Depression Phenomenon in PPDS, Fact or Mirage?

Skills in managing emotions–thoughts–behavior are needed to be resilient and competent when experiencing life stress.

A Ministry of Health survey in several Indonesian RSVs in March 2024 found that 22.4 percent of students in specialist medical education programs or PPDS, both strata 1 and 2, experienced symptoms of depression.

Does this mean that those who are screened in March 2024 are truly experiencing depression? Looking at the implementation of the survey, which happened to be carried out in the middle of the fasting month, there are many factors that could play a role in triggering depressive symptoms.

Depressive disorders are usually caused by the interaction of bio-psycho-social factors, such as brain and physical conditions, mental resilience (resilience and coping mechanisms), and certain social situations (distress).

In fact, the number of depressive symptoms in PPDS in Indonesia is still below the level of depression in PPDS abroad, namely 29 percent (Journal of the American Medical Association 2024). However, as said by the Minister of Health, the phenomenon of depressive symptoms in PPDS needs to be paid attention to and a solution sought by education providers so that it does not drag on and become an obstacle in the education process of prospective specialist doctors.

Also read: The Icarus Paradox of Indonesian Specialist Doctor Education

Depressive symptoms and disorders

Depressive disorder is a mental disorder in the form of a decrease in a person's mood/feelings that occurs almost every day, for at least two weeks, and this results in disruption in work/social functioning.

This depressed mood occurs without the individual's will, but dominates his feelings or thoughts so that he can no longer feel happy about things he previously enjoyed.

The thoughts of people who are depressed tend to be pessimistic, hopeless, guilty, and even often contemplate the idea of ​​it being better to die than to live while suffering. The behavior that seems common is silence, brooding, daydreaming, or easily becoming angry and offended.

Other symptoms of depressive disorders are insomnia, anxiety, loss of appetite, loss of initiative, lots of complaints.

So, a person who experiences symptoms of depression that persist (more than two weeks) so that he feels depressed and suffers because his work social function is disrupted can be said to have a depressive disorder, according to the diagnostic criteria for the Guidelines for the Classification and Diagnosis of Mental Disorders (PPDGJ)/International Classification of Diseases (ICD. Depressive symptoms are a component of depressive disorder).

KOMPAS

The Ministry of Health's screening results at 28 vertical hospitals in March 2024 found that 22.4 percent of specialist doctor education program participants experienced symptoms of depression.

Who can experience it?

Everyone, whether children, teenagers, young adults, or the elderly, has the potential to experience depressive disorders, including PPDS who have to study while working in a hospital. Resident doctors (PPDS) have a higher risk of becoming depressed, experiencing anxiety and burnout compared to their peers who work in other fields (Lisa M Meeks et al, 2019 ).

In the past three years, the post-pandemic Covid-19 situation has also affected the lives of resident doctors who must continue working despite fear of contracting/transmitting the infection, while the psychosocial situation continues to change.

All bio-psycho-social factors play a role in the emergence of depressive disorders with different compositions. A person's biological vulnerability, mental resilience and ability to adapt when faced with life stressors play an important role in the incidence of depressive disorders.

The symptoms of depression can be a manifestation of various pre-existing mental disorders (such as bipolar, dysthymia, neurotic, and others) or a reaction to new stressful situations (acute), namely an adjustment disorder with depressive reaction.

Depressive disorders can be properly managed by psychiatrists, whether non-pharmacological or pharmacological methods, provided there is support from the family and work environment.

Psychotherapy is a psychological therapy through verbal interaction/attitude in the form of intensive and professional interaction between doctors (therapists) and patients based on standard methods.

The minds of people who are depressed tend to be pessimistic, desperate, guilty-feeling, and often have thoughts of preferring death over suffering in life.

There are several types of psychotherapy, namely supportive, dynamic, re-educational (cognitive behavior therapy and behavioral dialectical therapy), and others. Apart from psychotherapy, pharmacotherapy (drugs) also need to be given if the symptoms of depression are quite severe.

Antidepressant drugs are usually taken for around 6-12 months or even longer. Other therapies include programmed activities so that people with depression can feel more empowered, more capable of doing things even though they have not fully returned to their previous social and work-related functions.

Prevention

The depression prevention program (PPD) in Indonesia needs to be accelerated, both for young and old people. Living in today's era which is full of stressful challenges and rapid changes in industrial technology can be a source of distress if individuals are less able to adapt, especially if they have certain biological vulnerabilities.

PPDS during the study period certainly faces many life challenges that can be a source of stress, such as friendship, family, and financial issues. The ability to manage emotions, thoughts, and behaviors is needed to be resilient and competent when experiencing life pressure. Counseling programs or other psychological therapies are already available in educational hospitals, but they may be underutilized due to busy work schedules or fear of stigma when seeking help.

Also read: Understanding the Phenomenon of Depression among Specialist Medical Education Participants

The more severe complications of depression such as social isolation, suicide attempts, and prolonged physical pain can be avoided if interventions are carried out earlier.

PPD can start from childhood, even during fetal development, through the lifecycle approach promoted by the Ministry of Health in efforts to promote physical and mental health for the Indonesian people, including aspiring specialist doctors.

Martina WS Nasrun, Psychiatrist, Lecturer at FKUI-RSCM