To the Editor:
We agree with Goebert et al1 that screening for and treatment of depression among medical students is necessary. Although the authors contend that their study is the first to report on the prevalence rate of suicidal ideation amongst medical students, numerous previous studies have done so.2–7 These studies suggest that, although an important step, simply screening for depression will fail to identify or assist students who are having suicidal ideation but are not depressed. Indeed, in the study by Goebert et al fourth-year students had the highest prevalence of suicidal ideation (9.4%) but the lowest prevalence of depressive symptoms (5%). In our recent longitudinal study of more than 2,000 U.S. medical students, we found that burnout predicted future suicidal ideation in a dose–response fashion.4 The relationship between burnout and suicidal ideation was independent of depressive symptoms. In the multivariable regression, both burnout and mental quality of life independently predicted subsequent suicidal ideation. These findings are important because burnout is dramatically more common among U.S. medical students than is depression.3,4 Importantly, recovery from burnout was associated with a decreased risk of suicidal ideation in our longitudinal study. Efforts to improve the well-being of students must go beyond prevention of and assessment for depression and should include attention to other forms of student distress, including burnout, fatigue, and anxiety/stress.
Liselotte N. Dyrbye, MD, MHPE
Assistant professor, Mayo Clinic, College of Medicine, Rochester, Minnesota; (email@example.com).
Tait D. Shanafelt, MD
Associate professor, Mayo Clinic, College of Medicine, Rochester, Minnesota.
1 Goebert D, Thompson D, Takeshita J, et al. Depressive symptoms in medical students and residents: A multischool study. Acad Med. 2009;84:236–241.
2 Tyssen R, Vaglum P, Gronvold NT, Ekeberg O. Suicidal ideation among medical students and young physicians: A nationwide and prospective study of prevalence and predictors. J Affect Disord. 2001;64:69–79.
3 Clark DC, Zeldow PB. Vicissitudes of depressed mood during four years of medical school. JAMA. 1988;260:2521–2528.
4 Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149:334.
5 Givens JL, Tjia J. Depressed medical students' use of mental health services and barriers to use. Acad Med. 2002;77:918–921.
6 Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: A cross-sectional study. Med Educ. 2005;39:594–604.
7 Tjia J, Givens JL, Shea JA. Factors associated with undertreatment of medical student depression. J Am Coll Health. 2005;53:219–224.