Brought to you by the Depression Is Real Coalition, The Down &
Up Show is dedicated to the reality of depression. Our
hosts will talk with some of the world's top experts on depression, as
well as people who have been impacted by this illness. The reality
of depression is that it is a debilitating and potentially deadly
medical condition that affects more than 15 million Americans every
year. The other reality of depression is that there is hope.
Down & Up Show #51: Struggling in Silence: Physician Depression
and Suicide
DR. REEF KARIM:
Welcome to the Down and Up Show on Depression is Real.org. I'm your
host, Dr. Reef Karim, psychiatrist, addiction medicine specialist
and relationship therapist. Today we're lucky to be speaking with
Dr. Paula Clayton. Dr. Clayton is a Medical Director at the American
Foundation for Suicide Prevention and she's currently been working
on a feature documentary called Struggling in Silence: Physician
Depression and Suicide. The documentary will premier on KCET TV
in May 2008 for Mental Health Awareness Month. The program takes
a deep look at the impact of physician suicide on families, patients
and communities through the stories of two physicians lost to suicide.
Dr. Clayton, it's a pleasure to speak with you today.
DR. PAULA CLAYTON
Thank you. It's a pleasure to be here.
DR. REEF KARIM
All right, so can you give our listeners some background into the
problem of physician suicide and depression?
DR. PAULA CLAYTON
Well, sort of the brief answer is that there are three to four hundred
physicians who kill themselves each year, which means there's at
least one a day, and that is equal to one or two entering medical
school classes each year. Our own interest started after a physician
in San Diego killed himself and his family and friends asked us
if we would do-bring this problem to the attention of the public.
So we convened a group of experts and held a consensus conference
that resulted in a paper that was published in the America-Journal
of the American Medical Association is 2003. And from that we developed
work groups and one of the groups was assigned to make a film for
the general public and target the audience for this Struggling in
Silence, the problem of physician depression.
DR. REEF KARIM
Okay.
DR. PAULA CLAYTON
And that's what we did. We started in 2006 to make that film and
we've just completed it.
DR. REEF KARIM
So can you tell us about the documentary, Struggling in Silence,
how it seeks to help resolve physician suicide and depression?
DR. PAULA CLAYTON
Well, I think it's-it's-it's really to bring awareness of the problem
of physicians' depression and the outcome of depression which may
be suicide. Ninety percent of people who kill themselves have a
psychiatric disorder, and the most common psychiatric disorder is
depression.
So what we do in the film in these five vignettes is we actually
feature two women whose physician husbands died by suicide, and
one of the physician's patients, as well as a medical student who's
struggling with depression and finally seeks help and resolves her
depression issues, and then two physicians who have-one, a surgeon
who has recurrent depression and a neurologist who has bipolar disorder.
And they all tell their stories and they are then interspersed with
experts speaking about depression symptoms, how it affects us, why
physicians are reluctant to seek help, etc. My-my-my hope is that
by showing this to the general public it will raise awareness about
depression in themselves and by teaching physicians starting in
medical school about depression in themselves and others.
It'll help them be aware of patients who might kill themselves.
DR. REEF KARIM
You mentioned that some of the factors of why physicians won't...
Well, you mentioned the topic of physicians not wanting to seek
help, kind of realize what was going on with them. What are the-what
are some of those? Why won't physicians that are in trouble like
that seek help?
DR. PAULA CLAYTON
Well, I believe that in general the data show that physicians don't
really even have primary care doctors. They have... They're more-less
likely than the general public to actually have even a-a-a-their
own doctor. And so they deny their illnesses and I'm sure that's
even more true of mental disorders.
They blame other things, their stress, their this or that, and they
don't recognize that depression is a disorder that can be fatal.
So they don't seek help. They don't go to doctors as frequently
and they may even self-treat, that is with their own medications
or with alcohol or other drugs.
So they're less likely to admit it, and then I think once they go,
they may not be treated equally. Sometimes doctors are given preferences.
You're less likely to hospitalize the doctor, I think, in a mental
hospital as it shows in our film. So doctors are also reluctant
to treat doctors with the same vigorousness that they treat other
patients.
And then there's the stigma and the possibility that it might interfere
with their career. That if they're... As the film says, if they're
regarded as having a disorder, they may not get patient referrals,
they may be discriminated against by hospitals, by the licensing
procedure and by insurance. So for all these reasons they struggle
in silence.
DR. REEF KARIM
Yeah. And there's a lot of truth to all of what you just said. You
know, being a physician myself, I didn't have a primary care doctor
throughout most of medical school and most of my residency because
it just didn't seem necessary and I could just diagnose something
myself or have my friends figure it out or, you know, we'd just
kind of work it out ourselves so to speak.
DR. REEF KARIM
I think there's this subculture of we'll just handle it on our own
kind of thing.
DR. PAULA CLAYTON
Right.
DR. REEF KARIM
And whether that is minor like an antibiotic or it's major like,
you know, suicidality and depression, it's-it just seems to stay
within the confines of what you're capable of doing cause we're
taught to be reassuring other people all the time and-and-and having
other people come to us for our knowledge base and our confidence.
And I think any chink in the armor that's perceived would be not
a positive thing, so you hide it. And so I do think that there's-this
is a very important topic to discuss for that-for that specific
reason.
DR. PAULA CLAYTON
Right. Right.
DR. REEF KARIM
Why is it that female physicians are at a greater risk of committing
suicide than their male counterparts?
DR. PAULA CLAYTON
Well, I'm not sure we have the answer to that but certainly women
physicians, compared to say women with Ph.D.s, have very high rates
of depression, significantly higher rates of depression in themselves.
And actually if you study it, you find that a third of them actually
had depression before they entered medical school.
So it's not the stress of medical school. So... And they have a
higher family history of depression. So I have a feeling that women
physicians are at risk for depression more than the general public
and they may go into medicine because of their own or some family
member's illness and they wanna understand and help, you know, so
it turns-they turn it in a positive way.
And then once they're at risk for depression, then they're at risk
for suicide.
DR. REEF KARIM
Yeah. Can you tell us some of the-some of the symptoms of depression
that are showcased in the-in the documentary?
DR. PAULA CLAYTON
That most important one, of course, is the change in mood. That
is just feeling down, depressed, and it has to be for at least two
weeks. It's not just a reaction to some particular event; it's day
in and day out for two weeks.
And then you have either-you have appetite changes, loss of appetite
or eating too much, loss-and sleep changes. And that is a cardinal
symptom, not being able to sleep, sleeping too much or waking at
3:00 or 4:00 in the morning. Loss of energy, just fatigue for no
reason and poor concentration.
So that the medical student who gets depressed really doesn't do
well in classes because even though she's done well in the past,
she's not concentrating and her memory is not as good. So no matter
how hard she tries, these symptoms interfere with her ability to
perform.
And then finally after those kind of somatic symptoms, there are
all these other symptoms of feeling guilty about being depressed
or not performing, feeling hopeless, worthless and then thinking
you'd be better off dead. And there's also an anxiety with depression
which is displayed in the medical student.
So they have high anxiety and that, too, is a painful state that
some people feel they'd rather be dead than live with this intense,
internal anxiety.
DR. REEF KARIM
Well, how are families and friends of physicians affected by the
overwhelming problem of physician suicide and depression?
DR. PAULA CLAYTON
Well, that's nicely displayed in the film. I think that none of
us are really good about trying to-if we recognize that our spouse
or family member is depressed, about really conscientiously intervening.
And that's really what it takes, because frequently the depressed
person isn't aware himself that he's suffering from depression.
So the family suffers when the patient suffers because he or she
isn't doing as well as they... They're different. They've changed
and they're not doing as well. But then they also suffer because
the person needs to be really encouraged to seek treatment. So the
family is affected by the depression.
Depressed patients are hard to live with. And then by the outcome,
if this outcome is suicide, I mean, it's something no one thinks
is going to happen to their child or their husband or their father.
DR. PAULA CLAYTON
So they really... You know, they feel guilty and remorseful themselves
because they feel they should have done something, whereas usually
it's very hard to detect.
DR. REEF KARIM
Well, why has so little attention been paid to physician depression
and suicide up until now?
DR. PAULA CLAYTON
It's been known for a very long time, I would say 30 years, that
women physicians have high suicide rates. The male physicians, when
matched with their counterparts of equal age, is more controversial,
but overwhelmingly they clearly have more suicides also.
I think it has to do with the stigma and the-the-the threat that
something may happen to their practice if they seek help. There
are many state boards that still ask questions about mental disorders
and deny licensure in the state because of that. So I think it's-it's-it's
been a well-kept, unfortunate secret.
DR. REEF KARIM
Yeah.
DR. PAULA CLAYTON
And even now... There was... We had an article in Newsweek and someone-people
have objected to that because they felt it put physicians in a poor
light, rather than saying, “Gee, this is a problem. Let's deal with
it”. I mean, it's interesting because doctors have stopped smoking
and so they're physical health has improved, but they haven't embraced
the same interventions for mental health.
DR. REEF KARIM
Yeah. Did... Have there been any studies that looked at the different
types of doctors, say, surgeons versus internists versus psychiatrists
versus anesthesiologists, to look at which ones might be more prone?
DR. PAULA CLAYTON
Yes, there have been studies but they've never come out with the
same specialty. So that psychiatrists, especially women, were said
to have higher depression rates. And I don't know about suicide
but certainly higher depression rates.
And they're-in the past otolaryngologists had high suicide rates,
and more recently anesthesiologists. But none of this is replicated
from study to study. And there aren't that many studies any way.
DR. REEF KARIM
So can you tell us what resource are available, say, the website
DoctorswithDepression.org or other websites?
DR. PAULA CLAYTON
Yes. That is our... And we will eventually... We haven't gotten
it up yet but by May we will have the-both the long film and the
two short films on that, as well as a set of slides that illustrate
the point and that... Then there are questions that could be asked
if you give a group lecture to start a discussion.
And then there's a small... Now there's a little, brief, mini, two-minute
ad on the site as well. And so it will not tell you how to get help;
I think that doctors have to do that independently in each of their
cities.
DR. REEF KARIM
Okay. Anything else you'd like to add before we close?
DR. PAULA CLAYTON
I don't think so. I mean, I think the real issue for physicians
is that-especially in medical school, that it's now apparent that
physical health and mental health need to-need attention, and it's
available in most medical schools through the Dean's office if you
have troubles.
And it will not be part of your medical record which is the... The
real issue here is can you-if you seek treatment, can you keep this
confidential. And it is possible. And I think that's the thing that
doctors need to know, that it can be kept confidential.
DR. REEF KARIM
Okay. Well, thank you so much for speaking to us today, Dr. Clayton.
DR. PAULA CLAYTON
Oh, thank you. I'm glad you understand the problem and I-I-I really
think it is the fact that they need to find the proper care.
DR. REEF KARIM
Yeah, doctors need care too. That's the take-home message.
DR. PAULA CLAYTON
Right. Exactly. Exactly.
DR. REEF KARIM
Okay.
DR. REEF KARIM
Thank you. To find out when Struggling in Silence will air
on your local TV programming, please visit www.doctorswithdepression.org.
For the Depression is Real Coalition, I'm Dr. Reef Karim. Join us
next time for another segment of the Down and Up Show on Depression
is Real.org. Take care.
