Rates of depression (33%), anxiety (24%) and PTSD (10%) are higher among physicians than the general population, according to a new study from the Journal of the American Medical Association. The paper cites demanding work schedules, frequent exposure to human suffering and perfectionist tendencies as major burdens on physicians’ mental health.
Unfortunately, the problem is not improving. At least one physician in the U.S. dies by suicide every day, with female physicians dying by suicide at a 53% higher rate than women in the general population, the study finds.
“Every day that goes by that we lose another physician, another nurse, another dentist, another pharmacist to suicide is too many,” says Dr. Jesse Ehrenfeld, co-author of of the study - “Reducing Barriers to Mental Health Care for Physicians.
Ehrenfeld is also executive director of the Advancing a Healthier Wisconsin Endowment at the Medical College of Wisconsin, where he’s also a tenured professor of anesthesiology.
Barriers to seeking help
Although many healthcare employers offer mental health resources for their physicians, a stigma around mental health persists – along with fears of professional consequences.
“There may be counseling, there may be professional psychologists or psychiatrists, but people are afraid to use them,” notes Ehrendfeld. “They're afraid that their colleagues are going to find out, that they will lose confidentiality.”
Finding time for a mental health appointment while working a doctor’s schedule poses an additional logistical barrier to treatment. At the policy level, Ehrenfeld says invasive licensing application questions from the start of physician's careers discourage honesty about mental health struggles.
“Every time a physician fills out a licensing application here in Wisconsin... a very broad, very intrusive, very inappropriate question has been asked: ‘Have you ever, at any point in your career, received psychiatric, psychological counseling help or been hospitalized at any point?’” he explains.
The study also found that many physicians self-medicate, with 9% to 15% of physicians reporting self-prescribing antidepressants and 7% turning to informal prescriptions from colleagues. Overall, Ehrenfeld says a culture of stoicism discourages vulnerability and frankness about mental health issues.
“You're expected to be a ‘strong student,’ a ‘strong resident,’ a ‘strong physician,’” he says. “I cannot tell you the hundreds of times I've heard those exact words uttered from my colleagues, my faculty, my peers, students who want to be seen as that.”
Closing the treatment gap
In recent years, Ehrenfeld has been heartened by various reforms to medical training programs, along with the expansion of mental health resources offered by employers. But he says there’s still a long way to go in removing intrusive questions from licensing documents and increasing access to confidential mental health treatment.
“Wisconsin is one of three states that does not have a physician health program –a confidential place that folks can go when they need help,” he says. “47 states have one. We don't.”
Ehrenfeld says institutional leadership can help fight mental health stigma in healthcare by leading by example, and opening up about their own struggles.
“Physician mental health is not just a work force issue — it's a public health imperative,” he says. “When our caregivers are suffering, our patients suffer too.”
