Key result
Self-referred doctors exhibit ~63% significant morbidity but rarely meet criteria for severe psychiatric illness.
Cross-Sectional (n=121)
Yes
Doctors utilizing a self-referral psychotherapeutic assessment service displayed high levels of distress and suicide risk despite low rates of severe psychiatric illness, highlighting the need for early intervention services.
May warrant accessible mental health services for physicians; leaves open whether self-referral models reduce suicide risk.
BACKGROUND: In the United Kingdom, specialist treatment and intervention services for doctors are underdeveloped. The MedNet programme, created in 1997 and funded by the London Deanery, aims to fill this gap by providing a self-referral, face-to-face, psychotherapeutic assessment service for doctors in London and South-East England. MedNet was designed to be a low-threshold service, targeting doctors without formal psychiatric problems. The aim of this study was to delineate the characteristics of doctors utilising the service, to describe their psychological morbidity, and to determine if early intervention is achieved. METHODS: A cross-sectional study including all consecutive self-referred doctors (n = 121, 50% male) presenting in 2002-2004 was conducted. Measures included standardised and bespoke questionnaires both self-report and clinician completed. The multi-dimensional evaluation included: demographics, CORE (CORE-OM, CORE-Workplace and CORE-A) an instrument designed to evaluate the psychological difficulties of patients referred to outpatient services, Brief Symptom Inventory to quantify caseness and formal psychiatric illness, and Maslach Burnout Inventory. RESULTS: The most prevalent presenting problems included depression, anxiety, interpersonal, self-esteem and work-related issues. However, only 9% of the cohort were identified as severely distressed psychiatrically using this measure. In approximately 50% of the sample, problems first presented in the preceding year. About 25% were on sick leave at the time of consultation, while 50% took little or no leave in the prior 12 months. A total of 42% were considered to be at some risk of suicide, with more than 25% considered to have a moderate to severe risk. There were no significant gender differences in type of morbidity, severity or days off sick. CONCLUSION: Doctors displayed high levels of distress as reflected in the significant proportion of those who were at some risk of suicide; however, low rates of severe psychiatric illness were detected. These findings suggest that MedNet clients represent both ends of the spectrum of severity, enabling early clinical engagement for a significant proportion of cases that is of importance both in terms of personal health and protecting patient care, and providing a timely intervention for those who are at risk, a group for whom rapid intervention services are in need and an area that requires further investigation in the UK.
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Garelick et al. (2007) conducted a cross-sectional in Psychological distress and morbidity (n=121). Self-referral to specialist psychotherapeutic service was evaluated on Psychological morbidity and severity of psychiatric distress. Among self-referred doctors to a specialist service, 42% were at some risk of suicide and 63% showed significant morbidity, yet only 9% met criteria for severe psychiatric illness.
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