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Physician suicide risk factors
No one knows why physicians
are at higher risk of suicide than the general
population, says Dr Kathryn Fung, but some of
the most common and best supported hypotheses
mention some or all of the following:
- self-selection: doctors
may typically have certain characteristics that
not only make them successful in medicine but
also predispose them to depression or substance
abuse (for more on this, see "The
perilous plight of the perfectionist physician");
- a stressful lifestyle, including
on-call hours and commonplace intimidation and
harassment of female doctors;
- malpractice litigation stress;
- the stigma of seeking medical
help as a physician;
- and, the dearth of doctors
trained and experienced at treating their colleagues'
mental health
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New York City cardiologist Dr Nicholas
Bartha had been depressed and physically unwell since
his wife left him five years ago. He lost custody of
his children and lived an increasingly isolated life.
On July 10, 2006, he sent his estranged wife an email
he'd been writing for four years. It warned he would
never leave their disputed heritage house on New York's
Upper East Side alive. Hours later, a violent explosion
blew the house sky high, scattering debris across the
posh block.
A still jittery post-9/11 New York
initially feared a terrorist attack — the White
House was reportedly on high alert — but it gradually
became clear that Dr Bartha had deliberately opened
the gas valve which caused the explosion. He died in
hospital five days later; his death was later ruled
a suicide.
Taken alone, this is a tragic case
of a man plagued by depression. But there is a wider
tragedy at issue here: did Dr Bartha's job put him at
risk for, or directly lead to, his suicide? Is practising
medicine a risk factor for suicide?
ELEVATED
RISK
The answer, which may surprise you, is yes. There is
a growing body of evidence that shows physicians are
at significantly higher risk of suicide than non-physicians.
A widely cited meta-analysis by Dr Eva Schernhammer
and Dr Graham Colditz published in the American Journal
of Psychiatry in 2004 found that male physicians
have a 41% higher risk of suicide compared to the general
population and female physicians have a shocking 130%
higher risk, though some other studies have found the
gender difference to be smaller or even nonexistent.
Another study showed that suicide is the number one
killer of young physicians, accounting for 26% of deaths
in that group. It's said that each year the US medical
profession loses the equivalent of an entire med school
graduating class to suicide. Those numbers are not definitive;
there are still relatively few reliable studies available,
and the absolute number of physician suicides is, thankfully,
quite small.
The elevated risk of suicide in
physicians has caused quite a panic in the medical community.
After all, doctors are healthier and live longer than
the general population and are at lower risk of mortality
for all causes... except suicide. Why?
STRESS
AND SHAME
Dr Kathryn Fung, a psychiatry resident at the University
of Alberta, knows suicide's toll firsthand, having lost
several classmates to suicide over the last few years.
She has since conducted research and given lectures
on the risk of suicide in Canadian physicians. "It was
an eye-opener," she says. "I'm doing anything I can
do now to promote awareness and well-being of doctors."
As with any group, the stigma associated
with mental illness is a huge stumbling block to getting
help for suicidal physicians. One study showed that
less than half of physicians who killed themselves were
receiving treatment for mental illness. "Physician health
used to mean drug abuse and mental illness — stigmatizing
stuff," says Dr Derek Puddester, director of the University
of Ottawa's Faculty Wellness Program. "But physician
health is just health, and we have to keep moving that
meaning forward."
Dr Puddester is one of the authors
of a forthcoming literature review on physician suicide,
a preview of which was presented at the AMA-CMA Conference
on Physician Health in Ottawa on November 30. He's seen
the tragedy of the suicide stigma firsthand. In 2005,
two of his colleagues from the University of Ottawa
medical faculty were hospitalized at the same time —
one after suffering a heart attack, the other after
a suicide attempt. Dr Puddester visited both and what
he saw shocked him: "There were cards, flowers and lots
of visitors for the MI patient. The other had no visitors,
no cards, no family there."
DOCTORS'
FEAR
A common fear among physicians, explains Dr Puddester,
is that seeking care will mean a mandatory report to
the College of Physicians and Surgeons and the loss
of one's license to practise.
But that fear is unfounded, according
to Dr Janet Wright, assistant registrar and psychiatrist
for the College of Physicians and Surgeons of Alberta.
"We have a very non-punitive approach," she says —
largely the same across Canada. "Most people with mental
illness who get it managed can be the same quality of
doctor as anybody else."
Suicide attempts are not reason
to strip physicians of their license, explains Dr Wright.
"We don't see a suicide attempt as a big bad warning
sign. We see it as a symptom. One of our jobs as licensing
authorities is to make sure our doctors are getting
the proper care."
But if things get really bad, action
might be taken. Dr Bartha, the New York physician who
blew up his heritage house, had attempted suicide twice
before, but he only stopped going in to work during
his depressions when he was forced. His wife later said
that his dedication and long surgery hours had in fact
been the root of their marital problems and his depression.
There is help out there for doctors,
says Dr Wright, but overcoming the fear and shame created
by the stigmatization of suicide and mental illness
is a major barrier that must be confronted.
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