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A Prognostic Index to Identify the Risk of Developing Depression Symptoms Among U.S. Medical Students Derived From a
Liselotte N Dyrbye1, Natalie M Wittlin, Rachel R Hardeman
1L.N. Dyrbye is professor of medicine and medical education, Program on Physician Well-Being, Department of Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-7820-704X. N.M. Wittlin is PhD student, Department of Psychology, Yale University, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-0858-3576. R.R. Hardeman is assistant professor, Division of Health Policy and Management, University of Minnesota, School of Public Health, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0003-3913-5933. M. Yeazel is associate professor, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota. J. Herrin is assistant professor of medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-3671-3622. J.F. Dovidio is Carl Iver Hovland Professor of Psychology and professor of public health, Department of Psychology, Yale University, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-6110-8344. S.E. Burke is assistant professor, Department of Psychology, Syracuse University, Syracuse, New York; ORCID: https://orcid.org/0000-0002-6952-924X. B. Cunningham is assistant professor of health disparities, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-3205-5538. S.M. Phelan is associate professor of health services research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2091-6297. T.D. Shanafelt is Jeanie and Stewart Ritchie Professor of Medicine and associate dean, Stanford School of Medicine, Stanford, California; ORCID: https://orcid.org/0000-0002-7106-5202. M. van Ryn is Grace Phelps Distinguished Professor, Oregon Health & Science University School of Nursing, Portland, Oregon; ORCID: https://orcid.org/0000-0002-4258-7319.
Purpose:
To determine baseline individual and school-related factors associated with increased risk of developing depression symptoms by year four (Y4) of medical school, and to develop a prognostic index that stratifies risk of developing depression symptoms (Depression-PI) among medical students.
Method:
The authors analyzed data from 3,743 students (79% of 4,732) attending 49 U.S. medical schools who completed baseline (2010) and Y4 (2014) surveys. Surveys included validated scales measuring depression, stress, coping, and social support. The authors collected demographics and school characteristics and conducted multivariate analysis to identify baseline factors independently associated with Y4 depression symptoms. They used these factors to create a prognostic index for developing depression. They randomly divided the data into discovery (n = 2,455) and replication (n = 1,288) datasets and calculated c statistics (c).
Results:
The authors identified eight independent prognostic factors for experiencing depression symptoms during training within the discovery dataset: age; race; ethnicity; tuition; and baseline depression symptoms, stress, coping behaviors, and social support. The Depression-PI stratified four risk groups. Compared with the low risk group, those in the intermediate, high, and very high risk groups had an odds ratio of developing depression of, respectively, 1.75, 3.98, and 9.19 (c = 0.71). The replication dataset confirmed the risk groups.
Conclusions:
Demographics; tuition; and baseline depression symptoms, stress, coping behaviors, and social support are independently associated with risk of developing depression during training among U.S. medical students. By stratifying students into four risk groups, the Depression-PI may allow for a tiered primary prevention approach.
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