Depression and suicidal ideation in medical students in China: a call for wellness curricula

Kunmi Sobowale1, A. Ning Zhou1, Jingyi Fan2, Ni Liu3 and Renslow Sherer4

1Pritzker School of Medicine, The University of Chicago, USA

2Department of Pediatrics, Zhongnan Hospital of Wuhan University, China

3Child/Adolescent Psychiatry, North Shore University Health System, USA

4Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago, USA

Submitted: 14/08/2013; Accepted: 25/01/2014; Published: 15/02/2014

Int J Med Educ. 2014; 5:31-36; doi: 10.5116/ijme.52e3.a465

© 2014 Kunmi Sobowale et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use of work provided the original work is properly cited. http://creativecommons.org/licenses/by/3.0

Objectives: To investigate rates of depression and suicidal ideation in medical students in mainland China and to explore wellness curricula and mental health services available to students.

Methods: Second and third year medical students (N=348) at one medical school in mainland China completed the Patient Health Questionnaire-9 (PHQ-9). Based on responses to the PHQ-9, students were labeled as depressed, with suicidal ideation, and/or impaired. Additionally, students' feedback from a focus group (N=30) evaluating the current state of the school's wellness curricula and mental health services was thematically analyzed.

Results: A total of 348 students responded (response rate = 99%) to the survey. Forty-seven of 348 (13.5%) students had moderate-severe depression. The mean PHQ-9 score was 6.02 (SD=3.44). Seven and a half percent of students reported suicidal ideation. The frequency of depression and suicidal ideation did not differ between second and third year medical students (p = 0.52). Nearly 30% of depressed students reported suicidal ideation. Depression and suicidal ideation were strongly correlated (r = 0.42, p < 0.001). Students with depression (p < 0.0001) or suicidal ideation (p = 0.004) were more likely to be impaired compared to students who were not. Focus group participants reported only off-campus student counseling services available to medical students in distress. No wellness curricula were established.

Conclusions: Rates of depression and suicidal ideation are high in medical students in mainland China. Mental health services are deficient and unlikely to address distress in students. Chinese medical schools should offer mental health support and treatment at an early stage, such as wellness curricula and proactive student counseling.