Bullying and Violence Trigger Depressive Symptoms in Potential Specialist Doctors

Specialist medical education program participants still experience bullying and violence that makes them depressed.

STEPHANUS ARANDITIO

One of the patients at Fatmawati Jakarta Central General Hospital, Erixs Gendala (28), during a consultation with orthopedic specialist doctor Phedy, on Friday (10/3/2023). The patient from Jakarta was diagnosed with herniated nucleus pulposus or pinched nerves in 2020 until finally recovering in September 2022.

JAKARTA, KOMPAS — High social pressure is one of the factors that triggers participants in specialist medical education programs or PPDS to experience depressive symptoms. This social pressure especially comes from seniors who often carry out bullying and violence.

The symptoms of depression were revealed in the screening conducted by the Ministry of Health (Kemenkes) related to the mental health of PPDS participants. Screening results at 28 vertical hospitals found that 22.4 percent of PPDS participants were detected experiencing symptoms of depression and 3.3 percent of them wanted to end their lives or harm themselves.

Marcelius Patria Prabaniswara admitted to having experienced symptoms of depression when he was a participant in the Orthopedic and Traumatology PPDS program at a state university in Yogyakarta in late 2019. During the four semesters he took the PPDS program before finally resigning, Marcel often became a victim of bullying and violence by his seniors.

"Becoming a full-time resident doctor is filled with pressure from seniors and consultant doctors. When we make mistakes and seniors don't like it, we are judged in an event called a parade in the afternoon after the outpatient clinic closes at 4 PM," he said on Wednesday (17/4/2024).

Since the first semester, Marcel has been experiencing bullying ranging from mild to severe. One example is that Marcel and other resident doctors often receive insults, curses, and harsh words from seniors simply because they don't answer the phone or respond to WhatsApp messages more than a minute late.

KOMPAS/HENDRA A SETYAWAN (HAS)

A heart specialist performs the process of primary percutaneous coronary intervention (PPCI), namely the action of opening a blockage in the coronary blood vessels in a patient in the catheterization room at Diagram Heart Hospital, Cinere, Depok, West Java, Thursday (29/8 /2019).

The senior at Marcel's place doing PPDS also does not tolerate the slightest mistake made by the resident doctor as his junior. If this happens, juniors will receive physical punishment, such as push ups. In fact, quite a few seniors commit violence, such as throwing hard objects, slapping, kicking, and even hitting their juniors.

"At that time, I was unable to sleep for seven days. However, lack of sleep is closely related to symptoms of depression. When I was being persecuted, I even diagnosed myself as possibly severely depressed. Because when I visited the ICU, I felt that they were happier than my life," he said.

Also read: Findings of Depression in Prospective Specialist Doctors Require Follow-up

Various pressures, such as bullying, are what caused Marcel to not complete his clinical education program and decide to withdraw in the fourth semester. Ironically, the university noted that the reason for his withdrawal was due to Marcel being perceived as lazy and not carrying out assignments correctly.

"Actually, the specialist doctors are aware of the bullying and violence in the parade activity because it has become a habit. However, they seem to let it happen and this activity is held in the evening outside of working hours. Many of us are also afraid to fight back because it will affect our value and future career advancement," said Marcel.

Similar confession regarding undergoing PPDS was also conveyed by EG (40), one of the specialist doctors in Central Java. He admitted that the pressure as a PPDS participant was not only related to education, but also pressure from seniors.

KOMPAS/EMANUEL EDI SAPUTRA

Muhammad Asroruddin, a specialist in ophthalmology at the Tanjungpura University Hospital in Pontianak (wearing batik), guided medical undergraduate students in the Koass program (professional education program for future doctors after completing academic programs) at FK Untan, on Monday (2/5/2015), in Pontianak.

At that time, she was even pregnant. However, that doesn't make the pressure any less intense. In "tradition" at the university, every PPDS student is asked to regularly meet with the professor who is in charge of his/her field. "This is not for guidance, but the term is like sowan (facing). "We have to bring gifts or food," he said.

Many of us also don't dare to fight because it will affect our grades and future career paths.

However, according to EG, such a thing should not be necessary, so he is reluctant to participate in the "tradition." This is what makes him often subjected to abuse from his seniors. Verbal bullying is often what he experiences.

Even so, several times EG was hindered in the process of his education. He was often assigned to take care of the hospital ward instead. The physical and mental pressure that EG faced even led to a miscarriage at that time.

Global problem

The condition of bullying that still occurs among PPDS students is highly susceptible to triggering depression. Although the risk of depression is highly dependent on each individual, the pressure of educational tasks, household issues, as well as socio-economic challenges can further exacerbate the risk of depression.

The condition of depression among PPDS doctors or residents does not only occur in Indonesia, but also in other countries. Several research findings and international journals have shown that symptoms of depression among residents have become a global issue.

One of these studies was published in JAMA on May 12, 2016. The study, based on a systematic review and meta-analysis, showed a prevalence of depression or depressive symptoms in resident doctors at 28.8 percent. It ranges from 20.9 percent to 43.2 percent, depending on the instrument used.

The Head of the Communication and Public Service Bureau of the Ministry of Health, Siti Nadia Tarmizi, stated that the screening results regarding the mental health of PPDS participants from the Ministry of Health were conducted using a standardized questionnaire method. Meanwhile, to determine depression results more accurately, further examinations need to be carried out.

Also read: Depression, 3.3 Percent of Prospective Specialist Doctors Want to End Their Lives or Injure Themselves

"What the Ministry of Health is doing is to first save those who show symptoms of wanting to die or harm themselves and provide comprehensive treatment. Then, those who suffer from severe depression should also be treated, such as being given medication," he said.

In addition, Nadia mentioned that the Ministry of Health will conduct an evaluation regarding the causes of depression among PPDS ranging from mild, moderate, to severe scales. All factors will be evaluated, ranging from education, healthcare, economy, to cases of bullying whose reported numbers continue to increase.