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The Catalyst

Prevention of depression, suicide among students a priority at MUSC

By Ashley Barker
Public Relations

On average, 400 physicians commit suicide in the United States each year according to the Psychiatric Clinics of North America. The male physician is two times more likely to commit suicide than the average male, and the female physician is three times more likely to commit suicide than the average female.

Director of Counseling and Psychological Services Dr. Alice Q. Libet, left, goes over some paper work with Dr. Kelly Anne Holes-Lewis, an attending physician with CAPS.
Director of Counseling and Psychological Services Dr. Alice Q. Libet, left, goes over some paper work with Dr. Kelly Anne Holes-Lewis, an attending physician with CAPS.

Many of the psychological issues that physicians face start when they are in medical school, which is something that MUSC is addressing through the Counseling and Psychological Services Program.

Kelly Anne Holes-Lewis, M.D., one of two attending physicians who see student patients at CAPS, said that in 2012 there were 2,894 MUSC student visits to address these issues.

The main reasons for the visits were anxiety (31 percent) and depression or problems with mood (20 percent). Academic and learning problems (16 percent) was the third largest reason followed by relationship problems (9 percent), adjustment concerns (8 percent), alcohol or substance abuse or dependence (7 percent), eating disorders (3 percent) and other mental health problems (6 percent).

Holes-Lewis estimates that 33 percent of all of those visits were from College of Medicine students.

“It’s a problem I’m very passionate about,” Holes-Lewis said. “When adequately treated, we can help these students fulfill their full potential.”

Any student who is enrolled in a health-based or research-based academic program on campus is eligible for free services at CAPS. Everything that they need is financially provided through a fee linked to their tuition bill.

“Students can come in for evaluation and receive appropriate treatment and services for as long as it takes to resolve the issue and restore wellness. I believe this is one of the most helpful and efficacious programs I have ever seen on a university campus,” Holes-Lewis said. “Oftentimes, these students are leaving home for the first time and are away from their support group. Additionally, they are often starting or in the midst of academically intensive programs. Depressive and anxious symptoms can develop that overwhelm a student’s ability to cope in these circumstances.”

Director of Counseling and Psychological Services Dr. Alice Q. Libet, left, stands with Dr. Kelly Anne Holes-Lewis, an attending physician with CAPS, in front of the MUSC Student Health facility.
Director of Counseling and Psychological Services Dr. Alice Q. Libet, left, stands with Dr. Kelly Anne Holes-Lewis, an attending physician with CAPS, in front of the MUSC Student Health facility.

There are numerous barriers in place that are currently holding back health care students and professionals from getting the care they need.

Holes-Lewis said one of the main reasons is the stigma of mental illness. Many of those in the medical field fear that if they are labeled with something like depression or anxiety, they will appear to be less effective or unable to cope.

The fear of lack of confidentiality is also a problem among students and physicians. With the use of the electronic medical record, access to diagnoses and medications is something that many physicians worry about before seeking help from another health care professional. CAPS has its own internal electronic medical record, not accessible through other MUSC systems, so student confidentiality is ensured.

“In terms of licensed physicians, one of the things that we have to do when we renew our license is check a box that we don’t have any psychiatric illness. Physicians fear that getting help will create implications for their licensure,” Holes-Lewis said. “What we know for sure is that this is a serious problem and one that we want to effectively be part of the solution. We do individual therapy, family therapy and medication management.”

Many of the students at MUSC and other medical universities are high functioning and may not realize there is a possibility of a mental issue like a learning disorder because they’ve always been able to keep up. The CAPS Program also offers extensive diagnostic testing for learning disorders, which can cause anxiety. If a learning disability is diagnosed, the CAPS staff will then take it a step further and recommend the necessary accommodations for that student to have within the classroom or during the board exam testing.

“We want our students to be able to work to their full potential and help them succeed in any way that we can,” Holes-Lewis said.

The same stressors that students go through continue, and in some ways are magnified, when they become physicians, according to Holes-Lewis.

“It is widely recognized that physicians and other people regularly engaged in end-point decision making are at increased risk for developing heart disease, hypertension and depression,” she said. “The goal of our program is to intervene in a meaningful way so as to reduce these comorbidities and overall provide effective treatment strategies for greater health and well-being.”

Holes-Lewis is currently proposing an executive wellness program to include providing care for MUSC physicians who are struggling with depression, stress, anxiety and other psychological concerns.

“We’re working on developing a program for physicians that will address the main concerns that limit physicians from accessing care,” Holes-Lewis said. “We know the problem exists and want to provide a confidential environment to provide necessary care so that the physicians in our community can find a balance of wellness and meaning in their work.”

Physicians also have access to the most popular way of committing suicide in the medical field – medication.

“Everyone knows of someone who committed suicide and in retrospect states that they never even knew there was a problem. This happens with physicians and students as well, as they are very often trying to hide the problem from colleagues and family members,” Holes-Lewis said. “The two most common ways physicians commit suicide are medication overdosages and firearms. As physicians we have ready access to medications, and it amplifies the problem.” 

The problems Holes-Lewis is helping students manage within the CAPS Program are what Constance Guille, M.D., assistant professor in the MUSC Department of Psychiatry and Behavioral Sciences, has decided to research.

Dr. Constance Guille

Guille said that over the course of medical internship year, about 40 percent of interns from multiple specialties become depressed. When asked when their first episode of depression occurred, they answered “sometime in medical school.”

This finding is consistent with a large body of literature that recognizes that medical students are at a much greater risk for depression in comparison to the general population, and they are less likely to seek mental health treatment.

“Prevention programs can be effective in lowering rates of depression and mental health problems in high-risk populations,” Guille said. “Medical students are an ideal population for a prevention program in that we can intervene with a prevention program prior to the start of their academic year and prior to the potential for their mental health to deteriorate.”

With the support of College of Medicine Dean Etta Pisano, M.D., Guille received a federal Suicide Prevention Grant from the Substance Abuse Mental Health Services Administration.

“We are currently evaluating the efficacy of a web-based cognitive behavioral therapy (CBT) program for the prevention of depression in first-year medical students. If effective, we will evaluate the program for students in all colleges at MUSC.”

The online CBT program is called MoodGym.

“It has been shown to be effective in lowering the incidence of depression in the general population, and the web-based platform overcomes many of the common barriers to care cited by medical students including lack of time, inconvenient access to care, concerns about confidentiality, stigma and documentation on their medical record,” Guille said. “We hope that by learning some CBT strategies, students will be better prepared to cope with the stressors of medical training and less likely to become depressed during  their medical school education.”

To find out more, visit To learn about the Department of Psychiatry and Behavioral Sciences, go to

September 5, 2013

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