Doctors in Australia are more likely than most professionals to experience depression, anxiety and, at its most devastating edge, suicide. For years, the burden has been measured and reported. What’s been less clear is what actually works to protect them.

Now, a global systematic review, published in Nature Mental Health [link here] and led by researchers at UNSW and the Black Dog Institute, has begun to fill that gap. Analysing 24 controlled trials involving 2,336 practising physicians, the review found that skill-based interventions, including cognitive behavioural therapy (CBT), mindfulness and stress management, delivered moderate and lasting reductions in symptoms of depression and anxiety.

“This was really the next step after my previous work, which looked at the prevalence and risk factors for mental illness and suicide among Australian doctors,” lead author Dr Katherine Petrie, a postdoctoral research fellow at UNSW and the Black Dog Institute, tells the limbic. “We know doctors are at high risk, the question we wanted to answer was: what actually works to help them?”

Mindfulness and mind–body strategies were the most common approaches, appearing in nearly half of the included studies. These yielded medium-sized improvements in symptoms, while CBT, peer support and stress management showed even stronger effects. Face-to-face programs were more effective than digital versions. And the benefits, Dr Petrie said, were sustained: follow-up data from seven studies showed that symptom improvements were still evident months after the intervention ended.

“These positive changes can be maintained over time, which is really promising,” she adds.

What didn’t work was just as clear. “Programs that only provided educational information about mental health – without teaching practical skills – did not show a meaningful benefit,” the authors write.

Yet even effective programs have limits. The absence of longer-term structural change casts a long shadow over the evidence, Dr Petrie warns.

“We’ve still got very little research about what works at the organisational level – and that’s a critical gap, given we know workplace conditions drive distress”. 

She pointed to workplace drivers like long hours, poor staffing and inflexible rosters as central contributors to mental health distress in doctors – yet absent from the evidence base. “Despite the growing awareness of burnout and psychological distress, few initiatives have been rigorously assessed,” the authors note. “None have targeted broader structural or institutional drivers of mental ill health.”

Dr Petrie has seen firsthand what’s possible when leadership engages. At two hospitals, she was involved in co-designing a multi-level program that combined individual-level interventions with workplace change [link here].

“The health service came to us and said, ‘We want to improve our staff wellbeing – what’s the evidence? What should we do?’ That kind of engagement from the top made all the difference.”

The changes were modest but meaningful – adjusting rosters, setting enforced work-hour limits, improving manager support – and framed as a workplace improvement initiative rather than a formal clinical trial – which made the intervention easier to implement. “We showed some positive effects in terms of work outcomes like work–life balance, less bullying, and increased manager support,” she says.

“You can’t just put up some wellbeing posters and expect things to change,” she added. “Doctors can sense when something is lip service – they know when it’s for show. You do need genuine intention to change across the organisation – from the top down and the bottom up,” says Dr Petrie. “Because if doctors don’t feel supported, it doesn’t matter how many individual-level interventions you roll out. You can offer CBT, mindfulness – but if their working conditions are poor, if they’ve got high job demands, no control and low autonomy, you’re not going to get very far.”

Even the most effective programs won’t reach those most in need, she adds, if barriers like stigma and system constraints go unaddressed.

“Doctors have very low rates of help-seeking,” Dr Petrie explained. “There are a number of reasons – confidentiality, concerns around mandatory reporting, stigma – even fear of losing registration.”

She added that doctors were a distinct group with distinct needs. “They’ve got high levels of mental health literacy, but that doesn’t necessarily translate to help-seeking,” she stressed. “They also work in a system that expects them to be invulnerable. So strategies need to be tailored – what works in other professions doesn’t always work for doctors.”

While some doctors might use workplace-based employee assistance programs (EAPs), many feel uncomfortable doing so. “It’s in my workplace, people will see me, there’s a lack of privacy,” she said. “We need to work out not just what’s effective, but what’s acceptable – what doctors will actually engage with.”

At the Black Dog Institute, Dr Petrie has contributed to the development of The Essential Network (TEN), a digital platform for clinicians that includes evidence-based information, low-level interventions and links to specialist services. The Institute’s clinic also treats healthcare professionals, including doctors.

But, she says suicide prevention remains critically under-researched. “Only two of the 24 studies in this review looked at suicide-related outcomes. Given that doctors are one of the professions with the highest suicide mortality, that’s a major gap.”

Her earlier research tracked suicide mortality in Australian health professionals over a 17-year period. “We found that female doctors had increasing suicide rates over time – and that increase wasn’t seen in male doctors or in any other healthcare professions,” she said.

She’s now working on co-designing a suicide prevention strategy with doctors, particularly those early in their careers. “We want them to tell us what they need,” she said. “Instead of designing something and giving it to them, we’re asking: what would you actually feel comfortable accessing?”

Doctors, she added, are highly skilled at recognising distress in others – but that doesn’t make them more likely to seek help themselves.

“There’s this idea that we should be the ones helping people – not needing help ourselves,” she said. “There’s this deep discomfort with the idea of being a patient. And when no one else is talking about it, it becomes even harder to speak up.”

Still, there are practical things health services can do now, she added.

“They can encourage doctors to access evidence-based approaches like CBT or mindfulness, and make sure all workplace supports are well known,” she said. “But most of all, just start talking, open conversations around mental health, around supporting each other and reducing stigma – that goes a long way.”

Because while individual interventions can help, Dr Petrie said, “you’re not going to get very far” if doctors are left to operate within a system that continues to make them unwell.

Dr Katherine Petrie and researchers at UNSW Sydney and the Black Dog Institute are launching a national survey to better understand the mental health and service needs of doctors. The findings will help shape tailored, evidence-based suicide prevention initiatives for the medical community.

The confidential survey will open in the coming months. For more information, contact Dr Petrie at: [email protected]

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. In an emergency, call 000.