Are medical doctors more or less likely to use antidepressants (and other prescription drugs) than the general population? I can see a couple of theoretical reasons why they might. On the supply side, medical doctors have more ready access to prescription drugs, and therefore the non-monetary costs of obtaining a prescription (from a trusted colleague) might be lower (on the other hand, perhaps there are social stigma costs, in which case perhaps the 'full cost' of obtaining prescription medications is higher than for the general population). On the demand side, medical doctors should have a better idea of when they need to obtain treatment (of course, that doesn't mean that they will necessarily seek such treatment).
It turns out that medical doctors are more likely to use antidepressants (and other prescription drugs) than the general population, and not because of either of the (relatively benign) reasons I outlined above. As this recent NBER Working Paper (alternative ungated version here) by Mark Anderson (Montana State University), Ron Diris (Leiden University), Raymond Montizaan (Maastricht University), and Daniel Rees (Universidad Carlos III de Madrid) notes:
...there is evidence that physicians disproportionately suffer from substance use disorder (SUD) and mental health problems. Ten to 15 percent of physicians will misuse alcohol or prescription drugs during their career... more than 20 percent of physicians are depressed or exhibit the symptoms of depression... and at least one third of physicians describe themselves as suffering from “job burnout”... a syndrome closely linked to SUD and depression...
However, such descriptive analysis doesn't disentangle whether becoming a medical doctor leads to substance use disorder, or whether the types of people who become medical doctors are also those who are predisposed to substance use disorder. That is essentially the question that Anderson et al. attempt to address. Specifically, they use data on over 27,000 first-time applicants to Dutch medical schools over the period from 1987 to 1999. Importantly, because medical school places were allocated randomly on a basis of a lottery, Anderson et al. can use the lottery selection as an instrument to estimate the causal impact of becoming a medical doctor on later life outcomes. They focus on prescription drug use over the period from 2006 to 2018, including total prescriptions, antidepressants, anxiolytics (anti-anxiety medication), opioids, and sedatives, as well as treatment for mental health issues. They find:
...evidence of an across-the-board increase in the use of prescription drugs, including anxiolytics, opioids, and sedatives.
Specifically, medical doctors received 22 percent more drug prescriptions than non-medical doctors over that period, were 23 percent more likely to have been prescribed antidepressants, 20 percent more likely to have been prescribed anxiolytics, 25 percent more likely to have been prescribed an opioid, and 61 percent more likely to have been prescribed a sedative. All of these differences are statistically significant. Digging a bit deeper, Anderson et al. find that the results are larger for female medical doctors, and especially for female medical doctors at the bottom of the GPA distribution.
The results for mental health treatment are more mixed. Overall, there is no statistically significant effect, but when Anderson et al. stratify their analysis they find that female medical doctors with low GPA have a 31 percent higher probability of treatment, while male medical doctors with high GPA have a 52 percent lower probability of treatment.
The question that this research doesn't really answer is, why do medical doctors receive more prescriptions? Bear in mind that this is not self-prescription - the doctors are being prescribed these drugs by other doctors. Anderson et al. don't really have an answer for this question, although they note that their results are consistent with the descriptive literature:
This pattern of results is consistent with descriptions of female physicians being at elevated risk for depression and SUD because they are being exposed to on-the-job sex-based harassment and are under added pressure to balance professional and family responsibilities...
While the results are consistent with that narrative, it isn't the only explanation. Male doctors also receive more prescriptions than the general population (just not to quite the same extent as female doctors). And the results on mental health treatment should make us a little sceptical that higher prescription drug use is necessarily picking up substance use disorder, as Anderson et al. don't really make that link explicit in the paper.
Overall, this paper gives us some definitive evidence that medical doctors use more antidepressants and other prescription drugs than the general population, but for developing policy and practice solutions (either to the underlying mental health issues that doctors face, or over-prescription of these medications if that is the issue), we'd first need to understand more about why.
[HT: Marginal Revolution]
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