Doctors get sad, like anyone else. So how do doctors cope when sad days turn into weeks, even months? Are there unique factors that lead to physician depression? Are doctors different from the general population in the way in which they respond to depression? What treatments do doctors seek or avoid?
Here’s what many depressed doctors do: Nothing. Or they try things that don’t help.
I recently interviewed 200 physicians who have experienced depression during their careers, and I asked what treatment they pursued. Results are as follows: 33% chose professional help, 27% self-care, 14% self-destructive behaviors, 10% nothing, 6% changed jobs, 5% self-prescribed medication, 4% other, 1% pray.
Most physicians tried multiple treatments. Sadly, the majority of doctors I spoke with did nothing for months to years until they finally decided to take action—sometimes self-harm. Professional help was not generally first-line therapy. This article presents a qualitative summary of my findings and related physician commentary.
I’ve been running a physician suicide hotline since 2012 and have had the opportunity to help hundreds of depressed and suicidal doctors. Physicians certainly face unique circumstances during their careers that lead to depression, such as bullying, hazing, sleep deprivation, and medical board investigations—plus the repeated near-daily exposure to suffering and death.
However, doctors also experience depression for the same reasons the general public does: for example, a failing marriage or the death of a loved one. Yet even in these cases, being a physician may make common depression risk factors even riskier.
Common Risk Factors for Depression
A failing marriage. A relationship on the rocks is destabilizing for anyone, yet physicians are more likely to lose marriages to spousal neglect. Doctors don’t have predictable 40-hour work weeks. They’re not often home by dinner. With erratic schedules requiring weekend and evening call, physicians routinely miss family events, kids’ activities, and holidays. Even after the workday is over, many doctors need hours to decompress and may rely on their partner for emotional support—at the risk of depleting rather than strengthening their primary intimate relationship. Being a physician is a marital stressor.
Social isolation. Loneliness may lead to depression in anyone, and physicians are at high risk for social isolation. Frequent moves during training and working 80+ hour work weeks leave little time for friends or family. Even when not working, doctors are talking about medicine, thinking about patients, studying for board exams, or gathering continuing medical education credits. Introverted, studious, and highly intelligent existential thinkers by nature, doctors may find it more difficult to develop friendships than the general population.
Being a physician is an independent risk factor for social isolation. Sue summarizes her predicament: “I see the loving couples at church, and accept that there will be no Prince Charming for me. There will be no one to care for me when the breast cancer comes. There is no savings, no retirement. As I do house calls and care for the dying, I know that there will be no such loving doctor for me.”
Death of a spouse. Physicians are uniquely affected by the loss of a life partner, because they have had less time to develop a support system than the general population. The death of a spouse can be a particularly devastating event for male physicians, who appear to be at higher risk for depression because they often rely on their marital partners for emotional support and are more challenged to ask for help or be vulnerable with friends or colleagues compared with female physicians.
Financial distress. Although doctors have greater earning capacity than the general population, they often save less and spend more on student loans, cars, and homes, owing to family and cultural expectations. Many physicians are financially preyed upon by unethical employers, other professionals, even friends and family who believe that “all doctors are wealthy.” Physicians can also make poor financial decisions, further exacerbating their inability to build a nest egg until much later in life than most. Some still have student loan debt into their 50s or 60s and have saved little for retirement.
Childhood trauma. Early sexual, emotional, and physical abuse increase the risk for depression for all. Some physicians have shared that these very childhood wounds led to their desire to attend medical school so that they could help others. Entering medicine as a “wounded healer” and submitting to a culture of self-neglect during training and beyond (without easy access to nonpunitive mental healthcare) further destabilizes these at-risk physicians.
Family history of depression. Both nonphysicians and physicians whose parents suffer from depression are at increased risk of developing depression. Yet nowhere in the application process for medical school is it made clear to these prospective students and their families that they will be at increased risk for depression (and suicide) from medical education itself. Up to 43.2% of resident physicians have depression or depressive symptoms. Informed consent must be uniformly required to alert these individuals of the added mental health risks of a medical education before they apply for medical school.
Retirement. A major life event, such as retirement, can lead to depression in many people—yet when one’s identity is wrapped so tightly around a career, as it is for a doctor, the depression may be far worse. As noted above, some doctors may not have saved enough money to retire comfortably, and others have not developed a personal life after devoting so much of their career to caring for others.