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Forced retirement in the spotlight as a risk factor for physician suicide

Systemic support systems should be implemented for physicians to prevent work-related stressors that can lead to suicide, suggested a thematic analysis of 200 physician deaths.

Among the suicides by physicians included in the National Violent Death Reporting System database from 2003 to 2018, six themes were found to predate such deaths, including disability due to physical health, substance use, mental health problems, relationship conflict, legal problems, and increased financial stress, all leading to work-related stress, Kristen Kim, MD, of the University of California San Diego and colleagues reported.

The results further suggested that suicide risk is associated with early retirement due to health problems affecting employment, they noted in: Suicide and life-threatening behavior

Of the 200 physician death stories, almost all that reported an earlier-than-expected retirement were linked to a physical condition, Kim said. MedPage todayincluding a surgeon with a tremor, a doctor with dementia, and a doctor with alcohol and prescription drug use problems who had lost hospital privileges.

Investigations by state medical boards, employers, and law enforcement also featured frequently in the stories, and a re-examination of the data found that the majority of physicians who died by suicide during the study period were unemployed or “waiting for job loss and typically not by choice,” the authors noted.

While interpersonal conflicts, including those at work, are common, “tense relationships with family members,” often in the context of a divorce or extramarital affair, were even more common, she added.

The study showed “significant overlap” with a previous study on work-related problems prior to nurse suicide, with few exceptions. While nurses struggled to access mental health support and medicines after job loss, doctors did not. Furthermore, legal issues were a factor in physicians’ suicide data, but not nurses’ data.

Physicians often neglect physical health when identifying job stressors, but poor physical health affects job performance and increases job stress, the authors said, noting that legal and psychological support, particularly during malpractice and “fit for duty” investigations evaluations is much needed.

“Medicine must dispel the myth of never-ill physicians who put their patients’ needs ahead of their own, at the expense of their own health,” they wrote.

Kim said she hopes this research will help doctors “give ourselves permission to meet those needs … to avoid the dire consequences we may see.”

To that end, Kim and team offered some anonymous screening tools and “confidential pathways” for treatment, including: UC San Diego’s Healer Education Assessment and Referral Programlinking physicians to counseling and outpatient treatment.

Also the “dr. Lorna Breen Health Care Professional Protection Act,Signed in March, it includes funding for hospitals to implement suicide prevention initiatives and promote help seeking.

Kim also emphasized the urgent need to reform the licensing application process to eliminate “invasive” questions about physicians’ mental health and substance use history, which discourage seeking help and have unintended consequences for patient care.

For this study, Kim and colleagues used a mixed-methods approach that combined thematic analysis and natural language processing to develop themes representing stories of 200 suicides by physicians included in the National Violent Death Reporting System database from 2003 to 2018.

Of the 200 physicians, the mean age was 53, 83.5% were male, 89.5% were white, and 62.5% were married. More than half had mental health problems, 16% had alcohol problems, 14.5% had other substance use problems and 22% had physical health problems.

Using natural language processing, the authors confirmed five of the six themes identified—except “disability due to deterioration in physical health”—which were “probably not identified by natural language processing because physical health problems were described as the distinct, specific conditions affecting the affect work performance (e.g., back pain, tremor), which were not grouped together as a common theme.”

Limitations of the study included the fact that the post-mortem evaluations were based on short stories—usually two paragraphs long—developed after interviews with loved ones.

“We use the best available data we have about why they decided to do what they did,” Kim said, but most of the data, with the exception of quotes from suicide notes in the stories, wasn’t first-hand accounts.

In addition, because most of the physicians in the study were male and white, the results may not reflect the work-related stressors of underrepresented minorities.

In addition, the database used in the study is voluntary. Although the number of participating states increased from six in 2003 to 42 in 2018, including the District of Columbia and Puerto Rico, ten states still do not report this data.

If you or someone you know is struggling with mental health issues or has suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

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    Shannon Firtha has been reporting on health policy since 2014 as a Washington MedPage Today correspondent. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow

disclosures

Kim reported no conflict of interest. A co-author reported receiving research support from COMPASS.

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