Understanding the Phenomenon of Depression among Specialist Medical Education Participants

Is the prevalence rate for depression really that high? Is the desire for self-harm and even suicide really that frequent? Let's take a look at some data.

Also read: Depression, 3.3 Percent of Prospective Specialist Doctors Want to End Their Lives or Injure Themselves

Also read: Depression in Students

Dauglas A conducted a research titled "Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis" in JAMA on December 8, 2015. The research concluded that the estimated prevalence of depression or depressive symptoms among residents is 28.8 percent. The number ranges from 20.9 to 43.2 percent, depending on the instrument used, and increases with each calendar year.

Further research is needed to identify effective strategies for preventing and treating depression among doctors in specialist medical education.

In the online media of the Ministry of Health "Sehat Negeriku" edition of October 7, 2021, the Acting Director-General for Disease Prevention and Control at the Ministry of Health, Dr. Maxi Rein Rondonuwu, stated that based on the Basic Health Research (Riskesdas) 2018, more than 19 million people aged over 15 years experienced emotional mental disorders, and more than 12 million people aged over 15 years suffered from depression.

In addition, based on the Sampling Registration System conducted by the National Institute of Health Research and Development in 2016, there were 1,800 suicide cases per year, or five people committing suicide every day. Furthermore, 47.7% of the suicide victims were aged 10-39, which includes teenagers and those in their productive years.

From the comparison of the above data, we can see that the incidence of depression among residents based on a survey conducted by the Ministry of Health is 22.4 percent, which is still lower than the incidence of depression abroad, which reaches 28.8 percent, as well as the rate of suicidal ideation.

Causes of depression

After the release of the screening results related to the mental health of participants in the specialist program, some policymakers even firmly stated the need for evaluation related to the specialist doctor education system. However, does this mean that changes need to be made to the education system?

Shouldn't we delve deeper into the causes of depression amongst PPDS students first to thoroughly understand the root of the problem and have comprehensive data before evaluating the education system?

Chen et al's (2022) study shows that neuroticism, family environment, and single status are risk factors for depression in the US. Meanwhile, young age is the main predictor of depression in China. Long working hours and lack of sleep duration emerged as predictors of depression in both countries. This shows the need for improvements to a more effective medical education system.

Depression often leads to high levels of anxiety and low levels of stimulation, which can result in decreased performance in the context of learning and teaching.

Please note, the majority of the results of this survey were obtained through self-report inventories that measure depressive symptoms and not through the gold standard interview for diagnosing depressive disorders.

Several preventive steps have been taken to overcome this. One of them is the introduction of wellness programs and other support programs, such as the provision of psychiatry carried out in Ohio, USA.

However, responses from PPDS students show that the related program is not completely helpful. This is because there is a stigma among PPDS students that they are afraid of appearing less competent compared to other colleagues (Levyet al, 2019).

The Accreditation Council for Graduate Medical Education and the European Working Time Directive are taking other preventive steps by reducing working hours and improving the work environment (Mata et al, 2015).

This step demonstrates an increase in the global medical community's awareness of depression within the PPDS education environment. Further studies need to be conducted to determine the determinants and stages of PPDS students experiencing depression so that more specific preventive measures can be taken to prevent depression among them.

Impact on the learning process

Depression can have a significant impact on the teaching and learning process. There are several mechanisms that can explain this, including activation of the fight or flight response which occurs in the nervous system when a person experiences excessive stress or anxiety.

When someone is depressed, their nervous system can become overactivated, especially the amygdala, an area of ​​the brain involved in emotional processing and quick decision making.

This excessive activation can lead to a fight or flight response, which in turn can interfere with higher order thinking skills, such as those that occur in the neocortex.

The learning and teaching process requires the involvement of the neocortex, which is involved in complex information processing, analysis, problem solving, and decision making.

However, if someone experiences depression that triggers a fight or flight response, their focus will shift to intense emotional experiences and simpler thoughts, hindering their ability to learn effectively. Negative stimuli from the environment are perceived as threats that trigger rapid, but inaccurate reactions by the amygdala.

In addition, depression can also cause concentration disturbances, fatigue, and loss of interest in activities that are usually enjoyable or beneficial. All of these can hinder an individual's ability to focus and fully engage in the teaching and learning process.

After the release of the screening results related to the mental health of participants in the specialist program, some policymakers even strongly stated the need for evaluation of the specialist medical education system.

The Yerkes-Dodson theory proposes a relationship between the level of stimulation or anxiety and cognitive or motor performance. Generally, this theory states that an individual's performance will improve as stimulation or anxiety increases until it reaches its optimal point, but it will decline thereafter.

In the context of depression, high levels of anxiety or stress can cause individuals to experience difficulty in the teaching and learning process. Depression often leads to high levels of anxiety and low levels of stimulation which can lead to a decrease in performance in the context of teaching and learning.

At low levels of anxiety, individuals may lose interest, motivation, and energy to fully engage in the learning or teaching process. Conversely, high levels of anxiety can cause cognitive disturbances, difficulty concentrating, and decreased cognitive performance.

Therefore, in this case, depression can produce an inverted Yerkes-Dodson curve, in which the levels of low and very high anxiety due to depression can cause a decrease in performance in the teaching and learning process.

Therefore, it is important to manage and treat depression properly. Additionally, it is important for teachers, individuals, and institutions to be able to identify this in order to find appropriate management so as to minimize its negative impact on the learning and teaching process.

Budi Santoso, Chair of the Indonesian Medical Education Association