Dentistry and depression: Part II -- How to cope

Few of those who attended the spring meeting of the California Dental Association in Anaheim, CA, suspected anything unusual. But while most were in the convention center listening to lectures on topics such as crown lengthening and digital photography, John H. Newman Jr., D.D.S., was losing his battle with depression. On May 2, the opening day of the conference, he leapt to his death from the balcony of his 14th-floor room at the nearby Disneyland Hotel.

Dr. Newman's suicide came as a reminder of the devastating potential of depression -- and the need for dentists to take care of themselves as well as their patients.

"The most important asset in the dental office is the health of the dentist," said James Willey, director of the American Dental Association's Council on Dental Practice, which now sponsors biannual conferences on health and wellness issues.

It's no secret that dentistry can be a stressful profession. Performing technically complicated procedures on anxious patients in a small, confined space can take its toll. Add financial pressures, government regulations, and the threat of malpractice suits, and it's no wonder that dentists have the reputation of committing suicide at a higher rate than any other profession (see part I of this series).

A difficult job

"It's a difficult job that is very demanding -- and people don't appreciate [dentists]," said Dorothea Lack, Ph.D., a San Francisco psychologist who used to work as a dental hygienist. Dentistry is comparable to medical surgery, she said, yet medical surgeons are revered like gods, while dentists are often feared.

Dentists reporting stress
Work is stressful 80%
Work stress is moderate 69%
Work stress is extreme 11.7%
Sometimes have difficulty falling asleep 21.4%
Sometimes feel depressed 17.8%
Sometimes feel hopeless 10.3%
Dentists in counseling 6.8%
It is unclear how many dentists are suffering. But in the ADA's 2003 Dentist Well-Being Survey of 2,565 dentists, 80% said their work was stressful. (See chart for more survey results.)

While the pressures may not always be openly discussed, many dentists appear eager to vent about them, if given the opportunity. When Robert Rada, D.D.S., M.B.A, co-authored an article for the Journal of the American Dental Association (June 2004, Vol. 135:6; pp. 788-794) on stress, depression, and burnout, he got more feedback than he has on anything else he ever published. The clinical assistant professor at the University of Illinois at Chicago found himself commiserating with dentists and even trying to give a dentist's wife ideas on how to help her husband cope.

Some dentists get too absorbed by the profession, Dr. Rada said. "Practices that were once simple have gone out of control."

But typically, it's not just work that that drives dentists over the edge, psychologists say. Instead, it's a combination of professional and personal stresses.

To deal with his own stress, Dr. Rada, who maintains a general practice in La Grange, IL, decided to shorten his workweek -- first from six to five days a week, and eventually down to four days. "I cut my hours, kept making as much money, and enjoyed my practice more," he said. Not only did he learn to be more efficient, but he had fewer patients cancel appointments. They knew that his shortened workweek meant that appointments were harder to reschedule.

When dentists are in their offices, they can find plenty of ways to reduce stress, too, experts say. "People don't realize how easy it is to reduce stress simply by breathing," said Uche Odiatu, D.M.D., a Canadian dentist who is also certified as a nutrition specialist and fitness trainer.

When most people are stressed, they hold their breath or take shallow breaths, while depressed people often hunch over or look at the ground, Dr. Odiatu said. Unfortunately, dentists are forced to hunch over for most of the workday, a posture that is not optimal for their mental well-being, he noted.

But it can help to simply take deep breaths and pause to lift your head up, pretending to look out over the horizon, he said. "The brain gets fooled into feeling good."

Dr. Odiatu also advocates exercise, getting enough sleep, and staying hydrated, noting that physiological changes in the body begin when the body is just 1% dehydrated.

When to get help

Depression and suicide resources

The ADA offers a Web page on health and wellness with links to other resources.

National Suicide Hotlines USA
Offers a list of state hotlines. (National hotlines include 1-800-SUICIDE and 1-800-273-TALK.)

American Association of Suicidology
The organization is dedicated to the understanding and prevention of suicide by promoting research, public awareness, education, and training for professionals and volunteers.

Suicide Prevention Action Network USA
A nonprofit organization dedicated to the creation of an effective national suicide prevention strategy.

American Foundation for Suicide Prevention
An organization also dedicated to understanding suicide.

On his Web site, Mark Hillman, Ph.D., a New York psychotherapist, wrote that dentists can use progressive relaxation techniques whenever they feel stressed -- even in the office. By tensing then releasing the muscles, the technique allows muscles to deeply relax, he wrote, inducing a physiological state that is incompatible with anxiety.

Hillman also recommends thought-stopping: concentrating briefly on unwanted thoughts and then emptying your mind of them. By controlling negative thoughts, stress levels can be reduced, he said.

There are productive ways to deal with anger, too, said psychologist Marian Stuart, Ph.D., a professor at Robert Wood Johnson Medical School and author of The Fifteen Minute Hour: Practical Therapeutic Intervention in Primary Care, a book on incorporating psychology into healthcare practices.

Instead of dwelling on what is wrong, dentists should think about what it is they want and what they can do about it, she said. If nothing can be done, then they need to try to accept the situation or try to reframe the problem.

Certainly, dentists need to know the warning signs of depression and seek professional help if they are suffering from them. These signs include feelings of worthlessness, decreased ability to concentrate, diminished interest in pleasurable activities, and recurrent thoughts of death or suicide. "When people think about killing themselves, they want to do anything possible to stop the pain," Stuart said.

Her message to overwhelmed dentists: There are better ways out of the anguish.

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