They had known each other well enough in the early days of medical school, when they were students studying well into the night. After graduation, they went their separate ways, each assuming the other was doing well.
“I wanted you to hear it from me,” a colleague sadly said on the phone. Dr. Ranjana Srivastava nearly fell to the pavement when she was told that her long-time friend and colleague—a clinician, wife, and devoted mother—had died by suicide.
Unfortunately, this is not the first that time Dr. Srivastava had to face the suicide of a colleague. In a piece she wrote for The Guardian, Srivastava explains:
“Forced smiles and tough hides abound in the workplace, where always being ‘fine’ is a badge of honour. This is why it can be so difficult to distinguish doctors who will indeed be fine from those who need help.”
Research shows a higher rate of mental health problems among physicians. A 2013 report estimates over 25% of doctors in Australia having at least a minor psychiatric disorder, with 10% reporting suicidal thoughts in the past year. A survey of 2000 U.S. physicians showed that roughly half believed they met criteria for a mental illness in the past, but had not sought treatment. And in Canada, recent research estimates over 26% of Canadian doctors suffer professionally due to poor mental health, with 20% of them reporting they had been depressed in the last 12 months. Overall, roughly 30% of physicians worldwide have depression or symptoms of it, according to an extensive review published in the Journal of the American Medical Association (JAMA).
Why is this the case? The answer isn’t all that clear, but according to physician and social worker Katharine Gold and colleagues, stigma is to blame. Their research looked at survey responses of over 2000 female physicians, and it showed that stigma attached to mental illness is greater among medical trainees and physicians than in the general population. According to one respondent:
“I have been discriminated against in a department after disclosing my history of well-treated depression to my department chief.”
And this is not an isolated incident. Studies show that 50% of doctors are less likely to work with a colleague who has a history of depression or anxiety disorder, with four in ten admitting to thinking less of such a colleague. And throughout the years, healthcare organisations have favoured a punitive approach when addressing the issue of physician mental illness, rather than a supportive one. So disclosing mental health issues by a medical doctor can pose a real threat to licensing, career, and reputation, leading to reluctance to seek help.
In an interview with the Trauma Mental Health Report, medical student Jamie Katuna explains the predicament physicians face:
“Getting care could mean problems for doctors. If they seek help for mental health issues and if someone decides they are ‘unstable’ and shouldn’t be seeing patients, that physician is out of a job and would have a really hard time finding another one. So instead, doctors suffer in silence.”
When deteriorating mental health makes it difficult to work, many physicians ignore their symptoms and continue to work anyway, often self-medicating with drugs or alcohol to avoid the perceived embarrassment of having a psychological disorder.
Steps are being taken to bring awareness. Many universities and medical organisations are starting conversations about physician wellness and stigma reduction. Physicians and medical students who have lived through suicide attempts, depression, and other mental health issues are standing up for themselves and each other. Likewise, organisations such as the American Foundation for Suicide Prevention and the American Medical Association have recommended reforming medical licensing questions to make it clear that physicians may get help without fear of negative consequences. Despite the growing support, Thomas Schwenk of the University of Nevada School of Medicine noted that change isn’t happening fast enough:
“A lot of [conversations about mental health stigma are] very difficult and very slow to happen, and unfortunately tragic incidents like the two suicides in Quebec and other suicides across the country are still occurring because it’s taking time to change that culture.”
There are some resources available. In Canada, organisations like Physician Health Program and the Canadian Medical Association provide a range of direct services for physicians and medical students at risk of, or suffering from, substance use, psychiatric disorders, or occupational stress. The interventions offered can include awareness workshops, referral to treatment, and monitoring, all while maintaining confidentiality. Also, online resources such as ePhysicianHealth and Combating Stigma are available.
Most solutions exist at a personal or program level, but the problems are pervasive and affect the entire structure of healthcare education. According to Katuna:
“The culture of medicine should undergo amazing and radical transformations. We need to redesign how we implement medical education.”
Systematic problems require systematic solutions and until then, medical professionals remain at risk.
— Ilia Azari, Contributing Writer
Many artists are taking to Instagram and other social media platforms to do their part in supporting individuals struggling with their mental health. “Santa_ana_dreamin714“, the Instagram account belonging to California artist Judith Villanueva, has an abundance of beautiful art for sale with all proceeds going directly towards mental health.
Judith Villanueva has personally suffered from anxiety for upwards of ten years and found that making art was a great outlet for her. Through the process of making art, her main goal is to raise funds for mental health awareness. Not only has art become a way for her to support her own mental health, but now Judith has dedicated all the proceeds from her artwork to NAMI OC, an organisation that provides various resources for families including educational meetings, fundraisers and support groups. Judith says: “I’m super excited. I’ll soon be taking some of their courses to educate myself more on the organisation and mental health”.
‘Even low levels of distress’ harm our well-being in the long run, warn researchers.
“Although the relationship between significant distress and the onset of arthritis, [chronic pulmonary obstructive disorder], cardiovascular disease, and diabetes is well established,” says Prof. Catharine Gale, from the University of Southampton in the United Kingdom, “there is a significant gap in knowledge regarding the link between lower and moderate levels of distress and the development of chronic conditions.”
Alongside Kyle McLachlan, at the University of Edinburgh in the U.K., Prof Gale conducted a study investigating whether exposure to low and moderate psychological distress — which includes symptoms of anxiety and depression — could increase the risk of developing a chronic disease.
The results, which have now been published in the Journal of Psychosomatic Research, indicate that we do not need to experience a lot of distress in order for our physical health to be endangered. A little distress will suffice, the authors warn.
Reducing distress may prevent disease onset
In the new study, the researchers analysed relevant data collected from 16,485 adults for a period of 3 years. Prof. Gale and McLachlan obtain this information using the UK Household Longitudinal Study, which gathers data regarding the health status, well-being, and living conditions — among other things — of U.K. citizens.
They looked specifically for links between psychological distress and the development of four chronic diseases: diabetes, arthritis, lung disease, and cardiovascular disease.
They also investigated whether any such association could be explained by modifiable factors such as eating habits, exercise, or smoking, or by participants’ socioeconomic status.
Prof. Gale and McLachlan’s study found that, despite the fact that they are not considered clinically significant, even low to moderate levels of experienced distress can heighten the risk for a chronic condition later in life.
“Our findings show that even low levels of distress, below the level usually considered clinically significant, appear to increase the risk of developing a chronic disease, so intervention to reduce symptoms of anxiety and depression may help to prevent the onset of these illnesses for some people.”
Prof. Catharine Gale
Compared with people who reported no symptoms of psychological distress, those who reported low distress levels were 57 percent more likely to develop arthritis.
Also, those experiencing moderate levels of distress were 72 percent more likely to develop this condition, and individuals reporting high distress levels were 110 percent more likely.
Similar associations were also found for cardiovascular disease and lung disease (specifically, chronic obstructive pulmonary disease [COPD]).
In fact, people with low levels of distress were 46 percent more likely to develop cardiovascular problems, those with moderate levels had a 77 percent higher risk, and those exposed to high levels of distress had a 189 percent higher risk.
For lung disease, the risk did not rise in people reporting low distress levels, but it was heightened by 125 percent in those with moderate distress levels, and by 148 percent in people with high distress levels.
However, the researchers found no significant links between psychological distress and the development of diabetes.
The researchers note that the new study’s results could change the way in which public health policies consider risk factors for chronic diseases.
“These findings have considerable clinical and public health implications,” explains Prof Gale.
“Screening for distress,” she explains, “may help to identify those at risk of developing arthritis, COPD, and cardiovascular disease, while interventions to improve distress may help to prevent and limit progression of disease, even for people with low levels of distress.”
Distress is a potentially modifiable risk factor, so if the links found by this study are confirmed by further research, it could indicate a new pathway in terms of preventive strategies for chronic diseases.
Prof. Cyrus Cooper, the director of the Lifecourse Epidemiology Unit at the UK Medical Research Council, believes that Prof. Gale and McLachlan’s findings have “the potential to have a major impact on the development and management of chronic diseases.”
Dr. Iain Simpson, former president of the British Cardiovascular Society, states that “cardiovascular disease remains one of the major causes of death and disability,” so “[the] knowledge that distress, even at low levels, is also a risk factor is an important finding which could have significant clinical implications.”
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