Challenges and Potential Solutions for Physician's Suicide risk factors in the COVID-19 Era: Psychiatric Comorbidities, Medicine Judicialization, and Burnout.

INTRODUCTION: Suicide in physicians outlines 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 a post-1980 suicide mortality ratio 46% higher in female physicians than women in the general population and a 33% lower risk in male physicians than men in general, despite an overall contraction in physicians' mortality rates in both genders. METHODS: This narrative review was conducted through a search and analysis of relevant articles/databases to address questions raised by the meta-analysis, and how they may be affected by COVID-19. The process included unstructured searches on physician suicide, burnout, medicine judicialization, healthcare organization and COVID-19 on Pubmed, and Google searches for relevant databases, medical society, expert and media commentaries on these topics. We focus on three factors critical to address physician suicides: epidemiological data limitations, psychiatric comorbidities, and professional overload. RESULTS: We found relevant articles on suicide reporting, physician mental health, effects of healthcare judicialization and organization on physician and patient health, and how COVID-19 may impact such factors. This review addresses information sources, underreporting/misreporting of physicians' suicide rates, inadequate diagnosis and management of psychiatric comorbidities and chronic effects on physicians' work capacity, and finally, medicine judicialization and organization failure increasing physician "burnout". We discuss these factors in general and in relation to the COVID-19 pandemic. CONCLUSIONS: We describe an overview of the above factors, discuss possible solutions, and specifically address how COVID-19 may impact such factors.

An iterative approach to promoting departmental wellbeing during COVID-19.

RATIONALE, AIMS, AND OBJECTIVES: Addressing wellbeing among learners, faculty, and staff during the COVID-19 pandemic is a challenge for many clinical departments. Continued and systemic supports are needed to combat the pandemic's impact on mental health and wellbeing. This article describes an iterative approach to conducting a needs assessment and implementing a COVID-19-related wellness initiative in a psychiatry department. METHODS: Development of the initiative followed the Plan-Do-Study-Act (PDSA) quality improvement cycle and was informed by Shanafelt and colleagues' framework for supporting healthcare workers during the COVID-19 pandemic. Key features included the establishment of a Wellness Working Group, the curation of relevant resources on the Department's website, and the deployment of regular, monthly surveys that informed the creation of further supports, such as a weekly online drop-in support group. RESULTS: Survey response rates ranged from 22% to 32% (n = 90-127) throughout our initiative. Across multiple surveys, approximately 80% of respondents reported feeling supported or very supported by the Department, and 90% were satisfied or very satisfied with the quantity and quality of information provided. Our support group and resources page were accessed by nearly one-quarter and one-third of respondents, respectively, with satisfaction rates of 81% or higher. Consistent with the Department's mandate, ensuring equity was a key focus of the Working Group throughout its operations. CONCLUSIONS: There is potential for this model to be scaled to create a faculty-wide, institution-wide, or regional approach to addressing wellbeing. Other departments may also wish to adopt similar approaches to supporting their members during this challenging time.

A Qualitative Investigation of Burnout and Well-being Among Faculty and Residents in a Canadian Psychiatry Department.

OBJECTIVE: This study used semi-structured interviews with faculty and residents in psychiatry to inform a qualitative, process-based understanding of well-being and related concepts, as well as to identify and critically explore strategies for maintaining well-being in psychiatry. METHODS: Using interpretive description as a qualitative research methodology, semi-structured phone interviews were conducted with 12 faculty (nine clinical and three non-clinical) and five residents in a Canadian psychiatry department between September and December 2019, prior to the onset of the COVID-19 pandemic. Interviews were transcribed, coded, and subsequently analyzed for themes by the research team. RESULTS: Fourteen women and three men completed the study, consisting of nine faculty members, five psychiatry residents, and three non-clinical PhD scientists. Four themes were developed from the interview data: (1) The nature of working in academic psychiatry, (2) professional identity as a double-edged sword, (3) feelings of isolation and powerlessness in the system, and (4) strategies to support well-being. CONCLUSION: In the absence of many qualitative perspectives on well-being in academic psychiatry, the findings of this study can be used as a first step to inform future interventions and meaningful institutional change around well-being in psychiatry. The findings may help to enable conversations about well-being that embrace humanity and vulnerability as essential components of professional identity in psychiatry and provide opportunities for open discussion and support.