Research into physician burnout is now looking at links between suicide and the surgical suite.
A new study finds that one in 16 surgeons reported having suicidal thoughts in the previous year — a worrisome rate, according to researchers at the Mayo Clinic.
Death from suicide is more common among physicians than the general population, researchers say. Yet the study, published Monday in the journal Archives of Surgery, found that surgeons were substantially less likely than those in the general population to seek help from mental health professionals.
Doctors in the survey said they were fearful that seeking mental health care could adversely affect their medical licenses, said Dr. Tait Shanafelt, an associate professor of medicine at the Mayo Clinic. The fear suggests significant distrust of licensing boards, researchers said, since boards don’t focus on whether a mental health condition is present but look to see if it constitutes an impairment.
“There may be a misunderstanding about how that information is used,” Shanafelt said. “Most boards are not trying to collect this in a way to use it against physicians such that they need to avoid seeking help when they need it.”
But there are other factors, added Dr. Teresa Rummans, chair of the psychiatry department at the Mayo Clinic and a co-author of the study.
“Physicians often don’t recognize they have a problem, and when they do, they don’t want to get help for fear of stigma,” she said.
Suicide is strongly linked to depression, but the lifetime risk of depression among physicians is similar to that for the general U.S. population, researchers say. Access to lethal medications and knowledge of how to use them has been suggested as one explanation for the higher rate of suicide among doctors, but the Mayo researchers suggest that professional characteristics also could play a role.
The new report is the latest in a series of studies by researchers at the Mayo Clinic about physician burnout. Earlier findings have included a study suggesting that burnout — which can include emotional exhaustion, depersonalization and low personal accomplishment — could give rise to unprofessional conduct in medical students.
In 2008, the Mayo researchers published study results showing a link between burnout and suicidal thinking among medical students — a link found in the new survey of surgeons, as well. Given the studies, the latest finding of a one-in-16 rate of suicidal thinking among surgeons isn’t particularly surprising, said Dr. Patricia Lindholm, a family physician in Fergus Falls, Minn., and president of the Minnesota Medical Association.
“Unfortunately, depression, burnout and suicidal thinking all are fairly common in medicine,” Lindholm said. “Physicians are just beginning to talk about this.”
The new study is based on a survey of about 7,905 practicing surgeons in June 2008. The survey asked questions about burnout, quality of life and suicide, including: “During the past 12 months have you had thoughts of taking your own life?”
About 6 percent of respondents, or 501 surgeons, reported suicidal thoughts. The prevalence of such thoughts in the general U.S. population is slightly more than 3 percent.
Surgeons ages 45 and older had a greater rate of suicidal thinking than the general population. Being married and having children were associated with less suicidal ideation, while those who were divorced were more likely to have suicidal thoughts.
About 26 percent of surgeons with suicidal thoughts said they sought help from a psychiatrist or psychologist — the rate in the general population is about 44 percent. The majority said they were reluctant to seek help because doing so might affect their medical licensure.
Among surgeons who had used antidepressant medications within the previous year, about 9 percent had self-prescribed the drugs while one-third had received the prescription from a physician friend not formally involved in their care.
Last year, Shanafelt and colleagues published a separate study based on the same survey of surgeons that found major medical errors are strongly related to a surgeon’s degree of burnout and mental quality of life.
The study published Monday harkened back to that report by noting the perception of having made a major medical error during the previous three months was associated with a threefold increased risk of suicidal thinking.
Compared with other doctors, “the repercussions from a medical error for a surgeon might be distinct because of the high-stakes nature of the surgeries they are involved in,” Shanafelt said. “That’s the question: Are errors for surgeons having a bigger effect on them personally?”
Christopher Snowbeck can be reached at 651-228-5479.
