Which factors contribute to undiagnosed depression and physician suicide?

Updated: Aug 01, 2018
  • Author: Louise B Andrew, MD, JD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Depressed physicians who do reach out may find that they receive only limited understanding or sympathy from colleagues. There is no specialized training for a physician's physician (as there is, for example, for the pope's confessor). Most physicians either shrink from this role or perform it poorly.

For many experiencing depression, the early symptoms are physical. A physician unable to diagnose his or her own symptoms commonly feels incompetent. To admit one’s inability to diagnose oneself to another colleague is to admit failure. When this admission is met with avoidance, disbelief, or derision by a reluctant treating physician, it can only reinforce a depressed physician’s feelings of worthlessness and hopelessness.

Physicians find it painful to share their experience of mental illness with others and know that doing so is somewhat risky; therefore, published accounts of physician depression are very difficult to find. However, recent highly publicized cases of resident and physician suicides and subsequent sharing of experiences of depression by physicians [28] suggest that either the incidence of depression is rising, or we are beginning to be more able to admit and to address the immensity of the problem. 

Marriage is in most populations considered to be an effective buffer to emotional distress. This does not seem to be true for women physicians. [23]  It is believed that physician divorces are less frequent compared to the general population, but marital problems are common, perhaps in part because of the tendency of physicians to postpone addressing marital problems and to avoid conflict in general. [29] Marital problems, separation, or divorce can certainly contribute to depressive symptoms, which can increase the likelihood of suicidality if unaddressed.

Physicians are a "high control" population (along with law enforcement, lawyers, and clergy), and situations that decrease physicians' ability to control their environment, workplace, or employment conditions predictably play a higher role in physician suicide than they do in lower control populations. [23]  The massive changes that have taken place in medicine in the past several decades, leading to increased workloads and regulatory requirements coupled with decreased ability to control income and patient safety and liability concerns also predictably lead to higher levels of stress, job dissatisfaction, burnout, and depression in physicians. 

Litigation-related stress can precipitate depression and, occasionally, suicide. [30, 31] The suicide note of a Texas emergency physician, written the day after he settled a malpractice case, read, “I hope that my death will shed light on the problem of dishonest expert testimony.” [32] Some physicians have completed suicide upon first receipt of malpractice claims, after judgments against them in court, or after financially motivated settlements foisted upon them by a malpractice insurer solely in order to cut the insurer’s losses. Any settlement in a malpractice case is by law reported to the National Practitioner Data Bank, which is yet another source of distress and stigma that can contribute to depression. 

Other physicians have attempted or completed suicide in response to employment discrimination relating to judgments or settlements or upon the realization that they are no longer able to practice because of discrimination by liability insurers who refuse to insure them because of past judgments or settlements or because of regulatory licensure investigations or limitations or databank reporting, [33, 34]  or in the setting of forced hospitalization or treatment for chemical dependency when a dual diagnosis has not been justified under medically accepted standards. [35]

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