|Molly Ferguson for Stat|
Why are doctors plagued by depression and suicide? A crisis comes into focus
by Judith Graham @judith_graham, statnews.com, 21 July 2016
A sense of angst was rattling students at the University of Southern California’s Keck School of Medicine. One of their peers had taken his life days before.
Professor Mikel Snow felt the dark undercurrent and knew he had to speak up. So, for the first time, he told his students about his decades-long struggle with depression. As word spread, students across the campus started contacting him to discuss the suicide — and to share their own psychological distress.
“The reaction has been astounding,” Snow said. “It crystallized that this is a much bigger issue than any of us really realized.”
Suicide among medical students and doctors has been a largely unacknowledged phenomenon for decades, obscured by secrecy and shame.
Now, it’s beginning to emerge from the shadows.
It’s time to recognize and prevent the tragedy of physician suicide
More than 62,000 people — many of them medical professionals and their families — signed a petition this year calling on medical associations to track physician suicides, provide confidential counseling, and require doctor training programs to address a “culture of abuse” too often characterized by bullying, harassment, and humiliation.
Those groups are responding. The Association of American Medical Colleges last month convened a meeting to address an escalating crisis of depression, burnout, and suicide among physicians. Among the ideas under consideration: encouraging medical students to join clubs so they feel less isolated; ensuring that counseling is more accessible and private; and more actively tracking the mental health of students and doctors.
“This is something that the profession as a whole needs to come together around and deal with as a shared concern,” said Dr. Darrell Kirch, president of the AAMC.
He knows the pain firsthand: He lost two students to suicide during his tenure as dean at medical schools in Pennsylvania and Georgia.
The Accreditation Council for Graduate Medical Education, which oversees the doctor training programs known as residencies, is also focusing on the issue. Officials are studying residents’ deaths to determine which might have been preventable, and how to respond. The group sets standards for residencies and is looking at how to strengthen them to protect young doctors’ mental health.
Hospitals, too, are racing to launch support groups, peer counseling, and sessions to teach doctors to manage stress by meditating or keeping journals.
The new attention to physicians’ mental health comes too late for Cheryl Collier, who had no inkling that her 25-year-old son, Sean Petro, had plunged into despair during his third year at USC’s medical school.
“If only he’d said, ‘I’m depressed, I’m unhappy, I don’t know what to do.’ Perhaps I could have helped him,” said Collier, weeping with grief and frustration.
In the weeks after Sean’s death in May, someone mentioned to Collier that medical students and physicians have a high suicide rate. “I had no idea that was even a possibility,” she said.
An epidemic of depression
The starkest sign of the crisis gripping medicine is the number of physicians who commit suicide every year — 300 to 400, about the size of three average medical school classes. Male doctors are 1.4 times more likely to kill themselves than men in the general population; female physicians, 2.3 times more likely.
The grim tally is probably an under-count, since many suicides aren’t listed as such on death certificates. And it doesn’t include suicides among medical students, which aren’t tracked systematically in the United States.
In one study of six medical schools, nearly 1 in 4 students reported clinically significant symptoms of depression. Almost 7 percent said they had thought of ending their lives in the last two weeks.
In another, more recent study, 29 percent of residents suffered from significant symptoms of depression. And those symptoms escalated within a year of starting training — a sign that residency programs themselves were contributing to the problem.
The stress starts in medical school, where students face pressure to master an overwhelming amount of material. Competition with peers can be brutal. Sleep deprivation is common. And students can face withering criticism from faculty who have little tolerance for ignorance, signs of weakness, or emotional displays.
Once they’re practicing, physicians face additional stresses: An immersion in human suffering. Long work hours. High expectations. A dread of making mistakes. They’re often profoundly uncomfortable with acknowledging vulnerability. And they must adapt to a rapidly changing health care environment.
Medical education and training are “a profoundly dehumanizing experience and it’s drilled into you: Do not show your heart or tears to anyone, ever again,” said Dr. Pamela Wible, a family doctor in Eugene, Ore., who has grappled with profound depression, written a book about physician suicide, and given a popular TEDMed talk on the topic.
By necessity, Wible said, doctors become “masters of disguise,” expert at concealing their emotions.
‘I never saw this coming’
Sean Petro must have learned to conceal despair and hopelessness at some point.
The article invites the reader to share his/her thoughts on depression, burnout, suicide in the medical profession.