Canadian Medical Association

The silent stigma around suicide

It’s time to end the stigma, support physicians and work toward a healthier medical community

Even with growing awareness of the issue, physician suicide continues to affect the profession. Around 400 physicians die by suicide in the U.S. each year — but by addressing the risk factors and working to change medical culture, health care leaders, physicians and medical students can make a difference. 

Stigma breeds silent suffering 

The CMA National Physician Health Survey found that one in three physicians had screened positive for symptoms of depression — and 8% had thought of taking their own lives within the last year.

These issues are compounded by the fact that physicians tend to delay or avoid seeking treatment for personal or workplace challenges, especially for psychosocial or psychiatric concerns. On top of that, 18% of Canadian physicians and residents do not have their own primary care physician.

Physicians might hesitate to seek help for a number of reasons, including:

  • A medical culture that values self-sufficiency and stoicism, encouraging physicians to push through their own distress to care for patients
  • Fear of being seen as weak and unable to manage the responsibilities of working in medicine 
  • Privacy concerns
  • Belief that the situation is not severe enough
  • Lack of awareness of available services 
  • Fear of being reprimanded by their college

How to recognize warning signs and risk factors for suicide

Suicide warning signs

The following behaviours may indicate that someone is considering suicide and should be addressed immediately: 

  • Increased alcohol or drug use
  • Anxiety, agitation, difficulty sleeping or sleeping all the time
  • Expressing a feeling of being trapped, like there's no way out
  • Expressing feelings of hopelessness or lack of purpose
  • Withdrawal from friends, family and society
  • Rage or uncontrolled anger
  • Acting reckless or engaging in risky activities, seemingly without thinking
  • Mood changes
  • Threatening or talking about a desire to hurt or kill themselves
  • Seeking access to firearms, pills or other means to kill themselves
  • Talking or writing about death, dying or suicide

Know the risk factors 

There are a number of underlying risk factors that could cause a person to consider suicide, including:

  • Diagnoses or a family history of mental illness or suicidal behaviour
  • Prior suicide attempts
  • Adverse childhood events
  • History of physical, psychological or sexual abuse
  • Major life events that affect a person’s stability and support network
  • Sleep deprivation
  • Relationship problems or domestic violence
  • Academic distress, including failing to match to a residency
  • Professional stressors such as: 
  • Legal troubles
  • General career concerns (e.g., job security, increased demands, sanctions for mistakes)
  • License restriction
  • Financial problems
  • Professional isolation
  • The stigma and associated professional risk of seeking help
  • The traumatic, life-and-death nature of the job

For more on some of these risk factors, see this article from CMAJ.

How to respond when a colleague is in distress

People with suicidal feelings can be helped — so if you suspect a colleague is at risk, take action right away. Speak with them directly and say, “I'm concerned about you. I’ve noticed [X or Y]. Have you had any thoughts of harming yourself?” See these sample scripts from the American Medical Association if you’re not sure what to say. 

Physicians need systemic change

To make a real impact, the medical culture and health systems that glorify self-neglect and sanction self-abuse must be transformed. Those transformations will require:

Data on suicides: To change the culture, the number of physician suicides must first be tracked and known. “There is still such secrecy and so much shame that goes around it,” says Dr. Sara Taylor in an article published in CMAJ

Psychologically safer workplaces: Leaders must promote physicians’ psychological well-being by ensuring they know about and have access to confidential mental health resources — and the time to take advantage of them. Some institutions now have programs to promote resiliency and self-care. Many also provide spaces for busy physicians to relax and commune with peers.

Peer support: Local and national peer support programs are emerging, allowing trainees and physicians to gather (in-person or virtually) to discuss difficult situations and support one another. Understanding what your colleagues are going through, relating it to your own experiences and sharing coping strategies can provide insight, hope and recovery.

Better residency matching: Canada’s residency match system needs to be overhauled to better serve medical students. Despite studying diligently and going into six-figure student debt, hundreds of Canadian medical graduates are expected to be locked out from residency positions by 2021. Without changes to the system, this reality can take a tragic toll on students’ mental health.

If you are in crisis:

Call 911 or go to the nearest hospital.

Call the Canada Suicide Prevention Service (available 24/7) at 1-833-456-4566.

For residents of Quebec, call 1 866 APPELLE (1-866-277-3553).

If you are struggling: 

Contact the Wellness Support Line and/or contact your local physician health program.

If you see a colleague struggling: 

Make sure they’re aware of the physician-specific mental health resources available to them, encourage them to seek the help they need — and follow up

Topics

Suicide Burnout Relationships Reducing stigma

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