While premeds are known for often having the blues, it doesn’t look like they have much to look forward to.

Three-fourths of the residents experienced burn out and one fifth experienced depression, according to a study conducted by researchers at Harvard Medical School. Worse yet, those who were depressed were six times more likely to make mistakes in placing medical orders.

“A key piece of information is that everybody who was depressed was also burned out, whereas the reverse is not true,” said Amy M. Fahrenkopf, a pediatrician at Children’s Hospital Boston and the lead author of the study. “Residency does lead to the state of being burned out and for some people, that’s a trigger that leads to depression.”

“There is something wrong with a system that produces a 20 percent depression rate,” she added.

Fahrenkopf—who examined groups of pediatric residents at three different children’s hospitals from around the country—said she suspects that poor treatment of residents on the job may be to blame for the high rate of burn out.

In addition to the long hours and sleep deprivation that is usually associated with medical residencies, Fahrenkopf said that residents “don’t have much autonomy, will spend very little time with patients, and will do a lot more secretarial labor.”

Most of the depressed residents in the study had no history of depression and were unaware of their condition.

Residents’ expectations that they will be miserable may be responsible for the undiagnosed depression, according to Fahrenkopf, since they do not often notice when they or their peers cross the line between simple unhappiness and clinical depression.

Fahrenkopf said this not only explains why early screening is ineffective, but also the fallacy in the current treatment system, which relies on physicians voluntarily choosing to speak with a psychiatrist.

She said that hospitals should reevaluate how they treat their residents, but in the meantime should be more diligent with screening residents for depression.

Her advice for premeds is simple: find a residency that will take care of you.

“Each place is going to be different,” Fahrenkopf said. “Picking up on the residents who are there on levels of unhappiness is important.”

—Staff writer Maeve T. Wang can be reached at mtwang@fas.harvard.edu.