New studies show special mental health risks for certain groups of new
doctors

Date:
April 29, 2022
Source:
Michigan Medicine - University of Michigan
Summary:
First-year surgery residents, and first-year medical residents in
all fields who are members of sexual minorities such as LGBTQ,
are more likely than others to develop depression during the
stressful training period.



FULL STORY ==========================================================================
The first year of medical training after medical school brings intense
stress, long work hours, irregular sleep schedules, and a risk of new
or worsened symptoms of depression.


==========================================================================
But two new studies identify two groups of first-year residents, also
called interns, who may be especially at risk of developing mental
health concerns: those who are training to be surgeons, and those who
are members of sexual minorities.

The studies, both published this week by teams from the University of
Michigan, add to the growing body of knowledge not just about mental
health concerns in medical training, but also about the impacts of
intense stress on mental health in general.

The data in both papers comes from the Intern Health Study, based at the Michigan Neuroscience Institute and led by the director of the Frances
and Kenneth Eisenberg and Family Depression Center.

Every spring, the study recruits physicians who are about to start their
first year of residency to volunteer to track their mood, activity,
sleep and other measures over the next 12 months through a wearable
device and smartphone app.

Their medical and life history, and DNA samples, are also collected
and analyzed.

Surgical interns and depression A new paper published in JAMA Surgery
by a team led by U-M Department of Surgery assistant professor Tasha
Hughes, M.D., M.P.H., shows for the first time how surgical residents'
mental health changes over time during their first year of training,
and how it compares with non-surgical residents' experience.

The study looked at data from 12,400 interns, including 2,793 surgeons-in- training, between 2016 and 2020.



========================================================================== Training in most surgical disciplines begins with at least one general
surgery intern year even if a physician ultimately will pursue specialized training in a particular type of surgery. Hughes and colleagues find
that surgical interns actually came into their training with a lower
rate of existing depression symptoms than peers of similar ages in the
general population.

But by the end of the intern year, 32% of those who had started with no
signs of depression had scored high enough on at least one mood survey to
be considered depressed. Female surgeons, those with a sexual orientation
other than heterosexual, those without partners, those who worked the
most hours on average, and those who had a history of adverse childhood experiences were more likely to develop signs of depression.

Even after adjusting for these factors, surgical interns were more likely
to develop new-onset depression than new physicians in other disciplines, except when work hours were taken into account.

Among those who showed signs of new-onset depression on at least
one survey, 64% had continued signs of depression on a later survey,
suggesting persistent issues.

And only 26% of those who screened positive for depression actually
reported seeking mental health care during their intern year, and even
among those who had an especially high score on their first screening,
only 39% sought help.



========================================================================== "Surgical training, especially in the United States, can be a period
of intense stress, which we find is linked to new onset of depression,"
says Hughes.

"These findings suggest a need for surgical program directors, leaders
and health systems to continue to find ways to mitigate the effects of
surgical training, normalize help-seeking, make mental health support
easily available, and pay special attention to those with characteristics
that might put them at increased risk." LGBTQ physicians-in-training
and depression: The second study, published in JAMA Health Forum,used
data from more than 7,000 interns who started training in medical or
surgical specialties in 2016 through 2018 and disclosed their sexual orientation as part of their intake questionnaire. Just over 7% said
they were a member of a sexual minority group, including lesbian, gay,
bisexual or another non-heterosexual group.

In all, depression scores were higher at the start of the intern year
for members of sexual minorities compared with their heterosexual peers,
and the gap grew as the year went on, with the biggest differences seen
in the second half of the year.

The study's lead author is Tejal Patel, who will graduate from the U-M
this week with her bachelor's degree and a double major in cognitive
science and biology, health and society. Intern Health Study director
Elena Frank, Ph.D., notes that the project was part of Patel's honors
thesis and that being first author of a research letter in a top journal
as an undergraduate is a rare feat.

"These results indicate that interns who are part of sexual minority
groups may experience unique workplace stressors leading to a widening disparity in mental health," says Patel. "This is important to note
because as physicians become more depressed, this can lead to greater
risk of medical errors and attrition from medicine. As a result, it may
be hard for sexual minority patients to find a physician with whom they
can relate, and who will be the right fit for them." Frank adds that
the experience of LGBTQ+ medical trainees has largely not been studied,
and that as many as one in five members of Generation Z identify as a
member of a sexual minority.

"Ensuring that we support the development of a diverse physician workforce
that reflects our communities is increasingly critical," says Frank,
an assistant research scientist at MNI. "With our large, national study
we realized we were in a unique position to be able to provide some
insight on potential disparities in mental health experiences and are
hopeful that our data will spur further research in this area and inform targeted efforts to facilitate a healthier and more inclusive educational environment for all physicians." The principal investigator of the Intern Health Study is Srijan Sen, M.D., Ph.D., who in addition to directing
the Eisenberg Family Depression Center is a member of the Institute for Healthcare Policy and Innovation. Hughes and the senior author of the
JAMA Surgery paper, Amy Bohnert, Ph.D., M.H.S., are also IHPI members.

The study was funded by the National Institute of Mental Health
(MH101459), and the American Foundation for Suicide Prevention

========================================================================== Story Source: Materials provided by
Michigan_Medicine_-_University_of_Michigan. Original written by Kara
Gavin. Note: Content may be edited for style and length.


========================================================================== Journal References:
1. Tasha M. Hughes, Jennifer F. Waljee, Yu Fang, Srijan Sen, Amy
Bohnert.

New-Onset Depression Among Surgical Interns. JAMA Surgery, 2022;
DOI: 10.1001/jamasurg.2022.0618
2. Tejal H. Patel, Jennifer L. Cleary, Zhuo Zhao et al. Assessment
of the
Prevalence and Trajectory of Depressive Symptoms by Sexual
Orientation During Physician Training. JAMA Health Forum, 2022 DOI:
10.1001/ jamahealthforum.2022.0812 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/04/220429144914.htm

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