Comments on "Indian Medical Students with Depression, anxiety, and Suicidal Behavior: Why Do They Not Seek Treatment?"

Sir,

The article titled “Indian Medical Students with Depression, anxiety, and Suicidal behavior: Why Do They Not Seek Treatment?” published in your esteemed journal has addressed an important issue regarding the mental health of medical students. We appreciate the authors for this study and for emphasizing the need to identify and address potential barriers to mental healthcare-seeking. However, the following issues need to be addressed in the mentioned study.

The authors were able to identify 14% of students suffering from depression using the cutoff score of more than 15 on Patient Health Questionnaire -9 (PHQ-9). They also mentioned that another 21.4% of students scored between 10 and 15 and were included in the normal group, “not suffering from psychiatric disorders.” As per PHQ-9, they might be suffering from a moderate degree of depression. This group (PHQ-9 score between 10 and 14) has a large proportion of students where early intervention can help to prevent worsening of their depression to a severe degree. Therefore, we suggest that they should be included in those suffering from psychiatric disorder or a separate category of moderate degree of depression, but not in the normal group.

Measuring tool assessing barriers to mental healthcare-seeking has many items related to psychiatrist/psychologist like item no 9 “I would either know the psychologist/psychiatrist at my institute or would have to have future dealings with him or her during my period of study here.” Authors depicted in the study flowchart that a significant number of students (26.5%) either did not respond or refused to participate in the study. Considering this, it is worth knowing if the person who approached the students for participation in the study was already known to them, like a psychiatrist or psychologist of the same institute.

A striking finding of this study is that more than half of students were willing to consult a psychiatrist, but outside their institute. Authors suggested, in conclusions, some measures to address this issue, like the availability of private consultation rooms and developing an institutional policy on confidentiality of student mental health. Hence, it is worth knowing about existing policy of students’ mental health at the research site before the study started as it may have affected the response of the students who participated in the study.