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Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis

Open access
Mata, Douglas A., Ramos, Marco A., Bansal, Narinder, Khan, Rida, Guille, Constance, Di Angelantonio, Emanuele, Sen, Srijan·2015·JAMA
DOI 10.1001/jama.2015.15845PMC PMC4866499
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Abstract

IMPORTANCE: Physicians in training are at high risk for depression. However, the estimated prevalence of this disorder varies substantially between studies. OBJECTIVE: To provide a summary estimate of depression or depressive symptom prevalence among resident physicians. DATA SOURCES AND STUDY SELECTION: Systematic search of EMBASE, ERIC, MEDLINE, and PsycINFO for studies with information on the prevalence of depression or depressive symptoms among resident physicians published between January 1963 and September 2015. Studies were eligible for inclusion if they were published in the peer-reviewed literature and used a validated method to assess for depression or depressive symptoms. DATA EXTRACTION AND SYNTHESIS: Information on study characteristics and depression or depressive symptom prevalence was extracted independently by 2 trained investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression. MAIN OUTCOMES AND MEASURES: Point or period prevalence of depression or depressive symptoms as assessed by structured interview or validated questionnaire. RESULTS: Data were extracted from 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals). Three studies used clinical interviews and 51 used self-report instruments. The overall pooled prevalence of depression or depressive symptoms was 28.8% (4969/17,560 individuals, 95% CI, 25.3%-32.5%), with high between-study heterogeneity (Q = 1247, τ2 = 0.39, I2 = 95.8%, P < .001). Prevalence estimates ranged from 20.9% for the 9-item Patient Health Questionnaire with a cutoff of 10 or more (741/3577 individuals, 95% CI, 17.5%-24.7%, Q = 14.4, τ2 = 0.04, I2 = 79.2%) to 43.2% for the 2-item PRIME-MD (1349/2891 individuals, 95% CI, 37.6%-49.0%, Q = 45.6, τ2 = 0.09, I2 = 84.6%). There was an increased prevalence with increasing calendar year (slope = 0.5% increase per year, adjusted for assessment modality; 95% CI, 0.03%-0.9%, P = .04). In a secondary analysis of 7 longitudinal studies, the median absolute increase in depressive symptoms with the onset of residency training was 15.8% (range, 0.3%-26.3%; relative risk, 4.5). No statistically significant differences were observed between cross-sectional vs longitudinal studies, studies of only interns vs only upper-level residents, or studies of nonsurgical vs both nonsurgical and surgical residents. CONCLUSIONS AND RELEVANCE: In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8%, ranging from 20.9% to 43.2% depending on the instrument used, and increased with calendar year. Further research is needed to identify effective strategies for preventing and treating depression among physicians in training.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis of 54 studies and 17,560 resident physicians estimated the pooled prevalence of depression or depressive symptoms at 28.8% (95% CI, 25.3%-32.5%), with instrument-specific estimates ranging from 20.9% to 43.2%. Prevalence increased with calendar year, and a secondary analysis of 7 longitudinal studies found a median absolute increase in depressive symptoms of 15.8% with the onset of residency training.

Key findings

  • Overall pooled prevalence of depression or depressive symptoms was 28.8% (4969/17,560 individuals; 95% CI, 25.3%-32.5%), with high between-study heterogeneity (Q = 1247, τ² = 0.39, I² = 95.8%, P < .001).
  • Prevalence varied by instrument: 20.9% for the PHQ-9 with cutoff ≥10 (741/3577; 95% CI, 17.5%-24.7%) to 43.2% for the 2-item PRIME-MD (1349/2891; 95% CI, 37.6%-49.0%); studies using inventories with specificity >88% yielded 20.2% (1119/5425; 95% CI, 18.0%-22.6%).
  • Prevalence increased with baseline survey year (slope = 0.5% per calendar-year increase; 95% CI, 0.03%-0.9%; P = .04), and this persisted when excluding 2-item PRIME-MD studies (slope = 0.6%; 95% CI, 0.1%-1.2%; P = .02).
  • In 7 longitudinal studies, the median absolute increase in depressive symptoms with onset of residency training was 15.8% (range, 0.3%-26.3%; relative risk, 4.5); no statistically significant differences were found between cross-sectional vs longitudinal studies, interns vs upper-level residents, or nonsurgical vs both nonsurgical and surgical residents.

Methods

  • Systematic search of EMBASE, ERIC, MEDLINE, and PsycINFO for studies published January 1963 to September 2015; eligible studies were peer-reviewed and used a validated method to assess depression or depressive symptoms among interns and/or resident physicians.
  • Included 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals), totaling 17,560 individuals; data were extracted independently by 2 trained investigators, and study quality was assessed with a modified Newcastle-Ottawa Scale.
  • Prevalence estimates were pooled using random-effects meta-analysis; heterogeneity was assessed with Q, τ², and I²; differences by study-level characteristics were examined with stratified meta-analysis and meta-regression; publication bias was assessed by funnel plot and Egger test.

Limitations

  • The paper states that substantial heterogeneity remained unexplained by examined variables; studies used different designs and trainee groups, all but 3 used screening tools rather than structured interviews, and the 3 structured-interview studies used convenience samples, so the prevalence of major depressive disorder could not be precisely determined.
  • The paper states that the analysis relied on aggregated published data and that smaller studies reported more extreme prevalence estimates, with evidence of small-study effects (Egger test P = .02); higher risk-of-bias studies yielded higher prevalence estimates.
  • Evident from the text: most estimates reflect self-reported depressive symptoms rather than clinical diagnosis, and instruments/cutoffs varied, including some nonstandard cutoffs, which limits comparability across studies.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1001/jama.2015.15845

Cites

93 of 93 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 33 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    There were no significant associations between prevalence and percentage of males (slope = 3.4% per percentage increase in males; 95% CI, -28.9% to 22.1%; Q = 0.1, P = .79).

    “or percentage of males (slope = 3.4% per percentage increase in males [95% CI, −28.9% to 22.1%]; Q = 0.1, P = .79).”
    Quote in the paperNot a substantial claim
  • Findingown data

    There were no significant associations between prevalence and mean or median age (slope = -1.0% per year; 95% CI, -2.8% to 0.8%; Q = 1.2, P = .28).

    “There were no significant associations between prevalence and mean or median age (slope = −1.0% per year [95% CI, −2.8% to 0.8%]; Q = 1.2, P = .28)”
    Quote in the paperNot a substantial claim
  • Findingown data

    No statistically significant differences in prevalence estimates were noted between studies of only interns vs only upper-level residents (31.9% vs 26.6%; Q = 0.9, P = .62).

    “or studies of only interns vs those of only upper-level residents (1411/5127, 31.9% [95% CI, 25.4% to 39.1%] vs 211/1061, 26.6% [95% CI, 14.9% to 42.8%]; Q = 0.9, P = .62)”
    Quote in the paperNot a substantial claim
  • Findingown data

    The summary prevalence for the PHQ-9 with a cutoff of 10 or more was 20.9% (741/3577 individuals; 95% CI, 17.5%-24.7%; Q = 14.4, τ2 = 0.04, I2 = 79.2%).

    “20.9% for the 9-item Patient Health Questionnaire with a cutoff of 10 or more (741/3577 individuals, 95% CI, 17.5%-24.7%, Q = 14.4, τ2 = 0.04, I2 = 79.2%)”
    • Also stated in: § Prevalence of Depression or Depressive Symptoms Among Resident Physicians · plain
      “Summary prevalence estimates ranged from 20.9% for the PHQ-9 with cutoff of 10 or more (741/3577 individuals, 95% CI, 17.5%-24.7%, Q = 14.4, τ2 = 0.04, I2 = 79.2%)”
    Quote in the paperNot a substantial claim
  • Findingown data

    No statistically significant differences in prevalence estimates were noted between studies of non-surgical vs both nonsurgical and surgical residents (28.9% vs 28.8%; Q = 0, P = .98).

    “studies of non-surgical vs both nonsurgical and surgical residents (1570/5841, 28.9% [95% CI, 24.7% to 33.4%] vs 3392/11 719, 28.8% [95% CI, 23.6% to 34.7%]; Q = 0, P = .98)”
    Quote in the paperNot a substantial claim
  • May combine two claims. 12
  • Classified as probably not a substantial claim. 17

  • May combine two claims.

    Findingown data

    There was evidence of small studies effect (Egger test P = .02), with smaller studies (<200 participants) reporting more extreme depression prevalence estimates than larger studies (32.0% vs 24.5%; Q = 4.2, P = .04).

    “there was evidence of small studies effect (Egger test P = .02), with smaller studies (<200 participants) reporting more extreme depression prevalence estimates than larger studies (32.0% [95% CI, 27.1%-37.4%] vs 24.5% [95% CI, 20.0%-29.7%]; Q = 4.2, P = .04)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among 8 studies using the 2-item PRIME-MD, heterogeneity was partially explained by respondent/nonrespondent comparability, with studies that established comparability yielding lower estimates (39.6% vs 50.4%; Q = 10.3, P = .001).

    “and respondent/nonrespondent comparability (studies that established comparability yielded lower estimates, 39.6% vs 50.4%; Q = 10.3, P = .001)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No statistically significant differences in prevalence estimates were noted when studies were stratified by respondent/nonrespondent comparability criteria (Q = 0.11, P = .75) or by quality of descriptive statistic reporting (Q = 0.23, P = .63).

    “No statistically significant differences in prevalence estimates were noted when studies were stratified by respondent/nonrespondent comparability criteria (Q = 0.11, P = .75) or by quality of descriptive statistic reporting (Q = 0.23, P = .63).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among 8 studies using the 2-item PRIME-MD, heterogeneity was partially explained by study design, with cross-sectional studies yielding higher estimates (49.8% vs 41.3%; Q = 5.2, P = .02).

    “Among the 8 studies using the 2-item PRIME-MD, heterogeneity was partially explained by study design (cross-sectional studies yielded higher estimates, 49.8% vs 41.3%; Q = 5.2, P = .02)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Between-study heterogeneity in the pooled prevalence estimate was high and statistically significant (Q = 1247, τ2 = 0.39, I2 = 95.8%, P < .001).

    “with high between-study heterogeneity (Q = 1247, τ2 = 0.39, I2 = 95.8%, P < .001).”
    • Also stated in: § Prevalence of Depression or Depressive Symptoms Among Resident Physicians · plain
      “with significant evidence of between-study heterogeneity (Q = 1247, P < .001, τ2 = 0.39, I2 = 95.8%)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    The prevalence of depressive symptoms is similar across specialties and countries.

    “This finding, in combination with evidence that the prevalence of depressive symptoms is similar across specialties and countries, suggests that the underlying causes of depressive symptoms are common to the residency experience.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Study design (cross-sectional vs longitudinal), country, survey years, specialty, postgraduate level, age, and sex also contributed to the heterogeneity between studies.

    “Study design (ie, cross-sectional vs longitudinal), country, survey years, specialty, postgraduate level, age, and sex also contributed to the heterogeneity between studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The data were derived from studies that used different designs and involved different groups of trainees (eg, from different countries, specialties, and years of training).

    “Second, the data were derived from studies that used different designs and involved different groups of trainees (eg, from different countries, specialties, and years of training).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The PHQ-9 has high sensitivity (88%, 95% CI, 74%-96%) and specificity (88%, 95% CI, 85%-90%) for diagnosing major depressive disorder.

    “other commonly used instruments, such as the PHQ-9, have high sensitivity (88%, 95% CI, 74%-96%) and specificity (88%, 95% CI, 85%-90%) for diagnosing major depressive disorder and have been shown to be comparable with clinician-administered assessments.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    A modified version of the Newcastle-Ottawa Scale was used to assess the quality of nonrandomized studies included in systematic reviews and meta-analyses.

    “A modified version of the Newcastle-Ottawa Scale was used to assess the quality of nonrandomized studies included in systematic reviews and meta-analyses.17”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Stang A Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010 25 9 603 605 20652370

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Between-study heterogeneity was assessed by standard χ2 tests and the I2 statistic.

    “Between-study heterogeneity was assessed by standard χ2 tests and the I2 statistic (ie, the percentage of variability in prevalence estimates due to heterogeneity rather than sampling error, or chance, with values ≥75% indicating considerable heterogeneity)19,20”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [19] Higgins JPT Thompson SG Quantifying heterogeneity in a meta-analysis. Stat Med 2002 21 11 1539 1558 12111919

      Not checked in the free run.

    • cites [20] Higgins JPT Thompson SG Deeks JJ Altman DG Measuring inconsistency in meta-analyses. BMJ 2003 327 7414 557 560 12958120 PMC192859

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Prevalence estimates were calculated by pooling study-specific estimates using random-effects meta-analysis that accounted for between-study heterogeneity.

    “Prevalence estimates of depression or depressive symptoms were calculated by pooling the study-specific estimates using random-effects meta-analysis that accounted for between-study heterogeneity.18”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Borenstein M Hedges LV Higgins JPT Rothstein HR A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods 2010 1 2 97 111 26061376

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Resident depression has been linked to poor-quality patient care and increased medical errors.

    “resident depression has been linked to poor-quality patient care and increased medical errors.6-8”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [6] West CP Huschka MM Novotny PJ Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA 2006 296 9 1071 1078 16954486

      Not checked in the free run.

    • cites [7] Fahrenkopf AM Sectish TC Barger LK Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ 2008 336 7642 488 491 18258931 PMC2258399

      Not checked in the free run.

    • cites [8] West CP Tan AD Habermann TM Sloan JA Shanafelt TD Association of resident fatigue and distress with perceived medical errors. JAMA 2009 302 12 1294 1300 19773564

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    A reliable estimate of depression prevalence during medical training is important for informing efforts to prevent, treat, and identify causes of depression among residents.

    “A reliable estimate of depression prevalence during medical training is important for informing efforts to prevent, treat, and identify causes of depression among residents.14”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Shanafelt TD Sloan JA Habermann TM The well-being of physicians. Am J Med 2003 114 6 513 519 12727590

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Resident physicians experience higher rates of depression than the general public.

    “Studies have suggested that resident physicians experience higher rates of depression than the general public.1-5”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [1] Schneider SE Phillips WM Depression and anxiety in medical, surgical, and pediatric interns. Psychol Rep 1993 72 3 pt 2 1145 1146 8337317

      Not checked in the free run.

    • cites [2] Kessler RC Berglund P Demler O Jin R Merikangas KR Walters EE Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005 62 6 593 602 15939837

      Not checked in the free run.

    • cites [3] Dyrbye LN Thomas MR Shanafelt TD Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Acad Med 2006 81 4 354 373 16565188

      Not checked in the free run.

    • cites [4] Sen S Kranzler HR Krystal JH A prospective cohort study investigating factors associated with depression during medical internship. Arch Gen Psychiatry 2010 67 6 557 565 20368500 PMC4036806

      Not checked in the free run.

    • cites [5] Joules N Williams DM Thompson AW Depression in resident physicians: a systematic review. Open J Depress 2014 03 03 89 100

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All discrepancies were resolved by discussion and adjudication of a third reviewer.

    “All discrepancies were resolved by discussion and adjudication of a third reviewer (S.S.).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Studies were judged to be at low risk of bias (≥3 points) or high risk of bias (<3 points).

    “Studies were judged to be at low risk of bias (≥3 points) or high risk of bias (<3 points).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Development of depression has been linked to a higher risk of future depressive episodes and greater long-term morbidity.

    “Because the development of depression has been linked to a higher risk of future depressive episodes and greater long-term morbidity, these findings may affect the long-term health of resident doctors.84,85”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [84] Clarke DM Currie KC Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Med J Aust 2009 190 (7)(suppl) S54 S60 19351294

      Not checked in the free run.

    • cites [85] Glassman AH Shapiro PA Depression and the course of coronary artery disease. Am J Psychiatry 1998 155 1 4 11 9433332

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The influence of individual studies on the overall prevalence estimate was explored by serially excluding each study in a sensitivity analysis.

    “The influence of individual studies on the overall prevalence estimate was explored by serially excluding each study in a sensitivity analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Bias secondary to small study effects was investigated by funnel plot and Egger test.

    “Bias secondary to small study effects was investigated by funnel plot and Egger test.23,24”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [23] Egger M Davey Smith G Schneider M Minder C Bias in meta-analysis detected by a simple, graphical test. BMJ 1997 315 7109 629 634 9310563 PMC2127453

      Not checked in the free run.

    • cites [24] Sterne JAC Egger M Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 2001 54 10 1046 1055 11576817

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The most comprehensive publication was used when there were several involving the same population of residents.

    “The most comprehensive publication was used when there were several involving the same population of residents.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Studies were included if they reported data on resident physicians, were published in peer-reviewed journals, and used a validated method to assess for depression or depressive symptoms.

    “Studies were included if they reported data on resident physicians, were published in peer-reviewed journals, and used a validated method to assess for depression or depressive symptoms.16”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Kerr LK Kerr LD Jr Screening tools for depression in primary care: the effects of culture, gender, and somatic symptoms on the detection of depression. West J Med 2001 175 5 349 352 11694495 PMC1071624

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Data were independently extracted from each article by 2 trained investigators using a standardized form.

    “The following information was independently extracted from each article by 2 trained investigators (D.A.M. and M.A.R.) using a standardized form”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The search and reporting used the approach recommended by the PRISMA guidelines.

    “using the approach recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Figure 1).15”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Moher D Liberati A Tetzlaff J Altman DG PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med 2009 3 3 e123 e130 21603045 PMC3090117

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    A secondary analysis was restricted to longitudinal studies reporting both preresidency and intraresidency depressive symptom prevalence estimates.

    “A secondary analysis restricted to longitudinal studies reporting both preresidency and intraresidency depressive symptom prevalence estimates was performed to better isolate associations with the residency experience from associations with assessment tools.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The systematic search was independently performed by two investigators (D.A.M. and M.A.R.).

    “identified using EMBASE, ERIC, MEDLINE, and PsycINFO (independently performed by D.A.M. and M.A.R.)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The Newcastle-Ottawa score assessed the risk of bias in each study.

    “These variations were captured in part by Newcastle-Ottawa score, which assessed the risk of bias in each study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The analysis relied on aggregated published data.

    “Third, the analysis relied on aggregated published data.”
    Quote in the paperNot a substantial claim
28 of 28

  • The paper relies on this without support.

    The study-level prevalence estimates from the included studies are sufficiently comparable to be combined into a single pooled prevalence estimate despite heterogeneity in instruments, populations, and study designs.

    “Meta-analytic pooling of the prevalence estimates of depression or depressive symptoms reported by the 54 studies yielded a summary prevalence of 28.8% (4969/17 560 individuals, 95% CI, 25.3%-32.5%), with significant evidence of between-study heterogeneity (Q = 1247, P < .001, τ2 = 0.39, I2 = 95.8%) (Figure 2).”

  • The paper relies on this without support.

    The increase in depressive symptoms observed in the longitudinal studies is attributable to the onset of residency training rather than to other temporal or assessment-related factors.

    “Overall, the median absolute increase in depressive symptoms with the onset of residency training was 15.8% (range, 0.3%-26.3%; relative risk, 4.5).”

  • The paper relies on this without support.

    The calendar-year increase in prevalence reflects a true increase in depression or depressive symptoms rather than changes in assessment or reporting.

    “There was an increased prevalence with increasing calendar year (slope = 0.5% increase per year, adjusted for assessment modality; 95% CI, 0.03%-0.9%, P = .04).”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Meta-analytic evidence estimates an overall prevalence of depression during residency of 28.8%, ranging from 20.9% to 43.2%.

    “meta-analytic evidence (54 studies; n = 17 560 resident physicians) estimates an overall prevalence of depression during residency of 28.8%, ranging from 20.9% to 43.2% (Mata et al., 2015).”

    From Chronic Stress, Hair Cortisol and Depression: A Prospective and Longitudinal Study of Medical Internship (2018) · cites this paper as Mata et al., 2015

    The Results report a pooled prevalence of 28.8% across 54 studies and 17,560 residents. The Discussion gives the 20.9%–43.2% range, but specifies that trainees screened positive for depression or depressive symptoms; it also says the prevalence of major depressive disorder could not be precisely determined. Calling these figures the prevalence of depression alone omits that qualification. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • The chronic stressor of medical internship triggers new onset depression in a substantial number of those exposed.

    “These longitudinal data, collected in the context of a chronic stressor that triggers new onset depression in a substantial number of those exposed (Mata et al., 2015; Sen et al., 2010), add weight to the idea that hypercortisolemia is neither a cause nor direct correlate of depressive symptom states, at least in the context of a non-clinical sample.”

    From Chronic Stress, Hair Cortisol and Depression: A Prospective and Longitudinal Study of Medical Internship (2018) · cites this paper as Mata et al., 2015

    The Results (Secondary Analysis of Longitudinal Studies; page not specified) report a median 15.8-percentage-point increase in depressive symptoms after residency training began. The Discussion suggests causes common to the residency experience, but the paper assesses changes in depressive symptoms rather than establishing that internship causes new-onset depression. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • A recent meta-analysis found that the prevalence of depressive symptoms was similar across specialties.

    “a recent meta-analysis of studies recruiting residents from both single (n = 26) and multiple (n = 28) specialties found that the prevalence of depressive symptoms was similar across specialties, suggesting common underlying factors (Mata et al., 2015).”

    From Chronic Stress, Hair Cortisol and Depression: A Prospective and Longitudinal Study of Medical Internship (2018) · cites this paper as Mata et al., 2015

    The Results (Study Characteristics) report 26 studies recruiting from single specialties and 28 from multiple specialties. The Results (Prevalence by Study-Level Characteristics) found no significant difference between studies of nonsurgical residents and studies including both surgical and nonsurgical residents, but this is narrower than finding similar prevalence across specialties generally. The Discussion also identifies specialty as a contributor to between-study heterogeneity; the suggestion of common underlying factors is the citing authors’ interpretation. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • The longitudinal data add weight to the idea that hypercortisolemia is neither a cause nor direct correlate of depressive symptom states, at least in a non-clinical sample.

    “These longitudinal data, collected in the context of a chronic stressor that triggers new onset depression in a substantial number of those exposed (Mata et al., 2015; Sen et al., 2010), add weight to the idea that hypercortisolemia is neither a cause nor direct correlate of depressive symptom states, at least in the context of a non-clinical sample.”

    From Chronic Stress, Hair Cortisol and Depression: A Prospective and Longitudinal Study of Medical Internship (2018) · cites this paper as Mata et al., 2015

Cites

Flagged first, then by citations

1 of the 94 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [80]Spielberger CD Manual for the State-Trait Personality Inventory (Form Y) 1983 Consulting Psychologists Press Palo Alto, CA

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Related

Authors
Mata, D. A., Ramos, M. A., Bansal, N., Khan, R., Guille, C., Di Angelantonio, E., & Sen, S.
Affiliations
  • Brigham and Women's Hospital (US)
  • Yale University (US)
  • University of Cambridge (GB)
  • Texas Medical Center (US)
  • Medical University of South Carolina (US)
  • Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
  • University of Michigan (US)
Corresponding author
Mata, Douglas A.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2015-12-08
Volume
314
Issue
22
Pages
2373
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2015.15845
PMC
PMC4866499
OpenAlex
W2192454956
Cited by
1,255
References
94
Citations by year
2026: 86 · 2025: 119 · 2024: 119 · 2023: 137 · 2022: 129 · 2021: 166 · 2020: 172 · 2019: 115 · 2018: 97 · 2017: 78 · 2016: 33 · 2015: 1 · 2012: 2
FWCI
12.51
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Explore Bristol Research (acceptedVersion)
Funders
  • National Institute for Health and Care Research (NF-SI-0512-10165)
  • British Heart Foundation (RG/08/014/24067)
  • National Institutes of Health
  • Medical Research Council (MR/L003120/1)
  • National Institute of Mental Health (F31MH064299, K23MH095109, R01MH101459)
  • National Institute of General Medical Sciences (TG 2T32GM07205, T32GM007205)
Topics
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Keywords
depression, depressive symptoms, medical residents, prevalence, physician mental health, Patient Health Questionnaire, PRIME-MD, assessment methods, temporal trends, study heterogeneity, meta-regression, self-report questionnaire, clinical interview, physician well-being, burnout, work-life balance, physician-patient communication
MeSH terms
Cross-Sectional Studies, Depression, Depressive Disorder, Humans, Internship and Residency, Longitudinal Studies, Prevalence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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