Medical — Suicide When Doctors Need Help: Students Battle Burnout by Gina Shaw In early January, the body of medical student Norman Smith was found in his apartment in Atlanta. His fellow students were stunned to learn that he had put a gun to his chest and pulled the trigger. He’d been attending classes since the previous October and had never seemed depressed or behaved strangely. And he gave no explanation of the reason for his suicide in the letters he left behind for his father, his landlady and a friend. There’s just one other fact about the suicide of Norman Smith: It happened in January of 1883, some 126 years ago. From that day to this, suicide and other less extreme consequences of a phenomenon some call medical student burnout have plagued medical schools in the United States and beyond. In January 2009, a fourth-semester medical student at Chhatrapati Shahu Ji Maharaj University was found dead in a hostel room in Kanpur, India; in June 2008, a student at the University of Leeds in Britain jumped from a campus building after failing exams; and in March 2006, second-year Duke medical student Carrie Largent also took her own life. Medical school is notoriously challenging, but few outside the profession realize just how stressful it can be. In September 2008, a study in the Annals of Internal Medicine reported that 50 percent of approximately 2,200 students surveyed at seven medical schools had experienced burnout, while 11 percent had considered suicide in the past year. Approximately 2 percent had actually attempted suicide in the previous year. (The stress continues in medicine itself — about 400 physicians commit suicide each year, a rate much higher than in the population overall.) The study found a direct link between medical student burnout and thoughts of suicide, according to study co-author Dr. Tait D. Shanafelt, director of the Mayo Clinic Department of Medicine Program on Physician Well-Being in Rochester, Minn. “There is extensive literature demonstrating medical students begin medical school with mental health profiles similar to their non-medical peers,” he told American Medical News. “But through the course of medical school they experience substantial deterioration in their mental quality of life.” Students come into medical school with about the same rates of depression and anxiety as others their age who are not in medical school, but by the end of the second year, their rate of depression symptoms more than doubles. In the pressure-cooker environment of medical school, students may fear revealing their symptoms of depression or burnout, imagining that professors may think less of them and that seeking treatment might mark them as unqualified to enter medicine. Likewise, full-fledged doctors struggling with depression often hide their situation due to similar fears about the stigma of mental illness, so much so that the American Foundation for Suicide Prevention has released a documentary called “Struggling in Silence: Physician Depression and Suicide.” Dr. Shanafelt’s research team found that rates of depression and burnout increase over the course of medical school, suggesting that it’s important to intervene early to keep a small problem from becoming a big one. According to the Association of American Medical Colleges, some medical schools are doing just that. The University of California, San Diego (UCSD) School of Medicine recently launched a Web-based screening tool that allows students and physicians to fill out a confidential online mental health survey. If their answers indicate depression or suicide risk factors, a live therapist responds. The screening program got a big initial push at a lunch meeting with all first- and second-year students, according to Dr. Christine Moutier, assistant dean for student affairs at UCSD. About half of the students filled out the online survey, and Moutier says that “a reasonable number” of those students screened have been interacting with the social worker trained to assess responses and flag those at risk. “Because this is completely anonymous and confidential, the social worker posts a response to the Web site, which the participant can then access to pursue further counseling,” Moutier explained. “A number have come in to meet with her in person and have been referred for treatment. The whole goal of the project was to reach out to people who need to be accessing mental health services, who otherwise wouldn’t — so it’s working.” A similar project was launched previously at the University of Pittsburgh’s medical school — long known as a leader in student mental health issues — but UCSD’s is different in that it’s not just for medical students. After the initial student rollout in April, UCSD plans to move forward with offering the service to medical residents, then to faculty physicians, and finally to students and faculty at its school of pharmacology. Moutier recently presented the online mental health-screening tool at a meeting of the Association of American Medical Colleges. “A lot of other medical school faculty and deans were interested in doing something like this,” she said. “The barrier to getting it going is that you really have to have someone who’s willing to put in the work — our system has been about two years in the making with about six people working on it. But using our experience, we could help others streamline putting something into place.” Gina Shaw is the medical writer for The Washington Diplomat. Finding Help If you’re a medical student, resident or practicing physician in crisis and cannot find assistance at your institution, there are a number of national organizations offering help, including 24-hour hotlines, contact information for local mental health professionals, and links to discussion and support groups. • American Foundation for Suicide Prevention: (888) 333-2377 or www.afsp.org • National Alliance on Mental Illness: (800) 950-6264 or www.nami.org • National Suicide Prevention Lifeline: (800) 273-8255 or www.suicidepreventionlifeline.org

Would you like to become a WashDiplomat sponsor?