All of us experience stress at times – it is a normal part of life.
But some people are exposed to it far more than others, and one such group is new doctors. For at least the first year after medical school, most are required to complete an internship, which is filled with stressors: round-the-clock hours, low rank, constant demands from patients and superiors, learning complex new skills, and constant fear of making a mistake that could harm a patient.
The barrage of stress, sleeplessness, and self-doubt that is endured in that time increases thoughts of suicide to nearly four times the normal rate.
But, a new study suggests that a free web-based tool for mental health support may cut the rate of suicidal thoughts in half.
It is called MoodGYM, and it is an interactive cognitive behavioral therapy (or wCBT) tool that offers a digital, streamlined form of the “talk therapy” that mental health professionals provide in office visits.
The study was recently published in JAMA Psychiatry by a team led by psychiatrists at the University of Michigan and the Medical University of South Carolina who have studied depression and suicide among medical students and young doctors for years.
Study authors Srijan Sen, M.D., Ph.D., a UM Medical School faculty member, and Connie Guille, M.D., of MUSC, tested the app on 199 interns. All volunteered to take part, and half were randomly assigned to use the wCBT group.
The other half got general information on depression and suicide, and contact information for mental health professionals.
In all, one in five of this latter group thought about suicide sometime in their internship year – compared with one in eight of those who used the MoodGYM. Most of those assigned to use the MoodGYM site stuck with it, using it all year.
The study’s findings suggest that such a tool could help others in high-stress, high-pressure positions. Teaching hospitals and medical schools could use the new results to guide mental health programs for interns, residents, and medical students.
Dr. Sen said of the findings:
This is a relatively risk-free intervention to help interns recognize and treat depression. This is the first study to show that wCBT can reduce suicidal ideation, or suicidal thoughts, in training doctors.
Medical interns make an ideal population to study wCBT’s effects, says Dr. Sen, because all of them experience a predictable sharp rise in stress and pressure with the start of their residency. Sen’s past work has shown how prone that makes them to depression. And, there aren’t many other populations like that to study.
Dr. Guille added that this type of intervention is well-suited to this population because
…the majority of interns won’t seek traditional mental health treatment, mainly because they lack the time, don’t have convenient access to care or have concerns about confidentiality.
Sen and colleagues are working to build on the success of the wCBT study by developing an app designed specifically for medical trainees. It will focus on specific situations and stresses new doctors encounter. They are not affiliated with MoodGYM’s developers, who are from the National Institute for Mental Health Research at the Australian National University.
Previous studies have shown that wCBT can help people treat existing depression, but never in a randomized controlled way to prevent mood problems in a group whose stress level changes almost overnight and remains high for an entire year.
Dr. Sen, an associate professor in the UM Department of Psychiatry and member of UM’s Molecular and Behavioral Neuroscience Institute, said:
Doing this in physicians means we now have a model that shows that this form of wCBT can be remarkably effective as a preventive tool. There’s a good chance that it would be helpful for all populations undergoing some sort of stress and should be explored and tested in these populations in the future.