The mental health jeopardy of our youngest healers

I was admitted to the hospital for psychiatric evaluation and stabilization just after my third year of medical school. Leading up to my episode, I thought I was fine – stressed, sure, overworked, definitely, but I thought that was normal for someone just finishing a year of clinical rotations. I deteriorated rapidly, and by the time I was admitted, I felt dazed, disoriented, and completely exhausted. I didn’t know what day it was or where I was, but I knew one thing with crystalizing certainty – I wanted to be dead. It was an incredibly isolating experience, one that left me feeling alone and terribly frightened. But since then, I’ve come to realize the harsh reality: I am not alone.

Over these past months, I’ve learned that many of my peers — my friends — are also suffering. The statistics became real. The emotional and physical strain became names and faces. And now, during these unprecedented times, the stressors that afflict the medical student community are only compounded. I don’t believe COVID-19 is unique to us, but I do believe it is important for us to understand the factors that affect our mental health and the measures we can take to combat them.

As the education and advocacy fellow for the American Medical Student Association, the largest independent medical student association, I work with our Wellness and Student Life Action Committee to advocate for medical student wellness. For the September Suicide Prevention Month, our organization is taking an active approach to raise awareness and provide students with mental health resources. This Suicide Prevention Month is especially critical with COVID-19. Americans are more stressed due to COVID-19, and 1 out of 4 young adults seriously contemplated suicide in recent months. In addition, there has been a rise in gun sales during COVID-19, with many of them sold to first time buyers.

Medical students begin medical school with lower depression and burnout rates compared to the general public. However, once in school, they have higher depression and burnout rates compared to the general public. Approximately 60 percent of medical students will experience depression, and 10 percent will experience suicidal ideation.

A large stressor on medical students is the intense competition for a limited number of residency spots. This can make it difficult to lean on peers or ask for help. With COVID-19 precautions changing how residency applications are conducted, there is even more uncertainty in an already uncertain process. The limitation on away rotations further makes it more difficult for students from smaller institutions to stand out.

In addition, the economic downturn from COVID-19 has emotionally charged the tremendous debt that medical students carry. The median education debt for medical students is nearly $200,000. This large debt can make the residency application process an even more nerve-wracking experience. Unsurprisingly, increased educational debt has been linked to a higher risk for alcohol abuse/dependence and burnout.

The high debt, combined with the intense competition for residency spots, can place medical students in a vulnerable position. This is especially concerning, considering that the majority of medical students also face mistreatment from residents and faculty. It is difficult for students to speak against the mistreatment due to the fear of receiving a negative evaluation. Some medical student students are even afraid to speak up regarding the lack of PPE or COVID-19 testing for themselves.

It is in this context that we at AMSA recognizes the importance of self-care and self-awareness during this unprecedented time in the history of U.S. medical education. In honor of this Suicide Prevention Month, we are providing free programming and a social media campaign on mental health amongst medical students. This is one small step in destigmatizing mental illness. Further systemic changes are needed to address the mental health jeopardy of our youngest healers.

Mattie Renn and Thomas Pak are medical students. September is AMSA Suicide Prevention Month.

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