.05–4.78]) and the experience of very poor university teaching (OR = 2.51; 95%CI = [1.29–4.91]). A high level of psychological distress was identified for 13% of participants, and associated with low social support (OR = 2.41; 95%CI = [1.48–3.93]) and the experience of very poor university teaching (OR = 2.89, 95%CI = [1.16–7.21]). Conclusion Hospital working conditions, social support, and the perception of teaching quality, were three major determinants of wellbeing and psychological distress among health profession residents. Demographic determinants, personal life and lifestyle habits were also associated. This supports a multilevel action in prevention programs aiming to enhance wellbeing and reduce mental distress in this specific population and local organizational specificities.
... Factors contributing to this stress include intense emotional demands, such as sleep deprivation, constant exposure to suffering patients, lack of autonomy, and a fast-paced work environment. Additionally, issues such as burnout and alcohol abuse have been reported during medical training (46)(47)(48)(49)(50)(51)(52)(53)(54)(55). These challenges were further exacerbated by the social isolation measures and lifestyle adjustments necessitated by the COVID-19 pandemic (56). ...
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Gamified interventions are an emerging approach in mental health treatment and prevention. Their positive effects on managing various clinical conditions stem from enhancing social skills. However, cost-effective options like Table-top Role-Playing Games (TTRPGs), which offer similar benefits to other game-based interventions, lack standardized methods for ensuring replicability. In this regard, the method outlined in this study endeavors, in a structured and guided manner drawing from the Consolidated Framework for Implementation Research (CFIR), to establish a six-step protocol for developing an intervention method utilizing TTRPGs. In all Steps, we aim to anchor ourselves in robust literature concerning social skills training (SST), cognitive behavioral therapy (CBT), and gamification comprehensively. Thus, the method presented encompasses the objectives of SST, the strategies of CBT, and the dynamics of gamification via TTRPGs. Furthermore, we demonstrate a possible application of the method to illustrate its feasibility. Ultimately, the final method is structured, evidence-based, easily applicable, cost-effective, and thus viable. Mental health professionals seeking a structured and instructional tool for protocol development will find support in the method proposed here.
... For instance, a study on ACGME-Accredited Programs' residents found higher suicide rates early in residency, especially during specific academic months [19]. This parallels a study of 740 interns, where a 370% increase in suicidal ideation was noted in the initial three months of internship, highlighting the stress associated with transitions in medical training [54]. Several factors specific to our study context and methodology could explain this discrepancy. ...
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Background The mental health of medical residents, challenged by their intensive training, is of utmost concern. In light of reported suicides among Iranian medical residents in 2021, this study investigates the factors behind suicidal ideation among medical residents during the COVID-19 pandemic in Tehran. Methods This study conducted a cross-sectional online survey among medical residents in various specialties in Tehran, Iran, amidst the COVID-19 pandemic. Suicidal ideation was assessed using the Beck Scale for Suicidal Ideation (BSSI), while depression, anxiety, and stress were measured using the DASS-21. It also collected demographic and clinical data from the participants. The data were analyzed using descriptive statistics, the Chi-square test, and multiple linear regression to examine the prevalence and determinants of suicidal ideation among medical residents. Results The study enrolled 353 medical residents and found that 34.3% of them had suicidal ideation, with 10.2% indicating a high risk. The study also found high levels of depression, anxiety, and stress among the participants. The variables that significantly predicted suicidal ideation were depression, history of alcohol/substance use, personal history of suicide attempts, history of self-mutilation, family history of suicide attempts, number of shifts in a month, death of close persons because of COVID-19, and income. Depression was the strongest predictor of suicidal ideation. Conclusion These findings underscore the urgent need for effective interventions and support systems to address the mental health needs of medical residents in Iran. The strategies should prioritize destigmatizing mental health, promoting access to mental health services, fostering a supportive training environment, and enhancing income opportunities.
... S1 Fig displays the mood scale. In addition, minute by minute sleep, heart rate, and step counts were collected while they wore the provided Fitbit device [38,39]. ...
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The interplay between circadian rhythms, time awake, and mood remains poorly understood in the real-world. Individuals in high-stress occupations with irregular schedules or nighttime shifts are particularly vulnerable to depression and other mood disorders. Advances in wearable technology have provided the opportunity to study these interactions outside of a controlled laboratory environment. Here, we examine the effects of circadian rhythms and time awake on mood in first-year physicians using wearables. Continuous heart rate, step count, sleep data, and daily mood scores were collected from 2,602 medical interns across 168,311 days of Fitbit data. Circadian time and time awake were extracted from minute-by-minute wearable heart rate and motion measurements. Linear mixed modeling determined the relationship between mood, circadian rhythm, and time awake. In this cohort, mood was modulated by circadian timekeeping (p<0.001). Furthermore, we show that increasing time awake both deteriorates mood (p<0.001) and amplifies mood’s circadian rhythm nonlinearly. These findings demonstrate the contributions of both circadian rhythms and sleep deprivation to underlying mood and show how these factors can be studied in real-world settings using Fitbits. They underscore the promising opportunity to harness wearables in deploying chronotherapies for psychiatric illness.
... Residency is a stressful, overwhelming period during which residents work long hours and during which the lives of others depend on residents as they increase their knowledge base exponentially [1]. Studies have suggested that resident physicians experience higher rates of depression than the general public [2], [3]. ...
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Doctors are not protected from the occurrence and consequences of mental illnesses, doctors (especially board trainees) face particular challenges such as high patients’ attendance, long duty hours, potentially violent situations, and critical decision-making that place them at more risk of anxiety, depression and other stress related psychosocial problem. The current study aimed to identify the prevalence of mental health problem and depressive syndrome among Iraqi and Arab board trainees in Medical City Teaching Center. A cross sectional study was carried out from 1/1/2022 to 1/4/2022 at the Medical City Teaching Campus using a questionnaire consisting of socio-demographic variables, Self-reporting questionnaire (SRQ-20) to detect the presence of mental illness and screened for depression by a standardized scale; Diagnostic and Statistical Manual Version IV (DSM-IV). Among the 535 participants 500 complete and returned the questionnaire with response rate of 93.4%. The prevalence of mental illness was 71.2%, it was more among males 55.9%, single 77.8%, had (≥4 children) 72.7% and trainees of surgical branches 78%. The associations were significant with branch of trainees. The prevalence of depressive symptoms was 15.4%. Higher rates were among males 63.6%, single trainees 35.3%, with children 12% and working in surgical branches 13.7% The associations were significant with branch of trainees. The current study revealed that mental illness is prevalent among board trainees. Male gender, single, having children and working in the surgical specialty were associated with higher rates of both mental illness and depression.
... 14 It is a primary cause of global disability and a significant contributor to the worldwide disease burden. 15 Resident physicians have been documented to exhibit higher depression rates compared to the general populace, [16][17][18] with reported depression prevalence or depressive symptoms ranging between 20.9% and 43.2%. 19 Among Saudi resident physicians, perceived stress is comparably high or slightly higher than global rates, 20 with regional studies showing depression prevalence from 57.3% to 75.8%. ...
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Background The mental health of healthcare workers, particularly family medicine residents, is an area of growing concern, more so in the context of the COVID-19 pandemic. High levels of burnout and depression among these professionals can affect their well-being and patients’ quality of care. Objectives The study aimed to determine the prevalence of depression and burnout among family medicine residents in Riyadh, Saudi Arabia. Materials and Methods A cross-sectional study was conducted among 213 family medicine residents, using a self-administered survey. The survey included the Maslach Burnout Inventory and the Patient Health Questionnaire (PHQ)-9 to assess burnout and depression. Descriptive statistics were used to summarize participants’ characteristics, and regression model was developed to explore predictors of burnout and depression. Results The mean age of participants was 26.85±1.42 years, and 53.3% were males. The study found a high prevalence of emotional exhaustion (EE) and depersonalization (DP) among participants, with mean scores of 21.10±9.38 and 15.44±7.69, respectively, indicating moderate to high levels. Similarly, a high level of personal accomplishment (PA) was reported, with a mean score of 11.46±6.33. Around 10% of participants reported moderately severe and severe depression, with a mean PHQ-9 scale score of 6.03±5.10. Gender and depression severity were significantly associated with burnout (p=0.001 and p<0.001, respectively). Conclusion The study underscores a significant prevalence of burnout and depression among family medicine residents in Riyadh, with notable variations across different demographic and professional characteristics. This necessitates tailored mental health interventions for this population, especially in challenging times like the ongoing pandemic.
... Specifically, we developed models using data collected during the Intern Health Study. The Intern Health Study is a multi-site prospective study to examine relationships among behavior, mental health and well-being during a medical internship [25,26]. Interns employed at participating residency programs throughout the United State were able to enroll in the study online. ...
... Physicians and health professionals are among the occupational categories that are particularly vulnerable to the risk of suicide 1-3 , especially women 4 . Medical residents in training 5,6 and medical students are also a high-risk group for suicidal behavior [7][8][9] . Psychological stress, depressive symptoms and burnout are more prevalent in the early years of training, but these symptoms are comparatively more prevalent at any stage of the medical career than in other occupations 10 . ...
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Introduction: Physicians and medical students constitute groups at risk for suicide and suicidal behavior. Suicidal behaviors encompass phenomena ranging from thoughts, planning, and finally death by suicide. Little is known about suicidal behavior among Brazilian medical students. Objective: The aim of this study was to assess the prevalence of suicidal ideation, planning and suicide attempt in a sample of undergraduate medical students in Brazil, as well as to identify the sociodemographic, student life aspects and health factors most often associated with suicidal behavior. Method: A total of 722 medical students at Unicamp, during 2017 and 2018, voluntarily and anonymously answered a broad questionnaire, including sociodemographic data, aspects of academic life and suicidal behavior. A statistical analysis was performed using the chi-square test, Mann-Whitney test, and multivariate logistic regression. A statistical significance level of 95% was adopted. Results: The lifetime prevalence rates of suicidal thoughts, planning and attempts were respectively 196 (27.3%), 64 (8.9%), and 26 (3.6%). In the 30 days prior to the survey, 36 (5%) seriously thought about ending their own lives, and 11 (1.5%) concretely planned to end their own lives. Bullying, presence of mental disorder, seeking mental health care at the university, use of sedatives without a prescription, low socioeconomic level, living alone, religion (atheists, agnostics and spiritualists) and degree of religiousness are the factors that, together, best explain the chance of suicidal behavior. Conclusion: Medical students show important prevalence rates of suicidal behavior.
... Physicians and health professionals are among the occupational categories that are particularly vulnerable to the risk of suicide 1-3 , especially women 4 . Medical residents in training 5,6 and medical students are also a high-risk group for suicidal behavior [7][8][9] . Psychological stress, depressive symptoms and burnout are more prevalent in the early years of training, but these symptoms are comparatively more prevalent at any stage of the medical career than in other occupations 10 . ...
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Resumo: Introdução: Médicos e alunos de Medicina são grupos de risco para o suicídio e comportamento suicida. Comportamentos suicidas abrangem fenômenos que vão desde pensamentos, planejamentos, tentativas e até a morte por suicídio. Sabe-se pouco sobre o comportamento suicida entre estudantes de Medicina brasileiros. Objetivo: Este estudo teve como objetivos avaliar a prevalência de ideação, planejamentos e tentativas suicidas em uma amostra de estudantes de graduação em Medicina do Brasil, e identificar os fatores sociodemográficos, de vida estudantil e de saúde mais associados a esses comportamentos. Método: Participaram do estudo 722 alunos do curso de Medicina da Unicamp, durante os anos de 2017 e 2018, que responderam de forma voluntária e anônima a um questionário amplo, que incluía dados sociodemográficos, de vida acadêmica e de comportamento suicida. A análise estatística foi realizada por meio do teste de qui-quadrado, do teste de Mann-Whitney e da regressão logística múltipla. Adotou-se o nível de significância estatística de 95%. Resultado: As prevalências de pensamentos, planejamento e tentativas de suicídio ao longa da vida foram respectivamente 196 (27,3%), 64 (8,9%) e 26 (3,6%). Nos 30 dias que antecederam a pesquisa, 36 (5%) pensaram seriamente em pôr fim à própria vida, e 11 (1,5%) planejaram concretamente colocar fim a própria vida. Bullying, presença de transtorno mental, procura de assistência em saúde mental na universidade, uso de calmante sem prescrição médica, baixo nível socioeconômico, morar sozinho, religião (ateus, agnósticos e espiritualistas) e grau de religiosidade são os fatores que, conjuntamente, melhor explicam a chance de comportamento suicida. Conclusão: Alunos de Medicina apresentam prevalências importantes de comportamento suicida.
... We also showed the usefulness of our method in the assessment of inter-and intra-individual differences in the HR clock (figure 5) and circadian biomarker development ( figure 6). Our work and other ongoing large population field studies such as PiCADo [44], inCASA [45], Intern Health Study [46] and Social Rhythms [14] will rapidly facilitate the validation of wearables. ...
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Laboratory studies have made unprecedented progress in understanding circadian physiology. Quantifying circadian rhythms outside of laboratory settings is necessary to translate these findings into real-world clinical practice. Wearables have been considered promising way to measure these rhythms. However, their limited validation remains an open problem. One major barrier to implementing large-scale validation studies is the lack of reliable and efficient methods for circadian assessment from wearable data. Here, we propose an approximation-based least-squares method to extract underlying circadian rhythms from wearable measurements. Its computational cost is ∼ 300-fold lower than that of previous work, enabling its implementation in smartphones with low computing power. We test it on two large-scale real-world wearable datasets: [Formula: see text] of body temperature data from cancer patients and ∼ 184 000 days of heart rate and activity data collected from the 'Social Rhythms' mobile application. This shows successful extraction of real-world dynamics of circadian rhythms. We also identify a reasonable harmonic model to analyse wearable data. Lastly, we show our method has broad applicability in circadian studies by embedding it into a Kalman filter that infers the state space of the molecular clocks in tissues. Our approach facilitates the translation of scientific advances in circadian fields into actual improvements in health.
... Factores estresantes relacionados con la formación médica como la gran carga de trabajo, competitividad entre pares, exámenes constantes, maltrato de estudiantes de medicina, entre otros; contribuyen al aumento del riesgo de sufrir TDM en la formación médica. Los síntomas depresivos están asociados a variables sociodemográficas y clínicas, como antecedentes familiares de psicopatología (Sokratous, Merkouris y Middleton, 2014), antecedentes personales de depresión (Sen et al., 2010), género femenino (Goebert et al., 2009) y vivir solo (Roh et al., 2010). En particular, una historia de abuso durante la infancia o la adolescencia (Romo-Nava et al., 2019) están fuertemente asociados. ...
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Los estudiantes de medicina enfrentan múltiples factores estre- sores a lo largo de su formación. Los cuales, pueden estar asocia- dos con consecuencias graves como la falta de empatía con los pa- cientes y colegas, estrés crónico, síndrome de burnout, depresión y, en situaciones extremas, ideación e intento suicida. Además, los síntomas afectivos de importancia clínica pueden afectar su capacidad de aprendizaje y rendimiento académico, lo que tam- bién puede tener importantes implicaciones a largo plazo. ◆ La literatura sugiere que las mujeres médicas enfrentan obstá- culos profesionales significativamente mayores en comparación con sus contrapartes masculinas: puestos no privilegiados para médicas en investigación, especialidades quirúrgicas, roles de liderazgo. Además, factores estresantes como el acoso, los avan- ces sexuales coercitivos, el abuso moral, el cinismo y los comen- tarios sexistas, son posibles impulsores de la vulnerabilidad a la depresión para las mujeres en las escuelas de medicina. ◆ El currículo oculto es un influyente conocido de los resultados educativos, incluidas las normas, los valores y las creencias del entorno social educativo que no se enseñan abiertamente en el currículo formal, el cual, promueve la empatía, la colegiali- dad y la igualdad; mientras que en el currículo oculto se puede rechazar esos valores y dar como resultado la aceptación o normalización del maltrato. ◆ Los estudiantes que ingresan a la carrera de medicina puntúan más alto en asertividad, autoestima, rasgos narcisistas, altas ex- pectativas y algunas medidas de estrés, ansiedad y mala salud mental, y también puntúan más bajo en autosuficiencia. ◆ La calidad de las relaciones familiares, incluido el apoyo social- comunitario influye en el bienestar y salud mental de los estu- diantes de medicina. ◆ La naturaleza estresante de la educación médica puede afectar su bienestar físico y mental, su capacidad para empatizar con su entorno, asociarse a la presencia de fatiga por compasión, problemas en medidas de autocuidado como es la higiene de sueño, el ejercicio y la alimentación. ◆ La educación médica implica emociones y los estudiantes de- ben aprender a manejar las propias, así como contender con las de los demás (por ejemplo, sus pacientes, familiares, colegas). ◆ Entre los recursos personales, el optimismo y la autoeficacia se han investigado como características individuales que constitu- yen amortiguadores del estrés percibido. ◆ La forma en que los estudiantes enfrentan el estrés académico (resiliencia) es la clave para determinar si se convierte o no en un problema de salud mental o podría tener un impacto en su desarrollo profesional posterior. ◆ Las escuelas y facultades de medicina deben implementar estudios para la conceptualización e implementación de in- tervenciones para mejorar la conciencia metacognitiva y las motivaciones de sus estudiantes durante su formación médica. ◆ La educación médica debe basarse en la investigación de los avances en la ciencia del aprendizaje.
... Factores estresantes relacionados con la formación médica como la gran carga de trabajo, competitividad entre pares, exámenes constantes, maltrato de estudiantes de medicina, entre otros; contribuyen al aumento del riesgo de sufrir TDM en la formación médica. Los síntomas depresivos están asociados a variables sociodemográficas y clínicas, como antecedentes familiares de psicopatología (Sokratous, Merkouris y Middleton, 2014), antecedentes personales de depresión (Sen et al., 2010), género femenino (Goebert et al., 2009) y vivir solo (Roh et al., 2010). En particular, una historia de abuso durante la infancia o la adolescencia (Romo-Nava et al., 2019) están fuertemente asociados. ...
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La pandemia por COVID-19 ha evidenciado el reto de diseñar y gestionar ambientes virtuales de aprendizaje. ◆ En el ámbito médico la supervisión educativa y mentoría es un fuerte pilar del proceso enseñanza y aprendizaje que se ha visto afectado en los últimos meses por la pandemia teniendo que recurrir a diversas estrategias de mentoría en línea para cum- plir con los objetivos. ◆ Los ambientes de aprendizaje exigen un cambio de paradigma educativo de los involucrados que fomente la reflexión y el pen- samiento crítico. ◆ El liderazgo es una habilidad necesaria en la formación médica, ya que involucra la toma de decisiones y el trabajo colaborativo.
... It is also worth noting that both burnout and depression among healthcare workers have negative repercussions on the healthcare system. These repercussions include patient dissatisfaction, high turnover rates, medical errors, and associated financial costs [7,[11][12][13]. Therefore, understanding the prevalence of burnout and depression among healthcare workers, especially in stressful environments such as emergency departments (EDs) and critical care units (CCU), is an excellent step toward managing these conditions. ...
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Burnout and depression are global problems affecting healthcare providers, especially those working in stressful departments such as emergency departments (EDs) and critical care units (CCUs). However, pooled data analysis comparing healthcare providers operating in the ED and CCU is yet to be conducted. Therefore, this meta-analysis was systematically conducted to investigate and compare the prevalence of burnout and depression among emergency medicine (EM) and critical care medicine (CCM) professionals. We systematically searched for articles related to our research topic using the database search method and manual search method, which involved reviewing the reference lists of articles from electronic databases for additional studies. After screening the literature from the databases using the eligibility criteria, a quality appraisal using the Newcastle-Ottawa scale was performed on the eligible studies. In addition, a meta-analysis using the Review Manager software was performed to investigate the prevalence rates of burnout and depression. A total of 10 studies with 1,353 EM and 1,250 CCM professionals were included for analysis in the present study. The pooled analysis did not establish any considerable differences between EM and CCM healthcare workers on the prevalence of high emotional exhaustion (EE) (odds ratio (OR) = 1.01; 95% confidence interval (CI) = 0.46-2.19; p = 0.98), high depersonalization (OR = 1.16; 95% CI = 0.61-2.21; p = 0.64), low personal accomplishment (PA) (OR = 0.87; 95% CI = 0.67-1.12; p = 0.28), and depression (OR = 1.20; 95% CI = 0.74-1.95; p = 0.45). Moreover, pooled data showed no considerable differences in EE scores (mean difference (MD) =-1.07; 95% CI =-4.24-2.09; p = 0.51) and depersonalization scores (MD =-0.31; 95% CI =-1.35-0.73; p = 0.56). However, EM healthcare workers seemed to have considerably lower PA scores than their CCM counterparts (MD = 0.12; 95% CI = 0.08-0.16; p < 0.00001). No considerable difference was recorded in the prevalence of burnout and depression between EM and CCM healthcare workers. However, our findings suggest that EM professionals have lower PA scores than CCM professionals; therefore, more attention should be paid to the mental health of EM professionals to improve their PA.
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Mistreatment from patients is prevalent and has far-reaching negative consequences. To develop a practice-based curriculum on patient-initiated mistreatment and examine participant perceptions before and after the curriculum. Single medical school in the United States. 306 senior medical students from classes 2022 and 2023. A single patient-initiated mistreatment session delivered during specialty-specific residency preparation courses (RPCs) featuring a literature discussion, a response framework, and patient-actor skills practice. Between February 2022 and October 2023, 22 sessions occurred. Electronic surveys were delivered before, following, and approximately eight months after each session. A total of 257 (84.0%) and 174 (56.9%) participants completed pre- and post-session surveys, respectively. Significant increases in mean scores were noted for confidence in recognizing mistreatment (pre-session 4.25, post-session 4.68; p < 0.001) and comfort in addressing mistreatment personally (pre-session 2.86, post-session 4.30; p < 0.001) and as a bystander (pre-session 2.98, post-session 4.27; p < 0.001). In the follow-up survey, participants noted that the session was useful in preparing them for residency. A novel patient-initiated mistreatment curriculum empowered students, resulting in enhanced confidence in responding and sustained skill usage. Medical schools may consider including this training for all graduating students.
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Depression and burnout syndrome among healthcare workers can have detrimental effects on psychological well-being and patient safety. The prevalence of such psychological difficulties is increasing among healthcare workers, often caused by various factors such as high workload, stress, and occupational trauma. When the effects of conditions such as burnout and depression on patient safety are examined, it is revealed that they contribute to an increased propensity of healthcare workers to make mistakes and to a decrease in the quality of patient care. On the other hand, depression and burnout among healthcare workers also affect their own health, leading to a high rate of attrition from the profession and even suicide. All of this causes serious harm to health workers, patients, and institutions. Therefore, intervention strategies to improve the psychological well-being of healthcare workers and enhance patient safety are of great importance. These strategies focus on various areas such as organizational culture, flexible working hours, support groups, counseling services, and professional development opportunities. The objective of this chapter is to examine the effects of depression and, especially burnout syndrome on both employee health and patient safety, as well as to evaluate prevention strategies.
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Suicide is a multifaceted public health problem that, unfortunately, remains the leading cause of death worldwide. Studies show that the rate of mental illness, particularly suicide, is higher among doctors than among the public, and the risk of depression and suicide among doctors has also increased. Interventions such as resilience and mindfulness programs can reduce suicidal thoughts among medical students. Suicide prevention programs should target high-risk groups, such as physicians. Studies have shown that medical students and physicians are at higher risk of suicide than the general population. The prevalence of mental health issues and suicidal thoughts increases during medical school. Psychological factors, such as burnout, depression, anxiety, and hopelessness, can lead to suicidal thoughts. Considering the worldwide significance of this issue and the recent increase in mortality among youthful Iranian physicians, we conducted and investigated the prevalence and possible causes of suicidal ideation among Iranian medical students and graduates in this study. The problem of suicides among Iranian doctors and the sudden increase in the deaths of doctors, especially young people, is dangerous. Suicides among Iranian medical, dental, and pharmacy students have increased in recent years. It may be beneficial to support populations at high risk for suicidal ideation and provide screening for early intervention, as well as raise awareness of the prevalence and impact of suicidal thoughts among male students, school officials, and teachers. Screening should include individuals with a family history of mental health issues and those who are separated from their parents, as these individuals are at increased risk for suicidal thoughts. Reducing the prevalence of suicidal ideation may benefit from smoking cessation interventions and stress-reducing curricula. In addition, studies show that work stress among Iranian doctors and dentists can affect their work and treatment. Controlling and managing occupational stress is vital to prevent future problems, as it can have physical and psychological consequences. High levels of occupational stress among these doctors can also pose a danger to their patients. Identifying the causes of physician suicide can help to control and manage it.
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Greater loneliness as well as a lack of social connectedness have often been associated with poorer sleep. However, the temporal dynamics and direction of these associations remain unclear. Aim of the current study was to examine bi-directional associations between loneliness/social connectedness and sleep in 48 stress-exposed medical students during their first medical internship, considered a period of heightened stress. We obtained trait-level questionnaire data on loneliness and global sleep completed before and during the internship as well as state-level diary- and wearable-based data on daily changes in social connectedness and sleep collected twice over the period of seven consecutive days, once before and once during the internship. Bi-directional associations among greater loneliness and higher daytime dysfunction on trait-level were identified. In addition, several uni-directional associations between loneliness/social connectedness and sleep were found on trait- and state-level. In sum, findings of this study point at a bi-directional relation among loneliness/social connectedness and sleep, in which variables seem to reciprocally influence each other across longer-term periods as well as on a day-to-day basis.
Article
Objective Despite depression being common in residents, there are no published studies on the prevalence and risk factors for depression in emergency medicine (EM) interns. Our objectives were to explore the prevalence of depression among EM interns and to identify risk factors for depression including sleep, work hours, rotation type, race, ethnicity, sex, and age. Methods The Intern Health Study is a national longitudinal cohort study on intern mental health in all specialties. Secondary analysis was performed for EM interns only in this study. Data were collected from 2007 to 2021 and study participants completed a pre–intern year baseline survey and quarterly surveys throughout intern year, which included demographics and information on depressive symptoms, work hours, sleep, and rotation specifics. Depression severity was objectified using the Patient Health Questionnaire (PHQ9) with scores of 10 and higher meeting criteria for moderate to severe depression. Results A total of 1123 EM interns completed all surveys. The prevalence of moderate to severe depression among EM interns before starting internship was 4.8%. At Months 3, 6, 9, and 12 of intern year, the prevalence of moderate to severe depression was 17.8%, 20.5%, 20.8%, and 18.8%, respectively. PHQ9 scores were significantly higher at Month 3 of intern year compared to pre–intern year, but there were no differences at subsequent time points during intern year ( p < 0.001). Females were more likely to have PHQ9 scores of 10 or above at all time points ( p < 0.001). Clinical rotation type had a significant effect on PHQ9 scores, with intensive care unit rotations having a significantly higher PHQ9 score than other rotations ( p < 0.001). Pearson's correlation revealed significant weak positive correlations between work hours and PHQ9 at each time point ( r = 0.195, 0.200, 0.202, 0.243) and significant weak negative correlations between sleep hours and time off with PHQ9 (−0.162, −0.223, −0.180, −0.178; all p < 0.001). Conclusions Many EM interns experience moderate to severe depression. Female EM interns are more likely to be depressed than male interns. Numerous factors influence depression scores for interns, many of which are modifiable.
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Wellness and resilience are central to health care as physician burnout rises. Numerous publications have identified this “epidemic” of burnout [1]. Burnout was first published in medical literature in 1974, and since then, it has been identified in a many professions. The Accreditation Council for Graduate Medical Education (ACGME) has partnered with the Association of American Medical Colleges (AAMC) and National Academy of Medicine (NAM) to create the Action Collaborative on Clinician Well-Being and Resilience. This network of more than 60 organizations is committed to reversing trends in clinician burnout [2].
Article
Mục tiêu: Mô tả thực trạng trầm cảm, lo âu, stress ở một số nhóm học viên chuyên khoa I Đại học Y Hà Nội năm 2022 và phân tích một số yếu tố liên quan. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang trên 308 học viên Chuyên khoa I của trường Đại học Y Hà Nội năm 2022 được lựa chọn vào nghiên cứu bằng phương pháp chọn mẫu thuận tiện, sử dụng thang đo DASS-21 (thang đo trầm cảm, lo âu, stress). Phân tích số liệu bằng phần mềm STATA. Kết quả: Tỷ lệ biểu hiện trầm cảm, lo âu, stress của học viên Chuyên khoa I trường Đại học Y Hà Nội năm 2022 lần lượt là 37,01%; 39,61%; 27,60%. Các yếu tố liên quan đến biểu hiện trầm cảm, lo âu, stress của đối tượng nghiên cứu bao gồm tình trạng hôn nhân, thường xuyên gặp rắc rối trong các mối quan hệ, bệnh mãn tính, áp lực việc học lý thuyết trên trường, áp lực việc học lâm sàng, trực tại bệnh viện và áp lực thi cử, các mối liên quan có ý nghĩa thống kê với p < 0,05. Kết luận: Học viên Chuyên khoa I phải chịu căng thẳng trong quá trình học tập dẫn đến các biểu hiện lo âu, trầm cảm, stress. Do đó, các nhà quản lý cần xây dựng những chính sách hỗ trợ giúp học viên Chuyên khoa I có thể đối phó với các vấn đề trầm cảm, lo âu và stress tại cơ sở y tế.
Article
Objective This study investigated the relationship between work-related factors at baseline and the risk of common mental disorder at 12 month follow-up among a cohort of junior doctors. Method The data comprised the junior doctor respondents from two annual waves of the ‘Medicine in Australia: Balancing Employment and Life’ (MABEL) survey, a national longitudinal cohort of Australian doctors. Individual and work-related risk factors were assessed at baseline and the mental health outcome of caseness of common mental disorder (CMD) was assessed using the 6-item Kessler Psychological Distress Scale at 12-month follow-up. Unadjusted and adjusted logistic regressions were conducted to estimate the association between each baseline variable and the likelihood of CMD caseness at follow-up 1 year later. Results Among 383 junior doctors, 24 (6%) had CMD 1 year later. Five work-related baseline variables were significantly associated with a higher likelihood of CMD 1 year later in adjusted models; lack of social support in work location (odds ratios (OR) = 6.11; 95% confidence intervals (CI) = [2.52, 14.81]), work-life imbalance (OR = 4.50; 95% CI = [1.31, 15.46]), poor peer support network in the workplace (OR = 2.61; 95% CI = [1.08, 6.27]), perceptions of patient expectations (OR = 2.46; 95% CI = [1.06, 5.71]) and total weekly work hours (OR 1.04; 95% CI = [1.01, 1.07]; p = 0.002)in models adjusting for gender. Conclusion These results identify key modifiable work-related factors that are associated with junior doctors’ future mental health. Our findings suggest the need for a greater focus upon interpersonal factors and work-life balance in multi-level interventions while continuing to address workplace and system-level factors to prevent future mental disorder in junior doctors.
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Medical studies are hard to manage especially for students with specific needs. These students warrant some adaptations in studies and trainings in order to achieve learning goals. Studies showed they face structural and cultural barriers and stigma. Current efforts aim to encourage integration of these persons in order to increase diversity. This study aimed to assess perception of Tunisian medical students with specific needs. Cross-sectional study through online questionnaire including learners affiliated to the Faculty of Medicine of Tunis (students, interns, and residents) who consider they have specific needs. This questionnaire was elaborated by authors and explored barriers faced by participants, needed help, and suggested solutions. Study respected consent and confidentiality. This study included 40 participants. Most of them (n = 32) were post-graduate (interns and residents). The most reported condition was mental disability (n = 14). Main challenges faced by participants were work time schedule, unhealthy lifestyle, and negative attitudes from peers and supervisors, and 19 felt victim of stigma. Reported specific needs were adapting work schedule and psychological support from peers, from supervisors, or from mental health professionals. Almost half of the participants did never disclose their difficulties (n = 21). Suggested solutions involved to have a counseling center within the faculty. Only 8 participants knew there was a new unit helping students with specific needs in FMT. Despite efforts of the university, medical learners with chronic conditions still face many structural and cultural barriers to inclusion. Most participants suggested to have more psychological support from faculty.
Article
Study objectives: Reduced sleep duration and work hour variability contribute to medical error and physician burnout. This study assesses the relationships between physician performance, burnout and the dimensions of sleep beyond hours slept. Methods: This was an ancillary analysis of 3 years of data from the international prospective cohort study: the Intern Health Study. Actigraphy data from 3,654 intern physicians capturing sleep timing, regularity, efficiency, and duration were used individually and combined as a composite sleep health index to measure the association of multi-dimensional sleep patterns on self-reported medical errors and burnout. Results: From 2017 to 2019, Interns' work hours decreased by 4 hours per week while total sleep time also decreased (6.7 to 5.99 hours) and sleep efficiency, timing and regularity all worsened (all p<0.05). In the 21.2% of participants who committed an error, there was no difference in sleep duration, timing or regularity. Lower sleep efficiency was associated with higher odds of committing an error (p=0.003) and higher burnout scores (p<0.001). While overall sleep quality was poor in the entire cohort, Interns in the lowest quintile of sleep duration, regularity and efficiency had higher burnout scores than those in the best quintile. Conclusions: Sleep efficiency, not duration, was associated with increased self-reported medical errors and burnout in Intern physicians. Overall sleep quality and duration worsened despite fewer hours worked. Future studies on physician burnout should measure all aspects of sleep health.
Article
Objectives: The current study aimed to explore the moderating role of psychological resilience in the association between workload and depressive symptoms among radiology residents during standardized residency training (SRT) in China. Methods: A nationwide cross-sectional online survey was conducted among radiology residents in China. Workload was measured by working hours per week and the frequency of frontline nightwork in the last month. Resilience was assessed by the 2-item Connor-Davidson Resilience Scale. Depressive symptoms were measured by the Depression Anxiety Stress Scales. The hierarchical regression and simple slope analyses were performed to examine the moderating effect of resilience. Results: Among 3666 radiology residents, the mean age was 27.3 years (SD = 2.6) and 58% were female. About 24.4% of the participants reported medium to severe depressive symptoms. The hierarchical regression showed that working hours (ba = 0.11, 95%CI: 0.08, 0.14) and having frontline nightwork more than once (ba = 1.22, 95%CI: 0.67, 1.78) were positively associated with depressive symptoms; the moderating effect of resilience was significant in the association of depressive symptoms with working hours (ba = - 0.02, 95%CI: - 0.03, - 0.01) and having frontline nightwork more than once (ba = - 0.28, 95%CI: - 0.49, - 0.07). The simple slope test showed the association between workload-related variables and depressive symptoms was only significant in those with a relatively lower level of resilience. Conclusions: The study found that resilience was an important modifier buffering the positive association between workload and depressive symptoms among radiology residents in China. Future medical training programs are suggested to include effective intervention components to increase personal resilience. Clinical relevance statement: Heavy workload in clinical setting may pose adverse effect on mental health and job performance of radiology residents. The study investigated whether psychological resilience would mitigate the association between workload and depressive symptoms among Chinese radiology residents. Key points: • Radiology residents with a heavier workload presented a higher level of depressive symptoms in China. • Psychological resilience mitigated the positive association between workload and depressive symptoms. • The association between workload and depressive symptoms was only statistically significant in radiology residents with a relatively lower level of resilience.
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Background and objective Choosing a medical specialty is one of the most critical career decisions medical students and interns make. However, little is known about the factors these graduates consider when choosing their specialty. Our study assessed factors that medical students and interns consider when determining their specialty. Methods This is a cross-sectional survey-based study, conducted from November to December 2022. We utilized a previously published questionnaire for 1074 participants, including 837 medical students and 237 interns from Saudi Arabian universities. Results The majority of female participants (80.4%), compared with only 19.6% of male participants, considered interest in specific procedures and techniques typical of the specialty an important factor in choosing a specialty (p = 0.036). Dissertation research experience was an important factor for 83.5% of female participants and 16.5% of male participants (p = 0.024). Additionally, good quality teaching within the study program framework was important for 81.2% of female participants and 18.8% of male participants (p = 0.033), suggesting that male and female participants viewed the importance of good quality teaching differently. Female participants accounted for 80% of those who considered the overseas experience a factor in their specialty choice. Also, 74.4% of female and 25.6% of male participants considered friends, relatives, or other connections in the healthcare field a factor that affects their choice. Furthermore, 79.6% of female and 20.4% of male participants reported having good experiences with physician role models as an impactful factor in their specialty choice. Conclusion Female participants were most interested in obstetrics and gynecology (12.1%,), internal medicine (11.8%), and family medicine (10.8%). Male participants, on the other hand, showed more interest in family medicine (12.7%,), internal medicine (11.0%), and emergency medicine (10.1%). Medical schools and healthcare institutions must provide students and interns with enough information and resources to help them explore different specialties and make well-informed decisions about their careers.
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Objective: Mental health distress and suicidal ideation are leading contributors to the silent epidemic of physician suicide leading to approximately 300 to 400 physician deaths per year. The Second Trial has illuminated the alarming fact that several of our residents have experienced suicidal thoughts within the last year. Unfortunately, our institution is not an outlier. Suicidal ideation and under- or untreated mental health disorders are increasingly prevalent in the surgical trainee population. Given the major concern for our residents' well-being, our department consulted a licensed mental health professional familiar with resident training and the GME to develop a program to provide access to a mental health professional that is free of cost for trainees, safe and confidential. Design: Implementation of a 30 minute opt-out resident check-in program with a licensed mental health professional and a post-session survey that provided retrospective survey data for analysis. Setting: This program was implemented at the University of Virginia Health System in Charlottesville, VA. Participants: General surgery categorical and preliminary residents participated in this program. Results: Thirty residents participated in the program and an overwhelming majority would like to continue this program at regular intervals. Sessions were 25 minutes on average and 27.7% of participants requested additional sessions. Conclusions: Implementation of this program for our surgical trainees was favorably perceived with request for continuation of the program and provided access to a safe space with a familiar provider.
Article
Importance: The National Academy of Medicine's National Plan for Health Workforce Well-Being provides recommendations for supporting the mental health and well-being of health care workers. This article aims to guide implementation of National Academy of Medicine recommendations by describing 2 programs at Columbia University Irving Medical Center and the University of California, San Francisco (UCSF), designed early in the COVID-19 pandemic to respond to the behavioral health needs of the health care workforce. The development of these programs, their similarities and differences, and the key lessons learned are discussed. Observations: The well-being programs, CopeColumbia and UCSF Cope, shared key elements. Both efforts were led by their respective departments of psychiatry and used similar frameworks. Teams created strategic cross-university partnerships to share difficulties and successes across both programs. Moreover, both programs addressed compounding stressors of racial and political unrest, evaluated program components, and created resources for employee self-management. CopeColumbia and UCSF Cope differed in approaches to identifying high-risk employees and formal assessment and treatment pathways. From the authors' experience implementing these programs and having knowledge regarding health care workforce burnout, this article offers recommendations for the development of well-being programs. These include structural changes and resources to promote group and individual well-being emphasizing equity and justice, intentional involvement of psychiatry on well-being leadership teams, and bold efforts to destigmatize mental health care alongside clear paths to mental health treatment. Conclusions and relevance: The impact of the COVID-19 pandemic revealed a need for institutions to support the mental health and emotional well-being of health care workers. By outlining the development and implementation of 2 well-being programs in large academic health care settings and making recommendations to promote workforce well-being, it is the authors' hope that leaders will be empowered to carry forward critical changes. Most importantly, implementing plans now will provide the resilience needed both for the long shadow of the pandemic and future crises.
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Orthopaedic surgeons may, at times, derive less enjoyment from their work. Limited engagement can arise, on the one hand, from limited autonomy, burdens of care, and reduced reimbursement. On the other hand, surgeons may enjoy their work less if they feel less able to help people. For instance, people with pressing medical, mental, and social health opportunities may place inordinate hope on what an orthopaedic surgeon can do to improve their lives. Pressure to provide tests and treatment with more potential for harm than benefit can, at times, contribute to a sense of futility and emotional exhaustion. There may, at times, be small and large pressures that can induce surgeons to compromise respect for evidence and lapse in adherence to ethical principles, placing them at risk for moral injury. These aspects of orthopaedic practice seem important given the association between limited joy in practice and self-harm, abandoning medical practice, and errors and patient harm. There are things to consider when working on joy in practice, including recognizing and naming the unsavory parts of practice; making improvement in the area for creativity, innovation, and personal growth; and developing strategies to limit and alleviate stress.
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Context The Primary Care Evaluation of Mental Disorders (PRIME-MD) was developed as a screening instrument but its administration time has limited its clinical usefulness.Objective To determine if the self-administered PRIME-MD Patient Health Questionnaire (PHQ) has validity and utility for diagnosing mental disorders in primary care comparable to the original clinician-administered PRIME-MD.Design Criterion standard study undertaken between May 1997 and November 1998.Setting Eight primary care clinics in the United States.Participants Of a total of 3000 adult patients (selected by site-specific methods to avoid sampling bias) assessed by 62 primary care physicians (21 general internal medicine, 41 family practice), 585 patients had an interview with a mental health professional within 48 hours of completing the PHQ.Main Outcome Measures Patient Health Questionnaire diagnoses compared with independent diagnoses made by mental health professionals; functional status measures; disability days; health care use; and treatment/referral decisions.Results A total of 825 (28%) of the 3000 individuals and 170 (29%) of the 585 had a PHQ diagnosis. There was good agreement between PHQ diagnoses and those of independent mental health professionals (for the diagnosis of any 1 or more PHQ disorder, κ = 0.65; overall accuracy, 85%; sensitivity, 75%; specificity, 90%), similar to the original PRIME-MD. Patients with PHQ diagnoses had more functional impairment, disability days, and health care use than did patients without PHQ diagnoses (for all group main effects, P<.001). The average time required of the physician to review the PHQ was far less than to administer the original PRIME-MD (<3 minutes for 85% vs 16% of the cases). Although 80% of the physicians reported that routine use of the PHQ would be useful, new management actions were initiated or planned for only 117 (32%) of the 363 patients with 1 or more PHQ diagnoses not previously recognized.Conclusion Our study suggests that the PHQ has diagnostic validity comparable to the original clinician-administered PRIME-MD, and is more efficient to use. Figures in this Article Mental disorders in primary care are common, disabling, costly, and treatable.1- 5 However, they are frequently unrecognized and therefore not treated.2- 6 Although there have been many screening instruments developed,7- 8 PRIME-MD (Primary Care Evaluation of Mental Disorders)5 was the first instrument designed for use in primary care that actually diagnoses specific disorders using diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition9(DSM-III-R) and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition10(DSM-IV). PRIME-MD is a 2-stage system in which the patient first completes a 26-item self-administered questionnaire that screens for 5 of the most common groups of disorders in primary care: depressive, anxiety, alcohol, somatoform, and eating disorders. In the original study,5 the average amount of time spent by the physician to administer the clinician evaluation guide to patients who scored positively on the patient questionnaire was 8.4 minutes. However, this is still a considerable amount of time in the primary care setting, where most visits are 15 minutes or less.11 Therefore, although PRIME-MD has been widely used in clinical research,12- 28 its use in clinical settings has apparently been limited. This article describes the development, validation, and utility of a fully self-administered version of the original PRIME-MD, called the PRIME-MD Patient Health Questionnaire (henceforth referred to as the PHQ). DESCRIPTION OF PRIME-MD PHQ ABSTRACT | DESCRIPTION OF PRIME-MD PHQ | STUDY PURPOSE | METHODS | RESULTS | COMMENT | REFERENCES The 2 components of the original PRIME-MD, the patient questionnaire and the clinician evaluation guide, were combined into a single, 3-page questionnaire that can be entirely self-administered by the patient (it can also be read to the patient, if necessary). The clinician scans the completed questionnaire, verifies positive responses, and applies diagnostic algorithms that are abbreviated at the bottom of each page. In this study, the data from the questionnaire were entered into a computer program that applied the diagnostic algorithms (written in SPSS 8.0 for Windows [SPSS Inc, Chicago, Ill]). The computer program does not include the diagnosis of somatoform disorder, because this diagnosis requires a clinical judgment regarding the adequacy of a biological explanation for physical symptoms that the patient has noted. A fourth page has been added to the PHQ that includes questions about menstruation, pregnancy and childbirth, and recent psychosocial stressors. This report covers only data from the diagnostic portion (first 3 pages) of the PHQ. Users of the PHQ have the choice of using the entire 4-page instrument, just the 3-page diagnostic portion, a 2-page version (Brief PHQ) that covers mood and panic disorders and the nondiagnostic information described above, or only the first page of the 2-page version (covering only mood and panic disorders) (Figure 1). Figure 1. First Page of Primary Care Evaluation of Mental Disorders Brief Patient Health QuestionnaireGrahic Jump Location+View Large | Save Figure | Download Slide (.ppt) | View in Article ContextCopyright held by Pfizer Inc, but may be photocopied ad libitum. For office coding, see the end of the article. The original PRIME-MD assessed 18 current mental disorders. By grouping several specific mood, anxiety, and somatoform categories into larger rubrics, the PHQ greatly simplifies the differential diagnosis by assessing only 8 disorders. Like the original PRIME-MD, these disorders are divided into threshold disorders (corresponding to specific DSM-IV diagnoses, such as major depressive disorder, panic disorder, other anxiety disorder, and bulimia nervosa) and subthreshold disorders (in which the criteria for disorders encompass fewer symptoms than are required for any specific DSM-IV diagnoses: other depressive disorder, probable alcohol abuse or dependence, and somatoform and binge eating disorders). One important modification was made in the response categories for depressive and somatoform symptoms that, in the original PRIME-MD, were dichotomous (yes/no). In the PHQ, response categories are expanded. Patients indicate for each of the 9 depressive symptoms whether, during the previous 2 weeks, the symptom has bothered them "not at all," "several days," "more than half the days," or "nearly every day." This change allows the PHQ to be not only a diagnostic instrument but also to yield a measure of depression severity that can be of aid in initial treatment decisions as well as in monitoring outcomes over time. Patients indicate for each of the 13 physical symptoms whether, during the previous month, they have been "not bothered," "bothered a little," or "bothered a lot" by the symptom. Because physical symptoms are so common in primary care, the original PRIME-MD dichotomous-response categories often led patients to endorse physical symptoms that were not clinically significant. An item was added to the end of the diagnostic portion of the PHQ asking the patient if he or she had checked off any problems on the questionnaire: "How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?" As with the original PRIME-MD, before making a final diagnosis, the clinician is expected to rule out physical causes of depression, anxiety and physical symptoms, and, in the case of depression, normal bereavement and history of a manic episode. STUDY PURPOSE ABSTRACT | DESCRIPTION OF PRIME-MD PHQ | STUDY PURPOSE | METHODS | RESULTS | COMMENT | REFERENCES Our major purpose was to test the validity and utility of the PHQ in a multisite sample of family practice and general internal medicine patients by answering the following questions: Are diagnoses made by the PHQ as accurate as diagnoses made by the original PRIME-MD, using independent diagnoses made by mental health professionals (MHPs) as the criterion standard?Are the frequencies of mental disorders found by the PHQ comparable to those obtained in other primary care studies?Is the construct validity of the PHQ comparable to the original PRIME-MD in terms of functional impairment and health care use?Is the PHQ as effective as the original PRIME-MD in increasing the recognition of mental disorders in primary care patients?How valuable do primary care physicians find the diagnostic information in the PHQ?How comfortable are patients in answering the questions on the PHQ, and how often do they believe that their answers will be helpful to their physicians in understanding and treating their problems?
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Substantial resources are being devoted to identify candidate genes for complex mental and behavioral disorders through inclusion of environmental exposures following the report of an interaction between the serotonin transporter linked polymorphic region (5-HTTLPR) and stressful life events on an increased risk of major depression. To conduct a meta-analysis of the interaction between the serotonin transporter gene and stressful life events on depression using both published data and individual-level original data. Search of PubMed, EMBASE, and PsycINFO databases through March 2009 yielded 26 studies of which 14 met criteria for the meta-analysis. Criteria for studies for the meta-analyses included published data on the association between 5-HTTLPR genotype (SS, SL, or LL), number of stressful life events (0, 1, 2, > or = 3) or equivalent, and a categorical measure of depression defined by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) or the International Statistical Classification of Diseases, 10th Revision (ICD-10) or use of a cut point to define depression from standardized rating scales. To maximize our ability to use a common framework for variable definition, we also requested original data from all studies published prior to 2008 that met inclusion criteria. Of the 14 studies included in the meta-analysis, 10 were also included in a second sex-specific meta-analysis of original individual-level data. Logistic regression was used to estimate the effects of the number of short alleles at 5-HTTLPR, the number of stressful life events, and their interaction on depression. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated separately for each study and then weighted averages of the individual estimates were obtained using random-effects meta-analysis. Both sex-combined and sex-specific meta-analyses were conducted. Of a total of 14,250 participants, 1769 were classified as having depression; 12,481 as not having depression. In the meta-analysis of published data, the number of stressful life events was significantly associated with depression (OR, 1.41; 95% CI,1.25-1.57). No association was found between 5-HTTLPR genotype and depression in any of the individual studies nor in the weighted average (OR, 1.05; 95% CI, 0.98-1.13) and no interaction effect between genotype and stressful life events on depression was observed (OR, 1.01; 95% CI, 0.94-1.10). Comparable results were found in the sex-specific meta-analysis of individual-level data. This meta-analysis yielded no evidence that the serotonin transporter genotype alone or in interaction with stressful life events is associated with an elevated risk of depression in men alone, women alone, or in both sexes combined.
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To review the evidence for an association between depression and anxiety and the National Health Priority Area conditions -- heart disease, stroke, diabetes mellitus, asthma, cancer, arthritis and osteoporosis -- and for the effectiveness of treatments for depression and anxiety in these settings. Systematic literature search of systematic reviews, meta-analyses and evidence-based clinical practice guidelines published between 1995 and 2007, inclusive. Each review was examined and summarised by two people before compilation. Depression is more common in all disease groups than in the general population; anxiety is more common in people with heart disease, stroke and cancer than in the general population. Heterogeneity of studies makes determination of risk and the direction of causal relationships difficult to determine, but there is consistent evidence that depression is a risk factor for heart disease, stroke and diabetes mellitus. Antidepressants appear to be effective for treating depression and/or anxiety in patients with heart disease, stroke, cancer and arthritis, although the number of studies in this area is small. A range of psychological and behavioural treatments are also effective in improving mood in patients with cancer and arthritis but, again, the number of studies is small. The evidence for the association of physical illness and depression and anxiety, and their effects on outcome, is very strong. Further research to establish the effectiveness of interventions is required. Despite the limits of current research, policy and practice still lags significantly behind best evidence-based practice. Models of integrated care need to be developed and trialled.
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High rates of schizophrenia and other psychoses have been repeatedly found in migrant populations. However, the development of public health responses has been hindered by unfounded claims that the high rates are an artefact of misdiagnosis. Recent research implicating exposure to social adversity across the life course as the key explanation for these high rates has the potential to inform initiatives to tackle this major public health problem.
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Adverse childhood experiences have been described as one of the major environmental risk factors for depressive disorder. Similarly, the deleterious impact of early traumatic experiences on depression seems to be moderated by individual genetic variability. Serotonin transporter (5-HTT) and brain-derived neurotrophic factor (BDNF) modulate the effect of childhood adversity on adult depression, although inconsistencies across studies have been found. Moreover, the gene x environment (GxE) interaction concerning the different types of childhood adversity remains poorly understood. The aim of this study was to analyse the putative interaction between the 5-HTT gene (5-HTTLPR polymorphism), the BDNF gene (Val66Met polymorphism) and childhood adversity in accounting for adult depressive symptoms. A sample of 534 healthy individuals filled in self-report questionnaires of depressive symptomatology [the Symptom Check List 90 Revised (SCL-90-R)] and different types of childhood adversities [the Childhood Trauma Questionnaire (CTQ)]. The 5-HTTLPR polymorphism (5-HTT gene) and the Val66Met polymorphism (BDNF gene) were genotyped in the whole sample. Total childhood adversity (beta=0.27, p<0.001), childhood sexual abuse (CSA; beta=0.17, p<0.001), childhood emotional abuse (beta=0.27, p<0.001) and childhood emotional neglect (beta=0.22, p<0.001) had an impact on adult depressive symptoms. CSA had a greater impact on depressive symptoms in Met allele carriers of the BDNF gene than in the Val/Val group (F=5.87, p<0.0001), and in S carriers of the 5-HTTLPR polymorphism (5-HTT gene) (F=5.80, p<0.0001). Childhood adversity per se predicted higher levels of adult depressive symptoms. In addition, BDNF Val66Met and 5-HTTLPR polymorphisms seemed to moderate the effect of CSA on adult depressive symptoms.
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There has been a large but inconsistent literature on interactions between the 5-HTTLPR polymorphism of the serotonin transporter gene and adversity on emotional disorders. We investigated these interactions in 4,334 children from a birth longitudinal cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC). We measured emotional symptoms at 7 years with the Strengths and Difficulties Questionnaire. Mothers rated stressful life events between ages 5 and 7 years. Maternal depression was defined as a score > or =12 on the Edinburgh Postnatal Depression Scale at 2 or 8 months postnatally. Triallelic genoptyping of the 5-HTTLPR polymorphism was performed. We found strong associations between stressful life events (OR 1.19; 1.12-1.26; P < 0.01) and maternal postnatal depression (OR 1.91; 1.63-2.24; P < 0.01) with emotional symptoms in the children. There were no main 5-HTTLPR genotype effects or significant interactions between genotype and life events or maternal postnatal depression on emotional symptoms. There was marginal evidence (P = 0.08) for an interaction between stressful life events and genotype in boys only, with those in the low and high 5-HTTLPR expression groups showing stronger associations. In these 7-year-old children, we did not replicate previously reported G x E interactions between 5-HTTLPR and life events for emotional symptoms. Gene by environment interactions may be developmentally dependent and show variation depending on the type and levels of exposure and sex. Young cohorts are essential to improve our understanding of the impact of development on gene and environment interactions.
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Using data from 1,805 interns, residents, and fellows in Ontario, Canada, the authors report the prevalence of symptoms measured by the Center for Epidemiologic Studies Depression Scale (CES-D). They found that the proportion of subjects scoring as depressed was somewhat higher than that found in community studies. Women had higher depression scores than men. The proportion of unmarried house staff with moderate or severe depression scores was higher than that of married house staff. Considerable differences were found by specialty, and depression was most prevalent in the first year of postgraduate training. These findings have implications for those who direct postgraduate medical training or who seek to alleviate unnecessary stress in the postgraduate education experience.
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In a prospective survey for changes in emotions and attitudes of all medical interns of The Oregon Health Sciences University (N = 22) at six intervals during the 1982-1983 academic year, both positive and negative emotional changes were noted. Satisfaction with the decision to become a physician decreased during the period, a change that correlated directly with depression and fatigue and inversely with excitement and importance.
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To elucidate the nature of the etiologic relationship between personality and major depression in women. A longitudinal twin design in which twins completed a time 1 questionnaire and, 15 months later, were personally interviewed for the occurrence of major depression during the last year and completed a time 2-questionnaire. Both questionnaires contained short forms assessing neuroticism and extraversion. 1733 twins from female-female pairs ascertained from the population-based Virginia Twin Registry. Extraversion was unrelated to lifetime or 1-year prevalence of major depression. Neuroticism was strongly related to lifetime prevalence of major depression and robustly predicted the prospective 1-year prevalence of major depression in those who, at time 1, denied previous depressive episodes. However, controlling for levels of neuroticism at time 1, levels of neuroticism at time 2 were moderately elevated in those who had had an episode of major depression between times 1 and 2 ("scar" effect) and substantially elevated in those experiencing an episode of major depression at time 2 ("state" effect). In those who developed major depression, levels of neuroticism did not predict time to onset. In the best-fit longitudinal twin model, the proportion of the observed correlation between neuroticism and the liability to major depression that is due to shared genetic risk factors was estimated at around 70%, that due to shared environmental risk factors at around 20%, and that due to a direct causal effect of major depression on neuroticism (via both "scar" and "state" effects) at around 10%. Approximately 55% of the genetic liability of major depression appeared to be shared with neuroticism, while 45% was unique to major depression. In women, the relationship between neuroticism and the liability to major depression is substantial and largely the result of genetic factors that predispose to both neuroticism and major depression.
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The Revised NEO Personality Inventory (NEO-PI-R) consists of 30 facet scales that define the broad domains of the Five-Factor Model of personality. No major revisions of the basic model are anticipated in the near future. Despite their popularity, social desirability and inconsistency scales will not be added to the NEO-PI-R because their validity and utility have not yet been demonstrated. Among possible changes are minor modifications in wording and more extensive adaptations for adolescents and for populations with low reading levels. Contextualized (e.g., work-related) versions of the instrument will be further explored. Many changes are more easily implemented on the computer than the print version of the instrument.
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To investigate the relation between accident and emergency senior house officers' psychological distress and confidence in performing clinical tasks and to describe work related stressors. Questionnaire survey with data collected at four points during senior house officers' six month attachment to accident and emergency departments. 171 newly appointed accident and emergency senior house officers from 27 hospitals in the South Thames region. Psychological distress measured with a 25 item questionnaire; confidence in performing a range of 35 clinical and practical activities (visual analogue scales); reported consultation stress factors, other work related stressors, and personal stressors. Overall confidence scores in carrying out a range of clinical and practical activities increased significantly between the end of the first and the end of the fourth month (Z = -6.05, P < 0.001). Senior house officers with higher psychological distress scores at the end of their first and fourth month had significantly lower confidence scores (Z = -3.20, P < 0.001; Z = -1.90, P < 0.05). Senior house officers with lower increases in confidence between the first and fourth month had significantly higher distress than those with greater increases (Z = -2.62, P < 0.001). Factors identified as causing stress during consultations included difficulties with communication, certain clinical presentations, and department organisational factors (particularly the intensity of workload). Psychological distress is linked to confidence in senior house officers. This supports the need to monitor and build confidence in senior house officers and to address work related stressors. Additional communication skills training needs to be considered.
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Objective: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. Measurements: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. Results: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. Conclusion: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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Background According to epidemiologic studies that use recall of lifetime episodes, the prevalence of depression is increasing. This report from the Stirling County Study compares rates of current depression among representative samples of adults from a population in Atlantic Canada.Methods Sample sizes were 1003, 1201, and 1396 in 1952, 1970, and 1992, respectively. The depression component of the study's method, the DPAX (DP for depression and AX for anxiety), was employed. The original procedure (DPAX-1) was applied in all years. A revision (DPAX-2) was used in 1970 and 1992. The Diagnostic Interview Schedule (DIS) was also used in 1992.Results With the DPAX-1, the overall prevalence of current depression was steady at 5% over the 2 early samples but declined in 1992 because of vernacular changes referring to dysphoria. The DPAX-2 gave a stable overall prevalence of 5% in the 2 recent samples, but indicated that women and younger people were at greater risk in 1992 than in 1970. The DIS, like the DPAX-2, found a current 1992 rate of 5% for major depressive episodes combined with dysthymia. Recalled lifetime rates using the DIS showed the same profile interpreted in other studies as suggesting an increase in depression over time.Conclusions Three samples over a 40-year period showed a stable current prevalence of depression using the DPAX methods that was comparable in 1992 with the current rates using the DIS. This casts doubt on the interpretation that depression is generally increasing. Within the overall steady rate observed in this study, historical change was a matter of redistribution by sex and age, with a higher rate among younger women being of recent origin.
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OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. MEASUREMENTS: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. RESULTS: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. CONCLUSION: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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To investigate the modifying effects of two candidate genes (serotonin transporter gene linked promoter region (5-HTTLPR) and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphisms) on the associations between general somatic morbidity and incidence of depression in an East Asian population with high frequencies of potential risk alleles. With a 2-year prospective study of a community sample (N = 521) of older people (aged 65+), information on baseline number of health complaints, diagnosis of moderate/severe depressive syndrome (Geriatric Mental State), and genotypes for 5-HTTLPR and MTHFR C677T polymorphisms were ascertained. Interactions between somatic morbidity and the two genotypes were investigated for incident depression. Incident depression was present in 63 (12%) and was associated with worse somatic health. Significant interactions between number of somatic complaints and both genotypes were observed. For the 5-HTTLPR genotypes, the association between the number of somatic disorders and depression was significant in s/s homozygotes (chi2 = 8.80 (1 df), p = .003) but not in heterozygotes (chi2 = 0.23, p = .634) or l/l homozygotes (chi2 = 0.04, p = .840). For the MTHFR genotypes, the association between the number of somatic disorders and depression was significant in T/T homozygotes (chi2 = 4.97, p = .026) but not in C/T heterozygotes (chi2 = 1.24, p = .265) or C/C homozygotes (chi2 = 1.04, p = .307). These findings suggest that associations between general somatic morbidity and late-life depression are modified by at least two genes, and that elders with particular genotypes are at greater risk for onset of depression in the presence of somatic ill health.
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To assess genetic variability in two serotonin-related gene polymorphisms (MAOA-uVNTR and 5HTTLPR) and their relationships to depression and adverse cardiac events in a sample of patients undergoing coronary artery bypass surgery. A total of 427 coronary artery bypass graft (CABG) patients were genotyped for two polymorphisms and assessed for depressive symptoms at three time points, in accordance with the Center for Epidemiological Studies-Depression (CES-D): preoperative baseline; 6 months postoperative; and 1 year postoperative. Logistic regression was used to assess the association between depressive symptoms (CES-D = >16), genotype differences, and cardiac events. Because MAOA-uVNTR is sex-linked, males and females were analyzed separately for this polymorphism; sexes were combined for the 5HTTLPR analysis. Depressed patients were more likely than nondepressed patients to have a new cardiac event within 2 years of surgery (p < .0001); depressed patients who carry the long (L) allele of the 5HTTLPR polymorphism were more likely than the short/short (S/S carriers to have an event (p = .0002). Genetic associations with 6-month and 1-year postoperative depressive symptoms do not survive adjustment for baseline depressive symptoms. A serotonin-related gene polymorphism--5HTTLPR--was associated with adverse cardiac events post CABG, in combination with depressive symptoms. Because depressed patients with the L allele of the 5HTTLPR polymorphism were more likely to have an event compared with the S/S carriers, combining genetic and psychiatric profiling may prove useful in identifying patients at the highest risk for adverse outcomes post CABG.
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Polymorphisms of the serotonin transporter gene (SERT) have been associated with mental illness. In people with long-term medical conditions, variants of the 5-HTTLPR and STin2 VNTR polymorphisms of SERT have been shown to confer a heightened vulnerability to comorbid depression. To determine whether the 5-HTTLPR, STin2 VNTR, and rs25531 polymorphisms of SERT are associated with poststroke depression (PSD) in stroke survivors. A case-control study in which stroke survivors were screened for depressive symptoms and assigned to either a depressed group or a nondepressed group. Outpatient clinic. Seventy-five stroke survivors with PSD and 75 nondepressed stroke survivors. Blood or saliva samples were collected from each participant for DNA extraction and genotyping. The associations between the 5-HTTLPR, STin2 VNTR, and rs25531 polymorphisms and PSD. Individuals with the 5-HTTLPR s/s genotype had 3-fold higher odds of PSD compared with l/l or l/xl genotype carriers (odds ratio, 3.1; 95% confidence interval, 1.2-8.3). Participants with the STin2 9/12 or 12/12 genotype had 4-fold higher odds of PSD compared with STin2 10/10 genotype carriers (odds ratio, 4.1; 95% confidence interval, 1.2-13.6). An association of rs25531 with PSD was not shown. The 5-HTTLPR and the STin2 VNTR, but not the rs25531, polymorphisms of SERT are associated with PSD in stroke survivors. This gives further evidence of a role of SERT polymorphisms in mediating resilience to biopsychosocial stress.
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Major depressive disorder (MDD) occurs in a subset of patients receiving interferon-alpha treatment, although many are resilient to this side effect. Genetic differences in the serotonin reuptake transporter promoter (5-HTTLPR) may interact with the inflammatory system and influence depression risk. A cohort of 71 nondepressed hepatitis C patients about to receive interferon-alpha was prospectively followed, employing a diagnostic structured clinical interview (Structured Clinical Interview for DSM-IV Axis I Disorders [SCID-I]) and self-report questionnaires. Patients were genotyped for the 5-HTTLPR (L(G), L(A), and S) and the variable number of tandem repeats (VNTR) polymorphism in the second intron. Kaplan-Meier analyses were used to compare major depression incidence. Genotype effects on sleep quality (Pittsburgh Sleep Quality Index) and Beck Depression Inventory (BDI) were assessed using mixed-effect repeated-measure analyses. The L(A) allele was associated with a decreased rate of developing MDD (Mantel-Cox log rank test p < .05) with the L(A)/L(A) genotype being the most resilient. This genotype was also associated with better sleep quality [F(61.2,2) = 3.3, p < .05]. The ability of baseline sleep quality to predict depression incidence disappeared when also including genotype in the model. Conversely, the relationship of neuroticism with depression incidence (B = .07, SE = .02, p < .005) was not mitigated when including genotype. Using a prospective design, 5-HTTLPR is associated with MDD incidence during interferon-alpha treatment. Preliminary evidence that this effect could be mediated by effects on sleep quality was observed. These findings provide support for a possible interaction between inflammatory cytokine (interferon-alpha) exposure and 5-HTTLPR variability in MDD.
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Although it is universally accepted that human disease and behavior depend upon both environmental and genetic variation, a view supported by family and twin studies, examples of environmental interactions with genes identified at the molecular level (G x E) are not so well established. We carried out a systematic review and meta-analysis of the serotonin transporter (5-HTTLPR) polymorphic region x stressful life event (SLE) literature and investigated to what extent the main effects reported in this literature are consistent with a number of G x E hypotheses. Our aim was to provide a framework in which to assess the robustness of the claim for the presence of an interaction. The results from our systematic review and meta-analysis indicate that the main effect of 5-HTTLPR genotype and the interaction effect between 5-HTTLPR and SLE on risk of depression are negligible. We found that only a minority of studies report a replication that is qualitatively comparable to that in the original report. Given reasonable assumptions regarding likely genetic and environmental effect sizes, our simulations indicate that published studies are underpowered. This, together with other aspects of the literature, leads us to suggest that the positive results for the 5-HTTLPR x SLE interactions in logistic regression models are compatible with chance findings.
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Empirical research focused on the stressful aspects of residency training has largely ignored the interactions between residents' psychosocial and demographic characteristics, stressful experiences, emotional responsivity, and coping styles. This article presents the results of a questionnaire, completed by 165 residents, that consisted of the Profile of Mood States, the Hassles Scale, the Ways of Coping Questionnaire, and a series of questions regarding demographic data, social support system features, and residency stress factors. The residents reported that time demands and indebtedness were the major sources of stress in their residency programs. Social support variables were significantly related to the degrees to which the residents successfully coped with daily stress factors. While the women residents reported higher stress levels than did the men, they did not report higher levels of emotional distress. Finally, the lengths of time residents had spent in training were significantly related to the levels of their mood disturbances and daily hassles.
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Symptoms of anxiety/depression and suicidal ideation were studied in medical students, house staff, and their spouses/partners in a large midwestern school by means of an anonymous questionnaire. A total of 634 medical students and 227 house staff completed the questionnaire. A significantly higher proportion of female trainees than male trainees reported symptoms of anxiety/depression (41% compared with 27%). This difference between men and women was most marked during residency training. The proportion of men reporting anxiety/depressive symptoms declined between medical school (33%) and residency (10%). No such decline occurred with women (medical students 42%, residents 37%).
Article
To examine the need for preventive and treatment interventions, a prevalence study was conducted to ascertain the rate of depressive symptomatology and other negative mood states among 112 first-year residents. The participation rate was 54%. Subjects (N = 61) were administered the Beck Depression Inventory and Profile of Mood States in personal interview sessions. The Profile measures five negative mood states, namely, "tension-anxiety," "depression-dejection," "anger-hostility," "fatigue-inertia," "confusion-bewilderment," and one positive state, "vigor-activity." A 15.5% rate of depression was found, which is lower than a rate of 23.5%, also measured by Beck's inventory, among a sample of university undergraduates and 19.9% among an adult sample from the general population. No differences were observed among residency programs or sex on Beck's scale; however, significantly higher scores were found for women on the "depression-dejection" dimension of the Profile. The mean scores on all negative mood dimensions of the Profile were below the mean for university undergraduate norms. Neither sleep nor hours worked over the past week were associated with increased Beck scores. These results indicate that sleep deprivation and long work hours did not contribute to depression among the subjects who participated in the study. Female interns, however, appear to be at increased risk of depression, and adequate support systems need to be provided.
Article
In a study of 170 junior house officers who were followed up from their fourth year in medical school mean levels of stress were higher than in other reported occupational groups, and the estimated prevalence of emotional disturbance was 50%, with 28% of the subjects showing evidence of depression. Nearly a fifth of the subjects reported occasional or frequent bouts of heavy drinking, a quarter took drugs for physical illness, and a few took drugs for recreation. Those who were emotionally distressed at the initial study and the follow up were more empathetic and more self critical than those who had low levels of stress on both occasions. Overwork was the most stressful aspect of their jobs, though the number of hours worked was not related to stress levels, unlike diet and sleep. The more stressed they were the more unfavourably they viewed aspects of their jobs. The incidence of distress is unacceptably high in junior house officers, and both they and the hospitals need to deal with the causes of the distress.
Article
This study tested the relation between mood (depressed [D], elated [E], or neutral [N]), induced by the Velten (1968) procedure, and college students' responses on a subjectively scored life events questionnaire and measures of perceived and received social support. A manipulation check showed that the mood manipulation was successful. There was a significant mood effect on the number of self-reported negative life events, with E subjects reporting the fewest. However, mood had no significant effect on the number of self-reported positive life events or the rated intensity of negative and positive events. Mood had a significant effect on perceived social support, with D subjects scoring the lowest. Self-report of received social support, however, was not affected by the mood manipulation. The findings challenge the widespread use of life event and perceived social support questionnaires whose independence from a mood-related response bias has not been adequately demonstrated. The findings also challenge causal interpretation of significant effects for self-reported life stress and perceived social support obtained in cross-sectional prediction studies of concurrent psychological distress.
Article
A review of empiric studies of the stresses of residency training and descriptions of intervention programs and mental health resource surveys published since 1980 indicated that inadequate sleep and fatigue are major stressors for residents, but they are only part of a more complex situation influenced by time demands, social support, and maturational factors. Other important stressful aspects of training appear to be those that interfere with social support. Increased anger, not depression, is emerging as the predominant mood change during residency, but the effects of any mood change on patient care have not been studied. Despite growing evidence of the need for change in training programs, especially attention to the affiliative needs of residents, few intervention programs have been reported.
Article
• To measure depressive symptoms in medical house officers, a self-report questionnaire was administered to 68 medical house officers each month for an academic year. Of 844 possible responses, 737 forms were completed (87.3%). Although the overall prevalence of depressive symptoms (21.4%) approximated that of the general population, subpopulations of residents with high prevalence rates of depressive symptoms could be identified. A 28.7% prevalence rate of depressive symptoms was noted for postgraduate year 1 (PGY-1) residents. Prevalence rates fell with each successive year of training. Depressive symptoms occurred in 34.8% of PGY-1 residents on ward rotations. Similarly, responses from PGY-1 and PGY-2 residents on intensive care rotations indicated prevalence rates of depressive symptoms for both groups of greater than 33%. The impact of these symptoms on resident function and patient care has yet to be determined. (Arch Intern Med 1985;145:286-288)
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Positive and negative life events and social support were correlated with illness among Navy Submarine School students. Negative, but not positive, life events in the recent past were related to reports of illness. Although social support by itself was not related to illness reports, the relationship between negative life events and illness was stronger among subjects with low rather than high levels of social support. The results suggest the importance of assessing both stressful life events and moderators of response to stress, such as social support, in investigating the role played by personality in illness.
Article
Fifty-five interns, representing 71% of the medicine, obstetrics-gynecology, surgery, and pediatric interns at one medical center for one year, participated in interviews involving the Schedule for Affective Disorders and Schizophrenia-Research Diagnostic Criteria (RDC) and Family History-RDC and completed symptom and attitudinal scales at 6-month intervals. Fifteen (27%) developed a depressive syndrome during the first 6 months of internship. Parental history of depression and high scores of trait neuroticism were significantly associated with onset of depression, but personal history of psychopathology, low capacity for experiencing pleasure, and workload were not.