Let’s start a conversation: mental health stigma in medical school Staff Writer – Monika Cieslak
The journey through medical school is, no doubt, a rigorous one. Medical students face daily emotional, physical, and mental challenges within an exceptionally competitive environment. The pressure to maintain academic excellence in spite of sleep deprivation, 60-hour work weeks, and exposure to illness and mortality can be grueling.
Unsurprisingly, medical students experience much higher rates of mental illness than the general population.1 Despite better access to mental health services, up to 30% of medical students suffer from depression.2 When medical students do seek help, it is frequently at a time of crisis, due to a fear of stigmatisation that delays their help-seeking behaviour.3 It is imperative to change this culture, as medical students of today are the doctors of tomorrow.
So, what do the numbers tell us? A recent systematic review and meta-analysis of 195 studies conducted in 47 countries determined that 27.2% of medical students screened positive for depression, and that 11.1% reported suicidal ideation during medical school.4 Of those who were diagnosed with depression, only 15.7% sought psychiatric treatment.4 Another systematic review of medical residentsâ€™ mental health demonstrated that the prevalence of depression was between 20.9% to 43.2%.5
There are numerous factors that may contribute to the high prevalence of depression among medical students. These include ethical conflicts, exposure to death and human suffering, abusive clinical environments, personal life events, and educational debt.6 Clinical training and clerkship also requires students to relocate every few weeks to different, unfamiliar hospitals and locations. This can cause students to feel very isolated, especially if separated from peer-support groups. Simultaneously, medical students are pressured with productivity targets, board exams, residency applications, and a heavy curriculum load. With this in mind, why are we and the systems in which we learn and work not doing more to provide support? Why are we not reaching for help, despite being offered resources?
â€œSelf-stigmaâ€ is described as the phenomenon wherein people adopt and internalise external social stigma and experience loss of self-esteem and self-efficacy.3 Studies have found three underlying stigma constructs in medical students: personal weakness, public devaluation, and social or professional discrimination.7 It is possible that, as medical students, we feel demonstrating resilience is part of the journey to becoming a doctor. However, experiencing depression should not be viewed as a set-back or a weakness. It is an all too common experience, and perhaps even a chance to see things from the patientâ€™s perspective and develop skills in communication and empathy that foster better discussions around mental health. Personal adverse health experiences give one an opportunity to gain unique understanding and insight, to provide better patient care in the future.
As medical students, we must change the culture and stigma related to mental health amongst our peers. For in order to take care of our patients, we must also learn to care for ourselves.
- Suwalska J, Suwalska A, Szczygiel M, Lojko D. Medical students and stigma of depression. Part 2. Self-stigma. Psychiatr Pol. 2017;51(3):503-13.
- Moir F, Yielder J, Sanson J, Chen Y. Depression in medical students: current insights. Adv Med Educ Pract. 2018;9:323-33.
- Hankir AK, Northall A, Zaman R. Stigma and mental health challenges in medical students. BMJ Case Rep. 2014;2014.
- Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA.2016;316(21):2214â€“2236. doi:10.1001/jama.2016.17324
- Mata DA, Ramos MA, Bansal N, et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA. 2015;314(22):2373â€“2383. doi:10.1001/jama.2015.15845
- Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc. 2005;80(12):1613-22.
- Wimsatt LA, Schwenk TL, Sen A. Predictors of Depression Stigma in Medical Students: Potential Targets for Prevention and Education. Am J Prev Med. 2015;49(5):703-14.