Depression & Stress: Risks, Treatments, and Burnout
New U-M research published in Nature Human Behaviour shows some potential for using genetic information to predict an individual’s risk of developing depression when under intense stress. Studying 5,200 physicians in their intern year of residency, the researchers created a polygenic risk score for major depressive disorder (MDD-PRS) for each individual and discovered that the scores accurately predicted which physicians would be most likely to report symptoms of major depressive disorder by the end of the year. “We found evidence that the association between MDD-PRS and depression is stronger in the presence of stress and that the additional predictive power of MDD-PRS under stress is largely independent of known risk factors for depression,” says Srijan Sen, M.D., Ph.D., the Frances and Kenneth Eisenberg Professor of Depression and Neurosciences and senior author of the paper. U-M research specialist Yu Fang says the ability of the MDD-PRS to predict resilience is stronger than its ability to predict susceptibility to depression. “We hope this will ease the worry that this tool might be misused to discriminate against at-risk individuals,” she says.
The increased time women physicians spend on parenting, domestic tasks, and patient care is associated with greater burnout, according to a new study by U-M Center for Bioethics & Social Sciences in Medicine research fellow Chithra R. Perumalswami, M.D., and center director Reshma Jagsi, M.D., who is also a professor of radiation oncology. Perumalswami and Jagsi say programs to prevent burnout are important for all physicians, and they identify a couple of current programs that they find promising: the Doris Duke Charitable Foundation’s Fund to Retain Clinical Scientists and Stanford University’s pilot program that involves career coaching and a time-banking system to promote flexibility, wellness, and success.
Is it cheaper to treat a depressed patient with pills or talk therapy? From an economic perspective, taking an inexpensive pill seems to make more sense than spending an hour on an expensive therapy session, but new research suggests this view is short-sighted. U-M and Harvard University researchers published a study in the Annals of Internal Medicine that used data on treatment costs, health effects, and impacts of treatment and depression on productivity to show that the costs and benefits of the two approaches end up being about the same after five years. “Since CBT [cognitive behavioral therapy] and antidepressants are roughly equivalent from a health-economic perspective, other factors should determine what treatment an individual patient receives — and the most important factor is the patient’s values and preferences,” says Kara Zivin, Ph.D., senior author of the new study and a professor of psychiatry at U-M.
As the holidays approach, many may worry about impending conversations with relatives and friends on hot-button political issues. “[G]iven this political climate, they’re changing plans to avoid meeting with family members who have differing views,” says Michelle Riba, M.D., M.S., psychiatrist and associate director of the U-M Comprehensive Depression Center. Riba offers several recommendations to mitigate political stress: limit time spent engaging with political content, making sure to follow reputable sources; be careful about sharing your political opinions (and don’t assume anyone shares your beliefs or your desire to talk about politics); be open to other perspectives; step away from potentially upsetting conversations; and decide in advance how politically engaged you want to be and what physical and mental health risks you’re willing to take for your beliefs.