Challenges and potential solutions for physician suicide risk factors in the COVID-19 era: psychiatric comorbidities, judicialization of medicine, and burnout

Abstract Introduction Suicide among physicians constitutes a public health problem that deserves more consideration. A recently performed meta-analysis and systematic review evaluated suicide mortality in physicians by gender and investigated several related risk factors. It showed that the post-1980 suicide mortality was 46% higher in female physicians than among women in the general population, while the risk in male physicians was 33% lower than among men in general, despite an overall contraction in physician mortality rates in both genders. Methods This narrative review was conducted by searching and analyzing articles/databases that were relevant to addressing questions raised by a prior meta-analysis and how they might be affected by COVID-19. This process included unstructured searches on Pubmed for physician suicide, burnout, judicialization of medicine, healthcare organizations, and COVID-19, and Google searches for relevant databases and medical society, expert, and media commentaries on these topics. We focus on three factors critical to addressing physician suicides: epidemiological data limitations, psychiatric comorbidities, and professional overload. Results We found relevant articles on suicide reporting, physician mental health, the effects of healthcare judicialization, and organizational involvement on physician and patient health, and how COVID-19 may impact such factors. This review addresses information sources, underreporting/misreporting of physician suicide rates, inadequate diagnosis and management of psychiatric comorbidities and the chronic effects on physicians' work capacity, and, finally, judicialization of medicine and organizational failures increasing physician burnout. We discuss these factors in general and in relation to the COVID-19 pandemic. Conclusions We present an overview of the above factors, discuss possible solutions, and specifically address how COVID-19 may impact such factors.

Physician suicide demographics and the COVID-19 pandemic

Objective: To identify suicide rates and how they relate to demographic factors (sex, race and ethnicity, age, location) among physicians compared to the general population when aggravated by the coronavirus disease 2019 (COVID-19) pandemic. Methods: We searched U.S. databases to report global suicide rates and proportionate mortality ratios (PMRs) among U.S. physicians (and non-physicians in health occupations) using National Occupational Mortality Surveillance (NOMS) data and using Wide-ranging Online Data for Epidemiologic Research (WONDER) in the general population. We also reviewed the effects of age, suicide methods and locations, COVID-19 considerations, and potential solutions to current challenges. Results: Between NOMS1 (1985-1998) and NOMS2 (1999-2013), the PMRs for suicide increased in White male physicians (1.77 to 2.03) and Black male physicians (2.50 to 4.24) but decreased in White female physicians (2.66 to 2.42). Conclusions: The interaction of non-modifiable risk factors, such as sex, race and ethnicity, age, education level/healthcare career, and location, require further investigation. Addressing systemic and organizational problems and personal resilience training are highly recommended, particularly during the additional strain from the COVID-19 pandemic.

Suicide: Managing self-directed violence?

The Centers for Disease Control and Prevention have put forth recommendations to document events in terms of well-defined categories of self-directed violence even though the evolution of terminology for decriminalization and de-stigmatization from “self-murder” to “suicide” to “self-directed violence” may be just avoiding calling a spade a spade. Suicide causes mortality (and morbidity if suicide attempt) in an individual leading to (a) physical suffering to others by injuring them during-and-after the act, (b) psychological toll on the next-of-kin, and (c) isolation of society due to its suicide-statistics and economic losses with overall loss of spirit to pursue happiness potentially resulting more mortality if morbidity becomes too severe for the affected. What is the story (myth) instigating an individual to commit (or think of committing) the act of self-directed violence? And what is the story (myth) in the society that is allowing the act in some instances while prohibiting and sometimes even punishing the act in other instances? We believe that Switzerland can provide an apt example to understand suicide. Swiss ideology may inspire societies around the world to recognize their stories (myths) when they scientifically decipher prevalence of self-directed violence “suicide” even in nonhuman animals. Consequently, astounding statistics of physician suicide call for action from physicians’ community to understand peers when none can remain untouched by harsh reality of unique stress which physicians’ workspace entails. One of the possible remedies may be thoughtlessness (a form of meditation) which may require strenuous practicing; however, the first step towards achieving it may possibly involve mindfulness (another form of meditation) inspiring peers to learn the need to refocus onto whatever good there is over whatever better there could have been. Essentially, the conception of birth and the birth itself is always planned to be joyful; and the embrace of death itself and the life after death is always purported to be peaceful.