The DOI matches its Crossref record, with a small difference in title or year; 93 of the 94 references it cites were found in a registry or an index; none of the 33 sources its claims cite is checked for support yet.
Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis
Open accessAbstract
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.
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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.
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39 Own result · 19 Not checked yet · 10 Own method · 9 No basis given · 5 Own interpretation
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“or percentage of males (slope = 3.4% per percentage increase in males [95% CI, −28.9% to 22.1%]; Q = 0.1, P = .79).”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Results > Prevalence of Depression or Depressive Symptoms by Study-Level Characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Results > Prevalence of Depression or Depressive Symptoms by Study-Level Characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Results > Prevalence of Depression or Depressive Symptoms by Study-Level Characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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%)”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Abstract > RESULTS
plainn = 3,577- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Prevalence of Depression or Depressive Symptoms Among Resident Physicians · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Results > Prevalence of Depression or Depressive Symptoms by Study-Level Characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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%).”
- Also stated in: § Discussion · plain
“To reflect the heterogeneity of the measures included in this meta-analysis, a range of prevalence estimates (ie, 20.9%-43.2%) was reported in addition to a single measure (ie, 28.8%).”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Abstract > RESULTS
plainn = 3,577- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Discussion · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
- Also stated in: § Prevalence of Depression or Depressive Symptoms Among Resident Physicians · plain
“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).”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Abstract > RESULTS
plainn = 17,560- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: 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.
- Also stated in: § Prevalence of Depression or Depressive Symptoms Among Resident Physicians · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“but not by specialty (Q = 0.3, P = .58), postgraduate year (Q = 0, P = .99), age (Q = 1.3, P = .26), or respondent/nonrespondent comparability (Q = 0, P = .99).”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Results > Heterogeneity Within Screening Instruments
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“baseline survey year (Q = 13.4, P < .001), and sex (Q = 10.7, P = .001)”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Results > Heterogeneity Within Screening Instruments
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This association persisted when studies using the 2-item PRIME-MD were excluded and the analysis was restricted to the 23 studies using the CES-D, PHQ-9, HANDS, BDI, or Zung SDS presented in Figure 3 (slope = 0.6% per calendar-year increase; 95% CI, 0.1%-1.2%, P = .02).”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Results > Prevalence of Depression or Depressive Symptoms by Study-Level Characteristics
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 12
- Probably not a substantial claim. 17
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Results > Assessment of Publication Bias
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and respondent/nonrespondent comparability (studies that established comparability yielded lower estimates, 39.6% vs 50.4%; Q = 10.3, P = .001)”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Results > Heterogeneity Within Screening Instruments
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Results > Prevalence of Depression or Depressive Symptoms by Study-Level Characteristics
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Results > Heterogeneity Within Screening Instruments
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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%)”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Abstract > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Also stated in: § Prevalence of Depression or Depressive Symptoms Among Resident Physicians · plain
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Study design (ie, cross-sectional vs longitudinal), country, survey years, specialty, postgraduate level, age, and sex also contributed to the heterogeneity between studies.”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Methods > Data Extraction and Quality Assessment
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Methods > Data Synthesis and Analysis
What the sources say
- Not checked yetcites [19] Higgins JPT Thompson SG Quantifying heterogeneity in a meta-analysis. Stat Med 2002 21 11 1539 1558 12111919
- Not checked yetcites [20] Higgins JPT Thompson SG Deeks JJ Altman DG Measuring inconsistency in meta-analyses. BMJ 2003 327 7414 557 560 12958120 PMC192859
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Methods > Data Synthesis and Analysis
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“resident depression has been linked to poor-quality patient care and increased medical errors.6-8”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Abstract > CONCLUSIONS AND RELEVANCE
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“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”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Abstract > CONCLUSIONS AND RELEVANCE
What the sources say
- Not checked yetcites [14] Shanafelt TD Sloan JA Habermann TM The well-being of physicians. Am J Med 2003 114 6 513 519 12727590
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may be too vague to check against evidence.
None of the sources cited for this claim have been checked yet.
In the paper
“Studies have suggested that resident physicians experience higher rates of depression than the general public.1-5”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Abstract > CONCLUSIONS AND RELEVANCE
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [5] Joules N Williams DM Thompson AW Depression in resident physicians: a systematic review. Open J Depress 2014 03 03 89 100
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All discrepancies were resolved by discussion and adjudication of a third reviewer (S.S.).”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Methods > Data Extraction and Quality Assessment
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies were judged to be at low risk of bias (≥3 points) or high risk of bias (<3 points).”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Methods > Data Extraction and Quality Assessment
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Discussion
What the sources say
- Not checked yetcites [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 yetcites [85] Glassman AH Shapiro PA Depression and the course of coronary artery disease. Am J Psychiatry 1998 155 1 4 11 9433332
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The influence of individual studies on the overall prevalence estimate was explored by serially excluding each study in a sensitivity analysis.”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Methods > Data Synthesis and Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Bias secondary to small study effects was investigated by funnel plot and Egger test.23,24”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Methods > Data Synthesis and Analysis
What the sources say
- Not checked yetcites [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 yetcites [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
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The most comprehensive publication was used when there were several involving the same population of residents.”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Methods > Data Extraction and Quality Assessment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Methods > Search Strategy and Study Eligibility
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The following information was independently extracted from each article by 2 trained investigators (D.A.M. and M.A.R.) using a standardized form”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Methods > Data Extraction and Quality Assessment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“using the approach recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Figure 1).15”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Methods > Search Strategy and Study Eligibility
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Methods > Data Synthesis and Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“identified using EMBASE, ERIC, MEDLINE, and PsycINFO (independently performed by D.A.M. and M.A.R.)”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Methods > Search Strategy and Study Eligibility
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“These variations were captured in part by Newcastle-Ottawa score, which assessed the risk of bias in each study.”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Third, the analysis relied on aggregated published data.”
§ Prevalence of Depression and Depressive Symptoms Among Resident Physicians A Systematic Review and Meta-analysis > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
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).”
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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
Citations
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,845
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722
The CES-D Scale: A Self-Report Depression Scale for Research in the General Population
Radloff, L. S. (1977) · Applied Psychological Measurement · doi:10.1177/014662167700100306 · Cited by 53,267
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859
An inventory for measuring depression
BECK, A. T. (1961) · Archives of General Psychiatry · doi:10.1001/archpsyc.1961.01710120031004 · Cited by 38,032
Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & the PRISMA Group* (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-4-200908180-00135 · Cited by 37,554
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763
Research works printed but not linked: 1
- [80]Spielberger CD Manual for the State-Trait Personality Inventory (Form Y) 1983 Consulting Psychologists Press Palo Alto, CA
Cited by
Sorted by citations
Rotenstein, L. S., Ramos, M. A., Torre, M., Segal, J. B., Peluso, M. J., Guille, C., Sen, S., & Mata, D. A. (2016) · JAMA · doi:10.1001/jama.2016.17324 · Cited by 2,479
Self-citationPrevalence of Burnout Among Physicians: A Systematic Review
Rotenstein, L. S., Torre, M., Ramos, M. A., Rosales, R. C., Guille, C., Sen, S., & Mata, D. A. (2018) · JAMA · doi:10.1001/jama.2018.12777 · Cited by 1,904
Self-citationMuller, A. E., Hafstad, E. V., Himmels, J. P. W., Smedslund, G., Flottorp, S., Stensland, S. Ø., Stroobants, S., Van de Velde, S., & Vist, G. E. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113441 · Cited by 895
Joyce, S., Shand, F., Tighe, J., Laurent, S. J., Bryant, R. A., & Harvey, S. B. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-017858 · Cited by 864
Burnout in medical students before residency: A systematic review and meta-analysis
Frajerman, A., Morvan, Y., Krebs, M.-O., Gorwood, P., & Chaumette, B. (2019) · European Psychiatry · doi:10.1016/j.eurpsy.2018.08.006 · Cited by 568
Metadata
- 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.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2015-12-08
- Volume
- 314
- Issue
- 22
- Pages
- 2373
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- 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
- FWCI
- 12.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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
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