National Physician Suicide Awareness Day “Shine A Light, Speak Its Name”

“Shine A Light, Speak Its Name”

By Vytas Karalius, MD, MPH and Suzanne Bentley, MD, MPH on behalf of the SAEM Wellness Committee September 17, 2022 will mark the 5th annual National Physician Suicide Awareness (NPSA) Day and serves as a powerful reminder to pause, reflect and continue to commit to #StoptheStigmaEM and support each other and take care of ourselves.

Suicide is a crucial topic that affects our physicians and the future of our specialty. In an effort to spotlight and address the growing issue of physician suicide and stigmatization of mental health struggles by physicians, CORD, in collaboration with SAEM, AAEM, ACEP, ACOEP, EMRA, RSA, and RSO collaborated to declare September 17th as National Physician Suicide Awareness (NPSA) Day in 2018. This initiative was initially started to raise awareness around physician suicide in Emergency Medicine and help drive change, while also commemorating colleagues lost to suicide. Excitingly, however, the movement has developed into a worldwide effort to end all physician suicide and has recently gained Congressional Support. Commemorating this day on September 17, 2022, the 5th annual NPSA Day, has never felt more pressing. Throughout the ongoing COVID-19 pandemic, physicians and healthcare workers serving on the frontlines were and still remain under critically high degrees of stress and burnout, and have undoubtedly endured unprecedented physical and emotional trauma over the past three years. Studies show serious numbers of physicians are suffering depression, anxiety, post-traumatic stress disorder and other mental health issues, while studies also suggest that physicians are less likely to seek professional support due to stigma and other factors. As such, the NPSA Day 2022 theme is “Shine a light. Speak Its Name.” It is up to us as a profession to advocate for a culture of support, transparency and openness, so that we may lessen the stigma for physicians, trainees, and all healthcare workers, to speak about their struggles, whether privately or openly -

and most importantly, to seek help. May this day act as a constant reminder to all of us, all year long, that we must care not only for our patients but also for ourselves and for each other.

Suicide Statistics: Approximately one physician dies by suicide every day.

• About 300-400 physicians die of suicide every year. • The physician suicide rate is double that of the general population. • The suicide rate among male physicians is 1.41 times higher than the general male population and the suicide rate among female physicians is even more pronounced with a relative risk of suicide 2.27 times greater than the general female population! • One in ten physicians said they have thought about or attempted suicide.

Research suggests that physicians have suicidal thoughts at about twice the rate of the general population. The 2022 Medscape Physician Suicide

Report revealed that roughly 40% of survey respondents reporting suicidal ideation chose not to disclose their suicidal thoughts to anyone, not even a family member or suicide hotline. Only a frighteningly low portion of physicians (10% of men and 13% of women) said that a colleague had discussed having suicidal thoughts with them. • While physicians and trainees have higher degrees of depression, mental health distress and suicide than the general public, they are less likely to seek mental health treatment. • Suicide is the #2 cause of death in residents, with the greatest proportion being PGY1s. • The prevalence of suicidal ideation among medical students is 11.1%, and the prevalence of depression or depressive symptoms is 27.2%. • According to Medscape 2022 surveys, the number of physicians reporting burnout this year increased by over 47%. There was also a major increase in burnout in emergency physicians specifically, from 43% in 2021 to 60%, landing

Emergency Medicine as the #1 most burned out physician specialty in their 2022 survey.

Contributing Factors

Suicide is comprised of many factors, including biological, psychological and social components. Burnout, depression, compassion fatigue, substance abuse, emotional exhaustion, and impaired relationships have all been associated with suicide among physicians.

In addition to the typical risk factors most are trained to associate with suicide (e.g., mental health history, prior attempts, drug/alcohol abuse, demographics), the following risk factors should be considered that could also put you or a colleague at increased risk for suicide: • Transition stages (e.g., completing medical school, seeking residency, starting residency, first attending job, starting a new job, nearing retirement) • Major life events that may affect a person’s stability and support network (e.g., ill family member, recent divorce, death in the family) • Relationship problems • Domestic violence • Litigation stressors • Financial struggles • Professional and social isolation Physicians and healthcare workers have historically been at disproportionate risk of suicide due to a variety of additional factors, including difficult working conditions, such as long work hours, rotating and irregular shifts; emotionally difficult situations with patients and patient’s family members; risk of exposure to infectious diseases and other hazards on the job, such as physical injury or workplace violence; routine exposure to human suffering and death; and access to lethal means such as medications and knowledge about using them.

Identifying Warning Signs: Red Flag Thoughts & Behaviors

• Do they verbally express any of the following? • Talk about self-harm • Hopelessness and not having a reason to live • Feeling like a burden to others • Feeling trapped • Unbearable pain • Do they exhibit any behavioral warning signs? • Increased use of alcohol or drugs • Withdrawing from activities or social interaction • Isolating from family and friends and/or colleagues at work • Visiting or calling people to say goodbye • Giving away prized possessions • Aggression or anger

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Words matter. Improving our language about suicide.

It is important for us to continue efforts to destigmatize mental health and suicide. One way we can do this is by changing the language of shame around suicide. Particularly, suicide is the only form of death “committed,” and separates it from all others. This stems from a long era when suicide was considered a sin or a crime.

“Died by suicide” is the most accurate term to use and does not convey the judgement that commit implies. The Associate Press changed its style book in 2017 to discourage the use of the phrase “committed suicide.” As health professionals, our goal must be to reduce the taboo and stigma surrounding suicide. To do so, we must update our language.

To learn more about the history of terminology surrounding suicide and betters ways to talk about suicide, check out CORD’s interactive module on The Impact of Language with Suicide.

Getting Help & Encouraging Colleagues to Get Help

If you, or someone you know, is exhibiting signs of depression or suicidal ideation, please seek help immediately! • If you are suicidal and need emergency help, call 911 or call 988 immediately.

You can also call the National Suicide

Prevention Lifeline at 1-800-273-8255 (1-800-273-TALK). • Rather text than talk on the phone?

You can contact the Crisis Text Line by texting 741741 anywhere in the United

States 24/7. • If you are outside the United States, find a 24/7 hotline at www.iasp.info/ resources/Crises_Centres. The National Council for Suicide Prevention (NCSP) reminds us to “Take 5 to Save Lives”… 1. Learn the signs 2. Do your part 3. Practice self-care 4. Reach out 5. Spread the word Learn more at: take5tosavelives.org Suicide is an important topic that affects our physicians and the future of our specialty, and all of healthcare. It is up to us as a profession to advocate for a culture of support, transparency and openness. Together, we can make the cultural shift to support mental health awareness in medicine and decrease depression and suicide rates. Let’s all partner to raise awareness, spread the word, #StopTheStigmaEM, and continue to look out for each other. May National Physician Suicide Awareness Day on September 17th, 2022 serve as a reminder to all physicians, especially in our great specialty of Emergency Medicine, to “Shine a light. Speak Its Name” on NPSA Day and every day.

For more information on NPSA Day, including videos, presentations, statistics and curricula for your residency or department, check out CORD’s NPSA website at: https://www.cordem.org/npsa.

This October will be the first year for #StopTheStigmaEM month. Please join SAEM and other national EM organizations in our efforts to address mental health support for physicians. Check out our website for resources and events.

ABOUT THE AUTHORS

Dr. Karalius is a Medical Education Scholarship Fellow at Stanford University and faculty for the Harvard Macy Institute’s Program for Educators in Health Professions. He looks forward to pursuing a career in graduate medical education, curriculum design and trainee/physician wellness.” @VytasKaralius

Dr. Bentley is an Associate Professor of Emergency Medicine and Medical Education at the Icahn School of Medicine and the Chief Wellness Officer and Director of Simulation Innovation & Research at NYC Health + Hospitals/Elmhurst in Queens, NY. Her passions are workforce wellness and advocacy, debriefing, simulation, and medical education innovation and research. @SuziBentleyMD