Is self-medication a barrier to seeking help: exploring psychiatrists’ and psychiatry residents’ knowledge and attitudes about self-medication in Türkiye

Abstract

Background

Self-medication, defined by the World Health Organization (WHO) as using medicines for self-diagnosed conditions, can lead to misdiagnosis, adverse effects, and ethical issues. Given that psychiatrists and psychiatry residents face unique mental health stigma and other barriers, this study investigates their knowledge and attitudes regarding self-medication.

Methods

A descriptive cross-sectional survey was conducted among 246 psychiatrists and psychiatry residents in Türkiye. Using convenience sampling, participants completed an anonymous online question form designed by researchers to assess sociodemographic factors, self-medication behaviors, and attitudes. Data were analyzed using descriptive statistics with SPSS 25.0.

Results

Findings indicated that 83% of participants engaged in self-medication in the past year, primarily with antidepressants. Although 80.9% of respondents reported knowledge of self-medication, many were unaware of legal and ethical guidelines. Major reasons for self-medication included viewing problems as minor, previous positive experiences with self-medication, and time constraints limiting help-seeking.

Conclusions

The study reveals that self-medication among psychiatrists and psychiatry residents is prevalent and potentially influenced by insufficient training on ethical implications. Many psychiatrists and psychiatry residents consider self-medication acceptable for minor issues, indicating a need for educational reforms and improved support systems. Addressing these gaps can promote a culture of professional help-seeking, ultimately enhancing psychiatrists’ well-being and patient care quality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12888-025-06660-3.

Introduction

According to the World Health Organization (WHO), self-medication is defined as the use of medicines to treat self-diagnosed symptoms or disorders, or the intermittent or continuous use of prescribed medicines for chronic or recurrent symptoms or diseases. In practice, this definition also includes the use of medicines for family members, especially when treating children or the elderly [1]. Self-medication is associated with misdiagnosis or delayed diagnosis, drug-related adverse effects or serious drug interactions, and inappropriate choice or doses of treatment for individuals and society. It is also associated with risks such as missed severe illness, addiction, drug abuse, reduced quality of care [2], and increased public health expenses [3, 4].

The United Kingdom (UK) General Medical Council (GMC) guidelines recommend that, as far as possible, physicians should not treat themselves, their family members, or others with whom they have a close personal relationship and, in particular, should not prescribe controlled substances to relatives or themselves [5]. The American Medical Association (AMA) Code of Medical Ethics states, “...physicians should not treat themselves or close family members. In such cases, the physician’s professional objectivity may be compromised” [6].

There are many studies investigating the relationship between increased burnout [7], psychiatric disorders, suicidal thoughts and behaviors in physicians [8, 9] and issues such as increased workload, anxiety about meeting the increasing expectations of patients and their families, problems related to working conditions and personal rights [4, 10]. However, there are limited studies on self-medication and reduced help-seeking behavior, which may be directly related to the causes or consequences of these problems.

In the 2001 report of the British Psychiatric Association, it was reported that the stigmatizing attitudes of physicians might be a reflection of society when it comes to mental health [11]. This may suggest that self-medication behavior may be higher for psychiatric disorders. Psychiatrists and psychiatry residents might be expected to show more help-seeking and less self-medication behavior for mental health problems in relation to their professional training. However, previous studies have reported that psychiatrists, like physicians in other specialties, may be reluctant to seek professional help for mental health problems [12, 13]. A survey of 567 psychiatrists in 2007 reported that 43% of psychiatrists found the idea of self-managing treatment for mild to moderate depression and 7% for severe depression appropriate; additionally, 15% of them still managed their own depression [14].

Although not among psychiatrists, a study of clinical psychologists in the UK found that 62.7% of the sample had at least one mental health problem, and only 3.8% of those sought professional help. The stigma surrounding mental health raised persistent concerns about potential negative outcomes, both for individuals and for how peers might perceive their professional competence. Thus, while disclosure to friends and family was common, shame was a barrier to disclosure at work for many [15]. This study tells us that mental health professionals may also be vulnerable to the effects of mental health stigma. Barriers to seeking help among psychiatry residents and psychiatrists include stigma, concerns about confidentiality, the fear of disappointing colleagues or patients, and worries that a diagnosis may hinder career advancement [12–14]. Research on physicians highlighted barriers to seeking help, including inability to find time to attend medical appointments, cost of lost work hours, and insufficient support from employers [16, 17]. As a result of these situations, the likelihood of self-diagnosis and self-treatment is reported to increase [17]. In addition, an important reason for self-medication among physicians is to increase/improve work performance and to extend their working hours. However, this can lead to the risk of drug abuse and addiction [18, 19].

There are almost no studies on psychiatrists’ and psychiatry residents’ attitudes toward self-medication for conditions other than psychiatric disorders. It is not known whether the practice of self-medication is more acceptable or more likely to be avoided in medical conditions other than psychiatric disorders. Additionally, there is a need to investigate the level of knowledge about self-medication in terms of its outcomes, examine attitudes towards it, and carry out practices within ethical and deontological boundaries.

The aim of this study was to assess the level of knowledge, thoughts, and attitudes of psychiatrists and psychiatry residents about self-medication in Türkiye, which seems to be an important gap in the literature, and to identify the reasons that may affect help-seeking behavior. Specifically, we investigated psychiatrists’ and psychiatry residents’ level of knowledge about self-medication practices, their thoughts and attitudes towards self-medication, and the key determinants shaping their help-seeking behavior when needed.

Material & methods

Procedure and participants

The study is a descriptive cross-sectional study and included psychiatry residents and specialists who volunteered to participate. Participants were recruited using a convenience sampling method by sharing the link to the online form on social media platforms and psychiatry email groups where only psychiatrists and psychiatry residents are present. The Survey Monkey website (www.surveymonkey. com) was used to create the question form for data collection. Before the questions, the participants were given an informative text about the study, emphasizing that their responses would be collected anonymously. Following the information text, participants were asked to tick a box expressing their willingness to participate and consent. This study did not require participants to answer every question; participants could respond to the questions at their discretion.

During the period defined for the study (June - August 2024), of the 264 participants who consented to participate in the study and began answering the questions, 18 were excluded because they left the study without completing the question form.

Data form

The sociodemographic data form was developed by researchers specifically for this study. Relevant literature [10, 18] and the researchers’ clinical experiences were carefully reviewed during the preparation of the survey questions. The survey was pilot tested with a cohort of 10 psychiatry specialists and residents. These ten colleagues provided feedback on overlooked possible reasons for self-medication, editing unclear questions, optimizing the number of questions to increase participant engagement, and removing questions that might not be relevant. Based on their feedback and suggestions, the survey was refined, and the final version of the data collection form was completed. The survey consists of four sections: (i) questions on the sociodemographic characteristics and working conditions of psychiatrists and psychiatry residents, (ii) questions to assess psychiatrists’ and psychiatry residents’ knowledge and attitudes towards self-medication in Türkiye, (iii) questions to explore psychiatrists’ and psychiatry residents’ attitudes towards self-medication, including ethical considerations and the reasons behind engaging in this practice, (iv) information on the psychotropic drugs prescribed by psychiatrists and psychiatry residents for self-medication. Further details can be found in Supplement 1.

Statistics

The total number of psychiatrists (specialists and residents) in Türkiye is approximately 5500. The Yamane formula was used to calculate the representativeness of the sample. According to the Yamane formula, the margin of error should be between 5% and 10% when calculating the representativeness of the sample. In our study, the minimum sample size calculated with a 7% margin of error was found to be 197.

The SPSS 25.0 package program (IBM SPSS Statistics for Windows version 25.0) was used for data analysis. The data were analyzed using normal distribution determination methods (graphical and test methods), and descriptive statistics were presented in univariate tables (n, %). Chi-square test was used to compare of study variables between groups with and without self-medication behavior. The type 1 error level of 0.05 was accepted for all analyses.

This study was approved by the Baskent University Institutional Review Board and Ethics Committee (KA24/211).

Results

The study included a total of 246 psychiatrists and psychiatry residents. There were 169 females (68.7%) and 77 males (31.3%), with the mean age of 36.3 ± 9.5 years. It was found that 86 (34.9%) of the participants had less than 5 years of professional experience and 104 (42.3%) had 10 years or more of professional experience. Of the participants, 85 (34.6%) were residents, 119 (48.3%) were specialists, 17 (6.9%) were assistant professors, 15 (6.1%) were associate professors and 10 (4.1%) were professors.

Of the participants, 109 (44.3%) had been diagnosed with a psychiatric disorder, and 103 (41.9%) were taking psychotropic medication for this reason. 119 (48.4%) reported receiving psychotherapy for themselves in the past or currently. 19 (7.7%) participants reported drinking three or more days per week, while 7(2.8%) reported drug use. Sociodemographic and professional experience data of psychiatrists and psychiatry residents participating in the study are presented in Supplement 2.

199 (80.9%) of the psychiatrists reported that they knew the definition of self-medication. When analyzing the responses to the questions on the definition of self-medication, 221 (89.8%) of the participants reported that ‘a psychiatrist prescribes medication for their own mental health problems without consulting another mental healthcare professional’. According to the WHO definition of self-medication, 191 (78,2%) of the participants reported self-medication once or more in the last year. The knowledge and attitudes of the psychiatrists and psychiatry residents in Türkiye regarding self-medication are shown in Table 1.

Table 1.

Knowledge and attitudes of psychiatrists and psychiatry residents in Türkiye regarding self-medication

	n	%
Have you ever attended a course/training on self-medication during your residency?
Yes	18	7.3
No	214	87.0
Have you ever attended a course/training on self-medication during your medical school education?
Yes	11	4.5
No	221	89.8
Do you know the definition of self-medication?
Yes	199	80.9
No	33	13.4
Which of the following behaviors do you consider to be self-medication?
A psychiatrist prescribes medication for their own mental health problems without consulting another mental healthcare professional	221	89.8
A psychiatrist who prescribes medication for their non-psychiatric complaints without consulting another healthcare professional	170	69.1
A therapist using mindfulness techniques to cope with stressors	46	18.7
A psychiatrist taking herbal supplements to sleep better	98	39.8
A psychiatrist obtains a prescription drug from a pharmacy and uses it to treat their symptoms of depression	189	76.8
A psychiatrist organizing psychiatric treatment for parents or children	73	29.7
A psychiatrist organizing non-psychiatric treatment for their parents or children	59	24.0
A psychiatrist self-adjusting their medication dosage without guidance from a colleague	196	79.7
Do you think that there is a law / regulation etc. on self-medication in Türkiye?
Yes	8	3.3
No	104	42.3
Don’t know	120	48.8
According to the WHO definition of self-medication, how many times have you self-medicated yourself in the last year?
None	41	16.7
1–3 times	98	39.8
4–6 times	47	19.1
7 times or more	46	18.7
Which of the following drugs have you used to self-medicate?
Any psychotropic	15	6.1
Antibiotics, painkillers, etc.	55	22.4
Both	122	49.6
Have you had a negative experience/adverse effect with a psychotropic drug that you have “self-medicated” with?
Yes	32	13.0
No	151	61.4
Have you changed to another psychotropic drug after the negative experience?
Yes	15	6.1
No	9	3.7
In the past year, how often have you ‘self-medicated’ for your relatives?
None	38	15.4
1–3 times	105	42.7
4–6 times	49	19.9
7 times or more	38	15.4
Which medicines have you used for ‘self-medication’ for your relatives?
Any psychotropic	18	7.3
Antibiotics, painkillers, etc.	39	15.9
Both	107	43.5
Have you ever asked your colleagues for a prescription for a psychotropic medication that was your own choice?
Yes	103	41.9
No	97	39.4

^†n: number of participants, %: percentage

Sixteen participants (6.5%) reported that they ‘never prescribe for themselves or their relatives except for psychiatric complaints’, while 102 (41.5%) reported that this behavior was appropriate and not problematic. Seventy-one participants (28.9%) thought that it was appropriate for ‘physicians to treat themselves or their relatives in an area of specialization’. 148 (60.2%) participants stated that ‘problems of objectivity or bias in diagnostic evaluation or treatment selection may arise when the physician treats themselves or their relatives in their specialty’. In comparison, 128 (52.0%) said the same problems might arise outside their specialty. When it was asked about the reasons for self-medication, the most common response (n:122, 49.6%) was ‘thinking their problems were minor, and they could treat themselves’, followed by ‘having done it in the past and benefited from it’ in second place (n:76, 30.9%) and ‘not having time to seek psychological help’ in third place (n:47, 19.1%). The psychiatrists’ and psychiatry residents’ attitudes towards self-medication, the ethical approaches, and the reasons for practicing self-medication are shown in Table 2.

Table 2.

Psychiatrists’ and psychiatry residents’ attitudes about self-medication, ethical considerations, and reasons for the practice of self-medication

	n	%
Please tick the most appropriate statement about a psychiatry resident or specialist writing prescriptions for themselves or their relatives other than for psychiatric disorders.
I do it, and I think it is appropriate. I don’t think it is improper.	102	41.5
I do not think it is appropriate, but I do it.	74	30.1
I would never do it.	16	6.5
Other	12
Please tick the statements below that you agree with. (You can tick more than one option.) Except in emergencies…
I think that problems of objectivity or bias in diagnostic evaluation or treatment selection may arise when the physician treats themselves or their relatives in their own specialty.	148	60.2
I think that a physician treating themselves or their relatives for diseases outside their area of specialization may lead to ethical problems.	128	52.0
It may be ethically problematic for a physician to treat themselves or their relatives for diseases within their specialty.	118	48.0
I think it is appropriate for physicians to treat themselves or their relatives in an area of specialization.	71	28.9
It is appropriate for physicians to treat themselves or their relatives in an area other than their own specialty.	44	17.9
If you have ever managed your own treatment, please tick the reasons for this
My problems are minor and at a self-treatable level (no resistance to treatment, moderate to severe severity)	122	49.6
I have done this in the past and have benefited from it	76	30.9
Not being able to find an acceptable psychiatrist (the options available are being too young / lack of professional experience)	39	15.9
Lack of time to seek psychological help (workload)	47	19.1
Fear that being diagnosed with a psychiatric disorder will have a negative impact on professional life (loss of reputation, feeling of inadequacy, etc.)	33	13.4
Fear that being diagnosed by a professional will have a negative impact on how I or others see me	26	10.6
Fear of having a diagnosis of a psychiatric disorder in the health system records	20	8.1
Unable to get psychological help due to financial constraints	12	4.9
No other psychiatrist in the immediate vicinity	6	2.4

^†n: number of participants, %: percentage

In all three categories, antidepressants were the most prescribed psychotropic drug when the psychiatrists and psychiatry residents were asked to prescribe for themselves (35.8%), to ask a colleague to prescribe (31.3%), or prescribed for a relative (45.1%). The second most frequently self-prescribed category of psychotropic drugs is methylphenidate (9.8%), and the third is benzodiazepines (8.9%). The least frequently prescribed psychotropics are antipsychotics (1.6%) and mood stabilizers (1.2%). The psychotropic drugs prescribed by psychiatrists and psychiatry residents for self-medication and to whom they were prescribed are summarized in Table 3.

Table 3.

Psychotropic drugs prescribed by psychiatrists and psychiatry residents for self-medication and prescription practices

	n	%
Antidepressants
Your prescription for yourself	88	35.8
Asked your colleague to prescribe for you	77	31.3
Prescribed for your parent or child	111	45.1
Antipsychotics
Your prescription for yourself	4	1.6
Asked your colleague to prescribe for you	2	0.8
Prescribed for your parent or child	16	6.5
Mood stabilizers
Your prescription for yourself	3	1.2
Asked your colleague to prescribe for you	1	0.4
Prescribed for your parent or child	3	1.2
Benzodiazepines
Your prescription for yourself	22	8.9
Asked your colleague to prescribe for you	31	12.6
Prescribed for your parent or child	35	14.2
Medicines used to treat sleep disorders other than benzodiazepines
Your prescription for yourself	10	4.1
Asked your colleague to prescribe for you	18	7.3
Prescribed for your parent or child	28	11.4
Methylphenidate
Your prescription for yourself	24	9.8
Asked your colleague to prescribe for you	48	19.5
Prescribed for your parent or child	22	8.9
Atomoxetine
Your prescription for yourself	1	0.4
Asked your colleague to prescribe for you	3	1.2
Prescribed for your parent or child	4	1.6
Modafinil
Your prescription for yourself	12	4.9
Asked your colleague to prescribe for you	20	8.1
Prescribed for your parent or child	13	5.3

^†n: number of participants, %: percentage

Comparisons were made between those who did not self-medicate at all in the last year and those who did any number of times (≥ 1 times). No significant difference was found in the research variables except the current professional title. It was found that psychiatrists with the title of professor have a significantly higher rate of not engaging in self-medication compared to other psychiatrists (p < 0.001, chi-square: 22.522). The detailed results of the group comparison can be found in Supplement 3.

Discussion

The main findings of our study, which aimed to evaluate the knowledge, attitudes, and behaviors of psychiatrists and psychiatry residents working in Türkiye about self-medication, showed that 83% of participants had self-medicated in the past year. The three most used psychotropic drugs for this purpose were antidepressants, methylphenidate, and benzodiazepines. While 80.9% of participants reported that they know the definition of self-medication, their responses to questions regarding its definition and the legal and ethical guidelines surrounding it indicated that many lacked knowledge. The main reasons for self-medication were perceived problems as minor, previous positive experiences with self-medication, and time constraints limiting help-seeking.

The prevalence of self-medication among psychiatrists is relatively high. In a study published in 2007 by Balon et al., 42.5% of psychiatrists reported that they would self-medicate for mild to moderate depression [14]. In a recent study published in Türkiye, 44% of psychiatrists reported that they would self-medicate if they had a mental health problem [10]. In this study, 41.5% of participants reported that they thought it was appropriate for doctors to prescribe for themselves or their relatives and that they practiced it.

Although the majority of respondents reported having knowledge about self-medication, there may be several reasons for the high prevalence of this behavior. First, insufficient knowledge of the definition of self-medication may have led to these results. When examining the questions related to self-medication, it was found that only a quarter of the participants considered ‘organizing treatment and prescribing medication for family members’ non-psychiatric complaints’ as self-medication. Additionally, only a third of the participants viewed ‘organizing treatment and prescribing for family members’ psychiatric complaints’ in the same way. Although not included in the definition of self-medication, the presence of participants who reported the use of herbal products and non-drug treatments (such as mindfulness) as self-medication draws attention to the lack of knowledge in this area. Our study showed that the percentage of those who reported having received training during medical school or residency is relatively low. Inadequate training may have led to a lack of knowledge about self-medication among psychiatrists, and the development of inappropriate attitudes and behaviors. All this suggests that there is a significant difference between the knowledge, perceptions, and actions of the participants in the study. This can be seen as a considerable incompatibility between professionalism and ethics in psychiatrists’ daily practice.

In addition, although 52% of the participants in our study thought that it would be ethically problematic to treat themselves or their relatives for a complaint outside their area of expertise, 41.5% reported that they did not find this behavior inappropriate and used it in their daily practice. These data show that, in addition to the definition of self-medication, the participants did not have sufficient knowledge about the ethical significance of this behavior and the negative consequences of it. This deficiency is in marked contrast to the current professional and ethical discourse of medicine in general and psychiatry in particular. First of all, the recommendation of medication outside the specialty (except for urgent situations) may pose a risk in terms of the principle of “first do no harm,” which is one of the basic principles of medical ethics. In addition, without specialist knowledge, there is an increased risk of misdiagnosis, inappropriate prescribing, or overlooking important aspects of patient care that could inadvertently lead to harm. Self-medication rather than seeking independent advice may delay access to optimal care. Such actions can prevent individuals from receiving a thorough, unbiased assessment or evidence-based treatment, potentially worsening their condition. In this sense, self-medication raises ethical concerns and reflects broader challenges in balancing professional responsibilities with personal health and decision-making [20].

60.2% of the participants stated that organizing the treatment of themselves or their relatives in their specialty could lead to problems of objective evaluation and bias. This result aligns with the general discourse in psychiatric and psychotherapeutic literature [21]. Despite the relative awareness of the problem, the reported high level of self-medication may be related to the decline in help-seeking behavior among psychiatrists and the barriers to help-seeking. In literature, stigma, financial problems, and time constraints have been associated with decreased help-seeking behavior [16, 17, 19]. Stigma among physicians, especially mental health professionals, is a significant concern that should be highlighted and may be related to help-seeking behavior.

Looking at the responses to the questions designed to understand self-medication reasons, 10.6% of participants reported stigma, and 8.1% reported fear of having a mental health diagnosis in the system as the reason. Although stigma was reported at a low rate, the high rate of self-medication can be interpreted in several ways. 49.6% of participants reported that they were self-medicating because of the mild to moderate severity of their symptoms. Indeed, low symptom severity may lead psychiatrists and psychiatry residents to self-prescribe rather than consult another doctor or spend time and money on an examination. One study reported that approximately 62.8% of psychiatrists had a mental disorder, and the most common mental disorders were anxiety and major depression [22]. Although not assessed in this study, the most commonly self-prescribed medication group was antidepressants may suggest that the participants in this study were also the most likely to suffer from depression and anxiety disorders. In this study, the diagnoses for which the drugs used for self-medication were prescribed were not recorded in detail. However, it is known that psychostimulants and benzodiazepines can be used for non-medical or symptom-specific (neuro-enhancement) purposes [23]. To improve our understanding of self-medication practices among psychiatrists and psychiatry residents, it is important for future studies to gather information on the diagnoses associated with self-medication.

Early career physicians may also have been influenced by an underlying bias against talking about doctors’ mental health, particularly in a clinical setting [24]. However, the well-being of doctors, both for themselves and the patients they care for, is accepted as an essential moral and professional duty. The importance of this subject for the physical and mental health of students, residents, specialists, and public health has been highlighted [25]. It is worth mentioning that this subject is included in the Declaration of Geneva, which is the current reflection of the Hippocratic Oath of the World Medical Association (WMA) [26]. It is also included in the current ethical codes of the Psychiatric Association of Turkey [27]. In this context, increasing knowledge about self-medication and its negative consequences may help reduce this behavior. It may be possible to create an ethical and professional climate in which physicians feel comfortable discussing their problems and seeking help [28]. In addition, peers, managers, and professors must have a proactive, non-stigmatizing awareness of their colleagues’ problems and manage the process with empathy.

Self-medication may be driven by concerns about how their colleagues may judge them, whether they will be viewed negatively or even questioned about their competence [12, 13, 29]. Thus, the low response rates about stigmatization observed in the study may already be intertwined with the tendency to seek self-solutions to problems. In other words, the perception that problems can be solved independently may also be interpreted as a barrier to seeking help from others [30]. Being a member of a Middle Eastern community may in itself be a barrier to help-seeking behavior, particularly due to the high levels of stigma associated with psychiatric disorders [31, 32]. Studies conducted in Middle Eastern countries such as Iran and Pakistan have reported significant levels of stigma towards psychiatric disorders [33]. However, as our study did not specifically focus on the relationship between help-seeking behavior and stigma, we did not use a scale to assess stigma. Future research should explore this area in more depth, as a better understanding of stigma could help to reduce self-medication with psychotropic drugs.

After completing their residency in psychiatry, psychiatrists in Türkiye are required to work in compulsory service regions and rural areas. In these regions, a small number of psychiatrists work long hours and manage heavy patient loads (40–80 patients/daily). The lack of suitable therapists (15.9%) and the lack of time to access psychological assistance (19.1%), which were identified as reasons for self-medication in this study, appear to be associated with the healthcare system in Türkiye. It has been reported that place of work and intensive working conditions make it difficult for clinicians to access their own health care [34, 35]. Previous studies have indicated that financial constraints may also contribute to physicians’ tendency to self-medicate rather than seek professional assistance. In a study conducted in the United States of America (USA), 42.5% of psychiatrists reported that they would prefer self-medication when they had mild to moderate depression. Of these, 40.4% cited financial reasons for this preference, while 25.6% cited stigmatization [14]. In our study, 4.9% of respondents indicated that economic constraints were a factor in their decision to self-medicate. This may be due to prioritizing other problems and psychiatrists in Türkiye being compensated at a level that does not impede access to treatment. We believe that the prevalence of self-medication and its related adverse effects can be mitigated through regulatory measures on self-prescription, improving the working conditions of psychiatrists and psychiatry residents and providing reliable and accessible healthcare services.

The most frequently self-prescribed, requested from a colleague for personal use, and prescribed for a parent or child psychotropic drug group were antidepressants. Due to the nature of their profession, psychiatrists possess a comprehensive understanding of the pharmacological mechanisms, potential adverse effects, and dosage regimens about psychotropic medications. Antidepressants can be used safely and long-term in the treatment of common psychiatric conditions, including generalized anxiety disorder and depression [36]. In addition to the reasons previously discussed, the perception of antidepressants as a safe drug group may be another factor contributing to their status as the most frequently self-prescribed psychiatric medication.

Stimulants and benzodiazepines were found to be the second and third most frequently self-prescribed drug categories, respectively. In addition to attention deficit hyperactivity disorder treatment, stimulants are widely used off-label in cases such as performance enhancement, fatigue management, weight loss and augmentation therapy in depression [23]. Their use for these purposes is more prevalent in adults than children and adolescents [37]. Benzodiazepines are known to be fast-acting drugs that are preferred for short-term management of anxiety disorders and sleep disorders [38]. Furthermore, they are also widely used among physicians [39]. Conversely, numerous studies have highlighted the potential for abuse and addiction associated with these substances [38]. It is worth noting that, to our knowledge, no regulatory framework in Türkiye explicitly prohibits physicians from self-prescribing medications. The ease of prescription and accessibility of both stimulants and benzodiazepines may precipitate an increase in the rates of self-prescription and abuse among psychiatrists and psychiatry residents. To the best of our knowledge, there is no research in the literature on the use of psychotropic drugs for self-medication and the attitudes of psychiatrists and psychiatry residents toward them. Further investigation is needed to understand why psychiatrists tend to prefer certain groups of medications, such as antidepressants, psychostimulants, and benzodiazepines, for self-medication.

Finally, about 70% of participants in this study stated that they had used groups of drugs such as antibiotics and painkillers for self-medication in the past year. This may be due to their low awareness of a clinical area in which they lack experience.

During the psychiatry residency, there should be emphasis placed on the significance of each mental disorder and the adverse consequences of mild-severe differentiation between mental disorder categories, both for the well-being of the psychiatrists themselves and for the patients they treat. This approach will help to reduce the prevalence of erroneous attitudes and behaviors on this subject. It is crucial to raise awareness of this topic. As asserted by various authors, when considering the role of the physician as an autonomous professional, their capacity for insight, and their grasp of relevant knowledge, while self-medication may be justifiable in certain cases, it is imperative in terms of professionalism, ethics, and public health to accept its continued use as a matter of concern [40, 41]. It is essential to recognize that the issue of self-medication cannot be addressed solely from the perspective of autonomy. Instead, it must also be considered in the context of the broader concept of providing benefit, avoiding harm, and ensuring the long-term well-being of the physician.

As a preliminary step, the legal regulation of self-prescription of medications with established abuse and addictive potential may prove beneficial. Furthermore, the development of routine medical and psychological assessment and support programs for psychiatry residents and psychiatrists, akin to those in existence for other occupational groups, could contribute to the mitigation of self-medication and related adverse outcomes. However, it is crucial to highlight that the fundamental objective should be the well-being of the psychiatrist when such regulations are established. Engaging in discussions with concerned parties is critical to preventing the restrictions from being regarded as an additional impediment. Furthermore, it is critical to develop clear delineations beyond the boundaries of strict limitations for borderline situations and situations of necessity. Since mental health problems are often stigmatized in several contexts and have the potential to exacerbate the difficulties faced by patients, it is understandable that concerns about being harmed by bureaucratic authority may be a significant concern for psychiatrists and psychiatry residents. In this context, it is essential to evaluate the initiatives aimed at preventing self-medication in conjunction with a strategy that encourages communication and the destigmatization [42].

It should be noted that this study is not without limitations. As a limitation, it has previously been reported that the response rate in most studies examining self-prescribing by physicians is low. This may lead to underreporting of prescribing, potentially due to a response bias caused by fear of reprimand [19]. In order to mitigate this limitation, anonymity was emphasized at the outset of the study, and there was no obligation to respond to the questions. The low response rate may have introduced underreporting bias, potentially underestimating self-prescribing behavior despite assurances of anonymity. On the other hand, no obligation to answer the questions can be seen as another limitation, which may lead to the risk of data loss. The voluntary nature of the survey may have led to non-response bias, with participation skewed towards individuals with particular experiences or opinions. Furthermore, compared to the total population of psychiatrists and psychiatry residents in Türkiye, the relatively small number of participants and the lack of homogeneity limit the generalizability of the study’s findings. Future research should focus on the underlying factors influencing self-medication among psychiatrists, particularly the role of stigma, professional workload, and access to mental healthcare. Longitudinal studies could explore the long-term consequences of self-medication on psychiatrists’ well-being and professional performance. Additionally, comparative studies across different healthcare systems may provide insights into the regulatory frameworks and cultural influences on self-medication practices. Evaluating targeted interventions, such as educational programs and mental health support systems, could inform strategies to reduce self-medication and promote professional help-seeking behaviors.

Conclusion

The present study examined the self-prescribing behavior of psychiatrists and the related factors that influence it. The findings revealed that self-medication is a prevalent issue in Türkiye. Commonly self-prescribed psychotropic drugs are antidepressants, stimulants and benzodiazepines. However, the study also highlighted that psychiatrists’ knowledge about self-medication is insufficient. This study makes a significant contribution to the existing literature on the subject, particularly given the lack of comparable studies in Türkiye evaluating the attitudes and behaviors of psychiatrists regarding self-medication. It seems imperative to establish a professional and ethical environment that will encourage psychiatrists to seek assistance without apprehension, particularly by prioritizing their well-being.

Electronic supplementary material

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Abbreviations

AMA

American Medical Association

GMC

United Kingdom General Medical Council

UK

United Kingdom

USA

United States of America

WHO

World Health Organization

WMA

World Medical Association

Author contributions

Literature Search: GA, ACK, BK, AYProtocol writing: GA, ACKData collection: GA, ACK, BK, AYStatistical analysis: GA, ACK, BK, AYManuscript draft writing: GA, ACK, BK, AYAll authors contributed and have approved the final manuscript.

Funding

Not applicable.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki and approved by the Baskent University Institutional Review Board and Ethics Committee (Project no: KA24/211). An informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Clinical trial number

Not applicable.