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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023
| Contributor Information
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
Suicide has become an American public health crisis, and among physicians, rates of suicidal thoughts and suicide attempts are higher than with average Americans, sometimes substantially so.
Psychiatrists and other physicians deal with the same pressures over finances, relationships, and the rest of daily life that other Americans do. But the special stressors for physicians — constantly increasing patient counts, administrative responsibilities, reduced autonomy, rising patient expectations — have been known for decades. And though the COVID-19 pandemic may be abating, that doesn't mean that the added despair it heaped on psychiatrists' shoulders has gone away.
Medscape surveyed over 9100 physicians across more than 29 specialties, including psychiatry, who were candid about their experiences with suicide attempts and suicidal thoughts. They revealed why they contemplated suicide, whether they reached out for help and to whom, how they look after their own mental well-being, and whether they helped colleagues who were struggling.
(Some totals in this presentation do not equal 100% because of rounding.)
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
Looking at the bigger picture in the medical profession, 1% of physicians said that they had attempted suicide and 9% acknowledged contemplating it.
Physicians in general significantly more often report suicidal thoughts or attempt suicide than the average for US adults (4.9% and 0.5%, respectively), according to the National Institute of Mental Health.
The combination of high rate of suicidal thoughts and knowledge of lethal means among physicians concerns Peter Yellowlees, MBBS, MD, CEO of the mental health platform Async Health. "In this context, [the percentages shown above] are worryingly high numbers and markers we should be concerned about," he says.
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
Compare those results with physicians overall: Men and women said that they contemplated or attempted suicide or, alternatively, that they never considered it at fairly similar rates.
In the general US population, studies show that "females are two to three times more likely to attempt suicide than males are," warns Perry Lin, MD, national co-chair of the American Association of Suicidology's Physician Suicide Awareness Committee and an assistant clinical professor of osteopathic medicine at Ohio University.
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
In the broader American population, older people, especially men aged 45 years or older, typically deal with higher suicide rates, notes Michael F. Myers, MD, professor of clinical psychiatry at SUNY Downstate Health Sciences University in Brooklyn, New York.
"Admitting to having felt suicidal but not attempted suicide does speak to how stressed a certain cohort of today's doctors are," he says. "The fact that only a small percentage of these individuals went on to attempt suicide is a good sign that they perhaps shared this with a trusted colleague, friend, or family member or sought professional help.
"It might also mean that disclosing [a suicide attempt] is less stigma-tainted than it used to be, that individuals understand this as part of a serious mental health issue and not a sign of weakness."
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
From year to year in our past few reports, the specialties with the highest rates of doctors saying that they had suicidal thoughts tend to be very different. Psychiatrists were near the top of all specialties this year.
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
In recent years, physicians overall have shown themselves slightly more likely to bring ideas about suicide to a therapist and slightly less likely to confide in none of the people listed above.
"It's pleasing that physicians are more prepared to see a therapist and less likely to keep their distress entirely to themselves," Yellowlees says.
"It's possible that the need for mental healthcare is become less stigmatized nationally, with the large and increasing emphasis on physician well-being during and after [the] COVID-19" pandemic.
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
As with physicians overall, psychiatrists most often cited the "I can do it alone" reason for not reaching out to a mental health professional. But possible professional impacts — fears that medical boards, insurance companies, or colleagues could find out and respond negatively — also played material roles.
"Though as physicians we recognize suicidal ideation as an area of high concern and would take what a patient says very seriously, we are less likely to do this ourselves," Lin notes. "There is a lot of stigma among help-seeking behavior."
As fears about how medical boards and other third parties could react, "these…are symptoms of the larger issues," he believes. "Doctors are willing and able to treat suicidal ideation among patients but appear fearful to seek such help themselves. We must do better."
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
Compare psychiatrists with physicians overall (among whom, 9% of men and 11% of women said that a colleague had shared their contemplation of suicide).
How well doctors listen during these conversation matters, for the colleague's sake and because potential impacts of colleague suicide on co-workers has not been widely researched, according to an analysis in the International Journal of Environmental Research and Public Health.
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
Among physicians across all specialties, 79% of respondents said that they had a talk with the struggling colleague, 78% recommended that physician seek professional help, and 17% spoke with a colleague's family member.
Respondents described arranging psychiatrist visits for a colleague ("I demanded and ensured they received help"), accompanying someone to the emergency department, and helping a co-worker arrange a leave of absence and inpatient treatment.
"I am a psychiatrist and treat more than 30 doctors," one respondent said.
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
Myers finds the idea of an institution bearing the ultimate responsibility bothersome and simplistic. "Most suicides are multifactorial, many stressors coming together all at once in a person's life, a so-called "a perfect storm," he notes. "When and if it appears that a vulnerable medical student or physician was very poorly treated by their medical school or healthcare organization, then yes, we might conclude that this was one of the drivers of their suicide.
"But there are suicides each year involving medical students and physicians that have nothing to do with the medical school or place of work."
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
As with physicians overall, psychiatrists turned to healthy behaviors like hobbies and personal interests; exercise; and more time with family and friends at strong rates, which could bode well for addressing suicide in the profession.
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
Doctors can turn to several physician-specific or general suicide phone or text help lines. The organizations listed above also can provide a variety of prevention and support resources. Yet another organization, the American Association of Suicidology, has a special committee generating awareness of suicide issues among doctors.
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
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Doctors' Burden: Psychiatrist Suicide Report 2023
Jon McKenna | March 31, 2023 | Contributor Information
For some physicians, the stress of practicing medicine has become so unbearable that they contemplate or attempt suicide. Others have found ways to support their mental health.Medscape Features Slideshow, Mar 2023
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