Why do people develop depression in medical school?

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JermanH

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I'm just curious about some of the reasons why medical students develop depression in medical school. Is it because of the rigor of the courses? Isolation? It seems like a large-ish percent of medical students do. Anyone care to share their experiences?
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From my perspective, general wear and tear. I'm an M2, and generally consider myself very happy to be where I am in life and location. Some of my best friends have been made in these past 2 years since starting. Even so, I felt the need to seek counseling from school provided services mid way through M2 year when I'd find myself depressed to the point that it impacted my ability to concentrate on my studies. I really couldn't put my finger on what was causing these feelings...there wasn't anything I'd think about and decide "that's the reason I feel depressed..." it just slowly kinda developed after sustained high levels of work load and anxiety, and I'd find myself getting teary eyed any time I would look at my notes. That being said, seeking out guidance made a dramatic difference and I am doing much better now...mentally prepared to start dedicated for Step 1, and would strongly recommend taking that route to anyone with such troubles.
 
JermanH said:
I'm just curious about some of the reasons why medical students develop depression in medical school. Is it because of the rigor of the courses? Isolation? It seems like a large-ish percent of medical students do. Anyone care to share their experiences?
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Isolation combined with the amount of information (much of it quite boring) that we have to learn in such a short period of time. I think some people are naturally suited for med school either because they love studying and find the information all very interesting or because they like the competitive culture of medical school and enjoy being able to measure themselves against someone else and, subsequently, feel better about themselves. The latter type is actually kind of common in med school, unfortunately. For the rest of us who don't really fit either of those two molds med school can really do a number on your mental health.
 
Because it sucks? And I say that as someone who has thoroughly enjoyed first year. Medical school can be very isolating and every week is worse than an undergrad finals week. A lot of people simply don't know how to cope with it.
 
I feel very alone.

I have severe testing anxiety that developed after I started school. I don’t do well on exams, have chronic anxiety and live with the thought everyday I am going to fail out, or do horrible on my boards and be stuck forever in debt with no future. This leads to a lot of self doubt and then I panic, which leads to burn out. It is terrible.

I have external family issues that never seem to stop that doesn’t help. I see my personal psychiatrist monthly.
 
Anxiety is so prevalent, just because it is so easy to fail. Our school has test like every four days. Anyone else smell the anxiety sweats (like a literal odor) on fellow students /self right before a standardized patient or a big exam or evaluation??
 
NickMT-RN said:
Isolation

Chronic performance anxiety

Borderline PTSD from the above

Most of us are perfectionist type people (in certain ways) in a very unperfect career field.
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Your last point really struck me. Very good insight.

welp18 said:
Isolation combined with the amount of information (much of it quite boring) that we have to learn in such a short period of time. I think some people are naturally suited for med school either because they love studying and find the information all very interesting or because they like the competitive culture of medical school and enjoy being able to measure themselves against someone else and, subsequently, feel better about themselves. The latter type is actually kind of common in med school, unfortunately. For the rest of us who don't really fit either of those two molds med school can really do a number on your mental health.
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Gotta have something to get the juices flowing.

Goro said:
All of the above, plus many people have the mindset that they are defined by their grades, and/or doing poorly is a sign of weakness (as is getting help).

To this add lack of proper coping mechanisms.
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For most of us all we have the time for is grades, and thus it becomes our only source of identity. When you take that away people, myself included, have been forced to take a long look in the mirror and decide if we're willing to sacrifice in order to be at the "top" as considered by the medical specialty.

Medical school is also the first time when that sacrifice is noticeable. In college you can work hard, get good grades, have friends and still go out/party/have hobbies. In order to out-compete medical students you really have to be on more or less 24/7, and its taxing on your psyche and relationships.

Lets_Run said:
Anxiety is so prevalent, just because it is so easy to fail. Our school has test like every four days. Anyone else smell the anxiety sweats (like a literal odor) on fellow students /self right before a standardized patient or a big exam or evaluation??
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It's easy to fail is something I think alot of people never get used to, having spent most of our lives in the mindset of "work hard and get an A, work a little less hard get a B". Whereas a B isn't the end of the world, failing in alot of ways can be.

MedicineZ0Z said:
Excessive studying + stress + isolation is a big part. Some people also think they'll acquire some special person status or that medicine is saving lives all day. When reality = / = expectations, depression skyrockets.
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Especially the kids that go straight through. They hit the wood chipper like a stack of bricks.
 
Everything that has been said so far is so true. From my observations (that are similar to what previous posters said with a few variations):

Workload: Wow is it a lot of work. And most med students are smart enough to have done their research going in to know that there's going to be a lot of work and a lot of stress. But no one KNOWS knows really how bad it is until they get there. Even during weeks when you think the information isn't that much and you have kind of a laidback week because you think you have the info on lockdown, you get a quiz back and you're like what the eff???

Obligations: There's so much administrative bullhonky they throw in your face everyday you wonder if the administrators are just complete sadists. Granted a lot of what is required of them to require of us is driven by LCME, AAMC, [insert other acronymic institutions], but they sometimes seem to go overboard. And they don't always have a schedule of things beforehand so you have your week planned out and then you get an email blast that's URGENT and there's some mandatory crap you have to do that takes over an hour that you didn't schedule for. The other obligations are kind of self-imposed but obligations nonetheless. You'll be signing up for clubs left and right so you can have a great CV and then you have keep up with them AND your grades AND your relationships AND your health.

Identity formation: Your 20s are the time to really figure out who you are. Luckily I started med school in my 30s and I went through all of those major identity crises before starting med school (but tbh I still have crises so that never really goes away). Even if you don't have the conscious realization that "hey, I don't think I know who I am," the thoughts are brewing underneath. You do a lot of growing up in your 20s but since those of you in your 20s are in med school, you don't even have time to reflect on who you really are and what you really want out of life. You're lucky if you leave the house having brushed your teeth. I would relate med school in your 20s to early closure of epiphyseal growth plates due to extreme stress: because of med school, you'll be a little stunted emotionally/mentally. Hopefully you'll be able to change that after residency, but who knows. I honestly don't know how anyone does med school before 24. Y'all are a lot more mature than I probably was.

Reality check: This kind of goes with identity formation, but I think it deserves a separate short paragraph. Like
@Osteoth said, reality and expectations definitely don't match up. You think you're gonna kickass in med school and stand out and save lives but, more than likely, you'll be in the middle or below, be just another face in the crowd, and not do much doctor-y type things for a very long time.

Keeping up appearances: So everyone jokes around about being stressed and not having time to do laundry, etc. etc. but very few people really open up about the current state of their mental health. It's for several reasons, but the major two are 1) no one wants to appear weak in front of their peers and future colleagues and 2) fear of these things being on your record. For 1) everyone is trying to keep up a good front. No matter how much it's drilled into us that it's ok to talk to a counselor or to admit you're depressed or so stressed that your hair's falling out, who's going to speak up if no one else is? Who is going to go to someone and cry on their shoulders? Even if it does happen, everyone keeps it on the d-l so the cycle of silence happens again. And this is just within med school. You also worry about keeping up appearances for non-med folk. How can you tell your non-medical family and friends that school is causing you major depression? They all know med school is hard, but to them you're living the dream, you get to be a doctor, what's there to cry about? So even if you do have sympathetic family/friends, you feel like a spoiled brat for even thinking about opening up to them because maybe they didn't get to live their dreams, but you're doing it now. For 2) even if you were brave enough to admit these things, it might go on your record somewhere. It probably won't go on your transcript or dean's letter, but it might show up on some official thing somewhere else. The school will say it won't, but can you really trust anyone? Even if the school doesn't put anything like this on your record, you still have to worry about state licensing and the questions you might have to answer there.

Sorry for the weirdly long post, but I felt it was important to get all of that out there. Some of these things I've experienced and some are just observations. I hope this helps someone some day. Please learn from our collective mistakes.

Great thread.
 
Thank you for this thread. As an incoming student, developing depression is one of the major things that worries me, despite how excited I am to start school. Having never experienced med school yet though, it's not like I would know what many med students feel. Not only is it comforting to hear other students speak about it, but now I have an idea of things I should be aware of to maintain my mental health and things I could do to cope, and, of course, that no one is alone in this. So, thank you all for sharing your thoughts and experiences.
 
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its_going_tibia_okay said:
Thank you for this thread. As an incoming student, developing depression is one of the major things that worries me, despite how excited I am to start school. Having never experienced med school yet though, it's not like I would know what many med students feel. Not only is it comforting to hear other students speak about it, but now I have an idea of things I should be aware of to maintain my mental health and things I could do to cope, and, of course, that no one is alone in this. So, thank you all for sharing your thoughts and experiences.
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Congrats on the accept, and I have to say that you have one of the best screen names ever!!!
 
curbsideconsult said:
even if you were brave enough to admit these things, it might go on your record somewhere. It probably won't go on your transcript or dean's letter, but it might show up on some official thing somewhere else. The school will say it won't, but can you really trust anyone? Even if the school doesn't put anything like this on your record, you still have to worry about state licensing and the questions you might have to answer there.
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Can you elaborate on this? I don't understand how seeing a medical professional confidentially about your mental health can just show up "somewhere."
 
harkas said:
Can you elaborate on this? I don't understand how seeing a medical professional confidentially about your mental health can just show up "somewhere."
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Most medical students get their insurance through the school and also see the physicians that are close by the school which are normally associated with said school. Even though its very unlikely its something that sucks to worry about when u really need help.
 
harkas said:
Can you elaborate on this? I don't understand how seeing a medical professional confidentially about your mental health can just show up "somewhere."
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I vaguely recall reading about someone who had this type of problem. Clearly, I don't have a source for it. I'm a bit older so I remember when privacy and confidentiality laws/rules weren't as strict amongst healthcare professionals and HIPAA was just enacted and kind of became a big thing overnight. So perhaps I'm just not as trusting of people/the system as others might be. Also, people have loose lips and rumors spread like wildfire so even if there's no official mention of any type of services you may have received during medical school, word could get around. There's a reason why most students who need help don't get it. Even in this day and age where schools are a little better about encouraging students to go seek help and constantly reassure students that it won't affect them negatively in terms of records and recommendations, students still put excessive pressure on themselves to suck it up and go it alone for fear of being looked down upon by everyone around them, including preceptors/profs/staff/administrators.

Maybe another SDNer has a very different view, with facts and sources, that proves me wrong. That would be fine.
 
harkas said:
Can you elaborate on this? I don't understand how seeing a medical professional confidentially about your mental health can just show up "somewhere."
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This is a huge problem in all of medical training that needs to be dealt with ASAP and I'm hoping myself and the next generation of physicians will take it on, which means taking on medical licensing boards that are very clearly in violation of the ADA when asking for mental health information.
 
I'll preface by saying that I love my medical school and have enjoyed my time as much as humanly possible...However, people develop depression because:

1. A lot of free time is taken up by 'less than ideal' activities.
2. Perfectionism. None of us are perfect, most of us stumble at one point or another, but somehow, almost everyone maintains the bullet-proof persona. Weakness or vulnerability is like finding water in a desert.
3. Isolation. There's no way around it.
4. Gunners. I'm not talking about people who work hard. Instead, I am talking about people who work hard, have to express to everyone else how hard they work, and make daily attempts to make others feel less-than. If you don't work hard, medical school will be tough if not impossible. However, if you work hard and get off by belittling others, I just feel sorry for you.
5. Constant exam pressure. Passing a class is no longer enough, you have to pass every exam with a minimum level of competency (at my school). No off days are allowed.
6. Being poor. Most of every medical school class is filled with people who come from fairly nice backgrounds. If you are one of the exceptions, life can look exceptionally gloomy.
7. The hand-waving to mental health services. Sure, the resources are available, but no one in the school truly gives AF. Luckily, I have a great support system, but many of my friends do not and I feel like they are just left in the breeze (however, many students are also afraid of being stigmatized).
 
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Because medical school is a giant pressure cooker, and when you take the highest achieving people from college and put them in a room, 50% of them come out below the average and very few actually feel they are achieving the grades they want. In a couple words, disappointment and dissatisfaction.

Years 1 and 2 are pretty boring , year 3 is dealing with some difficult personalities and always shuffling around, year 4 is full of audition/interview/matching stress. And all is done under extreme financial constraints .

5 weeks until I finish and it has been worth the hassle.
 
Thanks for all of the great responses! can someone explain to me the isolation thing? Is it because most med students are introverts who don't go out? Because everyone is too busy studying to socialize? I'd assume if you're all "in it together" there would be some natural bonding that occurs.
 
JermanH said:
Thanks for all of the great responses! can someone explain to me the isolation thing? Is it because most med students are introverts who don't go out? Because everyone is too busy studying to socialize? I'd assume if you're all "in it together" there would be some natural bonding that occurs.
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It's because you can't properly study while properly socializing (at least I can't). And everyone is under so much stress, you just learn to keep your distance from poor/malignant attitudes.
 
JermanH said:
I'm just curious about some of the reasons why medical students develop depression in medical school. Is it because of the rigor of the courses? Isolation? It seems like a large-ish percent of medical students do. Anyone care to share their experiences?
Click to expand...
FYI:
The learning environment and medical student burnout: a multicentre study. - PubMed - NCBI

Personal life events and medical student burnout: a multicenter study. - PubMed - NCBI

Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. - PubMed - NCBI

Relationship of pass/fail grading and curriculum structure with well-being among preclinical medical students: a multi-institutional study. - PubMed - NCBI

Relationships between medical student burnout, empathy, and professionalism climate. - PubMed - NCBI

Web-Based Tools and Mobile Applications To Mitigate Burnout, Depression, and Suicidality Among Healthcare Students and Professionals: a Systematic ... - PubMed - NCBI

Self-care as a professional imperative: physician burnout, depression, and suicide. - PubMed - NCBI
 
JermanH said:
I'm just curious about some of the reasons why medical students develop depression in medical school. Is it because of the rigor of the courses? Isolation? It seems like a large-ish percent of medical students do. Anyone care to share their experiences?
Click to expand...
Step 2 CS.
 
JermanH said:
Thanks for all of the great responses! can someone explain to me the isolation thing? Is it because most med students are introverts who don't go out? Because everyone is too busy studying to socialize? I'd assume if you're all "in it together" there would be some natural bonding that occurs.
Click to expand...
I will admit to being isolated from some of my classmates. I am first generation college student from blue-collar family. My classmates are nothing like me. I found it necessary to look outside of school for dates.
Also, it is hard to learn resilience when you have never struggled. Med school is hard, but some of us have never been challenged academically.
 
JermanH said:
I'm just curious about some of the reasons why medical students develop depression in medical school. Is it because of the rigor of the courses? Isolation? It seems like a large-ish percent of medical students do. Anyone care to share their experiences?
Click to expand...
Here is my take on this
1. Very high expectations. You are quite literally drinking material from a fire hose. In M3/M4, you may have crazy hours-preceptors who make you stay late just to do scutwork-and then don't have enough time to study. You'll be stressed over if you can do well or not.
2. schools making it increasingly difficult to get good grades. My school revamped how M3 grading is done. WAY few people now are getting Honors (and even before that not many people did)
3. Gunners. There are people who rub in your face how good they are, how much better they are than you. When you are slogging day and night and then deal with this...it is rough. People can be fake. It's hard to know whom to trust.
4. Abusive preceptors. They can be very verbally abusive sometimes, making students cry. They take out their frustration on students. In one department, it got so bad, the school had to get involved.
5. Isolation is a big part of it. Everyone else your age is moving on in life. Having fun, building families etc. Not impossible in med school but much harder.
I used to be so happy and motivated. But the combination of the factors above have made me really upset, and I'm having a hard time imagining a day when I as a doctor will be respected by superiors, treated like an actual person etc
 
ciestar said:
I feel very alone.

I have severe testing anxiety that developed after I started school. I don’t do well on exams, have chronic anxiety and live with the thought everyday I am going to fail out, or do horrible on my boards and be stuck forever in debt with no future. This leads to a lot of self doubt and then I panic, which leads to burn out. It is terrible.

I have external family issues that never seem to stop that doesn’t help. I see my personal psychiatrist monthly.
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I know this is an old thread but I feel exactly this way too. I’m a P1 (podiatry), finished my first semester and on vacation now, but I find myself crying at night and even during the day sometimes. Of course my family doesn’t know what’s going on, and I also can’t tell them (we don’t operate that way unfortunately). I used to be a top student in undergrad and now I’m in the bottom 25%. That ****ed me up a lot, my confidence levels are super low. I think I’ll probably fail out in my second year or worse, fail my boards. I am literally thinking about not going back to school and just stay with my family but that can’t happen.
 
xoxo111 said:
I know this is an old thread but I feel exactly this way too. I’m a P1 (podiatry), finished my first semester and on vacation now, but I find myself crying at night and even during the day sometimes. Of course my family doesn’t know what’s going on, and I also can’t tell them (we don’t operate that way unfortunately). I used to be a top student in undergrad and now I’m in the bottom 25%. That ****ed me up a lot, my confidence levels are super low. I think I’ll probably fail out in my second year or worse, fail my boards. I am literally thinking about not going back to school and just stay with my family but that can’t happen.
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you won't fail. being in the top 25% is fine but if you want to improve your academic performance experiment with other study methods that's what helped me. i felt like i was doing terribly the entire time but wasn't lol. dont give up on your dream and maybe start counseling that helps.
 
iamarosepetal said:
Dealing with abusive preceptor in my last rotation...it's insane.
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Crazy how an experience like that can make or break a rotation.
We as students, never hurt anyone. I don't get why some preceptors think they can abuse us
 
Because we're given a 50 minute lecture consisting of 76 slides of extremely dense, complex biochemistry pathway at which the professor wildly gestures and states "you should memorize this slide" before moving onto the next with no actual discussion of the material. This is then immediately followed by several questions requiring high-level synthesis of this material that we were "taught" (read: material that was gestured at), during which the professor states in a very annoyed tone "this is easy, you shouldn't have any problem answering."

I'll also second what someone said above about all the minutia the school requires that really adds up to eat huge portions of your time. "Only 4 hours of required activities a day, everyone! Also, we need you to sign up for a 3 hour physical exam skills session. Don't forget you need to sign up for a mandatory 1 hour meeting with your adviser. Plus, there's a 1 hour mandatory session about how to get involved in research. By the way, you have 2 hours of pre-reading before your small group session tomorrow at 8 AM. Please don't forget that you have 55 structures on the anatomy hitlist to memorize this week. And we finally sent out the list of possible anatomy questions for the written final - it's 27 pages long, so you should make sure you start memorizing those ASAP. There's also the 6 hours of research we need you to do for your small group sessions every week. Remember to do your weekly essays and reconcile your answers from last week's essays." I can keep going, but that seems sufficient to get the point across.

Tl;dr: terrible lectures, too much info, too little time, condescending faculty, everyone demanding that we prioritize their portion of the curriculum despite the 10001 other demands on our time.
 
Sagebrush said:
Because we're given a 50 minute lecture consisting of 76 slides of extremely dense, complex biochemistry pathway at which the professor wildly gestures and states "you should memorize this slide" before moving onto the next with no actual discussion of the material. This is then immediately followed by several questions requiring high-level synthesis of this material that we were "taught" (read: material that was gestured at), during which the professor states in a very annoyed tone "this is easy, you shouldn't have any problem answering."

I'll also second what someone said above about all the minutia the school requires that really adds up to eat huge portions of your time. "Only 4 hours of required activities a day, everyone! Also, we need you to sign up for a 3 hour physical exam skills session. Don't forget you need to sign up for a mandatory 1 hour meeting with your adviser. Plus, there's a 1 hour mandatory session about how to get involved in research. By the way, you have 2 hours of pre-reading before your small group session tomorrow at 8 AM. Please don't forget that you have 55 structures on the anatomy hitlist to memorize this week. And we finally sent out the list of possible anatomy questions for the written final - it's 27 pages long, so you should make sure you start memorizing those ASAP. There's also the 6 hours of research we need you to do for your small group sessions every week. Remember to do your weekly essays and reconcile your answers from last week's essays." I can keep going, but that seems sufficient to get the point across.

Tl;dr: terrible lectures, too much info, too little time, condescending faculty, everyone demanding that we prioritize their portion of the curriculum despite the 10001 other demands on our time.
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Wow. Bravo. This is it^. Not sure if youre an M1 or an M2 but M2 absolutely blows when it comes to having all your time eaten up. We barely have time to breathe lol. I guess M4 and attending life is what we have to look forward to. I need something to look forward to and I hope I didnt cue all the negative comments about attending life and M4 sucking I really dont need to hear that too. Regardless, I still cant picture myself doing anything else anyway I just think medical education in regards to burnout and mental health needs a little work
 
Sagebrush said:
Because we're given a 50 minute lecture consisting of 76 slides of extremely dense, complex biochemistry pathway at which the professor wildly gestures and states "you should memorize this slide" before moving onto the next with no actual discussion of the material. This is then immediately followed by several questions requiring high-level synthesis of this material that we were "taught" (read: material that was gestured at), during which the professor states in a very annoyed tone "this is easy, you shouldn't have any problem answering."

I'll also second what someone said above about all the minutia the school requires that really adds up to eat huge portions of your time. "Only 4 hours of required activities a day, everyone! Also, we need you to sign up for a 3 hour physical exam skills session. Don't forget you need to sign up for a mandatory 1 hour meeting with your adviser. Plus, there's a 1 hour mandatory session about how to get involved in research. By the way, you have 2 hours of pre-reading before your small group session tomorrow at 8 AM. Please don't forget that you have 55 structures on the anatomy hitlist to memorize this week. And we finally sent out the list of possible anatomy questions for the written final - it's 27 pages long, so you should make sure you start memorizing those ASAP. There's also the 6 hours of research we need you to do for your small group sessions every week. Remember to do your weekly essays and reconcile your answers from last week's essays." I can keep going, but that seems sufficient to get the point across.

Tl;dr: terrible lectures, too much info, too little time, condescending faculty, everyone demanding that we prioritize their portion of the curriculum despite the 10001 other demands on our time.
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1.) at least you had mentors to set meetings up with
2.) at least you had research in house to need an introduction for
Annddd 3.) WTF, you had to write essays in medical school? I think developing my PS was all we had
 
DO2015CA said:
1.) at least you had mentors to set meetings up with
2.) at least you had research in house to need an introduction for
Annddd 3.) WTF, you had to write essays in medical school? I think developing my PS was all we had
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You beautifully (if unintentionally) demonstrated exactly what @curbsideconsult discussed as a major contributor to medical student depression rates. provided an excellent example of another major factor contributing to medical student depression rates. (See the paragraph on "Keeping up appearances", particularly the portion about non-medical friends/family members).
 
Beck’s triad of depression.

Wrong perception of yourself, wrong perception of other people’s perception of you, leads to wrong perception of your future.

Basically all wrong perceptions. Wrong, wrong, and wrong; starting from that wrong perception of yourself.

Wrong expectation leads to disappointment in life.

Someone trained, and empathetic, can be very “Ordinary People” like to help you see it.

“May be you are stronger than you think.”
 
iamarosepetal said:
you won't fail. being in the top 25% is fine but if you want to improve your academic performance experiment with other study methods that's what helped me. i felt like i was doing terribly the entire time but wasn't lol. dont give up on your dream and maybe start counseling that helps.
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im in the bottom 25% not top...
 
Let‘s see how this “I am in bottom 25%” fits into that Aaron Beck’s triad.

I am at bottom 25%, therefore, therefore.......
 
xoxo111 said:
im in the bottom 25% not top...
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I think i'm like in the 25.6th percentile for my class. lol. But I'm pretty much classified as a ***** in the eyes of all the academic/GME advisors at our school. If you don't suck up, score >650 on comlex, >120s on COMATs, and did i mention suck up - you are told to just apply to FM.

No thanks, my righting relfex is too strong for that. I'm applying to whatever i feel like.
 
xoxo111 said:
im in the bottom 25% not top...
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sorry i meant bottom 25% as i was super frazzled this week! even if you're in the bottom 25%, you're still passing. graduate programs are notoriously difficult!
you're still not the bottom - try figuring out different study methods and one will work for you. happened to me too. realized i learned best a certain way and i've been doing better academically on exams since 🙂 now i wish i did this in undergrad lol
 
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Noisewater-TDX said:
I think i'm like in the 25.6th percentile for my class. lol. But I'm pretty much classified as a ***** in the eyes of all the academic/GME advisors at our school. If you don't suck up, score >650 on comlex, >120s on COMATs, and did i mention suck up - you are told to just apply to FM.

No thanks, my righting relfex is too strong for that. I'm applying to whatever i feel like.
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Q: What do they call the kid who graduates at the bottom of his/her medical school class?
A: Doctor.
 
Goro said:
Q: What do they call the kid who graduates at the bottom of his/her medical school class?
A: Doctor.
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Very true. But the amount of pressure and negativity that the lower 25%tile or 50%tile get from administration adds to the overall stress/depression that the OP was asking about. And heaven forbid you apply to anything other than Rural FM in BFE, Yukon.
 
Noisewater-TDX said:
Very true. But the amount of pressure and negativity that the lower 25%tile or 50%tile get from administration adds to the overall stress/depression that the OP was asking about. And heaven forbid you apply to anything other than Rural FM in BFE, Yukon.
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Glad my school doesn’t put rankings on mspe (or so we’re told).
 
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