Bring up Instagram and search "#medstudent" or "#doctor" and you'll find over five million results showing anything from workplace comradery to surgical procedures to textbooks. This is, of course, representative of our societal preconception of what it means to be a doctor: people who love their jobs, save lives and have genius-level knowledge of human medicine, otherwise leading normal lives. Although this is entirely true in a majority of cases, there is an ever-increasing plague that is tightening its grip on the profession of medicine, literally killing those who provide medical services. It is estimated that 300 - 400 physicians commit suicide every year, averaging out to approximately one per day. The roots of this reality run deep within the profession and can be traced back to where at all began: pre-med.
The journey towards becoming a doctor can be incredibly rewarding as the premedical undergraduate has nearly limitless resources to fuel their interests. Opportunities for relevant academic education, nearly endless scientific medical journals and shadowing or internships with current medical professionals are some of the associated enjoyments. However, as valuable and enjoyable as these things are, they do not come without the one commodity of which everyone seems to never have enough: time. This is undeniably the limiting factor in undergraduate life as a whole and is even more elusive amongst pre-professional students. The years that precede medical school are especially demanding, unlike that of the majority of other undergraduate programs; laden with a myriad of obstacles to overcome such as academic rigor, steep competition, self-inflicted isolation and the resulting ever-present sting of premedical depression.
We need more time to study for that organic chemistry exam, more time to shadow in a clinical setting or (the most often neglected) more time for social activities. If you're a pre-med and like me, then you'd most-likely prioritize your academics and career-related obligations over that of social interactions. This was beneficial in the short-term as it afforded me with more time to devote to my studies, however, I learned first-hand how destructive of a habit it can be. As a result, I experienced varying degrees of loneliness, unfounded feelings of undesirability and inadequacy as it related to my personality or physical attributes, irritability and also recognized an increase in apathy towards the feelings of those around me. Had it not been for the concern and interventions by family and a few close friends, this would have most certainly worsened as opposed to having improved. For the better part of a year, I saw how drastically it affected me, my work and even degraded my productivity. I have since acquired a newfound perspective on what it means to struggle with acute mental health concerns and wholly intend on using that understanding to better connect with my future patients, making me a better doctor when the time comes.
Like that of medical students and physicians, premedical undergraduates are showing signs of the same depressive disorders which indicates that there may be a causative correlation that can be derived. A 2009 research study at the University of California, San Diego, quantified the degree and distribution of premedical student depression at their institution, using the PHQ-9 standard for Major Depressive Disorder (MDD) as outlined in the DSM-IV. Their study revealed that premedical students have both greater depression intensity and prevalence of MDD than non-premedical students; that of which increases markedly amongst women and Hispanics. If left to fester, the consequences can be dire and life-threatening.
In order to fully understand the implications that untreated depression has on a person's physical and psychological well-being, consider the following amalgamation of a few of the relevant research findings. A three-year study (using Magnetic Resonance Imaging (MRI) scans and Gray Matter Density (GMD) analysis) showed that MDD causes morphological changes in the chemistry, structure, and function of various regions within the limbic system and prefrontal cortex of the brain. In other words, too much stress and depression will alter the way your brain works; specifically, how it regulates emotion, long-term memory and social interactions. With those effects in mind, let's consider again the focus of what we're trying to prevent.
It is well known that medical school is one of the most rigorous academic endeavors one can undertake and so it should be of little surprise that there is a high rate of depressive symptoms associated with it. In fact, 49.6% of 4,287 medical students across seven institutions suffered from burnout between 2006 to 2007, 11.2% of which had suicidal ideation. Further, a meta-analysis of data from 1960 - 2003 found that among male and female physicians, the suicide mortality rate is 40% and 130% higher, respectively, than those in the general population or of other academic fields.
This trend must be stopped. If the seeds of the same conditions that are directly correlated to physician suicide are being found in medical and premedical students, then that is where our efforts must start. Recognizing it in our colleagues, family members and friends who are striving to become medical professionals is imperative as this is a compounded effect that starts early and must be managed early. Although it is not defined as an official mental health disorder, the underlying implications of the commonly coined term "high functioning anxiety" can reveal some of the important precursors to look for. On the surface, people with this form of anxiety appear to be successful, focused, collected—the picture of success in one form or another. However, underneath that external persona is an entirely different reality from their own perspective that they rarely share with others. Driving them towards their success is a near constant churn of anxiety which may stem from fear of failure or disappointment of others. This is unsustainable as it inclines one to bottle up and compartmentalize their feelings only to deal with it "later" but of course later never comes.
The next big thing. I just need to pass biochemistry. I just need to score well on the MCAT. I just need to get into medical school. I just need to… I just need to… and so on until the once hopeful and vibrant person is found dead at suicide's door. The smoking gun here is our own apathetic approach to depression and anxiety, yet we have the ability to intervene before it ever reaches this point. You alone have the power over your thoughts, your decisions and your actions so use it to direct yourself towards your goals with a focus and determination that isn't temporarily propped up by anxiety. Putting all of your efforts into your aspirations while neglecting an internal conflict is not a temporary sacrifice—it is the beginning of a life of discontentment where nothing you do brings lasting happiness because that pain is always there. Success doesn't happen in a vacuum but comes by through the assistance of others and so, instead of suppressing the longing and emotional estrangement within, actively build meaningful relationships with other people. Doing so is just as integral to the fruition of your goals as it is to your lasting happiness.