According to the American Foundation for Suicide Prevention, physicians die by suicide more frequently than others of their gender and age in both the general population and other professional occupations. Death by suicide is about 70% more likely among male physicians in the United States than among other professionals and 250% to 400% higher among female physicians. Unlike other groups in which men die by suicide about 4 times more frequently than women, physicians' suicide rate is very similar for both men and women.
Why? Let's start with genetic loading. Physicians, not uncommonly, come from families with histories of mood disorders and substance abuse. In fact, for some individuals this is partly why they have chosen to become doctors. Studies of medical students and residents reveal that one quarter to one third have suffered clinical depression in training. Physicians have rates of depression and substance abuse that are equivalent to or higher than rates in the general population. The two most common illnesses that precipitate suicide in physicians are unrecognized, untreated, self-treated, or undertreated depression and substance abuse.
With this as the bedrock and given that all suicides involve a complex confluence of factors, the following is a list of what is known to push susceptible doctors to that desperate final act:
But there is some good news. Medical students are being taught about the importance of self-care. This is reinforced throughout their residency training. Average work weeks are shorter in total number of hours, including more rest and time off after being on call. Trainees are being encouraged to obtain disability insurance early. Physician health programs are promoting how they can help, and they are broadening their menu of services to ill doctors and their families. Medical licensing boards are more sophisticated and sensitive in their disciplinary work and how this impacts the physicians who come before them. Stigma is slowly diminishing as physicians who have suffered illness speak openly to their colleagues and urge them to get help early.
To quote former US Surgeon General Dr. David Satcher, who put it so simply but with great eloquence, "Suicide prevention is everyone's business." All of us in medicine can help by taking better care of ourselvesâ€”and each other.
Although you should always seek out the help of a trained professional whenever you or someone you care about is suffering from thoughts of suicide, the following resources may help you better understand the anatomy of suicide.
Michael F. Myers, a clinical professor in the Department of Psychiatry at the University of British Columbia in Vancouver, Canada, is a specialist in physician health and the author (with Carla Fine) of the newly published book, Touched by Suicide: Hope and Healing After Loss (Gotham/Penguin; 2006). He is the past president of the Canadian Psychiatric Association and welcomes questions or comments at firstname.lastname@example.org.