Mental health in medical students: the deciphered quandary

This article was exclusively written for the Sting by Mr Ankit Raj, a final year MBBS student from Kasturba Medical College, Manipal, India. Mr Raj is affiliated to the International Federation of Medical Students Associations (IFMSA). The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

“I don’t want any more of this try, try again stuff. I just want out. I’ve had it. I am so tired. I am twenty and I am already exhausted.”                                                        Elizabeth Wurtzel, Prozac Nation

​There are times in your youth when you are young and free and friends and lovers are plentiful. You have just qualified your pre-med and realize that you are living the life as it should be. And then, medical school hits you. Suddenly, you are in a high-pressure academic environ with an apathetic support system. You realize that everyone around you is a genius wracked with self-doubt, infused with ideation of depression and suicide. ​You realize that you will constantly be scared and anxious, be perpetrated by the continuous onslaught of self-doubt and stress that comes associated with the life in medical school. But why? What is it about medical school and medical training that predisposes medical students to depression and other mental health issues? Prevalence A meta-analysis from Rotenstein et al found that the overall prevalence of depression or depressive symptoms among medical students was 27.2%, and the overall prevalence of suicidal ideation was 11.1%.¹ It is no surprise that high prevalence of depression and suicide among doctors takes root very early in medical school. Medical school culture Medical schools, inherently, carry several risk factors that can lead to mental health issues among medical students. Medical schools are notoriously competitive and stressful, known for long hours of training, studies and clinical rotations. ‘The culture of perfection’ imbibed by medical schools, where students are expected to be faultless and flawless, leaves students with the feeling of constantly falling short.² Medical students also invariably suffer from ‘Imposter Syndrome’, an overwhelming feeling of inadequacy and self-doubts.³ We suffer this in isolation because we assume that we are the only ones who are ‘fraud’ and not ‘perfect’. Chances are, there are many others like us who fear failures and mistakes and are just as afraid as us. Added stress of clinical rotations, constant scrutiny by professors and intense competition with fellow classmates also takes a toll on our mental and physical health. Consequentially, beneath this facade of presumable perfectionism, med students suffer from depression, self-esteem issues, suicide ideation and burnouts. Stigmatization Stigmatizing attitude towards mental health problems is not left untouched by the very same community that trains and pledges to tackle them. Mental health issues among medical students are considered a sign of weakness and students coming out with these problems are often made an outcast by their peers and friends. Many a time, teachers and clinicians themselves play a significant role in perpetuating negative environment towards mental health issues. I have heard anecdotes of students being told ‘to just learn to deal with the stress and anxiety that comes with studying medicine’. The culture at medical schools does not allow students to show their vulnerability in anyway. If one accidently discloses his weakness or asks for help, he is made to feel like he does not belong to the system.⁴ An improper ‘way out’ For many, substance abuse is an easier way to deal with the burnout and stress than seeking counselling. Alcohol, smoking, marijuana and sometimes harder drugs find their way into the lives of these medical students, taking the cover of their solitude and helplessness.⁵ Improper guidance and support system only facilitates this unfortunate circumstance. Solving the problem Medical schools need to work harder in creating an environment where mental health is openly discussed and not stigmatized. A proactive and confidential support structure with equal focus on screening and prevention is the need of the hour. We need to make radical changes in curriculum with a focus on encouraging students to take part in activities outside medical school.⁶ Mental health issues among medical students is not an isolated situation. It is indicative of a larger problem with unknown consequences. It is an allegory of burnout, stress and emotional exhaustion in medical community, the stigmatizing attitude towards it and our unwillingness to tackle it. References

1. Rotenstein, Lisa S. et al. “Prevalence Of Depression, Depressive Symptoms, And Suicidal Ideation Among Medical Students.” JAMA 316.21 (2016): 2214.
2. Yanes, Arianna F. “The Culture Of Perfection.” Academic Medicine 92.7 (2017): 900-901.
3. Villwock, Jennifer A. et al. “Impostor Syndrome And Burnout Among American Medical Students: A Pilot Study.” International Journal of Medical Education 7 (2016): 364-369.
4. Slavin, Stuart J. “Medical Student Mental Health.” JAMA 316.21 (2016): 2195.
5. Katie LaGrone, Matthew Apthorp. “Medical School Secrets: Study Finds Alcohol And Drug Abuse In Med School.” WFTS. N.p., 2017.
6. “GMC | Supporting Medical Students With Mental Health Conditions.” Gmc-uk.org. N.p., 2017.

About the author Ankit Raj is a final year MBBS student from Kasturba Medical College, Manipal, India and a member of IFMSA. He is passionately interested in global health and medical education. He wishes for a better participation and a proactive role of medical students in designing and implementing a more innovative medical education.