To the Editor:
The high incidence of depressive symptoms in medical students and residents is worrying and warrants further investigation. However, it is not yet clear whether everybody who scores high on the Center for Epidemiologic Studies–Depression Scale (CES-D) needs specific treatment for depression.
I was reminded of this fact after reading Goebert et al's interesting report in the February Academic Medicine and the commentary on it by Reynolds and Clayton,1 who argued for easier access to mental health services. The report showed a high prevalence of depressive symptoms in medical students and residents. No diagnosis of depression according to DSM-IV criteria2 was made. However, even if a formal diagnosis had been made, it is unclear whether treatment would have been necessary.
The DSM-IV criteria for depressive disorder are contested in the literature. Wakefield et al3 asserted that those criteria should be adjusted. At the moment, if somebody has depressive symptoms, only bereavement—and no other environmental stresses—excludes making a diagnosis of depressive disorder. According to Wakefield, depressive symptoms are often normal responses to environmental stress factors.
In short, it remains to be seen whether everybody with a syndromal diagnosis of depression needs treatment,4 including those who score high on the CES-D.
Dieneke Hubbeling, MRCPsych
Consultant psychiatrist, South West London and St. George's Mental Health Trust, London, United Kingdom; (email@example.com).
1Reynolds CF III, Clayton PJ. Out of the silence: Confronting depression in medical students and residents. Acad Med. 2009;84:159–160.
2American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Arlington, Va: American Psychiatric Association; 2000.
3Wakefield JC, Schmitz MF, First MB, Horwitz AV. Extending the bereavement exclusion for major depression to other losses: Evidence from the National Comorbidity Survey. Arch Gen Psychiatry. 2007;64:433–440.
4Patten SB. Major depression prevalence is very high, but the syndrome is a poor proxy for community populations' clinical treatment needs. Can J Psychiatry. 2008;53:411–418.