Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan (Y.F., E.F., Z.Z.).
Departments of Anesthesiology and Epidemiology, University of Michigan, and VA Center for Clinical Management Research, Ann Arbor, Michigan (A.S.B.).
Ann Intern Med. 2022 Jan;175(1):56-64. doi: 10.7326/M21-1594. Epub 2021 Nov 16.
Efforts to address the high depression rates among training physicians have been implemented at various levels of the U.S. medical education system. The cumulative effect of these efforts is unknown.
To assess how the increase in depressive symptoms with residency has shifted over time and to identify parallel trends in factors that have previously been associated with resident physician depression.
Repeated annual cohort study.
U.S. health care organizations.
First-year resident physicians (interns) who started training between 2007 and 2019.
Depressive symptoms (9-item Patient Health Questionnaire [PHQ-9]) assessed at baseline and quarterly throughout internship.
Among 16 965 interns, baseline depressive symptoms increased from 2007 to 2019 (PHQ-9 score, 2.3 to 2.9; difference, 0.6 [95% CI, 0.3 to 0.8]). The prevalence of baseline predictors of greater increase in depressive symptoms with internship also increased across cohorts. Despite the higher prevalence of baseline risk factors, the average change in depressive symptoms with internship decreased 24.4% from 2007 to 2019 (change in PHQ-9 score, 4.1 to 3.0; difference, -1.0 [CI, -1.5 to -0.6]). This change across cohorts was greater among women (4.7 to 3.3; difference, -1.4 [CI, -1.9 to -0.9]) than men (3.5 to 2.9; difference, -0.6 [CI, -1.2 to -0.05]) and greater among nonsurgical interns (4.1 to 3.0; difference, -1.1 [CI, -1.6 to -0.6]) than surgical interns (4.0 to 3.2; difference, -0.8 [CI, -1.2 to -0.4]). In parallel to the decrease in depressive symptom change, there were increases in sleep hours, quality of faculty feedback, and use of mental health services and a decrease in work hours across cohorts. The decrease in work hours was greater for nonsurgical than surgical interns. Further, the increase in mental health treatment across cohorts was greater for women than men.
Data are observational and subject to biases due to nonrandom sampling, missing data, and unmeasured confounders, limiting causal conclusions.
Although depression during physician training remains high, the average increase in depressive symptoms associated with internship decreased between 2007 and 2019.
National Institute of Mental Health.
美国医学教育系统的各个层面都在努力解决培训医师中高抑郁率的问题。这些努力的累积效果尚不清楚。
评估随着住院医师培训的进行，抑郁症状的增加是如何随时间变化的，并确定以前与住院医师抑郁相关的因素的平行趋势。
重复年度队列研究。
美国医疗机构。
2007 年至 2019 年期间开始培训的一年级住院医师（实习生）。
在实习期间，通过 9 项患者健康问卷（PHQ-9）评估基线和每季度的抑郁症状。
在 16965 名实习生中，从 2007 年到 2019 年，基线抑郁症状增加（PHQ-9 评分，2.3 至 2.9；差异，0.6[95%CI，0.3 至 0.8]）。随着时间的推移，与住院医师培训期间抑郁症状增加相关的基线预测因素的患病率也有所增加。尽管基线风险因素的患病率较高，但随着时间的推移，住院医师培训期间抑郁症状的平均变化减少了 24.4%（PHQ-9 评分的变化，4.1 至 3.0；差异，-1.0[CI，-1.5 至-0.6]）。与男性（3.5 至 2.9；差异，-0.6[CI，-1.2 至-0.05]）相比，这种变化在女性（4.7 至 3.3；差异，-1.4[CI，-1.9 至-0.9]）中更大，与外科实习生（4.0 至 3.2；差异，-0.8[CI，-1.2 至-0.4]）相比，非外科实习生（4.1 至 3.0；差异，-1.1[CI，-1.6 至-0.6]）更大。与抑郁症状变化的减少平行的是，睡眠时间、教师反馈质量、心理健康服务的使用增加，以及工作时间减少。与外科实习生相比，非外科实习生的工作时间减少幅度更大。此外，女性的心理健康治疗增加幅度大于男性。
数据是观察性的，由于非随机抽样、数据缺失和未测量的混杂因素，存在偏倚，限制了因果结论。
尽管医生培训期间的抑郁仍然很高，但与住院医师培训相关的抑郁症状的平均增加在 2007 年至 2019 年间有所下降。
美国国家心理健康研究所。
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