Academic Psychiatry

, Volume 38, Issue 5, pp 547–553

Listening to Depression and Suicide Risk in Medical Students: the Healer Education Assessment and Referral (HEAR) Program

  • Nancy Downs
  • Wendy Feng
  • Brittany Kirby
  • Tara McGuire
  • Christine Moutier
  • William Norcross
  • Marc Norman
  • Ilanit Young
  • Sid Zisook
Empirical Report

Abstract

Objective

A growing body of literature documents high rates of burnout, depression, and suicidal ideation among physicians and medical students. Barriers to seeking mental health treatment in this group include concerns about time, stigma, confidentiality, and potential career impact. The authors describe a 4-year trial of the Healer Education Assessment and Referral (HEAR) program, designed to increase mental health services utilization (MHSU) and decrease suicide risk (SR) as assessed by an Interactive Screening Program (ISP)at one US medical school.

Methods

Over a 4-year period, medical students were engaged in face-to-face, campus-wide, educational group programs and were invited to complete an individual, online, and anonymous survey. This survey contained the 9-item Patient Health Questionnaire (PHQ-9) scale to assess depression and items to identify suicidal thoughts and behaviors, substance use, distressing emotional states, and the use of mental health treatment. Students who engaged in this ISP by corresponding electronically with a counselor after completing the survey were assessed and when indicated, referred to further treatment.

Results

The HEAR program was delivered to 1,008 medical students. Thirty-four percent (343/1,008) completed the online screening portion. Almost 8 % of respondents met the criteria for high/significant SR upon analysis of the completed screens. Ten out of 13 of the students with SR who dialogued with a counselor were not already receiving mental health treatment, indicating that this anonymous ISP identified a high proportion of an untreated, at risk, and potentially suicidal population. MHSU among medical students who completed the survey was 11.5 % in year 1 and 15.0 % by year 4. SR among medical students was 8.8 % in year 1 and 6.2 % in year 4 as assessed by the ISP.

Conclusions

This novel interventional program identified at risk, potentially suicidal medical students at one institution. Based on this single-site experience, we suggest that future multisite studies incorporate a comparison group, acquire baseline (prematriculation) data regarding MHSU and SR, and use an individualized yet anonymous identification system to measure changes in individual participants’ mental health status over time.

Keywords

Depression Suicide Medical student Screening Prevention 

References

  1. 1.
    Goebert D, Thompson D, Takeshita J, et al. Depressive symptoms in medical students and residents: a multischool study. Acad Med. 2009;84(2):236–41.PubMedCrossRefGoogle Scholar
  2. 2.
    Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment. Am J Psychiatry. 2004;161:2295–302.PubMedCrossRefGoogle Scholar
  3. 3.
    American Foundation for Suicide Prevention. “Struggling in silence: physician depression and suicide.” http://www.afsp.org/preventing-suicide/our-education-and-prevention-programs/programs-for-professionals/physician-and-medical-student-depression-and-suicide.
  4. 4.
    Gold KJ, Sen A, Scwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting system. Gen Hosp Psychiatry. 2013;35:45–9.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc. 2005;80(12):1613–22.PubMedCrossRefGoogle Scholar
  6. 6.
    Schwenk TL, Davis L, Wimsatt LA. Depression, stigma, and suicidal ideation in medical students. JAMA. 2010;304(11):1181–90.PubMedCrossRefGoogle Scholar
  7. 7.
    Tjia J, Givens J, Shea J. Factors associated with undertreatment of medical student depression. J Am Coll Health. 2005;53(5):219–24.PubMedCrossRefGoogle Scholar
  8. 8.
    Chandavarkar U, Azzam A, Mathews CA. Anxiety symptoms and perceived performance in medical students. Depress Anxiety. 2007;24(2):103–11.PubMedCrossRefGoogle Scholar
  9. 9.
    Tillet R. The patient within—psychopathology in the helping professions. Adv Psychiatr Treat. 2003;9:272–9.CrossRefGoogle Scholar
  10. 10.
    Center C, Davis M, Detre T, et al. Confronting depression and suicide in physicians: a consensus statement. JAMA. 2003;23:3161–6.CrossRefGoogle Scholar
  11. 11.
    Moutier C, Norcross W, Jong P, Norman M, Kirby B, McGuire T, et al. The suicide prevention and depression awareness program at the University of California, San Diego School of Medicine. Acad Med. 2012;87(3):1–7.CrossRefGoogle Scholar
  12. 12.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
  14. 14.
    Caplan G. Principles of preventive psychiatry. New York: Basic Books, Inc; 1964.Google Scholar
  15. 15.
    Mann JJ, Apter A, Bertolote J, et al. Suicide prevention strategies: a systematic review. JAMA. 2005;294(16):2064–74.PubMedCrossRefGoogle Scholar
  16. 16.
    van Os TW, van den Brink FH, Tiemens BG, et al. Are effects of depression management training for general practitioners on patient outcomes mediated by improvements in the process of care? J Affect Disord. 2004;80:173–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Gilbody S, Whitty P, Grimshaw J, Thomas R. Educational and organizational interventions to improve the management of depression in primary care: a systematic review. JAMA. 2003;289(23):3145–51.PubMedCrossRefGoogle Scholar
  18. 18.
    Preventive US. Services Task Force. Screening for depression in adults: U.S. preventive services task force recommendation statement. Ann Intern Med. 2009;151(11):784–92.CrossRefGoogle Scholar
  19. 19.
    Daigle MS, Pouliot L, Chagnon F, et al. Suicide attempts: prevention of repetition. Can J Psychiatry. 2011;56(10):621–9.PubMedGoogle Scholar
  20. 20.
    Council on Scientific Affairs. Results and implications of the AMA-APA physician mortality project. JAMA. 1987;257:2949–53.CrossRefGoogle Scholar
  21. 21.
    Perlis RH. Hard outcomes: clinical trials to reduce suicide. Am J Psychiatry. 2011;168:1009–11.PubMedCrossRefGoogle Scholar
  22. 22.
    O’Connor E, Gaynes BN, Burda BU, et al. Screening for and treatment of suicide risk relevant to primary care: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;158(10):741–54.PubMedCrossRefGoogle Scholar
  23. 23.
    Eisenberg D, Golberstein BA, Gollust SE. Help-seeking and access to mental health care in a university student population. Med Care. 2007;45:594–601.PubMedCrossRefGoogle Scholar

Copyright information

© Academic Psychiatry 2014

Authors and Affiliations

  • Nancy Downs
    • 1
  • Wendy Feng
    • 1
  • Brittany Kirby
    • 1
  • Tara McGuire
    • 1
  • Christine Moutier
    • 1
  • William Norcross
    • 1
  • Marc Norman
    • 1
  • Ilanit Young
    • 1
  • Sid Zisook
    • 1
  1. 1.University of California San DiegoLa JollaUSA

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