How to Discuss Mental Health Issues in Medical School Applications

Many people suffer from depression, anxiety and other mental conditions. It is endemic in the culture — everyone is vulnerable, including medical school students.

Based on nearly 200 studies, an estimated 27% of 129,000 medical students in 47 countries reported suffering from depression or symptoms of it at some time during medical school, according to research published in 2016 in the Journal of the American Medical Association. Some smaller studies since have indicated even higher rates. Depression also increases dramatically during the intern year or the first year of residency.

In med school, even more students will experience anxiety than depression, whether a short and mild episode or something that lasts much longer, according to some studies.

How, then, does a thoughtful student who has already had an episode of mental illness approach the topic once he or she has decided to apply to med school? As a psychiatrist and prior dean of student affairs and admissions, I recommend that applicants consider this aspect before applying, and not wait until getting accepted to med school.

Unless your experience with mental illness was the major reason you wanted to go to medical school, it is unlikely to be a part of the primary application or personal essay on why you want to become a physician. However, it is quite likely to come out in a supplemental essay about hurdles in life or explaining gaps in your education.

Address this upfront. Screeners on admissions committees are not happy with gaps left unexplained or vague smokescreens about what actually happened. If you had to drop out or take a leave of absence from the program for hospitalization or rehabilitation, explain that.

[Read: Address Mistakes, Weaknesses in Medical School Applications.]

Perhaps the stress that led up to the situation is a good place to start. It likely may include lifestyle contributions. For example, poor sleep is a known physiological factor that can set off depression. If that was a major provocation for the depression, how has that changed and how were you able to control for that in the future?

Lack of exercise, a poor diet loaded with processed carbohydrates, taking on excessive tasks and other circumstances require reflection. If you are prone to any of these, think about them and begin living your life in a new way. Setting an example for future patients begins with your personal insight and lifetime experience. It may also include staying on medication, following directions of your physician, attending therapy regularly or other ways of protecting the psyche like mindfulness or deep breathing.

Waiting until med school to address these factors is not a good idea. You might get into a medical school, but if you haven’t dealt with trying to live a healthy lifestyle, then mood disorders or excessive anxiety will attack again. These concerns are rarely one and done. If you want to attend med school and accept the stress and demands, you must work on the solution ahead of the game.

Personal statements in the primary med school application may include a short section on mental illness if that is why you decided to go to medical school. It might be about a family member, dear friend or yourself.

But remember that med school includes many specialties, and so do admissions committees. Too much emphasis on one area may not convince the majority of the committee that you will be equally dedicated or effective in all areas. Medical students must be proficient broadly, and only later will be given the opportunity to specialize.

Gaps without explanation or insufficient discussion can lead to uncomfortable questions during an interview. The plan during the interview generally would be the same as for the application. Avoidance of a direct question is not recommended, but every single detail is not required.

[READ: Discuss Wellness Curriculum in Medical School Interview.]

Show insight and growth in terms of your emotional and physical health. How you have fortified your lifestyle with tools and a support team is important to disclose. These same tools will allow you handle future questions and stressors.

Any period of more than a couple of weeks when you weren’t performing well should give you pause. Plan how that could be described in the application process and what has been done to prevent a recurrence. You don’t have to describe every detail, but it is important to include the progress you have made on any treatment plan and how you have adopted a healthy lifestyle that can ensure against returning symptoms and keep you at your best.

It is noteworthy that alcohol, marijuana or any other type of substance abuse is complex and often begins with periods of anxiety or depression. Undergraduate students often underestimate the impact of this during those early college years when it seems that “everyone is doing it.” Panic disorders and depression often worsen during substance use.

I have advised students, besides seeking therapy, to volunteer for programs like Mothers Against Drunk Driving and other community groups that help adolescents avoid misuse of substances. It’s best to choose to get preventive help or early intervention when symptoms of a problem surface.

Self-reflection is important for every applicant to consider. Will med school be a good decision for your health? Medical school is probably not the healthiest choice, but if you go will you have the tools to combat the stressors and succeed?

The answer isn’t straightforward and will vary from school to school. Some considerations like sleep deprivation can be problematic to most medical students and doctors. One young man I knew considered medical school for psychiatry but eventually decided against med school and went on to earn his doctorate in clinical psychology. He avoided years of night call that he knew would repeatedly throw him into depression.

[Read: Plan Ahead to Reduce Medical School Stress.]

Although it seems far in advance of choosing your residency, some future medical students begin setting their heart on a certain program that may not benefit their health. For some individuals, sleep deprivation and sleep-wake cycle alterations can be intolerable. I have known individuals who needed to leave emergency medicine or neurosurgical programs because of debilitating depression. Even though those specialties may be attractive for other reasons, they may not be the healthy choice that allows someone to continue indefinitely.

I also know individuals who had to leave residency programs for nearly uncontrollable mood swings. Such individuals can end up finding a job after medical training that allows more consistent sleep, or they may try to work in the same field in a different capacity. With better sleep schedules, they can practice and enjoy careers in other areas of medicine. Keeping an open mind to various specialties is a healthy decision.

Students with a history of mental illness can certainly become physicians. Many more students will develop depression or anxiety for the first time during their medical training. There is help, but students have to admit a problem and be willing to seek assistance and be committed to health-affirming decisions along the way.

If a student is unable to put in place a plan that will help protect himself or herself as much as possible from periods of anxiety and depression, then he or she should think twice about whether medical school is the right option.

If you decide that med school is right for you, make good choices about where you train that will support your total personal growth. You know the adage about square pegs and round holes. Seek out what will help you be your best.

More from U.S. News

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How to Discuss Mental Health Issues in Medical School Applications originally appeared on usnews.com

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