The quality of mental health among medical students worldwide is an issue that has existed for decades, but one that has not, as of yet, received sufficient resources, time, and practical consideration. A recently published meta-analysis of 195 studies in JAMA calculated the overall pooled prevalence, globally, of depression or similar indications of medical students was 27.2%. This clearly illustrates a concern among the mental health status of medical students. In conjunction with this meta-analysis, JAMA also published a systemic review by Wasson et al. focused their research on reviewing 28 different implementations thought to improve the mental health of medical students. Such implementation included a pass/fail system and mental health and wellness programs, all of which revealed an improvement in the medical students’ mental health status.

Given the growing need to solve issues involving mental health in the medical school setting, why has this subject not received the attention it clearly deserves and warrants? The accompanying editorial by Stuart J. Slavin, MD, MEd lists 5 reasons why this is the case. He first states that there is a belief that if a student cannot handle the stress and pressure and workload of medical school, then they should “seek another profession.” Stuart states that this leads to a flawed logic, which indicates that more hours and rigorous education must lead to better “educational outcomes” and that anything less than this is considered a lowering of the standards. Interestingly, curriculum changes at one medical school that implemented pass/fail grading system, less detail oriented study and more student involvement in volunteering and extracurricular showed less stress and anxiety and better overall quality of life among their students.

The second issue in medical school culture is the concern for physical illness over mental health. This is revealed in the lack of prevention of mental health related issues in a medical school setting. Thirdly, most of the resources, money, and medical research have been directed towards the curriculum and how to make the actual medical material better rather than towards the Student Affairs offices. While this might result in better teaching methods and more efficient presentation of material, the quality of the mental health of the student can be overlooked. A fourth aspect of the atmosphere in medical schools that leads to decreased concern for mental health among students is that the medical school administration remains indifferent. Stuart states that the reason for this indifference could lie in the fear that addressing these issues could reflect badly on the particular medical school.

The fifth and final cultural finding in the medical school setting is the attempt by medical schools to implement mindfulness programs, self-care courses, and resilience programs without addressing the issue of the learning environment of the student and how this affects their mental health. Simply providing students with these generalized programs, while well-intended, takes the responsibility away from the medical school administration, as they are not necessarily addressing the true mental health needs of their students.

Stuart states that “student wellness must be everyone’s concern” and should not be limited to just the Dean of Students office. It is crucial that such mental health concerns are valued just as much as board scores and residency matches and that the entire administration work together to create a culture in which the mental well-being of the student is the utmost priority.

References

Rotenstein LS, Ramos MA, Torre M, et al. (2016). Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA 316(21):2214-2236.

Wasson L.T., Cusmano A., Meli L., et al. (2016). Association between learning environment interventions and medical student well-being: a systematic review. JAMA 316(21):2237-2252.

Slavin S.J. (2016). Medical Student Mental Health Culture, Environment, and the Need for Change. JAMA 316(21):2195-2196.