Letters COMMENT & RESPONSE

Addressing Depression and Suicide Among Physician Trainees To the Editor In a JAMA Psychiatry Viewpoint, Goldman and colleagues1 addressed the current lack of concrete programs for the promotion of mental health among medical residents. Highlighting the success of programs implemented by the US Air Force and University of California, San Diego, they put forth a set of recommendations to educate, screen, and treat medical trainees. We agree that the similarities between the Air Force and medical residency programs would allow for an easy translation of such a model to the clinical setting. However, rather than waiting until residency to devote curricular time to mental health education, we believe that the proposed program would be most effective if implemented earlier and continued longitudinally throughout the entire course of medical training. Given the high burden of major depression among medical trainees of all levels,2,3 mental health and wellness education should begin as early as medical school orientation. A substantial proportion of incoming interns are already burned out and depressed prior to leaving medical school. Medical students should be educated on the risk factors and warning signs of burnout and depression and be equipped with resiliencepromoting strategies that will empower them to successfully adapt to adversity.4 Incorporating these lessons into a mandatory undergraduate curriculum will help students become more comfortable with conversations about and eliminate the stigma surrounding mental health issues. The program we envision would be continued into residency. During orientation, trainees would fill out validated screening tools for burnout and depression. As the year goes on, they would engage with quarterly small-group sessions guided by a psychotherapist. Ensuring widespread participation means that no individual would feel singled out. In addition, if a trainee were to develop issues with depression in the future, they would already have an easily accessible, established, and familiar resource. Past research has shown the value of peer support and

the active role it plays in professional growth and satisfaction.5 Group sessions would foster camaraderie; encourage honest, judgment-free discussions; and actively combat the feelings of isolation characteristic of depression. We hope that the Accreditation Council for Graduate Medical Education recognizes the gravity of this issue and addresses the need for immediate medical curriculum intervention. Early exposure in medical school will allow for information regarding resilience-based strategies to be disseminated to proactively address depression, and consistent mental health screenings will facilitate early detection. As medical trainees ourselves, we commend Goldman and colleagues1 for addressing this important and understudied issue. Rida Khan, BS Jamie S. Lin, MD Douglas A. Mata, MD, MPH Author Affiliations: Department of Student Affairs, Baylor College of Medicine, Houston, Texas (Khan); Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (Lin); Department of Pathology, Brigham and Women’s Hospital, Harvard University, Boston, Massachusetts (Mata). Corresponding Author: Douglas A. Mata, MD, MPH, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02114 ([email protected]). Published Online: June 24, 2015. doi:10.1001/jamapsychiatry.2015.0643. Conflict of Interest Disclosures: None reported. 1. Goldman ML, Shah RN, Bernstein CA. Depression and suicide among physician trainees: recommendations for a national response. JAMA Psychiatry. 2015;72(5):411-412. 2. Schwenk TL, Davis L, Wimsatt LA. Depression, stigma, and suicidal ideation in medical students. JAMA. 2010;304(11):1181-1190. 3. Sen S, Kranzler HR, Krystal JH, et al. A prospective cohort study investigating factors associated with depression during medical internship. Arch Gen Psychiatry. 2010;67(6):557-565. 4. Wu G, Feder A, Cohen H, et al. Understanding resilience. Front Behav Neurosci. 2013;7:10. 5. Satterfield JM, Becerra C. Developmental challenges, stressors and coping strategies in medical residents: a qualitative analysis of support groups. Med Educ. 2010;44(9):908-916.

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(Reprinted) JAMA Psychiatry Published online June 24, 2015

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Addressing Depression and Suicide Among Physician Trainees.

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