As doctors across America encourage their patients to share concerns about depression, anxiety and other mental health conditions, a new study suggests physicians may be less likely to seek help for these symptoms themselves.

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Part of the reason is stigma, or a belief others may doubt their ability to keep up with a demanding profession.

But there's another factor: Many states require physicians to report any mental diagnosis — no matter how mild or treatable, or how far in the past — to their state medical licensing boards. Physicians, then, fear that seeking help could lead to restrictions on their medical licenses.

In a survey of more than 2,100 female physicians who are also mothers, nearly half believed they met the definition for a mental illness at some point in their careers but had not sought treatment. Two-thirds reported that fear of stigma drove them to keep worries quiet.

One in three respondents said they received a formal mental health diagnosis since medical school. Many thought they could manage on their own, including writing their own prescriptions or paying cash for visits to avoid having an insurance company record, says lead researcher Katherine Gold, M.D., M.S.W., M.S., of the University of Michigan Medical School.

Only 6 percent of those with diagnoses reported them to their state licensing boards, because most felt their conditions didn't affect the care they gave.

More research is needed on this issue, to reduce stigma among physicians and to help physicians feel safe seeking care, says Gold. And, she says, state standards should be examined to ensure a focus on medical conditions that affect patient care, rather than requiring disclosure of old, mild or well-controlled problems.

The study, published in General Hospital Psychiatry, surveyed the physicians anonymously via a closed Facebook group that acts as an informal career and parenting support network for more than 57,000 physicians who are mothers.

Examining physician 'stigma and fear'

Gold, a U-M assistant professor of family medicine and obstetrics and gynecology, started the study because of anecdotes she heard from other female physicians who advised against seeking help for depression because of the professional consequences. Also, past studies have shown higher rates of suicide and suicidal thoughts among female physicians.

But Gold found few studies of mental health diagnosis, barriers to care and response to state reporting requirements among practicing physicians of either gender.

She started her research using the Facebook group because it includes a broad sampling of physicians across the country in various career stages and specialties. The resulting snapshot reveals wide variation in response to mental health symptoms.

Variation also exists in state requirements for reporting, says Gold.

For instance, some states ask if physicians have ever been diagnosed with a mental health problem, while others ask if they've had such a diagnosis in the past few years. Some ask if they have ever been hospitalized for a mental health reason. Most positive responses result in increased board investigation.

"There has always been a stigma and a fear around mental illness, and that's what's reflected in many state licensing board questionnaires," says Gold, who is a member of the U-M Depression Center and the Institute for Healthcare Policy and Innovation.

"There's a huge discrepancy between what states ask about physical conditions, such as whether those conditions affect their ability to practice, and what they ask about mental conditions, where the impact on their abilities is not asked about," she says.

Although studies have shown substance use issues can affect a physician's ability to practice, few studies have examined whether and how non-substance-related mental health issues impair performance. In fact, Gold says, some physicians report working even harder to keep their depression or other conditions from affecting their patient care.

Changes to come?

Gold notes that challenges under the Americans with Disabilities Act to licensing requirements for other professionals, such as lawyers, may help change the questions states ask physicians, too.

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Because some mental health issues — such as post-partum depression or anxiety related to a specific event — may be self-limiting, the wording of a state's questions matters greatly, Gold says. Similarly, medication and psychotherapy can control symptoms of other conditions over the longer term.

One option to help states modernize requirements around mental health might be to require endorsements from a physician's peers or supervisors based on performance.

Medical schools, hospitals, physician groups and medical professional societies also need to do more to help trainees and physicians understand that mental health symptoms can occur in anyone, especially in medicine, which encourages high standards and perfection, Gold says. They should also offer confidential, third-party options for physicians and other providers to seek help in a nonpunitive way when they do experience symptoms.

Gold and her colleagues hope to do further research on broader populations of physicians, including investigating the relationship of physician burnout or resilience to depression. She also hopes to study state management of self-reported physician mental health issues.