This might hurt

As a brand-new psychiatry resident at the Yale School of Medicine, Srijan Sen saw a lot of misery—among his peers.

“We saw these people around us who, during orientation, seemed all full of joy,” he says of his fellow first-year residents (known as interns). “But a few months later, they were crying, having trouble sleeping, having trouble with relationships.”

Finding “no large-scale, comprehensive studies” of depression among interns, Sen and colleague Constance Guille set out to conduct one while still residents themselves. In 2007–08 and 2008–09, 740 first-year residents at 13 U.S. hospitals answered questionnaires about depression symptoms before their internships began, then quarterly during the year. The results, published in the Archives of General Psychiatry, are, in Sen’s word, “concerning.”

At any given time, fully one in four interns is clinically depressed—a sixfold increase from the rate at the start of their training year. At least 40 percent are depressed at some point during the year. And the suffering seems to harm more people than just the doctors themselves: the survey responses also showed that 35.6 percent of depressed interns committed serious medical errors in any given quarter, twice the rate of their non-depressed peers.

“Hopefully this sort of work can help to spur changes to the medical education system,” says Sen, now an assistant professor at the University of Michigan. “Finding ways to change the system to be healthier for the interns would also be healthier for patients.”

One clear culprit is overwork. Interns reported working an average of about 70 hours a week. “Every hour they worked beyond 65 hours, they got more depressed,” Sen says. Since 2002, residents’ work hours have been capped at 80 per week, but enforcement is uneven, Sen notes. And while that cap might sound high, it serves a purpose: “The interns that worked between 90 and 100 hours—more than half of them met the criteria for depression.”