Research suggests that physicians have suicidal thoughts at about twice the rate of the general population (7.2% vs 4%). Now, as they bear the weight of a multiyear pandemic alongside the perpetual struggle to maintain some semblance of work-life balance, their resiliency has been stretched to the brink.
This year, the Medscape Physician Suicide Report surveyed more than 13,000 physicians in 29 specialties who were candid about their experiences with suicidal thoughts, how they support their besieged colleagues, and their go-to coping strategies.
Overall, 21% of physicians reported having feelings of depression. Of those, 24% had clinical depression and 64% had colloquial depression. Physicians who felt sad or blue decreased slightly compared with last year's report, but the number of physicians experiencing severe depression rose 4%.
One in ten physicians said they have thought about or attempted suicide. However, the number of physicians with suicidal thoughts dropped to 9%, down substantially from the 22% who reported similar feelings in 2020.
Still, there was a slight uptick in women physicians contemplating suicide, likely linked to their larger share of childcare and family responsibilities.
"They have needed to pull double duty even more than usual, and that may have increased their sense of burnout and vulnerability to suicidal thoughts," says Andrea Giedinghagen, MD, assistant professor in the Department of Psychiatry at Washington University School of Medicine, St. Louis, Missouri, and co-author of "Physician Suicide: A Call to Action."
Fighting the Stigma of Seeking Mental Health Help
Although the number of physicians attempting, but not completing suicide, has remained steady at 1% for several years, the recent passage of the Dr. Lorna Breen Health Care Provider Protection Act by Congress aims to drive that figure even lower. Breen, an emergency room physician at NewYork-Presbyterian Hospital, died by suicide in April 2020. Overwhelmed by the onslaught of COVID patients, Breen was reluctant to seek mental health services for fear of being ostracized.
"Many physicians don't seek mental health care due to fear of negative consequences in the workplace, including retribution, exclusion, loss of license, or even their job," Gary Price, MD, president of The Physicians Foundation, told Medscape Medical News. "This was the experience of Dr Lorna Breen. She was convinced that if she talked to a professional, she would lose her medical license. Perhaps if Dr Breen was equipped with the accurate information — there is no mental health reporting requirement in her state's medical license application — it might have saved her life."
This same stigma was reflected in the survey, with one physician saying, "I'm afraid that if I spoke to a therapist, I'd have to report receiving psychiatric treatment to credentialing or licensing boards." Roughly 40% of survey respondents, regardless of age, chose not to disclose their suicidal thoughts to anyone, not even a family member or suicide hotline. And just a tiny portion of physicians (10% of men and 13% of women) said that a colleague had discussed their suicidal thoughts with them.
"[T]here is a long-standing culture of silence around physician mental health in the medical community," says Price. "The strategies within the Act are critical to fixing this culture and making it acceptable and normalized for physicians to seek mental health care," and for it to "become a fundamental and ongoing element of being a practicing physician."
As part of the legislation, the US Department of Health & Human Services must award grants to hospitals, medical associations, and other entities to facilitate mental health programs for providers. They must also establish policy recommendations and conduct campaigns to:
Improve providers' mental and behavioral health
Encourage providers to seek mental health support and assistance
Remove barriers to such treatment
Identify best practices to prevent suicide and promote resiliency
Addressing Barriers to Mental Health
The new bill is a step in the right direction, but Price says health organizations must do more to address the six key structural barriers that are "discouraging physicians from seeking [mental health] help," such as the inclusion of "intrusive mental health questions on medical board, hospital credentialing, and malpractice insurance applications."
In addition, employers should allow physicians to seek out-of-network mental health services, if necessary, and not cause further humiliation by requiring them to be treated by colleagues within their hospital system. A similar proposal has recently been introduced and is gaining traction in Utah, following the suicide of emergency room physician Scott Jolley, MD, in 2021 after he was admitted for psychiatric care where he worked.
Diminishing the stigma surrounding physicians' mental health encourages a more open dialogue, so if a colleague reaches out — listen. "Start by thanking the colleague for sharing the information: 'I'm sure that wasn't easy but I appreciate that you respect me enough to share this. Let's talk more,'" says Michael F. Myers, MD, professor of clinical psychiatry at SUNY Downstate Health Sciences University in Brooklyn, New York. "Then ask what you can do to help, which cuts down on the sense of isolation that colleague may feel."
According to the survey, many physicians have developed strategies to support their happiness and mental health. Although fewer than 10% said reducing work hours or transitioning to a part-time schedule was most effective, the majority of physicians relied on spending time with family and friends (68%) — a choice that has considerable benefits.
"Close and intimate relationships are the single most protective factor for our mental health," says Peter Yellowlees, MBBS, MD, chief wellness officer for UC Davis Health and professor of psychiatry at the University of California, Davis. "Isolation and loneliness are very important stressors, and we know that about 25% of the population reports being lonely."
Steph Weber is a Midwest-based freelance journalist specializing in healthcare and law.
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Cite this: Depression, Suicidal Ideation Continue to Plague Physicians: Survey - Medscape - Mar 04, 2022.