An Addendum: It’s Time to Get Real About Suicide in the Healthcare Field
Yesterday I wrote an article about two former UPenn athletes who took their lives. The message resonated with our followers, my peers, my friends, even with my grandfather (Poppy) who, at 82 years old is still a practicing physician.
There is this unusual thing about my Poppy: he is 82, has been practicing medicine for over 50 years, and is seemingly unfazed by the “physician burnout” that has plagued our generation. In today’s state of affairs, it just seems different from the norm. It gave me a reason to dig a little deeper into the prevalence of mental health disorders among students and attempt to understand the barriers to seeking proper mental healthcare, especially, and quite paradoxically, for students in the healthcare field.
Madison Holleran and Owen Thomas inspired me to do some research in the field into which I am about to venture. What are suicide and depression rates like in physicians? What about in medical students? As an entering med student this upcoming fall, the results were truly frightening.
I started where most “almost” docs typically would – with a literature review. A study published by New England Journal of Medicine found that male physicians were 40% more likely than males in the general population to commit suicide; Female physicians, a staggering 130% more likely. Additionally, depression is at least as common in the medical profession as in the general population, affecting an estimated 12% of male physicians and 18% of female physicians. The article also reported that “despite better access to health care, [physicians] are more likely to cope by resorting to dysfunctional behaviors like excessive drinking and are less likely to seek counseling or even recognize that they need some kind of intervention.” An “Almost” Doc interview with Sam Shem, author of the controversial “The House of God,” highlights the psychological harm done to training physicians in the 1970s and the self-destructive coping mechanisms in which these doctors engaged.
Researchers have offered several explanations to these statistics, including the possibility that these depressive symptoms may start in medical school or that doctors are likely to be highly competitive and, thus, highly critical of themselves. I think both may be true.
My research led me to several articles surrounding the prevalence of depression, suicidal ideations, and “burnout” in medical students. A study published in Annals of Internal Medicine found that among 4,287 medical students at 7 different universities, a whopping 49.6% reported burnout symptoms and 11.6% reported suicidal ideations in the past year. Another study, published by the AAMC, studied 858 medical students across 5 medical schools and found that 11% had considered dropping out at some point and, furthermore, that these thoughts of dropout were predicated by feelings of burnout and depression.
While many medical schools have focused on providing better mental health services for their students, the problem may not be in the services that exist, but rather in the attitudes of students towards these services. A friend of mine, a current first year med student and former classmate underscored this issue:
“In my opinion, the greatest obstacle to students getting help for mental health issues may be the students themselves. Our ability to recognize when we’re really not okay has been crowded out by our desire to always be the best. We may complain about the workload and say it’s unreasonable to be expected to learn this amount of material, but behind closed doors we think less of those who can’t keep up. That way of thinking and disconnect from our own emotional well-being is a big part of the problem.”
It may sound harsh, but research shows that this statement does, in fact, have scientific merit. A study conducted by the AMA showed that students with depressive symptoms were more than twice as likely than students without depression to agree with the statement, “If I were depressed, fellow med students would respect my opinions less.” Additionally, about 83% of medical students with depressive symptoms agreed with the statement, “If I were depressed, faculty members would view me as unable to handle my responsibilities.” In accordance with the “gunner” mentality, students, especially 1st and 2nd year students believed that seeking help for depression would make them feel less intelligent. Yet another study found that among both medical and non-medical students, 50% reported that they would feel uncomfortable consulting their university tutors for help with their depression.
Another friend, a faculty member who closely works with her med students expresses a similar concern:
“Medical Schools and residency programs have shown the ability to address their patients’ mental health concerns and needs. What Medical Education as a community continues to struggle with is how to remove the perceived stigma attached to a current and/or future physician who avails him/herself of the same resources they would encourage their patients to take advantage of. Physicians, physicians-in-training and medical students are patients to someone. Yet, though they are in an extremely competitive and high-risk field, somehow it is perceived that they should not have the same needs as their patients.”
The list for possible causes for depression in med school is endless: an overwhelming amount of information to be learned in an unrealistic amount of time, the lack of mentor continuity especially in the 3rd and 4th year of med school, the lack of forgiveness students may feel from their superiors for making a mistake, the realization that another person’s life is in their hands, and the tremendous financial debt that is an inevitable outcome of a medical education, to name just a few.
It is difficult as a single individual to alter all of these variables, but in the past 24 hours I’ve learned there are two powerful tools which I do possess and which may make a difference: A powerful voice, and a network of peers, colleagues, friends and family willing to listen to this voice. With these tools, I aim to spread the message, shared by Kevin Breel at TedX Youth, that urges young people to try to avoid suppressing these issues and to start saying, “I suffer from depression.” An appreciation for the courage required to make such a statement has the potential to bring together training medical professionals in a supportive environment and to instill a sense of comfort and acceptance in the workplace.