ACP advises on physician suicide prevention; study examines depression in med students

New ethical guidance from the College offers advice on how to respond to physician suicide, while a recent study found that depressive symptoms became more common as medical students progressed through school.

Response to a physician's suicide should include respect, concern, and a supportive environment for those who are grieving, according to a new paper from ACP.

Physician Suicide Prevention and the Ethics and Role of a Healing Community: An American College of Physicians Policy Paper” was developed by ACP's Ethics, Professionalism, and Human Rights Committee and published in the Journal of General Internal Medicine (JGIM) on June 2.

Actions aimed at preventing physician suicide must occur at the individual, interpersonal, community, and societal levels, according to the paper. The medical community has an obligation to foster a culture that supports education and screening related to mental health, as well as access to treatment beginning at the earliest stages of medical training, it said.

The paper examines issues that arise when individuals and institutions respond to physician suicides and when they engage in broader efforts aimed at physician suicide prevention, including:

  • the need for improved but sensitive data collection surrounding physician suicide among practicing or nonpracticing medical students, residents, and fellows,
  • a call for physicians to respond compassionately to suicide events and communicate thoughtfully, in a transparent and confidential manner,
  • the need to learn from experience and close the knowledge gap around the causes of physicians dying by suicide and implement efforts to prevent future suicides,
  • calls for the medical community to reduce stigma around this issue and, in a unified manner, acknowledge grief, support its members in a safe environment, and take preventive actions, including combating the reluctance of physicians to seek mental health care for fear of damage to their career,
  • the need to address the unique environment and stressors of medical training, and
  • the need for research into the relationships between burnout and depression and suicidality.

A separate study on depression and burnout in medical students, published by JGIM on May 26, showed that symptoms of depression and burnout may increase during medical school.

Researchers conducted a prospective study to evaluate year-by-year changes in depressive and burnout symptoms over the course of medical school training among 758 students at a private medical school in Maryland from 2010 to 2016. Clinically significant depressive symptoms were defined as a score of 10 or more on the nine-item Patient Health Questionnaire, and burnout was measured using the Maslach Burnout Inventory. Significant depressive symptoms were found in 4.3% of the students. Prevalences of high emotional exhaustion, high depersonalization, and low personal accomplishment were 9.4%, 8.6%, and 37.7%, respectively. After adjustment for age, sex, race/ethnicity, marital status, and cohort, the odds of significant depressive symptoms were significantly higher at the beginning of the second, third, and fourth years of study compared with year 1 (odds ratios [ORs], 2.63, 2.85, and 3.77, respectively; all P<0.001 versus year 1). Compared with the first year, the odds of high emotional exhaustion also increased during the second, third, and fourth years, (ORs, 3.46, 4.79, and 8.20, respectively; P<0.001 for all comparisons), as did the odds of high depersonalization (ORs, 3.55, 6.14, and 12.53, respectively; P<0.001 for all comparisons). Odds of feeling low personal accomplishment did not significantly differ across years.

The authors of the single-institution study noted that only 46.2% of eligible participants completed the survey during the fourth year and that students may have taken a year or more off for further, nonmedical studies. Interventions earlier in the medical career pathway that aim to prevent, detect, and treat these symptoms may be of benefit to the physician community, they concluded.