Could Your Doctor Be Mentally Ill or Suicidal?

At a time when psychiatrists are considering whether suicidal behavior constitutes a disorder rather than a symptom, there is strong evidence that physicians have far higher rates of suicide than the general population, with psychiatrists found to be at the highest risk of suicide.^[1]

Prevalence rates between studies are reasonably consistent in finding that physicians have twice the suicide rate of the general population. An American literature review states:

“Overall physician suicide rate cited by most studies has been between 28 and 40 per 100,000, compared with the overall rate in the general population of 12.3 per 100,000. Overall, then, physicians are more than twice as likely as the general population to kill themselves.^[2]“

A recent Australian study of the mental health of doctors found almost 25% of doctors reported having thoughts of suicide prior to the last 12 months (24.8%), a figure significantly higher than that of the general population whose prevalence rate was  13.3%. Approximately 2% of doctors reported that they had attempted suicide.

Psychiatry tells us that 90.1% of those who kill themselves are mentally disordered. Depression, according to the medical literature, underpins most suicides and is a chronic, recurrent and debilitating brain disorder. The Royal College of Australian and New Zealand Psychiatrists tells us that:

1. If untreated, depression increases risk of suicide and other violent acts^[3].
2. Depression… is often associated with occupational dysfunction^[4]
3. Clinical depression can be very disabling, affecting a person’s emotions, thinking, behaviour and physical wellbeing. ^[4]
4. Severe depression can make it hard or even impossible for the person to relate and communicate with others, or to do day-to-day tasks.^[5]

The Australian survey of 12,252 doctors and 1,811 medical students found 21% of doctors reported having ever been diagnosed with, or treated for, depression with 6% having a current diagnosis, a rate similar to that of the Australian public but higher than that for other professionals. Approximately 9% of doctors reported having ever been diagnosed with, or treated for, an anxiety disorder (compared with 5.9% of the general Australian population with anxiety disorders), and 3.7% reported having a current diagnosis (Australian population 2.7%).^[5]

In a UK General Medical Council report detailing 1,384 doctors who had been assessed for underlying health concerns over the past five years, 98% were diagnosed with alcohol, substance misuse or mental health issues.^[6]

So what are doctors doing to manage their chemical imbalance induced brain disorders and ensuring they can practice safely and without “occupational dysfunction?” Taking drugs, of course!

The Australian study found that doctors had “high rates of… medication use for both depression and anxiety in comparison to the general population.” The survey authors noted that distinct patterns of drug use were observed in the medical profession, with higher rates of prescription drug use and that self-medication was common in medical practitioners.^[1]

This finding is not restricted to Australia with a survey of NHS staff, involving 2,500 doctors in Birmingham finding only 13% of respondents said they would seek help for mental health disorders or addiction, while 87% said they would self-medicate or seek informal medical advice.

Interestingly, the Australian doctors were more likely to seek help from a psychologist or counselor than from a psychiatrist.^[8]

Fahrenkopf et al reported that 20% of 123 pediatric residents at three U.S. children’s hospitals were depressed and made 6.2 times more medication errors than did those made by their peers.^[7]

So, we have thousands of doctors, with an over-representation of psychiatrists, who have, by their own reckoning, serious and debilitating mental disorders which affect their ability to practice. Doctors who self-medicate, are making medication errors and refuse to seek help.

How reassuring.

In light of this information, you may be asking yourself, as I am, whether it would be wise to conduct a brief mental state examination of any physician we consult (particularly any psychiatrist) as a way of ensuring our physical and emotional safety?

I believe it would not only be wise but should be de rigeur.

To this end, I have prepared a quick diagnostic test that you may carry in your pocket or purse for easy administration next time you are visiting a health professional.

My test is, of course evidence-based, and so I briefly summarise the particular risk factors for physician suicide that have been identified in the literature, in the form of a handy checklist.

Relationship Status

Suicide rates have been found to be higher among physicians who are divorced, widowed, or never married.^[8] Married physicians however have divorce rates some 10% to 20% higher than those in the general population and, where physicians remain married, studies have shown their marriages to be more unhappy than those of other professionals.^[2] Like the rest of the population, relationship break-ups and unhappy relationships are key triggers for suicide.

Personality Factors

Driven, competitive, compulsive, individualistic, ambitious; the physicians who kill themselves are likely to have graduated from a high-prestige school.^[2] These physicians often have mood swings.^[9] One study that assessed medical school students who later committed suicide found they had scored significantly higher than controls on a range of personality factors, “including self-destructive tendency, depression, and guilty self-concept.”^[10] The Physician Mortality Project conducted by the Council for Scientific Affairs in America found physicians who died by suicide were perceived as more likely to be critical of others and of themselves.^[11]

Alcohol and Drug Use

Physicians who complete suicide often have a  problem with alcohol or other drugs.^[9] More than one-third of the physicians who committed suicide were believed to have had a drug problem at some time in their lives, as opposed to 14% of controls.^[11] Data gathered in 1997 suggests that the prevalence of alcohol abuse or dependence and illicit drug abuse by physicians mirrors that of the general population, but that physicians may be at increased risk for prescription drug abuse. ^[12]

Social Isolation

Physicians who died by suicide were reported to have fewer friends and acquaintances than controls and to give and receive less emotional support to others.

Mental Disorders

The Physician Mortality Project found that physicians who killed themselves also had more mental disorders at the time of death.^[11] A review of the literature on stress during residencies found depression and anger were significant problems during medical training and that among physicians, psychiatrists had the highest rates of depression at 73% in comparison with 46% of other physicians.^[13]

Contact with Mental Health Professionals and Psychiatric Hospitalisation

Of the physicians who committed suicide, 42% had been seeing a mental health professional at the time of death, whereas 7% of controls had.^[11] One-third of the physicians who committed suicide had a history of at least one psychiatric hospitalization.

Now apart from consideration of the risks that may be posed to us in trusting a suicidal physician with our health, as good and caring citizens we may also want to identify suicidal doctors so they may be encouraged to seek help as they would encourage us to seek help.

The consensus statement on suicide and depression in doctors notes that:

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.^[14]

So, this simple six-question diagnostic questionnaire will help you peek behind that cheery “what brings you here today?” It may help you uncover the sadness, anxiety, aggression and substance abuse of your physician and help you make an informed choice about whether they are a suicide risk and should therefore focus on healing themselves rather than you.

Just remember, suicide is preventable and should your physician refuse your kind offer of referral to a biological psychiatrist, you may have to have them forcibly detained for their own good. As they tell us, vulnerable populations with high suicide risk can’t make good decisions for themselves and must often be coerced into accepting treatment.

Physician Suicide Assessment

If the dog is at home it’s not considered drinking alone.  TRUE / FALSE

I think of myself as a ‘healthy volunteer’ in a post marketing study of antidepressants.  TRUE / FALSE

As long as I have the DSM and my worm farm I am never lonely.  TRUE / FALSE

You hear a voice telling you to kill the President. You;

a)  Tell your spouse to keep it down while you’re watching TV?

b)  Block out a half-day in your diary?

c)  Check whether time spent killing the leader of the free world is billable?

d)  Diagnose yourself with Schizophrenia and write a prescription for an Atypical Antipsychotic?

You are sad that you chose psychiatry as your specialty and worried that it’s not real medicine. Do you;

a)  Pop an antidepressant and a benzo and carry on with ward rounds

b)  Section your next patient – you find doing the required paperwork soothing.

c)  Go to lunch with the nice, understanding drug rep in reception – the drinks are on him!

d) Check whether time spent diagnosing yourself with depression and anxiety is billable.

On a typical day at work, you;

a)  Experience at least 15 different emotions including overwhelming joy and murderous rage

b)  Have a vague sense of unease that you may be responsible for famine in Africa and the spontaneous human combustion of a middle-aged woman in Egypt.

c)  Apply for your boss’s job and a position as head of the International Monetary Fund.

d)  Play Candy Crush Saga to alleviate the boredom of listening to patients, post naked photos of your cat on Facebook, bite patients to make sure they’re real or engage in other behavior likely to get you fired/imprisoned/sectioned.

The answers to this easily administered diagnostic test will tell you everything you need to know about whether your physician is crazier than you are. I’d be keen to do some analysis of the results so feel free to post them in the comments section.