Depression, Burnout Make Surgeons Mull Suicide

Jan. 17, 2010— -- In a national survey, one in 16 surgeons reported contemplating suicide, researchers reported.

An increased risk of suicidal ideation was linked to three factors: depression, burnout, and the perception of having made a recent major medical error, according to Dr. Tait Shanafelt of the Mayo Clinic in Rochester, Minn., and colleagues.

But only about one in four of those who reported thinking about taking their own lives sought psychiatric or psychologic help, Shanafelt and colleagues reported in the January issue of Archives of Surgery.

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The findings come from a survey commissioned by the American College of Surgeons and conducted anonymously in 2008. All told, 7,905 doctors -- or 31.7 percent of those surveyed -- took part.

The survey asked about thoughts or plans of suicide and the use of mental health resources, and included a depression screening tool as well as assessments of burnout and quality of life.

Suicide is a disproportionate cause of mortality for physicians compared with other professionals and with the population as a whole, the authors noted.

The high rate of suicidal thoughts among surgeons in particular (6.3 percent compared with 3.3 percent for the population as a whole) was "striking," Shanafelt and colleagues reported, especially considering that surgeons are highly educated, nearly all have jobs, and most are married -- "all factors known to reduce risk of suicide in the general population."

Another surprise was that older respondents were more likely to report suicidal thoughts -- surgeons 45 and older had a rate of suicidal ideation that was 1.5 to 3.0 times the rate among older members of the general population, the researchers reported.

Survey Sheds Light on Problem

The study is an "exemplary and timely contribution on a subject too often ignored," according to Dr. Kelly McCoy and Dr. Sally Carty, both of the University of Pittsburgh School of Medicine.

In an invited critique of the study, McCoy and Carty said a key finding is that perceived medical errors are associated with thinking about suicide.

"Self-knowledge is the first part of a solution," they argued, "and the authors are contributing greatly with their article by naming the problem."

The study had a relatively low response rate, Shanafelt and colleagues cautioned, which might have introduced a response bias. While the survey went to members of the surgical college, it's not known how well college members are representative of all U.S. surgeons, they added.

As well, they cautioned, the study was a cross-sectional snapshot and says nothing about causality. Unmeasured factors might also have introduced some biases, Shanafelt and colleagues added.