Psychiatry for derm: Suicide risk, care disparity, and the necessity of physicians seeking mental health care – Dermatology Weekly Crossover

Candrice R. Heath, MD, and Nicole B. Washington, DO, MPH, spoke with Psychcast host Lorenzo Norris, MD, about physician mental health.

Dr. Heath is affiliated with Temple University Hospital, Philadelphia. She has no disclosures.

Dr. Washington disclosed serving as chief medical officer and founder of Elocin Psychiatric Services, a telemedicine company that provides care to physicians. Dr. Norris is a consultation-liaison psychiatrist and medical school dean affiliated with George Washington University, Washington. He has no disclosures.

And stick around for Renee Kohanski, MD, who talks about expectations.

Take-home points

• Physicians often delay seeking mental health treatment. Compared with the general population, the risk of suicide is 2.27 times higher in female physicians and 1.4 times higher in male physicians.
• The COVID-19 pandemic has created additional risk factors for all physicians, including those on the front lines and others whose clinical practices and home lives have changed because of the pandemic.
• Prevention and mitigation of mental illness start with understanding your own risk factors and stressors and trying to address them before they become overwhelming.

Summary

• During the best of times, physicians are at risk for anxiety, depression, and substance use disorders. The syndromes of demoralization and burnout should be seen as prodromes to clinical diagnoses, such as major depressive disorder. An estimated 300-400 physicians die from suicide each year.
• Prevention of mental illness starts with identifying one's stressors, such as balancing personal and professional demands on time; knowing one's risk factors, such as a history of substance use and previous episodes of distress or psychiatric diagnoses; and thinking about the phases of disaster response. When it comes to the COVID-19 pandemic, are you surging with adrenaline, hitting a plateau, or experiencing a decline?
• Dr. Washington suggests that her patients focus on what they can control in their lives, because uncertainty and loss of control of our usual routines contribute to stress, anxiety, and fatigue. It is also helpful to reflect on past periods of hardship and resilience to identify strengths and previous strategies used to overcome challenges.
• Physicians who are not on the front lines are experiencing different forms of hardship, such as financial stress from furloughs and loss of patient volume. There may also be guilt about not addressing the pandemic in the same way as frontline physicians. Even without direct patient care of COVID-19, it must be acknowledged that the impact of the pandemic is everywhere.
• Most physicians delay seeking mental health treatment. This may particularly occur for physicians with better "lifestyles," such as dermatologists, who some may view as suffering less. This pandemic is a reminder that all physicians need to take care of themselves, regardless of specialty.
• We are all adjusting to the "new normal," so in times like this, it is helpful to seek practices such as mindfulness and "radical acceptance," the latter of which is part of dialectical behavior therapy.
  • Accepting reality with judging and setting expectations at a realistic level can help prevent suffering.

References

• Phases of disaster timeline: https://www.samhsa.gov/dtac/recovering-disasters/phases-disaster
• American Psychiatric Association Well-being Toolkit: https://www.psychiatry.org/psychiatrists/practice/well-being-and-burnout/well-being-resources
• Radical acceptance by Tara Brach, PhD: https://www.youtube.com/watch?v=_K35O3G82L4
• Facts about physician suicide: https://www.acgme.org/Portals/0/PDFs/ten%20facts%20about%20physician%20suicide.pdf

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