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Consensus Statement |

Confronting Depression and Suicide in Physicians:  A Consensus Statement

Claudia Center, JD; Miriam Davis, PhD; Thomas Detre, MD; Daniel E. Ford, MD, MPH; Wendy Hansbrough, BSN; Herbert Hendin, MD; John Laszlo, MD; David A. Litts, OD; John Mann, MD; Peter A. Mansky, MD; Robert Michels, MD; Steven H. Miles, MD; Roy Proujansky, MD; Charles F. Reynolds III, MD; Morton M. Silverman, MD
JAMA. 2003;289(23):3161-3166. doi:10.1001/jama.289.23.3161.
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Objective To encourage treatment of depression and prevention of suicide in physicians by calling for a shift in professional attitudes and institutional policies to support physicians seeking help.

Participants An American Foundation for Suicide Prevention planning group invited 15 experts on the subject to evaluate the state of knowledge about physician depression and suicide and barriers to treatment. The group assembled for a workshop held October 6-7, 2002, in Philadelphia, Pa.

Evidence The planning group worked with each participant on a preworkshop literature review in an assigned area. Abstracts of presentations and key publications were distributed to participants before the workshop. After workshop presentations, participants were assigned to 1 of 2 breakout groups: (1) physicians in their role as patients and (2) medical institutions and professional organizations. The groups identified areas that required further research, barriers to treatment, and recommendations for reform.

Consensus Process This consensus statement emerged from a plenary session during which each work group presented its recommendations. The consensus statement was circulated to and approved by all participants.

Conclusions The culture of medicine accords low priority to physician mental health despite evidence of untreated mood disorders and an increased burden of suicide. Barriers to physicians' seeking help are often punitive, including discrimination in medical licensing, hospital privileges, and professional advancement. This consensus statement recommends transforming professional attitudes and changing institutional policies to encourage physicians to seek help. As barriers are removed and physicians confront depression and suicidality in their peers, they are more likely to recognize and treat these conditions in patients, including colleagues and medical students.

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Figure. Proportionate Mortality Ratio for White, Male Physicians vs White, Male Professionals, 1984-1995
Graphic Jump Location
HIV indicates human immunodeficiency virus. International Classification of Diseases, Ninth Revision. Error bars indicate 95% confidence intervals. Data from Frank and Dingle.32

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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