Persistent Depressive Symptoms in Interns Highlight Need for Ongoing Mental Health Support

Persistent depressive symptoms in first-year physicians, or interns, during medical residency, indicate the need for continuous mental health support for this group. Interns with positive depression screenings during their intern year showed higher long-term the 9-item Patient Health Questionnaire-9 (PHQ-9) scores and a greater likelihood of future positive screenings. These are the findings of a study published in JAMA Network Open.

Longitudinal data post-residency are limited, hindering the understanding of persistent depressive symptoms and ongoing vulnerability among physicians. The demanding nature of residency, with long hours and rigid schedules, significantly contributes to depression among doctors, highlighting the need for early intervention.

To measure how persistent and severe depressive symptoms are among physicians who did or did not screen positive for depression in their first year of residency training, researchers conducted a longitudinal cohort study. The primary outcome was the persistence and severity of depressive symptoms, measured using the PHQ-9 over a 10-year period. The researchers also assessed demographic characteristics, program features, personal history of depression, and baseline neuroticism scores among participants.

They gathered quarterly survey data from incoming interns participating in the prospective annual cohort study, known as the Intern Health Study (IHS), prior to the commencement of their residency training. Eligible individuals included those with a baseline PHQ-9 score indicating none to mild depression (less than 10) were included in the analysis.

A total of 858 incoming physician interns (mean age, 27.4; women, 53%) with a PHQ-9 score of <10 prior to the start of their internship were included in the final analysis. Throughout the intern year, 302 participants (35.2%) indicated experiencing depressive symptoms on at least 1 quarterly survey. New-onset depressive symptoms during the intern year were more common among women with higher baseline PHQ-9 and NEO Personality Inventory scores, and a personal or family history of depression.

Physicians with new-onset depressive symptoms as interns had consistently higher mean PHQ-9 scores during follow-up than those without, with nearly double the mean score 1-year post-internship (6.5 [95% CI, 6.1-6.9] vs 3.9 [95% CI, 3.6-4.2]; P <.001), and this significant difference persisted for all 10 years.

Compared with interns without positive screenings, those who initially screened positive for depression consistently exhibited significantly higher mean PHQ-9 scores at both the 5-year (4.7 [95% CI, 4.4-5.0] vs 2.8 [95% CI, 2.5-3.0]; P <.001) and 10-year marks (5.1 [95% CI, 4.5-5.7] vs 3.5 [95% CI, 3.0-4.0]; P <.001).

Study limitations included the inability to establish causality due to the observational design, potential selection bias from voluntary participation, and reliance on the PHQ-9 for assessing depression rather than clinical diagnoses.

“This research suggests that there may be lasting consequences of depressive symptoms well beyond the years spent in medical training, emphasizing the need to support training doctors to safeguard the long-term health of those entrusted to ensure the health of others,” the researchers concluded.