A qualitative analysis of the barriers and facilitators to physicians and trainees seeking help for suicidality

Background: Suicidal thoughts among physicians are common and increased during the COVID-19 pandemic, yet many hesitate to seek mental health support. We sought to examine factors influencing seeking help for suicidality among physicians and trainees, their narrative descriptions of suicidality, and the impacts of losing a physician in their lives to suicide. Methods: We conducted a qualitative analysis of published narratives from physicians and trainees describing experiences in seeking help for suicidality. We systematically searched MEDLINE and PsycInfo (March 2000 to March 2023) and manually reviewed reference lists of included articles. We analyzed narratives and generated themes using reflexive thematic analysis. Results: Across 52 narratives, authors commonly described preceding pressures, ways of coping, and intense emotional distress and altered self-perceptions. Barriers to seeking help were rooted in pressures that contributed to suicidality, including a medical culture that values achievement and stoicism, the growing severity of illness, stigma regarding mental health, fears about losing one’s license, reluctance to burden others, and limited access to timely, confidential care. In contrast, facilitators to seeking help included access to confidential services, mental health literacy and, most notably, the care and role modelling of seeking help by others. Narratives advocated for cultural and systemic changes within the profession. Interpretation: Intense pressures to achieve in medicine discourage physicians from acknowledging distress and seeking help, but role modelling of seeking help can attenuate the stigma. Understanding these intersecting factors can inform changes needed to develop targeted suicide prevention strategies for physicians and promote physician well-being.