Depression and suicide among Health Professionals

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According to the World Health Organization, depression is a common mental disorder, characterized by sorrow, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration. (WHO, 2015). About 60% of people who suffer from this disease commit suicide in Canada (Statistics Canada, 2012). The most frequently used methods are hanging, poisoning, and firearms. Taking all this into consideration, are health professionals at risk?

Depression

In Canada, nine percent of nurses had experienced depression compared to seven percent of women and four percent of men working another job (Statistics Canada, 2006). In addition, studies in the US show that physicians who specialize in areas of first care (e.g. family physicians, general practitioners and those working in the emergency department) have a greater risk of burnout compared to the rest of the US population. Forty-two percent of them are unable to have a balanced life, against only 23.2% of the US population in general. A similar observation is made when the same researchers compared two groups with different education levels. Those with a high school diploma were more likely to have a balance life compared to those with a doctorate. (Tait et al, 2012). Stress is an important factor that also affects caregivers. In this regard, the Mental Health Commission of Canada (2015) recently launched a report highlighting that 16.5% of people aged 15 and over who provided palliative care to a family member have very high stress levels. The full report will be available next fall. Moreover, in a period of crises (e.g. the threat of a virus), the levels of stress, anxiety, and fatigue of health professionals do not differ significantly compared to the rest of the population. However, those who have direct contact with a patient infected by the Ebola virus, for example, work in isolation and feel the need to reduce working hours (CDC, 2015).

Regarding the sources of stress, the results differ across health disciplines and countries. In Pakistan, for example, the most important sources of stress among physicians is lack of sleep, heavy workload, poor working conditions and unrealistic demands of patients (Hassan et al, 2014). As for occupational therapists, the cause of stress is a high engagement to their work even after working hours. They are also dissatisfied with their salary and have difficulty saying no when having accumulated less than 10 years of experience (Poulsen et al, 2014). Sources of stress also differ between genders. Women working in health related fields not only suffer from the expectations of pregnancy, but also suffer from holding the conflicting role as a mother. In addition, there is also a lack of role models and support when they reach an older age (Robinson, 2003). This accumulation of stress will not be without consequences.

Suicide

The suicide rate of the Canadian population is 10.8 per100,000 people (Mental Health Commission of Canada, 2015). The suicide rate for Canadian doctors, however, is unknown although within the United States, there are approximately 400 cases per year (McDonald, 2012). Various European studies have all shown that suicide was the only cause of death whose rate is higher among physicians compared to the rest of the population (McDonald, 2012). In the US, men are four times more likely to commit suicide than women are. There are, however, no gender differences in regard to doctor’s suicide rates, although female physicians possess more knowledge to commit the act (Robinson, 2003). Although this may be the case, it is not surprising that the suicide rate of a male doctor is 70% higher than that of men in other professions (American Foundation for Suicide Prevention, 2015).

In addition, the origin of high suicide rates could stem from numerous factors. The American Foundation for Suicide Prevention (2015) has shown that there is no direct causal link between job stress and the rising suicide rates of physicians. Therefore, physician suicide rates would be higher due to professional competition, having fewer close friends, having access to lethal substances and having occasionally abused drugs in the past (McDonald, 2012). Also, 75% of physicians do not seek treatment when suffering with depression and instead seek drugs from a colleague. Stigma, lack of confidentiality, an anticipated impact on their careers, and the possibility losing their license are a few reasons for the reluctance to seek help. Furthermore, a lack of time is another excuse given by 48% of physicians (McDonald, 2012).

Solution

From all the above, it appears that depression and suicide rates of health professionals should not be ignored. Efforts are being made to reduce these illnesses. Task-oriented coping is associated with a significant decrease in burnout while emotion-focused coping was proved to be detrimental to emergency physicians, nurses and support staff (Howlett et al). In Ontario, the PARO program provides assistance by phone every hour of everyday (McDonald, 2012). In addition, the PHP program (Physician Health Program) of the Ontario Medical Association helps physicians and their families deal with substance abuse problems and other personal issues (Kaufmann, 2000). Other suggestions would be to clarify the doctor-patient relationship and to encourage healthcare professionals to follow their own recommendation: adopt healthy lifestyle habits. It is important to discuss the significance in different perspectives, for example one may empathize with another, however, does not give the same courtesy to their own feelings.

Reference:

CDC (2015, May). Ebola and Psychological Stress of Health Care Professionals (Letter to the editor), Emerging Infectious Diseases Vol 21 (5). Retrieved from: http://wwwnc.cdc.gov/eid/article/21/5/14-1988_article

Mental Health Commission of Canada (2015). Informing the Future: Mental Health Indicators for Canada. Retrieved from: http://www.mentalhealthcommission.ca/English/document/68796/informing-future-mental-health-indicators-canada

American Foundation for Suicide Prevention(2015) Facts About Physician Depression and Suicide, retrieved from : https://www.afsp.org/preventing-suicide/our-education-and-prevention-programs/programs-for-professionals/physician-and-medical-student-depression-and-suicide/facts-about-physician-depression-and-suicide

Hassan D. A., Rossilah J., Tariq A., (2014). Stress of Medical Practitioners in Private Healthcare Industry, Asian Social Science, Vol 10(22), doi:10.5539/ass.v10n22p111 retrieved from: http://www.ccsenet.org/journal/index.php/ass/article/view/41730/22871

Howlett M., Doody K., Murray J., Leblanc-Duchin D., Fraser J., Atkinson P.R., (2015). Burnout in emergency department healthcare professionals is associated with coping style: a cross-sectional survey, Emerg Med J (0):1–6, doi:10.1136/emermed-2014-203750 retrieved from: http://emj.bmj.com.proxy.bib.uottawa.ca/content/early/2015/01/20/emermed-2014-203750.full.pdf+html

Kaufmann M., (2000). Physician Suicide: risk factors and prevention, Revue médicale de l’Ontario. Retrieved from : http://php.oma.org/PDF%20files/WellnessArticles/RR-PhysicianSuicide.pdf

McDonald C., (2012) Physician Suicide, PGY-4 Psychiatry, McMaster University. Retrieved from: http://fhs.mcmaster.ca/psychiatryneuroscience/documents/McDonaldPhysicianSuicidePresentation.pdf

OMS (2015). Health Topics: Depression, retrieved from: http://www.who.int/topics/depression/en/

Poulsen A. A., Meredith P., Khan A., Henderson J., Castrisos V., Khan S.R., (2014). Burnout and work engagement in occupational therapists, British Journal of Occupational Therapy, vol. 77(3) 156-164, doi:10.4276/030802214X13941036266621 retrieved from: http://bjo.sagepub.com/content/77/3/156.full.pdf+html

Robinson G. E., (2003). STRESSES ON WOMEN PHYSICIANS: CONSEQUENCES AND COPING TECHNIQUES, DEPRESSION AND ANXIETY 17:180–189, DOI 10.1002/da.10069, retrieved from: http://journals2.scholarsportal.info.proxy.bib.uottawa.ca/pdf/10914269/v17i0003/180_sowpcact.xml

Statistics Canada (2006). National Survey of the Work and Health of Nurses, The Daily, retrieved from: http://www.statcan.gc.ca/daily-quotidien/061211/dq061211b-eng.htm

Statistics Canada (2012). Les taux de suicide: un aperçu, retrieved from: http://www.statcan.gc.ca/pub/82-624-x/2012001/article/11696-fra.htm

Tait D. S., Boone S., Litjen T., Dyrbye L. N., Sotile W., Satele D., Colin P.W., Sloan J., Oreskovich M. R., (2012). Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population, Jama Internal Medicine, Vol 172(18) 1377-1385, doi:10.1001/archinternmed.2012.3199 retrieved from: http://archinte.jamanetwork.com/article.aspx?articleid=1351351

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Cendra Kidjo

Cendra Kidjo holds a Bachelor degree in Health Science with a minor in Business Administration at the University of Ottawa. She won the prize at the Ontario French Contest in 2010. She gained experience in the field of research working with several professors at the University of Ottawa including Dr. Linda Garcia and Dr. Angel Foster. She also undertook an internship in chemistry at the École Normale Supérieure in Lyon under the supervision of Professor Philippe Maurin.

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