The Impact of Mental Illness Disclosure in Applying for Residency
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EMPIRICAL REPORT
The Impact of Mental Illness Disclosure in Applying for Residency Mara Pheister 1 & Rachel M. Peters 1 & Marika I. Wrzosek 1 Received: 19 September 2019 / Accepted: 31 March 2020 # Academic Psychiatry 2020
Abstract Objective Medical students have higher rates of depression than age-matched peers. Given the societal stigma against mental illness, students with depression often seek guidance on disclosing this in residency applications. This study aimed to answer whether disclosing a mental illness during the residency application process affects an applicant’s success in the National Resident Matching Program. The authors hypothesized candidates disclosing mental illness would receive fewer interviews and would be ranked lower than those disclosing physical illness. Methods The authors randomized program directors from residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME) to receive one of two surveys. Both surveys included similar demographic information and three applicant vignettes, varying only in presence and type of illness disclosed (major depression or diabetes mellitus). The authors analyzed data using the Generalized Estimating Equation method for ordinal logistic regression. Results Out of 3838 ACGME residency programs, 596 responded (16.9%). A total of 380 (10.7%) program directors (survey 1, n = 204, 5.3%; survey 2, n = 176, 4.6%) completed the survey. Applicants who disclosed a history of depression had higher odds of being in a lower category of receiving an invitation (OR = 3.60, p < .001 for a “perfect” applicant, OR = 2.39, p < .001 for a “good” applicant with leave of absence) and a lower category for match ranking (OR = 1.94, p = .01 for a perfect applicant, OR = 2.30, p < .001 for a good applicant with leave of absence) compared with the candidate who disclosed a history of diabetes. However, strong applicants who disclosed depression still fared better in the application process than an average applicant without disclosed illness (OR = 0.13, p < .001 for invite and OR = 0.04, p < .001 for rank). Conclusion Disclosing depression during the residency application process puts an applicant at a notable, however not insurmountable, disadvantage compared with applicants who do not disclose mental illness. Keywords Residency application . Residency recruitment . Depression . Illness disclosure . Mental health
Medical students experience depression and depressive symptoms at higher rates compared with their age-matched peers [1, 2]. A recent meta-analysis found the prevalence of depression or depressive symptoms averages 27.2% among medical students, of whom only 15% were receiving psychiatric medical care [3]. This is compared with a depression prevalence of about 6–8% in 26–49 year-olds in the general population [4]. For some students, struggling with depression can have a negative impact on grades, test scores, or require a leave of absence from school. As such, medical students who have struggled with depression often seek guidance on disclos
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