Acad Psychiatry 30:235-237, May-June
doi: 10.1176/appi.ap.30.3.235
© 2006 Academic Psychiatry
An Evaluation of Depressed Mood in Two Classes of Medical Students
Ruth E. Levine, M.D.,
Stephanie D. Litwins, B.A. and
Ann W. Frye, Ph.D.
Received May 24, 2005; revised July 18, 2005; accepted September 19, 2005. Dr. Levine is affiliated with the University of Texas Medical Branch, Department of Psychiatry, Galveston, Texas. Address correspondence to Dr. Levine, Department of Psychiatry, University of Texas Medical Branch, 301 University Blvd., Route 0193, Galveston, TX 77555-0193; rlevine{at}utmb.edu (E-mail). Copyright © 2006 Academic Psychiatry.
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ABSTRACT
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OBJECTIVE: To assess depression rates in contemporary medical students. METHOD: The Beck Depression Inventory (BDI) was administered anonymously to two medical school classes at matriculation, the end of first year, and the end of second year. RESULTS: Median scores for both classes were low at all points. The proportion of students scoring in the moderate or severely depressed range increased from 5.8% at matriculation to 10.5% by end of Year 2 for the Class of 2004, and from 5.1% to 11.9% over the same time period for the Class of 2005. Overall, 75–83% of students at every administration scored in the lowest BDI score range. CONCLUSIONS: The percentage of medical students who experience depressed mood increased over time, but to a lesser degree than in previous studies.
Key Words: Education, Medical • Students, Medical • Depression
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INTRODUCTION
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High rates of depression, suicide, and other psychiatric symptoms have been well-documented in physicians, house officers, and medical students (1–10). Frequently, difficulties with mood and depression appear during the earliest years of medical training (4–10). At least 12% of medical students acknowledged significant symptoms of depression on the Beck Depression Inventory (BDI) (11) according to a 1988 study by Clark and Zedlow (4) in which students were surveyed for depression at three points during medical training. This 12% rate is in contrast to the 3–4% general population norm (12). Dysphoria severity for students in this study peaked near the end of their second year, when 25% of students had BDI scores > 14 (4). Using clinical interviews, Zoccolillo et al. also reported a 12% prevalence of major depression during the first 2 years of medical school (6). In a recent survey of over 1,000 students from nine medical schools, 46% of students reported having at least one mental health-related concern (7). Clearly, depression in medical students is of paramount importance and warrants serious study. As part of overall curriculum research, we measured students’ depression as they advanced through our curriculum.
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Method
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The Beck Depression Inventory (BDI) is a 21-item self-administered questionnaire widely used and well-validated for assessing the severity of depressed mood (11), but it does not diagnose major depressive disorder. Following the example of Clark and Zedlow (4), we defined BDI scores of 8–13 as indicative of "mild" depression, of 14–20 as "moderate," and scores  21 as "severe."
The BDI was administered at the University of Texas Medical Branch at Galveston to two consecutive classes of medical students (the classes of 2004 and 2005) at matriculation (Time 1), end of Year 1 (Time 2) and end of Year 2 (Time 3). Using a protocol approved by the University’s Institutional Review Board, student responses were collected anonymously to encourage candid responses (13).
Following Clark and Zedlow’s model (4), we calculated the percentage of responses, mean scores, and standard deviations at each depression level for each class at each administration. Because the data were not normally distributed, we used the median scores as measures of central tendency for the score distributions. The Wilcoxon signed-ranks test statistic was used to compare the BDI levels for each class at each administration. Finally, we carried out multiple Wilcoxon signed-ranks tests to compare scores at different administrations.
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Results
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Results are summarized in Table 1. For the Classes of 2004 and 2005, respectively, 186 (93%) and 190 (92%) completed the BDI during freshman orientation (Time 1), 168 (88%) and 186 (94%) completed the BDI during the spring of their first year (Time 2), and 171 (87%) and 159 (86%) completed the BDI during the spring of their second year (Time 3).
Median BDI scores for both classes over all administrations ranged from 2 to 4 (Table 1). Over all administrations, 75.4%–83.6% of students reported scores in the lowest range. However, a systematically increasing mean score and variability appeared over time. This pattern mirrors the increasing percentages of students’ scores in the higher score ranges over time.
At matriculation (Time 1), 5.1% of the Class of 2004 and 5.8% of the Class of 2005 had BDI scores of 14 or greater. Of these students, approximately 4% scored in the moderate range (14–20), while 2% scored in the severe range (21+).
At the end of Year 1 (Time 2), scores of 14 or greater increased to 10% in the Class of 2004 and 6.9% in the Class of 2005. Moderate range scores (14–20) increased to 6.5% in the Class of 2004 and to 3.2% in the Class of 2005, while severe range scores (21+) increased to 3.5% in the Class of 2004 and 3.7% in the Class of 2005.
At the end of Year 2 (Time 3), 10.5% of the Class of 2004 students scored 14, as did 11.8% of the Class of 2005 students. Moderate range scores were 7% and 8.1%, respectively, and severe range scores were about 4% for both classes.
We found no statistically significant differences (p<0.05) between the two classes’ median scores at any of the measured times. The Wilcoxon signed-ranks test, using a correction of p<0.01 for multiple comparisons, found no statistically significant differences between Time 1 and Time 2 scores, between Time 1 and Time 3 scores, or between Time 2 and Time 3 scores for the classes of 2004 and 2005.
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Discussion
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Our assessment of depressed mood in two medical student classes showed a modest increase over time in the percentage of students who are depressed. In neither class, however, did the increase or the actual proportion of depressed students reach the levels reported in similar studies (4, 6). Overall, our findings suggest that relatively fewer students in our curriculum experienced depression compared to previously studied cohorts.
There is no obvious explanation behind the fact that our rates of depression are lower than in previously studied cohorts. Possibilities could include differences in the demographics of our students, differences in our curriculum format, and even the role of cultural change over the last 15–20 years.
The demographic characteristics of our students probably differ from those of cohorts in earlier studies. Clark and Zedlow (4) reported on a cohort that was two-thirds male, whereas our classes were at least 40–50% female. One might predict, however, that this would lead to higher rates of depression in our population, since women (and particularly women trainees) tend to experience higher rates of depression than their male counterparts (2). Our results do not support this prediction.
While we would like to attribute our lower depression rates to our revised curriculum, one that is based on principles of adult learning, we lack the data to confirm that hypothesis. In order to test that hypothesis, we would have to design a study in which we would use a similar school with an alternative curriculum as a control.
Another factor to consider is the role of cultural change over the last 15–20 years. The stigma of mental illness is less pronounced than it once was, and the general knowledge about depression is vastly improved. Though medical students are still leery of admitting vulnerability, a larger percentage than in the past have already received or are likely to seek help. In a recent academic medical center survey, 13.6% of physicians acknowledged antidepressant use and 11.2% visited a mental health professional within the previous 12 months (10).
Lastly, we must consider the possibility that our students may be underreporting their depression levels. Earlier attempts at measuring medical student depression at our school were hampered by students’ reluctance to admit depressive symptoms (13). Nearly 10% of students in an earlier class later reported misrepresenting their BDI answers because of fear of reprisal. This finding led to the adoption of anonymous data collection procedures. In other surveys, women and ethnic minority medical students have admitted to having concerns about the implications of seeking help for stigmatizing illnesses (7). Therefore, the large percentage of women and minorities in our student population might have affected the degree to which students in this study were comfortable revealing their distress, resulting in some underreporting of symptoms.
Though anonymous administration at least partly mitigated symptom underreporting, it also prevented use of a more informative repeated-measures approach to track students over time. Future research should focus on relationships between mental health measures and other significant factors, with continued monitoring of students’ mental health that maintains anonymity while allowing the tracking of students over time.
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L. B. Dunn, A. Iglewicz, and C. Moutier
A Conceptual Model of Medical Student Well-Being: Promoting Resilience and Preventing Burnout
Acad Psychiatry,
February 1, 2008;
32(1):
44 - 53.
[Abstract]
[Full Text]
[PDF]
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ABSTRACT
INTRODUCTION
