PSI Tutor:Mentor

What implications are the gaps in knowledge about physician suicide rates, using a social psychological perspective

• Physicians’ suicide rates have repeatedly been reported to be higher than those of the general population or other academics, but uncertainty remains (Schernhammer & Colditz, 2004). Residents are at a higher risk than the general population for the development of stress-related problems, depression, or suicide (Broquet et al., 2004).
• Age, gender, seniority, time period and specialty are common factors looked at.
• There is an increased risk of suicide in female doctors, but male doctors seem to be at less risk than men in the general population (Hawton, Clementsa, Sakarovitchb, Simkina, & Deeks, 2001). Studies on physicians‘ suicide collectively show modestly (men) to highly (women) elevated suicide rate ratios. Larger studies should help clarify whether female physicians’ suicide rate is truly elevated or can be explained by publication bias (Schernhammer & Colditz, 2004).
• Appears to focus on gender so there are gaps in looking at other psycho-social factors; support networks, family and community connectedness; economic pressures; occupational pressures, e.g., bullying, sexual harassment, trauma
• UK, USA, Canada,  Australia and Northern Europe; what about in developing nations, crisis areas?
• The culture of medicine accords low priority to physician mental health despite evidence of untreated mood disorders and an increased burden of suicide. Barriers to physicians’ seeking help are often punitive, including discrimination in medical licensing, hospital privileges, and professional advancement (Cenre et al., 2003).

what suggestions are there on improving policy, program components and best practice

• The excess risk of suicide in female doctors highlights the need to tackle stress and mental health problems in doctors more effectively. The risk requires particular monitoring in the light of the very large increase in the numbers of women entering medicine (Hawton et al., 2001)
• Qualitative study using in-depth interviews with family physician peers (Jensen, et al., 2008). Four main aspects of physician resilience were identified: 1) attitudes and perspectives, which include valuing the physician role, maintaining interest, developing self-awareness, and accepting personal limitations; 2) balance and prioritization, which include setting limits, taking effective approaches to continuing professional development, and honouring the self;3) practice management style, which includes sound business management, having good staff, and using effective practice arrangements; and 4) supportive relations, which include positive personal relationships, effective professional relationships, and good communication.
• A curriculum for educating PGY-1s and residency program directors about physician impairment (Broquet, 2004). A resident wellness program established with the goals of preventing resident suicide, encouraging acceptance of treatment where appropriate, preventing self-prescribing, and aiding in stress management. Institutional support is necessary for effectively addressing these concerns with trainees.
• To encourage treatment of depression and prevention of suicide in physicians by calling for a shift in professional attitudes and institutional policies to support physicians seeking help (Centre et al., 2003).

what are the possible theories and models that can be applied to this

• Despite the large number of empirical studies available in the literature, there is no attempt in modelling the dynamics of an individual’s level of suicide risk theoretically yet (Lo & Kwok, 2006). In particular, a dynamic model which can simulate the time evolution of an individual’s level of risk for suicide and provide quantitative estimates of the probability of suicide risk is still lacking.
• In particular, depression, both unipolar and bipolar, is associated with the greatest suicidal risk. Among the components of depression, the cognitive component, which has been called pessimism and hopelessness by Beck and his colleagues (1979), is a more powerful predictor than the somatic components of depression (such as loss of appetite) or the mood symptoms (such as guilt).
• Suicidal individuals are found to have few resources, and the resources that they have are often unavailable (Lester 2000). For example, the people available to turn to for help may be resented by the suicidal person, or the resources may be hostile toward the suicidal person.
• Physiological and psychological theories of psychiatric disorder stress the role of the parents, either in passing on the genes for the disorder (in physiological theories) or in creating a pathological home environment (in psychological theories) (Maris, Berman, & Silverman, 2000). Family members are often the cause of much of the stress that suicidal individuals experience, and they are the resources that may be unavailable to the suicidal individual.
• Sociological theories of suicide attempt to explain the suicide rates of cultures or regions. They have focused on the role of social disorganization (social integration and social regulation in Durkheim’s theory, 1897) or in the opportunity to blame others for one’s misfortunes rather than oneself (Henry & Short, 1954). For example, African Americans have been oppressed by the racism in U.S. society and so have a clear source of blame for their misery, whereas white Euro Americans have been the oppressors. African Americans have higher murder rates whereas whites have higher suicide rates, in line with this argument.

References

Beck, A., Mintz, J., Obrien, C., & Woody, G. (1979). Depression in treated narcotic addicts, ex-

addicts, non-addicts, and suicide attempters – Validation of a very brief depression scale.

American Journal of Drug and Alcohol Abuse, 6(4), 385-396.

Durkheim, E. (1897). Suicide. New York: The Free Press reprint 1997.

Henry, A., & Short, J. (1954). Suicide and homicide. New York: Free Press.

Lester, D. (2000). Why People Kill Themselves: A 2000 summary of research on suicide (4^th ed.)

London: Charles C Thomas Pub Ltd.

Maris, R. W., Berman, A., & Silverman, M. M. (Eds.). (2000). Comprehensive textbook of

suicidology. New York: Guilford Press.

http://jech.bmj.com/cgi/content/abstract/55/5/296http://jech.bmj.com/cgi/content/abstract/55/5/296

http://www.cfp.ca/cgi/content/abstract/54/5/722

http://ajp.psychiatryonline.org/cgi/content/abstract/161/12/2295

http://ap.psychiatryonline.org/cgi/content/abstract/28/3/221

http://jama.ama-assn.org/cgi/content/abstract/289/23/3161

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHX-4JSMV8N-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=063f18bfe72a0487bbee7c9adf51a69f

[http://www.realoptions.org/papers2004/LoKwokSuicide.pdf  may be an interesting read tho relates to elderly rather than physicians per se]

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