Let's Talk About Depression in Healthcare

The data is concerning, and we need to normalize caring for our own mental health

Whenever I tell someone I’m a dentist, invariably either I am asked which toothpaste I recommend or I’m informed that my job has the highest suicide rate.

Dentists and suicide… it’s one of those weird bits of trivia that people share at a cocktail party. The sad truth is that I’ve personally known three lovely human beings in my profession that took their own lives.

My goal with Leaving Healthcare is to discuss why healthcare workers exit patient care and what they do next in their careers. I’ve tackled burnout before (source) but I knew one day I’d need to address the grim and important subject of depression and suicide.

Which healthcare profession has the highest rates? I have scoured the Internet and have seen robust studies by professional associations with pre- and post-COVID data, some of which I will reference below. I haven’t found a conclusive answer and, ultimately, what’s the point? Does it really matter if female veterinarians score a couple points higher than male anesthesiologists on completed suicides? What matters are the humans behind those numbers, the people who are at higher risks for depression and suicidal ideation, and figuring out how we can help each other live happier and healthier lives while we care for others.

The scope of the issue

According to a 2021 CDC report, healthcare worker suicide rate does not even break the top five (source). Farmers, forestry, and sports entertainment are among the occupations with significantly higher rates. Here’s the most troubling finding: “...the suicide rate in the U.S. working-age population overall has increased by approximately one third during the last 2 decades.” Let that sink in. There can be no question that there is a mental health crisis in this country.

I do want to share some data for healthcare professions. In a study from The Mayo Clinic, 41.7% of U.S. physicians tested positive on a depression screener, and 6.5% reported suicidal ideation within the past 12 months (source). A separate study by the AMA broke down self-reported depression rates by specialty, with urologists at the top with 38.5% and ophthalmology at the low end at 19.1% (source).

A 2021 JAMA Psychiatry article notes the incidence of suicide for physicians was comparable to the general population, but nurses were significantly higher– 23.8 per 100,000 vs 20.1 per 100,000 general population (source). Overall depression rates for nurses have been reported at 40% (source).

Depression rates amongst veterinarians have been cited at 34%, with suicidal ideation at 24.9% (source). An ADA study found 54% of dentists reported medium or high levels of depression (source). Do dentists have the highest suicide rate? Probably not. While recent data is lacking, the myth appears to have originated from articles in the 1960s that were later debunked (source).

Shared stressors across the professions

Some common themes amongst healthcare professions that separate us from other industries include:

(1) Emotional Burden

Routine exposure to suffering and death—be it in an ICU, operatory, or veterinary clinic—can take a profound psychological toll. Compassion fatigue and moral injury are pervasive and often underdiagnosed.

(2) Overwork and Burnout

Long shifts, administrative overload, and constant performance pressure drive high rates of burnout. Many providers sacrifice sleep, nutrition, and social life to meet the demands of care delivery.

(3) Stigma and Fear

Perhaps most devastatingly, many healthcare workers are reluctant to seek help.

One study summarized the reasons as: (1) their professional identity construction, with an exaggerated sense of duty combined with an increased sense of invulnerability and perfectionism; (2) their proneness to trying to cope alone; (3) their survival mentality; and (4) their high level of self-doubt, stigma and insecurity with regards to mental distress; and, (5) the fear of licensure problems when there are addictions or other severe mental disorders” (source).

Unique occupational challenges

As we begin to search for solutions, we should acknowledge some unique stressors in our respective professions.

Physicians grapple with administrative burdens, electronic health record fatigue, and pressure to make high-stakes decisions. Specialties such as emergency medicine and oncology face especially intense psychological strain.

Dentists, particularly in solo practices, often experience professional isolation. The repetitive nature of procedures and lack of collegial support can amplify stress. Financial strain from running a business adds to the burden.

Veterinarians frequently contend with the emotional labor of euthanasia, ethical dilemmas related to animal care and cost, and increasing rates of online harassment from clients.

Solutions

(1) Normalize Mental Health Care

Confidential access to therapy, mental health days, and institutional programs must become standard. Professional organizations can lead in destigmatizing help-seeking behavior.

I have two colleagues who have prioritized this topic in their lectures. Dr. Joshua Austin lectures around the world on dental materials and technology and he weaves in stories of mental health. He’s also created the best program I’ve ever seen that focuses on professional well-being, identifying the adverse effects of social media and what we can do to be healthier. Sherri Lukes is a renowned hygienist speaker on oral pathology who has devoted herself to raising mental health awareness. She was one of the first to address depression, anxiety, and stress in the dental field.

(2) Build Peer Support Networks

Encouraging open dialogue and mentorship programs can help mitigate isolation. The ADA tripartite (national, state, and local chapters) have excellent resources and are a great place to start, especially for solo practitioners who feel isolated.

(3) Change Workload

Healthcare professionals may be experiencing extreme workloads that are only temporary. Worker shortages caused by the pandemic are showing signs of recovery (source), and technological innovations like AI note transcription could dramatically ease administrative burdens (source).

If burnout and depression cannot be addressed in the short term, then providers should consider alternative careers that make use of their skills. In my article “How I Stopped Being a Dentist,” I shared the ways healthcare professionals can leave patient care for new and exciting jobs.

Final thoughts

If you are reading this and are suffering from depression, please know that you are not alone. Reach out to a loved one or a colleague and share your burden.

Let’s all commit to looking for signs of depression in our colleagues. Check in on one another if something seems amiss. If our outreach is quickly dismissed, consider a compassionate follow up.