Suicidal Ideation among Students and Physicians at a U.S. Medical School: A Healer Education, Assessment and Referral (HEAR) Program Report

Physicians are among the highest risk groups for suicide, and emerging data suggest this risk begins early in medical training. We describe a screening program at one medical center for identifying and referring physicians and students who may be at risk for suicide, and we explore differences between groups with respect to depressive symptoms, suicidal ideation (SI) and behaviors, and utilization of mental health resources. Over a 5-year period (May 2009-August 2014), we invited 1,134 medical students, 1,380 house staff (residents and fellows), and 1,922 faculty to complete an anonymous web-based "stress" questionnaire including items about depression symptoms, SI and behaviors, emotional distress features, drinking and drug-use behaviors, problematic eating, and utilization of treatments for depression and anxiety. Response rates among each group ranged from 17% (house staff) to 33% (students). Overall, 7% to 10% of respondents met criteria for a current major depressive syndrome, and 9% to 11% of respondents endorsed current SI. Similarities in depression severity and SI between groups far outweighed differences. The following were the four unique predictors of SI: presence of moderately severe or severe depressive symptoms, impairment, hopelessness, and past attempts. Only 17% of those endorsing current SI were taking antidepressant medication, and only 12% were receiving psychotherapy. However, 16% accepted referrals provided through this program. Increased efforts at education and destigmatization, outreach, assessment, and treatment at medical schools are essential. Our educational and screening program is one model others might employ to work toward this goal, though it is likely that additional outreach methods are needed.