High depression rate open secret among junior doctors and psychologists

The proportion of junior doctors reporting depression and depressive symptoms averages out at more than 28% across studies, and the rates are rising at 0.5% per year, according to a major meta-analysis recently published in JAMA.¹ Comments on the results of the systematic review, which included fifty studies, suggest that the medical profession needs to ask itself some hard questions.

But doctors are far from being alone. Results of a study of professional psychologists released this year by the British Psychological Society found that 46% reported depression.² A quarter said they had a long-term, chronic condition.

“I’m in a darker place than many of my patients,” a National Health Service clinical psychologist told The Daily Telegraph newspaper.³ “My head is thick – as if I’m thinking through porridge”, the anonymous psychologist said when describing how she felt during a consultation with a patient. “I find myself switching out and tuning to autopilot”.

The JAMA paper (written by Douglas A Mata, from the Brigham and Women’s Hospital, Harvard, Boston, USA, and colleagues) reviewed studies that had assessed the point or period prevalence of depression or depressive symptoms using structured interviews or a validated questionnaire. Mata et al urge the medical community to undertake further research to identify effective strategies for preventing and treating depression among doctors. Sleep loss, for example, appeared to be a risk factor.

Commenting on the paper, Thomas L Schwenk MD, of the University of Nevada School of Medicine, pointed out that the medical profession, despite better than average access to mental health care, shows rates of depression similar to those of the general population, and has a higher than average risk of suicide. These inconvenient facts are not readily admitted or discussed, he said.

The conclusions of the US meta-analysis complement those of the large Australian National Mental Health Survey of Doctors and Medical Students, whose results were published in 2013.⁴ Twenty-one percent of respondents said that they had at some point been diagnosed with or treated for depression. A current diagnosis of depression was reported by 6%. The figure in the general population was also 6%, while the rate among non-medical professionals was 5%.

However, the difference between Australian doctors and other population groups for “very high” levels of psychological distress, assessed using the Kessler 10 scale, was stark, especially among younger medics. This high degree of distress was reported by 5.9% of doctors aged thirty and younger. Among this age group, the comparable rate of very high psychological distress was 2.5% in the general population and only 0.5% in other professional groups.

Given the cognitive impairment associated with depression, especially in attention and executive function,⁵ these findings imply clear risks to patient care, as well as to the wellbeing of the junior doctors and clinical psychologists surveyed.

At a recent meeting of the US Food and Drug Administration’s Psychopharmacologic Drugs Advisory Committee (3rd February 2016), session chairman said that cognitive dysfunction in depression – even if difficult to define -- is real, it hurts people and it is a target for treatment.

The FDA Advisory Committee was addressed by Madhukar Trivedi, of the University of Texas Southwestern Medical Center, Dallas. Among the cognitive domains he listed as potentially affected by depression are the ability to concentrate, verbal and non-verbal learning, speed of information processing, and flexibility of thought.

Raymond Lam and colleagues from the University of British Columbia, Vancouver, Canada, had studied 164 patients with major depressive disorder.⁶ Forty‑five percent said that lack of concentration had interfered “very much” with their ability to work in the preceding week. Thirty‑nine percent said they had suffered similarly from trouble with memory.