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Physician-Training Stress and Accelerated Cellular Aging

  • Kathryn K. Ridout
    Affiliations
    Department of Psychiatry, Kaiser Permanente, San Jose, California

    Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
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  • Samuel J. Ridout
    Affiliations
    Department of Psychiatry, Kaiser Permanente, San Jose, California
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  • Constance Guille
    Affiliations
    Brain Research and Integrative Neuropsychopharmacology Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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  • Douglas A. Mata
    Affiliations
    Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

    Brigham Education Institute, Boston, Massachusetts
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  • Huda Akil
    Affiliations
    Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, Michigan

    Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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  • Srijan Sen
    Correspondence
    Address correspondence to Srijan Sen, M.D., Ph.D., 1066 Molecular and Behavioral Neuroscience Institute, 205 Zina Pitcher Place, Ann Arbor, MI 48109.
    Affiliations
    Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, Michigan

    Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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      Abstract

      Background

      Stress is a key precipitant for many common diseases, but established biological markers to track stress and guide investigations into mechanisms linking stress and disease are lacking. Cross-sectional studies have identified correlations between stress and telomere attrition, but no large, longitudinal studies examining the impacts of chronic stress on telomere length exist. Residency training for physicians is a well-established stressful experience and can be used as a prospective stress model.

      Methods

      In a longitudinal cohort study of 250 interns (first-year residents) at 55 United States hospital systems serving during the 2015–2016 academic year, we examined associations between measures of the residency experience and saliva-measured telomere attrition.

      Results

      Telomere length shortened significantly over the course of internship year, from mean ± SD of 6465.1 ± 876.8 base pairs before internship to 6321.5 ± 630.6 base pairs at the end of internship (t246 = 2.69; p = .008). Stressful early family environments and neuroticism were significantly associated with shorter preinternship telomere length. Longer work hours were associated with greater telomere intern telomere loss over the year (p = .002). Of note, the mean telomere attrition during internship year was six times greater than the typical annual attrition rate identified in a recent meta-analysis.

      Conclusions

      This work implicates telomere attrition as a biologically measurable consequence of physician training, with the magnitude of attrition associated with workload. Identification of an objective, biological sequela of residency stress may help to facilitate the development of effective interventions. Further, the findings implicate telomere attrition as an objective biomarker to follow the pathologic effects of stress, in general.

      Keywords

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      Linked Article

      • Telomeres, Trauma, and Training
        Biological PsychiatryVol. 86Issue 9
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          There was no glamour in this. My first patient of the New Year was a 5-year-old found in a clothes dryer, face bloodied. She had been hit by her pregnant mother, hit over and over with a bludgeon of pantyhose stuffed with shards of broken glass. How could I survive? —Samuel Shem, The House of God
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