Depressed British medical students: An ignored demographic?

Dear Sir

Psychological well-being is important for students, their peers and their future medical practice. International studies have reported significant prevalence (12–37%) of depression among medical students. However, these results cannot be generalised to the UK due to differences in course structure, intensity, and environmental factors. Despite the scarcity of research in depressed British medical students, only two studies have been conducted in the past decade. Studies reported wide variations in prevalence (5.6–32.4%) depending on the year of study. The studies had significant limitations which included one or more of: no data on past medical or family history of depression, use of a cross-sectional design and assessing students at only one time point, which was prior to or immediately after exams or at the beginning of the academic year. Current research on depression in British medical students is inadequate and neglected. The General Medical Council (GMC) must encourage medical schools to conduct prospective longitudinal cohort studies to identify prevalence, predictive individual and environmental factors and local barriers to seeking treatment.

International studies have reported higher rates of depression in medical students than age-matched peers. However these studies are not generalizable to the UK due to differences in course structure and environment. Despite this, research to identify prevalence of depression in British medical students has been scarce, with only two studies conducted in the past decade.

Quince et al. (2012) reported 5.7–10.6% of pre-clinical students and 2.7–8.2% of clinical students at Cambridge University were depressed. In contrast Honney et al. (2010) at University College London reported 32.4%, 10.8% and 5.6% of students in all year groups had mild, moderate or severe depression respectively. However both studies had numerous limitations.

Quince did not identify which students were already diagnosed with depression prior to medical school, making it difficult to ascertain whether depression occurred due to factors prior to or during medical school. Furthermore Cambridge utilises a pastoral system where there is a much higher level of contact with tutors compared to other schools and so vulnerable students may have been given much more support to prevent depression.

Finally, due to the fluctuating nature of mood disorders, measurements at one time point are not a reliable indicators of prevalence in individuals as a number of factors such as: exams and holidays can affect mood through the year. Only the Cambridge study followed students over several years, but it failed to make any significant conclusions due to a high rate of non-responders.

The lack of reliable prevalence and causative data on depression in this vulnerable group is a worrying sign. Medical students with depression are more likely to drop out of the course resulting in time and money inefficiently spent on incomplete education. Furthermore, as medical students form the foundation of the future National Health Service (NHS), the social impact can be significant. Regulatory organisations for UK medical schools such as the GMC need to encourage schools to frequently collect data and analyse it locally to identify prevalence rates, predictive individual and environmental factors and local barriers to seeking help and treatment. Data also needs to be pooled nationally so the GMC in concert with the NHS and the Royal College of Psychiatrists can implement national strategies aimed at the general factors affecting all medical students.

Declaration of interest: The authors report no conflicts of interest.