Should Mental Health Screenings for Physicians Be Standard Procedure?

The suicide rate among physicians far exceeds that of the general population. Suicide among physicians is commonly attributed to job stress and inadequate treatment.¹ Despite these figures, physicians rarely receive appropriate care, with many citing stigma, time constraints, costs, and confidentiality concerns as barriers to seeking help.²

Matthew L. Goldman, MD, of the Psychiatry Department of Columbia University Medical Center; Carol A. Bernstein, MD, of the New York University School of Medicine; and Richard F. Summers, MD, of the Perelman School of Medicine at the University of Pennsylvania, outlined the benefits and risks of implementing standardized mental health screenings for physicians in an article published in JAMA.³

At present, only 1 mental health screening resource for physicians is described in the literature. The American Foundation for Suicide Prevention’s Interactive Screening Program is a web-based platform that provides confidential screening resources to users. Additionally, a 2017 update to the Accreditation Council for Graduate Medical Education Common Program Requirements dictates that physician training programs must provide “access to appropriate tools for self-screening.”⁴ Benefits to introducing a standardized screening process include early detection of mental health conditions and timely implementation of suicide prophylaxis. Currently, a 7-item Physician Well-Being Index has been validated as a measure of mental quality of life and suicidal ideation among practitioners, although no longitudinal data exist to support its impact on improved outcomes. Even so, research in the general population supports the efficacy of early detection for improved linkage with appropriate care.

A number of risks exist alongside the implementation of a mental health screening program for physicians, the authors wrote. Confidentiality is of concern to patients, particularly those who receive treatment within their same institution of work. Moreover, many physicians cite concerns regarding staff privileging, as licensure applications require reporting of mental health status. In response to these concerns, the authors noted, physicians should be made aware of the distinction between seeking help for depression and undergoing assessment for impairment.

To combat these concerns, the authors suggested an anonymous online screening platform for care triage, such as that offered by the American Foundation for Suicide Prevention. Depression screenings should also be embedded in primary care, authors wrote, to bypass concerns about confidentiality, cost, and timing. Institution-level psychiatric resource programs could further reduce barriers to care access and improve physician health outcomes.

The US Preventive Services Task Force recommends annual depression screening for adults.⁵ Substantial psychiatric research shows that this recommendation should be followed for the physician population to lessen the burden of depression and mitigate the risk for suicide among this group.

References

1. Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting System. Gen Hosp Psychiatry. 2013;35(1):45-49.
2. Guille C, Speller H, Laff R, Epperson CN, Sen S. Utilization and barriers to mental health services among depressed medical interns: a prospective multisite study. J Grad Med Educ. 2010;2(2):210-214.
3. Goldman ML, Bernstein CA, Summers RF. Potential risks and benefits of mental health screening of physicians. JAMA. 2018;320(24):2527-2528.
4. Accreditation Council for Graduate Medical Education. ACGME Common Program Requirements. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRs_2017-07-01.pdf. Updated July 1, 2017. Accessed August 22, 2018.
5. Siu AL, for the US Preventive Services Task Force (USPSTF). Screening for depression in adults. US Preventive Services Task Force recommendation statement. JAMA. 2016;315(4):380-387.