Identifying Warning Signs of Depression in a Fellow Clinician

Physicians are continuously in a position of caring for others. But what happens when a clinician is the one who needs caring? This World Mental Health Day, we’re putting the focus squarely on healthcare professionals, offering tips to identify warning signs of depression in your colleagues and practical advice for broaching the subject with them.

In a New York Times essay, Aaron E. Carroll, health services researcher and professor of pediatrics at Indiana University School of Medicine, revealed that he had suffered from depression during his residency and declined to acknowledge it because “medicine is a profession in which admitting a problem carries a stigma.” The weight of battling depression coupled with the duty to care for others “leaves both patients and physicians at risk.”¹

Carroll’s experience is not uncommon. More than one-quarter of residents experience a major depressive episode. Physicians have higher rates of depressive symptoms and are at greater risk for suicide than the general population.²

The American Medical Association (AMA) recently adopted a policy to reduce barriers to seeking mental health care. The new policy gives members of the medical community the ability to seek care for depression, anxiety, burnout, and substance-related disorders without fear that doing so will impede their ability to obtain a medical license.³

The AMA addresses burnout in its policy for good reason: burnout rates are significant across medical specialties. In 2011, 45.5% of physicians reported feeling burned out. By 2014, that figure increased to 54.4%.⁴ While burnout and depression are separate experiences, they often develop in tandem.⁵ Further, long hours are linked with burnout.⁶ Not everyone who works long hours will develop burnout and depression, but it’s worth noting if a colleague appears more spent or upset at work than usual.

Burnout isn’t the only sign to look out for: isolation, withdrawal, lethargy, and difficulty concentrating are hallmark indicators of depression.⁷ But keep in mind that these telltale signs can be misleading. For example, extreme fatigue isn’t necessarily indicative of depression. The same is true for changes in eating habits, irritability, and hostility. Depression is a chronic illness that can manifest in a variety of ways, and diagnosing it is best left to a mental health professional.

That said, spending hours every day around a coworker puts you in a unique position to sense shifts in mood. If you suspect a colleague is depressed, start a conversation. Even if the subject is something benign such as weekend plans or an episode in a television series, you may be able to open the door to discussion. A little social contact can help, so think up an excuse to talk.

From there, you can nudge the conversation forward with open-ended and nonjudgmental questions such as “is something on your mind?” If your colleague seems distracted or overwhelmed, ask if there’s anything you can do to help.

Also consider inviting your coworker to lunch or for a quick walk. These activities afford your colleague an opportunity to open up. If the situation arises, you can gently ask “have you considered talking to anyone about this?” When you broach the subject of seeking professional help, do not insist or apply pressure. Rather, show support and be sensitive in the way you present the idea.

The AMA’s new policy offers hope that mental health issues in clinicians will become less taboo. But it may take time before physicians feel comfortable opening up about their struggles. Regardless, as Carroll concludes, “we can’t avoid talking about this.” If you think someone you work with may be suffering in silence, try to strike up a friendly conversation and see where it leads. It’s a good place to start.

References

1. Carroll AE. Silence is the enemy for doctors who have depression. The New York Times. January 11, 2016. Accessed October 2, 2018.
2. Healthcare professional burnout, depression and suicide prevention. American Foundation for Suicide Prevention. Accessed October 2, 2018.
3. AMA adopts policy to improve physician access to mental health care [press release]. Chicago, IL; American Medical Association; June 13, 2018.
4. Alexander AG, Ballou KA. Work-life balance, burnout, and the electronic health record. Am J Med. 2018;131(8):857-858.
5. Ahola K, Hakanen J, Perhoniemi R, Mutanen P. Relationship between burnout and depressive symptoms: a study using the person-centred approach. Burnout Res. 2014;1(1):29-37.
6. Hu NC, Chen JD, Cheng TJ. The associations between long working hours, physical inactivity, and burnout. J Occup Environ Med. 2016;58(5):514-518.
7. Grohol JM. Top 10 signs of depression. Psych Central. Reviewed July 17, 2016. Accessed October 2, 2018.