Physicians: Depression

and Burnout The Untold Story

Natalie Sieb, DO

IntroductionMore than 1 out of 20 over the age of 12 reported depression in 2005-06 according to CDC

Lifetime prevalence in physicians is comparable to general population; 13% in males, 20% in females

HOWEVER- rate of suicide remarkably higher in physicians around 400 a year

WHY?????

Physician DepressionThis starts as early as the first year of medical school!!

By the start of intern year, depression rates are around 4% (same as general pop)

But during and after that intern year that number shoots up to about 25% (data gathered from 55 institutions and about 10,000 interns)

Stanford is doing a pilot study of an innovative meditative group for their interns with great results

Physician Depression

Personality Traits That Predispose:

• Perfectionism

• High self-criticism

• Very driven• Competitiv

e• Compulsive• Mood

swings

Difficult relationships with senior doctors

and patients

Lack of sleep

Making mistakes

Dealing with death24 hour

responsibility

Marriage instability due to nature of job

Substance Abuse

Risk Factors

Physician DepressionManifestations of physician depression can look like many things, including:

Behavioral• Severe irritability and anger• Vacillations in energy,

confidence, creativity, & enthusiasm

• Erratic behavior• Isolation and withdrawal• Diminished or heightened

need for sleep

Job Performance• Inappropriate boundaries• Inattention to chart work

and/or patient calls• Inappropriate dress and/or

change in hygiene• Sexually inappropriate

comments or behavior• Frequent job changes

and/or moves• Inconsistency in

performance• Absenteeism

Physician Suicide

Relative risk in physicians is between 1.1 and 3.4 for men and 2.5 and 5.7 for women (review of 14 studies)

Relative rate among specialties is unknown

Suicide rate in physicians is 2-3 times the general population (between 28 and 40 per 100,000 compared to 12.3 per 100,000) and rate for female physicians is 4 times general population rate

Physician Suicide

Second most common cause of death among young physicians (26%)

Physician suicide rates are higher among those who are divorced, widowed, or never married

Disease Suicide Unintentional injuries

Homicides0%

5%

10%

15%

20%

25%

30%

35%

40%

Young Physician Causes of Death

Mortality of young physicians in the United States, 1980-1988.

Physician SuicideIn one study, the high-risk physicians were those who were:

In this study, of the physicians who completed suicide, 42% had been seeing mental health at time of death and 1/3 had at least one psychiatric hospitalization in the past

More Driven

Compulsive

Mood Swings

Grad of High Prestige

Competitive

Ambitious

Alcohol or Drug

Physical Illness

Physician SuicideAlthough many are at risk:

Most common means of completed suicide by physicians is lethal medication overdoses and firearms

There was a strong correlation between depressive symptoms as well as indicators of burnout with the incidence of suicidal ideation

Most don’t seek help:

Recent survey of American Surgeons revealed that although 1 in 16 thought about suicide in past 12 months only 26% sought help

Over 60% of those surveyed positively who did not seek help did so due to fear of repercussions to their medical license

This is a HUGE reason physicians aren’t seeking help!!!!!

BurnoutWarning signs: You should be taking notice if constant stress has you feeling exhausted, detached from your patients, or cynical

Burnout is more prevalent in physicians than in any other profession

A study of 8,000 surgeons found that depression and burnout were the strongest predictors of reporting a medical error

“As a patient, you’d never guess that half of all American doctors are burned out, because the culture of medicine dictates that doctors show no weakness.” TIME

7 Signs You May Be Suffering From

Burnout Dr. Mark Linzer,MD

1. High Tolerance To Stress

2. Exceptionally Chaotic Practice

3. You Don’t Agree With Your Boss’s Values or Leadership

4. You’re the Emotional Buffer

7 Signs You May Be Suffering From Burnout

5. Your Job Constantly Interferes With Family Events

6. You Lack Control Over Your Schedule and Free Time

7. You Don’t Take Care of Yourself

Barriers To TreatmentSocial Stigma- CONFIDENTIALITY!!

Finding a local mental health care provider whom you trust but is not a colleague can be a challenge

Recrimination by your peers, facilities where you work and licensing boards

Licensing concerns is a VERY big concern for many physicians in seeking help with depression

Providing inaccurate information on a medical licensure application may result in denial or revocation,23 but acknowledging a history of mental health or substance abuse treatment triggers a more in-depth inquiry by the medical board

Questionable ADA issues

Barriers To TreatmentSome states impose what feels like “punishment” to those physicians who do answer “yes” to the question “Do you or have you ever been treated for a mental health disorder?” on their licensing applications

Some states even make board appearances public record

Some physicians who have reported depressive symptoms have faced a range of negative consequences including :• Repetitive and intrusive examinations• Licensure restrictions• Discriminatory employment decisions• Practice restrictions• Hospital privilege limitations • Increased supervision

Education and Resources

There is an urgent need for more education regarding this disease and it’s potential outcomes (suicide) not only to the general public but very much also within our own profession where there is still so much stigma

This needs to start at the earliest stages of medical training

Critical Change Needed: a suffering physician should be more receptive to the diagnosis of depression and let them feel free to seek treatment without repercussions

Education and Resources

What can we all do?-Be more mindful of our colleagues who might be going through a difficult time and create an environment for them that allows them to feel more comfortable being depressed in their workplace instead of hiding it and thus perpetuating the disease

NAMI (National Alliance on Mental Illness) can be a huge resource for institutions seeking to change policies or even on a more personal level- county, state and national chapters for advocacy

Video

Education and Resources

Ideal Medical CarePamela Wible, MD

Ideal Clinics

www.idealmedicalcare.org

Education and Resources

www.black-bile.com- a wonderful resource not only for those who are suffering but for their loved ones looking for information on how to help; also offering info on special populations (e.g. female physicians, physicians in training)

www.mdmentor.com- Helpful for any physician feeling depressed and going through litigation and not knowing how to navigate the litigation system

www.afsp.com (American Foundation for Suicide Prevention)- aimed at helping to understand, prevent, and cope with suicide, suicide research and advocacy

Education and Resources

THERE IS HELP and THERE IS HOPE!!

You are NOT alone!!!!!!

Physicians: Depression and Burnout-

The Untold Story

Works Cited

1. Depression and Suicide Among Physicians. Bright RP, Krahn L. Current Psychiatry. Vol 10, No 4. April 2011

2. The Painful Truth: Physicians are Not Invincible. Miller MN, Mcgowan KR. South Med Journal 2000;93(10)

3. Physician Suicide. Andrew LB. Medscape. http://emedicine.medscape.com/article/806779-overview. Updated July 9, 2015

4. When Darkness Settles: Depressed Physicians Face Barriers To Treatment. Raymond R. May3, 2013. The DO. thedo.osteopathic.org

5. How To Beat Burnout: 7 Signs Physicians Should Know. Linzer M. AMA Wire 3/4/2015. http://www.ama-assn.org/ama/ama-wire/post/beat-burnout-7-signs-physicians-should

6.  www.NAMI.org

7. www.black-bile.org

8. www.afsp.com

9. www.mdmentor.com

10. http://www.cdc.gov/mentalhealth/data_stats/depression.htm

11. Oaklander M. Life Support. TIME9/7-9/14/2015

12. www.idealmedicalcare.com