The trials of residency, particularly in the first year after completing medical school, are well documented. First year residents or interns work long and demanding hours in a high stress environment, and do so on little and irregular sleep. And two new studies out of the University of Michigan, which used data from the Michigan Neuroscience Institute’s Intern Health Study, show that two groups are at higher risk for developing negative mental health outcomes during this time: surgical trainees and those who identify as a sexual minority (lesbian, gay, bisexual, or other non-heterosexual).
The first study led by Tasha Hughes, MD, MPH, and an assistant professor in the University of Michigan Department of Surgery, explored changes in surgical residents’ mental health during the intern year, and also looked at how surgical residents’ experiences compare to those of other (non-surgical) residents.
Hughes and her team found that, initially, surgical interns enter the program with lower rates of existing depression symptoms than a similar age cohort within the general population. However, after the intern year, almost one-third (32 percent) of interns screened positive for depression, based on their scores from at least one mood survey.
Among the surgical interns, some demographic groups were more likely to develop depression—females, sexual minorities, singles (those with no partner), those working the most hours on average, and those with a history of negative childhood experiences. However, even after adjusting for these demographic factors, surgical interns were more likely than other interns to develop new-onset depression, except for when work hours were taken into account. Additionally, among those who screened positive for depression, 64 percent continued to report signs of depression on a later survey.
Perhaps, equally worrisome, was that many of the surgical interns did not seek assistance. Just 26 percent of those whose scores were consistent with depression sought mental health care during their intern year. Hughes explains the importance of the findings for promoting a healthier learning environment. “Surgical training, especially in the United States, can be a period of intense stress, which we find is linked to new onset of depression,” said Hughes. “These findings suggest a need for surgical program directors, leaders, and health systems to continue to find ways to mitigate the effects of surgical training, normalize help-seeking, make mental health support easily available, and pay special attention to those with characteristics that might put them at increased risk.”
The second study, led by Tejal Patel, a student in her senior year at the University of Michigan, looked specifically at interns who started training in 2016 through 2018 and who identified as lesbian, gay, bisexual, or other non-heterosexual.
At the commencement of the intern year, the sexual minority group’s depression scores were higher than those of the heterosexual group. However, rather than remaining consistent over time, the study found that the gap increased throughout the year with larger differences in mental health occurring in the second half of the year. “These results indicate that interns who are part of sexual minority groups may experience unique workplace stressors leading to a widening disparity in mental health,” said Patel.