When psychiatrist Connie Guille, M.D., was in the first year of her residency, she saw the toll that a medical internship could take with its long hours, high expectations and emotional ups and downs.
“Sadly, one of my co-interns attempted suicide during our internship year,” Guille said.
She decided to try to find a way to reduce interns’ risk of having suicidal thoughts, and today the result appears in the Journal of the American Medical Association (JAMA) Psychiatry.
In the randomized, controlled trial, Guille and her colleagues chose a free, publicly available web-based program called Mood Gym to work with. It teaches cognitive behavioral therapy skills to help people prevent or deal with depression.
Then, they assigned about 200 medical interns at a pair of university hospitals to one of two study groups. The researchers knew those interns were at the start of one of the toughest years of their lives. “Interns are working long hours, they’re sleep deprived and they’re dealing with pretty intense experiences with their patients, including suffering, pain and death,” Guille said.
A previous study that looked at suicidal thoughts among medical interns, assessing their mental state before their internships and three months into their training, found their rate of suicidal thoughts went up 370 percent.
“Unfortunately, the majority of interns won’t seek mental health treatment mainly because they lack the time, don’t have convenient access to care or have concerns about confidentiality,” Guille said. “Interns have also cited a preference to manage their problems on their own as another reason they don’t seek mental health treatment. We wanted to know if a web-based intervention, delivered before the start of internship year, could help overcome those barriers to care.”
In Guille’s study, doctors in two groups were assessed for suicidal thoughts before they started their internships.
Then, doctors in one group used the Mood Gym once a week for four weeks before they started their internships. The program has four modules. Each takes about a half hour to finish.
“The first module helps participants understand that there is a really tight interplay between the way we think, the way that we feel and the way we behave. Often when we’re faced with stressful events, the thoughts we have might be really unrealistic and inaccurate or overly negative. What follows is a poor mood and negative behavior,” Guille said.
The second and third Mood Gym modules teach users how to identify and challenge inaccurate or overly negative thoughts. That gives them a more accurate look at what’s happening in their lives. They also learn the importance of doing things that make them feel better, from planning fun activities to making sure their bills are paid and the laundry is done. Finally, the program teaches problem solving techniques for stressful life events.
Doctors in the control group had a simpler regimen. They got emails with general information about mental health problems and how to get help from local mental health professionals. They were asked to study them for 30 minutes a week for four weeks before starting their internships as well.
Interns in both groups were then assessed for suicidal thoughts every three months during their first year in practice.
The result: Doctors in the group that used the Mood Gym were 60 percent less likely to have suicidal thoughts during their internships.
Guille said the study suggests that the Mood Gym and other cognitive behavioral therapy websites might help similar groups of people undergoing a major stressful life event.
“I think from a research perspective, we would always like to see replication of findings before wide scale dissemination. However, from a practical standpoint we have an intervention that is free, available to anyone with Internet access, takes only about 2 hours to complete and has the potential for benefit on multiple levels,” Guille said.
“First, it may prevent suicidal ideation in a high risk group, but it also teaches physicians about depression and a very effective treatment for depression, cognitive behavioral therapy, which has the potential to benefit the physician and also the patients they see. It trains young doctors in how to help themselves, which will make them better physicians.”