Depressive and anxiety symptoms in academic physicians (R. Lam)

Size: px

Start display at page:

Download "Depressive and anxiety symptoms in academic physicians (R. Lam)"

Duane Hancock
6 years ago
Views:

1 R3 Research Presentation Depressive and anxiety symptoms in academic physicians (R. Lam) St.-Antoine, Friday, Oct. 26, 2012 (3:45 pm-5:15 pm)

2 Depressive and Anxiety Symptoms in Academic Physicians Raymond W. Lam, MD, FRCPC Professor, Department of Psychiatry University of British Columbia Patricia Nolan, MD; Cindy Woo, MA; Andrew Clarke, MD; Erica Frank, MD, MPH; Dorothy Shaw, MBBCh, FRCSC UBC Institute of Mental Health

3 Disclosure Statement Dr. Raymond Lam, MD, FRCPC Ad hoc Consulting/Advisory Ad hoc Speaking honoraria Clinical trials/research (through UBC) Stocks Patents/Copyrights Royalties AstraZeneca, Bristol Myers Squibb, CANMAT, Common Drug Review, Eli Lilly, GlaxoSmithKline, Lundbeck, Mochida, Pfizer, Takeda. AstraZeneca, Biovail, CANMAT, Canadian Psychiatric Association, Lundbeck, Lundbeck Institute, Mochida, Servier. AstraZeneca, Bristol Myers Squibb, Canadian Institutes of Health 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. None. Lam Employment Absence and Productivity Scale (LEAPS) 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.

4 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.

5 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 selfreported lifetime depression = 19.5% What about academic physicians? Schwenk et al, J Clin Psychiatry 2008; Frank & Dingle, Am J Psychiatry 1999.

associated with high rates of productivity loss Screening by internet is

6 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?

those screening positive, using the FeelingBetterNow.

7 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 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

Moderate Severe MODERATE problems with anxiety None

8 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. Take our Mental Health Tune-Up. go

9 Stress and Depression Checkup Responses 3 waves of notifications. Reminders and incentives used to increase responses. Estimated Total Sample Responses Estimated Response Rate Full-time Academic Faculty Support Staff and Administration ~ ~48% ~ ~28% Clinical Faculty ~ ~23% Total ~ ~33%

10 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

11 Distribution of PHQ-9 scores in Academic Physicians Number of Physicians (n=271) Clinically significant (PHQ 10) PHQ-9 Score

12 Clinically significant depressive symptoms in Academic Physicians Sample Scale Minimal Mild Moderate to Marked Lam et al, 2012 Faculty of Medicine (n=271) PHQ-9 69% 23% 8% Linn et al, 1985 Teaching hospital (n=211) Zung Depression Scale 86% 10% 4% Linn et al, JAMA 1985.

13 Clinically significant depressive symptoms in Academic Physicians Characteristics Depressed Physicians* (N=22) Non-depressed Physicians (N=249) Male 77% 63% Full-time Academic Faculty 64% 1 38% Previously seen a physician for mental health symptoms 46% 2 27% Does not have a family doctor 18% 1 4% Previously diagnosed with depression or anxiety 41% 1 22% Current significant anxiety* 55% 2 2% Current work impairment is Moderate or greater* * PHQ-9 10; GAD-7 10; LEAPS % 2 2% 1 p<0.05; 2 p<0.001.

14 Clinically significant depressive symptoms, by sex MDs Only: % of sample with PHQ-9 10 % Response: % p=n.s. 5% N= Academic physicians 11% Men Michigan Medical Society* ~25% 23% 12% Women 7% 76K 10% 123K U.S. general population* * Schwenk et al, J Clin Psychiatry 2008; Kroenke K et al, J Affect Disord 2009

15 Suicidality and Physicians Meta-analyses show that physicians have 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 better off dead or of hurting yourself in some way. Number of Physicians Not at all 275 Several days 11 More than half the days 4 Nearly every day 2 Male = 77% Previous consultation = 41% Previous treatment = 47% Clinically depressed = 65% Clinically anxious = 41% Work impairment = 33% 1 Schernhammer & Colditz, Am J Psychiatry 2004.

16 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

17 Internet Care Management (for physicians) Top 5 myths about physician mental health Employee Assistance Program ephysicianhealth.com

Overall progress Stress and Depression Checkup MYTH #1: Doctors are capable, high-achieving professionals who deal with stress all the time; we don t become depressed or anxious.

18 Overall progress Stress and Depression Checkup MYTH #1: Doctors are capable, high-achieving professionals who deal with stress all the time; we don t become depressed or anxious. MYTH #2: I often diagnose and treat patients with mental health issues, so I should be able to help myself. MYTH #3: I already know a lot about mental health, but treatments that help others won t help me. MYTH #4: I ll need to notify the College about my symptoms and I ll lose my career. Top 5 myths about physician mental health FACTS: Practicing medicine is a rewarding and meaningful career for most physicians. But many of the traits 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. FACTS: When professional or personal tragedies strike, such as a divorce, a lawsuit, or the death of a family 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. FACTS: In the Michigan survey, compared to non-depressed colleagues, depressed physicians were 2-3 times more likely to hold dysfunctional beliefs about mental health care and to avoid seeking help because of confidentiality concerns. FACTS: 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 mental health. FACTS: 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? Please direct questions about any technical aspects of the survey to: info@mhcheckup.ca What can you do?

19 Internet Care Management Approximately 20% of participants clicked through to FBN

20 Thanks to our collaborators and funders Collaborators in workplace mental health: Melady Preece Paula Cayley Anne Bowen Walker Debra Wolinsky Erin Michalak Ellen Anderson Sagar Parikh Andrew Clarke Dorothy Shaw Erica Frank Cindy Woo Patricia Nolan CV Manjunath Marie-Josee Filteau David Bond Lakshmi Yatham Auby Axler Raj Ramasubbu Funding partners: Canadian Institutes of Health Research Michael Smith Foundation for Health Research Mathematics of Information Technology and Advanced Computing Canadian Psychiatric Research Foundation Canadian Network for Mood and Anxiety Treatments UBC Institute of Mental Health / Coast Capital Savings Lundbeck Canada AstraZeneca Canada

21 On-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?

The Relevance of an Employee Assistance Program to the Treatment of Workplace Depression

The Relevance of an Employee Assistance Program to the Treatment of Workplace Depression Melady Preece Paula M. Cayley Ulrike Scheuchl Raymond W. Lam ABSTRACT. Employees presenting to an Employee Assistance