Stigma stops doctors seeking help for depression and anxiety

Findings of a research review commissioned by beyondblue: the national depression initiative to investigate the mental health of medical students and doctors were presented at a forum of the beyondblue Doctors’ Mental Health Program in Melbourne on Tuesday 31 August.The Mental Health of Doctors – A systematic literature review has found depression and anxiety are common in doctors and medical students, but many won’t seek help despite their awareness and understanding of the effects of depression and anxiety.

The 2009 research review looked at 86 publications worldwide, including the UK, USA and Canada, that described 68 studies which examined issues related to mental health disorders among doctors such as prevalence rates and barriers to help seeking. However, there were few relevant studies conducted in Australia.

beyondblue research adviser, Prof David Clarke, says barriers to help-seeking in the medical profession include concerns about stigma, career progress, impact on colleagues and patients, confidentiality and embarrassment.

"International research indicates medical students and doctors are less likely to seek help for depression from colleagues and health services because they fear it will stifle their careers and that colleagues will question their professional integrity," says Prof Clarke. "They are also less likely than the general community to seek help from family members and friends, or they won’t seek help at all because they are embarrassed or worried about stigma in the profession."

One UK study reported that many doctors had a negative attitude towards fellow doctors with depression.

Prof Clarke continues: "What’s also of great concern is that doctors in Australia have a higher suicide rate compared with the general population, and this is particularly true of female doctors in whom the rate is more than twice as high as females in the general population."

beyondblue developed the Doctors’ Mental Health Program in August 2009 to address mental illness among medical students and doctors and prevent mental health issues from impacting on the medical profession and its work. The program was developed in consultation with key stakeholders including medical schools and colleges, doctors’ health advisory services, academics and practitioners.

Dr Mukesh Haikerwal, Chairman of the Advisory Committee for the Doctors’ Mental Health Program and a former President of the Australian Medical Association, says the forum is an opportunity to discuss the review’s key findings, acknowledge the work of the Expert Reference Group and outline how the program will progress.

"The purpose of this research is  to understand the prevalence of depression and anxiety among medical students and practitioners, associated risk factors and barriers to seeking help, and to assist with the development of awareness and intervention programs for the medical community in Australia.

"It’s important that doctors are on the lookout for depression in the people they treat and that they realise they are at risk too – they can’t look after other people if they don’t look after themselves first," Dr Haikerwal says.

Other key findings of the international review include:

• Alcohol use was lower in doctors and medical students compared to the general population;
• Distinct patterns of drug use were observed in the medical profession, with higher rates of prescription drug use (e.g. sedatives such as benzodiazepines). Self-prescribing by doctors was common;
• Risk factors such as high work demands, poor sleeping patterns and poor work-life balance are related to higher levels of depression and anxiety disorders in doctors;
• There is no Australian research evaluating the effectiveness of mental health programs for doctors.

beyondblue will invest in Australian research that further investigates the prevalence of depression, anxiety disorders and substance use in the medical profession. It will also look at profession-specific risk factors, barriers for doctors to seek professional help, attitudes and stigma toward colleagues with depression and anxiety disorders, and the effectiveness of doctors’ mental health services and programs.

beyondblue Chairman, The Hon. Jeff Kennett AC, says the mental health of doctors is a priority for beyondblue, as part of the Doctors’ Mental Health Program.

"beyondblue is committed to improving the mental health of Australia’s medical students and doctors. We will be working with experts in the field to develop self-help resources, including an online program, for doctors and medical students," Mr Kennett says.

(Source: beyondblue: The Mental Health of Doctors – A systematic literature review)