Survey: 1 in 4 cardiologists report having a mental health condition
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In an American College of Cardiology survey with responses from nearly 6,000 cardiologists worldwide, about one-quarter reported having a mental health condition.
The ACC conducted an online survey in 2019, which included responses from 5,931 cardiologists from around the world (22.6% women; two-thirds aged 40 years or older; 53.5% white) to determine the prevalence of mental health conditions (MHCs).
Data were derived from Sharma G, et al. J Am Coll Cardiol. 2022;doi:10.1016/j.jacc.2022.11.025.
“There is little understanding on the prevalence of MHCs among cardiologists on a global scale, any gender differences, as well as the relationship between MHC and professional satisfaction. We sought to further explore the global prevalence and differences in MHCs among cardiologists worldwide, the predictors of MHCs, and the influence of MHCs,” Cardiology Today Editorial Board Member Garima Sharma, MD, FACC, FACP, associate professor of medicine and associate vice chair, women’s academic careers in medicine, department of medicine, at Johns Hopkins University School of Medicine and governor of the ACC’s Maryland chapter, and colleagues wrote.
Prevalence of MHCs
Among the respondents, 28%, or about one in four, reported having an MHC, including psychological stress or a psychiatric disorder, the researchers wrote, noting that women were more likely to report having an MHC than men (34% vs. 26%; P < .001).
“Amongst those with self-reported mental health conditions, psychological distress (anxiety, irritability, and anger) was the most pervasive type, affecting more than 75% of them,” Cardiology Today Editorial Board Member Laxmi Mehta, MD, FACC, FAHA, FNLA, chief well-being liaison and faculty director of the Gabbe Health and Well-being Program at The Ohio State University Wexner Medical Center and chair of the ACC’s Clinician Well-being Workgroup, told Healio.
Prevalence of MHCs varied greatly by geographic region, with the highest rate in South America (39.3%) and the lowest rate in Asia (20.1%; P < .001), according to the researchers.
Independent predictors of having an MHC included experiencing emotional harassment (OR = 2.81; 95% CI, 2.46-3.2), experiencing discrimination (OR = 1.85; 95% CI, 1.61-2.12), being divorced (OR = 1.85; 95% CI, 1.27-2.36) and being aged younger than 55 years (OR = 1.43; 95% CI, 1.24-1.66).
Compared with men, women were more likely to consider suicide in the past 12 months (3.8% vs. 2.3%; P < .001) but were more likely to seek help (42.3% vs. 31.1%; P < .001), Sharma and colleagues found.
Among those who reported having an MHC, 44% said they felt dissatisfied on at least one professional metric such as feeling valued, being treated fairly and adequate compensation, the researchers wrote.
“Dedicated efforts are needed to reduce some of the causes of mental illness,” Mehta told Healio. “Given the association with hostile work environments, we need respectful and inclusive environments for both work and learning. It is important to reduce the fear of reporting mental health conditions. We also need to recognize and address the issues surrounding mental health conditions, especially amongst women and younger cardiologists.”
When it comes to identifying and treating MHCs in cardiologists, “The first step is for all of us to acknowledge that mental health conditions do exist amongst cardiologists,” Mehta told Healio. “Self-awareness and/or recognizing others are struggling mentally is important. Treatment varies based on the type of mental health condition, but most benefit from counseling therapy and some may benefit from medications. However, there is stigma surrounding mental health conditions. The culture and many of the current medical systems don’t support those who have mental health conditions. We need to normalize mental health for health care workers [and] reduce barriers to treatment and reporting of conditions.”
The findings of the survey can also support the 2020 ACC/American Heart Association Professionalism and Ethics document, which “outlines the need for organizations to support the psychosocial health of its health care workforce and advocate for mental health support,” Mehta said.
‘Cause for hope’
In a related editorial, Andrew J. Sauer, MD, FHFSA, a cardiologist and associate professor at Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, wrote, “We have a cultural problem with appropriately addressing mental health in our ranks. We have fostered a culture of silent suffering. And although we know we need to better attend to our multiplicity of needs, we find ourselves immersed in dedication to our patients while subservient to a hierarchal system without compunction for exploiting our ethos while also conditioning us to retreat to our lonely workspace and think ‘I am crazy’ rather than ‘This is crazy.’
“But there is cause for hope,” he added. “Although isolation is deadly, connection heals.”
Mehta told Healio that the ACC’s Clinician Well-being Workgroup is dedicated in part to improving mental health issues among cardiologists and has “supported the ACC’s advocacy efforts regarding the Lorna Breen Healthcare Provider Protection Act and efforts surrounding state licensure reforms to revise the language regarding mental health questions.”
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For more information:
Laxmi Mehta, MD, FACC, FAHA, FNLA, can be reached at laxmi.mehta@osumc.edu.
Perspective
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Daniel Murphy, MD
The survey was conducted pre-pandemic. It confirms data from the previous decade demonstrating the levels of stress and distress amongst clinicians of all specialties. Physician distress is not a new issue and has only been exacerbated by the pandemic. The study also highlights the fact that practicing cardiologists worldwide are experiencing similar mental health conditions, although local circumstances may lead to variable outcomes. This paper represents an interesting initial glimpse into the well-being of cardiologists globally.
The authors summarize the take home message succinctly when they state “Dedicated efforts toward prevention and treatment are needed to maximize the contributions of affected cardiologists.”
One challenge in interpreting this study is the definition of mental health conditions. The survey identified many different conditions, from anxiety, irritability and anger through major mental health diagnoses. Although burnout was not specifically measured, we know also that burnout has risen dramatically for clinicians during the pandemic and adds to the challenges clinicians face in their emotional, mental, and physical well-being.
At Stanford, we have a model of professional fulfillment and well-being that incorporates the culture of well-being along with the efficiency of our work and its relationship to personal well-being and resilience. We know that issues such as leadership support, values alignment, autonomy, respect and other aspects of culture strongly impact individuals and groups and affect their well-being. As the accompanying editorial highlights, enhancing leadership and the culture of medicine is a major opportunity to prevent distress and enhance well-being. In addition, improving working conditions by relieving administrative burden, improving job control and workplace synergy will certainly result in improved well-being for CV clinicians and their teams.
Clinicians should have access to a wide range of emotional and mental health support opportunities. These should include clinician coaching, peer support and mental health resources. They should be readily available, well publicized and free from censure and stigma.
One of the suggestions made by the authors is important to emphasize that it is imperative that we reduce the fear of reporting mental health issues and eliminate the stigma associated with seeking treatment for them. Fortunately, there has been progress on this front. During the past 5 or 6 years, advocacy efforts have led many state medical boards to alter their questions regarding prior treatment of mental health and substance abuse disorders. There is still room for improvement, but the change is dramatic. Unfortunately, many health care organizations continue to include such stigmatizing questions during their credentialing processes. Changing those credentialling practices is an important opportunity for improvement.
I must emphasize that it is critically important for health care organizations to embed the well-being of their clinicians within their strategic and operational imperatives. Critical safety, quality, financial and patient experience outcomes dependent upon a healthy, robust and well-supported workforce.
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