Psychiatrists witness the benefits of mental healthcare daily. And they’re witnessing those benefits with greater frequency as the COVID-19 pandemic drives increasing numbers of patients to seek care on a regular basis.

But unfortunately, psychiatrists are struggling with their own mental health, according to a 2022 MDLinx report. And fear of stigmatization may be keeping some from seeking the support that they need.

 

Inside the report

MDLinx conducted a survey in 2022 of 50 practicing psychiatrists to glean insights on their mental health, as well as lifestyle issues and personal challenges.

Zeglis A, et al. The psychiatrists’ report: The changing state of our own mental health. MDLinx. 2022.

Researchers also delved into the actions psychiatrists are taking to improve their mental health as well as their attitudes about mental health in the field.

 

The psychiatrists identified five factors affecting their mental health:

• 58%—Excess time spent on administrative tasks

• 52%—Logging too many hours at work and not enough hours for leisure and rest

• 46%—Lack of administrative support

• 42%—Lackluster pay

• 42%—Pandemic-related struggles

“Institutions have often encouraged self-care to improve mental health and burnout while simultaneously requiring as many hours and as much productivity as ever,” one psychiatrist wrote.

Should we be concerned about compassion fatigue and burnout among psychiatrists?

 

A closer look at burnout

The data suggest that we should. Among the respondents, 32% said they were experiencing compassion fatigue and/or a “general loss of interest.”

This is part of an overall trend of pandemic-related distress among physicians. A March 2022 BMC Health Services Research study painted a clear picture.

Melnikow J, Padovani A, Miller M. Frontline physician burnout during the COVID-19 pandemic: national survey findings. BMC Health Serv Res. 2022;22(1):365.

Researchers surveyed 10,000 US physicians in two waves, May-June 2020 and December-January 2021, assessing them with burnout scores. All specialties (with the exception of EM physicians) had increased burnout scores.

 

That’s distressing enough on its own, but the authors of a July 2019 JAMA Psychiatry Viewpoint raised an interesting question that perhaps makes the situation more dire: Are we missing an important differential diagnosis of major depressive disorder (MDD) by blanketly labeling this type of distress as physician burnout?

Oquendo MA, Bernstein CA, Mayer LES. A key differential diagnosis for physicians—major depression or burnout? JAMA Psychiatry. 2019;76(11):1111.

 

“Physician depression and suicide prevention are relatively ignored, in part fueled by the fact that burnout and MDD have overlapping symptoms and clinical features,” the authors wrote.

 

Assessing stigma

Fortunately, the MDLinx survey indicated that the vast majority of psychiatrists (76%) were comfortable or very comfortable with discussing their mental health, and only 4% were uncomfortable or very uncomfortable. Moreover, 72% said that they felt somewhat or completely supported by colleagues; only 2% said they felt somewhat or completely unsupported.

It’s worth noting that nearly a quarter of surveyed psychiatrists did not feel comfortable or very comfortable about discussing their mental health while working in a field that encourages patients to do the same. What’s going on here?

The survey author, Amanda Zeglis, DO, a practicing psychiatrist, had some ideas.

It can be difficult to see yourself as both provider and patient. It takes a shift in mindset.

A July 2021 InStyle essay penned by Jessi Gold, MD, MS, also a practicing psychiatrist, peeled back yet another layer of stigma that psychiatrists face: While some may feel encouraged to discuss their own therapy, they may not feel so free to discuss taking medications.

Gold J. I’m a psychiatrist and even I kept my mental health meds a secret. InStyle. July 21, 2021.

 

“Asking for help, including from medications, is a strength, not a weakness,” Dr. Gold wrote.

When I take my medication, I am better able to show up for my patients and myself.

Zeglis said that reservations about discussing medications may stem from a perception that they’re more invasive than therapy, although both have their benefits in appropriate settings.

 

Licensing concerns

Another major factor contributing to the stigma and fear of physicians not seeking help for their mental health is having to disclose this information to the medical board and potentially risk losing their medical license.

A research letter recently published in JAMA noted, “state medical license applications often ask broad questions about mental health history or its hypothetical effect on competency,” which can influence physicians' decisions not to seek help.

Saddawi-Konefka D, Brown A, Eisenhart I, et al. Consistency between state medical license applications and recommendations regarding physician mental health. JAMA. 2021;325(19):2017–2018.

 

A study published in 2018 by Journal of the American Academy of Psychiatry and the Law, found that 32 state medical licensing bodies continued to ask mental health questions on applications that were inconsistent with standards under the Americans with Disabilities Act.

Jones JTR, North CS, Vogel-Scibilia S, et al. Medical licensure questions about mental illness and compliance with the Americans With Disabilities Act. J Am Acad Psychiatry Law. 2018;46(4)458–471.

 

Even if a physician is not reprimanded by the medical board for disclosing their mental health status, they could still be under extreme scrutiny and feel as though their privacy is being invaded by the state medical board.

 

Moving forward

Outside of traditional clinical settings, the MDLinx survey indicated that 64% of surveyed psychiatrists turned to diet, mediation, and exercise to cope. Sixty percent of respondents said they spent more time with loved ones, 54% took time away from work or pursued hobbies, and 48% talked about their troubles in non-clinical settings.

There are a number of online resources that can help psychiatrists independently achieve these goals. Here are some examples:

• Headspace, a subscription-based app, offers guided meditations, mindfulness exercises, and sleep hygiene support.

• Shine guides daily meditations, self-care courses, and community workshops.

• Calm is another app that offers guided meditations as well as approaches for improving sleep quality.

• Simple Habit is perhaps the ideal option for busy psychiatrists, as it features 5-minute meditations.

• Day One is a journaling app that supports voice memos, notes, drawings, and photos.

Another option is to look into joining a physician support group or specific programs that treat physicians’ for mental health concerns and burnout.

Zeglis also encouraged psychiatrists to view the American Psychiatric Association’s Well Being Resources—which can give some insight into resources for the options above or, if need be, use the new national suicide hoteline number: 988.

But, until all psychiatrists feel comfortable seeking conventional care, there’s still room for improvement on stigma elimination.

As one survey respondent put it, “I believe the environment has improved so that providers can discuss their own mental health, but it is still far less in comparison to fields outside of medicine.”