Burnout, Depression, and Quality of Life in Medical Students

Abstract

To the Editor: The article on burnout, depression, and quality of life (QOL) in US medical students by Dyrbye et al1Dyrbye LN Thomas MR Huschka MM et al.A multicenter study of burnout, depression, and quality of life in minority and nonminority US medical students.Mayo Clin Proc. 2006; 81: 1435-1442Abstract Full Text Full Text PDF PubMed Scopus (132) Google Scholar certainly brings attention to issues often dismissed by many students and some teachers of medicine. Many have considered a poor QOL during the early phases of medical training to be a norm, almost an expectation, or even the acid test required to prepare them for the grueling years ahead. Previous surveys have quantified the prevalence of depression at up to a quarter of first- and second-year medical students, only a fraction of whom seek mental health counseling.2Givens JL Tjia J Depressed medical students' use of mental health services and barriers to use.Acad Med. 2002; 77: 918-921Crossref PubMed Scopus (323) Google Scholar, 3Tjia J Givens JL Shea JA Factors associated with undertreatment of medical student depression.J Am Coll Health. 2005; 53: 219-224Crossref PubMed Scopus (194) Google Scholar Dyrbye et al reported that depressive symptoms did not depend on minority status, but as pointed out by the authors, their study had a 50% response rate, with minority students being less likely to respond to the survey. Given that depression is a complex illness and its very symptomatology may affect one's willingness to participate in a study, the decreased response rate of the minority students may in fact hint at a higher incidence of depression and burnout in the nonresponder group. However, the response difference between minority and nonminority groups may also reflect other unrelated cross-cultural factors. Although the authors used several QOL measures in their methodology, they overlooked another important metric of student well-being: students seeking professional psychiatric treatment and being treated with prescription antidepressant medications. Obviously, this being a sensitive issue, it too would be vulnerable to reporting bias. Dyrbye et al reported rating scores for various coping strategies used by the 538 survey respondents. They included the use of alcohol among the coping strategies but omitted the use of illicit substances. Alcohol and other substance abuse is a problem among medical students4Newbury-Birch D White M Kamali F Factors influencing alcohol and illicit drug use amongst medical students.Drug Alcohol Depend. 2000; 59: 125-130Abstract Full Text Full Text PDF PubMed Scopus (138) Google Scholar, 5Newbury-Birch D Walshaw D Kamali F Drink and drugs: from medical students to doctors.Drug Alcohol Depend. 2001; 64: 265-270Abstract Full Text Full Text PDF PubMed Scopus (128) Google Scholar and should not be taken for granted. Despite the difficult-to-avoid limitations of response and reporting bias, Dyrbye et al should be congratulated on an informative study of a challenging topic. Their findings and conclusions are intriguing and serve as a reminder that reported rates of depression and burnout among medical students may very well represent only the tip of the iceberg. Teachers of the art of medicine need to be observant of, and sensitive to, students who may be faltering. Burnout, Depression, and Quality of Life in Medical Students–Reply–IMayo Clinic ProceedingsVol. 82Issue 2PreviewResponse bias is a concern with survey studies. We do not know if depressed students are more apathetic and less likely to fill out surveys on QOL and depression or if, on the other hand, they are more likely to complete such surveys because the survey content is more relevant to their circumstances. As pointed out by Drs Khoo and Tan, there may be other factors as well that impede minority students from filling out survey forms. As we pointed out in the discussion, minority students may feel that their anonymity is threatened because there are few minority students like them. Full-Text PDF