Four physicians committed suicide in Massachusetts this summer. This sad and staggering statistic reminds us that physicians, despite their knowledge and medical expertise, are not immune to the devastating effects of depression. It is estimated that 70 percent of physicians will experience an episode of significant depression during their professional career. Those in training are especially vulnerable, with estimates ranging as high as 25 to 30 percent.

According to The Handbook of Physician Health, physicians who are at the highest risk for this tragic event are both male and female, white, and over 45 years old. They can be divorced, separated or single. Alcohol or other substance abuse is usually present as are symptoms of depression and/or anxiety. These individuals are usually seen as "workaholics" and are often risk takers, gamblers and thrill seekers.

Physicians at risk may also have either chronic pain or a debilitating illness and access to lethal medications (like potassium chloride, insulin, barbiturates and narcotics) as well as access to firearms. In terms of psychosocial stressors, any perceived threat to professional or personal autonomy, security, and/or financial stability, recent losses, and increased work demands can all have a powerful impact.

A history of individual or family psychiatric illness, prior attempts, isolation, and malpractice allegations, litigation, and guilty findings may all contribute to a physician's susceptibility to suicide.

Barriers to identification and referral to treatment include denial and minimalization of symptoms. In addition, fears of disclosure, reporting to regulatory agencies and damage to professional reputation can all act as barriers to getting appropriate treatment.

For the physician at risk, the most important preventive measure is getting professional help as soon as possible. Express your concerns about yourself or a colleague to another associate, friend, or significant other who can access assistance. Asking for help is not a sign of weakness but one of strength.

- John A. Fromson, M.D.

For more information, contact Physician Health Services at (781) 434-7404 or www.physicianhealth.org.