The portrait of Kevin Dietl that hangs in the home of his parents, Michele and John Dietl. Kevin's parents testified in favor of a bill that would bring awareness to the suicide and depression issue plaguing medical students across the country. (Photo: KRCG)

Missouri could be the first state to address what experts call the depression and suicide epidemic in the medical field.

Representative Keith Frederick (R-Rolla) filed House Bill 1658 in December. The bill, also known as the Show-Me Compassionate Medical Education Act would establish a committee to study mental illness, suicide and depression in the state's six medical schools. The bill would also prohibit any medical school from restricting a study on the mental health of its students.

The Missouri House of Representatives passed the bill Thursday. It is the first bill of its kind, not just in the state, but in the country.

"[Medical students] have unique risk factors that put them at a higher risk than the general population for suicide," said Frederick, who is also a practicing physician in Rolla.

Frederick said there are many obstacles in the way of students getting help. If a medical students wants to seek mental health treatment or care, it could deter them from getting a job.

"To apply for a residency, to get your license to practice, to prescribe medication, to participate with a health care program, to get hospital privileges, they all ask you about your mental health history. And that can be a red flag for the progress of their career," said Frederick.

Aside from medical students being discouraged to seek mental healthcare, experts on the topic say suicide and depression among medical students isn't being tracked.

The Association of American Medical Colleges confirmed to KRCG13 medical schools are not required to report student suicides to external sources, though it may be recorded internally by the school as a death. The Missouri Medical Association confirmed medical schools in Missouri do not report student suicides to any agency or organization.

"We haven't been measuring it because we haven't valued it enough to measure it," said Frederick. "Without data you just have an opinion like everybody else."

Frederick filed a similar bill last legislative session, House Bill 867, but it was filibustered in the Senate. While lawmakers debated the legislation, Frederick said the deans from each of the state's medical schools sent him a joint letter expressing opposition to his proposed law.

"I think they're scared to that they'll find the alarming rates of depression and anxiety like Saint Louis University did," said Frederick.

KRCG13 reached out to the University of Missouri School of Medicine for comment on this story. School leaders were not available for interview, but the school released a statement:

"Like our counterparts across the country, leaders of the MU School of Medicine recognize the dangers of high levels of stress and depression among medical students. That is why we have many robust programs, processes and curricula in place to help MU medical students manage stress.

These include a pass/fail curriculum for first-year medical students; a patient-based learning environment that facilitates peer interaction, teamwork and student-faculty contact; stress-management as part of medical students' required curriculum; required educational sessions about management of stress, anxiety and depression; a wellness program and student wellness committee; and confidential assessment and treatment resources for medical students. In keeping with our commitment to support our medical students and help them reduce stress, anxiety and depression, the MU School of Medicine supports HB 1658."

"Frankly, our students seemed fine and quite happy," said Dr. Stuart Slavin, a medical professor at Saint Louis University's School of Medicine.

Seven years ago, Slavin decided to give medical students depression and anxiety surveys. He said the results devastated him.

"Our school didn't look worse than other schools, but it looked like everyone else; very high rates of depression, very high rates of anxiety. At that point we said, that's not okay."

As a result, SLU School of Medicine changed its curriculum to fit the mental health needs of its students. Slavin said students have more elective time and mental health professionals available for students without any ramifications. Students receive the survey several times a year.

Slavin says in 2009, the year he started administering depression and anxiety surveys, 30% of students reported moderate to severe the depression and 60% had moderate to severe anxiety.

After seven years of altering curriculum, in the most recent survey given to students, Slavin says 4% reported moderate to severe depression and 14% reported moderate to severe anxiety.

Slavin says he feels lucky in the eleven years he's taught at SLU, no medical students have died by suicide.

"I think we as medical educators have a moral obligation to be concerned about these issues, the mental health outcome when they're in this place and when we leave this place," said Slavin.

Experts say there are many factors that lead to medical student suicide and depression including the large amount of material they're expected to master and the financial cost of getting a medical education. "They're used to setting the curve and being the best and the brightest in their school, but then they enter med school.. Professors tell them half are going to be below average, and that's a shock to them," said Frederick.

"Third year was when it hit Kevin really hard," said John Dietl, Kevin's father. "He just felt like he wasn't as smart as the others, he felt having to take his Boards [exams] and things like that we're getting very intense."

Kevin Dietl studied at the A.T. Still College of Osteopathic Medicine. On a Facebook page created in his memory, friends write about how kind and caring he was.

"Kevin was the life of the party. He was interested in everybody and everything," said Kevin's mother, Michele Dietl.

"He was rated top notch, excellent in all of his rotations, they all commented on his demeanor, his bedside manner and his ability to diagnose and get to the source of a problem... He was on his way to helping so many people."

John and Michele said Kevin's depression developed gradually. They said Kevin started losing his hair, he started withdrawing.

"He said 'Mom, everyone's depressed, my whole class is depressed," said Michele.

While Kevin struggled with depression, his parents said he was afraid to ask for help, afraid to seek treatment, afraid to tell the truth for fear of a black mark on his record.

Ten days before Kevin's medical school graduation, John found him in the family's garage, dead, with a shotgun wound to the head.

"The emotions... I just really can't explain it," John said. "You get sort of a feeling of relief, if that makes sense, because he's not suffering. But then it strikes you how horrible this is."

The Dietls testified in favor of House Bill 1658 in front of a committee in January.

"We have his white coat, we have his diploma, we have a proclamation signed by the speaker of the house, but all of it means nothing," said Michele. "We don't have our son. He didn't deserve this, nobody does."