Assessing the Standardization of Physician Mental Health Screenings

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Physicians are dying at much higher rates of suicide than the general population. Due to job stresses and barriers to treatment, resident physicians are more likely to undergo depression. So, how should Physician Mental Health Screenings be addressed?

A recently published article discusses the importance of mental health screening of physicians, highlighting the importance of addressing this increasing concern. Where physicians are routinely screened for tuberculosis and influenza medications, the authors of this viewpoint advocate that physicians need to be just as regularly screened for mental illnesses.

Matthew L. Goldman, MD, of the Psychiatry Department of Columbia University Medical Center; Carol A. Bernstein, MD, of the New York University School of Medicine; and Richard F. Summers, MD, of the Perelman School of Medicine at the University of Pennsylvania, outlined the benefits and risks of implementing standardized mental health screening protocol for physicians in an article published in JAMA.

Mental health challenges for physicians

Even though there still exists no conclusive data on comparative rates of mental illness in physicians, previous research has shown that resident physicians are more likely to experience depression than the general population. A 2015 systematic review estimated the prevalence of depression among resident physicians was around 28.8 percent, ranging from 20.9 percent to 43.2 percent.

Identified barriers to treatment are based upon concerns regarding confidentiality or judgments of colleagues, a mindset to manage their problems by themselves, concerns about ‘tainting’ their career and factoring in practical elements such as time, cost and limited accessibility.

Doctor in Surgery MaskPresently, there exists only one confidential web-based physician screening program, the American Foundation for Suicide Prevention’s Interactive Screening Program, as described in the literature.

The authors believe that prioritizing improvements in retention of physicians and avoiding resource-intensive repercussions, such as leaves and debilitation, has taken away the focus of health care institutions from this important matter.

Authors question whether institutions should take up the responsibility for ensuring consistent screenings of physicians for mental health conditions. A 2017 update to the Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements encouraged training programs, in association with their sponsoring institutions, to facilitate access to adequate tools for self-screening. As high rates of reported depression are being reported in both medical students and residents, residency and fellowship training programs are also paying closer attention to this question.

Benefits of screening

As the prevalence of and the associated challenges with mental illnesses such as depression, burnout, and suicide are being increasingly recognized, it only becomes more imperative to detect these symptoms early on, in order to effectively engage at-risk physicians in evidence-based treatments.

Established screening tools for detection of suicidal tendencies, depression, alcohol abuse and other mental illnesses in the wider population have already been verified. The US Preventive Services Task Force “recommends screening adults for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow-up.”

Currently, a 7-item Physician Well-Being Index has been validated as a measure of mental health and suicidal tendencies among practitioners, although presently no longitudinal data exists to support its influence on improved outcomes. Even so, research in the general population supports the efficacy of early detection for effective association with appropriate care. Timely screening in physicians may open up avenues for education and eradication of stigma in support of physicians that in need of help.

Associated potential risks of screening

Mental Health ScrabblePhysicians regard the fear of losing confidentiality to be the biggest barrier in accessing mental health services.

It can be particularly concerning for those receiving treatment within their same institution of work, the authors explain. There is often a lack of adequate mechanisms regarding online screenings, in-person meetings, protection of medical records and referrals that ensure privacy.

Despite advocacy by the Federation of State Medical Boards for their removal, licensure application questionnaires still include inappropriate questions regarding the applicant’s history of mental health care. Physicians are reasonably concerned regarding reporting incomplete information or risk investigation by a state medical board in the face of mandated reporting in certain states.

Only when positive screens result in referrals for adequate treatment, can a screening process be deemed effective, stated the authors. Finding affordable and accessible mental health services still remains to be a challenge for the majority, including physicians whose employee health benefits plan may not cover mental health services.

Furthermore, distinguishing between burnout and depression may prove to be trickier especially in high-stress work environments. False-positive screening results may be indicative of disrupted sleep schedules, long and unpredictable working hours and other workplace issues than a depressive episode.

Looking ahead

Concluding their assessment of such complex risks and benefits, the authors proposed a few strategies that may help make screening of physicians for mental illnesses a smoother process.

The viewpoint highlighted the need for anonymous screenings and referrals. One important tool to ensure privacy is the Interactive Screening Program, by the American Foundation for Suicide Prevention, that allows access for institutions to a customizable software to facilitate confidential and web-based screenings. If necessary, a counselor may help refer a patient for adequate treatment.

Medical examOn the other hand, the authors proposed that mental health screenings could be embedded as part of primary care and conducted alongside annual physical examinations and other health screenings.

Such an integration of mental health services into primary care would also help diminish stigma and facilitate service coverage with health insurance.

This also calls upon the necessity of developing a comprehensive health program that could ensure optimization of mental health services and confidentiality mechanisms helping to eradicate these barriers to treatment.

The authors further stressed upon future research to assess the outcomes of the implementation of screening and referral programs for physicians. Increasing concerns regarding physicians’ well-being and their influence upon patient outcomes are worth considering for the shaping and establishment for future policies and goals in the health care industry.


About the Author:

Mark GoldMark S. Gold, M.D.  served as Professor, the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry from 1990-2014. Dr. Gold was the first Faculty from the College of Medicine to be selected as a University-wide Distinguished Alumni Professor and served as the 17th University of Florida’s Distinguished Alumni Professor.
Learn more about Mark S. Gold, MD

About the Transcript Editor:

Sana Ahmed photoSana Ahmed is a journalist and social media savvy content writer with extensive research, print, and on-air interview skills. She has previously worked as staff writer for a renowned rehabilitation institute, a content writer for a marketing agency, an editor for a business magazine and been an on-air news broadcaster.

Sana graduated with a Bachelors in Economics and Management from London School of Economics and began a career of research and writing right after. Her recent work has largely been focused upon mental health and addiction recovery.

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Published on May 2, 2019
Reviewed by Jacquelyn Ekern, MS, LPC on May 2, 2019
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