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Addressing the Need for Physician-Scientists in Geriatric Mental Health

By Maja Gawronska

There is a dire need for physician-scientists in geriatric neuropsychiatry. Our Medial Students’ Sustained Training and Research Experience in Aging and Mental Health (MSTREAM) program is addressing this challenge.

Unrecognized and untreated depression, dementia, substance use disorders, anxiety disorders, schizophrenia, and other mental health conditions in late life can be severely disabling, even fatal. The rate of suicide, frequently a consequence of depression or other serious mental illnesses, is highest among older adults. Mental disorders can also negatively affect the ability of older individuals to recover from health problems. Heart attacks are four times more likely to be fatal in a depressed person. The risk of death among nursing home residents with major depression is 60 percent higher than for residents without depression.

Because of a shortage of geriatric mental health researchers, there are still many basic unknowns in treatments for older patients. Many published studies of seriously mentally ill people have frequently excluded older participants. Clinicians are often forced to extrapolate guidelines from data collected on younger people, yet that presents obvious dangers.

There is also a shortage of geriatric psychiatrists: one for every 23,000 older Americans, or about 1,700 who are board certified. That ratio is estimated to decrease to only one geriatric psychiatrist for every 27,000 individuals sixty-five and older by 2030.

“Yet, little is being done to address this challenge. Geriatric psychiatric services are already in high demand, and specialists are in short supply,” said Dilip V. Jeste, MD, director of the UC San Diego Center for Healthy Aging and the Stein Institute for Research on Aging. “Developing a cadre of physician-scientists devoted to forwarding knowledge and treatment for geriatric mental health disorders is essential to meet the growing needs of American society.” Trainee pool is a critical issue.

This is why the Stein Institute and the UC San Diego Center for Healthy Aging has developed a unique training program in neuropsychiatry and aging, funded by the National Institute of Mental Health. MSTREAM provides sustained mentored research support to medical students. Though administered through UC San Diego, MSTREAM is a multisite, national program with students and mentors from schools such as Harvard, Columbia, and Texas Tech Universities; and UC San Francisco. Each trainee conducts a research project for ten weeks during the summer between the first and second years of medical school.

The trainees then attend a two-day conference in La Jolla and present their summer research projects. They also prepare manuscripts with their mentors’ help.

During the second year, students participate in NIMH Day, when they meet NIMH program officers and intramural scientists. During the third year, the trainees present their work at a relevant professional conference. In the fourth and final year, they work on a research project in geriatric mental health during their elective rotation.

We have trained 250 medical students in the past five years of the MSTREAM program. Our trainees have published 120 scientific articles on their projects in top journals. Many have chosen to pursue a career in geriatric psychiatry, and all are gearing up to becoming medical researchers.

Congratulations to out trainees who participated in the MSTREAM program, and a big thank you to the dedicated mentors who volunteered their valuable time.