Physician Suicide Awareness Day comes and goes each September, bringing with it the sad and perplexing realization that physicians usually top the lists of professionals most likely to take their own lives—something often described as the “silent epidemic.” I sample recent literature on the topic each year, each time noting how varied and complex the statistics and issues surrounding it are. Over the years, there have been physician suicides in Austin, though the exact number remains unclear. Many of us who have lost someone close to suicide know just how devastating this kind of loss can be.
An often-quoted statistic is that 300-400 physicians in the United States commit suicide each year, but most experts agree that this underestimates the true number, as there is no organized tracking of physician suicides, and death by suicide is often concealed by grieving family members and colleagues.
Physician suicide is twice as common as suicide in the general population. Recent studies have repeatedly pointed out that, compared to non-physicians, suicide rates are particularly high among female physicians—somewhere between 2.5 and 4.1 times higher—while male physicians have a risk ratio of 1.41 compared to the general population. Physicians in training are particularly susceptible. Medical students entering training have lower rates of depression compared with age-matched controls, but by the end of just one year of medical training, they have a higher rate of depression and suicide, which continues to increase during medical school and residency. In one study, 23 percent of interns experienced suicidal thoughts at some point. Suicide is the second-highest cause of death among medical students.
Numerous risk factors for physician suicide have been described. At the top of the list are previous suicide attempts, major depressive or other psychiatric disorders, and a history of substance abuse. Additional risk factors include a family history of suicide, being unmarried, an unmanageable workload, experiences of discrimination, bullying, or microaggression, medical specialty (surgery, anesthesiology, family medicine, and psychiatry are often at the top of the list), malpractice litigation, social isolation, and repeated second victim trauma—though this is only a partial list.
In the end, a sense of isolation—a loss of connection with those who might help—may be a common thread. As a family—and I think our medical community should think of ourselves in just those terms—we have both an obligation and a unique opportunity to look out for each other. If you sense that a colleague’s behavior has changed, if they are showing signs of withdrawal or depression, ask them if they are OK. Don’t be shy about it. Hope that you are wrong, but ask. It’s unlikely that reaching out in that way would ever be seen as anything other than a show of love and concern. If you sense they are in real trouble, ask them if they have any thoughts of harming themselves. Asking this hard question may well open a dialogue that they desperately need and may be a first step toward getting much-needed help.
When I was young, around the time my father died, I spent a great deal of time with my uncle and cousins, and we would often spend weekends camping at Lost Pines near Bastrop. Those were great times, but what I remember most was sitting around the campfire at night. My uncle was a wise man and a fantastic storyteller who spent the last half-century of his life in recovery after years of wandering the Southwest and Mexico as a traveling salesman. He knew how to tell us stories that were just scary enough to keep us spellbound, but not so scary as to leave us awake all night sleeping under the stars, and each story had some lesson, some nugget, that I still carry after all these years. That campfire may not have helped the entire world, but it warmed and entertained our small gathering—connected us, gave meaning. Lighting an emotional campfire for our colleagues may only help a relatively small number of people, but the world is saved one person at a time, and each of us at some point has the opportunity to light a fire, to tend it and nurture it, and to gather someone in need to feel its warmth and a renewed sense of connection. Reaching out and being available in this way will surely make a difference and may just save a life.
Brian Sayers is a rheumatologist.
