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“I would never want to have a mental health diagnosis on my record”: A survey of female physicians on mental health diagnosis, treatment, and reporting
Abstract
Introduction:
Physicians have high rates of suicide and depression. Most state medical boards require disclosure of mental health problems on physician licensing applications, which has been theorized to increase stigma about mental health and prevent help-seeking among physicians.
Methods:
We surveyed a convenience sample of female physician-parents on a closed Facebook group. The anonymous 24-question survey asked about mental health history and treatment, perceptions of stigma, opinions about state licensing questions on mental health, and personal experiences with reporting.
Results:
2106 women responded, representing all 50 states and the District of Columbia. Most respondents were aged 30-59. Almost 50% of women believed that they had met the criteria for mental illness but had not sought treatment. Key reasons for avoiding care included a belief they could manage independently, limited time, fear of reporting to a medical licensing board, and the belief that diagnosis was embarrassing or shameful. Only 6% of physicians with formal diagnosis or treatment of mental illness had disclosed to their state.
Conclusions:
Women physicians report substantial and persistent fear regarding stigma which inhibits both treatment and disclosure. Licensing questions, particularly those asking about a diagnosis or treatment rather than functional impairment may contribute to treatment reluctance.
... More concerningly, stigma, fear of negative career consequences, and lack of time commonly hinder healthcare workers from seeking mental health support [64,65], potentially exacerbating feelings of guilt and worry. Despite their medical expertise, many healthcare workers remain affected by mental illness stigma and view mental health diagnoses and treatment as embarrassing and shameful [66,67]. Perceived stigma often led to their selfstigma, leading to self-blame for perceived failures as caregivers and concerns about damage to their professional image [68,69]. ...
... Additionally, taking time off to prioritize mental health may evoke guilt toward colleagues and patients due to staff shortages and a strong sense of duty [65,69]. Limited time also reduce their willingness to participate in therapies such as counseling or cognitive behavioral therapy, which typically require multiple sessions to be effective [67]. In sum, these barriers undermine help-seeking behaviors and may accelerate the progression of comorbid depression and anxiety. ...
Background
After the official end of the dynamic zero-COVID policy in China, healthcare workers continued to heavy workloads and psychological stress. In this new phase, concerns related to work and family, rather than infection, may have become new sources of psychological issues such as depression and anxiety among healthcare workers, leading to new patterns of comorbidity. However, few studies have addressed these issues. To fill this gap, this study used network analysis to examine new features and mechanisms of comorbidity between depression and anxiety symptoms, and simulated symptom-specific interventions to identify effective targets for intervention.
Methods
A total of 708 Chinese healthcare workers (71.2% females; Age: M = 37.55, SD = 9.37) were recruited and completed the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). This study first calculated the incidence rates of anxiety, depression, and their comorbidity, and then constructed the comorbid Ising network. Central and bridge symptoms were identified with expected influence (EI) and bridge EI, respectively. The NodeIdentifyR algorithm (NIRA) was then used to simulate interventions within the network, examining the effects of alleviating or aggravating specific symptoms on the network’s severity.
Results
48.2% of Chinese healthcare workers reported experiencing depression (19.8%), anxiety (11.7%), or both (16.2%). In the anxiety-depression network, “guilt” and “appetite changes” were identified as the central symptoms, and “guilt” and “excessive worry” were identified as the bridge symptoms. Simulated interventions suggested that alleviating “Anhedonia” can the most reduce the overall severity of the network, while aggravating “guilt” can the most increase the overall severity. These two symptoms were considered the key target for treatment and prevention, respectively.
Conclusions
Chinese healthcare workers still face high risk of depression, anxiety, and comorbidity in the post-dynamic zero-COVID policy era. Our findings highlight the key roles of guilt, appetite changes, and excessive worry in the network of depression and anxiety symptoms. Future research should apply the results of the simulated interventions, develop intervention strategies targeting anhedonia, and focus on preventing guilt to improve the healthcare workers’ mental health.
Trial registration
Not applicable.
... In consumer behaviour, PR primarily pertains to potential negative outcomes or uncertainties in purchasing a product or service (Featherman and Pavlou 2003). Seeking professional mental health services can similarly be viewed as a special consumer behaviour, with multiple PRs-social, psychological, service quality and functional value-potentially influencing an individual's professional psychological help-seeking intention (Gold et al. 2016;Rees et al. 2019). Moreover, financial risk and time risk are more like perceived barriers (PB) in mental health help-seeking contexts, which may prevent individuals from seeking professional mental health services. ...
... Similarly, because professional psychological help is a purchased service, healthcare workers contemplate various adverse consequences when deciding whether to seek help. A previous study found that over two-thirds of healthcare workers were unwilling to seek psychological help due to concerns about privacy and autonomy infringement, with these beliefs spanning across all age and professional categories (Gold et al. 2016). ...
Aim
Although healthcare workers often experience significant mental health challenges, their willingness to seek professional psychological help remains relatively low. However, the factors associated with healthcare workers' psychological help‐seeking remain unclear. This study aims to identify the determinants of professional psychological help‐seeking intention among healthcare workers based on the theory of planned behaviour.
Design
Cross‐sectional study.
Methods
A questionnaire, incorporating demographic information and latent variable items, was developed and employed on 403 healthcare workers through online and offline surveys from December 2022 to January 2023 using convenience sampling. Structural equation modelling was applied to test the research hypotheses.
Results
The model explained 46.9% of the variance in help‐seeking intention. Subjective norm had the strongest total association with help‐seeking intention. Attitude towards help‐seeking behaviour, subjective norm and perceived behavioural control were directly positively related to help‐seeking intention. Moreover, self‐stigma, public stigma, perceived barriers and perceived risk were indirectly associated with help‐seeking intention mediated by attitude towards the behaviour and perceived behavioural control. Of the four constructs, public stigma showed the most significant indirect relation to behavioural intention.
Conclusion
Healthcare workers' intention to seek psychological support is associated with multiple interacting factors, particularly subjective norm and public stigma. Targeted interventions addressing individual and systemic barriers are essential to create a supportive environment for healthcare workers to access mental health services.
Impact
This study identified key barriers and facilitators to healthcare workers seeking psychological support, which can assist authorities in enhancing mental health services and implementing tailored intervention strategies, thereby promoting help‐seeking behaviour among healthcare workers. Moreover, our research reinforces the applicability of the theory of planned behaviour in explaining healthcare workers' intention to seek professional psychological support.
Patient or Public Contribution
No patient or public contribution.
... In the three-dimensional model, low levels of burnout were defined in line with the work of Costa et al. (2012) using the following scores: exhaustion (0-9), cynicism (0-1), and professional efficacy > 27. Moderate level was identified as following: exhaustion (10)(11)(12)(13)(14), cynicism (2)(3)(4)(5)(6), and professional efficacy (23)(24)(25)(26)(27). A high level of burnout was defined as exhaustion > 14, cynicism > 6, and professional efficacy < 23 [16]. ...
... According to international literature, women face particular challenges during the COVID-19 pandemic, with fear of infection contributing significantly to stress and burnout [26,27]. ...
Background
The coronavirus pandemic has significantly impacted lives worldwide, especially of medical and health science students. In Hungary, education has been relegated to the online space, with a substantial proportion of students having to attend medical secondments. Increased stress, uncertainty, and the presence of medical secondments can have an impact on students’ premature burnout.
Methods
In 2021, we conducted a follow-up survey among students of the University of Pécs studying medicine and health sciences in two data collection periods (from March to May and September to November). Our online questionnaire consisted of the Maslach Burnout Inventory General Survey for Students and our self-designed questionnaire. We used descriptive and paired two-sample t-tests for data analysis at a 95% confidence interval (p ≤ 0.05).
Results
We excluded from our survey respondents whose data we could not follow-up; finally, 183 students’ responses were analyzed. The majority of students were female (n = 148; 80.9%). Overall, there was a significant decrease in both exhaustion (EX) and cynicism (CY) scores (p = 0.001; p = 0.004). Female respondents had higher EX scores, but a significant decrease was observed for both genders (p ≤ 0.05). Excluding paramedic students, a significant decrease in EX scores was observed for the specialties we studied (p ≤ 0.05). General medicine students’ CY scores decreased; physiotherapy students’ profesisonal efficacy (PE) scores increased significantly (p ≤ 0.05). Students who were on medical secondments (n = 127; 69. 4%) were found to be more affected by burnout, but in all cases, these scores significantly improved (p ≤ 0.05). Students serving in the National Ambulance Service (n = 76; 41.5%), Hospitals (n = 44; 24.0%), or both (n = 7; 3.8%) had a significant decrease in their burnout score (p ≤ 0.05). Students who served in either a hospital or a hospital and National Ambulance Service had significantly improved CY and PE scores (p ≤ 0.05). Students concerned about their health had elevated EX and CY scores, which also improved (p ≤ 0.05).
Conclusions
In conclusion, medical secondments positively affected student burnout scores for medicine and health sciences students at our institution. This fact implies that it is necessary to have more internships in real-life settings during the training.
Trial registration
Our survey has been approved by the Medical Research Council (Case No IV/4573-1/2021/ECU).
... Lack of trust in digital interventions was as a key barrier to psychological care in the general population, according to a recent umbrella review [10]. For HCWs, additional barriers included time constraints during the initial periods of the pandemic [11], internalized stigma [12], or the belief that HCWs never require psychological help [13]. In this study, we investigate the use of psychological support among HCWs in Spain over the two-year period following the initial outbreak of the pandemic and we explore the association between baseline workplace-and COVID-19-related factors and prospective use of psychological support. ...
... First, we call for a generalised reduction of psychosocial risks at work that extend beyond the midst of initial pandemic crises, as the use of psychological support in 2021 and 2022 was at least as frequent as it was in 2020. Second, health promotion strategies at work should target barriers for accessing to psychological support among HCWs, which include not only contextual factors such as rotating shifts or worklife balance, but also internal factors, such as internalised stigma caused by seeking or using psychological support [12], or fear for the negative consequences of a mental health diagnosis [13]. Last, we found only a 10% increase of use of psychological support among people with probable major depressive disorder, compared with people without it. ...
Introduction
Although healthcare workers (HCWs) have reported mental health problems since the beginning of the COVID-19 pandemic, they rarely use psychological support. Here, we described the use of psychological support among HCWs in Spain over the 2-year period following the initial pandemic outbreak and explore its association with workplace- and COVID-19-related factors measured at baseline, in 2020.
Materials and methods
We conducted a longitudinal study on HCWs working in Spain. We used an online survey to collect information on sociodemographic characteristics, depressive symptoms, workplace- and COVID-19-related variables, and the use of psychological support at three time points (2020, 2021, and 2022). Data was available for 296, 294, and 251 respondents, respectively at time points 1, 2, and 3.
Results
Participants had a median age of 43 years and were mostly females (n = 242, 82%). The percentage of HCWs using psychological support increased from 15% in 2020 to 23% in 2022. Roughly one in four HCWs who did not use psychological support reported symptoms compatible with major depressive disorder at follow up. Baseline predictors of psychological support were having to make decisions about patients’ prioritisation (OR 5.59, 95% CI 2.47, 12.63) and probable depression (wave 2: OR 1.12, 95% CI 1.06, 1.19; wave 3: OR 1.10, 95% CI 1.04, 1.16).
Conclusions
Our results suggest that there is call for implementing mental health promotion and prevention strategies at the workplace, along with actions to reduce barriers for accessing psychological support.
... De plus, un nombre croissant d'apprenants et d'apprenantes font état de problèmes de santé physique et mentale chroniques, de troubles du déficit de l'attention avec hyperactivité, de troubles senso riels, moteurs ou d'apprentissage et plusieurs sont confrontés à des obstacles qui nuisent à la divulgation et à la recherche d'aide [3][4][5] . Les médecins qui ont des problèmes de santé en reportent le traitement ou la divulgation par peur de la stig matisation ou d'éventuelles difficultés à se procurer leur permis d'exercice [6][7][8][9] . Cet enjeu doit entrer en ligne de compte lors de la délivrance du permis d'exercice aux médecins qui ont des pro blèmes de santé; les ordres de médecin ont le devoir de protéger le public en s'assurant que les médecins n'exercent pas s'ils y sont inaptes, mais ils doivent également encourager les méde cins à chercher l'aide nécessaire tout en protégeant leur vie privée et en évitant les vérifications indues 10,11 . ...
... Il est possible que l'approfondissement de la recherche et la priorisation des nouvelles politiques émises en 2018-2019 par les instances natio nales améri caines aient contribué à ce changement. En effet, dans un sondage mené aux ÉtatsUnis en 2016 auprès de plus de 2000 médecins de sexe féminin, seulement 6 % des répondantes ayant reçu un diag nostic ou un traitement pour un problème de santé mentale ont déclaré avoir divulgué cette information au moment de déposer leur demande de permis d'exercice 6 . Les principales raisons de la non divulgation incluaient l'absence perçue de risque pour la sécurité des patients, la nonpertinence du diagnostic pour les soins cli niques, l'inquiétude quant à la protection de la vie privée et la crainte de restrictions appliquées au permis d'exercice 6 . ...
... Despite increased education and resources, many medical students are less likely to seek help for mental health symptoms due to the stigma associated with mental health [5]. Many physicians report that if they were experiencing mental health symptoms they wouldn't want others to know [2,3,[13][14][15][16]. In 2003 a study at the University of Manchester found 50% of students feared disclosing their mental illness would be risky [15]. ...
... Mental health stigma and self-stigma (internalized public stigma) are higher in the medical community than the general population [5]. Physicians have higher rates of mental health stigma, and many report that they will not seek help for mental health [2,3,[13][14][15][16]. Medical students report fear that disclosing a mental health problem will decrease their chances of getting a residency position [27]. ...
Anxiety levels in medical students have been reported as higher than the aged-matched general population, yet medical students are less likely to seek care for mental health issues. Medical students carry high levels of self-stigma about their own mental health and fear the negative consequences of seeking care. The purpose of this study was to examine the student population at the University of South Carolina School of Medicine Greenville (UofSC SOMG) for anxiety levels and determine the self-stigma attitudes this population carries. UofSC SOMG students were surveyed using the GAD7, questions about mental health stigma, and open-ended questions on barriers to mental health care in medical students. Anxiety levels were compared to student responses. 31% of students reported moderate-severe anxiety levels. Stigma was the most frequently listed barrier to care, however, students with moderate-severe anxiety were more likely to report cost as a barrier to care than students with minimal anxiety levels. Despite free and accessible mental health care, medical students at UofSC SOMG still have anxiety at rates higher than the general population. Future work should help to provide interventions to the barriers of care, so medical students can better utilize mental health care resources.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12909-023-04460-5.
... Indeed, in a 2016 US survey of more than 2000 female physicians, only 6% of respondents with a history of mental health diagnosis or treatment reported disclosing this information on a licensure application. 6 Top reasons for nondisclosure included a perceived lack of risk to patient safety, irrelevance of diagnosis to clinical care, privacy concerns and fear of licence restrictions. 6 What are the gaps in current procedures for medical licensure in Canada? ...
... 6 Top reasons for nondisclosure included a perceived lack of risk to patient safety, irrelevance of diagnosis to clinical care, privacy concerns and fear of licence restrictions. 6 What are the gaps in current procedures for medical licensure in Canada? ...
... Previous studies have found that physicians' self-reported mental health and well-being (e.g., burnout and work-life dissatisfaction) are worse compared to non-physicians [18,19]. This discrepancy may be explained by physicians' reluctance to seek care due to stigma, confidentiality concerns, fear of licensing implications, and impacts on their career development/progression [24][25][26]. In addition, a culture of self-treatment [27,28] and a preference to seek help from professionals that are not physicians (e.g., psychologists) [24] may contribute to physicians' underuse of outpatient mental health services. ...
... Finally, we found a much higher proportion of outpatient MHA visits were related to drug and alcohol use in non-physicians (approximately 20% of visits) than physicians (approximately 5% of visits). This finding may reflect lower levels of substance use among physicians or a reluctance of physicians to seek help for addictions services due to fear of licensing implications and stigma [26]. ...
Background
The Coronavirus Disease 2019 (COVID–19) pandemic has exacerbated mental health challenges among physicians and non–physicians. However, it is unclear if the worsening mental health among physicians is due to specific occupational stressors, reflective of general societal stressors during the pandemic, or a combination. We evaluated the difference in mental health and addictions health service use between physicians and non–physicians, before and during the COVID–19 pandemic.
Methods and findings
We conducted a population–based cohort study in Ontario, Canada between March 11, 2017 and August 11, 2021 using data collected from Ontario’s universal health system. Physicians were identified using registrations with the College of Physicians and Surgeons of Ontario between 1990 and 2020. Participants included 41,814 physicians and 12,054,070 non–physicians. We compared the first 18 months of the COVID–19 pandemic (March 11, 2020 to August 11, 2021) to the period before COVID–19 pandemic (March 11, 2017 to February 11, 2020). The primary outcome was mental health and addiction outpatient visits overall and subdivided into virtual versus in–person, psychiatrists versus family medicine and general practice clinicians. We used generalized estimating equations for the analyses.
Pre–pandemic, after adjustment for age and sex, physicians had higher rates of psychiatry visits (aIRR 3.91 95% CI 3.55 to 4.30) and lower rates of family medicine visits (aIRR 0.62 95% CI 0.58 to 0.66) compared to non–physicians. During the first 18 months of the COVID–19 pandemic, the rate of outpatient mental health and addiction (MHA) visits increased by 23.2% in physicians (888.4 pre versus 1,094.7 during per 1,000 person–years, aIRR 1.39 95% CI 1.28 to 1.51) and 9.8% in non–physicians (615.5 pre versus 675.9 during per 1,000 person–years, aIRR 1.12 95% CI 1.09 to 1.14). Outpatient MHA and virtual care visits increased more among physicians than non–physicians during the first 18 months of the pandemic. Limitations include residual confounding between physician and non–physicians and challenges differentiating whether observed increases in MHA visits during the pandemic are due to stressors or changes in health care access.
Conclusions
The first 18 months of the COVID–19 pandemic was associated with a larger increase in outpatient MHA visits in physicians than non–physicians. These findings suggest physicians may have had larger negative mental health during COVID–19 than the general population and highlight the need for increased access to mental health services and system level changes to promote physician wellness.
... When students confess about their problems related to mental wellbeing, they sense really worthless and mocked. However, if students considered that raising their problems would result in more assistance without stigma or labelling, they will be more incline to seek mental health care (Gold, et al., 2016). (Saleem, et al., 2013) supervised an investigation on issues related to mental health among university students in Pakistan aged 19-26 and revealed four significant features of mental health problems that were mentioned by the student's dysfunctionality, lack of confidence, insufficient self-management and an anxiety aptitude. ...
Mental health disorders, particularly depression, have become increasingly prevalent among university students worldwide, with Pakistan facing a distinct set of cultural, social, and economic challenges that exacerbate the issue. Despite the growing need, mental health remains a neglected topic in Pakistani academic institutions, often hindered by stigma, misinformation, and inadequate services.
... For healthcare professionals, lack of time is a common barrier to psychological help, especially considering that mental health support such as counselling and cognitive behavioural therapy requires numerous sessions to be effective [27,28]. Time constraints and inadequate self-monitoring strategies pose obstacles to achieving a balance between work responsibilities and personal wellbeing [29]. However, organizational support, such as flexible working hours and available mental health resources, can alleviate these pressures. ...
Background
Despite facing significant mental health risks, healthcare professionals often demonstrate a low frequency of seeking psychological support. This study aimed to explore the factors influencing healthcare professionals’ psychological help-seeking behaviours in order to enhance the mental health of this critical population.
Methods
Semi-structured interviews were conducted with registered clinical doctors, nurses, and hospital managers aged 21–55 years, recruited from comprehensive public hospitals in China. Participants were selected through purposive and snowball sampling to ensure diversity in roles, specialities, and work experiences. The interview guide was developed using the Theoretical Domains Framework (TDF) to explore the reasons for seeking psychological support. Data were analyzed using framework analysis and relevant domains were identified according to the frequency of participants’ belief statements. The facilitators and barriers in each domain were summarized using the coded reference points.
Results
A total of 34 participants were interviewed (12 nurses, 8 physicians, 14 hospital managers). We identified seven relevant domains in influencing the behaviour of seeking psychological support: knowledge, beliefs about capabilities, environmental context and resources, social/professional role and identity, emotion, social influences, and behavioural regulation. The most common facilitators of psychological help-seeking include accessible resources, positive interpersonal relationships, increased awareness, effective behavioural strategies, and emotional acknowledgement, while barriers include privacy concerns, stigma, time constraints, doubts about the effectiveness of psychological services, limited knowledge, and perceived professional role conflicts.
Conclusion
The behaviour of healthcare professionals seeking psychological support is complex and influenced by the interaction of multiple factors. The findings highlight the need for targeted interventions that enhance mental health literacy, address stigma, provide accessible psychological support resources, and cultivate a supportive organisational culture to improve their well-being.
... Reports indicate that around 50% of female physicians do not seek treatment despite recognizing that they meet the criteria for mental disorders. 7 One significant barrier is stigma, which involves prejudice and negative attitudes. 8 This stigma particularly impacts younger female healthcare workers. ...
Background/objectives
Mental health issues are prevalent among healthcare workers, but help-seeking behavior in this groups remains under-researched. The purpose of this study was to explore predictors of and barriers to mental health help-seeking among healthcare workers in Canada, compared to workers from other sectors.
Design
This quantitative study analyzed cross-sectional data from Mental Health Research Canada (MHRC) from October 2022 to January 2024.
Methods
The total sample consisted of 8,191 workers from various sectors, including 419 healthcare workers. We examined prevalence of help-seeking, barriers to accessing mental health support, and predictors of help seeking using descriptive and inferential statistics. A multivariate logistic regression analysis was performed to explore the relationship between sociodemographic factors and help-seeking.
Results
Healthcare workers were more likely to seek mental help support compared to workers from other sectors (OR 1.73, 95% CI: 1.35, 2.20). Healthcare workers least likely to seek mental health support were male (OR 0.58, CI 0.52, 0.66), residing in Quebec (OR 0.49, 95% CI: 0.41, 0.59), or of older age (OR 0.40, 95% CI: 0.30, 0.52). Key barriers to mental health help-seeking identified among healthcare workers included concerns about exposure to COVID-19 (33%), preference for self-management (25%), concerns about the safety of care options (18%), and lack of knowledge on how or where to seek help (13%).
Conclusions
This study provides valuable insight into the barriers and predictors of mental help-seeking behavior among healthcare workers. Findings underscore the need for workplaces to foster safe, supportive, and inclusive environments to better support healthcare workers facing mental health challenges.
... Attention-Deficit/ Hyperactivity Disorder (ADHD) is a condition that is diagnosed frequently in children yet symptoms often persist into adulthood with an estimated prevalence of 7.2% (95% confidence interval: 6.7 to 7.8) (Thomas et al. 2015). However, some people are never formally diagnosed with mental health conditions due to a variety of factors including social stigma and privacy concerns (e.g., Gold et al. 2016;van Beljouw et al. 2010). The physiological aspect of the condition is unrelated to neurobiological factors such as intelligence but actually driven by dopamine hormone dysregulation (Barkley and Benton 2022). ...
In Japan, much research has been conducted regarding the experiences of neurodiverse students in the language classroom with several teacher-researchers offering recommendations for how to make language classrooms more inclusive and equitable (e.g., Burke et al 2024, Plummer 2020, Sato 2021). A focus on learners is necessary if we, as language educators, are to provide neurodiverse students opportunities for academic success. However, it is also prudent to examine neurodivergence in teachers in order to understand how it affects teaching practices and perspectives on learning. Current research on the experiences of neurodiverse language teachers is scarce, with Cuervo Rodriguez and Castañeda-Trujillo (2021) and Jones and Noble (2023), providing the impetus for a mixed-methods study conducted by the authors of this paper on self-efficacy and how it affects teaching practice (Jones and Clark 2024). This paper seeks to fill the lacuna in this area and provide workplaces with concrete practical suggestions for how to support their faculty with ADHD. The paper reports initial findings of an interview study conducted with nine non-Japanese tertiary level instructors selected from the original sample (Jones and Clark 2024). The research concerns three questions: 1) How do language teachers with ADHD describe their everyday work lives? 2) What kind of supports and obstacles do language teachers with ADHD encounter in the workplace? 3) How can teachers with ADHD be better supported in the workplace? While the sample population is university teachers in Japan, findings are relevant to other settings and contexts. The findings will be of interest to administrators and educators who wish to create a working environment that is inclusive for neurodiverse teachers.
... Breast cancer is a typically diagnosed malignancy in women (Çalışkan, 2018). Breast cancer diagnosis, medical interventions and side effects present several issues for women, all of which affect their overall health (Brunault et al., 2016;Gold et al., 2016;Dheda et al., 2017;Zyga et al., 2015). The diagnosis and treatment of breast cancer may be terrifying (Dheda et al., 2017). ...
Breast cancer was supposed to induce existential issues among women. The study's major aims were to examine breast cancer patients' existential issues and coping mechanisms. The author conducted the interviews using an existential approach to capture the extent to which breast cancer women encountered existential issues. Sample was collected via purposive sampling. In Punjab, Pakistan interviews were conducted with documented breast cancer ladies. The researcher looked at numerous themes that emerged from interviews with ten women with breast cancer, all of whom were under support from the government at the time of the interview. This research was qualitative. Death anxiety, loss of control, meaninglessness, loneliness, freedom of choice, helplessness, and hopelessness were some of the existential challenges identified by reflective thematic analysis of the interview data from women living with breast cancer. And applied a lot of coping strategies against these existential issues like religiosity, sense of spirituality, improved family bounding, rescuer defense, anxiety defense mechanisms (denial, suppression, projection), distancing herself, reinterpreting the event, enhanced self-esteem, reframing the situation, sharing their experience with others, finding reasons to be hopeful, realization, reevaluation, believe on fate, acceptance, universalize the predicament, meaningful activities, counseling session helped them against existential issues.
... However, many of the research showed that women suffer more from depression compared to males in general and also during the pandemic [54][55][56]. Previous studies have identified several common reasons for reduced healthcare utilization among women, such as the belief that they can manage without medical help, lack of time, and concerns about the embarrassment or shame associated with receiving a mental health diagnosis [57]. Non-white people were found to utilize less mental healthcare services compared to white people, which is also supported by previous studies [58,59]. ...
Objectives
This study aimed to explore the change in mental health service utilization before and after the COVID-19 pandemic as well as determine the association of various sociodemographic characteristics and comorbidities on the utilization pattern.
Methods
Data from the National Health Interview Survey (NHIS) 2019 and 2022 were explored in this study. Along with the univariate analysis, bivariate analysis was conducted using the Chi-square and Cochran-Armitage trend tests. Stepwise binary logistic regression was implemented to find the best-fitted model and examine the effects of different factors on mental healthcare utilization. We also conducted a subgroup analysis for the variables that showed heterogeneous changes in utilization from 2019 to 2022.
Results
Analysis of a total of 53,856 complete cases showed that the percentage of mental healthcare utilization changed from 20% in 2019 to 23.31% in 2022. Logistic regression results showed that the odds of mental health service utilization in the post-COVID period is 1.41 times of the pre-COVID [95% CI odds ratio (OR) = (1.26, 1.58)]. Sex, age, race, education, income group, insurance coverage, birth country, marital status, limitations of social functioning, having a place for healthcare, symptoms and history of depression/anxiety, diabetes, and hypertension had significant effects on the odds of receiving mental healthcare. Subgroup analysis revealed that the utilization changed significantly from 2019 to 2022 for age group “18–34” [OR = 1.41, 95% CI = (1.26, 1.58)], “35–49” [OR = 1.35, 95% CI = (1.21, 1.50)], and “50–64” [OR = 1.12, 95% CI = (1.01, 1.24)], while for the age group “above 64” was not significant.
Conclusion
Pre- and post-COVID periods were found to be significantly different in terms of the utilization of mental healthcare utilization. Changes in the utilization was also found to differ in terms of different age groups.
... However, navigating the complex and multifaceted mental health landscape demands a delicate balance between professional demands and societal expectations. Several factors, including a strong preference for self-reliance, a low perceived need for help, stigma, and a lack of awareness, often hinder the health workforce from seeking help, leading to unaddressed mental health concerns that are perpetuated over time [4][5][6][7]. ...
Introduction
Ensuring the mental well-being of the health workforce is important in maintaining a robust healthcare system. This paper aims to describe the development of PsyHELP pocket guide and its potential to encourage the health workforce to recognise and seek help from mental health professionals for their mental health concerns.
Method
Developed with the Health Belief Model (HBM) as its theoretical framework, this PsyHELP pocket guide integrates theoretical and practical strategies, employing a user-centric design that combines text, visuals, and interactive elements, such as QR codes linked to animation videos, to enhance engagement and accessibility. The content development involved a thorough literature review and was structured to align with the HBM, addressing various constructs that influence help-seeking.
Result
The PsyHELP pocket guide series, conceptualised as multiple pocket guides, begins with foundational information about mental health and progresses to offer actionable strategies tailored for the health workforce. It addresses vital mental health concepts, combating stigma, recognising the need for professional help, and providing steps towards mental well-being, ensuring a comprehensive approach to mental health awareness and action among the health workforce.
Conclusion
The PsyHELP pocket guide stands out as a promising resource, aiming to enhance mental health awareness and encourage help-seeking behaviours among the health workforce, fostering a supportive and mentally healthy work environment.
... What was unexpected was that consumers also perceived this as crucial, which contrasts with the prevailing notion within the consumer movement. The common belief within the movement suggests that diagnosis often leads to stigmatisation and impedes treatment (Gold et al., 2016;. A large study by Hazell et al. (2022) reported that diagnoses such as schizophrenia and personality disorder were subject to the greatest stigma with anxiety having less stigma. ...
Preparing enrolled nurses (ENs) to effectively work with mental health consumers is crucial to meeting Australia's healthcare demands. This qualitative study aimed to explore various stakeholders’ perceptions regarding the mental health knowledge, skills, and attributes (KSAs) required by ENs to engage with individuals experiencing mental health issues, thus guiding future training priorities. The sample comprised 44 participants including 18 students, 3 graduate ENs, 5 experienced ENs, 5 registered nurses (RNs), 4 nurse unit managers (NUMs), 5 teachers, and 5 consumers of mental health services. Focus groups were used to collect data from the students, whilst individual interviews were conducted with all other participants. A thematic analysis revealed communication was the most vital skill for effectively working with mental health consumers. Skills such as critical thinking and clinical reasoning were also deemed crucial, given the volatile nature of the mental health inpatient environment, necessitating effective responses to acute escalations to prevent adverse outcomes for both staff and consumers. Essential knowledge components included understanding mental health disorders, symptoms, and treatments, particularly medications used for mental health issues. Participants also emphasised the importance of attributes like confidence and empathy in supporting and caring for consumers, who often experienced trauma and vulnerability. These findings provide valuable insights into the content that should be incorporated into the diploma of nursing (DN) training to produce competent graduate ENs.
... Not only are surgeons fighting professional expectations and stereotypes, but also stigmas bred as early as medical school that may prevent those that need help from speaking up. 6,7 Fear of persecution is compounded by perception of appearing 'weak' or 'unfit' to practice medicine by colleagues, employers, and leadership. Medical professionals who have a documented current or prior mental health diagnosis can face scrutiny by state medical licensing boards despite recommendations by the Federation of State Medical Boards (FSMB) to remove such questions from medical licensing. ...
... Healthcare workers (HCW) represent an important occupational group at elevated risk for mental disorders (McFarland et al., 2019) compared to the general population (Petrie et al., 2019) and this risk increases during pandemics (Hill et al., 2022), including the COVID-19 pandemic (Dragioti et al., 2022). HCW often neglect to seek help for mental disorders (Gold et al., 2016) due to concerns about stigma, confidentiality and professional retaliation (Dunn et al., 2009) and these delays in help-seeking lead to greater mental health (co)morbidity (Michel et al., 2018), impaired work functioning, general medical and medication errors, patient safety issues, and low patient satisfaction (Fahrenkopf et al., 2008;Gärtner et al., 2010;Anagnostopoulos et al., 2012). ...
... [2][3][4][5] Stigma and fear of job security create tremendous barriers to reporting and seeking help. 6,7 Increasing rates of untreated mental illness and substance use disorders, both risk factors for suicidal ideation, likely perpetuate 300 physician deaths by suicide each year in the United States. 8,9 Surgeons have one of the highest suicide rates among physicians. ...
Objective
To characterize the current state of mental health within the surgical workforce in the United States (US).
Summary Background Data
Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown.
Methods
Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed.
Results
Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P <0.001), anxiety (31.6% vs. 16.2%, P =0.001), PTSD (12.8% vs. 5.6%, P =0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P =0.022). 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past two weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P =0.033), and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P <0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P =0.002) were associated with increased odds of suicidal ideation over the past 12 months.
Conclusions
Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the US.
... Reasons for exclusion of the other seven articles were: no digital component was involved (n = 4) and no primary research article (n = 2) or only a study protocol was published (n = 1). One article described a process evaluation of a study with no results included (42). The primary research article was searched and included into the scoping review (37). ...
Aim
Healthcare professionals are at increased risk of burnout, primarily due to workplace-related stressors. The COVID-19 pandemic has further increased this risk. Different interventions exist with varying degrees of effectiveness; little is reported on the content and implementation of such programs. This review fills this gap, with attention to recent programs using digital components.
Methods
PubMed, Embase, PsycInfo, and Google Scholar were searched between January 24th and 28th, 2022, limited to the last 5 years (≥2017). Articles were included if they (1) focused on stress reduction or burnout prevention for nurses and medical doctors within workplace health promotion for nurses or medical doctors, (2) included a digital program component, (3) were conducted in high-income country contexts, and (4) were clinical studies published in English or German. Data was extracted using a priori designed spreadsheets. A group of at least 2 authors at each stage carried out the screening, selection, and data extraction.
Results
The search strategy identified 153 articles, all except 7 were excluded. Two studies were conducted in the USA, two in Spain, one in the Netherlands, Poland, and Korea each. Four studies used a randomized study design, all but one had a control group. A wide range of outcome measures was used. The types of interventions included an adapted mindfulness-based stress reduction program combined with aspects of behavioral therapies, cognitive behavioral therapy, or acceptance and commitment therapy. The digital components used were apps (4 studies), a digital platform, blended learning, and a web-based intervention (1 study each). Six studies focused on individual interventions, one included organizational interventions.
Conclusion
Despite an acute burnout crisis in the healthcare sector, only seven recent interventions were found that integrated digital components. Several problems emerged during the implementation of the interventions that made it clear that organizational support is urgently needed for successful implementation. Although interventions for stress reduction and burnout prevention should combine individual and organizational measures to be as successful as possible, this was only partially the case in one of the intervention programs. The results of this scoping review can be used to further develop or optimize stress and burnout prevention programs.
... 14 Second, as has been shown in previous research, there is still a stigma among HCPs (physicians) towards sharing potential mental health issues and seeking support, particularly to avoid a diagnosis of adverse mental health. 40 However, it has been well established that suicide risk is higher among HCPs Moderate burnout 58 (23) High burnout 31 (13) Emotional exhaustion (n=250) ...
... In the literature, one of the main protective factors against PTSS remains seeking social support in the form of talking with a friend or colleague, be it formally or informally (33,37,39,57,59,(67)(68)(69)(70)(71). However, both in the literature and in the current interviews, one of the main barriers to seeking support is the fear to be perceived as "weak" and being stigmatized as not being able to perform the job (25,39,(72)(73)(74)(75). This attitude may lead to the idea that extremely stressful and untreated potentially traumatizing events are the norm rather than the exception (41,57) and, in extremis, could nurture feelings of indifference and compassion fatigue (76-78). ...
Introduction
Emergency Medicine (EM) personnel in both military and civilian prehospital settings are often exposed to stressful and extreme events. Therefore, a cross-pollination between both contexts in terms of coping strategies may generate new information for purposes of training, prevention, and support programs. In the current study, we aimed at comparing both contexts to understand the type of stress events personnel experience; whether experience differs between civilian and military personnel; and how they cope with it.
Methods
We used a mixed method approach, combining the results of a quantitative questionnaire and a thematic analysis of 23 in-depth semi-structured interviews to gain additional qualitative information.
Results
Whereas the questionnaire pointed to a significant preference for task-oriented coping over avoidant and emotion-oriented coping, the interviews offered a more nuanced insight, showing a constant aim to position themselves on a continuum between emotional disconnection from the patient to preserve operationality on the one hand; and remaining enough empathic to preserve humanity on the other hand. We further identified an ambivalent awareness regarding emotions and stress, a vulnerable disbalance between an excessive passion for the job with the sacrifice of own's personal life (for a growing volatile and dangerous working environment) and a lack of recognition from both the patient and organizational environment. The combination of these factors may carry the risk for moral injury and compassion fatigue. Therefore, mutual trust between the organizational level and EM personnel as well as among team members is crucial.
Discussion
The results are discussed from a systemic SHELL perspective, indicating how the specific profile of EM personnel relates to the software, hardware, environmental and liveware components of their professional and private life. Trainings on stress- and risk awareness should be approached both on an individual and systemic level, knowing that there is clearly no “one-size-fits-all” manner.
... 29 In a study of women physicians, 46% did not know whether their license application queried current mental health diagnoses or treatment. 30 In the same study, the vast majority (94%) reported not disclosing diagnoses because they felt their condition did not affect care or pose a safety risk for patients, while approximately a quarter to half of women worried about licensure, follow-up paperwork, referral to a Physician Health Program, or privacy. Nearly half of the women in the study reported not seeking treatment to avoid having to report to their care to medical boards. ...
In this series of three manuscripts, we will explore real-life scenarios encountered by clinicians, learners, and researchers in healthcare, which challenge our assumptions and our understanding of how to navigate issues as diverse as mental health, racial diversity, gender discrimination, imposter syndrome, and substance use disorder.
... This can make discussing mental health issues difficult [42,43]. When dealing with mental health issues, hospital staff may worry that coming forward about mental issues could have negative consequences including social exclusion or being seen as weak or less competent [43,44]. Such effects have been evidenced, both within and outside of healthcare settings [42]. ...
Background
Psychosocial support programs are a way for hospitals to support the mental health of their staff. However, while support is needed, utilization of support by hospital staff remains low. This study aims to identify reasons for non-use and elements that are important to consider when offering psychosocial support.
Methods
This mixed-method, multiple case study used survey data and in-depth interviews to assess the extent of psychosocial support use, reasons for non-use and perceived important elements regarding the offering of psychosocial support among Dutch hospital staff. The study focused on a time of especially high need, namely the COVID-19 pandemic. Descriptive statistics were used to assess frequency of use among 1514 staff. The constant comparative method was used to analyze answers provided to two open-ended survey questions (n = 274 respondents) and in-depth interviews (n = 37 interviewees).
Results
The use of psychosocial support decreased from 8.4% in December 2020 to 3.6% by September 2021. We identified four main reasons for non-use of support: deeming support unnecessary, deeming support unsuitable, being unaware of the availability, or feeling undeserving of support. Furthermore, we uncovered four important elements: offer support structurally after the crisis, adjust support to diverse needs, ensure accessibility and awareness, and an active role for supervisors.
Conclusions
Our results show that the low use of psychosocial support by hospital staff is shaped by individual, organizational, and support-specific factors. These factors can be targeted to increase use of psychosocial support, whereby it is important to also focus on the wider hospital workforce in addition to frontline staff.
... 14 Second, as has been shown in previous research, there is still a stigma among HCPs (physicians) towards sharing potential mental health issues and seeking support, particularly to avoid a diagnosis of adverse mental health. 40 However, it has been well established that suicide risk is higher among HCPs Moderate burnout 58 (23) High burnout 31 (13) Emotional exhaustion (n=250) ...
Objective To explore the prevalence of symptoms of mental health conditions and burnout of healthcare professionals (HCPs) working during the Tokyo 2020 Paralympic Games and the Beijing 2022 Paralympic Winter Games.
Methods In this cross-sectional, observational study, HCPs working during the Tokyo 2020 and Beijing 2022 Paralympic Games were asked to complete an online, anonymous survey, which included demographic questions and questions regarding mental health symptoms including depression (Patient Health Questionnaire 9-item depression scale) and anxiety (Generalized Anxiety Disorder 7-item scale) as well as burnout (Maslach Burnout Inventory-Human Services Survey: depersonalisation, emotional exhaustion, personal accomplishment). Correlation coefficients (r) were calculated between demographic characteristics and mental health symptoms.
Results In total, 256 HCPs (of 857 HCPs; 30%) completed the surveys. Twelve and eight per cent of HCP scores fell within the moderate to severe depression and moderate to severe anxiety categories, respectively. More than 30% reported moderate to high burnout (depersonalisation: 36%; emotional exhaustion: 36%; personal accomplishment: 58%). In addition, thoughts of self-harm and/or suicidality were reported by some HCPs (8%). Weak correlations were observed between age and depression (r=−0.13, p=0.046), anxiety (r=−0.16, p=0.010) and burnout (emotional exhaustion: r=−0.14, p=0.032; personal accomplishment: r=0.27, p<0.001).
Conclusion Although most HCPs reported good mental health, this study suggests that a subset of HCPs experienced symptoms of depression, anxiety, burnout or thoughts of self-harm during the Tokyo 2020 and Beijing 2022 Paralympic Games. While the generalisability of these findings outside of COVID-19 restrictions should be tested, appropriate guidance and mental health support of HCPs leading up to the Paralympic Games should be prioritised.
... April Doctors' own attitudes may be the reason for their hesitancy in seeking professional help for psychological or behavioral health problems. A survey of United States female physicians revealed that almost 50% believed that they fit the criteria for mental illness although they had not sought treatment [51]. The main reasons for avoiding care included limited time, the belief that diagnosis was embarrassing or shameful, fear of reporting to a medical licensing board, and a belief that they could independently manage their illness. ...
Medical practitioners' duties are highly stressful and performed in a particularly challenging and competitive work environment. Stress and burnout among physicians have emerged as a worldwide public health problem in recent years. A high level of distress and burnout can lead to clinically significant behavioral health problems, such as stress-related psychiatric disorders. Mounting evidence shows that physicians have higher risks of insomnia, anxiety, and depression than the general population, especially during the coronavirus disease 2019 pandemic. However, the behavioral health problems of these vulnerable healthcare professionals are noteworthy for being underrecognized and undertreated. In this mini-review, we summarize the current progress of studies on the prevalence and determinants of distress and stress-related psychiatric disorders among phy-sicians and their healthcare-seeking behaviors. We discuss future research directions and the clinical approach that may maximize self-awareness and promote prompt and adequate treatment for clinically significant behavioral health problems of physicians.
... Doctors' reluctance to seek formal health care, especially with regard to mental health difficulties, has been well documented [16,[53][54][55][56][57]. This is further confirmed in this study by the fact that doctors seek psychiatric expertise in the context of a peer support service that explicitly does not offer medical treatment. ...
Background
Doctors’ health is of importance for the quality and development of health care and to doctors themselves. As doctors are hesitant to seek medical treatment, peer support services, with an alleged lower threshold for seeking help, is provided in many countries. Peer support services may be the first place to which doctors turn when they search for support and advice relating to their own health and private or professional well-being. This paper explores how doctors perceive the peer support service and how it can meet their needs.
Materials and methods
Twelve doctors were interviewed a year after attending a peer support service which is accessible to all doctors in Norway. The qualitative, semi-structured interviews took place by on-line video meetings or over the phone (due to the COVID-19 pandemic) during 2020 and were audiotaped. Analysis was data-driven, and systematic text condensation was used as strategy for the qualitative analysis. The empirical material was further interpreted with the use of theories of organizational culture by Edgar Schein.
Results
The doctors sought peer support due to a range of different needs including both occupational and personal challenges. They attended peer support to engage in dialogue with a fellow doctor outside of the workplace, some were in search of a combination of dialogue and mental health care. The doctors wanted peer support to have a different quality from that of a regular doctor/patient appointment. The doctors expressed they needed and got psychological safety and an open conversation in a flexible and informal setting. Some of these qualities are related to the formal structure of the service, whereas others are based on the way the service is practised.
Conclusions
Peer support seems to provide psychological safety through its flexible, informal, and confidential characteristics. The service thus offers doctors in need of support a valued and suitable space that is clearly distinct from a doctor/patient relationship. The doctors’ needs are met to a high extent by the peer-support service, through such conditions that the doctors experience as beneficial.
(1) Background: Physicians and medical students face unique barriers balancing career progression and their mental health. Some medical schools and residency programs have described interventions in which senior clinicians, residents, or medical students disclose their experiences with mental health diagnosis and treatment to peers, students, and those junior in training status. (2) Methods: The authors conducted a scoping review to describe how medical training environments incorporate the self-disclosure of mental health diagnosis and treatment by senior clinicians to junior trainees. They searched six databases and hand-searched references from relevant publications. Following Arksey and O’Malley’s steps for scoping reviews, at least two reviewers independently screened all publications for eligibility and extracted data from included publications. (3) Results: A total of 2326 unique publications were identified; eight were included. Psychiatry was the medical specialty most represented by physician–authors. One publication described an intervention that impacted learner’s behaviors, while the remainder (n = 7) focused on participant satisfaction. (4) Conclusions: Research aims often sought to describe behavior changes. However, most (n = 7) of the literature included in this study did not present the behavioral outcomes of implementing these interventions. This study aims to direct future research into the role of mental health history self-disclosure in medical training environments.
Introduction: Despite the availability of various treatments for anxiety and depression, the diagnosis, treatment, and care-seeking are very low in Bangladesh, which can have effects on both individual and societal levels. We explored the situation and factors associated with the diagnosis, treatment, and care-seeking of anxiety and depression among reproductive-aged women in Bangladesh.
Methodology: We utilized data from the Bangladesh Demographic and Health Survey (BDHS), 2022. Diagnosis (ever told by a healthcare provider), treatment (took prescribed medicine), and care-seeking (who have ever sought help) were outcome variables. We used log-binomial logistic regression to explore the factors associated with diagnosis, treatment, and care-seeking of anxiety and depression.
Findings: Among all respondents, 3.39% were diagnosed with anxiety, 0.56% were diagnosed with depression by a provider, and only 2.0% received treatment, with 7.9% seeking help from a doctor or medical personnel. Compared to women aged 15-19, diagnosis and care-seeking were significantly higher among women aged 20-49. Significant regional variations were observed for treatment and care seeking. Women with a positive attitude towards wife beating had significantly higher levels of diagnosis (PR=1.28, CI: 1.06, 1.45, p=0.008), treatment (PR=1.50, CI: 1.17, 1.92, p=0.001), and care-seeking (PR=1.52, CI: 1.34, 1.72, p<0.001) than others. Middle class (PR=1.19, CI: 1.00, 1.41, p=0.046) and working women (PR=1.22, CI: 1.09, 1.38, p=0.001) had a higher, and women who didn't use the internet (PR=0.67, CI: 0.59, 0.77, p<0.001) had a lower prevalence of care-seeking.
Conclusion: Policy actions should be taken to reduce the stigma towards asking for and receiving help for common mental health disorders and create a specialized department in government hospitals. Internet and social media can be used strategically for this, and special focus should be given to women suffering from intimate partner violence.
This chapter reviews the literature on a sample of occupations commonly reported to have an increased suicide risk, based on systematic reviews population-based surveillance, and U.S. government reports. These occupations include: first responders, veterinarians, construction workers, healthcare workers, and the military. This chapter primarily focuses on U.S. studies and highlights some of the risk and protective factors associated with suicide among these five occupations. While there are no legal requirements in the U.S. that require individuals to report suicides or a mandatory reporting requirement, there are, however, two distinct federal data systems that capture suicides—The National Violent Death Reporting System (NVDRS) and the Census of Fatal Occupational Injuries. The NVDRS collects data on all violent deaths as defined as “a death resulting from the intentional use of physical force or power against oneself, another person, or against a group or community.“ The NVDRS data collection began in 2003 with six participating states and has expanded over time. The Centers for Disease Control and Prevention (CDC) now provides NVDRS funding to all 50 states, the District of Columbia, and Puerto Rico. The CFOI is a Federal-State cooperative program implemented in all 50 States and the District of Columbia since 1992 to compile counts of fatal work injuries. CFOI only includes suicides that occur in a workplace.
There are numerous risks of untreated burnout, including downstream mental health concerns, patient safety issues, and increased costs to the United States healthcare system. Family medicine physicians are heavily impacted by burnout, and faculty physicians and residents are at greater risk than most. Widespread stigma and licensing concerns are significant barriers to seeking help. Residency training programs have a responsibility to address the well-being of their trainees according to the Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements. There is a wide array of evidence-based tools for both individual and residency-wide well-being promotion, as well as recommendations on how to assist a colleague with a mental health concern, including possible impairment. Cultural change within the medical profession is desperately needed, and residencies are well-positioned to train well physicians who can help lead this change.
Physician impairment represents a substantial concern for the medical community, not only for the individual, but for their patients as it can lead to an increase in medical errors. Impairment is wide ranging and includes physical, mental, and behavioral disorders. The Federation of State Medical Boards in conjunction with the American Medical Association have worked with state medical boards to help create Physician Health Programs. Despite physicians having mental disorders and substance use disorders comparable to the general population, many clinicians avoid seeking treatment due to concerns related to their medical license. This article discusses common presentations of impaired physicians, mandated reporting, and ways to reduce stigma for clinicians treating physicians. [ Psychiatr Ann . 2025;55(3):e62–e66.]
Total wellness (mental and physical health) is a core element and a foundational pillar in the mental health counseling field. The counseling literature is lacking research on supporting physicians in the United States, who are a unique population facing complex mental and physical health issues. Health-based screening has notable utility for monitoring and promoting physician wellness. However, the literature is missing a package of health-based screeners with valid scores among a normative sample of U.S. physicians. We tested the psychometric properties of the following wellness-based screeners with a national sample of U.S. physicians: Mental Health Inventory–5, Lifestyle Practices and Health Consciousness Inventory–2, and Inner Wealth Inventory. Results revealed support for convergent validity and factorial invariance of physicians’ scores on all three screeners by gender identity and help-seeking history. We offer recommendations for how these wellness-based screeners can edify the practice of mental health counselors when working with physician clients.
Introduction
Suicide rates for healthcare workers, coupled with mental health challenges, continue to increase in the USA. This study aimed to assess how the Interactive Screening Programme (ISP) is being used by US healthcare employees and how ISP counsellors’ use of motivational interviewing (MI) techniques was associated with employee help-seeking outcomes.
Methods
We used a retrospective one-group study to analyse secondary deidentified ISP interactive counselling dialogue (written communications between the ISP counsellor and ISP user) (time frame 2009–2019) from 5922 healthcare employees at 15 US workplaces. Help-seeking outcomes included referral requests, commitment to mental health services and improved willingness to seek mental health services. Key exposures included counsellors’ use of MI techniques.
Results
45% of ISP users scored in high distress on their ISP screening. Among ISP users in high distress, over 25% engaged in ISP dialogue and 63% of those who engaged in dialogue requested a referral. Bivariate analysis showed ISP users more likely to request referrals included women, younger employees, those with higher distress levels and those not currently receiving mental health services. Counsellors’ use of the MI technique, asking questions, was associated with approximately three times the odds of requesting referral (OR=3.12, p<0.001), higher odds of service commitment (OR=2.18, p<0.001) and improved willingness towards services (OR=2.21, p<0.001), compared with no questions asked during ISP dialogue. Asking questions also demonstrated a large effect size for all three dependent variables.
Conclusion
Results support the use of the MI techniques, especially asking questions, with ISP dialogue to encourage healthcare employees’ mental health help-seeking.
Background
National and international policies on parental leave for physician trainees are inconsistent. Physician trainees, including nephrology fellows, may be at higher risk of pregnancy complications. Physician trainees face barriers in meeting their breastfeeding goals and in finding childcare due to nontraditional work hours with extended or unpredictable shifts. Here, we examine awareness of current policies in United States (US) nephrology fellowship programs regarding parental leave, pregnancy/breastfeeding accommodations, and fellows’ perspectives on family planning.
Methods
An anonymous, on-line survey of US nephrology fellows was undertaken from June 9 to August, 24, 2023.
Results
One hundred twenty nephrology fellows submitted the survey. A majority of fellow respondents were unaware of parental leave policies of their training programs (63%), Accreditation Council for Graduate Medical Education (ACGME) (75%), and/or American Board of Medical Specialties(ABMS) (75%). Forty two percent were unaware of the duration of parental leave at their program. Nearly 45% of all respondents were unsure if their program limited night shifts or shifts greater than 24 hours for pregnant trainees. Forty three percent reported they were unsure of lactation accommodations, and 40% were unsure of access to subsidized childcare. When fellows received work accommodations for pregnancy or parenthood, their work obligations were largely covered by co-fellows (60%) or attendings (38%). Over 60% of fellows agreed or strongly agreed that they would avoid a pregnancy in fellowship due to concern they would have to extend their training. Of the 40 fellows who chose to pursue pregnancy or parenthood during medical training, 75% did not change their career plans as a result.
Conclusions
Most nephrology fellows were unaware of parental leave policies and pregnancy/lactation accommodations. While the topic itself has a broad impact to all physician trainees, there is need for improved awareness about national and local program policies among trainees across individual nephrology programs.
Importance
Physicians are exposed to high stress and strain that results in burnout, which affects them, their families, their patients, and the entire health care system; thus, there is an urgent need to develop methods to increase the resiliency of physicians. Sudarshan Kriya Yoga (SKY) is a comprehensive yoga breathing and meditation-based program that is a potential approach to mitigate physician burnout.
Objective
To determine whether SKY can reduce psychological distress and improve wellness in physicians.
Design, Setting, and Participants
This randomized clinical trial assessed the potential efficacy of SKY compared with a stress management education (SME) training as control. This study was conducted online from November 11, 2021, to March 14, 2022, and included physicians from Turkey, Germany, and Dubai. Both the SKY and the SME control groups received 1.5 hours of training for 3 consecutive days via a group video conference call. Participants were physicians willing to do some form of relaxation exercise everyday for 2 months. Exclusion criteria included presence of major illness and maintaining a regular mind-body program practice. Statistical analysis took place from March to November 2023.
Interventions
Participants were randomly assigned 1:1 into 2 groups—the SKY group or the SME (control) group—using a computer algorithm. After the 3-day instruction period, the participants in the SKY group practiced for approximately 30 minutes per day on their own and participated in a weekly 1-hour, group-based online follow-up practice. After the 3-day instruction period, participants in the SME group reviewed and applied the notes from stress management education training at their initiative and had a weekly 1-hour group-based online follow-up session.
Main Outcomes and Measures
The primary outcomes were stress and depression (measured by the 42-item Depression, Anxiety, and Stress Scale [DASS-42]) and insomnia measured by the Regensburg Insomnia Scale (RIS) with primary end point at 8 weeks. Secondary outcomes included anxiety (DASS-42); optimism (Life Orientation Test-Revised [LOT-R]); professional fulfillment, work exhaustion, interpersonal disengagement, and overall burnout (Professional Fulfillment Index [PFI]); and self-reported professional errors (Self-Reported Professional Error Questionnaire).
Results
This study included 129 participants (SME, 63 participants [48.9%]; SKY, 66 participants [51.1%]; 115 females [89.2%]; 14 males [10.8%]; mean [SD] age, 46.2 [9.0] years). Compared with the SME control group, participants in the SKY group had significantly decreased stress on the DASS-42 at posttraining (difference, −6.8 points; 95% CI, −9.6 to −4.1 points; P = .006) and at postintervention (difference, −6.0 points; 95% CI, −8.8 to −3.3 points; P = .03), significantly decreased depression at posttraining (difference, −5.7 points; 95% CI, −8.6 to −2.8 points; P < .001) and postintervention (difference, −5.4 points; 95% CI, −8.3 to −2.5 points; P < .001), and significantly decreased anxiety at postintervention. In addition, there was a significant decrease in insomnia from baseline to postintervention in the SKY group (difference, −0.3 points; 95% CI, −2.3 to 1.7 points; P = .01). The SKY group also showed significantly increased professional fulfillment as well as significant decreases in work exhaustion, interpersonal disengagement, and burnout. There was no effect on self-reported medical errors.
Conclusions and Relevance
In this randomized clinical trial, physicians who regularly practiced SKY throughout a 2-month period experienced improvements in wellness and decreased burnout. These data suggest that SKY may be an effective, practical, and safe strategy to increase wellness and mitigate burnout in physicians.
Trial Registration
ClinicalTrials.gov Identifier: NCT05956470
This cross-sectional study evaluates the consistency of US medical license renewal applications with the Federation of State Medical Boards recommendations for questions regarding physician mental health.
Specific causes of mortality among various types of health care professionals (HCPs), including those characterized by age, gender, and race, have not been well described. The National Occupational Mortality Surveillance data for deaths in 26 US states in 1999, 2003-2004, and 2007-2014 were queried to address this question. Proportionate mortality ratios (PMRs) were calculated to compare specific causes of mortality among HCPs compared with those among the general population. HCPs were less likely to die from heart disease (PMR 93, 95% confidence intervals [CI] 92-94), alcoholism (PMR 62, 95% CI 57-68), drugs (PMR 80, 95% CI 70-90), and more likely to die from cerebrovascular disease (PMR 105, 95% CI 104-107) and diabetes (PMR 107, 95% CI 105-109). HCPs aged 18-64 years were more likely to die by suicide (PMR 104, 95% CI 101-107), whereas those aged 65-90 years were less likely to die by suicide (PMR 84, 95% CI 77-91), with physicians (PMR 251, 95% CI 229-275) and other HCPs having high PMR for suicide. Among all HCPs, suicide PMR was similarly increased, whereas heart disease PMRs are similarly decreased among Black compared with those among White HCPs and those among male compared with those among female HCPs. HCPs as a group and specific types of HCPs demonstrate causes of mortality that differ in important ways from the general population. Race and gender-based trends in PMRs for key causes of mortality among HCPs suggest that employment in a health care field may not alter race and gender disparities noted among the general population.
The COVID-19 pandemic is over, but US healthcare workers (HCWs) continue to report high levels of work-related exhaustion and burnout but are unlikely to seek help. Digital tools offer a scalable solution. Between February and June 2022, we surveyed Missouri hospital administrators to assess HCW mental health and identify related evidence-based or evidence-informed resources. Simultaneously, we conducted a digital survey and focus groups with HCWs and leaders at Washington University School of Medicine (WUSOM) in St. Louis to evaluate HCW mental health needs, and preferences for digital support. Here, we describe the results and subsequent development of the Gateway to Wellness (G2W) program, a digital precision engagement platform that links HCWs to the most effective tailored resources for their mental health needs.
Introduction
Physicians die by suicide at rates higher than the general population, with the increased risk beginning in medical school. To better understand why, this study examined the prevalence of mental distress (e.g., depressive symptoms and suicide risk) and behavioral and psychosocial risk factors for distress, as well as the associations between mental distress and risk factors among a sample of medical students in a pre–COVID-19-era.
Methods
Students enrolled in a large California medical school in 2018–2019 (N = 134; 52% female) completed questionnaires assessing sociodemographic characteristics, depression and suicide family history, health behaviors, and psychosocial wellbeing. Assessment scores indexing mental distress (e.g., depressive symptoms, thoughts of suicide in the past 12 months, suicide risk, and history of suicidality) and risk factors (e.g., stress, subjective sleep quality, alcohol use, impostor feelings, and bill payment difficulty) were compared across biological sex using chi-squared tests, and associations between mental distress and risk factors were determined through logistic regression.
Results
Elevated mental distress indicators were observed relative to the general public (e.g., 16% positive depression screen, 17% thought about suicide in previous 12 months, 10% positive suicide risk screen, and 34% history of suicidality), as well as elevated risk factors [e.g., 55% moderate or high stress, 95% at least moderate impostor feelings, 59% poor sleep quality, 50% screened positive for hazardous drinking (more likely in females), and 25% difficulty paying bills]. A positive depression screen was associated with higher stress, higher impostor feelings, poorer sleep quality, and difficulty paying bills. Suicidal ideation in the previous 12 months, suicide risk, and a history of suicidality were independently associated with higher levels of impostor feelings.
Discussion
Higher scores on assessments of depressive symptoms and suicidal thoughts and behaviors were related to several individual-level and potentially modifiable risk factors (e.g., stress, impostor feelings, sleep quality, and bill payment difficulties). Future research is needed to inform customized screening and resources for the wellbeing of the medical community. However, it is likely that the modification of individual-level risk factors is limited by the larger medical culture and systems, suggesting that successful interventions mitigate suicide risk for medical providers need to address multiple socio-ecological levels.
How do coaches make decisions when they become concerned about a client's mental health needs? Using a Grounded Theory approach, this U.S. based study explored key decisions made by 12 experienced coaches of physicians; a group of highly stressed professionals more likely to engage in coaching than therapy. Findings included a theory describing how coaches recognise mental health needs and make decisions about how to respond, without attempting to diagnose or treat any psychological condition. This theory, called the Decision Bridge, has general coaching implications, as well as practical application for coaching distressed physicians.
Substance use disorder is often met with stigma, which delays the diagnosis and treatment of the disease. Health-care professionals are no exception, and likely face greater barriers than the general public in getting help. As trusted professionals who serve the public, nurses and doctors are rewarded for being strong, resilient, unbreakable, and dependable. Solutions to stopping the stigma start with education, advocacy, support and a look into one's own prejudices. Clear workplace and licensing guidelines that focus on treatment rather than punishment contributes to successful rehabilitation of the health-care professional including return to work and ultimately public safety.
Objective: Physicians ' suicide rates have repeatedly been reported to be higher than those of the general population or other academics, but uncertainty remains. In this study, physicians ' suicide rate ratios were estimated with a meta - analysis and systematic quality ...
As part of their ongoing effort to protect the public, the nation's 70 state and territorial medical and osteopathic boards regularly collect and disseminate information about actively licensed physicians in their jurisdictions to the FSMB's Federation Physician Data Center. This article summarizes results from the first-ever comprehensive analysis by FSMB of this information, from state boards and additional sources, to present a census of actively licensed physicians in the United States and the District of Columbia in 2010. While noting the value to state boards and multiple stakeholders of an accurate count of physicians - including information about their gender, age, specialty certification and location by region-the article acknowledges opportunities for future collaboration among organizations and agencies to better define current physician supply in order to better predict future physician needs for a growing and aging national population.
Physicians in training are at high risk for depression, and physicians in practice have a substantially elevated risk of suicide compared to the general population. The graduate medical education community is currently mobilizing efforts to improve resident wellness.
We sought to provide a trainee perspective on current resources to support resident wellness and resources that need to be developed to ensure an optimal learning environment.
The ACGME Council of Review Committee Residents, a 29-member multispecialty group of residents and fellows, conducted an appreciative inquiry exercise to (1) identify existing resources to address resident wellness; (2) envision the ideal learning environment to promote wellness; and (3) determine how the existing infrastructure could be modified to approach the ideal. The information was aggregated to identify consensus themes from group discussion.
National policy on resident wellness should (1) increase awareness of the stress of residency and destigmatize depression in trainees; (2) develop systems to identify and treat depression in trainees in a confidential way to reduce barriers to accessing help; (3) enhance mentoring by senior peers and faculty; (4) promote a supportive culture; and (5) encourage additional study of the problem to deepen our understanding of the issue.
A multispecialty, national panel of trainees identified actionable goals to broaden efforts in programs and sponsoring institutions to promote resident wellness and mental health awareness. Engagement of all stakeholders within the graduate medical education community will be critical to developing a comprehensive solution to this important issue.
In their efforts to protect the public from impaired professionals, licensure boards often have created special rules for applicants with mental disorders. The authorities in charge of admission to the Louisiana bar required extensive disclosure of mental health status, even if an applicant's professional functioning was not impaired. After the U.S. Department of Justice found that Louisiana's practices violated applicants' rights under the Americans with Disabilities Act, the state agreed to focus on applicants' functional impairment rather than on mental disorders. This settlement may provide a model for licensure boards in other states and for other professions, including the health professions.
Individuals often avoid or delay seeking professional help for mental health problems. Stigma may be a key deterrent to help-seeking but this has not been reviewed systematically. Our systematic review addressed the overarching question: What is the impact of mental health-related stigma on help-seeking for mental health problems? Subquestions were: (a) What is the size and direction of any association between stigma and help-seeking? (b) To what extent is stigma identified as a barrier to help-seeking? (c) What processes underlie the relationship between stigma and help-seeking? (d) Are there population groups for which stigma disproportionately deters help-seeking? Method Five electronic databases were searched from 1980 to 2011 and references of reviews checked. A meta-synthesis of quantitative and qualitative studies, comprising three parallel narrative syntheses and subgroup analyses, was conducted.
The review identified 144 studies with 90��189 participants meeting inclusion criteria. The median association between stigma and help-seeking was d��=�������0.27, with internalized and treatment stigma being most often associated with reduced help-seeking. Stigma was the fourth highest ranked barrier to help-seeking, with disclosure concerns the most commonly reported stigma barrier. A detailed conceptual model was derived that describes the processes contributing to, and counteracting, the deterrent effect of stigma on help-seeking. Ethnic minorities, youth, men and those in military and health professions were disproportionately deterred by stigma.
Stigma has a small- to moderate-sized negative effect on help-seeking. Review findings can be used to help inform the design of interventions to increase help-seeking.
A number of factors appear to discourage physicians from seeking help for mental illness. This reluctance may be exacerbated by fears – well-founded or imagined – that by seeking help, physicians may put their medical license in jeopardy. To examine this risk, an analysis of all state medical board (SMB) license applications was followed by a seven-item survey mailed to SMB executive directors, and 70 percent responded. Follow up interviews were conducted with a sample of those not responding and also with a small group of directors whose responses were problematic. Thirteen of the 35 SMBs responding indicated that the diagnosis of mental illness by itself was sufficient for sanctioning physicians. The same states indicated that they treat physicians receiving psychiatric care differently than they do physicians receiving medical care. In follow-up interviews all 13 indicated that without evidence of impairment or misrepresentation any such sanctioning was likely to be temporary. A significant percentage (37 percent) of states sanction or have the ability to sanction physicians on the basis of information revealed on the licensing application about the presence of a psychiatric condition rather than on the basis of impairment. The same percentage state they treat physicians receiving psychiatric care differently than they do those receiving medical care. Physicians’ perceptions of this apparent discrimination is likely to play a role in their reluctance to seek help for mental health-related conditions. Suggestions are made for how SMBs and state physician health programs and state and county medical societies might collaborate in ways that while protecting patients decreases barriers to physicians help seeking.
There is a culture within medicine that doctors do not expect themselves or their colleagues to be sick. Thus, the associated complexities of self-diagnosis, self-referral and self-treatment among physicians are significant and may have repercussions for both their own health and, by implication, for the quality of care delivered to patients.
To collate what is known about the self-treatment behaviour of physicians and medical students.
The following databases were searched: PubMed, PsychInfo, EBSCO, Medline, BioMed central and Science Direct. Inclusion criteria specified research assessing self-treatment and self-medicating of prescription drugs among physicians and/or medical students. Only peer-reviewed English language empirical studies published between 1990 and 2009 were included.
Twenty-seven studies were identified that fitted the inclusion criteria. Self-treatment and self-medicating was found to be a significant issue for both physicians and medical students. In 76% of studies, reported self-treatment was >50% (range: 12-99%). Overall, only one of two respondents was registered with a general practitioner or primary care physician (mean = 56%, range = 21-96). Deeper analysis of studies revealed that physicians believed it was appropriate to self-treat both acute and chronic conditions and that informal care paths were common within the medical profession.
Self-treatment is strongly embedded within the culture of both physicians and medical students as an accepted way to enhance/buffer work performance. The authors believe that these complex self-directed care behaviours could be regarded as an occupational hazard for the medical profession.
There is a concerning prevalence of depression and suicidal ideation among medical students, a group that may experience poor mental health care due to stigmatization.
To characterize the perceptions of depressed and nondepressed medical students regarding stigma associated with depression.
Cross-sectional Web-based survey conducted in September-November 2009 among all students enrolled at the University of Michigan Medical School (N = 769).
Prevalence of self-reported moderate to severe depression and suicidal ideation and the association of stigma perceptions with clinical and demographic variables.
Survey response rate was 65.7% (505 of 769). Prevalence of moderate to severe depression was 14.3% (95% confidence interval [CI], 11.3%-17.3%). Women were more likely than men to have moderate to severe depression (18.0% vs 9.0%; 95% CI for difference, -14.8% to -3.1%; P = .001). Third- and fourth-year students were more likely than first- and second-year students to report suicidal ideation (7.9% vs 1.4%; 95% CI for difference, 2.7%-10.3%; P = .001). Students with moderate to severe depression, compared with no to minimal depression, more frequently agreed that "if I were depressed, fellow medical students would respect my opinions less" (56.0% vs 23.7%; 95% CI for difference, 17.3%-47.3%; P < .001), and that faculty members would view them as being unable to handle their responsibilities (83.1% vs 55.1%; 95% CI for difference, 16.1%-39.8%; P < .001). Men agreed more commonly than women that depressed students could endanger patients (36.3% vs 20.1%; 95% CI for difference, 6.1%-26.3%; P = .002). First- and second-year students more frequently agreed than third- and fourth-year students that seeking help for depression would make them feel less intelligent (34.1% vs 22.9%; 95% CI for difference, 2.3%-20.1%; P < .01).
Depressed medical students more frequently endorsed several depression stigma attitudes than nondepressed students. Stigma perceptions also differed by sex and class year.
To encourage treatment of depression and prevention of suicide in physicians by calling for a shift in professional attitudes and institutional policies to support physicians seeking help.
An American Foundation for Suicide Prevention planning group invited 15 experts on the subject to evaluate the state of knowledge about physician depression and suicide and barriers to treatment. The group assembled for a workshop held October 6-7, 2002, in Philadelphia, Pa.
The planning group worked with each participant on a preworkshop literature review in an assigned area. Abstracts of presentations and key publications were distributed to participants before the workshop. After workshop presentations, participants were assigned to 1 of 2 breakout groups: (1) physicians in their role as patients and (2) medical institutions and professional organizations. The groups identified areas that required further research, barriers to treatment, and recommendations for reform.
This consensus statement emerged from a plenary session during which each work group presented its recommendations. The consensus statement was circulated to and approved by all participants.
The culture of medicine accords low priority to physician mental health despite evidence of untreated mood disorders and an increased burden of suicide. Barriers to physicians' seeking help are often punitive, including discrimination in medical licensing, hospital privileges, and professional advancement. This consensus statement recommends transforming professional attitudes and changing institutional policies to encourage physicians to seek help. As barriers are removed and physicians confront depression and suicidality in their peers, they are more likely to recognize and treat these conditions in patients, including colleagues and medical students.
To explore doctors' perceptions of the acceptable limits to self-treatment and to identify barriers to doctors seeking appropriate healthcare.
Self-completion, postal survey using three hypothetical case vignettes.
896 Australian doctors randomly selected from the Health Insurance Commission database and stratified by sex, discipline (general practitioner or specialist) and location (urban or rural). Data were collected between May and July 2001.
Doctors' self-reported attitudes on illness behaviour and choice of medical care in response to case vignettes.
358 (40%) doctors returned questionnaires. More participants believed it was acceptable to self-treat acute conditions (315/351; 90%) than to self-treat chronic conditions (88/350; 25%). Nine per cent (30/351) of participants believed it was acceptable to self-prescribe psychotropic medication. A greater proportion of GPs (206/230; 90%) than specialists (101/121; 83%) believed doctors are reluctant to attend another doctor, especially if the problem is psychological. Women and GPs were significantly less likely to report that it was easy to find a satisfactory treating doctor (women, 58/140 [41%]; men, 128/211 [61%]; GPs, 106/231 [46%]; specialists, 80/120 [67%]). Being a specialist was predictive of seeking appropriate healthcare for all three vignettes.
Doctors have varying opinions regarding the acceptability of self-treating chronic conditions, and perceive considerable barriers to seeking appropriate medical care. Strategies are needed to challenge the culture of self-reliance.
Physicians' suicide rates have repeatedly been reported to be higher than those of the general population or other academics, but uncertainty remains. In this study, physicians' suicide rate ratios were estimated with a meta-analysis and systematic quality assessment of recent studies.
Studies of physicians' suicide rates were located in MEDLINE, PsycINFO, AARP Ageline, and the EBM Reviews: Cochrane Database of Systematic Reviews with the terms "physicians," "doctors," "suicide," and "mortality." Studies were included if they were published in or after 1960 and gave estimates of age-standardized suicide rates of physicians and their reference population or reported extractable data on physicians' suicide; 25 studies met the criteria. Reviewers extracted data and scored each study for quality. The studies were tested for heterogeneity and publication bias and were stratified by publication year, follow-up, and study quality. Effect sizes were pooled by using fixed-effects (women) and random-effects (men) models.
The aggregate suicide rate ratio for male physicians, compared to the general population, was 1.41, with a 95% confidence interval (CI) of 1.21-1.65. For female physicians the ratio was 2.27 (95% CI=1.90-2.73). Visual inspection of funnel plots from tests of publication bias revealed randomness for men but some indication of bias for women, with a relative, nonsignificant lack of studies in the lower right quadrant.
Studies on physicians' suicide collectively show modestly (men) to highly (women) elevated suicide rate ratios. Larger studies should help clarify whether female physicians' suicide rate is truly elevated or can be explained by publication bias.
Compared with other health professionals and the general population, doctors and medical students reported higher rates of psychological distress, burnout, diagnosed mental illness, suicidal ideation and attempted suicide. Where possible, the problematic and unnecessarily stressful aspects of working as a doctor must be improved. Collectively, we must change the often toxic culture of medicine into a culture that promotes a nurturing and supportive approach to teaching and supervision. The goal should be to develop medical practices that facilitate well-being and quality of life, where sustainable medical careers can develop and better serve the community.
The authors replicated a program developed by UC San Diego, identified medical staff at risk for depression and suicide using a confidential online survey, and studied aspects of that program for 1 year.
The authors used a 35-item, online assessment of stress and depression depression developed and licensed by the American Foundation for Suicide Prevention that aims to identify and suicide risk and facilitate access to mental health services.
During 2013/2014, all 1864 UC Davis residents/fellows and faculty physicians received an invitation to take the survey and 158 responded (8 % response rate). Most respondents were classified at either moderate (86 [59 %]) or high risk for depression or suicide (54 [37 %]). Seventeen individuals (11 %) were referred for further evaluation or mental health treatment. Ten respondents consented to participate in the follow-up portion of the program. Five of the six who completed follow-up surveys reported symptom improvement and indicated the program should continue.
This program has led to continued funding and a plan to repeat the Wellness Survey annually. Medical staff will be regularly reminded of its existence through educational interventions, as the institutional and professional culture gradually changes to promptly recognize and seek help for physicians' psychological distress.
Past research has consistently found that men are less likely to seek help for mental disorders than women. However, the reasons for this difference are not clear. This study explored whether sex differences in attitudes toward help seeking, perceived interference caused by mental disorders, and attending routine medical visits could explain sex differences in help seeking.
Analyses focused on 1,963 participants who met DSM-IV diagnostic criteria for a 12-month mood or anxiety disorder in the National Comorbidity Survey-Replication (NCS-R). Multiple logistic regression analyses were conducted to examine sex differences in help seeking from different types of providers after adjusting for attitudes toward help seeking, perceived interference in functioning, attending routine medical visits, and sociodemographic factors.
While men were less likely than women to seek help from health care providers, this difference was limited to seeking care from medical doctors and informal services. Men were as likely to seek help from mental health professionals as women. Men's lower likelihood of attending routine medical visits as compared with women partially explained the sex difference in help seeking from medical doctors. In contrast, attitudes toward help seeking did not explain much of the sex differences in help seeking from medical doctors.
Efforts aimed at reducing attitudinal barriers toward treatment seeking for mental disorders may not effectively reduce the sex disparity in mental health help seeking. The results highlight the importance of encouraging men to attend routine medical visits, as medical doctors are a key gateway to mental health services.
© 2015 Wiley Periodicals, Inc.
Because of the high prevalence of burnout among medical students and its association with professional and personal consequences, the authors evaluated the help-seeking behaviors of medical students with burnout and compared their stigma perceptions with those of the general U.S. population and age-matched individuals.
The authors surveyed students at six medical schools in 2012. They measured burnout, symptoms of depression, and quality of life using validated instruments and explored help-seeking behaviors, perceived stigma, personal experiences, and attitudes toward seeking mental health treatment.
Of 2,449 invited students, 873 (35.6%) responded. A third of respondents with burnout (154/454; 33.9%) sought help for an emotional/mental health problem in the last 12 months. Respondents with burnout were more likely than those without burnout to agree or strongly agree with 8 of 10 perceived stigma items. Respondents with burnout who sought help in the last 12 months were twice as likely to report having observed supervisors negatively judge students who sought care (odds ratio [OR] 2.06 [95% confidence interval (CI) 1.25-3.39], P < .01). They also were more likely to have observed peers reveal a student's emotional/mental health problem to others (OR 1.63 [95% CI 1.08-2.47], P = .02). A smaller percentage of respondents would definitely seek professional help for a serious emotional problem (235/872; 26.9%) than of the general population (44.3%) and age-matched individuals (38.8%).
Only a third of medical students with burnout seek help. Perceived stigma, negative personal experiences, and the hidden curriculum may contribute.
The prevalence of burnout is higher in physicians than in other professions and is especially high in neurologists. Physician burnout encompasses 3 domains: (1) emotional exhaustion: the loss of interest and enthusiasm for practice; (2) depersonalization: a poor attitude with cynicism and treating patients as objects; and (3) career dissatisfaction: a diminished sense of personal accomplishment and low self-value. Burnout results in reduced work hours, relocation, depression, and suicide. Burned-out physicians harm patients because they lack empathy and make errors. Studies of motivational factors in the workplace suggest several preventive interventions: (1) Provide counseling for physicians either individually or in groups with a goal of improving adaptive skills to the stress and rapid changes in the health care environment. (2) Identify and eliminate meaningless required hassle factors such as electronic health record "clicks" or insurance mandates. (3) Redesign practice to remove pressure to see patients in limited time slots and shift to team-based care. (4) Create a culture that promotes career advancement, mentoring, and recognition of accomplishments.
Although rates of treatment seeking for mental health problems are increasing, this increase is driven primarily by antidepressant medication use, and a majority of individuals with mental health problems remain untreated. Helpseeking attitudes are thought to be a key barrier to mental health service use, although little is known about whether such attitudes have changed over time. Research on this topic is mixed with respect to whether helpseeking attitudes have become more or less positive. The aim of the current study was to help clarify this issue using a cross-temporal meta-analysis of scores on Fischer and Turner's (1970) helpseeking attitude measure among university students (N=6796) from 1968 to 2008. Results indicated that attitudes have become increasingly negative over time, r(44)=-0.53, p<0.01, with even stronger negative results when the data are weighted (w) for sample size and study variance, r(44)=-0.63, p<.001. This disconcerting finding may reflect the greater emphasis of Fischer and Turner's scale toward helpseeking for psychotherapy. Such attitudes may be increasingly negative as a result of the unintended negative effects of efforts in recent decades to reduce stigma and market biological therapies by medicalizing mental health problems.
To compare the prevalence of burnout and other forms of distress across career stages and the experiences of trainees and early career (EC) physicians versus those of similarly aged college graduates pursuing other careers.
In 2011 and 2012, the authors conducted a national survey of medical students, residents/fellows, and EC physicians (≤ 5 years in practice) and of a probability-based sample of the general U.S. population. All surveys assessed burnout, symptoms of depression and suicidal ideation, quality of life, and fatigue.
Response rates were 35.2% (4,402/12,500) for medical students, 22.5% (1,701/7,560) for residents/fellows, and 26.7% (7,288/27,276) for EC physicians. In multivariate models that controlled for relationship status, sex, age, and career stage, being a resident/fellow was associated with increased odds of burnout and being a medical student with increased odds of depressive symptoms, whereas EC physicians had the lowest odds of high fatigue. Compared with the population control samples, medical students, residents/fellows, and EC physicians were more likely to be burned out (all P < .0001). Medical students and residents/fellows were more likely to exhibit symptoms of depression than the population control samples (both P < .0001) but not more likely to have experienced recent suicidal ideation.
Training appears to be the peak time for distress among physicians, but differences in the prevalence of burnout, depressive symptoms, and recent suicidal ideation are relatively small. At each stage, burnout is more prevalent among physicians than among their peers in the U.S. population.
To address physician depression and suicide at one U.S. medical school, a faculty committee launched a Suicide Prevention and Depression Awareness Program in 2009 whose focus is medical students', residents', and faculty physicians' mental health. The program consists of a two-pronged approach: (1) screening, assessment, and referral and (2) education. The screening process is anonymous, confidential, and Web based, using customized software created by the American Foundation for Suicide Prevention. The educational component consists of a medical-school-wide campaign including Grand Rounds on physician burnout, depression, and suicide as well as similar sessions geared toward trainees. The authors document the process of developing and implementing the program, including the program's origins and goals, their critical decision-making processes, and successes and challenges of the program's first year.Of the 2,860 medical students, housestaff, and faculty who received the e-mail invitation in the first year, 374 individuals (13%) completed screens, 101/374 (27%) met criteria for significant risk for depression or suicide, and 48/374 (13%) received referrals for mental health evaluation and treatment. The program provided 29 Grand Rounds and other presentations during the first year.This may be the first program that aims to increase awareness of depression and to destigmatize help-seeking in order to prevent suicide and whose target population includes the full panoply of medical school constituents: students, residents, and faculty physicians. The program was well received in its first year, and while demonstrating the prevention of suicides is difficult, the authors are encouraged by the program's results thus far.
This article reviews recent research (1999 - 2009) on the effects of parenthood on wellbeing. We use a life course framework to consider how parenting and childlessness influence well-being throughout the adult life course. We place particular emphasis on social contexts and how the impact of parenthood on well-being depends on marital status, gender, race/ethnicity, and socioeconomic status. We also consider how recent demographic shifts lead to new family arrangements that have implications for parenthood and well-being. These include stepparenting, parenting of grandchildren, and childlessness across the life course.
Suicide risk may be elevated in 'medical' occupational groups, although results of studies are inconsistent. National data are required to examine this issue. It is also important to investigate the possible contribution of psychiatric disorder and access to specific suicide methods.
In a nested case-control design we used data from Danish national registers for 1981-2006 to examine risk of suicide in nurses, physicians, dentists, pharmacists and veterinary surgeons compared to teachers and the general population, and associations with psychiatric service contact and suicide methods.
Crude age- and gender-adjusted rate ratios for suicide compared to teachers were significantly elevated in nurses (RR 1.90, 95% CI 1.63-2.21), physicians (RR 1.87, 95% CI 1.55-2.26), dentists (RR 2.10, 95% CI 1.58-2.79) and pharmacists (RR 1.91, 95% CI 1.26-2.87), but not veterinary surgeons. Risk was also elevated in nurses, physicians and dentists compared with the rest of the general population, the relative risk increasing following adjustments for psychiatric service contact, marital status, gross income and labour market status. Results were similar in both genders. The elevated risk in nurses and dentists decreased during the study period. Elevated risks were not associated with greater psychiatric service contact. Medicinal drugs were commonly used for suicide by nurses, physicians and pharmacists.
The study was based in one country.
Risk of suicide is increased in nurses, physicians, dentists and pharmacists in Denmark. This is not reflected in excess psychiatric service contact. Ready access to medicinal drugs may influence risk in nurses, physicians and pharmacists.
Suicide is a disproportionate cause of death for US physicians. The prevalence of suicidal ideation (SI) among surgeons and their use of mental health resources are unknown.
Members of the American College of Surgeons were sent an anonymous cross-sectional survey in June 2008. The survey included questions regarding SI and use of mental health resources, a validated depression screening tool, and standardized assessments of burnout and quality of life.
Of 7905 participating surgeons (response rate, 31.7%), 501 (6.3%) reported SI during the previous 12 months. Among individuals 45 years and older, SI was 1.5 to 3.0 times more common among surgeons than the general population (P < .02). Only 130 surgeons (26.0%) with recent SI had sought psychiatric or psychologic help, while 301 (60.1%) were reluctant to seek help due to concern that it could affect their medical license. Recent SI had a large, statistically significant adverse relationship with all 3 domains of burnout (emotional exhaustion, depersonalization, and low personal accomplishment) and symptoms of depression. Burnout (odds ratio, 1.910; P < .001) and depression (odds ratio, 7.012; P < .001) were independently associated with SI after controlling for personal and professional characteristics. Other personal and professional characteristics also related to the prevalence of SI.
Although 1 of 16 surgeons reported SI in the previous year, few sought psychiatric or psychologic help. Recent SI among surgeons was strongly related to symptoms of depression and a surgeon's degree of burnout. Studies are needed to determine how to reduce SI among surgeons and how to eliminate barriers to their use of mental health resources.
To evaluate the relationship between burnout and perceived major medical errors among American surgeons.
Despite efforts to improve patient safety, medical errors by physicians remain a common cause of morbidity and mortality.
Members of the American College of Surgeons were sent an anonymous, cross-sectional survey in June 2008. The survey included self-assessment of major medical errors, a validated depression screening tool, and standardized assessments of burnout and quality of life (QOL).
Of 7905 participating surgeons, 700 (8.9%) reported concern they had made a major medical error in the last 3 months. Over 70% of surgeons attributed the error to individual rather than system level factors. Reporting an error during the last 3 months had a large, statistically significant adverse relationship with mental QOL, all 3 domains of burnout (emotional exhaustion, depersonalization, and personal accomplishment) and symptoms of depression. Each one point increase in depersonalization (scale range, 0-33) was associated with an 11% increase in the likelihood of reporting an error while each one point increase in emotional exhaustion (scale range, 0-54) was associated with a 5% increase. Burnout and depression remained independent predictors of reporting a recent major medical error on multivariate analysis that controlled for other personal and professional factors. The frequency of overnight call, practice setting, method of compensation, and number of hours worked were not associated with errors on multivariate analysis.
Major medical errors reported by surgeons are strongly related to a surgeon's degree of burnout and their mental QOL. Studies are needed to determine how to reduce surgeon distress and how to support surgeons when medical errors occur.
To determine whether medical licensing board application questions about the mental or physical health or substance use history of the applicant violate the Americans with Disabilities Act (ADA) of 1990.
Content analysis of 51 allopathic licensing applications (50 states and District of Columbia) was performed at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School in 2005. Questions referencing physical or mental health or substance use were identified by a team of physicians and reviewed and categorized based on the ADA and appropriate case law by legal counsel.
Of the 51 applications reviewed, 49 (96%) contained questions pertaining to the physical or mental health or substance use history of the applicant. Thirty-four of the 49 (69%) state medical licensing applications contained at least one "likely impermissible" or "impermissible" item based on the ADA and appropriate case law.
Most state medical licensing applications contain questions that ask about the physical or mental health and substance use of physician applicants. Many licensing applications appear to be in violation of the ADA, even 19 years after enactment of the regulation. These questions do not elicit responses by which professional competence can be judged. The presence of these questions on licensing applications may cause physicians to avoid or delay treatment of personal illness.
This multisite, anonymous study assessed depressive symptoms and suicidal ideation in medical trainees (medical students and residents).
In 2003-2004, the authors surveyed medical trainees at six sites. Surveys included content from the Center for Epidemiologic Studies-Depression scale (CES-D) and the Primary Care Evaluation of Mental Disorders (PRIME-MD) (measures for depression), as well as demographic content. Rates of reported major and minor depression and of suicidal ideation were calculated. Responses were compared by level of training, gender, and ethnicity.
More than 2,000 medical students and residents responded, for an overall response rate of 89%. Based on categorical levels from the CES-D, 12% had probable major depression and 9.2% had probable mild/moderate depression. There were significant differences in depression by trainee level, with a higher rate among medical students; and gender, with higher rates among women (chi2 = 10.42, df = 2, and P = .005 and chi2 = 22.1, df = 2, and P < .001, respectively). Nearly 6% reported suicidal ideation, with differences by trainee level, with a higher rate among medical students; and ethnicity, with the highest rate among black/African American respondents and the lowest among Caucasian respondents (chi2 = 5.19, df = 1, and P = .023 and chi2 = 10.42, df = 3, and P = .015, respectively).
Depression remains a significant issue for medical trainees. This study highlights the importance of ongoing mental health assessment, treatment, and education for medical trainees.
The 1990 enactment of the Americans With Disabilities Act (ADA) and subsequent case law have established that medical board screening of physician licensure applicants for histories of mental illness or substance use may constitute discrimination. This study examines how physician licensure questionnaires have evolved since the enactment of the ADA. Specifically, we requested medical licensure applications in 2006 from all U.S. affiliated medical licensing boards (n = 54) and analyzed their mental health and substance use inquiries comparatively with application data from 1993, 1996, and 1998. Response rates were 96 percent (n = 52) for initial registration applications and 93 percent (n = 50) for renewal applications. Our results indicate that applicants in 2006, compared with applicants in the 1990s, were questioned more about past, rather than current, histories of mental illness and substance use. These findings revealed medical board practices that seem to run counter to existing court interpretations of the ADA as well as licensure guidelines established by several professional organizations.
The number of admissions to hospital, reported diagnoses, prevalence of reported depression and contributory causes of death among Finnish physicians, engineers and teachers who committed completed suicide between 1986 and 1993 were studied. The data for hospital admissions with diagnoses were obtained from the Finnish Hospital Discharge Register. Thin-layer chromatography was used to detect drugs in the liver, a dual-column gas chromatographic method was used for screening and quantification of drugs in the blood sample, and a head-space chromatographic method was used to measure blood alcohol levels. Physicians had more somatic diagnoses than the reference groups, and the prevalence of reported depression was higher among females than males. A minority of the depressed subjects had been admitted to hospital, although depression was observed to be the most prevalent contributory cause of death in all of the groups studied. The physicians used solid or liquid substances, especially barbiturates, as the main method of suicide. It is possible that depression in physicians, especially in male subjects, is undertreated in psychiatric hospitals.
Physicians have a higher suicide rate than the general population or other academics. Little is known about the reasons for this. Analysing risk factors may be a valuable way of identifying reasons for the high suicide rate among physicians, thereby leading to preventive efforts. The present study is one of the first papers on suicidal thoughts and attempts among physicians. A questionnaire about suicidal thoughts (developed by E.S. Paykel) was completed by 1,063 of 1,476 active Norwegian physicians (72%). Lifetime prevalence ranged from 51.1% for feelings that life was not worth living to 1.6% for a suicide attempt. Risk factors were being female, living alone, and depression. Suicidal thoughts, however, were hardly attributed to working conditions. A high rate of suicide and a low rate of suicidal attempts support the hypothesis that physicians do not 'cry for help,' but are inclined to act out their suicidal impulses.
The aim of the present study is to compare suicide rates between 1960 and 1989 for Norwegian physicians with corresponding rates for other Norwegians with and without university education, by age, gender, and five-year period, based on death certificates for all Norwegians who died in the period 1960-1989. There were 82 registered physician suicides, of which 9 were female, 265 suicides by persons with other university education, and 11,165 by persons with no university education. Suicide rate is measured in number of deaths per 100,000 person years. Crude suicide rates were 47.7 (95% CI 37.7-60.4) for male physicians, 20.1 (17.7-22.9) for other male university graduates, and 22.7 (22.2-23.2) for men with no university education. The corresponding figures for females were 32.3 (15.8-63.7), 13.0 (8.4-19.8) and 7.7 (7.5-8.0). Both for males and females, suicide rates, controlled for age and period, were significantly higher for physicians than for persons with other or no university education. Poisson modelling showed that the risk of suicide for male physicians has the same age pattern as for other males with higher education. In 1985-89 the suicide rate for male physicians increased nearly linearly from about 35 at the age 35-40 to about 100 at the age 75-79, which was almost three times higher than for the other male university graduates. For the age group 50-54 the estimated rate increases from about 50 in 1960-64 to about 90 in 1985-89. For the female physicians, the low number of cases prevents reliable estimation of trends. For male physicians, the trend from 1960 to 1989 is increasing. The estimated risk for a single physician to commit suicide was almost 5 times that of a married or co-habitant colleague. For 52% of the male and 85% of the female physicians the suicide method was poisoning. This is about twice the rates in the general population.
To systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students.
Medline and PubMed were searched to identify peer-reviewed English-language studies published between January 1980 and May 2005 reporting on depression, anxiety, and burnout among U.S. and Canadian medical students. Searches used combinations of the Medical Subject Heading terms medical student and depression, depressive disorder major, depressive disorder, professional burnout, mental health, depersonalization, distress, anxiety, or emotional exhaustion. Reference lists of retrieved articles were inspected to identify relevant additional articles. Demographic information, instruments used, prevalence data on student distress, and statistically significant associations were abstracted.
The search identified 40 articles on medical student psychological distress (i.e., depression, anxiety, burnout, and related mental health problems) that met the authors' criteria. No studies of burnout among medical students were identified. The studies suggest a high prevalence of depression and anxiety among medical students, with levels of overall psychological distress consistently higher than in the general population and age-matched peers by the later years of training. Overall, the studies suggest psychological distress may be higher among female students. Limited data were available regarding the causes of student distress and its impact on academic performance, dropout rates, and professional development.
Medical school is a time of significant psychological distress for physicians-in-training. Currently available information is insufficient to draw firm conclusions on the causes and consequences of student distress. Large, prospective, multicenter studies are needed to identify personal and training-related features that influence depression, anxiety, and burnout among students and explore relationships between distress and competency.
Self-treatment and treatments of friends or relatives is a controversial issue, tolerated by some and discouraged by others, including professionals. The author studied the attitudes toward self-treatment of depression among psychiatrists in Michigan.
A questionnaire asking whether the psychiatrist would or did self-treat for depression was mailed to 830 members of the Michigan Psychiatric Society.
The response rate was 68.3% (567 psychiatrists). Almost 43% of responders would consider self-medication or would self-medicate if afflicted with mild/moderate depression. Seven percent would self-medicate or consider self-medication for severe depression or if suicidal ideation became a component of one's depression. In the past, 15.7% responders treated themselves for depression.
These results suggest that a considerable number of psychiatrists would treat themselves for depression, possibly because of fear of stigma or fear of a permanent record, or other reasons.
Some studies have shown that physicians and dentists have elevated risks of suicide, while other studies have not.
Using all deaths and corresponding census data in 26 US states, we examine the suicide risk for working physicians and dentists.
Death and census data for working people were obtained from 1984 through 1992. Directly age-standardized suicide rate ratios (SRRs) were calculated for white male and white female physicians and white male dentists.
For white female physicians, the suicide rate was elevated compared to the working US population (SRR = 2.39, 95% CI = 1.52-3.77). For white male physicians and dentists, the overall suicide rates were reduced (SRR = 0.80, 95% CI = 0.53-1.20 and 0.68, 95% CI = 0.52-0.89, respectively). For older white male physicians and dentists, however, observed suicide rates were elevated.
White female physicians have an elevated suicide rate. Only older white male physicians and dentists have elevated suicide rates, which partially explains the varied conclusions in the literature.
Recent studies have addressed the need to better understand the nature and risk of depression and suicide in physicians.
To assess the prevalence of depressive symptoms in a sample of practicing physicians, their perceptions of the impact of depression on their work lives, and their perceptions of the impact of being a physician on their pursuit of mental health care.
An anonymous survey was mailed in April 2005 that included the Patient Health Questionnaire depression module (PHQ-9) and other Likert-style questions.
Five thousand randomly selected practicing physicians in Michigan, from whom 1154 usable responses were received (23% response rate).
The prevalence of depressive symptoms and the perceptions by respondents of the impact of depression on work roles and on their approach to seeking mental health care.
Moderate to severe depression scores were reported by 130 physicians (11.3%). Roughly one quarter of respondents reported knowing a physician whose professional standing had been compromised by being depressed. Physicians reporting moderate to severe depression were 2 to 3 times more likely to report substantial impact on their work roles compared to physicians with minimal to mild depression scores, including a decrease in work productivity (57.7% vs. 18.5%; p < .001) and a decrease in work satisfaction (90.8% vs. 36.2%; p < .001). The same physicians were 2 to 3 times more likely to report a wide range of dysfunctional and worrisome approaches to seeking mental health care compared to physicians with minimal to mild depression scores, including a higher likelihood that they would self-prescribe antidepressants (30.0% vs. 9.9%; p < .001) and a higher likelihood that they would avoid seeking treatment due to concerns about confidentiality (50.7% vs. 17.3%; p < .001).
Moderate to severe depression scores are reported by a substantial portion of practicing physicians in Michigan, with important influences on physician work roles and potential negative impact on licensing and medical staff status. The risk of being stigmatized may cause depressed physicians to alter their approach to seeking mental health care, including seeking care outside their medical community and self-prescribing antidepressants. Destigmatization of depression in physicians and interventions to improve the mental health care of physicians in ways that do not compromise their professional standing should receive more attention.
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- Jtr Jones
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A national analysis of medical licensure applications. The journal of the American Academy of Psychiatry and the Law
- Sj Polfliet
Polfliet SJ. A national analysis of medical licensure applications. The journal of the American
Academy of Psychiatry and the Law. 2008;36(3):369-374.
Suicide rates from 1960 to 1989 in Norwegian physicians compared with other educational groups
- O G Aasland
- O Ekeberg
- T Schweder
Aasland OG, Ekeberg O, Schweder T. Suicide rates from 1960 to 1989 in Norwegian physicians compared with other educational groups. Soc Sci Med 2001;52(2):259-65.
Predictors of depression stigma in medical students: potential targets for prevention and education
- L A Wimsatt
- T L Schwenk
- A Sen
Wimsatt LA, Schwenk TL, Sen A. Predictors of depression stigma in medical students:
potential targets for prevention and education. Am J Prev Med 2015;49(5):703-14.
beyondblue Doctors' Mental Health Program. National Mental Health Survey of Doctors and Medical Students
- A C C E P T E D M A N U S C R I P T Accepted Manuscript
A C C E P T E D
M A N U S C R I P T
ACCEPTED MANUSCRIPT
24. beyondblue Doctors' Mental Health Program. National Mental Health Survey of Doctors and
Medical Students. Victoria, Australia 2013.