Mousa Omar Y, Dhamoon Mandip S, Lander Sarah, Dhamoon Amit S
Department of Medicine, State University of New York-Upstate Medical University, Syracuse, New York, United States of America.
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
PLoS One. 2016 Jun 10;11(6):e0156554. doi: 10.1371/journal.pone.0156554. eCollection 2016.
Mental health disease is under recognized in medical professionals.
To screen medical students (MS), residents and fellows for major depressive disorder (MDD) and generalized anxiety disorder (GAD) under the new era of work hour reform with age-matched controls from a large representative cross-sectional survey.
We conducted an anonymous online survey at a medical university in 2013-2014. We incorporated the Patient Health Questionnaire 2 (PHQ-2) to screen for MDD and the generalized anxiety disorder scale (GAD-7) to screen for GAD, along with additional questions on life stressors and academic performance. We compared these results to age-matched controls from the National Health and Nutrition Examination Survey (NHANES) database.
126 residents/fellows and 336 medical students participated voluntarily. 15.1% and 15.9% of postgraduates as well as 16.4% and 20.3% of MS screened positive for MDD and GAD, respectively. When compared to national estimates, the prevalence of a positive screen for MDD was over five-fold higher in medical trainees compared to age-matched controls (16% vs. 2.8%, p<0.0001). Similarly, the prevalence of a positive screen for GAD was over eight-fold higher in medical trainees (19% vs. 2.3%, p<0.0001).The prevalence was consistently higher within age strata. 33.3% of postgraduates and 32% of MS believe there is a significant impact of depression or anxiety on their academic performance. For stress relief, one fifth of residents/fellows as well as MS reported alcohol use.
The stresses of medical education and practice may predispose trainees to psychopathological consequences that can affect their academic performance and patient care. The current study showed a significantly higher rate of MDD and GAD positive screens in medical trainees than the prevalence in an age-matched U.S. population, despite significant work hour reform for medical trainees. Increased awareness and support services are required at all levels of medical training. We propose that the ACGME and the Institute of Medicine may consider these findings when implementing future changes to work hour regulations.
心理健康疾病在医学专业人员中未得到充分认识。
在工作时间改革的新时代，通过一项具有代表性的大型横断面调查，对医学生、住院医师和研究员进行筛查，以确定其是否患有重度抑郁症（MDD）和广泛性焦虑症（GAD），并与年龄匹配的对照组进行比较。
2013 - 2014年，我们在一所医科大学进行了一项匿名在线调查。我们纳入了患者健康问卷2（PHQ - 2）以筛查MDD，纳入广泛性焦虑症量表（GAD - 7）以筛查GAD，并附加了关于生活压力源和学业成绩的问题。我们将这些结果与来自国家健康和营养检查调查（NHANES）数据库的年龄匹配对照组进行比较。
126名住院医师/研究员和336名医学生自愿参与。研究生中分别有15.1%和15.9%、医学生中分别有16.4%和20.3%的MDD和GAD筛查呈阳性。与全国估计值相比，医学实习生中MDD筛查阳性的患病率比年龄匹配的对照组高出五倍多（16%对2.8%，p<0.0001）。同样，医学实习生中GAD筛查阳性的患病率比年龄匹配的对照组高出八倍多（19%对2.3%，p<0.0001）。各年龄层的患病率一直较高。33.3%的研究生和32%的医学生认为抑郁或焦虑对他们的学业成绩有重大影响。为缓解压力，五分之一的住院医师/研究员以及医学生报告有饮酒行为。
医学教育和实践中的压力可能使实习生易患心理病理后果，进而影响他们的学业成绩和患者护理。尽管对医学实习生的工作时间进行了重大改革，但当前研究表明，医学实习生中MDD和GAD筛查呈阳性的比例显著高于年龄匹配的美国人群中的患病率。医学培训的各个层面都需要提高认识并提供支持服务。我们建议毕业后医学教育认证委员会（ACGME）和医学研究所（Institute of Medicine）在对工作时间规定进行未来改革时可考虑这些发现。
