Suicide in Medical Trainees: Lack of Data Hurts Prevention

Marcia Frellick


August 22, 2019

When Does the Path to Physician Suicide Begin?

More data are available on physician suicides. A literature review of physician suicide shows that the rate is more than double that in the general population. In information presented at the 2018 American Psychiatric Association annual meeting, physicians were found to have the highest suicide rates of any profession. So when do the factors that contribute to physician suicide first take root?

Blacker said her team's study was intended to investigate whether there is a point in medical training when suicide factors become more prevalent. "If we're recruiting kids into medical school who are at normal risk or possibly even lower risk than the general population, then what on Earth is happening that changes their risk from normal or low into high?" she said.

Pinpointing when this risk increases may be key. A study by Nicholas Yaghmour, MPP, an American Council for Graduate Medical Education research analyst, and colleagues used National Death Index data matched with information updated each year by residency programs in the Accreditation Data System. Researchers looked at causes of residents' deaths from 2000 to 2014. It found that suicide was the leading cause of death for male residents, and the second-leading cause for female residents.

"An important finding is that the majority of suicides (49 of 66; 74%) occurred in years 1 and 2 of training," the authors write. That information is valuable, Skochelak said, because if they are in a new place and don't necessarily have a social support network, "that gives you information that as a program director you can start to take action on."

The Time Is Now

To address concerns now, the AMA has developed an education module to help physicians, residents, and medical students learn about suicide risks to look for in students, residents, colleagues, and patients. The new module is available on the AMA Ed Hub.

The AMA is also supporting data collection through the reimagining residency grant initiative, in partnership with Johns Hopkins Medicine in Baltimore, Maryland, to look at stressors in the resident environment that contribute to burnout. Skochelak said Johns Hopkins is proposing doing time-motion studies at Hopkins, Stanford University in California, and the University of Alabama at Birmingham, and tracking how residents' days are spent.

These data can help inform interventions to reduce burnout and stress, she said. "We're really trying to find out earlier what's causing the stress and the burnout, and what can we do to mitigate it before it gets to such a tragic outcome," she said.

As debates about who should gather data and how it can best be collected rage on, the only clear consensus is that steps to address the lack of information must be taken. As Laitman and Muller conclude their commentary, "Medical student suicides demand our urgent attention. Lives are literally at stake, and the time for action is now."

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