Of all occupations and professions, the medical profession is at the top of the list of occupations with the highest risk of death by suicide, 300 to 400 physicians a year. Although many physicians are practicing what they preach as far as healthy habits, such as quitting smoking, exercising regularly, and eating healthier, they remain reluctant to address depression, a significant cause of morbidity and mortality in this group.

Depression is at least as common in the medical profession as in the general population, affecting an estimated 12 percent of males and up to 19.5 percent of females. Among male physicians, depression is the leading factor for myocardial infarction, suppressing the immune system, and increasing the risk of cancer.

Nearly half of 2,000 female physicians surveyed about mental health reported that they thought they had met the definition for mental illness at some point in their careers but had not sought treatment, two-thirds because of stigma-related reasons, which inhibits both treatment and disclosure on license applications.

Admitting to past depression could pose problems for physicians with the Medical Licensure Board. Although some of the more discriminatory questions have been amended, other questions on the license applications remain problematic, particularly those asking about a diagnosis or treatment rather than functional impairment.

Most state medical boards require that physicians disclose mental health problems on their physician licensing applications. In fact, many medical boards ask more questions about mental health issues than physical conditions.

Katherine J. Gold, M.D., M.S.W., M.S., assistant professor in the University of Michigan's Department of Family Medicine, examined how state medical licensing boards in all 50 states and Washington, D.C., evaluated mental illnesses compared to physical illnesses or substance abuse on state licensing forms.

States more often asked if physicians had been diagnosed, treated, or hospitalized for mental health or substance abuse versus physical health disorders. Gold found that many such questions violated the Americans with Disabilities Act.

States don't ask physicians whether they have a mental health problem that might interfere with their ability to provide good care to their patients. In fact, some of their questions intrude on physicians' privacy rather than possible impairments to treating patients. According to Gold, although states asked about both mental and physician health, the physical health questions were more lenient, whereas the mental health questions were much more specific and often intrusive.

Although the boards vary, responses to physicians' disclosures regarding mental health are worrying those who want to be forthcoming about mental health issues, such as depression, on their forms. Physicians are becoming increasingly fearful that disclosing all past mental health issues, such as postpartum depression, may limit licensing.

Boards may ask physicians to submit medical records from treatment or testify before the board to defend their mental fitness to practice. Other states may monitor physicians on an ongoing basis and/or place restrictions on their medical licenses.

Given such focus, there is little data reporting the impact of physician mental health on patient outcomes. One danger of these mental health questions is that physicians may feel pressured not to seek mental health treatment. Some hospitals have responded to this focus on physician mental health by implementing programs to help residents and physicians improve their overall health.

Gold recommends that another positive step would be for states to ensure that all mental health questions on medical licensing applications comply with the Americans with Disabilities Act, and that questions pertain to current mental health issues rather than previous issues that may have been treated and resolved.