Women’s health providers face mental health ‘tsunami’

Key takeaways:

• OB/GYNs practice in a social and political setting that can lead to poor mental health.
• To combat excessive stress, fatigue and moral injury, clinicians should build a resiliency plan and seek help when needed.

BALTIMORE — The pandemic, political discord, misinformation and what the U.S. Surgeon General has called an “epidemic of loneliness and isolation,” confront OB/GYN providers as intensely as the rest of the population, according to a speaker.

This situation has created not only a mental health crisis, but a public health crisis, Samantha Meltzer-Brody, MD, MPH, chair of the department of psychiatry at the University of North Carolina School of Medicine at the University of North Carolina at Chapel Hill, said during The Samuel A. Cosgrove Memorial Lecture at the ACOG Annual Clinical & Scientific Meeting. To address the crisis, OB/GYNs must prioritize self-care and taking care of their colleagues.

“There's no question we are living during turbulent times, and your specialty is certainly caught in the crosshairs,” Meltzer-Brody said. “One of the things that's very clear is that health care has been under attack. ... It can feel like there's a tsunami that's hitting us each day.”

The current practice environment puts health care providers at risk for depression, anxiety and other mental health conditions as a result of fatigue, loss and accumulating stress. In addition, clinicians, and OB/GYNs in particular, perhaps, may face moral injury — when they are required to act while providing care in ways that go against their beliefs and commitments to healing.

The impact of widespread moral injury, as experienced during the COVID-19 pandemic, for example, can be “dire” for public health, said Meltzer-Brody, causing health care professionals to leave the field.

“I encourage you to take a look and think about moral injury in your own lives,” Meltzer-Brody said. “Does anything related to moral injury apply to you?”

Mental health and professionalism are put at risk by accumulating stress and exhaustion, Meltzer-Brody said. She described some warning signs of excessive stress:

• Cognitive symptoms, such as difficulty concentrating;
• Emotional symptoms, such as feeling criticized, angry, frustrated or irritable;
• Behavioral symptoms, such as taking risks and acting out; and
• Physical symptoms, such as tension, headache, gastrointestinal issues, inability to relax and trouble sleeping.

To combat this mental health tsunami, Meltzer-Brody suggested clinicians foster their resilience.

“When we talk about resilience, it's not meant to be a ‘suck it up’ concept, nor is it something that people are innately born with. It refers to the phenomenon that many people are able to adapt to the changes of life and maintain their mental health despite exposure to adversity,” Meltzer-Brody said. “But, I would add, it's because they make intentional choices on how they navigate it.”

An individual can build a resiliency plan by answering four types of questions:

• Who am I? What are my priorities?
• Why am I here? What is my purpose?
• What do I need? What are my goals?
• How will I do this? What actions can I take?

To maintain compassion for self and colleagues, Meltzer-Brody said, it may help to remember the “why” that led to the choice of medicine in the first place. She suggested clinicians go back to the essay they wrote for their medical school application to rediscover meaning in their work.

Lastly, she said, clinicians facing the “tsunami” should seek professional help, when needed.

“I ask all of you, when your tank is low, look to someone to help you,” she said. “All of us as physicians, and all of you as OBGYNs, your work is so needed. There is a crisis in health care, there is a crisis in women's health care, and we need you now more than ever.”