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Confronting Depression and Suicide in Physicians
A Consensus Statement
Claudia Center, JD;
Miriam Davis, PhD;
Thomas Detre, MD;
Daniel E. Ford, MD, MPH;
Wendy Hansbrough, BSN;
Herbert Hendin, MD;
John Laszlo, MD;
David A. Litts, OD;
John Mann, MD;
Peter A. Mansky, MD;
Robert Michels, MD;
Steven H. Miles, MD;
Roy Proujansky, MD;
Charles F. Reynolds III, MD;
Morton M. Silverman, MD
JAMA. 2003;289:3161-3166.
Objective To encourage treatment of depression and prevention of suicide in physicians by calling for a shift in professional attitudes and institutional policies to support physicians seeking help.
Participants An American Foundation for Suicide Prevention planning group invited 15 experts on the subject to evaluate the state of knowledge about physician depression and suicide and barriers to treatment. The group assembled for a workshop held October 6-7, 2002, in Philadelphia, Pa.
Evidence The planning group worked with each participant on a preworkshop literature review in an assigned area. Abstracts of presentations and key publications were distributed to participants before the workshop. After workshop presentations, participants were assigned to 1 of 2 breakout groups: (1) physicians in their role as patients and (2) medical institutions and professional organizations. The groups identified areas that required further research, barriers to treatment, and recommendations for reform.
Consensus Process This consensus statement emerged from a plenary session during which each work group presented its recommendations. The consensus statement was circulated to and approved by all participants.
Conclusions The culture of medicine accords low priority to physician mental health despite evidence of untreated mood disorders and an increased burden of suicide. Barriers to physicians' seeking help are often punitive, including discrimination in medical licensing, hospital privileges, and professional advancement. This consensus statement recommends transforming professional attitudes and changing institutional policies to encourage physicians to seek help. As barriers are removed and physicians confront depression and suicidality in their peers, they are more likely to recognize and treat these conditions in patients, including colleagues and medical students.
Author Affiliations: Employment Law Center and the University of California, Hastings College of Law, San Francisco (Ms Center); George Washington University School of Public Health and Health Services, Washington, DC (Dr Davis); Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh (Dr Detre); Departments of Medicine, Epidemiology, and Health Policy and Management, Johns Hopkins School of Medicine, Baltimore, Md (Dr Ford); Department of Education, Research, and Development, University of California Medical Center, San Diego (Ms Hansbrough); American Foundation for Suicide Prevention and Department of Psychiatry, New York Medical College, New York (Dr Hendin); American Cancer Society, Atlanta, Ga (Dr Laszlo); Office of the US Surgeon General, Washington, DC (Dr Litts); Division of Neuroscience, Department of Psychiatry, Columbia University Medical Center, New York, NY (Dr Mann); Committee for Physicians' Health, Medical Society of the State of New York, and Department of Psychopharmacology at Albany College of Union University, Albany (Dr Mansky); the Payne Whitney Clinic, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY (Dr Michels); Department of Medicine and Geriatrics, University of Minnesota Medical School, Minneapolis (Dr Miles); Alfred I. duPont Hospital for Children, Wilmington, Del, and Jefferson Medical College, Philadelphia, Pa (Dr Proujansky); Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pa (Dr Reynolds); and National Suicide Prevention Resource Center, Newton, Mass, and Department of Psychiatry, University of Chicago Medical School, Chicago, Ill (Dr Silverman).
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