Importance of web-based intervention in minimizing depressive symptoms and associated stigma in depressed medical students

Abstract

Revista Brasileira de Psiquiatria. 2013;35 s 2013 Associac¸a˜o Brasileira de Psiquiatria LETTERS TO THE EDITOR Importance of web-based intervention in minimizing depressive symptoms and associated stigma in depressed medical students Rev Bras Psiquiatr. 2013;35:334 doi:10.1590/1516-4446-2012-0972 There is a considerable prevalence of depression in medical students, and those who are depressed more frequently endorse feeling stigmatized than non- depressed students. 1 Because concerns about confidentiality are often cited by depressed medical students as a major barrier in seeking help, there is a significant need to develop an innovative way to provide medical students with safe and confidential access to services to improve prevention, detection, and intervention in depression and its asso- ciated stigma. 1 A web-based approach could be potentially useful for addressing this issue and has already been used for delivering intervention in various health conditions, with benefits such as low cost, user convenience, timely information, privacy and confidentiality, reduced levels of stigmatization, and increased user and supplier control. 2 Moreover, although current evidence is limited, a recent meta-review 3 points to the efficacy of web-based cognitive behavioral interventions in treating/improving depression symptoms in adults. In relation to depression stigma, there is evidence that web-based interventions (e.g., MoodGYM) can reduce personal stigmatizing attitudes toward depression. The web-based approach assumes even greater importance when we consider that stigmatization increases with either the use of prescription medication or mental health counseling, and that only a small percentage of depressed medical students seek mental health counseling services, due to lack of time, con- fidentiality, stigma, and fear of documentation in aca- demic records. 4 However, unintended negative effects could easily arise with web-based approaches as well (e.g. decline in seeking support from family and friends, avoidance of in-person mental health services, inade- quate assessment and diagnosis). We should also bear in mind that it is important to target depressive symptoms in this undertreated population 4 not only for their own health but also for that of their patients. Web-based anonymous platforms could serve as screen- ing tools in helping to identify associated factors and causes of depression, and provide self-initiated interven- tion. In Portugal, the available literature and research on depression in medical students is scarce. However, one study reported a prevalence of 58.2% of clinically significant stress symptoms in a medical student popula- tion of Portugal. 5 Based on these findings, our team is currently developing a protocol to assess Portuguese medical students’ needs and the perceived relevance of a (web-based) intervention. We believe that it is imperative to develop and test the efficacy of a novel web-based program designed to meet medical students’ needs (and preferences) in their specific context, addressing risks and protective factors and stressors. Although we hypothesize/expect that an approach comprising cognitive behavioral techniques and psychoeducation will benefit this population, we believe that testing currently available tools with proven efficacy in adults might dilute their effectiveness and not benefit this population due to their experiential specificities (e.g., specificities related to health professional/medical train- ing and practice of tackling high emotional and physical demands, high level of responsibility, exposure to human physical and psychological suffering, etc.), which have the potential to translate into depression and burnout. However, later trials should further compare the efficacy of standard computer-based interventions for depression with interventions designed specifically for medical students. Jorge Alves, 1 Thomas L. Schwenk, 2 O scar F. Gonc¸alves, 1,3 Agavni Petrosyan 1,4 Neuropsychophysiology Laboratory, Center for Research in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal. 2 University of Nevada School of Medicine, Reno, NV, USA. 3 Department of Counseling and Applied Educational Psychology, Bouve´ College of Health Sciences, Northeastern University, Boston, USA. 4 Department of Cognitive Sciences, University of California, Irvine, CA, USA. Submitted Aug 25 2012, accepted Feb 13 2013. Disclosure The authors report no conflicts of interest. References 1 Schwenk TL, Davis L, Wimsatt LA. Depression, stigma, and suicidal ideation in medical students. JAMA. 2010;304:1181-90. 2 Griffiths F, Lindenmeyer A, Powell J, Lowe P, Thorogood M. Why are health care interventions delivered over the internet? A systematic review of the published literature. Joˆ Med Internet Res. 2006;8:e10. 3 Foroushani PS, Schneider J, Assareh N. Meta-review of the effectiveness of computerised CBT in treating depression. BMC Psychiatry. 2011;11:131. 4 Givens JL, Tjia J. Depressed medical students’ use of mental health services and barriers to use. Acad Med. 2002;77:918-21. 5 Loureiro E, McIntyre T, Mota-Cardoso R, Ferreira MA. [The relationship between stress and life-style of students at the Faculty of Medicine of Oporto]. Acta Med Port. 2008;21:209-14.