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Viewpoint |

Depression and Suicide Among Physician Trainees Recommendations for a National Response

Matthew L. Goldman, MD, MS1,2; Ravi N. Shah, MD1,2; Carol A. Bernstein, MD3
[+] Author Affiliations
1Department of Psychiatry, Columbia University Medical Center, New York, New York
2New York State Psychiatric Institute, New York
3Department of Psychiatry, New York University School of Medicine, New York
JAMA Psychiatry. 2015;72(5):411-412. doi:10.1001/jamapsychiatry.2014.3050.
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This Viewpoint suggests that national organizations should address the mental health of residents and fellows by proposing strategies for comprehensive education, screening, and treatment.

In the first 2 months of the 2014-2015 academic year, 2 New York City medical interns died in apparent suicides. In response, an intern from Yale School of Medicine wrote an op–ed in the New York Times highlighting the link between medical training and isolation, depression, and suicide among trainees. Physician suicide is a common occurrence. According to the American Foundation for Suicide Prevention, 300 to 400 physicians commit suicide each year, approximately 1 physician per day.1 Medical training involves numerous risk factors for mental illness, such as role transition, decreased sleep, relocation resulting in fewer available support systems, and feelings of isolation. A substantial body of evidence has demonstrated that trainees in particular are at high risk for depression and suicidal thinking, but many training programs have not been able to identify and provide treatment for these residents and fellows in a systematic way. National organizations, such as the Accreditation Council for Graduate Medical Education (ACGME), should address the mental health of residents and fellows by proposing strategies for comprehensive education, screening, and treatment.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Submit a Comment
? Vitamin D
Posted on April 2, 2015
Kenneth M. Berc, MD
retired-formerly Columbia U Med School
Conflict of Interest: None Declared
With the recent discovery that Vitamin D plays both a role in depression and is often low in residents of the Northern Hemisphere, and coupled with house staff's likely inability to ever get out into the sunshine, perhaps someone should do the mundane experiment of comparing all house staff Vit. D levels.
Medical Trainees should be taught that this is a very real risk of practicing medicine
Posted on April 5, 2015
Louise B. Andrew MD JD FACEP FIFEM
Conflict of Interest: The writer is owner of a non profit informational website for the education of physicians and family members who may be dealing with aspects of depression.

It took several suicides of fellow trainees and faculty for me to realize how very common affective disorders are within our profession. My subsequent exposure to the regulatory environment through representation of a major specialty organization convinced me that these disorders are not only common, but very poorly addressed because of the very real and reasonable fear of loss of livelihood on the part of affected trainees/physicians if help is sought. My principal career focus has been addressing the stress of litigation. I see stark parallels between these threats. Just as we were never taught that malpractice litigation is part and parcel of a career in medicine in the U.S. and trained to deal with the stress engendered, we were never told that we might have entered medicine with a vulnerability to depression, and that we are at significantly increased risk for suicide because of that vulnerability coupled with knowledge of and access to lethal means. We need to both teach and believe that this is the reality, and be trained and prepared to address this very potentially lethal condition more effectively. Asking for help should not be an admission of inadequacy, and in fact students and house staff should be asked privately, routinely and as a matter of course, "How are you doing right now and could you use some support?" And then, of course confidential and effective support must be provided. As those most familiar with and also in the best position to respond, we the senior members of the medical profession are responsible for beginning to heal our replacement generations.

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