Depression and Suicidality in Pathology and Laboratory Medicine: We Should Be Concerned

This note is a plea, a call to action to all of us in this specialty, but especially to the leadership. We need to discuss depression and suicide in pathology and laboratory medicine. Absent this discussion, we risk losing one of our own (again) to suicide, and we put our trainees and staff at risk of suffering the traumatic loss of a work-family member to suicide. When this happens, perhaps the astute leader will send out a supportive email and arrange for a visit from a mental health professional. Of course, none of us will avail ourselves of this service—we do not seek mental health assistance in private—and we are not about to do it in public. Many will suffer long-term effects ranging from prolonged grief reactions to full-blown depression, deterioration in work performance, burnout and disengagement, increased substance abuse, loss of personal relationships, and perhaps even attempted suicide, among others.That healthcare workers have an increased rate of suicidal ideation is broadly recognized. Emerging data suggest that our field may be at higher risk than other specialties. It has been documented that the field of pathology has the highest suicidal ideation among specialties at 13%,1 and low resilience levels.2 We have high depression rates, despite having “low burnout rates,”3 suggesting that the low burnout rates may be spurious. Those burned out are likely self-excluding from surveys (a “not missing at random” bias). Data document introversion4,5 and depression-type symptoms5,6 among pathologists, factors also linked to suicidality.Suicidality has long been known to have social roots, as identified in Durkheim’s7 seminal sociological study “Le Suicide,” and is thus heavily moderated by an individual’s social integration and regulation into a group. Thus, the field of pathology needs to look at itself and consider what in our specialty’s social structure puts our members at risk. Possibly, we receive a subset of medical students at risk. Our own (and others’) stereotyping of ourselves (scientific, factual, cold) may be a hard landing spot for many looking to belong.8,9 The climate is undoubtedly disheartening, with an increasing commoditization in pathology; the oft-repeated minimization of the specialty (“pathology professionals are not medical professionals”); the stigma and perceived low prestige of the specialty;10,11 the prevalent concern that as a non–patient contact specialty, pathologists will soon be obsolete and replaced by computers.9 The majority of us do not see the direct impact of our work for patients; rare is the case in which we hear the protective “thank you” that our clinical colleagues hear from patients. A sense of anomie, especially after the long slog and financial burdens of medical school, is not entirely misplaced.Chair persons and residency directors in pathology need to put depression and suicide central on their “well-being of the field” agenda, and we need to develop pathology-specific strategies to target the issue.12 Universal strategies—strategies designed to influence everyone (eg, organizational “awareness” strategies)—are not enough, not for a subspecialty “at risk” and not for one that gets lost in the larger structure of medicine. One of the authors, who is contacted not infrequently by individuals about suicide, has concern that suicide risk is seemingly higher in US medical graduates.13 This hypothesis should be explored most expeditiously, as it is consistent with data that recent immigrants show a lower incidence of suicide relative to long-term residents of a country. Implicated in this question are concerns of how US medical graduates adjust to the practice of pathology or develop resilience during residency training. How do these trainees adjust to a social structure where the plurality of cotrainees and attending physicians are culturally non-American, especially if trainees have chosen pathology because advisors have suggested pathology because it is “quiet, undemanding, and non–patient contact”?Whatever the drivers, we are morally obligated to discuss depression and suicide in pathology much in the way that other high-risk professions—such as law enforcement, firefighting, and the armed services—are so bound. We need to determine the true risk of depression and subsequent suicide in the field of pathology, and then develop programs to identify, help, and support those at risk. Regrettably, but necessarily, there are also no well-developed guidelines for supporting members of the profession when suicide occurs. We have provided a rough outline of recommendations to accomplish these goals (Table).Action is necessary now—a pathology program lost another recently—not 4 years since we lost one of ours. Pathologists need to embrace the spirit of the Lorna Breen Law16 and take active steps to embrace a wellness leadership process and culture within our profession. The field and practice of pathology can be isolating in healthcare systems; our leadership should proactively work to avoid isolationism in medicine and more effectively engage both patients and clinicians so as to reflect the value and impact of the work of pathologists.

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