Mental Health a Concern for Many Cardiologists: ACC Survey

Destigmatizing mental illness among physicians and promoting diversity, equity, and inclusion are key steps, says Andrew Sauer.

Mental Health a Concern for Many Cardiologists: ACC Survey

More than one-quarter of cardiologists suffer from mental health issues, primarily anxiety and stress, with many of them also citing hostile workplaces, according to a global survey. Yet only one in three of these physicians said they sought professional help.

Senior author Laxmi S. Mehta, MD (The Ohio State University Wexner Medical Center, Columbus), told TCTMD she was shocked the numbers were so high despite the survey being conducted in the pre-COVID-19 era.

“I think one reason this is surprising is because we don't talk about mental health in cardiology at all,” she said. “Unfortunately, it’s not surprising that people aren't seeking help, because there's some real barriers, especially stigma barriers, that preclude them from seeking that help.”

Among cardiologists reporting any mental illness, psychological distress accounted for 76% of the reports and was most common among those who were early career and female. Other psychiatric disorders—like panic disorder, post-traumatic stress, and eating disorders—also were higher in women compared with men. Nearly 3% of those reporting any mental health condition said they had considered suicide in the previous 12 months, again with a higher prevalence in women than in men (3.8% vs 2.3%; P < 0.001).

Reasons given for not seeking help for a mental health issue included lack of privacy, lack of time, embarrassment, impact on professional advancement, impact on practice, and lack of resources.

“There's the fear of not being able to practice and it affecting their hospital credentialing if they report that they've sought help,” Mehta added. Some institutions require staff to report treatment for mental illness, and it’s also a question on many state medical licensing boards, she noted.

We don't talk about mental health in cardiology at all. Laxmi S. Mehta

The results are “sobering,” says Andrew J. Sauer, MD (Saint Luke’s Mid America Heart Institute, Kansas City, MO), in an editorial accompanying the paper in the Journal of the American College of Cardiology.

“We have fostered a culture of silent suffering,” Sauer adds, as physicians immersed in dedication to their patients are also “subservient to a hierarchal system.” This, he says, often conditions them to isolate and avoid speaking out about what they are going through or actively seeking help.

Among Sauer’s recommendations for turning things around is selective promotion of leaders “who strive to mitigate implicit bias, discrimination, and harassment while advancing diversity, equity, and inclusion within the broad ranks of cardiologists.”

This survey and others, he adds, is more reason to call for destigmatization of mental illness in medicine and ensure that physicians not only report their condition, but are allotted adequate time to receive necessary treatment. He points out, however, that the situation is bigger than just physicians, extending to trainees and support staff who were not included in the survey.

Variations by Sex, Race, Marital Status

Mehta and colleagues led by Garima Sharma, MD (Johns Hopkins University School of Medicine, Baltimore, MD), sent invitations to 5,931 cardiologists practicing in Africa, Asia, Eastern Europe, European Union, Middle East, Oceania, and South, Central, and North America, asking them to participate in the American College of Cardiology (ACC)-supported survey. The 50-item online anonymous survey was completed by 5,890 individuals between September and October 2019. Mental health conditions included self-reported experience with alcohol/drug use disorder, suicidal tendencies, psychological distress, other psychiatric disorder, and major psychiatric disorder.

The majority of survey participants were married, had children, and lived in a dual-income household. Most reported full-time employment, with 61.5% having been in practice for 10 or more years. The European Union was the most represented of all regions.

The overall rate of mental illnesses reported was 28%. The prevalence was higher in those under age 40 versus 70 or older (P < 0.001) and in women versus men for any mental health condition, as well as for major psychiatric disorder and other psychiatric disorder. In contrast, alcohol or drug use disorder was more common among men than women who reported any mental health condition (6.5% vs 1.8%; P < 0.001).

The overall prevalence of major psychiatric disorders such as major depressive disorder, bipolar disorder, or schizophrenia was 4.7% and was higher in women than men, the survey found.

Married cardiologists were less likely than those who were divorced or single to report mental health conditions. By race and ethnicity, Hispanic cardiologists were more affected than those who were white, non-Hispanic Black or Asian. By practice duration, longer length of practice was associated with less reporting of mental health conditions than those in earlier stages of their career.

The study also found significant geographic variation, with the highest concentration of cardiologists reporting mental health conditions based in South America, followed by Central America, and the lowest concentration in Asia.

Another contributor to mental health conditions was a hostile work environment, which was defined as experiencing discrimination on the basis of age, gender, race, or sexual orientation. In the group of cardiologists who reported a hostile work environment, the rate of any mental health issue was 42%. The numbers were even higher, greater than 50%, among those who reported sexual harassment on the job. Having any mental health condition also was associated with a greater likelihood of some level of professional dissatisfaction, the survey noted, with rates of 44% and 29% in cardiologists with versus without mental health conditions.

What Can Be Done?

The intersection of mental health issues and work environment in this new study elucidates prior research by Sharma and colleagues, in which the presence of some form of hostility in the workplace was reported to be more than 40% worldwide among cardiologists.

According to Sauer, an important conduit for improving the workplace environment is assisting cardiologists through mentorship programs that can help them transition from early to mid-career, for example, and provide support as their professional and personal lives evolve to include familial and other responsibilities. He also notes that the situation that plays out in the survey may be worse today than it was in 2019 as a result of burnout from the COVID-19 pandemic.

Mehta, who serves as chair of the ACC’s Clinician Well-Being workgroup, said the survey results are pertinent to that group and others who are looking at ways to enhance the work environment for the CV workforce, with an eye toward advocating for mental health policies.

“The [challenge] is how do we reduce the stigma of having a mental health condition and remove the shame associated with it and work toward allowing people to safely seek assistance without any negative ramifications for seeking that help,” she said.

  • Sharma reports support from the Blumenthal Scholarship in Preventive Cardiology at the Ciccarone Center for the Prevention of Cardiovascular Disease and AHA HRSN.
  • Sauer reports no relevant conflicts of interest.