Commentary: Out of the silence: Confronting depression in medical students and residents

In this commentary, the authors reinforce the call to action made in the accompanying reports by Goebert et al and Dunn et al. Depression among medical students and residents is a continuing and worrisome phenomenon; its chronic nature has long-term and compounding effects on trainees. Yet, barriers exist to appropriate care seeking, such as inadequate education about causes, effects, and treatment; unwillingness to take the needed time; limited financial resources to pay for care; and concerns over confidentiality, stigma, or adverse effects on residency application or licensability. Each of these barriers, the authors contend, can be circumvented. Moreover, given the cost of unrecognized or untreated depression among the health care workforce, removal of the barriers reflects both moral and practical necessities. The authors discuss successful prevention and treatment plans at some medical schools and academic health centers (AHCs), as well as initiatives by the American Foundation for Suicide Prevention geared specifically to the nation's medical trainees and physicians. Finally, strong leadership is encouraged in order to remove the barriers to recognizing and treating depression and to change the culture of medicine that contributes to and/or stigmatizes depression among its members.The authors outline the chronic nature of depression and discuss its possibility for long-term impacts on trainees. Given these conditions, the leadership of the nation's schools of medicine and AHCs.