← Daniel Saddawi‑Konefka · dansaddawi.com

Barriers to Help-Seeking for Healthcare Workers

Full talk references

All 78 references from the talk. The summary paper is first; the rest are alphabetical. Links go to the DOI or publisher where one exists.

In crisis, or worried about someone else? The 988 Suicide & Crisis Lifeline is free, confidential, and staffed 24 hours a day: call 988, text 988, or visit 988lifeline.org.

  1. Saddawi-Konefka D, Moutier CY, Ehrenfeld JM. Reducing Barriers to Mental Health Care for Physicians: An Overview and Strategic Recommendations. JAMA. Published online August 14, 2025. doi:10.1001/jama.2025.12587
  2. Aaronson A, Backes K, Agarwal G, Goldstein J, Anzia JM. Mental health during residency training: Assessing the barriers to seeking care. Academic Psychiatry. 2018;42(4):469-472. doi:10.1007/s40596-017-0881-3
  3. ACGME. Common Program Requirements (Residency). July 1, 2023. Link
  4. The Americans with Disabilities Act (ADA). ada.gov
  5. Adams EF, Lee AJ, Pritchard C, White R. What Stops Us From Healing the Healers: a Survey of Help-Seeking Behaviour, Stigmatisation and Depression Within the Medical Profession. International Journal of Social Psychiatry. 2010;56(4):359-370. doi:10.1177/0020764008099123
  6. AMA Media & Editorial. AMA president sounds alarm on national physician shortage. American Medical Association. October 25, 2023. Link
  7. Bhatia G, Sharma P, Pal A, Parmar A. The silent epidemic: Death by suicide among physicians. Asia-Pacific Psychiatry. 2022;15(1). doi:10.1111/appy.12522
  8. Brown GK, Have TT, Henriques G, Xie SX, Hollander JE, Beck AT. Cognitive therapy for the prevention of suicide attempts. JAMA. 2005;294(5):563. doi:10.1001/jama.294.5.563
  9. Center C, Davis M, Detre T, et al. Confronting depression and suicide in physicians. JAMA. 2003;289(23):3161. doi:10.1001/jama.289.23.3161
  10. Cho HL, Huang CJ. Why mental Health-Related stigma matters for physician wellbeing, burnout, and patient care. Journal of General Internal Medicine. 2020;35(5):1579-1581. doi:10.1007/s11606-019-05173-6
  11. Cunningham C. 2023 AAS Presidential address - removing the mask. March 3, 2023. Link
  12. D'Anci KE, Uhl S, Giradi G, Martin C. Treatments for the prevention and management of suicide. Annals of Internal Medicine. 2019;171(5):334. doi:10.7326/m19-0869
  13. DeCamp M, Levine M, Ethics PA. Physician Suicide Prevention and the Ethics and Role of a Healing Community: an American College of Physicians Policy Paper. Journal of General Internal Medicine. 2021;36(9):2829-2835. doi:10.1007/s11606-021-06852-z
  14. Douglas RN, Sharpe EE, Kraus M, Saddawi-Konefka D, Hanson AC, Pulos BP. Mental health questions on state medical license applications and evaluation of updates. JAMA Network Open. 2023;6(9):e2333360. doi:10.1001/jamanetworkopen.2023.33360
  15. Duarte D, El-Hagrassy MM, Couto TCE, De Sousa Gurgel W, Fregni F, Corrêa H. Male and female physician suicidality. JAMA Psychiatry. 2020;77(6):587. doi:10.1001/jamapsychiatry.2020.0011
  16. Dutheil F, Aubert C, Pereira B, et al. Suicide among physicians and health-care workers: A systematic review and meta-analysis. PLOS ONE. 2019;14(12):e0226361. doi:10.1371/journal.pone.0226361
  17. Dyrbye LN, West CP, Sinsky CA, Goeders LE, Satele D, Shanafelt TD. Medical licensure questions and physician reluctance to seek care for mental health conditions. Mayo Clinic Proceedings. 2017;92(10):1486-1493. doi:10.1016/j.mayocp.2017.06.020
  18. The Emotional PPE Project. 2023. emotionalppe.org
  19. Epstein RM, Krasner MS. Physician resilience: what it means, why it matters, and how to promote it. Academic Medicine. 2013;88(3):301-303. doi:10.1097/ACM.0b013e318280cff0
  20. Epstein RM, Privitera MR. Addressing physician mental health. Lancet Psychiatry. 2019;6(3):190-191. doi:10.1016/S2215-0366(19)30036-7
  21. Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. The BMJ. 2008;336(7642):488-491. doi:10.1136/bmj.39469.763218.be
  22. Federation of State Medical Boards. Physician Wellness and Burnout. April 2018. Link
  23. Fridner A, Belkić K, Marini M, Sendén MG, Schenck-Gustafsson K. Why don't academic physicians seek needed professional help for psychological distress? Schweizerische Medizinische Wochenschrift. 2012. doi:10.4414/smw.2012.13626
  24. Garelick A. Doctors' health: stigma and the professional discomfort in seeking help. The Psychiatrist. 2012;36(3):81-84. doi:10.1192/pb.bp.111.037903
  25. Gerada C. Doctors, suicide and mental illness. BJPsych Bulletin. 2018;42(4):165-168. doi:10.1192/bjb.2018.11
  26. Givens JL, Tjia J. Depressed medical students' use of mental health services and barriers to use. Academic Medicine. 2002;77(9):918-921. doi:10.1097/00001888-200209000-00024
  27. Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting System. General Hospital Psychiatry. 2013;35(1):45-49. doi:10.1016/j.genhosppsych.2012.08.005
  28. Gold KJ, Schwenk TL. Physician Suicide - A personal and community tragedy. JAMA Psychiatry. 2020;77(6):559. doi:10.1001/jamapsychiatry.2020.0009
  29. Gøtzsche PC, Gøtzsche PK. Cognitive behavioural therapy halves the risk of repeated suicide attempts: systematic review. Journal of the Royal Society of Medicine. 2017;110(10):404-410. doi:10.1177/0141076817731904
  30. Grover S, Dua D, Shouan A, Nehra R, Avasthi A. Perceived stress and barriers to seeking help from mental health professionals among trainee doctors at a tertiary care centre in North India. Asian Journal of Psychiatry. 2019;39:143-149. doi:10.1016/j.ajp.2018.12.020
  31. Guille C, Speller H, Laff R, Epperson CN, Sen S. Utilization and barriers to mental health services among depressed medical interns: a prospective multisite study. Journal of Graduate Medical Education. 2010;2(2):210-214. doi:10.4300/JGME-D-09-00086.1
  32. Haas K. Mental health challenges among physicians in the United States. Ballard Brief. November 15, 2023. Link
  33. Halter MJ, Rolin DG, Adamaszek M, Ladenheim MC, Hutchens BF. State nursing licensure questions about mental illness and compliance with the Americans With Disabilities Act. Journal of Psychosocial Nursing and Mental Health Services. 2019;57(8):17-22. doi:10.3928/02793695-20190405-02
  34. Hampton T. Experts address risk of physician suicide. JAMA. 2005;294(10):1189. doi:10.1001/jama.294.10.1189
  35. Harvey SB, Epstein RM, Glozier N, et al. Mental illness and suicide among physicians. The Lancet. 2021;398(10303):920-930. doi:10.1016/s0140-6736(21)01596-8
  36. Hawton K, Clements A, Simkin S, Malmberg A. Doctors who kill themselves: a study of the methods used for suicide. QJM. 2000;93(6):351-357. doi:10.1093/qjmed/93.6.351
  37. Hendin H, Reynolds C, Fox D, et al. Licensing and physician mental health: problems and possibilities. Journal of Medical Licensure and Discipline. 2007;98(2):6-11.
  38. Holmes E, Connolly A, Putnam K, et al. Taking Care of Our Own: a multispecialty study of resident and program director perspectives on contributors to burnout and potential interventions. Academic Psychiatry. 2016;41(2):159-166. doi:10.1007/s40596-016-0590-3
  39. Kalmoe MC. Physician suicide: a call to action. Missouri Medicine. 2019;116(3):211-216. Link
  40. Kamenov K, Twomey C, Cabello M, Prina M, Ayuso-Mateos JL. The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: a meta-analysis. Psychological Medicine. 2016;47(3):414-425. doi:10.1017/s0033291716002774
  41. Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open. 2020;3(3):e203976. doi:10.1001/jamanetworkopen.2020.3976
  42. Lindeman S, Läärä E, Hakko H, Lönnqvist J. A Systematic Review on Gender-Specific Suicide Mortality in medical Doctors. The British Journal of Psychiatry. 1996;168(3):274-279. doi:10.1192/bjp.168.3.274
  43. Lindeman S, Henriksson M, Isometsä E, Lönnqvist J. Treatment of mental disorders in seven physicians committing suicide. Crisis. 1999;20(2):86-89. doi:10.1027//0227-5910.20.2.86
  44. Loas G, Lefebvre G, Rotsaert M, Englert Y. Relationships between anhedonia, suicidal ideation and suicide attempts in a large sample of physicians. PLOS ONE. 2018;13(3):e0193619. doi:10.1371/journal.pone.0193619
  45. Dr. Lorna Breen Heroes Foundation. January 31, 2024. drlornabreen.org
  46. Martin A, Chilton J, Paasche C, et al. Shared Living Experiences by Physicians have a Positive Impact on Mental Health Attitudes and Stigma among Medical Students: A Mixed-Methods Study. Journal of Medical Education and Curricular Development. 2020;7. doi:10.1177/2382120520968072
  47. Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among resident physicians. JAMA. 2015;314(22):2373. doi:10.1001/jama.2015.15845
  48. The Medical Society of New Jersey v. Fred M. Jacobs, MD, JD, and the New Jersey State Board of Medical Examiners (D.N.J. 1993). Link
  49. Melnyk BM, Holod AF, Hsieh AP, Feist JC. An audit of mental health questions on U.S. nursing licensure applications: evidence to guide urgent action for change. Worldviews on Evidence-Based Nursing. 2023;20(5):422-430. doi:10.1111/wvn.12680
  50. Menon V, Sarkar S, Kumar S. A cross-sectional analysis of barriers to health-care seeking among medical students across training period. 2017. doi:10.4103/jmhhb.jmhhb_34_17
  51. Menon NK, Shanafelt TD, Sinsky CA, et al. Association of physician burnout with suicidal ideation and medical errors. JAMA Network Open. 2020;3(12):e2028780. doi:10.1001/jamanetworkopen.2020.28780
  52. Mihailescu M, Neiterman E. A scoping review of the literature on the current mental health status of physicians and physicians-in-training in North America. BMC Public Health. 2019;19(1). doi:10.1186/s12889-019-7661-9
  53. Miles SH. A challenge to licensing boards: The stigma of mental illness. JAMA. 1998;280(10):865. doi:10.1001/jama.280.10.865
  54. Milner A, Spittal MJ, Pirkis J, LaMontagne AD. Suicide by occupation: Systematic review and meta-analysis. The British Journal of Psychiatry. 2013;203(6):409-416. doi:10.1192/bjp.bp.113.128405
  55. Moutier C. Physician Mental Health: An Evidence-Based Approach to Change. Journal of Medical Regulation. 2018;104(2):7-13. doi:10.30770/2572-1852-104.2.7
  56. Myran DT, Cantor N, Rhodes E, et al. Physician health care visits for mental health and substance use during the COVID-19 pandemic in Ontario, Canada. JAMA Network Open. 2022;5(1):e2143160. doi:10.1001/jamanetworkopen.2021.43160
  57. Nagy C, Schwabe D, Jones W, et al. "Time to Talk About It: Physician Depression and Suicide" video/discussion session for interns, residents, and fellows. MedEdPORTAL. 2016;12:10508. doi:10.15766/mep_2374-8265.10508
  58. Olfson M, Cosgrove CM, Wall MM, Blanco C. Suicide risks of health care workers in the US. JAMA. 2023;330(12):1161-1166. doi:10.1001/jama.2023.15787
  59. Oppenheimer K, Miller MD, Forney PD. Effect of history of psychological counseling on selection of applicants for residencies. Academic Medicine. 1987;62(6):504-508. doi:10.1097/00001888-198706000-00008
  60. Petrie K, Crawford J, Baker ST, et al. Interventions to reduce symptoms of common mental disorders and suicidal ideation in physicians: a systematic review and meta-analysis. The Lancet Psychiatry. 2019;6(3):225-234. doi:10.1016/s2215-0366(18)30509-1
  61. Reynders A, Kerkhof A, Molenberghs G, Van Audenhove C. Attitudes and stigma in relation to help-seeking intentions for psychological problems in low and high suicide rate regions. Social Psychiatry and Psychiatric Epidemiology. 2014;49(2):231-239. doi:10.1007/s00127-013-0745-4
  62. Rotenstein L, Torre M, Ramos MA, et al. Prevalence of burnout among physicians. JAMA. 2018;320(11):1131. doi:10.1001/jama.2018.12777
  63. Ruitenburg MM, Frings-Dresen MHW, Sluiter JK. The prevalence of common mental disorders among hospital physicians and their association with self-reported work ability: a cross-sectional study. BMC Health Services Research. 2012;12(1). doi:10.1186/1472-6963-12-292
  64. Saddawi-Konefka D, Brown A, Eisenhart I, Hicks K, Barrett E, Gold JA. Consistency between state medical license applications and recommendations regarding physician mental health. JAMA. 2021;325(19):2017. doi:10.1001/jama.2021.2275
  65. Saddawi-Konefka D. Role modeling vulnerability. CLOSLER. August 16, 2022. Link
  66. Schernhammer E. Taking their own lives - the high rate of physician suicide. The New England Journal of Medicine. 2005;352(24):2473-2476. doi:10.1056/nejmp058014
  67. Schwenk TL, Gorenflo DW, Leja LM. A survey on the impact of being depressed on the professional status and mental health care of physicians. The Journal of Clinical Psychiatry. 2008;69(4):617-620. doi:10.4088/jcp.v69n0414
  68. Shanafelt TD, Balch CM, Dyrbye LN, et al. Suicidal ideation among American surgeons. Archives of Surgery. 2011;146(1):54. doi:10.1001/archsurg.2010.292
  69. Thompson WT, Cupples ME, Sibbett CH, Skan DI, Bradley T. Challenge of culture, conscience, and contract to general practitioners' care of their own health: qualitative study. The BMJ. 2001;323(7315):728-731. doi:10.1136/bmj.323.7315.728
  70. Torre DM, Wang NY, Meoni LA, Young JH, Klag MJ, Ford DE. Suicide compared to other causes of mortality in physicians. Suicide and Life-Threatening Behavior. 2005;35(2):146-153. doi:10.1521/suli.35.2.146.62878
  71. Tyssen R, Vaglum P, Grønvold NT, Ekeberg Ø. Suicidal ideation among medical students and young physicians: a nationwide and prospective study of prevalence and predictors. Journal of Affective Disorders. 2001;64(1):69-79. doi:10.1016/s0165-0327(00)00205-6
  72. United Nations. Disability laws and acts by country/area. Link (accessed February 10, 2024)
  73. Virginia HB1573: 2023 Regular Session. LegiScan. March 16, 2023. Link
  74. Weiniger CF, Shalev AY, Ofek H, Freedman S, Weissman C, Einav S. Posttraumatic stress disorder among hospital surgical physicians exposed to victims of terror: a prospective, controlled questionnaire survey. J Clin Psychiatry. 2006;67:890-896.
  75. White AC, Shiralkar P, Hassan T, Galbraith N, Callaghan R. Barriers to mental healthcare for psychiatrists. Psychiatric Bulletin. 2006;30(10):382-384. doi:10.1192/pb.30.10.382
  76. Wilberforce N, Wilberforce K, Aubrey-Bassler FK. Post-traumatic stress disorder in physicians from an underserviced area. Fam Pract. 2010;27:339-343.
  77. Wu P, Fang Y, Guan Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. The Canadian Journal of Psychiatry. 2009;54(5):302-311. doi:10.1177/070674370905400504
  78. Ye GY, Davidson JE, Kim K, Zisook S. Physician death by suicide in the United States: 2012-2016. Journal of Psychiatric Research. 2021;134:158-165. doi:10.1016/j.jpsychires.2020.12.064

← Back to the talk page