Depressive and anxiety symptoms in academic physicians (R. Lam) - R3 - Research Presentation - St.-Antoine, Friday, Oct. 26, 2012 (3:45 pm-5:15 pm)
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R3 – Research Presentation
Depressive and anxiety symptoms in academic physicians
(R. Lam)
St.-Antoine, Friday, Oct. 26, 2012 (3:45 pm-5:15 pm)
Depressive and Anxiety Symptoms
in Academic Physicians
Raymond W. Lam, MD, FRCPC
Professor, Department of Psychiatry
University of British Columbia
r.lam@ubc.ca
Patricia Nolan, MD; Cindy Woo, MA; Andrew Clarke, MD;
Erica Frank, MD, MPH; Dorothy Shaw, MBBCh, FRCSC
UBC Institute of
Mental Health
Disclosure Statement 2010-2012
Dr. Raymond Lam, MD, FRCPC
Ad hoc Consulting/Advisory AstraZeneca, Bristol Myers Squibb, CANMAT, Common Drug Review,
Eli Lilly, GlaxoSmithKline, Lundbeck, Mochida, Pfizer, Takeda.
Ad hoc Speaking honoraria AstraZeneca, Biovail, CANMAT, Canadian Psychiatric Association,
Lundbeck, Lundbeck Institute, Mochida, Servier.
Clinical trials/research AstraZeneca, Bristol Myers Squibb, Canadian Institutes of Health
(through UBC) Research, Canadian Psychiatric Association Foundation, CANMAT,
Lundbeck, Litebook Company, Michael Smith Foundation for Health
Research, Pfizer, St. Jude Medical, UBC Institute of Mental
Health/Coast Capital Savings.
Stocks None.
Patents/Copyrights Lam Employment Absence and Productivity Scale (LEAPS)
Royalties American Psychiatric Press, Cambridge University Press,
Oxford University Press.
Objectives At the end of this presentation, participants will be able to: 1) Discuss the evidence for rates of depression and anxiety in physician samples. 2) List the rates of self-reported depression and anxiety in an academic physician sample. 3) Discuss strategies for identifying and managing these symptoms in academic physicians.
Stress and Depression in Physicians
Are physicians at risk for depression and anxiety?
Survey of Michigan Medical Society using PHQ-9 =
11.3% had major depression
Women’s Physician Health Study (n=4500) found self-
reported lifetime depression = 19.5%
What about academic physicians?
Schwenk et al, J Clin Psychiatry 2008; Frank & Dingle, Am J Psychiatry 1999.
Mental Health Screening in Businesses
Depression screening programs have
demonstrated the high prevalence of
depression within businesses
Depression is associated with high
rates of productivity loss
Screening by internet is appealing:
convenient, anonymous and
confidential, low cost
Does screening lead to improved
outcomes?
Stress and Depression Checkup Mental health promotion initiative for faculty and staff in the UBC Faculty of Medicine Brief screening questionnaire for depression/anxiety, by email Internet intervention for those screening positive, using the FeelingBetterNow.com web site Follow up surveys to evaluate outcomes Entirely anonymous and confidential Funded by the UBC Institute of Mental Health / Coast Capital Savings Fund
Your Stress and Depression Checkup shows that you have:
MILD problems with depression None Mild Moderate Severe
MODERATE problems with anxiety None Mild Moderate Severe
Don’t worry -- You can feel better!
There are many treatments that can help with symptoms of depression and anxiety.
go
Take our Mental Health Tune-Up.
Stress and Depression Checkup – Responses
3 waves of email notifications.
Reminders and incentives used to increase responses.
Estimated
Estimated
Responses Response
Total Sample
Rate
Full-time
~600 290 ~48%
Academic Faculty
Support Staff and
~1500 423 ~28%
Administration
Clinical Faculty ~1000 233 ~23%
Total ~3100 1018 ~33%
Scales used in Stress and Depression Checkup For depression = PHQ-9 Sensitivity and specificity for diagnosis of Major Depressive Disorder (MDD) = 88% and 88% For anxiety = GAD-7 Sensitivity and specificity for diagnosis of anxiety disorder = For Generalized Anxiety Disorder: 89% and 82% For Others: 66-74% and 80-81% For work impairment = LEAPS Lam Employment Absence and Productivity Scale
Distribution of PHQ-9 scores in
Academic Physicians
55
50
45
40
35
Number of 30
Physicians 25
(n=271)
20
15
10 Clinically significant (PHQ≥10)
5
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
PHQ-9 ScoreClinically significant depressive symptoms
in Academic Physicians
Moderate
Sample Scale Minimal Mild
to Marked
Lam et al, Faculty of
PHQ-9 69% 23% 8%
2012 Medicine (n=271)
Zung
Linn et al, Teaching hospital
Depression 86% 10% 4%
1985 (n=211)
Scale
Linn et al, JAMA 1985.Clinically significant depressive symptoms
in Academic Physicians
Depressed Non-depressed
Characteristics Physicians* Physicians
(N=22) (N=249)
Male 77% 63%
Full-time Academic Faculty 64%1 38%
Previously seen a physician for
46%2 27%
mental health symptoms
Does not have a family doctor 18%1 4%
Previously diagnosed with
41%1 22%
depression or anxiety
Current significant anxiety* 55%2 2%
Current work impairment is
58%2 2%
Moderate or greater*
* PHQ-9 ≥10; GAD-7 ≥10; LEAPS ≥10. 1 pClinically significant depressive symptoms,
by sex
20
18 Men Women
16
MDs Only: 14
p=n.s.
% of sample 12 11% 12%
with PHQ-9 10 10% 10%
10
8
7%
6 5%
4
2
N= 187 105 865 285 76K 123K
0
Academic Michigan Medical U.S. general
physicians Society* population*
% Response: ~25% 23%
* Schwenk et al, J Clin Psychiatry 2008; Kroenke K et al, J Affect Disord 2009Suicidality and Physicians
Meta-analyses show that physicians have 1.4 - 2.3 times the
risk of death by suicide compared to the general population.1
PHQ: Over the last 2 weeks, how often have you
been bothered by:
Thoughts that you would be
Number of
better off dead or of hurting
Physicians
yourself in some way.
Not at all 275
Male = 77%
Several days 11
Previous consultation = 41%
More than half the days 4 Previous treatment = 47%
Nearly every day 2 Clinically depressed = 65%
Clinically anxious = 41%
Work impairment = 33%
1Schernhammer & Colditz, Am J Psychiatry 2004.Discussion and Conclusions In a survey sample of academic physicians: A significant proportion of academic physicians have depressive and anxiety symptoms Clinically significant depression = 8% (of which 54% had not consulted a physician) Clinically significant anxiety = 6% Men appear to have greater risk than women; Full-time faculty have greater risk than Clinical faculty Early identification and intervention for academic physicians should be a priority for faculties of medicine
Internet Care Management (for physicians)
“Top 5 myths about physician mental health”
Employee
Assistance
Program
www.physicianhealth.com
ePhysicianHealth.comOverall progress
Stress and Depression Checkup Top 5 myths about physician mental health
MYTH #1: “Doctors are capable, high-achieving FACTS:
professionals who deal with stress all the time; • Practicing medicine is a rewarding and meaningful career for most physicians. But many of the traits
we don’t become depressed or anxious.” that the profession might require of you (such as perfectionism, a heightened sense of responsibility,
and self-reliance) can lead to guilt, inability to delegate tasks, and burnout.
• Physicians are a high-risk group for depression and anxiety. In a 2005 survey of 5000 doctors
in Michigan, 11% were moderately to severely depressed.
MYTH #2: “I often diagnose and treat patients FACTS:
with mental health issues, so I should be able to
• When professional or personal tragedies strike, such as a divorce, a lawsuit, or the death of a family
help myself.”
member, you might not know how to ask for help. By instinct, many physicians might continue to try
and solve things on their own (even though they would never advise their patients to do the same).
Others turn to self-prescribing, alcohol, or illicit drugs to hep them deal with their difficulties.
• Self-prescribing medications is a common error made by depressed physicians – “a doctor who
treats him/herself has a fool for a physician”. Every physician should have their own family doctor.
• If you don’t already have a family physician, or if you would like to talk to an expert in the field of
physician mental health and well-being, the Physician Health Program of BC can arrange prompt
referrals.
MYTH #3: “I already know a lot about mental FACTS:
health, but treatments that help others won’t help • In the Michigan survey, compared to non-depressed colleagues, depressed physicians were 2-3
me.” times more likely to hold dysfunctional beliefs about mental health care and to avoid seeking help
because of confidentiality concerns.
MYTH #4: “I’ll need to notify the College about FACTS:
my symptoms and I’ll lose my career.” • There is no mandatory reporting about mental health treatment (except in uncommon situations
involving hospitalization and safety). You can get confidential help.
• Most physicians who have obtained help continue to work, and most recover fully.
MYTH #5:“I’m too busy to take time off for my FACTS:
mental health.” • You may have deferred personal fulfillment for years while attending medical school and residency
and while building your career. Long hours of work can lead to neglect of self-care, problems in
relationships, and a work-focused lifestyle.
• Most treatments do not take a lot of time. Can you afford NOT to take care of yourself?
What can you do?
Please direct questions about any technical aspects of the survey to: info@mhcheckup.caInternet Care Management Approximately 20% of participants clicked through to FBN
Thanks to our collaborators and funders
Collaborators in workplace mental health:
Melady Preece Sagar Parikh CV Manjunath
Paula Cayley Andrew Clarke Marie-Josee Filteau
Anne Bowen Walker Dorothy Shaw David Bond
Debra Wolinsky Erica Frank Lakshmi Yatham
Erin Michalak Cindy Woo Auby Axler
Ellen Anderson Patricia Nolan Raj Ramasubbu
Funding partners:
Canadian Institutes Canadian Psychiatric Research
of Health Research Foundation
Michael Smith Foundation Canadian Network for Mood and
for Health Research Anxiety Treatments
Mathematics of Information UBC Institute of Mental Health /
Technology and Advanced Coast Capital Savings
Computing Lundbeck Canada
AstraZeneca CanadaOn-Line Depression Screening and
Intervention: Summary
Depression leads to serious economic burden
to employees and employers.
Early identification and intervention will likely
improve productivity and prevent short- and
long-term disability.
On-line screening offers convenient,
anonymous identification of clinically
significant symptoms.
Academic physicians have at least a
similar risk for depression and anxiety
as the general population.
Does screening/intervention improve
health and productivity outcomes?You can also read
