n engl j med
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demic performance, but major de-pression was diagnosed in 25 of them. A fourth-year medical stu-dent at Harvard estimated that three quarters of her close friendsin medical school have taken psy-chiatric medications at some point during the four years.Depression not only affectsstudents’ lives but may also haverepercussions for patient care inthe long run. Jennifer Tjia, an in-structor in internal medicine at the University of PennsylvaniaSchool of Medicine in Philadel-phia, believes that many practic-ing physicians are afraid of beingtreated for depression and there-by revealing that they have thecondition. But “if people don’t know how to treat their own de-pression, it has a negative im-pact on how they treat patients,”Tjia said.Why does being a medicalstudent increase the risk of de-pression? Raymond believes that students’ coping strategies andpersonal health deteriorate asthey progress through medicalschool. Students “see themselvesgoing into a very narrow tunnel,”she said. “A lot of the depression we see halfway through the [first] year — it’s a reaction to havingconstricted themselves down tostudying these subjects in a very intense way. It’s pretty unidimen-sional.”Symptoms of depression inmedical students can be difficult to distinguish from the effects of the stress inherent in student life.Students often dismiss their feel-ings of despondency as a normalemotional response to medicalschool, where they live from test to test and don’t take time forthemselves.“It’s hard to ask about depres-sion in medical students, because you ask about sleep, and all med-ical students aren’t sleeping,” ex-plained Angela Nuzzarello, a psy-chiatrist and dean of students at Northwestern University’s Fein-berg School of Medicine in Chi-cago. “They are overwhelmed,they are working hard, and they aren’t having fun socially. . . .Of course they are fatigued.”The emotional and academicchallenges involved in becominga physician wear on students.Their initial encounters with ill-ness and death may unmask psy-chological vulnerabilities. Suchencounters often resonate withunresolved episodes of loss ortrauma in the student’s past orcome as a shock to those whohave had little experience withdeath. The treatment of death asa part of the daily routine may ap-pear cold and calculating to stu-dents, who may fear becomingemotionally detached. Some be-come overwhelmed by the emo-tional toll of caring for others.For students who have beenlifelong achievers, getting a me-
white coat, mood indigo — depression in medical school
M a l e F e m a l e W h i t e A s i a n H i s p a n i c B l a c k O t h e r F i r s t S e c o n d T h i r d F o u r t h H e t e r o s e x u a l H o m o s e x u a l o r b i s e x u a l Y e s N o
P e r c e n t a g e o f M e d i c a l S t u d e n t s
SexRace orEthnic GroupMedical SchoolYearSexualOrientationHistory of Depression
Students whoreceived treatmentStudents who did notreceive treatmentStudents who wereclassified as depressedStudents who were notclassified as depressed1751476208622917807475933129242980100908070605040302010
P e r c e n t a g e o f D e p r e s s e d M e d i c a l S t u d e n t s
O v e r a l l M i l d - t o - M o d e r a t e D e p r e s s i o n S e v e r e D e p r e s s i o n S u i c i d a l I d e a t i o n N o S u i c i d a l I d e a t i o n
Rates of Depression among Medical Students (Panel A) and Treatment of Depressed Medical Students (Panel B).
Data in Panel A are for 322 medical students who responded to a questionnaire; data in Panel B are for the 49 medical students whose responsesto the questionnaire indicated that they were depressed. Treatment consisted of counseling, antidepressants, or both. Total numbers (given in thebars) reflect the numbers of students who replied to the relevant question. Data are from Tjia et al.
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