Report notes few surgeons seek help for suicidal thoughts

As many as one in 16 surgeons reported having suicidal thoughts in the previous year, but few sought help from a mental health clinician, according to the results of a survey recently published in Archives of Surgery.

Of the 7,905 surgeons who participated in the 2008 American College of Surgeons survey, 501 of them (6.3 %) reported having thoughts of suicide during the previous year.

Tait D. Shanafelt

Tait D. Shanafelt, MD, of the Mayo Clinic in Rochester, Minn., and colleagues, conducted the anonymous survey and questioned surgeons about suicidal ideation — thoughts or plans of suicide — and their use of mental health resources, a depression screening tool, and assessments of burnout and quality of life.

“The perception of having made a major medical error in the previous 3 months was associated with a three-fold increased risk of suicidal ideation, with 16.2 percent of surgeons who reported a recent major error experiencing suicidal ideation compared with 5.4 percent of surgeons not reporting an error,” Shanafelt and colleagues wrote in the study.

Link with age

Suicidal thoughts were also strongly associated with distress, depression and with all three domains of burnout: emotional exhaustion, depersonalization and low personal accomplishment, according to a press release about the report.

Older surgeons were more likely to report suicidal thoughts and surgeons aged 45 years and older had 1.5 to three times the rate of suicidal ideation of the general population. Being married and having children were associated with a lower likelihood of suicidal thoughts, and the risk was higher among those who had been divorced, according to press release from Archives of Surgery.

Efforts to reduce stress

Of the surgeons with suicidal thoughts, 26% sought help from a psychiatrist or psychologist, whereas 60.1% were reluctant to do so because it might affect their medical license. Among the 461 surgeons who had used antidepressant medications in the past year, 8.9% had self-prescribed and 7.4% received the prescription from a friend who was not formally caring for them as a patient.

Reluctance to seek care is likely reinforced by the fact that 80% of state medical boards inquire about mental illness on initial licensure applications, the authors noted.

“Additional studies are needed to evaluate the unique factors that contribute to the higher rate of suicidal ideation among surgeons in conjunction with efforts to reduce surgeons’ distress and eliminate barriers that lead to underuse of mental health resources,” Shanafelt and colleagues concluded.

Reference:

Shanafelt TD. Arch Surg. 2011;146(1):54-62.

This study illustrates several important realities about surgeons and their lack of self care. The take home message is that surgeons are reluctant to seek help when they are suffering. Roughly only one quarter of suicidal surgeons sought counseling. The stigma of seeking professional help must be addressed. Licensing boards need to promote well surgeons, not politically-correct ones.

Counseling to mitigate the perfectionistic and obsessive qualities that surgeons share would greatly enhance the ability to embrace mistakes and errors. Finally, the signs of burnout — exhaustion, depersonalization and low personal accomplishment — must be recognized and treated expediently since the risk of suicidal ideation is markedly increased in surgeons who are emotionally spent.

— John D. Kelly IV, MD
Orthopedics Today Your Practice/Your Life column editor
Philadelphia

John D. Kelly IV, MD, has no direct financial interest in any products or companies mentioned in this article.

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