Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979-1995

Psychopathological and interpersonal factors associated with suicide attempts in Mexican clinical patients with and without a history of child sexual abuse

Suicidal behavior in the Mexican population is understudied, and there is a paucity of research exploring the role of psychological factors and of the interpersonal theory of suicide in this population. The objectives of this work were: to explore the associations between interpersonal and psychopathological variables and suicide attempts. We also explored psychopathological differences in suicidal behavior between patients with a history of child sexual abuse and those without and examined the most accurate predictors of suicide attempts in the study sample. Finally, we tested the mediation between related variables. Results showed that the most accurate predictors of suicide attempts were perceived burdensomeness, suicidal ideation, and suicide plans. Patients with a history of child sexual abuse differed in levels of depressive symptoms, hopelessness, perceived burdensomeness, and NSSI frequency. Suicide plans mediated the associated between perceived burdensomeness and suicide attempts. Clinical and intervention implications are discussed.

A case report of complex suicide in physician: attempt drugs poisoning and adhesive tape asphyxia

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.

Healthcare Provider Burnout: Red Flag for a Rising Epidemic

OBJECTIVES

This article aims to broaden the understanding of burnout in healthcare providers, its causes, and its reduction strategies. The objectives are to raise awareness, facilitate early intervention, and, ultimately, improve the overall well-being of healthcare providers and the quality of patient care.

METHODS

The study investigated healthcare-provision-associated burnout, an often-unrecognized syndrome affecting professionals worldwide, and its prevalence. It also examined the impact of burnout on patient outcomes, safety, and provider health and well-being. Here, we delve into the triad of burnout attributes: emotional exhaustion, depersonalization, and decreased personal accomplishment. Specific causes, such as work-life balance, workplace environment, and communication/teamwork, are investigated. The existing literature and studies we report explore the pathophysiological effects of burnout, including its impact on health, sleep patterns, and the alarming correlation with suicide.

RESULTS

The prevalence of burnout among healthcare providers is between 30% and 50%. Burnout is a significant factor contributing to poor patient outcomes and threatening patient safety. Furthermore, burnout can induce physical symptoms, including psychological, cardiovascular, and gastrointestinal disorders. We emphasize the importance of identifying and preventing burnout to maintain the overall integrity of healthcare providers and eliminate vulnerabilities for harm to their patients.

CONCLUSIONS

Burnout awareness should be a priority from the early stages of healthcare providers' careers because it is crucial for maintaining their well-being, preventing medical errors, and sustaining high-quality patient care. The identification and prevention of burnout are deemed vital not only for the well-being of healthcare providers but also to safeguard against potential harm to patients. This article calls for increased awareness of burnout, its underlying causes, and the implementation of effective reduction strategies in the healthcare profession.

Suicide rates among physicians compared with the general population in studies from 20 countries: gender stratified systematic review and meta-analysis

OBJECTIVES

To estimate age standardised suicide rate ratios in male and female physicians compared with the general population, and to examine heterogeneity across study results.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Studies published between 1960 and 31 March 2024 were retrieved from Embase, Medline, and PsycINFO. There were no language restrictions. Forward and backwards reference screening was performed for selected studies using Google Scholar.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Observational studies with directly or indirectly age standardised mortality ratios for physician deaths by suicide, or suicide rates per 100 000 person years of physicians and a reference group similar to the general population, or extractable data on physician deaths by suicide suitable for the calculation of ratios. Two independent reviewers extracted data and assessed the risk of bias using an adapted version of the Joanna Briggs Institute checklist for prevalence studies. Mean effect estimates for male and female physicians were calculated based on random effects models, with subgroup analyses for geographical region and a secondary analysis of deaths by suicide in physicians compared with other professions.

RESULTS

Among 39 included studies, 38 studies for male physicians and 26 for female physicians were eligible for analyses, with a total of 3303 suicides in male physicians and 587 in female physicians (observation periods 1935-2020 and 1960-2020, respectively). Across all studies, the suicide rate ratio for male physicians was 1.05 (95% confidence interval 0.90 to 1.22). For female physicians, the rate ratio was significantly higher at 1.76 (1.40 to 2.21). Heterogeneity was high for both analyses. Meta-regression revealed a significant effect of the midpoint of study observation period, indicating decreasing effect sizes over time. The suicide rate ratio for male physicians compared with other professions was 1.81 (1.55 to 2.12).

CONCLUSION

Standardised suicide rate ratios for male and female physicians decreased over time. However, the rates remained increased for female physicians. The findings of this meta-analysis are limited by a scarcity of studies from regions outside of Europe, the United States, and Australasia. These results call for continued efforts in research and prevention of physician deaths by suicide, particularly among female physicians and at risk subgroups.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019118956.

Suicide rates among health-care professionals in Norway 1980-2021

BACKGROUND

Suicide rates have been high in several health-care professions. Suicide rates were described in physicians, dentists, veterinarians, psychologists, pharmacists, nurses, as well as theologians, other graduates and the general population in Norway.

METHODS

Data on educational attainment were linked to data on suicide and all-cause mortality from 1980 to 2021. Suicide rates were reported per 100,000 person-years. The total number of person-years included in the study was 66.4 and 67.2 million for males and females, respectively.

RESULTS

Between 1980 and 2021, male veterinarians (35.9, 95 % CI 19.3-52.4), physicians (25.7, 21.3-30.2) and nurses (22.2, 16.6-27.7) had higher suicide rates compared others with higher education (11.7, 10.7-12.7). For females, this was the case for psychologists (15.0, 8.2-21.7) and nurses (9.3, 8.3-10.3), vs. others with higher education (5.1, 4.2-6.0). Suicide rates declined over the four decades for most groups. For physicians, suicide rates declined and approached the suicide rate of others with higher education. Suicide rates among physicians increased with age, with physicians over 60 years having twice as high suicide rates compared to others with higher education.

LIMITATIONS

The study included only educational status, not current occupation or employment status. This is a descriptive study, with some known risk factors for suicide not accounted for.

CONCLUSIONS

Suicide rates for physicians declined over time, but not for nurses. From 2010 to 2021, nurses of both genders was the only group with higher suicide rates compared to other graduates. The increased suicide rates among veterinarians, nurses, female psychologists and elderly physicians are concerning.

Suicidal ideation and their relationship with job satisfaction and job strain among Jordanian hospitals' healthcare professionals: a cross-sectional study

Suicidal ideation is a major health problem that occurs in response to complex interactions among psychological, sociocultural, and environmental factors. The phenomenon of suicidal ideation among healthcare professionals is still shrouded in mystery in Jordanian society, and there is still a scarcity of studies on its relationship with job strain and job satisfaction has been examined in the Arab world. Therefore, to fill this gap, this study aimed to reveal the prevalence of suicidal ideation among Jordanian hospitals health care professionals, and its relationship to job satisfaction and job strain. Additionally, how some sociodemographic factors were correlated with suicidal ideation levels, including age, sex, monthly income, occupation, years of experience, and sector type. Data were collected through a survey including sociodemographic characteristics, Suicidal ideation Scale (SIS), Job Satisfaction Survey (JSS), and Demand Control Support Questionnaire (DCSQ). The survey was distributed among 910 physicians and nurses of both sexes in public and private Jordanian hospitals. The survey was conducted using an anonymous online platform via Google Forms between October 2022 and December 2023. In light of the strain theory of suicide (STS), our results showed that physicians and nurses reported low levels of suicidal ideation and job satisfaction, with high levels of job strain. Suicidal ideation was positively correlated with job strain and negatively correlated with job satisfaction. Job satisfaction is negatively correlated with job strain. Job satisfaction was a significant mediator between job strain and suicidal ideation. Greater attention should be paid to the work environment in healthcare, particularly to enhance social support, increase job satisfaction levels, reduce job strain, and provide extensive training on effective prevention strategies for suicidal ideation and behaviour in the workplace. Additionally, policies and practices related to the health sector should be modified to create stable, healthy, and safe relationships and work environments.

Reducing the risk of suicide among healthcare staff

Reducing the number of deaths by suicide is an important area in public health. Several factors, including excessive workload demands and burnout, mean that healthcare staff such as nurses are at higher risk of death by suicide compared with people working in other occupations. This article explores the contributory factors involved in suicide among healthcare professionals and outlines some of the methods that nurses can use to enquire about suicide risk with their colleagues. It also details appropriate interventions that nurses can use to reduce the risk of suicide among their colleagues. The authors aim to increase nurses' understanding of their role in suicide prevention in the healthcare workforce.

Factors associated with suicide in physicians: a silent stigma and public health problem that has not been studied in depth

Suicide is a complex and multifaceted public health issue that affects individuals from all walks of life, including healthcare professionals such as physicians. According to research, physicians have a higher risk of suicide compared to the general population, with an estimated suicide rate that is two to three times greater than that of the general population. Suicide in physicians can have devastating consequences, not only for the individual but also for their patients and colleagues. The factors contributing to suicide in physicians are numerous and often interrelated. Physicians are exposed to numerous stressors in their daily lives, including long work hours, high workload, burnout, and exposure to traumatic events. These stressors can lead to mental health problems such as depression, anxiety, and substance use disorders, which in turn can increase the risk of suicide. In addition to work-related stressors, personal factors such as relationship problems, financial stress, and a history of mental health problems can also contribute to suicide risk in physicians. Stigma and shame around seeking help for mental health issues may also prevent physicians from seeking treatment, exacerbating the problem. Understanding the complex factors that contribute to suicide in physicians is crucial for developing effective prevention strategies. For this reason, it is necessary to know the behavior of this phenomenon and the factors associated with a higher risk of suicide in this population. However, taking into account that different regions of the world vary in socioeconomic, cultural, professional, occupational, and health attributes, it is to be expected that the behavior of these risk factors will also be heterogeneous. At present, it is presumed that there is a significant gap in the evidence, due to a predominance of evidence on this topic from high-income countries. Considering the importance of having a comprehensive understanding of the risk factors for suicide in the medical population and possible strategies to mitigate this condition, the aim of this review is to analyze the most recent evidence on these factors, and to assess the quality of the evidence and gaps that need to be studied further.

StackDPP: Stacking-Based Explainable Classifier for Depression Prediction and Finding the Risk Factors among Clinicians

Mental health is a major concern for all classes of people, but especially physicians in the present world. A challenging task is to identify the significant risk factors that are responsible for depression among physicians. To address this issue, the study aimed to build a machine learning-based predictive model that will be capable of predicting depression levels and finding associated risk factors. A raw dataset was collected to conduct this study and preprocessed as necessary. Then, the dataset was divided into 10 sub-datasets to determine the best possible set of attributes to predict depression. Seven different classification algorithms, KNN, DT, LGBM, GB, RF, ETC, and StackDPP, were applied to all the sub-datasets. StackDPP is a stacking-based ensemble classifier, which is proposed in this study. It was found that StackDPP outperformed on all the datasets. The findings indicate that the StackDPP with the sub-dataset with all the attributes gained the highest accuracy (0.962581), and the top 20 attributes were enough to gain 0.96129 accuracy by StackDPP, which was close to the performance of the dataset with all the attributes. In addition, risk factors were analyzed in this study to reveal the most significant risk factors that are responsible for depression among physicians. The findings of the study indicate that the proposed model is highly capable of predicting the level of depression, along with finding the most significant risk factors. The study will enable mental health professionals and psychiatrists to decide on treatment and therapy for physicians by analyzing the depression level and finding the most significant risk factors.

Suicide among health professionals in Australia: A retrospective mortality study of trends over the last two decades

OBJECTIVE

To examine the relative risk of suicide among healthcare professionals compared to other occupations and examine changes in suicide rates over time.

METHODS

Suicide cases were identified using the National Coronial Information System and were included if they were recorded as a death by intentional self-harm between 2001 and 2017 and were by an employed adult aged 20-69 with a known occupation at the time of death. Suicide methods were reported descriptively. Workforce data at the population level was extracted from the Australian Bureau of Statistics 2011 Census. Age-standardised suicide rates per 100,000 person-years for each of the four occupational groups were calculated using direct standardisation and using the Australian Bureau of Statistics population-level data from the 2011 Census. Negative binomial regression was used to estimate suicide risk by healthcare employment status and profession, to investigate differences by sex and to examine trends in suicide rates over time, using rate ratios and 95% confidence intervals.

RESULTS

Healthcare professionals were at increased risk of suicide compared to other occupations (rate ratio = 1.30, 95% confidence interval = [1.19, 1.42], p < 0.001), controlling for age, sex and year of death. Nurses and midwives were identified as being at significantly increased risk of suicide (rate ratio = 1.95, 95% confidence interval = [1.73, 2.19], p < 0.001). Suicide rates among female medical practitioners increased substantially over time (p = 0.01).

CONCLUSION

Health professionals are at significantly increased risk of suicide, though the relative risk of different groups is changing over time. There has been a substantial increase in the risk of suicide among female medical practitioners with rates of suicide in this group more than doubling over the last two decades. Findings highlight the need for targeted suicide prevention initiatives for healthcare professionals.

Depression and suicidal ideations in relation to occupational stress in a sample of Egyptian medical residents

INTRODUCTION

Medical students, interns, and residents have higher rates of depression than the general population, according to previous literature.

OBJECTIVE

The objectives of this paper were to determine the rate of depression and its severity in a group of Egyptian residents of Ain Shams University hospitals.

METHODS

This is a cross-sectional comparative study that took place in El-Demerdash Hospital from March 1, 2019 to September 1, 2020, with 220 Egyptian residents of Ain Shams University Hospitals participating.

RESULTS

The socioeconomic stress scale had a statistically significant relationship with depression scores (p value = .008) and suicide scores (p-value = .010), according to the findings. Additionally, there was a statistically significant relationship between suicide scores and depression scores (p-value = .001). The relationship between obstetrics and gynecology and high suicide risk was statistically significant (p value = .010), with obstetrics and gynecology having the highest percentage of high suicide risk (10 out of 19 residents, 52.63%), followed by pediatrics with 4 out of 11 residents (36.36%).

CONCLUSION

The pediatrics department had the highest percentage of residents who were depressed, while the obstetrics and gynecology department had the highest suicide risk. Feeling underpaid, disruption of home life, having insufficient time, being concerned about keeping skills up to date, and having a large volume of work were also found to be the most stressful aspects of residency.

Suicide and Self-Harm Among Physicians in Ontario, Canada

BACKGROUND

Studies of occupation-associated suicide suggest physicians may be at a higher risk of suicide compared to nonphysicians. We set out to assess the risk of suicide and self-harm among physicians and compare it to nonphysicians.

METHODS

We conducted a population-based, retrospective cohort study using registration data from the College of Physicians and Surgeons of Ontario from 1990 to 2016 with a follow-up to 2017, linked to Ontario health administrative databases. Using age- and sex-standardized rates and inverse probability-weighted, cause-specific hazards regression models, we compared rates of suicide, self-harm, and a composite of either event among all newly registered physicians to nonphysician controls.

RESULTS

Among 35,989 physicians and 6,585,197 nonphysicians, unadjusted suicide events (0.07% vs. 0.11%) and rates (9.44 vs. 11.55 per 100,000 person-years) were similar. Weighted analyses found a hazard ratio of 1.05 (95% confidence interval: 0.69 to 1.60). Self-harm requiring health care was lower among physicians (0.22% vs. 0.46%; hazard ratio: 0.65, 95% confidence interval: 0.52 to 0.82), as was the composite of suicide or self-harm (hazard ratio: 0.70, 95% confidence interval: 0.57 to 0.86). The composite of suicide or self-harm was associated with a history of a mood or anxiety disorder (odds ratio: 2.84, 95% confidence interval: 1.17 to 6.87), an outpatient mental health visit in the past year (odds ratio: 3.08, 95% confidence interval: 1.34 to 7.10) and psychiatry visit in the preceding year (odds ratio: 3.87, 95% confidence interval: 1.67 to 8.95).

INTERPRETATION

Physicians in Ontario are at a similar risk of suicide deaths and a lower risk of self-harm requiring health care relative to nonphysicians. Risk factors associated with suicide or self-harm may help inform prevention programs.

Suicide deaths among medical students, residents and physicians in India spanning a decade (2010-2019): An exploratory study using on line news portals and Google database

BACKGROUND

Despite having one of the world's largest medical education consortium, India lacks a comprehensive and nationally representative data on suicide deaths among medical students and physicians unlike the one found in most of the developed nations of the world.

AIM

We aimed to explore the different characteristics of suicide deaths among medical students, residents and physicians in India over a decade (2010-2019).

METHODS

Content analysis of all suicide death reports among medical students, residents and physicians available from online news portals and other publicly available sites was done. Search was done retrospectively using pertinent search words individually or in combination with language restricted to Hindi and English and timed from January 2010 to December 2019. Reports on completed suicide by allopathic medical students, residents and physicians from India were included. Socio-demographic and suicidological variables were analysed using R software.

RESULTS

A total of 358 suicide deaths among medical students (125), residents (105) and physicians (128) were reported between 2010 and 2019. Around 7 out of 10 suicides happened before the age of 30 and had mean age 29.9 (±12.2) years. Female residents and physicians were younger than their male counterparts at the time of suicide. Overall maximum suicide deaths were concentrated in South India except the state of Kerala. The specialty of anesthesiology (22.4%) followed by obstetrics-gynaecology (16.0%) had the highest suicide deaths. Violent suicide methods were more commonly used by all, with hanging being the most common mean of suicide. Academic stress among medical students (45.2%) and residents (23.1%), and marital discord among physicians (26.7%) were the most noticeable reasons for suicide. Mental health problems were the next most common reason in medical students (24%) and physicians (20%) while harassment (20.5%) was in residents. Twenty six percent had exhibited suicide warning signs and only 13% had ever sought psychiatric help before ending their lives. A total of nine reports of suicide pact were found with the average deaths per pact being 2.4 and predominantly driven by financial reasons.

CONCLUSION

Academic stress among medical students and residents, and marital discord in physicians emerged as the key reasons for suicide. However, this preventable domain should be further explored through focused research. This is the first of its kind study from India which attempted to explore this vital yet neglected public health issue using the most feasible and practical method of online news content-based analysis.

Suicide among physicians: Major risk for women physicians

INTRODUCTION

The risk of suicide is related to professional activity. Preliminary data suggest that being in the medical profession increases the risk of suicide in women. The objective of this nationwide study is to compare the death rate of physicians due to suicide with that of the general population and to assess the differences based on gender.

MATERIALS AND METHODS

All physicians and the general population who died by suicide in Spain between 2005 and 2014, both inclusive, were studied. Between these years, the Spanish population grew from 43,662,613 to 46,455,123 persons and from 199,123 to 238,240 number of doctors. The data relating to the deaths of physicians were extracted from the databases of the General Council of Official Medical Associations (CGCOM) and data related to the general population were obtained from the National Institute of Statistics (INE). The variables included in the analyses are gender, age, specialty, place of residence and death, and causes of death according to the ICD-10.

RESULTS

The annual mean of physician deaths was 918, with an annual crude rate of 4.8 per 1,000 registered physicians. It is confirmed that physicians have a significantly higher suicide rate (average of 1.3%) than the general population (average of 0.8%) (p = 0.003). The comparison of suicide between men and women doctors is significantly higher in women (X2= 53.068, p<0.001). In addition, if we separate by gender, female physicians have a suicide rate 7.5% higher than women from the general population, although the difference is not significant (X2 = 2.614, p = 0.107).

CONCLUSIONS

. Suicide is higher among physicians than the general population and affects female physicians significantly more.

Identifying Risk Factors for Self-reported Mental Health Problems in Psychiatry Trainees and Psychiatrists in Mexico

OBJECTIVE

The objective was to determine and compare demographic features, professional activities and adversities, physical health conditions, and self-care behaviors related to the most frequently self-reported mental health problems among psychiatrists and psychiatry trainees.

METHODS

A cross-sectional, retrospective, comparative study was conducted on a total of 330 (48.2%) psychiatry trainees and 355 (51.8%) psychiatrists from Mexico through an online survey. Demographic features, professional activities and adversities, physical and mental health problems, self-care behaviors, and social support were examined. Comparative analyses and multiple logistic regression models were performed.

RESULTS

Major depression, anxiety, and burnout were the most common mental health problems reported with a higher frequency of anxiety disorders in psychiatry trainees. Being a woman, having a physical health problem, and lack of restful sleep were the main risk factors in both groups. Consultation in the government sector and having patients with severe suicidal ideation affected more psychiatry trainees. Perceived discrimination and inadequate eating schedules were risk factors for mental health problems for psychiatrists.

CONCLUSION

Psychiatry trainees constitute a vulnerable group for anxiety disorders. Particular attention should be paid to how students cope with the training experience to determine whether additional support is required. These professionals face major stressors leading to a high prevalence of depression, burnout, and anxiety. Encouraging psychiatrists to have better health habits is a step in the right direction, which must be accompanied by tangible organizational avenues to do so and creating a culture that truly promotes self-care.

Propofol misuse in Ireland - Two case reports and a review of the literature

Propofol is a rapidly acting sedative drug, which is usually administered intravenously. It is widely used in procedural sedation due to its rapid onset and easy reversibility. It has a good safety profile when used in combination with ventilation and monitoring. However, propofol can bring on feelings of euphoria, sexual disinhibition, tension relief and hallucinations, creating a potential for abuse. At an international level, recreational propofol use among medical staff is a growing, yet under reported problem. In order to highlight this issue in an Irish context, the case reports described are among the first recorded deaths in Ireland due to unmonitored self-administration of propofol. The difficulties facing forensic pathologists in detecting propofol and its metabolites in these cases are outlined. The potential for propofol abuse should influence healthcare facilities to make their staff aware of the risks associated with it. This in turn would promote vigilance and encourage those affected to seek treatment.

Risk of mortality and suicide associated with substance use disorder among healthcare professionals: A systematic review and meta-analysis of observational studies

BACKGROUND

Previous studies have suggested that healthcare professionals may be susceptible to substance use disorders, and among the medical specialties, anaesthesia providers appear to be overrepresented.

OBJECTIVE

We aimed to compare the prevalence of substance use-related mortality and suicides between anaesthesia and nonanaesthesia professionals.

DESIGN

Systematic review of observational studies with meta-analyses. We defined anaesthesia providers as any healthcare professionals belonging to the specialty, regardless of age and duration of employment. Other healthcare professionals served as the control group.

DATA SOURCES

Ovid Medline, EMBASE, Web of Science, Scopus, Scielo, LILACS and ProQuest databases up to March 2020.

RESULTS

Thirty-nine studies were included, 31 cross-sectional studies involving 13 819 participants and eight cohorts with a total 129 811 participants proved eligible. Results suggested a higher rate of drug-related mortality with odds ratio (OR) 2.69 [95% confidence interval (CI), 1.80 to 4.00; P < 0.001; I2 = 0%, P = 0.55; high-certainty evidence] and suicide (OR 2.18, 95% CI, 1.33 to 3.58; P = 0.002; I2 = 0%, P = 0.68; moderate-certainty evidence) for anaesthesia providers compared with other healthcare professionals.

CONCLUSION

High-to-moderate-certainty evidence shows that there is more than a two-fold increased rate of substance use-related mortality and suicide among anaesthesia providers compared with other healthcare professionals. Investigations examining substance abuse between healthcare professionals, with particular attention to working conditions and exposure are essential to further develop preventive strategies.

Emotional exhaustion in cancer clinicians: A mixed methods exploration

Objectives: The aim of the current study was to explore the associations of emotional exhaustion in oncology clinicians and perceptions of doctors about their work–life balance in a developing country. Methods: The current study used quantitative semi-structured interviews and qualitative in-depth interviews to explore emotional exhaustion and burnout in doctors in a tertiary care cancer center. Sociodemographic details, Maslach Burnout Inventory, and Patient Health Questionnaire were used for the quantitative analysis. Results: Increased work pressure (adjusted odds ratio [AOR]: 5.39, 95% confidence interval [CI]: 2.01–14.47, P < 0.01), reduced job-related satisfaction (AOR: 3.56, 95% CI: 1.37–9.25, P < 0.01), being a woman (AOR: 3.4, 95% CI: 1.2–9.5, P < 0.01), and having higher anxiety and depression scores (AOR: 2.89, 95% CI: 1.11–7.46, P = 0.03) were independently associated with higher levels of emotional exhaustion. In the qualitative interviews, many doctors felt working in oncology a satisfying as well as stressful experience. Dealing with palliative and end-of-life situations and counseling patients and their family members about various treatment options contributed to the stress. Male and female clinicians viewed work–life balance differently. Female doctors charted a larger area of influence for which they felt responsible in work and life. Conclusion: Increased work pressure, reduced job satisfaction, and increased affective symptoms contribute to emotional exhaustion in oncology clinicians, and the risk increases especially in female doctors. Having gender-sensitive and employee-friendly policies will likely help in having a nurturing work environment.

Suicide in anaesthetists: a systematic review

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.

Suicide committed by a paramedic using a cocktail of drugs: Morphine, etomidate, diazepam and rocuronium. Case report and review of literature

Suicide is still an important issue in developed countries. The problem affects all age groups and both sexes, although usually more commonly middle-aged men. Attempted suicides committed by taking drugs ended in death are rare (regardless of gender, age, social group) except among health professionals who have easy access to medications and the knowledge of their use. This paper describes a case of a paramedic's suicide and discusses the literature on the issue of suicides in terms of statistics. The paramedic, who is the subject of this case story suffered from depression and alcohol dependence and committed suicide at work using the medicines available in the Medical Air Rescue service: morphine, diazepam, etomidate and rocuronium. Toxicological studies revealed that the man had also been taking sertraline, a commonly used antidepressant. The reasons for suicide among healthcare professionals are the same as for the general population; however, given the extremely high work-related stress and easy availability of drugs that can be effectively used to commit suicide, a special approach to the issue is necessary.

Depression and Suicidal Ideation in a Sample of Malaysian Healthcare Workers: A Preliminary Study During the COVID-19 Pandemic

Objective: The burden of suicidal behavior is anticipated to increase as a sequela of the COVID-19 pandemic. However, there is limited evidence on suicidal behavior among healthcare workers, an at-risk population. Our study aimed to investigate suicidal ideation in terms of the rate and associated factors in a sample of Malaysian healthcare workers during the early-phase of the COVID-19 pandemic. Methods: A subpopulation analysis (N = 171) was conducted within a larger, nation-wide cross-sectional study of Malaysian healthcare worker psychological distress from March 18-21, 2020. Current suicidal ideation was measured with item 9 of the Patient Health Questionnaire-9 (PHQ-9). The following independent variables were assessed: socio-demographic profile, occupation and service-related factors, health-anxiety (Health Anxiety Inventory, HAI), lifetime anxiety disorder and severity of depression (PHQ-9). Results: The proportion of healthcare workers with current suicidal ideation (19/171) and clinical depression (17/171) were 11.1 and 9.9%, respectively. Multivariable analysis showed that clinical depression was the most significant factor associated with current suicidal ideation (p < 0.001, OR = 55.983, 95% CI = 9.015-347.671) followed by mild (subthreshold) depression (p = 0.001, OR = 115.984, 95% CI = 2.977-85.804). Service duration of more than 10 years was associated with significantly less suicidal ideation (p = 0.049, OR = 0.072, 95% CI = 0.005-0.993). Conclusions: Depression (subthreshold and especially within the clinical range) and early-career status (<10 years in service) may be target areas of early intervention for reduction of suicidal ideation amongst healthcare workers who have served during the COVID-19 pandemic. Further research is warranted to elucidate specific occupational stressors related to COVID-19 work conditions to tailor appropriate suicide preventive strategies in this population.

Krankheitsängste bei Psychotherapeut_innen

Zusammenfassung. Hintergrund: Krankheitsängste beziehen sich meist auf die Angst vor dem Leiden an somatischen Erkrankungen. In Einzelfallberichten wurden auch Ängste vor psychischen Störungen berichtet, jedoch bisher nicht systematisch untersucht. Psychotherapeut_innen sind ständig mit psychischen Erkrankungen konfrontiert. Fragestellung: Diese Studie untersucht, wie stark Krankheitsängste bei Psychotherapeut_innen ausgeprägt sind und welche Faktoren diese beeinflussen. Methoden: Insgesamt 239 Psychotherapeut_innen wurden per anonymer Onlinebefragung mit den Illness Attitude Scales und der Mini-Symptom-Checklist untersucht. Ergebnisse: Krankheitsängste bei Psychotherapeut_innen waren geringer ausgeprägt als in der Allgemeinbevölkerung und bei Psychologiestudierenden. Faktoren wie die allgemeine psychische Belastung und das Vorhandensein tatsächlicher Diagnosen gingen mit erhöhten Krankheitsängsten einher. Schlussfolgerungen: Krankheitsängste können sich nicht nur auf somatische Erkrankungen beziehen, sondern auch psychische Störungen betreffen. Eine stärkere Berücksichtigung psychischer Krankheitsängste und deren weitere systematische Erfassung erscheinen daher wünschenswert.

"Doing" healthcare at end-of-life: Identity tensions, negotiations, and conflicts

Observing how healthcare providers deal with death and dying, in terms of "doing" identity, allows us to explore how they cope with patient end-of-life (EOL) and highlights how the professional identity breaks down while managing patient death and dying. We conducted a digital ethnography of a publicly-accessible online forum for healthcare professionals. Providers' personal experiences with patient death and dying were interpreted through internalized values associated with their professional identity, which when dealing with EOL are challenged and must be negotiated. Training and support are needed to better equip providers with the skills and tools needed at EOL.

Part-time work and other occupational risk factors for suicide among working women in the Swiss National Cohort

Objective

The aim of this study was to describe the factors associated with mortality by suicide among working women focusing on work-related factors.

Methods

The study population consisted in all Swiss residents recorded in the 1990 and/or the 2000 compulsory national censuses and were linked to emigration and mortality registers. We selected all women aged 18–65 and at work at the official census dates. Following work-related variables were available: socio-economic status, weekly hours of work, the sector of activity and the job title coded according to the International Standard Classification of Occupations (ISCO). The risk of suicide was modelled using negative binomial regression.

Results

The cohort comprised 1,771,940 women and 2526 deaths by suicide corresponding to 24.9 million person-years. The most significant non-occupational predictors of suicide were age, period, civil status, religion, nationality and geographical regions. Adjusted on these factors, part-time work was associated with increased suicide rates. According to job codes, health and social activities, in particular care-worker had the highest suicide risks.

Conclusion

Suicide among working women depended on work-related factors even taking into account other socio-demographic factors.

Suicide deaths among diagnostic medical radiation workers in South Korea, 1996–2017

Objectives

Suicide is a leading cause of death in the working-age population. We investigated suicide mortality among diagnostic medical radiation workers in relation to their demographic and occupational factors in South Korea.

Methods

The study population consisted of all diagnostic medical radiation workers enrolled in the National Dosimetry Registry from 1996 to 2011. The registry data were linked with mortality data through the end of 2017. We calculated age-standardised suicide rates, standardised mortality ratios (SMRs) and rate ratios (RRs) by demographic and occupational factors.

Results

A total of 207 suicides were identified among 94 367 medical radiation workers, exhibiting a suicide rate of 14.0 per 100 000 person-years. Compared with the general population, suicide rates were lower for both male and female workers (SMR 0.49, 95% confidence interval (CI) 0.42 to 0.57; SMR 0.54, 95% CI 0.41 to 0.70, respectively). Similarly, decreased SMRs were observed across job titles and other work-related factors. However, a shorter duration of employment was positively associated with RRs for suicide; risks were 2.74 (95% CI 1.56 to 4.81) and 4.66 (95% CI 1.53 to 14.20) times higher in male and female workers with less than 1 year of employment, respectively, than in those with at least 10 years of employment.

Conclusions

Diagnostic medical radiation workers in South Korea showed lower suicide rates than in the general population. However, a shorter duration of employment was associated with higher risk of suicide. Suicide prevention efforts could target workers engaged in short-term employment.

Are Groote Schuur Hospital anaesthesiologists burnt out? A cross-sectional study of prevalence and risk

Background: Burnout and physician wellness are becoming increasingly topical. While some surveys have been performed with South African anaesthesiologists, these have been conducted in limited samples. While burnout is often measured, there is a paucity of research on contributory risk and protective factors. Method: A contextual, prospective, cross-sectional study was conducted. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Areas of Worklife Survey (AWS) were used to assess burnout and contributory organisational risk factors amongst state-employed anaesthesiologists working at Groote Schuur Hospital. Results: Out of a possible 127 members of staff (medical officers, registrars and consultants), 81 responded with 75 completing the full survey (59% response rate). Only 4% of respondents were classified as “burnt out”, defined as scoring high in all three domains of burnout: high emotional exhaustion and depersonalisation and low personal accomplishment. However, 67% of respondents scored high for at least one of the components of burnout, indicating the majority of the respondents are at risk for developing clinically significant burnout. The AWS showed that respondents found their workload inappropriate. However, responses for the categories of control, reward, community, fairness and values were all in the acceptable range. Conclusion: While the overall rate of burnout was low, the majority of respondents were at risk for developing burnout. High perceived workload appeared to be a particular contributory factor. Protection against burnout in this group may be provided by a combination of few organisational risk factors together with feelings of personal accomplishment.

Male and Female Physician Suicidality: A Systematic Review and Meta-analysis

IMPORTANCE

Population-based findings on physician suicide are of great relevance because this is an important and understudied topic.

OBJECTIVE

To evaluate male and female physician suicide risks compared with the general population from 1980 to date and test whether there is a reduction of SMR in cohorts after 1980 compared with before 1980 via a meta-analysis, modeling studies, and a systematic review emphasizing physician suicide risk factors.

DATA SOURCES

This study uses studies retrieved from PubMed, Scielo, PsycINFO, and Lilacs for human studies published by October 3, 2019, using the search term "(((suicide) OR (self-harm) OR (suicidality)) AND ((physicians) OR (doctors)))." Databases were also searched from countries listed in articles selected for review. Data were also extracted from an existing article by other authors to facilitate comparisons of the pre-1980 suicide rate with the post-1980 changes.

STUDY SELECTION

Original articles assessing male and/or female physician suicide were included; for the meta-analysis, only cohorts from 1980 to the present were included.

DATA EXTRACTION AND SYNTHESIS

The preregistered systematic review and meta-analysis followed Cochrane, PRISMA, and MOOSE guidelines. Data were extracted into standardized tables per a prespecified structured checklist, and quality scores were added. Heterogeneity was tested via Q test, I2, and τ2. For pooled effect estimates, we used random-effects models. The Begg and Egger tests, sensitivity analyses, and meta-regression were performed. Proportional mortality ratios were presented when SMR data could not be extracted.

MAIN OUTCOMES AND MEASURES

Suicide SMRs for male and female physicians from 1980 to the present and changes over time (before and after 1980).

RESULTS

Of 7877 search results, 32 articles were included in the systematic review and 9 articles and data sets in the meta-analysis. Meta-analysis showed a significantly higher suicide SMR in female physicians compared with women in general (1.46 [95% CI, 1.02-1.91]) and a significantly lower suicide SMR in male physicians compared with men in general (0.67 [95% CI, 0.55-0.79]). Male and female physician SMRs significantly decreased after 1980 vs before 1980 (male physicians: SMR, -0.84 [95% CI, -1.26 to -0.42]; P < .001; female physicians: SMR, -1.96 [95% CI, -3.09 to -0.84]; P = .002). No evidence of publication bias was found.

CONCLUSIONS AND RELEVANCE

In this study, suicide SMR was found to be high in female physicians and low in male physicians since 1980 but also to have decreased over time in both groups. Physician suicides are multifactorial, and further research into these factors is critical.

Provider burnout: Implications for our perinatal patients

OBJECTIVE

To describe the syndrome of physician burnout within neonatology, its relation to neonatal quality of care, and outline potential solutions.

FINDINGS

Burnout affects up to half of physicians, including up to one-third of neonatologists, at any given time. It is linked to suicidality, substance abuse, and intent to leave practice, and it is strongly associated with reduced quality of care in the published literature. Resilience and mindfulness interventions rooted in positive psychology may reduce burnout among individual providers. Because burnout is largely driven by organizational factors, system-level attention to leadership, teamwork, and practice efficiency can reduce burnout at the level of the organization.

CONCLUSIONS

Burnout is common among neonatologists and consistently relates to decreased quality of patient care in a variety of dimensions. Personal resilience training and system-wide organizational interventions are needed to reverse burnout and promote high-quality neonatal care.

Physician, heal thyself: a cross-sectional survey of doctors' personal prescribing habits

BACKGROUND

Self-prescribing and prescribing to personal contacts is explicitly discouraged by General Medical Council guidelines.

AIMS

This study examines how widespread the practice of self-prescribing and prescribing to personal contacts is.

METHODS

A 16-item questionnaire was distributed via an online forum comprising 4445 young medical doctors (representing 20% of all Irish registered doctors), which asked respondents about previous prescribing to themselves, their families, friends and colleagues, including the class of medication prescribed. Demographic details were collected including medical grade and specialty.

RESULTS

A total of 729 responses were obtained, the majority of which were from young non-consultant hospital doctors from a range of specialties. Two-thirds of respondents had self-prescribed, over 70% had prescribed to family, and nearly 60% had prescribed to a friend or colleague. Older doctors were more likely to self-prescribe (χ²=17.51, p<0.001). Interns being less likely to self-prescribe was not unexpected (χ²=69.55, p<0.001), while general practitioners (GPs) and paediatricians were more likely to self-prescribe (χ²=13.33, p<0.001; χ²=11.35, p<0.001). GPs, paediatricians and hospital medicine specialties were more likely to prescribe to family (χ²=5.19, p<0.05; χ²=8.38, p<0.05; χ²=6.17, p<0.05) and surgeons were more likely to prescribe to friends (χ²=15.87, p<0.001). Some 3% to 7% who had self-prescribed had prescribed an opiate, benzodiazepine or psychotropic medication. Male doctors, anaesthetists and surgeons were more likely to self-prescribe opioids (χ²=7.82, p<0.01; χ²=7.31, p<0.01; χ²=4.91, p<0.05), while those in hospital medicine were more likely to self-prescribe psychotropic medications (χ²=5.47, p<0.05).

CONCLUSION

Prescribing outside the traditional doctor-patient relationship is widespread despite clear professional guidance advising against it.

The prevalence, determinants and the role of empathy and religious or spiritual beliefs on job stress, job satisfaction, coping, burnout, and mental health in medical and surgical faculty of a teaching hospital: A cross-sectional survey

OBJECTIVE

Systematically ascertained data on job stress and burnout and their antecedents and mediators in health professionals from low- and middle-income countries are scant.

METHODS

This cross sectional survey, conducted from July 2007 to August 2008, of consenting medical and surgical faculty of a large, charitable, teaching hospital aimed to evaluate: 1) the prevalence and sources of job stress and job satisfaction, and the ways used to cope with stress; 2) the prevalence of burnout and mental distress; and 3) the influence of age, gender, empathy and religious or spiritual beliefs on job stress, satisfaction, mental health and burnout.

RESULTS

Of 345 respondents, high job stress on the Physician Stress and Satisfaction questionnaire were reported by 23%. However, 98% of faculty reported high levels of job satisfaction with deriving intellectual stimulation from teaching and a high level of responsibility identified as important contributory sources. Significantly more respondents aged<45 years compared to older faculty achieved moderate or high scores on Emotional Exhaustion and Depersonalization. General Health Questionnaire-12 scores suggested psychiatric morbidity in 21%, particularly in younger faculty. High job stress was associated with high scores for Emotional Exhaustion and Depersonalization. High scores on the Jefferson Scale of Physician Empathy correlated with high scores of Emotional Exhaustion. Religious or spiritual beliefs strongly influencing attitudes to work were significantly associated with high levels of Personal Accomplishment.

CONCLUSIONS

This study provides data that will inform the design and implementation of interventions to reduce job stress and burnout and improve retention of faculty.

Toward fostering resilience on a large scale: Connecting communities of caregivers

In interventions for at-risk children, Tom Dishion strongly exhorted programs that are short term, cost-effective, and delivered in families' own communities, just as resilience researchers underscore the need for programs that provide ongoing support for children's primary caregivers, and are implementable on a large scale. Presented here are preliminary results on a short-term intervention for mothers, the Authentic Connections Virtual Groups. A previous randomized trial of the in-person version of this program, conducted with mothers at high risk for stress and burnout, showed significant benefits. There had been zero dropouts across the 3-month program, and participants showed significant improvements on psychological indices as well as cortisol, even 3 months after the program ended. In the present study, virtual groups were conducted with five sets of women, all white-collar professionals with highly stressful, exacting careers, and most also primary caregivers of their children. Again, there were zero dropouts. Mean satisfaction ratings were 9.6 of 10, and the Net Promoter Score (promoters vs. detractors) fell in the "world class" range. To illuminate mechanisms of change, participants' responses to open-ended questions on the groups' value are presented verbatim. Recurrently mentioned were the development of new, authentic connections and invaluable ongoing support. These results, with the low costs and ease of women's attendance, attest to the value of expanding offerings such as these, toward benefiting even more highly stressed mothers themselves as well as the children for whose care they are responsible.

Professional Adversities and Protective Factors Associated with Suicidal Ideation in Mexican Psychiatrists

BACKGROUND

Psychiatrists may be at an increased risk of suicide, since they encounter stressful factors in their everyday activities in addition to the sociodemographic factors for suicidal ideation reported for Mexican population.

AIM OF THE STUDY

To determine whether experiences inherent to the profession were related to the self-report of suicidal ideation among Mexican psychiatrists or could be attributed to factors previously reported in the general population (age, marital status, presence of a mental disorder and not having received specialized treatment).

METHODS

This was a cross-sectional retrospective study with 288 psychiatrists from Mexico who participated through an online survey where current working activities, self-reported mental health conditions (major depression, anxiety, burnout and suicidal ideation) and professional adversities (assaults, lawsuits, patients with suicidal ideation or who had committed suicide, perceived discrimination and social support) throughout the professional lifespan were evaluated.

RESULTS

Twenty-two psychiatrists (7.6%) reported having had suicidal ideation at some point in their training in psychiatry or their professional lives as psychiatrists. Depression and burnout were the most important predictors for suicidal ideation while greater satisfaction with social support was the most important protector, followed by being married/living together and having other physicians in the family.

CONCLUSIONS

Psychiatrist represent a risk population for suicidal ideation. As such, detection and attention are essential. Psychiatrists need to be encouraged to pursue healthy, lasting interpersonal relationships and seek professional help when required.

Changes in Working Conditions and Mental Health Among Intensive Care Physicians Across a Decade

Background: International studies have shown that among physicians working in intensive care, a relatively high level of work load, an elevated risk of developing burnout and reduced mental health are frequent. The implementation of a legislative intervention in Germany with the goal to reduce the working hours of physicians, offered an opportunity to investigate the potential influence of occupational conditions on stress and mental health. The present study investigates working conditions, occupational stress and burnout risk in two samples of German Intensive Care Physicians in 2006 and 2016. The aim was to assess how occupational and private stress factors influenced burnout and Effort-Reward-Imbalance indices over this time-period. Methods: Intensive care physicians were surveyed during the annual conference of their profession in two cross-sectional studies (10-year gap). Data on demographic (occupational, family), medical history, and mental health (burnout and Effort-Reward-Imbalance) were assessed by paper pencil questionnaires. Results: In total, N = 2,085 physicians participated (2006: N = 1,403, 2016: N = 695), with N = 1,840 (2006 = 1,248; 2016 = 592) eligible for propensity score matching comparison. In general, more working hours per week and working days on weekends were associated with an increased effort/reward imbalance and higher burnout scores. From 2006 to 2016, reductions in working hours per week and days worked on weekends were accompanied by improvements in occupational stress (Effort-Reward-Imbalance) and by trend in mental health indices (burnout) after matching for differences in working conditions. Conclusions: The study presents the changes concerning occupational stress factors and mental wellbeing in physicians working in intensive care in 2016 as compared to 2006. These findings may promote the implementation of preventive strategies in the vocational context to protect health and productivity of physicians, especially intensive care physicians.

Suicide among physicians and health-care workers: A systematic review and meta-analysis

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.

Update on Addressing Mental Health and Burnout in Physicians: What Is the Role for Psychiatry?

PURPOSE OF REVIEW

To highlight an emerging understanding of burnout and physician mental health. This review will provide a discussion of conceptual and diagnostic issues of the burnout syndrome with its relevance to psychiatry, and how psychiatry may interface with other medical disciplines to provide support in creating burnout prevention and treatment programs.

RECENT FINDINGS

Descriptive data of burnout correlations and risk factors are available while an understanding of burnout best practices is lacking but growing. Two recent meta-analyses provide efficacy data along with key subgroup analyses that point to greater efficacy among systemic/organizational over individual level interventions. Among individual interventions, groups work better than individual therapy and the incorporation of Mindfulness-Based Stress Reduction and/or Cognitive Behavioral Therapy modalities provide greater efficacy over other therapies. Ultimately, addressing burnout will be an iterative process specific to institutional cultures and therefore should be thought of as quality improvement initiatives involving leadership to adopt the quadruple aim of physician wellness and to seek institution-specific collaboration and feedback. Psychiatry is uniquely positioned to help change institutional cultures regarding the burnout syndrome, which has been labeled a national crisis. Combinatorial strategies that combine efficacious individual-level interventions with systemic-level interventions that enhance workflow will likely provide the most sustainable model for preventing and treating burnout. Psychiatry should be involved, especially at the level of the liaison psychiatrist to assist with how these types of interventions may be best implemented in specific institutions.

Gender differences among medical students, house staff, and faculty physicians at high risk for suicide: A HEAR report

BACKGROUND

In comparison with the general population, physicians, and physicians-in-training are at greater risk for suicide. Although key gender differences in suicide risk factors and behaviors have been identified in the general population, the extent to which these differences apply to physicians and physicians-in-training is unclear. Here, we aimed to identify gender differences in risk factors, clinical presentation, and help-seeking behaviors of medical students, house staff, and physician faculty at high risk for suicide.

METHODS

We explored gender differences among 450 physicians and trainees meeting criteria for high suicide risk on anonymous online questionnaires completed between 2009 and 2017.

RESULTS

High-risk female trainees and physicians had higher mean Patient Health Questionnaire-9 (PHQ-9) scores compared with the males (11.1, standard deviation [SD] 5.1 vs. 9.8, SD 4.7) and were more likely to endorse feeling worried (73.8% vs. 61.2%), irritable (60.4% vs. 49.4%), and stressed (79.6% vs. 70%). High-risk male trainees and physicians were more likely than females to endorse suicidal thoughts (31.2% vs. 22.1%), intense anger (24.3% vs. 16.1%), drinking too much (31.2% vs. 22.3%), and recreational drug or prescription medication use without clinically appropriate follow-up (9.4% vs. 4.3%). There were no gender differences in help-seeking behaviors.

CONCLUSIONS

This is the first study to report gender differences among risk factors, presentation, and help-seeking behaviors of physicians, and trainees at high risk for suicide. Our findings are mostly consistent with those of the general population and show that only a minority of at-risk men and women in healthcare sought treatment, highlighting the importance of intervention and suicide prevention in this population.

Psychiatrist burnout: a meta-analysis of Maslach Burnout Inventory means

BACKGROUND

Doctors are known to have poor mental health compared with the general population. Psychiatrists are exposed to a number of unique stressors that may increase the risk of poor mental health. The aim of this study was to undertake a meta-analysis of burnout rates in psychiatrists.

METHODS

Electronic databases (including MEDLINE, PsycINFO and Embase) were searched. Only studies published since 1999 and using the 22-item Maslach Burnout Inventory were included in the analysis. A meta-analysis was conducted using the Comprehensive Meta-Analysis software.

RESULTS

A total of 11 studies, across nine publications, were included in the final analysis. Studies were significantly heterogenous but there was no indication of publication bias. The pooled mean for emotional exhaustion was 22.03 (95% confidence interval (CI): 19.71-24.34, tau = 3.74). For depersonalisation, the pooled mean was 7.41 (95% CI: 5.91-8.90, tau = 2.45). The pooled mean for personal accomplishment was 30.00 (95% CI: 24.75-35.27, tau = 8.87).

CONCLUSIONS

The high level of psychiatrist emotional exhaustion is a significant concern. Further research is needed to consider the role of modifiable risk factors in the aetiology of psychiatrist burnout.

Prevalence and relationship between burnout and depression in our future doctors: a cross-sectional study in a cohort of preclinical and clinical medical students in Ireland

OBJECTIVES

This cross-sectional study was designed to measure burnout and its impact on risk of depression in a medical student population, comparing the preclinical and clinical years.

DESIGN

We conducted a survey of 269 medical school students in both preclinical and clinical years at the Royal College of Surgeons in Ireland, using the Beck Depression Inventory-Fast Screen (BDI-FS), the Maslach Burnout Inventory-Student Survey and items assessing willingness to use mental health services. Burnout scores were calibrated to probability of depression caseness and classified as low risk (<25%), intermediate (25%-50%) and high risk (>50%) of depression.

RESULTS

There was a 39% (95% CI 33% to 45%) prevalence of depressive caseness based on a score of ≥6 on the BDI-FS. Prevalence did not vary significantly between clinical and preclinical years. The rate of burnout varied significantly between years (p=0.032), with 35% in the high-burnout category in clinical years compared with 26% in preclinical years. Those in the low burnout category had a 13% overall prevalence of depressive symptoms, those in the intermediate category had a 38% prevalence and those in the high category had a 66% prevalence of depressive symptoms. Increasing emotional exhaustion (OR for one-tertile increase in score 2.0, p=0.011) and decreasing academic efficacy (OR 2.1, p=0.007) increased the odds of being unwilling to seek help for mental health problems (11%).

CONCLUSION

While previous studies have reported significant levels of burnout and depression, our method of calibrating burnout against depression allows burnout scores to be interpreted in terms of their impact on mental health. The high prevalences, in line with previous research, point to an urgent need to rethink the psychological pressures of health professions education.