Mental health in female doctors

Author: Victor Khou

In recent years, there has been extensive discussion in the media regarding the mental health of doctors and medical students. Studies have found an increased prevalence of mental health issues in the medical community, particularly among female doctors. A survey conducted by beyondblue found significantly higher rates of psychological distress, depression, anxiety and suicide ideation in female health professionals compared to their male counterparts. Furthermore, female doctors more commonly experienced work-related stress and emotional burnout. Mental health within this population may be negatively impacted by gender inequities in social status, employment rates and income. Gender-based discrimination in the workplace and greater domestic responsibilities may further contribute to poorer mental health.

To date, little has been done to address the burden of mental health issues in female doctors. While organisations such as the Medical Board of Australia and the Australian Medical Association have recently increased funding and resources to support mental health in doctors, more needs to be done to specifically address the needs of female health professionals. Moreover, barriers such as stigmatisation and lack of confidentiality continue to prevent doctors from seeking help and support. Therefore, it is necessary to continue advocating for this issue and work towards the development of targeted treatment and support for women in the health profession. Possible strategies include restructuring of training programs, and continued open discussion of mental health in public forums.

Background

The unique challenges and pressures faced by doctors in their work may contribute to higher rates of poor mental health in the medical community. Female health professionals are at particular risk of developing mental health disorders due to higher rates of work-related stressors and stressful life events. This may in turn negatively impact upon their wellbeing, and the quality of care delivered to their patients. It is therefore essential that the burden of mental health problems in female doctors and medical students is recognised and addressed.

A 2013 national survey conducted by beyondblue found significantly higher rates of mental health problems in female health professionals compared to their male counterparts [1]. Female doctors reported higher rates of psychological distress (4.1% vs 2.8%), and current diagnoses of depression (8.1% vs 5.0%) and anxiety (5.1% vs 2.9%). Females were also more likely to experience work-related stress, burnout and emotional exhaustion. Similarly, female medical students experienced higher rates of depression, anxiety and stress compared to males, with 47.2% at high risk of developing a minor psychiatric disorder.

Rates of suicidal ideation were higher in female doctors compared to males, both in the previous 12 months (11.0% vs 10.0%) and the period prior (28.5% vs 22.3%) [1]. Furthermore, suicide rates in Australian female health professionals were 2.5 times higher than in women from other occupations [2].

A number of factors contribute to poor mental health in female doctors and medical students. The influence of sociocultural gender roles on mental health in female doctors cannot be discounted. Inequities in social status, employment rates and income continue to have a negative impact on the mental health of women globally [6]. These inequities continue to be pertinent to female doctors – who were on average paid 16.6% less than their male counterparts in 2016 [7].

Female doctors are exposed to greater levels of gender-based discrimination and bullying than their male peers. Overall, female doctors in Australia report greater levels of personal and family demands, such as those related to child-bearing [1]. These greater levels of domestic responsibility heighten the time and emotional pressure experienced by female doctors compared to their male colleagues [4].

Compared to females in other professions, doctors are more likely to be involved in training programs in their early 30s (a common age for embarking on parenthood), creating potential conflicts between career and personal responsibilities [3]. Data suggests that female doctors are also more vulnerable to the effects of work related stressors such as long work hours, high levels of responsibility, bullying, and demands of study and examinations [1].

It remains unclear why females are more sensitive to stressful events than males, particularly in the medical profession. Personal vulnerability to stressors may be influenced by adverse experiences early in life, which contribute to poor self-esteem and feelings of helplessness in adulthood [4]. Some of the disparity to vulnerability of stressors may arise from differences in coping strategies employed by different genders. Females tend to respond to stressful events with highly gendered “feminine” methods, such as verbal and self-consolatory strategies [4,5]. Women are also more likely to dwell on possible triggers and implications of their depressive moods, resulting in long-term depression [5]. Moreover, depressive episodes early in life (which are more prevalent in females than males), are strong predictors of adult depression and anxiety [4].

What’s happened in this area lately?

To date, little work has specifically addressed the mental health needs of female doctors. beyondblue is a non-profit organisation aimed at raising awareness of mental health issues in Australia. It established the Doctor’s Mental Health Program in 2009 to address the prevalence of depression and anxiety in Australian medical students and doctors. A 2013 survey conducted by beyondblue was a world-first of Australian doctors and medical students, showing a significantly higher burden of mental health problems in females compared to males. Other features of the program include Grand Rounds facilitated by beyondblue at several Australian hospitals, to encourage doctors to seek treatment for their mental health issues.

While doctors’ health services have existed in Australia since the 1980s, they have received varying levels of support and funding. In 2014, the Medical Board of Australia announced a significant increase in resources and funding to support doctors’ health. In 2015, the Australian Medical Association established Doctor’s Health Services Pty Ltd, the first national health program for Australian doctors and medical students. An expanded network of health services was introduced in May 2016. An increased focus on mental health in the medical community can also be seen in the position statements of organisations such as the Australian Medical Students Association (AMSA) and the Royal Australasian College of Physicians (RACP). For instance, the 2017 position statement of the RACP states “we support raising awareness of mental health conditions, reducing stigma, supporting people with mental health conditions at work and creating healthy and supportive workplace cultures.”

What still needs to change?

Mental health is inextricably related to the socio-cultural determinants of health. We know that social position is a powerful predictor of mental illnesses such as depression and anxiety. So long as women’s subordinate social status is reinforced in the workplace, they are likely to continue to experience higher levels of mental distress. Striving for gender equity in our healthcare system is therefore imperative to improving the mental health of female doctors.

Importantly, stigmatising attitudes regarding mental health issues are still prevalent in the medical community. Up to 40% of doctors perceive medical professionals with mental health disorders as being less reliable than their peers [1]. Barriers such as embarrassment, concerns about career development, and lack of confidentiality also prevent doctors from seeking help and support. Meanwhile, a culture of workplace bullying and harassment further contributes to work-related stress in female doctors.

What should Level do?

To tackle this issue, it is important that Level continues to raise awareness of the issue of mental health in the medical community, and continues to advocate for gender equity within the medical profession.

Gathering more data on how the workplace contributes to poor mental health among female doctors might inform targeted treatments and support for women. This could include management of the many workplace stressors believed to be responsible for poor mental health. Restructuring of training programs, including more flexible options for women who plan to concurrently start a family, could help alleviate the burden of personal and professional responsibilities.

Other strategies might include organising talks from female doctors who have struggled with their mental health in the past, or workshops that develop more effective techniques to cope with conflict, stress and balance work/life responsibilities.

How can medical students advocate on this issue?

As the future workforce, medical students have an important role to play in shaping the culture of the medical community moving forward. Becoming educated about the persistent inequities that face female doctors and being advocates for change are powerful actions available to students and junior medical staff.

Frank and open discussion of mental health issues is necessary in overcoming the stigma of mental illness in the medical community. Medical students can help create a supportive environment for their peers by being involved in mental health-related events, and promoting awareness of mental illness among their colleagues.

Individual students may also watch out for warning signs of mental illness in their peers, and offer support if appropriate. They should also be encouraged to seek professional help for mental health issues where necessary

References

1. beyondblue. National Mental Health Survey of Doctors and Students. October 2013. Monash University, Australia. Available from: https://www.beyondblue.org.au/docs/default-source/research-projectfiles/bl1132-report—nmhdmss-full-report_web
2. Milner A, Maheen H, Bismark M, Spittal MJ. Suicide by health care professionals: a retrospective mortality study in Australia, 2001–2012. MJA. 2016;205(6):260–265.
3. Gerada C, Jones R, Wessely A. Young female doctors, mental health, and the NHS working environment. BMJ Careers 9 Jan 2014. Available from: //careers.bmj.com/careers/advice/view-article.html?id=20015983
4. Piccinelli M, Wilkinson G. Gender differences in depression. Critical review. Br J Psychiatry. 2000;177:486–92.
5. Hänninen, V. & Aro, H. Sex differences in coping and depression among young adults. Social Science and Medicine, 1996;43:1453 -1460.
6. World Health Organisation. Gender Disparities in Mental Health.
7. Cheng TC, Scott A, Jeon SH, Kalb G, Humphreys J, Joyce C. What factors influence the earnings of general practitioners and medical specialists? Evidence from the medicine in Australia: balancing employment and life survey. Health economics. 2012;21(11):1300-17.
8. Royal Australasian College of Physicians, Australia. Health of Doctors Position Statement 2017. 2017. https://www.racp.edu.au/docs/defaultsource/default-document-library/doctors-39-health_positionstatement_2017_f.pdf?sfvrsn=0
9. Australian Medical Students’ Association. Mental Health and Wellbeing Policy. 2015. Available at: https://www.amsa.org.au/sites/amsa.org.au/files/Mental%20Health%20and%2 0Wellbeing%20%282015

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