Prevention of Physicians' Suicide.

2014·0.03 MB·English

by  Sheikhmoonesi, Fatemeh

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Editorial

Prevention of Physicians’ Suicide

Fatemeh Sheikhmoonesi MD•*, Mehran Zarghami MD**

Suicide rate in physicians has been reported to be higher than general population or other academics.
Previous studies found that 85-90% of people who commit suicide had been suffering from some type of
psychiatric disorder. Suicide prevention is the key element in lowering the numbers of physicians who destroy
themselves and end their lives each year. It is needed to provide some educational programs to increase
physicians’ awareness of warning signs of suicidal ideation such as observable signs of serious depression.
According to previous studies, some specialties such as psychiatry, anesthesiology, and dentistry are at higher
risk for physicians’ suicide. Hence, it is important to select candidates in these fields carefully as a primary
prevention program.

Declaration of interest: None.
Citation: Sheikhmoonesi F, Zarghami M. Prevention of physicians’ suicide. Iran J Psychiatry Behav Sci
2014; 8(2): 1-3.

This article has its roots in my consternation over the loss of my medical school classmate: Dr. “N.F.”
(F. Sheikhmoonesi)

W orld H•••• ealth Organization disorder (6). Frank and Dingle reported the
(WHO) defined suicide as “an history of depression, cigarette smoking,
act with a fatal outcome, which alcohol abuse or dependence, sexual abuse,
the deceased knowing or expecting a fatal domestic violence, poor current mental health,
outcome had initiated and carried out with the more sever harassment, and family history of
propose of provoking the change that he psychiatric disorder as some characteristics of
desired” (1). Suicide rate in physicians has women physicians who had attempted suicide
been reported to be higher than general (7). Furthermore, orphaned and childless
population or other academics in many physicians, and those who have home
studies (2, 3). For example, Frank et al. in a stressors, obesity, chronic fatigue syndrome,
national study on causes of death found that worse health, eating disorders, substance
mortality due to suicide and self-injury among abuse, hardworking, career displeasure, and
white male USA physicians is 70% higher job stressors have been reported as high risk
than other professionals. They have reported physicians (7). On the other hand, some other
that suicide rate among female physicians is studies indicate that drug abuse, alcoholism,
3-4 times more prevalent than the general marital discord, and admission to psychiatric
population (4). institutions are prevalent among the medical
Suicide rates increase abruptly by age profession (3).
among doctors (5). Previous studies found that Gold et al. found that all medical
85-90% of people who commit suicide had specialties are not equally influenced by
been suffering from some type of psychiatric substance dependence and abuse.
Anesthesiologists are more engaged with drug

abuse disorders significantly (8). Easy access
Authors’ affiliation: * Associate Professor, Psychiatry and
to drugs with high abuse potential may be an
Behavioral Sciences Research Center, Addiction Institute AND
Department of Psychiatry, Mazandaran University of Medical important factor in physician suicide attempts.
Sciences, Sari, Iran. ** Professor, Psychiatry and Behavioral
Epstein et al. reported some psychological
Sciences Research Center, Addiction Institute AND Department of
Psychiatry, Mazandaran University of Medical Sciences, Sari, Iran. characteristics, which have predictive value in
• Corresponding author: Fatemeh Sheikhmoonesi, Zare Hospital,
identifying future physicians’ suicide. Many
Neka Road, Sari, Iran. PO Box: 4843185774
Tele: [phone] personality factors, particularly self-
Fax: [phone]
Email: [email protected]
www.ijpbs.mazums.ac.ir Iran J Psychiatry Behav Sci, Volume 8, Number 2, Summer 2014 1
Prevention of Physicians’ Suicide

destructive tendency, depression, and guilty consisted of screening, assessment, referral
self-concept are significantly higher among and education. The screening practice was
suicidal physicians than the controls (9). trustworthy. The educational part consisted of
Gagne et al. found that borderline personality Grand Rounds on students’ and physicians’
disorder is more prevalent among physicians exhaustion, depression, and suicide (14).
who committed suicide (10). From ecological point of view, two main
Physicians’ suicide has also been components of suicide prevention are
associated with marital status, relationship identification of vulnerable groups and
and occupational difficulties, and financial individuals, and limitation of access to
problems as well as alcoholism, drug abuse, specific methods of suicide (15).
and positive psychiatric history (10). Unfortunately, there is no documented data
The literature also suggests that physicians on prevalence of physicians’ suicide and
who kill themselves are more critical of others related factors in Iran. It seems that medical
and of themselves and more likely to blame professional suicides can be categorized in
themselves for their own illnesses. two major classes: 1) The young student
Furthermore, there is some evidence that especially girls that face to emotional conflict.
physicians do not welcome to colleagues for 2) The hard working residents and specialists.
help, and instead utilize alcohol or drugs and However, it is recommended to screen suicide
resort to isolation. Besides, once they look for risk factors such as medical (depression, drug
help it seems that they are not taken seriously abuse, borderline personality disorder, and
and adequately by their colleagues (2). other psychiatric disorders), and sociological
Previous researchers found that more than factors (particularly anomic factors as a result
50% of physicians who sought help and later of weak social protective elements) in
committed suicide had been diagnosed with medical students, as well as residents, while
psychiatric disorders (11); most of them were they enter to medical university and when
not hospitalized before death (12). they want to choose their specialty field.
Several conceptual models have been put According to previous studies some
forward to prevent this complex phenomenon. specialties such as psychiatry, anesthesiology,
Suicide prevention is the key element in and dentistry are at higher risk for physicians’
lowering the numbers of physicians who suicide (16). So it is important to select
destroy themselves and end their lives each candidates in these fields carefully as a
year. Preven in a primary prevention primary prevention program. More severe
movement suggested that medical school regulations and limitation of access to the
curriculum should include programs to sedative, hypnotic, analgesic as well as
advance more self-awareness in students of stimulant drugs, which have abuse potential
their emotional needs. Furthermore as a and consequently addiction and vulnerability
secondary prevention, any intervention to suicide is another effective needed primary
requires that doctors have the ability to preventive attempt. Also, we should keep in
believe that anyone, regardless of status, may mind that when vulnerable individuals face an
be suicidal. Besides, professional roles should important event or conflict beyond their
not limit coworkers and friends from capacity to solve problems, they tend to resort
identifying preliminary signals. Finally, to suicide (17). Counseling and
tertiary prevention offers the survivors the psychotherapeutic assistance for medical
chance to deal with the searing loss in a students and physicians who are stressed and
therapeutic manner (13). burned-out can implement another effective
The first suicide prevention and depression preventive program. It is needed to provide
awareness program was established at the some educational programs to increase
University of California in 2009 to physicians’ awareness of warning signs of
destigmatize help-seeking and prevent suicide suicidal ideation such as observable signs of
among medical student, residents and faculty serious depression. As Preven noted long ago,
physicians. The approach of the program “If the physician cannot heal himself, perhaps
2 Iran J Psychiatry Behav Sci, Volume 8, Number 2, Summer 2014 www.ijpbs.mazums.ac.ir
Sheikhmoonesi F, Zarghami M

he can learn to recognize the need for based on medical student data. J Nerv Ment
assistance” (13). Dis 1973; 156(1): 19-29.
10. Gagne P, Moamai J, Bourget D.
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