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Thanks for joining us today for a discussion about physician suicide. The American Psychiatric Association along with Dr. Michael Myers, Professor of Clinical Psychiatry at SUNY-Downstate Medical Center in Brooklyn, NY, are here to answer questions about this important topic.
Let’s start with our first question: What do we know about the epidemiology of physician suicide?
300-400 physicians die by suicide each year in the US—that’s one doctor dying by suicide each day in America
This may be an underestimate given the taboo of suicide
The aggregate suicide rate ratio for male physicians, compared to the general population, was 1.41. For female physicians the ratio was 2.27. Studies on physicians’ suicide collectively show modestly (men) to highly (women) elevated suicide rate ratios. To put it another way, the rate of physician suicide in men and women is equal.
It's not clear. We know a lot now about resilience but that is variable. We can be resilient at one time in our life but not later.
Yes. Male MD rates are higher and female rates much higher. Very troubling. Very real.
t is believed that two of the facilitating factors in physician suicide are: knowledge about how to kill oneself and access to means.
One of the major predictors of death by suicide is a previous suicide attempt and physicians are distinguished by relatively fewer instances of previous attempts
Work related issues PLUS not reaching out for professional help!
Does this mean that physicians contemplating suicide are less likely to receive intervention-- because that first attempt is more likely to be lethal?
A family history of suicide, a previous history of suicidal depression and a previous attempt are all risk factors.
Pamela - will look for your article. Thanks for your expertise and passion.
Yes. Psychiatric illness is very scary. It affects our minds and functioning - precious to all human beings but especially MDs. Also too many doctors feel "weak" if they become ill.
Can we identify those most at risk?
Maintaining balance is fundamental and so very hard to do for busy medical students, residents and practicing clinicians.
Yes – physicians who are open about a family history of suicide, a previous history of suicidal acts, a previous bout of major depressive disorder with a suicidal diathesis, a current depression that is increasingly treatment refractory, a physician with bipolar illness that is rapidly cycling and poorly treatment adherent, a physician with burnout and/or SUD with many losses and few supports, a physician facing a humiliating lawsuit or medical licensure investigation, a physician living with a chronically progressive and debilitating medical disorder (including pain)
No – note the number of doctors who are below the radar or who fall through the cracks each year where no one saw it coming – are these physicians who fit into the 10-15% of suicide deaths without a psychiatric illness or are they individuals who masterfully cover up their pain and desperation?
Specialty yes. Thanks. Psychiatrists too.
It is troubling that women physicians rates are the same as male physicians. Are they not getting proper support for the medical work and family responsibilities they juggle? Are they getting good care by knowledgeable practitioners?
Re work related stress becoming genetic, very interesting. What troubles me is how normative overwork is for doctors. Many folks think we're nuts!
Jenna - wise words - couldn't agree more. Many residents - and attendings - are doing the work of too many. We do need more help so that quality and safety do not continue to suffer!
Can protective factors be fostered in med school?
YES!!!! This language is important and when students know that there are things they can do to increase their resilience they feel more positive and affirming.
Examples are: regular exercise, proper nutrition, minimal alcohol and other drug usage, supportive friendships, family sustenance, non-scholastic interests, mindfulness meditation, balance, spirituality and religion, having a primary care physician
Abigail - we all need to examine our perfectionism. Senior docs need to openly admit to trainees their doubts and insecurities at times in their career. We are human. To err is human. Law suits need re-examination!