Author: Michael Vlessides
Although often underestimated, suicide rates among physicians are higher than the general population, and according to experts, are exacerbated by a professional culture that tends to stigmatize mental illness beyond the amount seen in nonphysicians. Overcoming such stigma is the first step toward creating emotionally healthy workplaces that support, rather than frown upon, the emotional challenges that clinicians face on a daily basis.
Admitting one’s personal struggles with mental illness is particularly challenging for physicians, said Anne Glowinski, MD, MPE, a professor of psychiatry at Washington University School of Medicine in St. Louis. “I am here because I want to take you on the journey that I went through with mental illness, because I am a physician and it nevertheless took me a while to get to this point, even though I am a psychiatrist,” said Dr. Glowinski during a presentation at the 2018 annual meeting of the Society for Pediatric Anesthesia.
As Dr. Glowinski discussed, the statistics regarding physician suicide are sobering. Although the exact number is often disputed, it is estimated that 300 to 400 physicians die by suicide every year. “It’s scary to think that the population of one entire small or medium medical school dies every year of suicide,” she said.
Multiple factors increase the number of physician suicides. For many physicians, suicidal ideation and depression begin under the intense pressure environments of medical school and residency training. That depression can continue as a physician’s medical knowledge increases. As Dr. Glowinski explained, physician knowledge of pharmacology makes drug overdose a particularly accessible form of suicide. “We know how to overdose. We know how to titrate to fatality,” Dr. Glowinski said. “So our rate of suicide attempts to completions are very different than the general population.”
In a society where as much as half the population does not seek help for depression and mental illness, physicians are among the worst offenders, Dr. Glowinski said. Even many first-year medical students say they are averse to seeking treatment.
“If you look at people who have started medical school, they’re already reporting that it is not normative to want to get help, and that most people are going to look down on them and think they’re not coping if they do,” she explained.
Stigmatization also seems to be an issue with respect to licensing, added Myron Yaster, MD, a professor of anesthesiology at the University of Colorado, in Aurora. “One of the problems with disclosure is that you can’t get your license,” he said. “So when you get your medical license every year, you have to disclose if you have any mental health issues.”
“There’s a lot of variation between the states right now,” Dr. Glowinski said. “Some states are very progressive and ask the questions in a way so that there’s parity between mental and physical issues. Nevertheless, I believe this is going to change.”
“Do you think physicians should have compulsory, regular mental health assessments as a way of promoting wellness and preventing suicide?” asked an audience member.
“I think the reason I would say no right now is that we’re in a culture that gives a lot of mixed messages,” Dr. Glowinski replied. “Compulsory treatment right now would really go against cultural norms and potentially create stigma. That said, I think a lot of schools now are moving to toward screening, and that seems to be well accepted by the students at those schools.”