The legal profession already has a reputation for overworking practitioners and causing chronic stress, burnout and substance use, but new research shows that its negative psychological impact may also be gendered: More women than men contemplate leaving the law because of mental health stressors, and female lawyers are much more likely to engage in hazardous or risky drinking behaviors because of their work.

A survey of nearly 3,000 members of the California Lawyers Association and the D.C. Bar, detailed in a paper published Wednesday in PLOS One, revealed that as lawyers, women experience higher rates of attrition, stress and problems with alcohol than their male counterparts, with several factors of their jobs contributing to these problems.

The paper's joint senior authors, Patrick R. Krill and Justin Anker, told The Academic Times that the legal profession has only recently begun to acknowledge the long-standing mental health and substance use problems in its ranks. In 2016, Krill conducted a study on lawyer mental health and substance use with the American Bar Association Commission on Lawyer Assistance Programs, which helped launch the ABA Well-Being Pledge, a campaign to improve mental health among legal professionals. Lawyer Assistance Programs can also help judges, lawyers and law students who are facing substance use disorders or mental health issues. 

Krill said that although the 2016 study demonstrated that there were significant challenges related to addiction, depression and anxiety in the legal profession, additional data has not emerged on the root causes of these problems, prompting him and Anker to develop the current study. And while inequalities between men and women in the industry have been a problem for decades, the starkness of the team's findings still came as something of a surprise.

"We didn't necessarily go into this expecting to see such clear [gender] disparities. We knew that there have been some, but there wasn't a lot of data on the legal profession as it relates to gender disparities around mental health," said Krill, founder of Krill Strategies, a consulting firm that works to improve the well-being of lawyers. "But that story so clearly emerged from the data that we received, that we knew it was a really compelling story that needed to be reported."

Participants took a survey that collected their demographic information, including their age, race, relationship status and whether they had children, and work-related and personal information, such as how many hours they worked per week, their job title, whether they had ever been diagnosed with an alcohol use disorder and whether they abstained from alcohol or drugs. 

They completed the Patient Health Questionnaire-9 to assess their symptoms of depression and the Generalized Anxiety Disorder-7 Scale to test for anxiety symptoms, as well as the Perceived Stress Scale test to measure their overall stress and the Alcohol Use Disorders Identification Test to screen for any risky or hazardous drinking behavior. 

The survey was meant to establish if work-related factors, including over-commitment to work, an imbalance between effort and reward, work-family conflict and workplace permissiveness toward alcohol, predicted the stress, substance misuse and attrition problems commonly experienced by lawyers. "Other studies have just looked at prevalence [of these problems], while we looked at predictors of them that have been shown to negatively impact the legal profession, maybe more so than a lot of other professions," said Anker, an assistant professor of psychiatry and behavioral sciences at the University of Minnesota.

In the total sample of 2,863 lawyers, roughly 51% of whom were women, about 67% reported working more than 40 hours per week, with almost 25% working more than 51 hours per week on average. And moderate or high stress levels were more common in lawyers younger than 41 than in their older colleagues.

Over 80% of all the lawyers who were sampled reported being current drinkers, and 30% screened positive for high-risk hazardous drinking — yet only 2% reported being diagnosed with an alcohol use disorder. "This disparity suggests an extreme level of under-diagnosis and treatment for a widespread problem, possibly owing to pervasive denial, stigma and a professional culture that normalizes heavy drinking," the authors said in the paper. 

Strikingly, almost 56% of women engaged in risky drinking behavior and 34% were high-risk or hazardous drinkers. By contrast, just 46% of men engaged in risky drinking, and roughly 25% were high-risk or hazardous drinkers. Additionally, more women than men in the sample were people of color, and women attorneys also tended to be relatively young, unmarried or divorced, and without children. They scored higher on the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 Scale and the Perceived Stress Scale tests, indicating worse mental health symptoms than men. 

"The most important findings are that levels of depression, anxiety, stress and hazardous drinking are very high in the legal profession generally, but that women are having a meaningfully worse experience," Krill said. "They are at a greater risk for mental health problems, but also alcohol problems, and there seems to be a connection there to their experience in the workplace."

Nearly 25% of the women said they had contemplated leaving the legal profession due to mental health or burnout, while just 17.4% of men said the same. High work-family conflict was found to be a strong predictor of women contemplating leaving the profession, and while high work over-commitment was associated with stress for both men and women, the association was stronger among women. 

Male respondents typically held more senior positions than female respondents, and if they perceived that they had a high likelihood of a promotion, they were less likely to contemplate leaving the industry due to mental health or stress factors. The same was not true for women, who still were likely to consider leaving their jobs due to stress even if they were up for a promotion. 

"Hard work and professional rigor have long been associated with the life of a practicing lawyer. However, there is a point where workloads become untenable, threatening to diminish the health and well-being of those tasked with supporting them," Krill and Anker said in the paper. "Excessive workloads also have the potential to undermine the quality and reliability of the work product delivered in their service since chronic stress has been consistently associated with lower cognitive function."

The survey was conducted in 2020 during the COVID-19 pandemic, which the authors noted may have had an impact on the results. Some questions directly addressed the international crisis, such as asking whether the participants thought that the pandemic was causing them to drink more or less than usual.

Krill called the results "unprecedented research" for the field. "My hope is that it will provide a lot of illumination around issues that are clearly there, and that are clearly problematic," he continued. "This data is very novel for the legal profession, and will hopefully allow stakeholders within the profession to start developing some more effective strategies for not only improving mental health overall, but specifically targeting the experience of women in the profession."

In the paper, the authors suggested several avenues the industry could take to improve these problems, specifically recommending strategies that have been effective in addressing burnout among doctors, including "Cognitive behavioral therapy, monthly meetings focused on work-life and personal challenges, offloading non-essential tasks to staff, standardizing and synchronizing workflows, stress reduction activities and adherence to limitations in work hours."

"What we're trying to do is to get at root causes and to try and shed some light on what might be responsible for the higher than normal levels of depression, anxiety and hazardous drinking," Krill said. "The legal profession has higher than normal levels of all of these things. It is, in many ways, a very unhealthy population, and knowing that in and of itself is important to raise awareness. But it's not going to solve the problem."

The study, "Stress, drink, leave: An examination of gender-specific risk factors for mental health problems and attrition among licensed attorneys," published May 12 in PLOS One, was authored by Patrick Krill, Krill Strategies; and Justin Anker, the University of Minnesota.