Beyond Burnout: Physician Depression and Suicide

 

 

“We masquerade as strong and untroubled professionals even in our darkest and most self-doubting moments. How, then, are we supposed to identify colleagues in trouble - or admit that we may need help ourselves?”                                                     -Pranay Sinha, MD

 

 

 
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Frightening Statistics

  • Each year approximately 400 physicians commit suicide. That is more than one per day and roughly the equivalent of two entire classes of graduating medical students.

  • When screened, approximately 10% of medical students, resident and physicians report current suicidal thoughts.

  • Suicide accounts for 26% of deaths among physicians aged 25-39. This is more than twice (11%) that of same age group in the general public.

  • Male physicians have a 40% increased risk of suicide compared to non-physician counterparts.

  • Female physicians have a 130% increased risk of suicide compared to non-physician counterparts.

 

Depression is not the Same as Burnout

Burnout is defined in many ways but it generally encompasses emotional exhaustion, depersonalization, and a sense of decreased personal accomplishment. Burnout is more directly related to your professional environment.  While burnout is a risk factor for depression and suicide, they are not the same. Depression is a medical condition with specific set of diagnostic criteria.

 

Potential Reasons Why Physicians Have an Increased Risk of Depression and Suicide

  • Physicians are much less likely to seek treatment for mental health conditions.  Treatment for depression and other conditions has been shown to be protective against suicide.
  • A stigma of mental health persists even with physicians.
  • State medical boards and hospital credentialing forms ask about mental health treatment and physicians fear that reporting this could jeopardize careers. 
  • Physicians have access and knowledge of medications and other lethal techniques.
  • Increased rates for female physicians may be due to increased work-family conflicts (more time on domestic tasks, higher rates of divorce, etc) and gender bias in medicine (pay differential, less career advancement).
 

How do We Help Our Colleagues?

  • Take care of each other - reach out to people who are struggling.
  • Be a vocal advocate to combat stigma about mental health.
  • Do not participate in shaming of people with mental health conditions.
  • Advocate for change to medical board licensing criteria.
 

Tired if reading? watch Dr. Macvane discuss Physician depression and suicide

 

 

References & Further Reading/Listening

1.  Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed February 15, 2018.  www.cdc.gov/injury/wisqars

2.  EMRAP: Suicide Risk in Physicians. August 2017.

3.  Guille C et al. Work-Family Conflict and the Sex Difference in Depression Among Training Physicians. JAMA Intern Med. 2017;177(12):1766–1772. [Pubmed]

4.  Hill A. Breaking the Stigma- a Physician’s Perspective on Self-Care and Recovery. New England Journal of Medicine 376; 12, 2017.

5.  Jolly S et al. (2014). Gender Differences in Time Spent on Parenting and Domestic Responsibilities by High-Achieving Young Physician-Researchers. Annals of Internal Medicine, 160(5), 344–353.[Pubmed]

6.  Khullar D. Being a Doctor is Hard. It’s Harder for Women. NY Times, December 7, 2017.

7.  Muller D. Kathryn. New England Journal of Medicine 376; 12, 2017.

8.  Schernhammer, ES., Dolditwz, GA. “Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis). American Journal of Psychiatry. 161 (12). December 2004.[Pubmed]

9.  Sinha P. Why do Doctors Commit Suicide? The New York Times. September 4, 2014.

10.  Sowa McPartland A. Suicide and the Yong Physician. The Atlantic, September 2014.

11.  Lindeman S et al.  A systematic review on gender-specific suicide mortality in medical doctors.  Br J Psychiatry. 1996 Mar;168(3):274-9. [Pubmed]