Depression and suicidal ideation common among medical students

1. The prevalence of depression or depressive symptoms among over 120 000 medical students across the world was 27%, with only 15% of these students seeking medical treatment.

2. The prevalence of suicidal ideation among over 21 000 medical students was 11%.

Evidence Rating Level: 2 (Good)

Study Rundown: It is well known that medical students are at high risk for depression and suicidal ideation given their high levels of stress and responsibility. Current studies vary in their estimates of rates of depression and suicidal ideation, and there are conflicting findings with regards to how these vary by year, sex, and other characteristics. The purpose of this study was to conduct a systematic review and meta-analysis to estimate prevalence of depression, depressive symptoms, and suicidal ideation in medical students. In over 180 studies comprising more than 120 000 students from 43 countries, the overall rate of depression or depressive symptoms was 27%. There was a 13% increase in depressive symptoms before compared to during medical school. The prevalence did not differ between students in preclinical and clinical portions of their training. Only 15% of students with depression sought psychiatric treatment for their depression. In 24 studies with over 21 000 students from 15 countries, the overall rate of suicidal ideation was 11%.

Overall, this study suggests that depression, depressive symptoms, and suicidal ideation are quite common in the medical student population across the world, but not nearly enough seek medical treatment. The study benefited from its large sample size which included students from around the world and thus increases its generalizability. However, there was a large degree of heterogeneity among studies as each had different designs.

Click to read the study in JAMA

Relevant Reading: Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis

In-Depth [systematic review and meta-analysis]: This study performed a systematic search of EMBASE, ERIC, MEDLINE, psychARTICLES, and psychINFO databases for studies published before September 2016 looking at the prevalence of depression, depressive symptoms, or suicidal ideation in medical students. A total of 167 cross-sectional studies were included with 116 628 students along with 16 longitudinal studies with 5728 students to determine prevalence of depression and depressive symptoms. The overall rate of depression or depressive symptoms was 27.2% (CI_95% 24.7%-29.9%), with estimates ranging rom 1.4% to 73.5%. Among students screening positive for depression, 15.7% (CI_95% 10.2%-23.4%) sought psychiatric or mental health treatment. In 9 longitudinal studies which assessed the prevalence of depression before and during medical school, the mean increase in depressive symptoms was 13.5% (range 0.6%-35.3%). Finally, in 24 studies looking at 21 002 students from 15 countries, the prevalence of suicidal ideation was 11.1% (CI_95% 9.0%-13.7%), with estimates ranging from 4.9% to 35.6%.

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