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Comparative Study
. 2010 Jun;67(6):557-65.
doi: 10.1001/archgenpsychiatry.2010.41. Epub 2010 Apr 5.

A prospective cohort study investigating factors associated with depression during medical internship

Srijan Sen  1 , Henry R Kranzler, John H Krystal, Heather Speller, Grace Chan, Joel Gelernter, Constance Guille
Affiliations
Comparative Study

A prospective cohort study investigating factors associated with depression during medical internship

Srijan Sen et al. Arch Gen Psychiatry. 2010 Jun.

Abstract

Context: Although the prevalence of depression among medical interns substantially exceeds that of the general population, the specific factors responsible are not well understood. Recent reports of a moderating effect of a genetic polymorphism (5-HTTLPR) in the serotonin transporter protein gene on the likelihood that life stress will precipitate depression may help to understand the development of mood symptoms in medical interns.

Objectives: To identify psychological, demographic, and residency program factors that are associated with depression among interns and to use medical internship as a model to study the moderating effects of this polymorphism.

Design: A prospective cohort study.

Setting: Thirteen US hospitals.

Participants: Seven hundred forty interns entering participating residency programs.

Main outcome measures: Subjects were assessed for depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9), a series of psychological traits, and the 5-HTTLPR genotype prior to internship and then assessed for depressive symptoms and potential stressors at 3-month intervals during internship.

Results: The PHQ-9 depression score increased from 2.4 prior to internship to a mean of 6.4 during internship (P < .001). The proportion of participants who met PHQ-9 criteria for depression increased from 3.9% prior to internship to a mean of 25.7% during internship (P < .001). A series of factors measured prior to internship (female sex, US medical education, difficult early family environment, history of major depression, lower baseline depressive symptom score, and higher neuroticism) and during internship (increased work hours, perceived medical errors, and stressful life events) was associated with a greater increase in depressive symptoms during internship. In addition, subjects with at least 1 copy of a less-transcribed 5-HTTLPR allele reported a greater increase in depressive symptoms under the stress of internship (P = .002).

Conclusions: There is a marked increase in depressive symptoms during medical internship. Specific individual, internship, and genetic factors are associated with the increase in depressive symptoms.

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Conflict of interest statement

Competing Interests: SS, HS, GC, JG and CG declare that the answers to the questions on your competing interest form are no competing interests and therefore have nothing to declare. HK reports consulting arrangements with Alkermes, Inc., Ortho-McNeil Pharmaceuticals, Elbion Pharmaceuticals, Solvay Pharmaceuticals, and Sanofi-Aventis Pharmaceuticals and research support from Merck and Merck Company, Bristol-Myers Squibb Company and Ortho-McNeil Pharmaceuticals. JK reports consulting arrangements with Abbott Laboratories, Astra-Zeneca, Atlas Venture, Bristol-Meyers Squibb, Cypress Bioscience, Inc., Eli Lilly and Co., Fidelity Biosciences, Forest Laboratories, Glaxo-SmithKline, Houston Pharma, Lohocla Research Corporation, Merz Pharmaceuticals, Organon Pharmaceuticals, Pfizer Pharmaceuticals, Schering Plough Research Institute, Shire Pharmaceuticals, Sumitomo Pharmaceuticals America, Ltd., Takeda Industries, Transcept Pharmaceutical, UCB Pharma, US Micron, Tetragenex Pharmaceuticals (compensation in exercisable warrant options until March 21, 2012; value less than $10K) is co-sponsor on pending patents related to 1) glutamatergic agents for psychiatric disorders (depression, OCD) and antidepressant effects of oral ketamine.

Figures

Figure 1
Figure 1
This figure demonstrates the proportion of interns who meet PHQ criteria for depression prior to internship and at 3-month intervals through intern year.
Figure 2
Figure 2
This figure displays PHQ depression scores for Caucasian subjects stratified by the presence of at least one copy of a 5-HTTLPR low functioning allele. The left side of the figure shows the PHQ depression score prior to the stress of internship. The right side of the figure shows the mean PHQ depression score during internship.
See this image and copyright information in PMC

Comment in

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