In Their Own Words: An Analysis of the Experiences of Medical Interns Participating in a Prospective Cohort Study of Depression

Abstract

Purpose: To compare the subjective experiences of interns with and without symptoms of depression using a mixed-methods approach.

Method: In 2007-2008, interns from six institutions were screened for depression before and during internship using an online survey that included the Patient Health Questionnaire (PHQ-9). At the end of internship, participants were asked what made the year difficult, easy, and memorable, and how they had changed. Computerized lexical and qualitative thematic analyses were performed to analyze their free-text responses.

Results: Sixty-three percent (244/388) of invited interns participated in the original cohort study. Of those, 42% (103/244) answered the open-ended questions for this analysis. Thirty-five percent (36/103) screened positive for clinically significant depression (i.e., PHQ-9 score ≥ 10) during their intern year. Respondents with symptoms of depression were more likely to report problems with cynicism, exhaustion, and stress, while those without them were more likely to mention positive patient care and educational experiences. Respondents with symptoms of depression preferentially described experiences that "broke" their confidence, sense of well-being, and belief in the medical profession, while those who did not described profoundly positive, life-changing experiences regarding interactions with patients and supportive colleagues, through which they grew personally and professionally.

Conclusions: Depression during internship affects not only objective outcomes like medical errors but also how interns value the profession and themselves, with potentially profound consequences for their future career decisions. Residency programs should implement reactive interventions targeting depression and proactive interventions promoting resilience and well-being to address the issues that lead to depression.

Figure 1

Themes expressed by interns describing the factors that made their internship year difficult or easy, stratified by whether or not they screened positive for depression during the study. Investigators used the constant comparative method to derive and agree on the reported themes. Values represent the percentage of respondents who mentioned each theme. Results are displayed in descending order by the ratio of depressed to non-depressed interns' responses.

Figure 2

Themes expressed by interns describing their most memorable experiences and how they had changed during internship, stratified by whether or not they screened positive for depression during the study. Investigators used the constant comparative method to derive and agree on the reported themes. Values represent the percentage of respondents who mentioned each theme. Results are displayed in descending order by the ratio of depressed to non-depressed interns' responses.