Ethical Concerns if Medical Students Struggle with Mental Health

By Stacey Kusterbeck

At the urging of medical students, faculty at Michigan State University in East Lansing created a Medical Student Mental Health Committee (MSMHC) back in 2015. “At the time, medical school mental health initiatives across the country were in their infancy,” notes Alyse Folino Ley, DO, FACN, associate chair of education and research at Michigan State University Department of Psychiatry. The faculty began by surveying students on depression, anxiety, sleep, and burnout. “We were astonished by the level of anxiety and mental health symptoms that the students were expressing,” Ley says. Ley and colleagues conducted a formal study, believing that the results could help other medical schools meet the needs of their student bodies.

The researchers surveyed medical students over a four-year period from 2015 to 2019 (973 students in 2016, 889 students in 2017, 547 students in 2018, and 606 students in 2019).¹ Students were asked about symptoms of depression, burnout, anxiety, and sleep problems. “Mental health symptoms were seen throughout medical school and appeared to have an onset in the early years,” says Ley.

Symptoms of burnout, depression, and anxiety were observed throughout all four years. A large number of students (33.7% to 77.6%) reported depressive symptoms. “This is especially relevant because major depressive disorder is a risk factor for suicide,” notes Ley. Most students reported anxiety (67.0% to 88.2%). “Many students also endorsed burnout, which seemed to increase by the second to third year, similar to depression,” adds Ley.

On a positive note, many students who acknowledged mental health symptoms (43.1% to 48%) knew where to find help and sought help. Lack of time was the most common reason cited for not seeking help. Students who did not seek help acknowledged they knew where to seek help. Students also trusted that their concerns would be held confidential, another encouraging sign. “We believe this is because we made mental health a priority in the college through the MSMHC,” says Ley.

Providers met twice a year with the first- and second-year classes, reviewed the survey results, brought in individuals with lived experience, and reviewed available resources. “This information should be used to encourage medical schools to develop programs that make services readily available,” urges Ley.

Overall, the study’s findings show that burnout, depression, and anxiety symptoms begin early in medical school and often worsen throughout training. “This should propel us toward the development of programs that move us beyond awareness alone,” asserts Ley. “It is necessary to recognize and treat psychiatric symptoms, and then treat those symptoms as we would any other potentially life-threatening medical condition.”

Burnout should signal healthcare providers to screen for symptoms of other conditions (such as depression) that place the individual at risk of suicide. “Based on our survey findings, measures to help identify those suffering and implementation of supportive and time-sensitive interventions should start as early as the first year of medical training,” argues Ley.

The study data have spurred additional efforts to incorporate wellness and mental health education within curricula for first- and second-year osteopathic medicine and physician assistant students. “Currently, we are working with faculty to incorporate streamlined topics into their courses,” reports John R. Taylor, PsyD, director of Wellness & Counseling at MSU College of Osteopathic Medicine. These include emotions and heart health, alcohol and substance use, meditation, test anxiety, burnout mitigation, and depression mitigation.

There is a critical need to prepare medical students early in their training to recognize emerging signs of psychiatric illnesses. “Creating institutional cultures where faculty, particularly physician educators, are involved in this process can have a positive influence on student receptivity and future professional practice,” offers Taylor.

REFERENCE

1. Ley AF, Han JJ, Hare E, et al. Beyond burnout: A four-year survey of osteopathic medical student mental health and the implications for the development of wellness and mental health programs. J Osteopath Med 2023;123:225-233.