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Many first-year residents felt their new depressive symptoms were getting in the way of their functionality, researchers reported.

In a cohort study of 15,566 medical interns, there was a significant increase in average depression scores relating to clinical impairment -- such as difficulty performing social, occupation, and other important tasks -- Lisa Meeks, PhD, of the University of Michigan Medical School in Ann Arbor, and colleagues reported in a research letter.

Measured via the self-reported Patient Health Questionnaire-9 (PHQ-9), interns' mean depressive symptom scores were significantly higher during internship compared with their preinternship year, respectively, across all perceived impairment categories (P<0.001 for all):

• Extremely difficult perceived impairment: 14.2 vs 9.4
• Very difficult: 9.0 vs 6.3
• Somewhat difficult: 4.9 vs 3.1

Even individuals who reported no perceived symptoms or difficulty had higher depressive symptom scores during internship versus their preinternship year (2.4 vs 0.9; P<0.001).

In addition, all median PHQ-9 scores associated with each perceived impairment category were also significantly higher during internship year (measured in September or December) compared with preinternship (measured in June).

Interns know that once they embark on their first year of residency, the expectations put upon them will be even greater. Because of this, Meeks' group explained that symptom severity that would have previously been described as "very impairing" would become normalized, and therefore be relabeled as "somewhat impairing" after entering the internship.

It's likely, the authors explained, that symptoms of depression -- such as having trouble sleeping or having negative feelings about yourself -- have become so habitual during the internship year that residents' true perceptions of their levels of functioning become skewed.

The perception that depressive symptoms are not that serious is a common barrier to treatment, even among those with suicidal ideation. Given the prior research on the relationship between depressive symptoms and the frequency of medical errors, interns may be especially high-risk if their symptoms are not identified.

But for first-year resident physicians, these findings may indicate there could be a turning of the tide.

"This potentially suggests a shift in interns' ability to recognize the impact of depressive symptoms in the context of medical training," the researchers pointed out. This is important, as failure to perceive such impairment carries some heavy implications for these early-career physicians, such as disengagement from patient care and risk for medical errors.

An analysis of data from the Intern Health Study, the study included responses from interns in the 2007 to 2018 cohorts. Participants' mean age was 27.5 years old and just over half identified as women. The majority were white (61%), 21.4% were Asian, 3.6% were Black, and 3.5% were Latino or Hispanic.

Corresponding to the DSM-IV symptoms of clinical depression, the PHQ-9 collected self-reported responses on symptom frequency from the prior 2 weeks.

The authors noted that among the study's limitations was the possibility that respondents were afraid to report any level of impairment. Nonrandom attrition, they added, may also limit the generalizability of these results.

"Future research should investigate whether ... personalized feedback on depressive symptoms and potential impairment is associated with recalibration of misperceptions," the authors concluded. "Recognizing impairment may be associated with decreased adverse outcomes, including medical errors and attempted suicide among interns."

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