Physician Training as a Model for Understanding Depression and Suicidality Under Stress

Available with English captions and subtitles in Spanish.

Srijan Sen, MD, PhD, University of Michigan, presents as part of the 2022 Suicide-Focused Assessment and Treatment: An Update for Professionals course.

Provider Mental Health

Sen has pioneered a life model to study the effect of stress on medical staff. He and his research team collected data on thousands of people in countries including the United States, Kenya, and China during medical internships to identify factors associated with increased depression.

Watch now to learn more about:

  • How the focus on physician well-being is growing
  • How a person’s mental health can change during internship
  • Why the medical community should expand the discussion of burnout

“The focus on well-being among physicians has grown dramatically in the last few years,” Sen states.

“In particular, I’ve been gratified and impressed by the courage of so many people who have talked about their own experiences with suicide attempts, depression, and anxiety during their time training as physicians.”

The goal of Sen and colleagues’ research is to provide an empirical or quantitative complement to the stories and anecdotes that people in the medical profession have been sharing.

Sen and his colleagues have been following medical interns for the past 16 years. Each year in March, when interns are matched to training programs, Sen and his team invite thousands of them to participate. Participants wear Fitbits to track activity and note their moods and sleep patterns in an app.

Sen and his colleagues have discovered that interns’ mental health symptoms increase across the board during a year of internship. For example, at the beginning of each internship, 3 to 4% of interns experience depression. However, at any given time of the internship year, about a quarter of interns experience depression.

Similarly, before the internship year starts, about 2% of interns express suicidal ideation. However, during the internship year, about 10 to 11% of interns express suicidal ideation at any given time. The research team has observed similar increases in anxiety and PTSD symptoms.

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In addition to data collected through apps, Sen and his colleagues look at genetic factors, such as telomeres, which indicate the effect of stress on aging. They also observe individuals’ polygenic and chronotype risks for depression.

The studies have shown that increased work hours lead to depression, and social support during the internship period can alleviate depression.

In this talk, Sen also discusses the medical community’s increasing openness to the topic of burnout. He would like to see more discussion of depression and other mental health risks.

“When we focus only on burnout and encourage physicians to identify as burned out, rather than depressed, we lose all the evidence-based, individual-level interventions that we know are effective at preventing and treating depression and suicide risk,” Sen says. “There are no individual-level interventions for burnout.”

He adds, “My hope is if we can expand the conversation to include depression, anxiety, and suicide risk, we can open up access to those sorts of interventions.”


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About Srijan Sen

Dr. Srijan Sen is the Frances and Kenneth Eisenberg Professor of Depression and Neurosciences and director of the Eisenberg Family Depression Center at the University of Michigan. Dr. Sen’s research focuses on the interactions between genes and the environment and their effect on stress, anxiety, and depression.

Dr. Sen is a member of the National Academy of Medicine Collaborative on Clinician Well-Being. His clinical practice focuses on helping physicians with depression and anxiety.