Admin_Adham
When he was a medical student, University of Michigan psychiatry professor Srijan Sen, MD, PhD, struggled with depression and considered ending his life. “I had thoughts that it’d be better to be dead, and they’re scary to have,” he recalls.
Then a friend killed himself during residency, and another friend survived a suicide attempt. Now, decades later, Sen is a leading advocate for suicide prevention among medical students and trainees.
“Losing people close to me really drove my research,” he says. “I’m heartened by the progress we have made as a field in reducing depression among interns.” Still, “we have much more to do.”
Sen, who runs an international study tracking stress and mood among medical interns, spoke in an interview about the impact of his own experiences, the causes of depression among medical students and residents, and the interventions that work.
About Medscape Data
Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, the Physicians and Suicide Report 2025 found that:
- More than 1 in 6 physicians have thought about or attempted suicide.
- 38% of physicians surveyed personally knew one or more doctors who attempted or thought about suicide.
- 2 in 3 doctors surveyed who considered or attempted suicide said that the rigors of medicine played a key role.
Struggles Shaped His Early Years
Mental illness was a constant for Sen as he grew up. “My mother struggled with depression her whole life, and I had depression myself at various points during high school, college, and my own medical training,” he says.
While Sen was in an MD-PhD program, one of his good friends went on to residency training. “He had depression in his background and also went through LASIK surgery with bad complications. After going through that for a couple of years, he took his own life.”
Another friend suffered a mental health crisis during residency. “After a bad call and being up for 24 hours, he jumped off the balcony at his apartment.”
The friend, who survived but is paralyzed, has written about his experience. He returned to residency and continued his career in medicine in Canada.
Suicidal Thoughts During Training
As for his own struggles, Sen says he had more thoughts of suicide in medical school than residency. “I never made a suicide attempt, but the thoughts were there in strong ways sometimes, feeling like there’s no pathway to feeling good again.”
The third year, he recalls, was the worst. “I think it was how much work there was, the endless and hopeless feeling of it. Seeing death –– seeing patients die who I didn’t think were going to die –– was really hard.”
Sen believed he was the only one doing badly. Everyone else, he assumed, was “handling this work okay and still going home, running 10 miles, cooking a beautiful meal, spending time with friends, and getting 8 hours of sleep.”
That wasn’t true. “Once I found out most people were struggling in the same way, that really helped. It made it seem like it wasn’t something uniquely wrong with me, but that we’re all going through this together.”
Sen says his own struggles, and those of his friends, shaped his interest in suicide prevention. “My own experience with depression, and the growing number of people in America struggling with it, continues to motivate me. It is gratifying that we have made some progress among training physicians, but we need to do so much more.”
Suicide Remains Leading Cause of Death Among Residents
Suicide is the leading cause of death among residents, according to Sen, who believes there are dozens of cases a year, and perhaps even more.
“We don’t have great numbers because there’s no national tracking system. The information we have comes largely from anecdotes. It’s estimated that probably more than half of resident suicides are classified differently as accidents or other causes because of stigma or family members trying not to hurt their reputations.”
The tragedy when even one suicide happens is huge, Sen says. “These are incredibly promising, gifted people who have already gotten through so many barriers. They often have thousands of patients who are affected.”
Suicide Trends Aren’t Heading Down
Death remains relatively uncommon among doctors in their 20s, but suicide rates in this age group seem to be steady or are even going up a little bit, Sen says, while almost all other causes of death in this population are going down.
The numbers for attempts are much higher than completed suicides, Sen adds. “At any given time, about 10%-15% of residents are thinking about death or suicide.
Thankfully, not that many convert from ideation to actually taking their own lives.”
However, “because this population is very knowledgeable about medicine and death, a much higher percentage of attempts among physicians end up in actual death compared to the general population,” Sen says. “This is particularly true for women physicians.”
Among medical residents as a whole, suicide ideation is at least three to four times higher than the general population. “Only about 3% of these individuals are depressed before they come into medicine, but that jumps dramatically during training,” Sen says. “About 45% of interns meet criteria for depression at least once during their first year of residency training.”
The end of residency slows down the incidence of mental health struggles but does not restore them to normal levels. “Once residents finish, depression rates go down from the worst levels during intern year and other important parts of training. But they remain higher than before medical school and higher than the general population, often twice as high as pre-medical school rates,” Sen says.
Workload Is a Major Driver of Depression
The “incredible workload” that young physicians face is a top contributor to depression. “They’re seeing so many patients and spending so much time at work at the expense of sleeping enough and having normal lives and social connections with families,” Sen explains.
“Places that have made progress in reducing depression rates –– 20%-25% lower now than 20 years ago–– have done so mostly by reducing workload, particularly the mind-numbing administrative work. We’ve probably gone down from 70-71 hours per week to something like 63-64 hours on average.”
He says the current limits are 80 hours per week averaged over 4 weeks, but these aren’t always followed. “The lower we can go, at least down to 50 hours a week, the more improvements we’ll make. Even incremental changes of a couple hours can make a big difference.”
Institutions can also help by standing with trainees who make medical errors. They’re especially at risk for depression and suicide, he said, and “the support residents get from their program and people around them matters enormously.”
Stigma and Lack of Sleep Play Roles Too
Individual factors are also important — how much residents are sleeping, whether they’re sleeping at times that match their natural rhythms, their connections with others. “We’re finding that different people are susceptible to different things,” Sen says. “For some, the most important thing is getting 6 hours of sleep a night. For others, it’s time with family or working out three times a week.”
He adds, “There’s also significant stigma and barriers around depression, anxiety, and particularly suicide that prevent people from reaching out for help.”
The Nature of Medical Work Has Changed
“An hour of work today is probably more intense than in 1975 because of the number of patients coming through. Most patients are in the hospital for much shorter times and are much sicker when they’re there,” Sen says.
According to him, the burdens of work have also shifted dramatically. “We’ve gone from most work being face-to-face with patients to now most work being on a computer –– sending out orders, writing notes, trying to talk with insurance companies. That administrative work that’s not directly done with patients seems linked to bad outcomes and worse mental health.”
Promising Interventions
Sen says medicine has made progress with different cognitive therapies and interventions, particularly helping people when they go through medical errors or tragedies. But the biggest thing the field can do is make the workload more tolerable.
“We’ve also made progress in reducing stigma. Many more young doctors today are more willing to get help than doctors even 15 or 20 years ago. Having senior physicians talk openly about their own struggles helps.”
Sen adds that treatments for trainees are not different than for other people: therapy plus medication when needed. Peer support is particularly helpful with residents.
The best strategy, however, is prevention. “Since we know residency is a high-risk period, helping people figure out what’s most important for their well-being and prioritizing it is crucial. We’re much better at preventing depression than we are at treating it. ”
What Has the Intern Health Study Taught Us?
The Intern Health Study, which Sen leads, has followed 30,000 physicians over the past 20 years and has relied on mobile technology, Apple watches, Fitbits, phone usage data, and DNA samples. The study, which is still enrolling participants in the US and China, has no set end date.
For physician mental health, Sen says one main message of the study is that depression rates rise four- to fivefold with the start of internship. “Several factors contribute to the rise in depression, but far and away, the most important factor is work hours.”
In regard to depression, “the main messages are that factors such as sleep consistency and circadian alignment are important to protect against depression,” he says.
Also, about 35% of the risk for depression is due to genetic factors, he adds. “An important portion of genetic risk for depression is how sensitive we are to stress. Different individuals are sensitive to different types of stress.”
Advice for Residents Who Are Struggling
What should residents know if they’re having a hard time? “First, realize that you’re probably normal, and others are going through similar struggles,” Sen says. “You’re not alone. About 40%-50% of residents get depressed during training. But even though it’s common, it doesn’t mean it’s healthy, or that you should just tolerate those feelings.”
He adds that “getting in touch with a therapist or psychiatrist as early as possible is important. If you’re having thoughts of death, that’s a real signal that it’s gotten bad enough that it needs attention. Talk about it, address it, and make sure you have a plan if the thoughts get worse.”
And Sen advises that “there’s no shame in reaching out for help. Having a support network –– whether professionals or others –– is crucial, particularly if you reach the stage of having thoughts of death.”
What’s Next for Research?
For now, Sen says, “we’re working on reducing work hours further and understanding differences between populations. The progress we’ve made among interns hasn’t translated yet to physicians in practice, so we need to bring what we’ve learned to those other populations.”
More broadly, he explains, “we’re trying to translate what we’ve learned about depression pathways to help with precision medicine approaches. We’re studying people at their sickest — those on wait lists for mental health care — using genetics, wearables, and smartphones to predict who will respond to different treatments like medications, digital apps, or advanced treatments like ketamine or electroconvulsive therapy.”
The goal, he says, “is to get more precise so that when someone gets depressed, we don’t make them wait 6 months and trial through multiple treatments. We want to be able to say based on their profile that you need Prozac, or you’ll do better with this behavioral program, or you need electroconvulsive therapy.”
A Long-Term Vision for Mental Health
In regard to the long term, “I’m heartened by the progress that we have made as a field in reducing depression among interns,” Sen says. “We have much more to do. But the fact that we have made progress and the fact that we did it by identifying and modifying an upstream factor –– work hours –– gives me hope that we can make more progress for interns, other physicians, and even the broader population.”
Randy Dotinga is an independent writer and board member of the Association of Health Care Journalists.
