Page 65 - JCBP-2-3

Journal of Clinical and
Basic Psychosomatics Depression among medical students and doctors

and doctors discovered that almost half of the students 2. Methods
exhibited symptoms of depression, while about a third
of doctors and residents did. However, despite doctors 2.1. Study design and population
having better mental health ratings compared to students, Between February and March 2024, we conducted a cross-
their mental health remains poorer than that of the general sectional study involving medical students and doctors
population. Factors such as being single, longer weekly (including resident doctors) in Lithuania. The survey
8
working hours, an increased average number of on-call was conducted in Lithuanian and utilized an anonymous
9
days per week, lower levels of expertise, and personality online survey consisting of the PHQ-9 and demographic
traits such as perfectionism significantly risk the questions. The distribution of the survey was carried out
10
emotional health of doctors. At work, doctors mostly deal via social media platforms, specifically closed groups on
with human health and constantly encounter a multitude Facebook dedicated to medical students and doctors.
of intense emotions in their interactions with patients. We opted for a cross-sectional study design for two main
Some doctors employ strategies such as depersonalization reasons: Firstly, there is a lack of recent studies examining
and acquiescence to cope with negative emotions such as the prevalence of depression symptoms among doctors and
anger, frustration, and guilt, stemming from the tension medical students in the scientific literature, especially in
between professional ideals of expertise and the realities Lithuania. Secondly, we intend to pursue further research
of organizational constraints and self-preservation. These aimed at implementing interventions to improve the
coping mechanisms may contribute to the deterioration of mental health of medical students and doctors. The results
doctors’ relationships with their work, posing a significant of this research will guide our decision-making regarding
threat to the health system. 11 which group — whether medical students or doctors —

Growing research underscores the significant impact should be prioritized for these interventions.
of poor mental health among doctors on the health-care
system, which includes lower quality of communication 2.2. PHQ-9
and/or care, increased errors, poorer overall outcomes, The severity of depressive symptoms was assessed using
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and/or higher costs. The specifics of doctors’ work often the Lithuanian version of the PHQ-9. The PHQ-9 is a
involve uncontrollable stress, unpredictability, and low self-administered instrument that is used for screening
work control. Research indicates that such uncontrollable depressive symptoms and their severity in the general
stress directly disrupts the function of the prefrontal population. The PHQ-9 is a reliable and valid screening
cortex, causing neuronal connections in this brain region tool, demonstrating high sensitivity and specificity in
to deteriorate, which explains the psychological difficulties detecting major depression. 16,17 So far, the PHQ-9 has been
experienced by doctors and the decline in their work widely used in various scientific studies, as well as in the
18
efficiency when subjected to prolonged, chronic stress. screening for depression in doctors, making it a valuable
13
19
The decreased work productivity and errors among instrument for comparative analysis of results.
doctors lead to patient morbidity and mortality and pose The questionnaire consists of nine questions and
an economic burden. For example, annually in England, an additional patient-rated difficulty item assessing
there are 237 million medication errors, with 66 million symptom-related impairment. Each answer is rated by the
potentially clinically significant. These avoidable adverse respondent on a 4-point Likert scale, ranging from 0 (“not
drug events cost the National Health Service £98,462,582 at all”) to 3 (“nearly every day”), reflecting experiences
annually. Despite global progress in reducing the harm over the previous 2 weeks. Total scores range from 0 to 27,
14
caused by adverse effects of medical treatment (AEMT), with higher scores indicating greater severity of depressive
the overall incidence and prevalence of AEMT remained symptoms. The summed-item scoring method with
largely unchanged. 15 a threshold of ≥ 10 is favored, as it seems to be a better
Considering the high rates of depression among option than the PHQ-9 algorithm in identifying major
medical students and professionals, the lack of studies, depression. When comparing a PHQ-9 cutoff of ≥10 to
and depression’s burden on the healthcare system, we semi-structured interviews, sensitivity and specificity
have decided to investigate the symptoms of depression (95% confidence interval [CI]) were 0.88 (0.82 – 0.92)
among medical students and doctors in Lithuania using and 0.86 (0.82 – 0.88), respectively. For major depression
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the Patient Health Questionnaire-9 (PHQ-9). Our goal is screening, we used a cut-off score ≥10. Also, we presented
to raise awareness about this critical population, stimulate the results by categorizing PHQ-9 scores into the following
further research, deepen understanding, and advocate for categories: none (0 – 4), mild (5 – 9), moderate (10 – 14),
interventions aimed at improving mental health. moderately severe (15 – 19), and severe (20 – 27). Our

Volume 2 Issue 3 (2024) 2 doi: 10.36922/jcbp.3570