Doctors shun the help that could cut suicide risk
■ Concerns about stigma, confidentiality and professional repercussions often dissuade them from seeking help.
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Physicians with mental illness are at a higher risk of committing suicide than nonphysicians, says a study published online Nov. 5 in General Hospital Psychiatry.
Compounding the problem is the fact that many physicians fail to seek treatment for their illness.
“In general, doctors have lower rates of primary health care, but that's particularly true for mental health,” said Katherine J. Gold, MD, MSW, lead study author and assistant professor in the Dept. of Family Medicine and Dept. of Obstetrics and Gynecology at the University of Michigan Medical School.
“We are in a profession that expects perfection,” Dr. Gold said.
Researchers evaluated 2003-08 data from the Centers for Disease Control and Prevention's National Violent Death Reporting System on 31,636 adult suicide victims in 17 states. The 203 physicians in the study were more likely than nonphysicians to have a known mental health disorder or to have experienced recent job-related stress.
Physicians also were more likely to have antipsychotics, benzodiazepines and barbiturates in their toxicology testing. Compared with other suicide victims, however, doctors were less likely to have a known alcohol or substance abuse problem — 14% compared with 23% for nonphysicians.
The findings are consistent with previous research, said Warren Pendergast, MD, president of the Federation of State Physician Health Programs. Studies have shown that suicide rates are higher for physicians than the general population, but the new study highlights how risk factors for suicide are different for doctors, he said.
Because physician suicide rates have been shown to be high, it was surprising that physicians made up less than 1% of the suicide victims who were studied, said Charlene Dewey, MD, MEd, associate professor of medical education and administration and co-director of the Center for Professional Health at Vanderbilt University School of Medicine in Tennessee.
“That seems like a low number compared to what we usually find,” Dr. Dewey said.
Barriers to getting help
Physicians may resist seeking mental health treatment for a variety of reasons, Dr. Gold said. They may believe getting help could harm them professionally, or they have limited access to mental health professionals beyond their medical community. They may be in denial or concerned about the stigma associated with mental illness, she said.
Doctors often are hesitant to seek care because they are concerned about confidentiality, Dr. Dewey said. For example, they might worry that a colleague could access their electronic health records. Fear of professional repercussions is a major deterrent. Physicians have to spend so many years in training, they are reluctant to do anything they think might jeopardize their careers, she said.
“It is ingrained in us in training that you just do, do, do at the expense of yourself,” Dr. Dewey said. “They often don't stop and say, 'I need to do for myself first before I can do for others.' ”
Research has shown that physicians experience burnout at higher rates than the general population. An Oct. 8 Archives of Internal Medicine study found that 45.8% of 7,288 physicians surveyed experienced at least one symptom of serious burnout, such as emotional exhaustion.
Some state medical boards add to the problem by requiring physicians to self-report psychiatric treatment, Dr. Gold said. That can deter physicians from seeking care, because they are afraid it could jeopardize their medical licenses. Instead of asking whether a doctor has received mental health help, Dr. Pendergast said boards should ask whether the doctor has a problem that might impair patient care.
Cultural change needs to occur on many levels to make it easier for physicians to seek care, he said. Physician leaders need to set an example, and doctors should realize it ultimately could be more harmful not to get help.
“The reality is that physicians are humans,” Dr. Dewey said. “We are subject to all the same illnesses as everyone else. Having an MD does not make us immune.”