Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis.
Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis.
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DOI：
10.1001/jama.2016.17324
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发表时间：
2016-12-06
期刊：
影响因子：
--
通讯作者：
Mata DA
中科院分区：
文献类型：
--
作者：
Rotenstein LS;Ramos MA;Torre M;Segal JB;Peluso MJ;Guille C;Sen S;Mata DA
医学生是抑郁症和自杀意念的高危人群。然而，这些疾病的患病率估计在不同研究之间存在差异。评估医学生抑郁、抑郁症状和自杀意念的患病率。对EMBASE、ERIC、MEDLINE、PsycARTICLES和PsycINFO进行系统检索，无语言限制，检索2016年9月17日之前发表的关于医学生抑郁症、抑郁症状或自杀意念患病率的研究。纳入了在同行评审文献中发表并使用经验证的评估方法的研究。关于研究特征的信息;抑郁症或抑郁症状和自杀意念的患病率;以及抑郁症筛查阳性的学生是否寻求治疗由3名研究者独立提取。使用随机效应荟萃分析汇总估计值。使用分层荟萃分析和荟萃回归估计研究水平特征的差异。通过有效问卷或结构化访谈评估的抑郁、抑郁症状或自杀意念的时点或时期患病率。抑郁症或抑郁症状患病率数据来自43个国家的167项横断面研究（n = 116628）和16项纵向研究（n = 5728）。除1项研究外，所有研究均使用自我报告工具。抑郁或抑郁症状的总体合并粗患病率为27.2%（37 933/122 356例; 95% CI，24.7%至29.9%，I2 = 98.9%）。各评估模式的汇总患病率估计值范围为9.3%至55.9%。在研究期间，抑郁症状患病率保持相对稳定（基线调查年份范围为1982-2015年;斜率，每年增加0.2%[95%CI，-0.2%至0.7%]）。在评估医学院之前和期间抑郁症状的9项纵向研究（n = 2432）中，症状的绝对增幅中位数为13.5%（范围：0.6%至35.3%）。仅临床前学生的研究和仅临床学生的研究之间的患病率估计值没有显著差异（23.7% [95%CI，19.5%至28.5%] vs 22.4% [95%CI，17.6%至28.2%]; P = 0.72）。抑郁症筛查阳性的医学生寻求精神科治疗的百分比为15.7%（110/954人; 95%CI，10.2%至23.4%，I2 = 70.1%）。自杀意念流行率数据来自15个国家的24项横断面研究（n = 21002）。除1项研究外，所有研究均使用自我报告工具。自杀意念的总体汇总粗患病率为11.1%（2043/21002例; 95% CI，9.0%-13.7%，I2 = 95.8%）。各评估模式的汇总患病率估计值范围为7.4%至24.2%。在这项系统性回顾中，医学生中抑郁或抑郁症状的患病率的概括估计为27.2%，自杀意念的患病率为11.1%。需要进一步的研究来确定预防和治疗这一人群中这些疾病的策略。
Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies. To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students. Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included. Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview. Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982–2015; slope, 0.2% increase per year [95% CI, −0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%. In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.
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