CHICAGO – There's a grim, rarely talked about twist to all that medical know-how doctors learn to save lives: It makes them especially good at ending their own.

An estimated 300 to 400 U.S. doctors kill themselves each year – a suicide rate thought to be higher than in the general population, although exact figures are hard to come by.

Some doctors believe the stigma of mental illness is magnified in a profession that prides itself on stoicism and bravado. Many fear admitting psychiatric problems could be fatal to their careers, so they suffer in silence.

And when the pain is too much, doctors have easy access to prescription drugs and a precise knowledge of both how the body works and the amount of a drug needed for an overdose to stop breathing and halt the heart.

"All physicians have access to neat, clean ways to commit suicide," said Dr. Robert Lehmberg, a Little Rock, Ark., surgeon who has battled depression and long considered suicide "an exit strategy if absolutely necessary."

The American Medical Association has called physician suicide "an endemic catastrophe" and pledged two years ago to work to prevent the problem.

But the suicides have persisted. So the American Foundation for Suicide Prevention has launched an educational campaign in hopes of making troubled doctors more willing to seek help.

The foundation, the American College of Psychiatrists and Wyeth Pharmaceuticals, a maker of antidepressant pills, paid for the program. It includes a documentary titled Struggling in Silence that begins airing on public television stations this week.

"It really has been swept under the carpet," said Dr. Paula Clayton, the suicide foundation's medical director.

The foundation says 300 to 400 doctors commit suicide each year, based on estimates from research, but that more studies are needed to get a more precise count.

Suicide figures in broader society are not completely reliable because suicide is often not given as the cause of death.

The overall U.S. suicide rate among men is almost four times higher than in women – about 23 per 100,000 vs. about six per 100,000 in women, according to the most recent government data.

But among doctors, suicide rates are about equal for men and women.

A 28-state study from 1984 to 1995 found that female doctors were more than twice as likely as women in the general population to kill themselves. Men were more than 70 percent more likely inside the medical profession than overall to commit suicide.

One explanation is that most suicide attempts in the broader population are unsuccessful, while doctors know how to successfully commit suicide, said Dr. Erika Frank, who specializes in research on physician health.

Lindsey Tanner,

The Associated Press