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Feature Doctors’ Health

What I learnt from studying doctors’ mental health over 20 years—an essay by Jenny Firth-Cozens

BMJ 2020; 369 doi: (Published 09 April 2020) Cite this as: BMJ 2020;369:m1374
  1. Jenny Firth-Cozens, emeritus professor of clinical psychology
  1. Northumbria University
  1. jenny.cozens{at}

Covid-19 has put mental health in the spotlight more than ever. Jenny Firth-Cozens spent two decades following cohorts of doctors through the trials of their career. She looks back on the persisting problems from a failure to acknowledge the reality of a life in medicine—and the organisational changes needed to support it

In 1983 I was working as a clinical scientist in Sheffield, at the Medical Research Council (MRC) Social & Applied Psychology Unit. We studied job related issues and ran a small clinic looking at depression in the workplace.

One day, two young doctors arrived saying that two junior house officers (JHOs), one in each of their teams, had died by suicide the week before and that no one had mentioned it in team meetings since then. Look into doctors, they said—no one does. I did so, and response rates were never less than 71%: doctors, it seemed, really wanted to talk about their mental wellbeing.

I was fascinated by the question of whether the job or the person weighs heaviest when it comes to work related stress and depression. Any answer to this must involve a longitudinal design and, because of the medical register, I knew that I could follow UK doctors over years. At the time, just one such study had been done: the US Precursors study from Johns Hopkins, begun in the 1940s and focusing on male doctors and physical disease.1 My study focused on 304 fourth year medical students at three UK universities, who completed questionnaires and were followed up in their first postgraduate year and again 10 years later. Building on this, I studied various samples of the original participants on and off for 20 years.

A feature of this design is that you hope that you’ve chosen the right variables early on. …

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