By Suzanne Batchelor
Monday, January 31, 2005
Female physicians face a surprising killer; themselves. Although no research has been conducted on reasons for their especially high suicide rate, people close to the problem suspect heavy work-life burdens and gender bias in the profession.
(WOMENSENEWS)--Female physicians excel in eating right, exercising and other healthy behaviors, researchers say, compared to other women. But when it comes to coping with serious depression and stress, something is very wrong: Female physicians are dying by suicide at a rate two to three times greater than women outside the profession.
Saddened by the suicide deaths of female colleagues in 1997 during her Vienna residency and of a medical student in 2001, epidemiologist Dr. Eva Schernhammer of Boston's Harvard Medical School and Channing Laboratory wanted toknow whether female physicians had a higher rate of suicide, as some research had suggested. So she began an analysis of 25 studies of North American and northern European physicians and suicide.
When a woman is a physician, Schernhammer found, her suicide risk becomes greater than that of other professional women and women generally.
Female physicians die by suicide at a rate "substantially higher" than that of women in the general population, lead researcher Schernhammer and Graham Colditz reported in the December 2004 issue of American Journal of Psychiatry. The pattern of female physicians' higher rate appeared when all 25 studies, selected for quality, were compared, Schernhammer explained, though each study had focused on smaller physician groups, such as some U.S. states, certain years or countries.
A complete number for all U.S. physician suicide deaths each year, male and female, is harder to find, Schernhammer said. Psychiatrist Dr. Herbert Hendin, medical director of the New York-based nonprofit American Foundation for Suicide Prevention, agreed. Pressed for a rough estimate, Hendin said the number might be about 250 a year. The number of suicide deaths may be higher still, because the under-reporting of suicide is a well-documented problem, Schernhammer said, as coroners with any doubt about the cause of death often call it accidental.
Schernhammer and Colditz' research also confirmed male physicians' suicide risk to be somewhat higher than men in the general population. In the U.S. generally, male suicide deaths outnumber the female by 4 to 1, according to the National Institute of Mental Health.
Female physicians do a better job of practicing good health habits than women generally, researchers led by Dr. Erica Frank of Atlanta's Emory University found in research published in 1998. Frank is principal investigator of the Women Physicians' Health Study of 4,501 female U.S. physicians. She found that female physicians smoke and drink less, wear seat belts and exercise more, are more likely to get recommended health screenings, and eat more fruits and vegetables and less fat than other U.S. females.
A month earlier, Frank had published another research finding from the same study of 4,501 female physicians: Nearly half (47.7 percent) of U.S. female physicians said they had experienced gender bias and 36.9 percent reported sexual harassment. Younger physicians reported higher rates of sexual harassment than older ones and medical schools were the most common site, wrote Frank, "perhaps because of the importance of hierarchy" there.
"There's some stigma attached if you are a doctor and admit you have problems," Schernhammer speculated. She said she hopes their findings will attract researchers who will investigate why women physicians kill themselves.
Schernhammer emphasized that her study shows the female physician suicide rate but can't show the reasons why and that risk factor research is badly needed. Still, she said, she can speculate based on her own observations.
"There are so many situations in medicine where one could easily get overwhelmed if there is an underlying problem as well," said Schernhammer. "Work load is a huge stress factor for physicians, with a hundred or more work hours per week. Sleep deprivation is another enormous stress factor."
"Even though I personally don't have a family," Schernhammer said, "I imagine that double work load from both housekeeping and being a physician may add additional stress, especially in societies where it's not customary to have a nanny at home and where women tend to take over large parts of the housework."
She said she knows of only one physician suicide study, done in Germany, that provided information on whether the female physicians were married or single, with or without children.
In 1970, women were 7.6 percent of all physicians in the United States. By 2002, women's share had risen to 25.2 percent. Today women remain a minority of U.S. physicians, but this school year (2004-2005) women became nearly one-half (49.5 percent) of all medical school students, according to the American Medical Association.
Many female physicians are quick to point out, however, that the profession still has very few women in top medical school posts.
"It will take years or decades before women will be fully represented in the leading positions in their profession," Schernhammer said.
Dr. Molly Carnes, head of Madison's University of Wisconsin Center for Women's Health Research, agrees that women still have underdog status in medicine.
"Women can't get to leadership positions in medicine," Carnes said. "If you look at the senior faculty in academic medical centers, it's still less than 10 percent. We have fewer than 10 deans who are women."
Carnes points to Dr. Frank's 1998 research Frank of indicating a "dose-response" relationship between gender bias and sexual harassment in the medical workplace and female physicians' depression and suicide. The more bias and harassment a female physician experienced in her career, the more likely she would suffer from depression and die by suicide, Carnes said.
"Sexual harassment continues to occur. Every year we have at least one report from a medical student," Carnes said. "I've had it, hands reaching over to grab your knee, someone corners you, makes lewd suggestions during national meetings. I was, 'Oh, come on, get a clue!' It's about keeping women in their place, viewed as sexual objects."
Far from being less intense at higher professional levels, Carnes said that gender bias actually intensifies for women as they pursue higher professional rank.
"Generation after generation the awareness of gender bias increases," said Carnes. "My mother experienced gender bias in college. For me, college was a given but it (bias) kicked in medical school. Now, for the generation after me, it doesn't kick in until medical school or residency, but at the fellowship level or faculty level where the minority level dips below 50 percent substantially. The higher up they go, the more they hit against the system that is biased against women across the board."
Dr. Alan Swann of the University of Texas Medical School at Houston is a psychiatrist specializing in suicide and in stress. He praised the quality of Schernhammer's study and agreed that much is still unknown about why physicians, male and female, have a higher suicide rate than the general population, though alcohol and substance abuse, depression, stress and loss of social supports and isolation, such as after divorce, play a part in suicides generally.
Swann said physicians' overall suicide rate, though troubling, remains lower than that of alcoholics, and lower still than that of elderly white men, who have the highest suicide rate. Still, Swann was surprised to see female physicians' risk far exceed that of other women.
But, Swann said, alcoholism, major depression or bipolar disorder magnify the risk of suicide and "it's a higher magnification in women than in men. Sort of like being a doctor does, but it's a gender effect."
Attention to all physician suicide is overdue, said Hendin, a suicide specialist. He said Schernhammer's study indicated that female physicians had risen to the persistently high rate of male physician suicide and that widespread changes are needed in their profession.
Although stressful events may trigger suicide, most people who die by suicide already suffer from a mood disorder, most commonly depression (30 percent to 70 percent of suicide victims), according to the American Foundation for Suicide Prevention, and depression is treatable.
"Physicians don't diagnose depression in themselves or in their patients. They aren't trained to recognize it," said Hendin. And when they do, they may be penalized.
"If they indicate they are in treatment, in some states that makes it hard to get their license and there are some problems with regard to insurance and how hospitals treat them, if they will be watched or guarded," Hendin said. "And that's without regard to whether they have impairment."
Hendin said his foundation, along with the Milbank Foundation for Rehabilitation, have already gathered physicians, representatives from hospitals, the U.S. medical licensing boards and insurance companies, to find out how to make it easier for physicians to get help. Their recommendations will be published late this year or in 2006.
Suzanne Batchelor is a journalist based in Austin, Texas.
The American Journal of Psychiatry--
Suicide Rates Among Physicians: A Quantitative
and Gender Assessment (Meta-Analysis):
American Foundation for Suicide Prevention--
Physician Depression and Suicide Prevention Project:
JAMA and Archives--
Health-Related Behaviors of Women Physicians vs Other Women
in the United States:
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