Sunday, February 8, 2009

Doctor Suicide

No one has been able to explain why doctors, as a profession, have the highest suicide rate of any profession. Every year, between 300-400 doctors take their own lives. In the general population, males commit suicide 4 x higher than women. But the suicide rate among male and female doctors is the same. Female doctors take their lives at a rate more than twice that of the general public.

There is really very little research done on this subject and most of it is old. The most definitive study was done in 2003 and published in JAMA. It stated that undiagnosed and untreated depression is the problem and even when physicians seek help for depression, they are not treated aggressively.

Mental illness still has a stigma in our society. Doctors realize, with good reason, that if they admit to a mental health problem they could lose respect, referrals, income and even their licenses. Doctors have access to drugs that can mask their symptoms without getting help and that may make the situation worse.

If depression is considered something shameful and secret, that can further lower the self confidence and self-worth of a professional which exacerbates the depression. Medicine is a pretty macho profession. It is rare for physicians to even admit they get a "cold" let alone a serious illness. It is a point of pride to admit you can function on little sleep or work without taking time for rest, food or friendship.

There are no easy answers to this problem, but educating medical students about depression and how to deal with their own emotional health might be a start. The American Foundation for Suicide Prevention has information and has created a documentary called "Struggling in Silence" about physician suicide.


KM said...

I'm glad you wrote about this subject. I had read before on the higher suicide rate with doctors. I had the experiance of answering the phone for a friend when a call came through about my friend's brother (not a physician) taking his own life and saw the affect on the family.

I wonder if physicians are afraid to to admit to another physician that could help them because of being pushed so hard to meet so many tough mental and emotional demands in medical school and their training that they think it might make them look weak rather then human.

I know a doctor who has practiced medicine for forty plus years and was out of the office for two weeks (for reasons unrelated to this subject and some of the patients were so upset and concerned that an illness or accdient might have happened as if this physician was like a family member or close friend. It was nice to see the very special relationship, care, and warmth from the patients and how some of their faces light up when they see this doctor come into the room to see them.

tracy said...

i, too have read about this subject and in fact, have a young doctor friend who is suffering, yet faces all the stigma you mentioned about getting help. i am so very frightened for her.
i find this situation so very sad, in particular because physicans are my "most admired profession". i know that makes no difference, but there must be some way for doctors to get the help they so despereately need, without all the fear of "what might happen if they do". Because what might happen if they don't is just soooo much, much more horrible.

tracy said...

Dear Dr. Brayer,
i sent the link to my friend...thanks so much.

Jonathan said...

What an unfortunate irony. The people who help care for us are having difficulty caring for themselves. It gives a whole new meaning to “Physician, heal thyself”. Clearly more research and concomitant treatment needs to be directed at this unfortunate statistic.

Linda Leighton said...

This must be especially painful for a physician. The stigma, unfortunately, still exists. I know someone who will not turn in her receipts to her medical insurance and pays for her medication and doctor visits out of pocket as she does not want to have those on her record. Thank you, Toni, for addressing this important topic!

Steven Reidbord MD said...

I'm not familiar with the research and certainly don't have the answer, but a few thoughts come to mind. First, I read a study years ago that said 30% of medical interns are clinically depressed. At the time I assumed this rate of depression was a reaction to the sense of inadequacy, sleep deprivation, and other "hazing" rituals of medical training. Of course, it could alternatively be a pre-existing trait of medical students.

It would be interesting to compare the means used by doctor suicides, versus the general population. Ready access to medicines might make overdose more easy and common.

I agree that medicine is a macho profession that discourages signs of weakness (or even humanity sometimes). Perhaps this explains the disproportionate increase in female doctor suicides, i.e., the destructive need to be macho when it doesn't come naturally is even more pronounced, on average, in women doctors than in men doctors. As a woman yourself, perhaps you could write more about your views on gender issues in medical practice?

Thanks for raising the issue of physician suicide.

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