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Physician suicide and depression: Helping doctors heal themselves

Raising awareness among physicians about their own risk of suffering depression may lead to improved care of patients.

Editorial. July 28, 2003.

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As early as 1858, English physicians observed that members of their profession had a higher suicide rate than that of the general population.

So notes a recent article in the Journal of the American Medical Association that addresses this disturbing professional reality in the present day. Research confirms that physicians as a group -- especially female physicians -- have an elevated suicide risk.

The link between major depression and suicide is well known. This connection, both in terms of its effect on those who practice medicine and the implications it has for patients, led experts to hold a consensus workshop last October in Philadelphia.

The meeting, sponsored by the American Foundation for Suicide Prevention, resulted in recommendations to treat this longstanding ailment. A consensus statement was published in the June 18 JAMA. The take-home message: Attention to physician depression and the prevention of physician suicide is long overdue.

"The culture of medicine accords low priority to physician mental health," wrote workshop participants. They recommended "transforming professional attitudes and changing institutional policies to encourage physicians to seek help."

It's an effort that tracks closely with the work of the AMA, where an ongoing physician health program has increasingly emphasized issues of wellness and well-being, rather than punitive approaches to impairment. One of its most visible aspects is the regularly held conference on physician health, which explores factors that can lead to depression and other serious problems for doctors.

Policies also focus on reducing the incidence of physician suicide -- beginning at the medical school level. But it doesn't stop there.

The AMA also urges state and county medical societies, specialty societies and hospitals to be alert to psychiatric problems of troubled colleagues and to ensure early intervention. Efforts should be intensified to overcome stigma that can hinder a rehabilitated doctor's attempts to make a comeback.

Moving toward these goals will trigger positive outcomes on two levels. The problem is not just that physicians neglect to seek help for themselves. They also do not always do well for their patients.

About 16% of adults will have major depression at some time in their lives, according to another study published in the same issue of JAMA. But while many more Americans are being treated for depression, only 22% of those who receive care are treated adequately, the researchers concluded. Thus, raising physicians' awareness of their own depression and suicide risks may improve their abilities to help others.

The consensus workshop offered a number of steps toward this endpoint.

First, physicians should establish regular sources of personal health care and seek help for mood disorders, substance abuse or suicidality. This point may seem simple, but it's not. The group's data indicate that 35% of physicians do not have their own medical home. These doctors are less likely to use preventive medical and mental health services. This reticence is attributed to attitudes in medicine that make it difficult for doctors to accept their own health vulnerabilities -- a part of medicine's culture the panel hoped would change.

The statement also encouraged physicians, even those in training, to become more aware of the burden of depression within their profession and society. Physicians also should become informed about state and federal protections for confidentiality of medical records in the event they ever need to seek help.

Broader systemic and cultural pressures are involved, too, and more research is needed on topics such as physician risk and protective factors and the roles that gender, ethnicity and specialty play.

Obviously, issues related to physician mental health are complex -- operating on both personal and professional levels. But it's been 150 years since the initial diagnosis was made regarding physicians' increased suicide rate. No more time should pass without taking serious steps to combat the problem.

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