As in the general population, physicians suffer a range of mental disorders, including depression, anxiety, and burnout. Increasing numbers of reports in recent years have brought to light the high rates of mental illness, suicidal ideation, and completed suicide among the medical community worldwide. Dr Samuel Harvey, et al sought to summarize available international evidence and considered a range of potential solutions in a recently published Lancet review article. The authors reported that the rate of suicide among physicians and other health professionals is much higher than that of the general population. This may be due in part to increased access to lethal means and the knowledge to effectively use such means. It has been suggested that there may be a link between area of specialty and suicide risk, with anesthetists, psychiatrists, general practitioners, and general surgeons at greater risk compared with other specialists.
Some risk factors for mental illness among physicians include excessive or conflicting job demands, an imbalance of work or family life, long working hours, and interpersonal conflict. Junior physicians have even higher rates of depression and suicidal ideation, possibly due to additional risk factors such as excessive working hours, study, and examinations. Length of medical education, increased debt, and higher likelihood of competing family responsibilities during early training contribute to the increased risk in junior physicians. Other areas of concern are physicians’ increased administrative burden, including external roster scheduling, electronic records, and health system constraints, as well as the ongoing COVID-19 pandemic. One study reported that as many as 67% of physicians had post-traumatic stress symptoms in areas most affected by the pandemic.
Some physicians may be reluctant to seek help due to regulations such as mandatory reporting of mental illness. Qualitative studies have reported that physicians who have had mental health problems have a high prevalence of self-stigma, which is another major barrier to seeking help and recovery. Many resort to substance abuse; between 5% and 20% of physicians consume alcohol problematically, and some resort to prescription drugs. These barriers are impacting patient care—prospective studies have shown that depressed physicians make 6 times more medication errors than healthy staff, often attributed to mental illness or substance abuse.
Urgent action is needed to help protect the mental health and well-being of physicians; stakeholders must rethink the training and employment conditions of physicians and prioritize evidence-based interventions in order to bring about change. Dr Harvey, et al suggest that having a mentally healthy workplace requires a coordinated range of initiatives, implemented at both the individual and organizational level, that extend from prevention through recovery and return-to-work. At the individual level, this begins in medical school, where physicians should be taught healthy habits and self-awareness, effective coping mechanisms for stress, and how to ask for help when needed. The transition period at the beginning of a junior doctor’s career is another opportunity to reinforce adaptive coping skills and provide individually focused interventions such as cognitive behavioral therapy or mindfulness-based techniques, as well as interventions aimed at reducing physician burnout.
High level
From an organizational perspective, health systems should aim to minimize work-based risk factors and promote protective factors. Studies have shown that interventions such as modifications to processes and shortened shifts can help improve mental health outcomes, including burnout symptoms. Other recommendations from the authors include team training, reduced administrative tasks, improved electronic health record systems, flexible scheduling, job security, and leave or other policies that reduce work-family conflicts.
Ground level
From an individual perspective, the authors suggest use of e-health and mobile phone apps to deliver and receive mental health interventions. Physicians should feel empowered to seek help, ideally working with specialists who focus on supporting medical practitioners. Appropriate measures must be taken to ensure not only the mental health and well-being of physicians, but to ensure that patient outcomes are not affected.
