Suicide-Awareness Project Targets M.D.s, Med Students

When renowned burn surgeon John Hansbrough, M.D., took his own life in San Diego in 2001, his family and friends decided to take steps to raise awareness of the problem of suicide in physicians. Their efforts culminated in an educational campaign led by the American Foundation for Suicide Prevention (AFSP) geared to preventing suicide in physicians and medical students.

At the center of the campaign are two films, a longer film targeting physicians, titled “Struggling in Silence: Physician Depression and Suicide,” and a shorter film targeting medical students, titled“ Out of the Silence: Medical Student Depression and Suicide.”

“Struggling in Silence” will air on Los Angeles PBS station KCET in May (check local listings).

The physician depression-awareness and suicide-prevention campaign began in 2002 with a consensus conference that culminated in a statement titled“ Confronting Depression and Suicide in Physicians,” which was published in the June 18, 2003, Journal of the American Medical Association.

The statement concluded, “The culture of medicine accords low priority to physician mental health despite evidence of untreated mood disorders and an increased burden of suicide” and barriers to treatment for physicians, such as discrimination in medical licensing, hospital privileges, and professional advancement.

According to data posted on the AFSP Web site, physicians die by suicide more frequently than others of their gender and age in both the general population and other professional fields.

“Suicide is disproportionately high among physicians, especially women, and usually related to mood disorders, substance abuse disorders, or both,” Charles Reynolds III, M.D., told Psychiatric News.

Reynolds is the UPMC Professor of Geriatric Psychiatry and a professor of neurology and neuroscience at the University of Pittsburgh School of Medicine. Reynolds chaired an advisory committee that offered input and direction on the making of the film.

Depression often goes unrecognized and untreated in physicians due to“ professional attitudes that discourage admission of health vulnerabilities,” according to psychiatrist Paula Clayton, M.D., who is the AFSP'S medical director and convened the advisory committee that Reynolds chaired. “There is a fear of asking for help because some think that by doing so, they may be hindering their careers,” she told Psychiatric News.

Medical students with depression may be hesitant to seek help because they believe it will impact their standing in the class or keep them from matching with the residency program they desire, she noted. “More needs to be done to educate physicians and medical students about depression.”

“Struggling in Silence” features interviews with families, friends, and a patient impacted by a physician suicide, as well as physicians dealing with mood disorders themselves.

For instance, Alice Flaherty, M.D., Ph.D., discusses her experiences as a neurologist who began experiencing significant symptoms of depression after her twins died during childbirth. When later symptoms of mania occurred, she sought help after colleagues encouraged her to do so. Her own treatment for bipolar disorder was successful, and her experiences inspired her to conduct research on the brain and creativity.

The film also features commentary by Robert Lehmberg, M.D., a plastic surgeon in Little Rock, Ark., who reveals that he tried to escape from depression symptoms through his work, which occupied the majority of his time. When Lehmberg did seek treatment, he found that he was required to have his psychiatrist submit a form stating that he was capable of practicing medicine.

Viewers will also learn about the work of psychiatrist G. Richard Smith, M.D., who worked to remove language in licensure applications that required physicians to answer questions about psychiatric and other medical treatment (Psychiatric News, May 19, 2006).

Though Smith's work helped to destigmatize treatment seeking among physicians, many physicians with depression are still hesitant to come forward and seek help, according to Reynolds.

“We need to change the culture of medicine to support appropriate help seeking by physicians with depression,” he said. “Perhaps by helping ourselves, we will do a better job of recognizing depression in our patients.”

APA Medical Director James H. Scully Jr., M.D., served on the advisory committee and noted that physicians must find a way to overcome the resistance to seeking help stemming from concerns about the impact it may have on their careers. “The film is a wonderful tool to adress this issue,” he told Psychiatric News.

Extra footage from the longer film was used to make “Out of the Silence,” a 13-minute film focusing on depression among medical students and featuring interviews with a medical student being treated for depression at the University of California, San Diego. In the film, the student is portrayed interacting with a campus therapist and serving in a peer-mentoring program in the medical school.

It is Clayton's hope that medical schools will incorporate the film into curricula to raise awareness about the risk of depression and suicide among medical students.

Production of the films was funded by Wyeth Pharmaceuticals, the American College of Psychiatry, and the AFSP.

More information about the films “Struggling in Silence: Physician Depression and Suicide” and “Out of the Silence: Medical Student Depression and Suicide,” including purchase information, is posted at<www.doctorswithdepression.org>.▪