An editorial in the New Zealand Medical Journal has called for an end to the ‘pathogenic’ work culture which is impacting doctors’ mental health and, in some cases, causing them to take their own lives.
The editorial, published 28 October 2022, highlighted that suicide in doctors appeared to be associated with multiple factors including organisational and occupational stressors, such as long working hours, increasing administration, lack of support, and dealing with death.
This was further compounded by individual differences such as personality, coping style, and skill set, as well as life stressors such as relationship breakups, complaints, and litigation.
Lead author, Professor Roger Mulder from Department of Psychological Medicine at the University of Otago, NZ, said that these conditions impair doctors’ ability to perform at home and at work, as well as cope with life stressors, and are a common contributor to suicide risk.
“The most common contributors to suicide risk are burnout, depression, alcohol and drug disorders, and compassion fatigue,” Professor Mulder said.
“Most surveys report that rates of burnout and depression in doctors are higher than rates found in the general population, and a series of meta-analyses (conducted in 2018 by Beyond Blue) estimated the prevalence of depression to be 27% in medical students, 29% in resident doctors, and up to 60% in practising doctors.”
Professor Mulder explained that the first systematic review, published back in 2004, estimated doctors’ relative risk at 1.41 (95% CI 1.21–1.65) for men and 2.27 (95% CI 1.90–2.73) for women compared with the general population, and that this data has served as the basis for subsequent research for nearly 20 years.
“However, a second more recent systematic review and meta-analysis (published 2016) reported that male physicians had a lower rate compared with men in general (0.67; 95% CI 0.55–0.79), and while female physicians still had a higher rate (1.46; 95% CI 1.02–1.91), it was considerably less than that reported 15 years prior,” he said.
“Interventions are more likely to be effective if there are good data, yet NZ does not have this. As far as we can ascertain, there are no data on NZ doctor suicide or attempted suicide rates. We have some data on doctors’ burnout which, at 45%, appears similar to OECD countries.”
Despite this, rates of depression and thoughts of suicide in doctors are reported to be significantly higher than other professionals leading to speculation that personality traits associated with good doctoring—perfectionism, obsessiveness, and competitiveness— may act against them when stressed.
“In addition, doctors tend to neglect their own need for psychiatric, emotional, or medical help, and are more critical of themselves and others,” Professor Mulder said.
“They are more likely to blame themselves for their illnesses and feel they have failed by becoming mentally unwell.”
Henderson et al. (2012) studied doctors out of work with mental illness and reported that most felt guilty, ashamed, and fearful, in addition to experiencing stigmatisation both within and outside the profession, leaving them feeling isolated and sad.
“Most described a lack of support from colleagues, which may help explain why 41% of doctors said they would not disclose their mental illness,” Professor Mulder said.
“Complaints and disciplinary processes are also burdens that weigh heavily on doctors, increasing their risk.”
A survey of doctors, comparing those with recent or current complaints, found that they were more than twice as likely to report thoughts of self-harm or suicidal ideation and, of those referred to the General Medical Council in the UK, around one in four had moderate to severe depression and/or anxiety.
Similarly, data from the University of Melbourne has shown that in Australia, one in five medical students reported suicidal ideation in 2017, and half of junior doctor’s experience “moderate to high levels of distress”.
“Interventions such as reducing workload and improving teamwork appear to be the most effective at improving doctor’s mental health, while mindfulness and general stress management training give only minor benefits,” Professor Mulder said.
“In New Zealand the use of confidential counselling services has increased significantly in the last few years, but some doctors avoid treatment as they fear sanctions.”