Dear depression, why do you even exist in the budding medicos? MEDICAL INDUCED DEPRESSION IN BUDDING

It is a matter of fact that the high demands and pressure of medical school and pre-residency entrance tests pose a tremendous challenge to the personal wellbeing for the physicians in training which leads to high rates of anxiety, burnout, decreased attention, increased incidence of errors, negligence and depression.

It is a matter of fact, that the high demands and pressure of medical school and pre-residency entrance tests pose a tremendous challenge to the personal wellbeing of the physicians in training which leads to high rates of anxiety, burnout, decreased attention, increased incidence of errors, negligence and depression [1,2]. Furthermore, stress and depression can also result in illnesses like headaches, coronary heart disease, Gastro-Intestinal diseases, absenteeism, selfmedication, and the consumption of drugs and alcohol [3].
The global prevalence rate of depression in medical students according to a meta-analysis is 28.0% (95% confidence interval [CI] 24.2-32.1%) while that of medical graduates is not yet available. First year students had the highest rates of depression at 33.5% (95% CI 25.2-43.1%) while it then gradually decreased to reach 20.5% (95% CI 13.2-30.5%) at fifth year [4]. Studies have shown prevalence rates as high as 51.3% amongst medical students in one of the institution in India while that of German medical students studying in different institutions across Europe showed a prevalence rate of 23.5% [5,6]. One such study conducted in one of the premiere institution of the USA showed a prevalence rate of moderate to severe depression as 14.3% [7]. Hence different countries shows different prevalence rates of depression in medical students. Early onset depression among students interferes with functioning. Depression during early academic years of medical career may continue further and affect the professional functioning of the subjects later. Thus, there is a need for screening of this population.
Even students who are preparing for post-graduation courses suffer severely from depression. The main reason is scarcity of the seats for the desired courses. The examination scheme is also not uniform throughout. In most countries, the exam is made in such a way, that only students who can by heart every line are selected. Some countries including India even have 50% reservation system where students getting just passing marks (50%) are selected and students who get 80% are not selected, further leading to depression.
Examination scheme, especially for the entrance test of the post-graduation courses, should be made uniform throughout the world. Currently, some of the countries including India have exams which are completely theoretical based and the question stems are nothing but a pick-up-line from the textbooks. Such exams do not help in selecting bright minds, but for sure can add more to depression. Whereas exams like United States Medical Licensing Examination (USMLE) has a great pattern for selecting the candidates (3 steps examination and then the interviews). Even medical students who don't have depression could be suffering from burnout, a measure that includes depersonalization, emotional exhaustion, and feelings of professional inadequacy [1]. Burn out is a major problem in physicians, especially in countries like India. It couldeven lead to more severe depression [9].
Medical schools should include courses like anxiety and stress reducing courses. More students-teachers interactions should be entertained. Seniority complex and Quota/Reservations should be removed as well. More sports and research activities should be inculcated [10,11]. These could definitely help in decreasing the depression prevalence and incidence rate. Furthermore, relaxation interventions like abdominal breathing, applying relaxing or activating words appropriately, learning to identify and counter negative thoughts, practical ways to increase healthy eating, use of the imagery in relaxation, building positive coping, and redirecting time and energy to different tasks based on the level of importance, improvement in relationship with the staff and gaining emotional support should be incoporated into the medical education system [12,13].

CONCLUSION
The incidence and prevalance of depression in the medicos has been on a rise since the last decade. Since, the health of every patient depends upon these budding doctors, it is of utmost importance to make them stay happy and healthy.