Health Professional Wellbeing

Confronting Physician depression and suicide

The American Foundation for Suicide Prevention planning group invited 15 experts with expertise in physician health, medical education, licensing and credentialing issues, public health, disability law, substance abuse, depression, and suicidology to evaluate the state of knowledge about physician depression and suicide and barriers to treatment. The consensus statement articulated the following common concerns.

Current State

Depression is as common in physicians as in the general population however they are higher in medical students and residents. In physicians the female rate of suicide is higher than in the general population.

Risks

90% of physicians who die by suicide have a mental disorders and/or a substance abuse disorder

Many have untreated mood disorders and there is an increased burden of suicide.

Barriers

Physician reluctance to admit health vulnerabilities or seek help.

Practicing physicians with psychiatric disorders often encounter overt or covert discrimination.

Recommendations

Physicians should establish a regular source of health care and seek help for mood disorders.

Provide information about state and federal protections for confidentiality of medical records and legal protections for physicians and others with disabilities.

New research is needed. Most of the literature is out dated and contains significant methodological problems.

Comment

It is clear physicians often neglect their own mental health and this appears to contribute to reduced recognition of the significance of mental illness in their patients.  Depression is among the most common condition in primary care patients. And physicians do not adequately detect or treat 40% to 60% of cases. Physicians are more likely to recognize and treat depression and suicide in patients if they are able to first confront it within themselves and their peers. This consensus statement suggests it is high time to transform professional attitudes and change institutional policies to encourage physicians to seek help.

Writer Kabir Sattarshetty, Masters Student

Supervisor Dr Ramesh Manocha.

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Aim

An Australian field study evaluated the feasibility, acceptability and effectiveness of wellbeing seminar designed to train GPs in a set of evidence based meditation skills.

Method

The seminar was held on Saturday afternoon. Following a lecture on healthy lifestyles, they received 1.5 hrs of instruction in basic and intermediate meditation skills. GPs then had the option of doing 2 weeks of structured home practice. Professional development points were granted by the RACGP for the event. The main measures were The K10 Psychological Distress Scale (K10), a visual analogue scale (VAS), and a Diary card to assess compliance. The K10 questionnaire was completed at the beginning of the seminar at the end of the 2-week home practice period. The participants rated their subjective experience of mental silence using the VAS.

Results
299 GPs attended. 111 GPs completed the 2 week home-based and provided pre/post K10 data. At the end of the 2 week home based program, one-quarter (25.1%) of the at risk participants had improved sufficiently to shift into the low risk category. The Diary Cards showed an improvement in the achievement of mental silence by 40%.

Conclusions
The K10 baseline scores indicated higher levels of psychological distress among GPs as compared to the rest of the population. The pre/post scores showed that highly distressed GPs improved significantly. Overall, meditation has practical potential as a mental health promotion and primary prevention strategy for health professionals.

Comment

Meditation it seems is something Health Professionals are enthusiastic about. A survey of Australian GPs in 2000 found that almost 80% of respondents had recommended meditation to patients at some time in the course of their practice.

The question is should they practice what they preach? A pertinent question considering the high stress levels in the profession and their own confidence in suggesting meditation to others. A recent field study went in the direction of answering this question by evaluating the feasibility, acceptability and effectiveness of an initiative to train GPs in a set of evidence based meditation skills.

Writer Kabir Sattarshetty, Masters Student

Supervisor Dr Ramesh Manocha.

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