Policy Playbook: Physician Suicide Awareness
- Sep 17th, 2020
- Summer Chavez
Author: Summer Chavez, DO, MPH, MPM (Health Policy Fellow, Georgetown University/Medstar) // Reviewed by: Alex Koyfman, MD (@EMHighAK); and Brit Long, MD (@long_brit)
What is the issue?
Although the entire month of September is recognized as National Suicide Prevention Month, September 17th is acknowledged National Physician Suicide Awareness Day.1,2 This event is collectively recognized by both emergency medicine affiliated professional societies including Society of Academic Emergency Medicine (SAEM), American College of Emergency Physicians (ACEP) and Council of Residency Directors in Emergency Medicine (CORD) as well as broader interest groups including the American College of Physicians (ACP) and American Medical Women’s Association (AMWA).2–4 Compared to the general population, physicians have a higher rate of suicide—1.41 times higher for males and 2.27 times for females.5 Other estimates report the rate of physician death due to suicide is twice as much compared to the rest of society.6 Recent studies on the effect of COVID-19 on healthcare workers show at least 20% of healthcare providers report symptoms of anxiety or depression and close to 40% reported sleeping difficulties.7Sadly, attention was called to physician suicide and mental health by the death of Dr. Lorna Breen, an emergency medicine physician in New York.8
Why does this matter?
Although physicians dedicate their lives to treating others, one prior study concluded 35% of physicians surveyed had no regular source of medical care with a more recent study of only female physicians determining close to half thought they met criteria to be diagnosed with a mental health condition but were not seeking treatment.9,10 In the second study, only 6% of respondents had disclosed treatment or diagnosis of a mental health condition, with stigmatization and fear, especially with regards to licensing as barriers.10,11
Higher rates of mental illness and lower rates of treatment compared to the general population have been found in both undergraduate and graduate medical education.11 A study of resident concluded most suicides occurred in the first or second year of training and in either July-September and January-March.12 Furthermore, suicide was the primary cause of death for male residents and second-most for female residents.12 Maximizing physician wellness, reducing stigma about psychiatric illness and increasing willingness to seek treatment are all things that should be prioritized at every level of our careers.
What can I do about it?
Multiple bills have been introduced in Congress specifically addressing healthcare providers including:
- Lorna Breen Health Care Provider Protection Act (S.B. 4349)
- The Helping Emergency Responders Overcome (HERO) Act of 2019 (H.R. 1646)
- The Coronavirus Health Care Worker Wellness Act (H.R. 7255).13–16
Write or call your representatives and let them know you support these bills.
Dozens of professional medical organizations have signed a joint statement with recommendations to support the mental health of healthcare providers and recognize the increased strain due to the COVID-19 pandemic.17 In May of this year, the Joint Commission released a statement of their own, remarking “The Joint Commission does not require organizations to ask about a clinician’s history of mental health conditions or treatment. We strongly encourage organizations to not ask about past history of mental health conditions or treatment…. The Joint Commission supports the removal of any barriers that inhibit clinicians and health care staff from accessing mental health care services, including eliminating policies that reinforce stigma and fear about the professional consequences of seeking mental health treatment.”18 We are starting to see a greater awareness and organized effort to improve physician mental health. Continue to support these organizations and look for opportunities to advance these objectives.
If you or someone you know needs someone to talk to, call the National Suicide Prevention Lifeline at 800-273-8255 or text TALK to 741741 for the Crisis Text Line.19,20 These resources are available 24/7. If someone is suicidal, please call 911 and do not leave them alone.21
We have a difficult job. It’s more uncommon than not to go a shift without eating, drinking or removing our masks. The social isolation and increased pressure doesn’t make it easier. We don’t have to go through this alone. On September 17th, be part of the AMWA #Light4Docs and CORD #NPSAday campaign and light a candle to raise awareness.22
Helpful Resources & Links:
- ALiEM: The Case of the Resident At Risk
- American Foundation for Suicide Prevention
- Foundations of Emergency Medicine Group Discussion Guide
- CORD Curated Podcasts & Videos
- National Academy of Sciences: A Call to Action to Break the Culture of Silence
- Suicide Prevention Hotline. Promote National Suicide Prevention Month. Promote National Suicide Prevention Month. Accessed September 12, 2020. https://suicidepreventionlifeline.org/promote-national-suicide-prevention-month/
- Physician Suicide Awareness Day. Council of Residency Directors in Emergency Medicine. Accessed September 12, 2020. https://www.cordem.org/npsa
- September 17 – The First National Physician Suicide Awareness Day. American Medical Women’s Association. Published September 11, 2018. Accessed September 12, 2020. https://www.amwa-doc.org/
- ACP supports National Physician Suicide Awareness Day on Sept. 17. ACP Internist. Published September 10, 2019. Accessed September 12, 2020. https://acpinternist.org/weekly/archives/2019/09/10/5.htm
- Schernhammer ES, Colditz GA. Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis). Am J Psychiatry. 2004;161(12):2295-2302. doi:10.1176/appi.ajp.161.12.2295
- Council of Emergency Medicine Residency Program Directors. Fast Facts. National Physician Suicide Awareness Day. Accessed September 12, 2020. https://www.cordem.org/globalassets/files/npsa/npsa-files/npsa-2020-fast-facts.pdf
- Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun. 2020;88:901-907. doi:10.1016/j.bbi.2020.05.026
- After Dr. Lorna Breen Died By Suicide in April, Her Family Took Up a Cause They Never Wanted. ACEP Now. Accessed September 12, 2020. https://www.acepnow.com/article/after-dr-lorna-breen-died-by-suicide-in-april-her-family-took-up-a-cause-they-never-wanted/
- Gross CP, Mead LA, Ford DE, Klag MJ. Physician, heal Thyself? Regular source of care and use of preventive health services among physicians. Arch Intern Med. 2000;160(21):3209-3214. doi:10.1001/archinte.160.21.3209
- Gold KJ, Andrew LB, Goldman EB, Schwenk TL. “I would never want to have a mental health diagnosis on my record”: A survey of female physicians on mental health diagnosis, treatment, and reporting. Gen Hosp Psychiatry. 2016;43:51-57. doi:10.1016/j.genhosppsych.2016.09.004
- Mehta SS, Edwards ML. Suffering in Silence: Mental Health Stigma and Physicians’ Licensing Fears. Am J Psychiatry Resid J. 2018;13(11):2-4. doi:10.1176/appi.ajp-rj.2018.131101
- Yaghmour NA, Brigham TP, Richter T, et al. Causes of Death of Residents in ACGME-Accredited Programs 2000 Through 2014: Implications for the Learning Environment. Acad Med. 2017;92(7):976–983. doi:10.1097/ACM.0000000000001736
- Dr. Lorna Breen Health Care Provider Protection Act Introduced in Senate. Accessed September 12, 2020. https://www.acep.org/corona/COVID-19-alert/covid-19-articles/dr.-lorna-breen-health-care-provider-protection-act-introduced-in-senate/
- Kaine T. S.4349 – 116th Congress (2019-2020): Dr. Lorna Breen Health Care Provider Protection Act. Published July 29, 2020. Accessed September 12, 2020. https://www.congress.gov/bill/116th-congress/senate-bill/4349
- Krishnamoorthi R. H.R.7255 – 116th Congress (2019-2020): Coronavirus Health Care Worker Wellness Act of 2020. Published June 18, 2020. Accessed September 12, 2020. https://www.congress.gov/bill/116th-congress/house-bill/7255
- Bera A. H.R.1646 – 116th Congress (2019-2020): HERO Act of 2019. Published July 15, 2020. Accessed September 12, 2020. https://www.congress.gov/bill/116th-congress/house-bill/1646
- American College of Emergency Physicians. Joint Statement: Supporting Clinican Health in the Post-COVID Pandemic Era. Accessed September 12, 2020. https://www.acep.org/globalassets/new-pdfs/ac_stmt_jsmh_physicians-mh_06202.pdf
- Joint Commission. Joint Commission Statement on Removing Barriers to Mental Health Care for Clinicians and Health Care Staff.
- National Suicide Prevention Lifeline. Accessed September 12, 2020. https://suicidepreventionlifeline.org/
- Crisis Text Line | Text HOME To 741741 free, 24/7 Crisis Counseling. Crisis Text Line. Accessed September 12, 2020. https://www.crisistextline.org/
- Suicide: What to do when someone is suicidal. Mayo Clinic. Accessed September 12, 2020. https://www.mayoclinic.org/diseases-conditions/suicide/in-depth/suicide/art-20044707
- Physician Suicide Prevention. American Medical Women’s Association. Accessed September 12, 2020. https://www.amwa-doc.org/