Examining Mental Health Within the Field of Cardiology 

Mental health concerns affecting physicians have received increasing attention recently, including high rates of professional burnout, depression, and other psychological conditions that have further increased since the onset of the COVID-19 pandemic.^1,2 New study results from the American College of Cardiology (ACC) shed light on the state of mental health among cardiologists from around the world.³

Noting the dearth of evidence regarding mental health conditions in this population, researchers at The Ohio State University (OSU) Wexner Medical Center in Columbus, Ohio, conducted a survey on the topic and received responses from 5931 cardiologists (22.6% women and 53.5% White). Two-thirds of respondents were aged 40 years and older.³

The survey results showed that 28% of cardiologists reported a mental health condition, which could indicate the presence of various behaviors, disorders, or types of emotional distress.³

“In our study, we used a broad definition of mental health conditions, which included self-reported experience with alcohol or drug use disorder, suicidal tendencies, psychological distress such as anxiety, irritability, or anger, other psychiatric disorder such as panic disorder, posttraumatic stress disorder, and eating disorders, and major psychiatric disorder such as major depressive disorder, bipolar disorder, or schizophrenia,” explained study co-author Dr Laxmi Mehta, MD, cardiologist and professor, chief well-being liaison, and faculty director of the Gabbe Health and Wellbeing Program at OSU Wexner Medical Center, and chair of the ACC’s Clinician Wellbeing Workgroup.

The survey “asked if respondents had ever had these conditions, so some may have preexisted prior to becoming a cardiologist,” she noted. It is also unclear whether rates of mental health conditions among cardiologists have changed since the pandemic began, as the ACC survey was conducted in 2019.

Women were more likely to have considered suicide within the previous 12 months compared with men (3.8% vs 2.3%). Additionally, women were more likely than men (42.3% vs 31.1%) to seek help for mental health issues. Predictive factors of mental health conditions included a history of experiencing emotional harassment (OR, 2.81; 95% CI, 2.46-3.20) or discrimination (OR, 1.85; 95% CI, 1.61-2.12) and being divorced (OR, 1.85; 95% CI, 1.27-2.36) or aged younger than 55 years (OR, 1.43; 95% CI, 1.24-1.66).³

“The higher rates of mental health conditions observed in women and younger cardiologists is likely related to the higher prevalence of emotional harassment or discrimination in these groups,” Dr Mehta said. These findings highlight the need to ensure “respectful and inclusive environments for both work and learning.”

The results also showed that 44% of respondents reporting a mental health condition had experienced professional dissatisfaction as assessed by metrics such as feeling valued, being treated fairly, and receiving adequate compensation.³

In other research, cardiologists reported higher levels of burnout and longer work hours compared to other physicians, and only 23% of cardiologists struggling with depression or suicidality indicated a willingness to seek professional help. Such findings suggest that “many cardiologists may be suffering silently,” wrote Patel et al in a 2021 paper in Heart.⁴

Regarding broad measures needed to address mental health among cardiologists, efforts are needed to “reduce barriers to seeking mental health care, including reducing the associated stigma and reducing the fear of reporting mental health conditions to our hospital credentialing committees and state licensing boards,” according to Dr Mehta. “In addition, efforts need to be made to address the systemic issues that are contributing to employee burnout.”⁵

On the individual level, Arianna Galligher, LISW, director of the Gabbe Health and Well-Being Program and associate director of the STAR Trauma Recovery Center at OSU Wexner Medical Center, offers the following suggestions for physicians who are struggling with mental health concerns:

• The first step to getting the right support is to acknowledge that something is wrong or out of balance. Next, it’s important to treat that reality with self-compassion rather than judgment. Struggling with a mental health concern doesn’t mean you’re damaged or broken, and it’s okay to reach out for help.
• For many, accessing peer support can help in regaining a healthy perspective and developing a plan for how best to move forward. Sometimes that plan will involve seeking treatment from a mental health professional, especially if stress and symptoms are impacting more than 1 area of life.
• Linkage with peer support and mental health care should be quick, simple, and stigma-free. Institutions also have a responsibility to foster and maintain a culture of caring that prioritizes support among colleagues through formal peer support programs. At OSU Wexner Medical Center, for example, staff have access to the Stress, Trauma and Resilience (STAR) Program, which offers fast, free, confidential support for groups and individuals as well as education, training, and guidance for providers who would like to become peer supporters.       

Dr Mehta added, “The Physician Support Line is a resource that provides free, confidential support by psychiatrists for US physicians and medical students.” The phone number is 1-888-409-0171. The peer-to-peer organization — which encourages individuals to “call for any issue, not just a crisis” — does not record personal information, and physicians seeking help are not required to report the calls to their medical board. The 988 Suicide & Crisis Lifeline (formerly the National Suicide Prevention Lifeline) is an all-hours resource for individuals experiencing a mental health or substance abuse crisis.

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org

Resources

• 988 Suicide & Crisis Lifeline | SAMHSA
• Physician Support Line and their resource list: Physicians Who Need Help
• Preventing Physician Suicide | American Medical Association
• Suicide Prevention and Emergency Help | AAFP
• AMA Steps Forward: Transform Your Practice

This article originally appeared on The Cardiology Advisor