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Baldino G, Vanin S, Burrascano G, Forzese E, Asmundo A, Ventura Spagnolo E. A case report of complex suicide in physician: attempt drugs poisoning and adhesive tape asphyxia. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00836-1. [PMID: 38839741 DOI: 10.1007/s12024-024-00836-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/07/2024]
Abstract
Complex suicides are rare occurrences that can be categorized into planned (or primary) cases and unplanned (or secondary) cases. Additionally, individuals often select suicide methods based on their availability and accessibility. The body of a 58-year-old man was discovered deceased inside his medical office. He was found seated on the waiting room sofa, with his airways obstructed by several layers of adhesive tape wrapped around his head. An intravenous needle was observed in his left arm, and on the table in front of him, an empty 50 ml syringe, two empty vials of 10 ml potassium chloride, and an empty 10 mg vial of Valium (diazepam) were found. A roll of adhesive tape, similar to the one around his head, was also present. The autopsy, conducted 36 h after the body's discovery, revealed therapeutic concentrations of diazepam and its metabolite nordiazepam in the blood samples, while potassium chloride was not detected. Integrating forensic findings obtained from autopsy, histology, and other postmortem investigation, including toxicological analysis, can aid in defining suicidal behavior and preventing misinterpretation, particularly in differentiating diagnosis between homicide and suicide. It is crucial to consider circumstantial data and professional knowledge in such cases.
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Affiliation(s)
- Gennaro Baldino
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Stefano Vanin
- Department of Earth, Environmental and Life Sciences (DISTAV), University of Genoa, Genoa, 16132, Italy
| | - Giorgia Burrascano
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Elena Forzese
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Alessio Asmundo
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Elvira Ventura Spagnolo
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.
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NishanthaVadysinghe A, Thambirajah B, Denniss KM. Abuse of defibrillator pads: Suicide by electrocution. J Forensic Leg Med 2021; 83:102252. [PMID: 34537515 DOI: 10.1016/j.jflm.2021.102252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/11/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
We report a Case of a medical professional, with a very good knowledge of emergency medical devices, who committed suicide using defibrillator pads to electrocute. The decedent attached the defibrillator pads in the standard position on his chest and manually connected the terminals to an extension cord through an additional switching device. When he switched on the device, electricity passed through his heart. The autopsy showed attached defibrillator pads and severe skin burns beneath it. Scene findings were consistent with suicide. The cause of death was electrocution and manner of death was suicide. Suicide by electrocution is uncommon and suicide by electrocution using defibrillator pads has not been reported in English literature.
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Affiliation(s)
- Amal NishanthaVadysinghe
- Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Balachandra Thambirajah
- Office of the Chief Medical Examiner/ Associate Clinical Professor in the Department of Pathology, University of Alberta, Edmonton, Canada.
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Stephenson L, Kenneally M, van den Heuvel C, Humphries M, Stockham P, Byard RW. Recent trends in barbiturate detection in medicolegal deaths. Leg Med (Tokyo) 2021; 53:101928. [PMID: 34119997 DOI: 10.1016/j.legalmed.2021.101928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 04/05/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022]
Abstract
A study was undertaken of 51 cases where barbiturates were detected in post-mortem blood samples from 2000 to 2019 at Forensic Science South Australia, Adelaide, Australia. The cause of death was drug toxicity in only 27 (53%) (M:F = 19:8; age range 19-74yrs, mean 46yrs). In 17 cases, barbiturate toxicity was the primary cause of death, 14 due to pentobarbitone and 3 to phenobarbitone. All were suicides. Barbiturates were obtained by online purchase from overseas sources in 9 cases (33%), and through veterinary practice in 2 cases (7%). Drug toxicity deaths where barbiturates were detected rose from 1 in 2000-2004 to 11 in 2015-2019, and those where deaths were primarily due to barbiturate toxicity rose from 1 in 2000-2004 to 9 in 2015-2019. However, the mere detection of barbiturates in post mortem samples did not equate with illicit use, as 23 of the deaths (45%) were due to natural causes in individuals prescribed barbiturates for epilepsy. The usefulness of examining subset populations separate from accrued national data is also demonstrated in the significantly younger age of decedents in South Australia dying from deliberately administered barbiturates (46 yrs) compared to the national average of 57.9 yrs. The reasons for this difference will require further investigation as this may impact upon local suicide prevention strategies.
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Affiliation(s)
- Lilli Stephenson
- Forensic Science South Australia (FSSA) and the Adelaide Medical School, The University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Michaela Kenneally
- Forensic Science South Australia (FSSA) and the Adelaide Medical School, The University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Corinna van den Heuvel
- Forensic Science South Australia (FSSA) and the Adelaide Medical School, The University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Melissa Humphries
- Forensic Science South Australia (FSSA) and the Adelaide Medical School, The University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Peter Stockham
- Forensic Science South Australia (FSSA) and the Adelaide Medical School, The University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Roger W Byard
- Forensic Science South Australia (FSSA) and the Adelaide Medical School, The University of Adelaide, Adelaide, South Australia 5000, Australia.
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Plunkett E, Costello A, Yentis SM, Hawton K. Suicide in anaesthetists: a systematic review. Anaesthesia 2021; 76:1392-1403. [PMID: 34061350 DOI: 10.1111/anae.15514] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/28/2022]
Abstract
Evidence suggests that healthcare professionals are at an increased risk of dying by suicide, with anaesthetists at particularly high risk. However, much of the data on which this is based are historical. With a focus on the epidemiology and methods used, we conducted a systematic review of evidence regarding suicide and suicidal behaviour among anaesthetists to provide a more contemporary summary. The systematic review process was adapted from a previous similar study in veterinary surgeons and was consistent with recommended guidance. We identified 54 articles published in or after 1990 that had anaesthetist-specific data and met the inclusion criteria. Seven of these reported epidemiological data, of which four were published after 2000. Although none of the more recent studies reported standardised mortality rates specific to suicide in anaesthetists, the proportion of anaesthetists dying by suicide was increased with respect to comparator groups, which is consistent with previous findings. Eleven studies that included information on suicidal behaviour reported suicidal ideation in 3.2-25% of individuals (six studies) and suicide attempts in 0.5-2% (four studies). Studies reporting methods of suicide highlighted the use of anaesthetic drugs, particularly propofol, supporting the suggestion that the increased risk of suicide in anaesthetists may be related to the availability of the means. We discuss our findings in relation to other recently published data and guidance concerning mental health problems in anaesthetists.
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Affiliation(s)
- E Plunkett
- Department of Anaesthesia, University Hospitals Birmingham, Birmingham, UK
| | - A Costello
- Department of Anaesthesia, Milton Keynes University Hospitals, Milton Keynes, UK
| | - S M Yentis
- Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.,Imperial College London, London, UK
| | - K Hawton
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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Barranco R, Caputo F, Pinto SL, Drommi M, Ventura F. Unusual suicide by a speargun shot: Case report. Medicine (Baltimore) 2020; 99:e22308. [PMID: 33285667 PMCID: PMC7717817 DOI: 10.1097/md.0000000000022308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/25/2020] [Accepted: 08/21/2020] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Only a few cases of accidental deaths due to speargun injuries are reported in the literature. Murder or suicide cases are even rarer. PATIENT CONCERNS A 59-year-old male with a history of major depression and previous suicide attempts, was found, still alive and conscious, with a spear in his mouth and a fishing speargun a few meters away. The spear then penetrated the cranium and crossed the entire left cerebral hemisphere. DIAGNOSES The patient underwent a retrograde removal of the spear. During the surgery, there was a massive encephalic bleeding. After about 2 days of coma, brain death was confirmed. An autopsy was performed to determine the cause of death. INTERVENTIONS The scalp presented hemorrhagic infiltrates in the left parieto-temporal region. There were an acute subdural hematoma and subarachnoid hemorrhage. At the opening of the lateral ventricles a massive fronto-parieto-temporal hematoma was evident. The skull base had a massive hemorrhagic infiltration and a circular fracture of about 0.5 cm in diameter, due to the penetration of the spear. The hard palate showed a circular solution of continuity with net margins whose diameter was consistent with the size of the spear. OUTCOMES The cause of death was attributed to the traumatic cranial-encephalic lesions due to the speargun shot in the mouth. LESSONS The investigation into unusual cases of death constitutes a complex matter and requires a careful evaluation on the part of the forensic pathologist. A differential diagnosis may be necessary in order to rule out simulated suicide/homicide. In this particular case, the analysis of the scene of the self-suppression event and available circumstantial information, the evaluation of clinical data, the complete autopsy and the comparison between the injuries of the victim and the characteristics of the weapon used led to the confirmation of the suicidal nature of the death.
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Xu H(G, Kynoch K, Tuckett A, Eley R. Effectiveness of interventions to reduce emergency department staff occupational stress and/or burnout: a systematic review. JBI Evid Synth 2020; 18:1156-1188. [DOI: 10.11124/jbisrir-d-19-00252] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Dutheil F, Aubert C, Pereira B, Dambrun M, Moustafa F, Mermillod M, Baker JS, Trousselard M, Lesage FX, Navel V. Suicide among physicians and health-care workers: A systematic review and meta-analysis. PLoS One 2019; 14:e0226361. [PMID: 31830138 PMCID: PMC6907772 DOI: 10.1371/journal.pone.0226361] [Citation(s) in RCA: 225] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/24/2019] [Indexed: 12/14/2022] Open
Abstract
Background Medical-related professions are at high suicide risk. However, data are contradictory and comparisons were not made between gender, occupation and specialties, epochs of times. Thus, we conducted a systematic review and meta-analysis on suicide risk among health-care workers. Method The PubMed, Cochrane Library, Science Direct and Embase databases were searched without language restriction on April 2019, with the following keywords: suicide* AND (« health care worker* » OR physician* OR nurse*). When possible, we stratified results by gender, countries, time, and specialties. Estimates were pooled using random-effect meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Suicides, suicidal attempts, and suicidal ideation were retrieved from national or local specific registers or case records. In addition, suicide attempts and suicidal ideation were also retrieved from questionnaires (paper or internet). Results The overall SMR for suicide in physicians was 1.44 (95CI 1.16, 1.72) with an important heterogeneity (I2 = 93.9%, p<0.001). Female were at higher risk (SMR = 1.9; 95CI 1.49, 2.58; and ES = 0.67; 95CI 0.19, 1.14; p<0.001 compared to male). US physicians were at higher risk (ES = 1.34; 95CI 1.28, 1.55; p <0.001 vs Rest of the world). Suicide decreased over time, especially in Europe (ES = -0.18; 95CI -0.37, -0.01; p = 0.044). Some specialties might be at higher risk such as anesthesiologists, psychiatrists, general practitioners and general surgeons. There were 1.0% (95CI 1.0, 2.0; p<0.001) of suicide attempts and 17% (95CI 12, 21; p<0.001) of suicidal ideation in physicians. Insufficient data precluded meta-analysis on other health-care workers. Conclusion Physicians are an at-risk profession of suicide, with women particularly at risk. The rate of suicide in physicians decreased over time, especially in Europe. The high prevalence of physicians who committed suicide attempt as well as those with suicidal ideation should benefits for preventive strategies at the workplace. Finally, the lack of data on other health-care workers suggest to implement studies investigating those occupations.
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Affiliation(s)
- Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Occupational and Preventive Medicine, WittyFit, Clermont-Ferrand, France
- Australian Catholic University, Faculty of Health, School of Exercise Science, Melbourne, Victoria, Australia
- * E-mail:
| | - Claire Aubert
- Université de Versailles Saint-Quentin-en-Yvelines, Faculty of Health Science Simone Veil, Versailles, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Biostatistics Unit, the Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Michael Dambrun
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, Clermont-Ferrand, France
| | - Fares Moustafa
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Emergency, Clermont-Ferrand, France
| | - Martial Mermillod
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
- Institut Universitaire de France, Paris, France
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Marion Trousselard
- French Armed Forces Biomedical Research Institute-IRBA, Neurophysiology of Stress, Neuroscience and Operational Constraint Department, Brétigny-sur-Orge, France
| | - François-Xavier Lesage
- University of Montpellier, Laboratory Epsylon EA, Dynamic of Human Abilities & Health Behaviors, CHU Montpellier, University Hospital of Montpellier, Occupational and Preventive Medicine, Montpellier, France
| | - Valentin Navel
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France
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Aparici I, Byard RW. Characteristics of unnatural deaths in Tierra del Fuego, Argentina: A 10-year study (2008-2017). MEDICINE, SCIENCE, AND THE LAW 2019; 59:219-222. [PMID: 31462150 DOI: 10.1177/0025802419871216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A retrospective review was undertaken of 287 unnatural deaths undergoing medicolegal investigation over a 10-year period from January 2008 to December 2017 in Rio Grande, Tierra del Fuego, Argentina. There were 219 males and 68 females, age range 7 months to 88 years (average 38.4 years). The 135 accidental deaths (47%) were due mainly to vehicle crashes ( N = 62) and carbon monoxide toxicity from fires ( N = 31). The 115 cases of suicides (40.1%) were predominantly due to hanging ( N = 75) and gunshot wounds ( N = 20). The 37 cases of homicide (12.9%) were mainly due to stabbing/sharp force injury ( N = 20) and blunt force trauma ( N = 9). Carbon monoxide toxicity from faulty heating accounted for a substantial percentage (8.1%) of the accidental deaths. Firearm homicides and suicides related to drug toxicity and carbon monoxide inhalation were relatively uncommon medicolegal cases in this centre.
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Affiliation(s)
| | - Roger W Byard
- Forensic Science SA and School of Medicine, The University of Adelaide, Australia
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McFarland DC, Hlubocky F, Susaimanickam B, O'Hanlon R, Riba M. Addressing Depression, Burnout, and Suicide in Oncology Physicians. Am Soc Clin Oncol Educ Book 2019; 39:590-598. [PMID: 31099650 DOI: 10.1200/edbk_239087] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The best practice of oncology relies heavily on a mentally and physically healthy oncology clinician workforce. Historically, the mental health of physicians and clinicians has largely been ignored, perhaps in the spirit of a collective collusion to maintain the illusion of Oslerian equanimity. With exceedingly high and unacceptable rates of burnout and suicide in the practice of medicine and oncology in particular, a tacit disavowal of the problem is no longer acceptable. The practice of oncology presents several unique work-related issues that challenge the mental health of its clinicians and contribute to burnout, depression, and suicide. Oncologists work with patients at or nearing the end of life and face administrative and insurance hurdles to obtain needed anticancer medications, heavy workloads, paperwork and electronic medical record demands, and keeping up with expanding pertinent oncologic knowledge for practice and public relations issues. Although oncologists exhibit higher rates of depression with longer work hours than many other internal medicine colleagues, they have higher job satisfaction ratings. This article will (1) review the mental health of professionals in oncology, (2) explore similarities and differences between depression and burnout, (3) describe the unique nature of the oncology work environment, (4) examine suicide and its implications for oncology, and (5) review the evidence for interventions to prevent burnout and suicide. Although individual and system-level strategic approaches to the problem of burnout and its consequences are effective, combinatorial approaches offer the most hope for affecting the most long-lasting change and lessening burnout, depression, and suicide in oncology.
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Affiliation(s)
- Daniel C McFarland
- 1 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fay Hlubocky
- 2 Department of Medicine, Section of Hematology/Oncology, Comprehensive Cancer Center, University of Chicago, Chicago, IL
| | - Bibiana Susaimanickam
- 1 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin O'Hanlon
- 3 Medical Library, Memorial Sloan Kettering Cancer Center. New York, NY
| | - Michelle Riba
- 4 University of Michigan Department of Psychiatry and University of Michigan Rogel Cancer Center, Ann Arbor, MI
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Mintz S, Jamison E, Bol K. Suicide Among Health Care Practitioners and Technicians in Colorado: An Epidemiological Study. Suicide Life Threat Behav 2019. [PMID: 29512834 DOI: 10.1111/sltb.12449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Suicide is a public health concern with risks that vary between occupation groups. Many suicide victims with a health care occupation die by poisoning, but few studies have epidemiologically studied this association. The objective of this study was to quantify the increased risk of suicide death by poisoning among health care professionals in Colorado. Eleven years (2004-2014, N = 8,753) of suicide deaths in Colorado were compiled from the Colorado Violent Death Reporting System. A retrospective cohort study using multivariate logistic regression was conducted to examine the risk associated with having a health care occupation and eventual suicide death by poisoning, compared independently to firearm and hanging methods. Suicide victims with a health care occupation were more likely to die by poisoning rather than by hanging (RR 1.54, 95% CI: 1.41-1.68) or firearm (RR 1.79, 95% CI: 1.60-2.01), when compared to suicide victims without a health care occupation. The association between health care occupation and suicide method was significantly (p = .032) modified by gender. The results show that health care workers who die by suicide have an increased risk of eventual suicide death by poisoning rather than by firearm or hanging. These results can be used to inform tailored suicide prevention efforts in health care professionals.
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Affiliation(s)
- Sasha Mintz
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Ethan Jamison
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Kirk Bol
- Colorado Department of Public Health and Environment, Denver, CO, USA
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Brooks E, Gendel MH, Early SR, Gundersen DC. When Doctors Struggle: Current Stressors and Evaluation Recommendations for Physicians Contemplating Suicide. Arch Suicide Res 2017; 22:519-528. [PMID: 28990863 DOI: 10.1080/13811118.2017.1372827] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of this study was to document current risk factors associated with physicians' suicide ideation among a group of doctors enrolled in a Physician Health Program. A retrospective cohort study was drawn from administrative data. The study compared intake information between doctors who reported recent thoughts of suicide (n = 70) and those who did not (n = 1,572) using adjusted regression analysis. Current stressors included personal, financial, health, and occupational problems; ideation was more likely with multiple stressors. Physicians endorsing suicidal ideation lacked personal supports and scored differently on Short Form-36 measures. Evaluators treating physicians should assess enduring risks and current stressors, particularly multiple stressors, to help detect suicidal patients. Current stressors should not be viewed as transitory and it is critical to bring in collateral information.
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The Radiologist and Depression. J Am Coll Radiol 2016; 13:863-7. [PMID: 27085789 DOI: 10.1016/j.jacr.2016.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 11/20/2022]
Abstract
Clinical depression affects physicians, including radiologists. Medical professionals, including radiologists, may be more comfortable treating a patient than being one, and psychiatric issues may be regarded as taboo for discussion, so the issue of clinical depression in the specialty and subspecialty has not received widespread attention. Specifically, a review of the national and international literature in PubMed, Scopus, and Google reveals few publications dedicated to the issue of clinical depression in radiology; although statistically, they must exist. The purpose of this report is to define the terms and describe the manifestations and scope of the issues related to clinical depression, with special attention given to risk factors unique to radiologists, such as working in low ambient light or near different fields of magnetic strength. By the end of the article, it is the authors' hope that the reading radiologist will be aware of, and open to, the possibility of clinical depression in a colleague or within his or herself because clinical depression is common and it is important to get help.
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Huang CLC, Weng SF, Wang JJ, Hsu YW, Wu MP. Risks of Treated Insomnia, Anxiety, and Depression in Health Care-Seeking Physicians: A Nationwide Population-Based Study. Medicine (Baltimore) 2015; 94:e1323. [PMID: 26334890 PMCID: PMC4616506 DOI: 10.1097/md.0000000000001323] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
High occupational stress and burnout among physicians can lead to sleep problems, anxiety, depression, and even suicide. Even so, the actual risk for these behavioral health problems in health care-seeking physicians has been seldom explored. The aim of this study was to determine whether physicians have higher odds of treated insomnia, anxiety, and depression than the normal population.This is a nationwide population-based case-control study using the National Health Insurance Research Database in Taiwan for the years 2007 to 2011. Physicians were obtained from the Registry for Medical Personnel in 2009. Hospital physicians who had at least 3 coded ambulatory care claims or 1 inpatient claim with a principal diagnosis of insomnia, anxiety, or depression were identified. A total of 15,150 physicians and 45,450 matched controls were enrolled. Odd ratios (ORs) of insomnia, anxiety, and depression between physicians and their control counterparts were measured.The adjusted ORs for treated insomnia, anxiety, and depression among all studied physicians were 2.028 (95% confidence interval [CI], 1.892-2.175), 1.103 (95% CI, 1.020-1.193), and 0.716 (95% CI, 0.630-0.813), respectively. All specialties of physicians had significantly higher ORs for treated insomnia; among the highest was the emergency specialty. The adjusted ORs for treated anxiety among male and female physicians were 1.136 (95% CI, 1.039-1.242) and 0.827 (95% CI, 0.686-0.997), respectively. Among specialties, psychiatry and "others" had significantly higher risks of anxiety. Obstetrics and gynecology and surgery specialties had significantly lower risks of anxiety. The adjusted ORs for treated depression among physicians in age groups 35 to 50 years and >50 years were 0.560 (95% CI, 0.459-0.683) and 0.770 (95% CI, 0.619-0.959), respectively. Those in the psychiatry specialty had significantly higher risks of depression; internal and surgery specialties had significant lower risks of depression.Hospital physicians have lower odds of treated depression than the general population, although they have higher odd of treated insomnia and anxiety. Undertreatment was noted in some sex, age, and specialty subgroups of physicians. Additional studies are needed to determine how to eliminate barriers to their use of psychiatry resources.
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Affiliation(s)
- Charles Lung-Cheng Huang
- From the Department of Psychiatry, Chi Mei Hospital; Department of Social Worker, Chia Nan University of Pharmacy and Science (CL-CH); Department of Medical Research, Chi Mei Hospital; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science (S-FW, J-JW, Y-WH); Division of Urogynecology and Pelvic Floor Reconstruction, Department of Obstetrics and Gynecology, Chi Mei Hospital; and Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan (M-PW)
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Massaro L. Unusual Suicide in Italy: Criminological and Medico-Legal Observations-A Proposed Definition of “Atypical Suicide” Suitable for International Application. J Forensic Sci 2015; 60:790-800. [DOI: 10.1111/1556-4029.12731] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 03/07/2014] [Accepted: 05/28/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Luca Massaro
- Luca Massaro; Via degli Artigiani 4 35042 Este Padova Italy
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Eckleberry-Hunt J, Lick D. Physician Depression and Suicide: A Shared Responsibility. TEACHING AND LEARNING IN MEDICINE 2015; 27:341-5. [PMID: 26158336 DOI: 10.1080/10401334.2015.1044751] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
ISSUE Although the exact number is often disputed, it has been reported that approximately 300 to 400 physicians in the United States take their own lives annually. Despite calls from key interest groups for prevention and treatment protocols of physician suicide, little systematic change has taken place. EVIDENCE Research on suicide risk factors among physicians has expanded. Increasing reports are surfacing that highlight suicidal ideation and depression in medical school, residency training, and later professional practice. IMPLICATIONS The purpose of this article is to draw attention to the problem of physician suicide with an emphasis on the role of medical education. Multiple accreditation bodies should be involved to effect a change in physician suicide prevalence. Thirty years have demonstrated that without mandates, large-scale change will not occur. We adapted some of the 2012 National Strategy for Suicide Prevention goals to medical education as a guide.
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