Working in healthcare can be incredibly rewarding, from helping wounded veterans regain their strength to welcoming newborn babies into the world. And while the positives of making a difference are many, healthcare professionals can also experience stress, burnout, compassion fatigue, and grief. Many work through these feelings in healthy and productive ways, but some don’t.
Depression, substance abuse, and even suicide are real and present factors among healthcare professionals, and the more we can help them find resources, understand what they’re going through, and get the help they need, the better.
“The rate of suicide among healthcare workers is unusually high,” says Dr. Cali Estes, an addiction specialist, “but with more resources, we can end the stigma behind mental health and addiction and make sure that medical boards are not so quick to fire someone, but rather offer them the help they need instead.”
Suicide in Healthcare: The Facts
- About 15-30% of residents and medical students have symptoms of depression.
- One doctor dies by suicide in the United States every day.
- Almost 55% of doctors and over 37% of nurses report symptoms of burnout.
- The three main symptoms of burnout include exhaustion, lack of efficacy at work, and depersonalization.
- Self-medicating often occurs among physicians who suffer from insomnia, anxiety, and the like
- Physicians who died by suicide often have 20-40 times the rate of benzodiazepines, barbiturates, and antipsychotic medications in their systems than nonphysicians, indicating that they were self-medicating.
Understanding the Concern
Healthcare professionals learn early in their careers to find balance between the pros and cons in their line of work. To get through the challenges of working with grieving families and sick patients, healthcare workers must focus on the rewarding aspects of their jobs like curing people and saving lives. However, it’s not always so simple. Feelings of burnout are normal, but when burnout turns to depression, anxiety, or even suicidal thoughts, professionals should take notice and seek help. Here’s what you need to know about suicide among healthcare professionals from warning signs to risk factors.
When someone dies by suicide, hindsight may reveal warning signs. Though sometimes there are no signs of their intentions, in many cases there are at least a few things “off” that could have been a red flag. Warning signs typically fall into one of three categories.
When it comes to healthcare workers, a few other signs might be more prevalent, such as substance abuse.
“For years it has been a long-kept secret that health professionals can be more susceptible to addiction, and the most commonly used drugs are prescription pills, like Xanax, Adderall, Oxy and even Roxy,” says Dr. Estes. “The medical board can be relentless when dealing with a frontline worker and suspend them or take their license. This is why we see a lot of closet drug use, which, in some cases, can end in suicide.”
Certain risk factors may appear in those who consider suicide. These factors are present in the general population as well as in healthcare workers, but certain environmental stressors – some of which can be experienced on the job — can intensify the factors in other areas. Here’s a full list of the primary factors to watch out for.
Demystifying Suicide in Healthcare
No matter who you are or where you work, certain myths surround suicide. Things like “only sad people die by suicide”, or that it’s easy to tell who’s at risk and who isn’t. We’ve debunked some of the common myths and misconceptions to help give everyone a more reality-based view.
A Crucial Link: Mental Health & Suicide
A person’s mental health can affect every part of their lives, including how prone they might be to suicidal thoughts and actions. Although people with severe mental illness are 12 times more likely to die by suicide than others, suicide is not limited to those who suffer from bipolar disorder or schizophrenia. For example, depression can lead to suicidal thoughts, as well, especially when combined with triggers such as divorce, legal issues, or trouble at work. For healthcare providers, some of the work-related challenges that can increase suicidal thoughts include:
|Burnout||A state of emotional,physical,and mental exhaustion that occurs during a time of excessive and prolonged stress. It is often the response to constant demands while feeling overwhelmed and drained.||Feelings of exhaustion from time-to-time are to be expected,but when those feelings become frequent or constant and prevent you from doing your job to your potential,burnout is likely the culprit. Professionals might believe they have nothing more to give when experiencing burnout. Studies have found that one in three physicians suffers burnout at any given time.|
|Chronic Stress||When a person suffers extreme stress with no reprieve,their body reacts with an endocrine response. The result is often low energy,insomnia,aches and pains,headaches,and other physical and emotional symptoms. Learn more about chronic stress here.||Those in busy or difficult healthcare settings might feel constant stress during their shifts and even when the shift is over. The result of the endocrine response,in turn,makes the stress seem even worse. The result is often burnout,compassion fatigue,and other issues that can affect care for themselves and for their patients.|
|Compassion Fatigue||Emotional and physical exhaustion that makes it difficult to feel compassion or empathy in a situation where that person would normally feel those things. It is sometimes described as the negative cost of caring. Learn more about compassion fatigue here.||Considered a secondary trauma,this often occurs over a long period of stress. Doctors and nurses might become less interested in work,less attached to the outcomes of patients,and sometimes reduced empathy toward the patients in their care.|
|Depression||This is a mood disorder characterized by deep sadness,a loss of interest in things that once brought happiness,distress,changes in sleep and energy levels,and more. Depression is often caused by a combination of psychological,biological,and social causes. For a more in-depth look at depression and other mental health issues,go here.||Depression can lead to changes in sleep,appetite,and energy level,which in turn can affect the care a doctor or nurse can provide. They might begin to feel as though they aren’t really making a difference,and their self-esteem can plummet. They might have trouble with concentration and make mistakes that could have serious implications for their patients.|
|Sleep Disorders||Of all the sleep disorders,insomnia is the most common,and also tends to be associated with depression,burnout,and other symptoms of concern. On the other hand,serious fatigue can make a person fall asleep at all hours and never feel as though they got enough shut-eye.||Insomnia will keep a person awake,with very little reprieve,and that can lead to being incredibly tired and making many mistakes on charts or with patient care. Fatigue can lead to doctors and nurses sneaking away to find any window of sleep possible,and might even lead them to calling in “sick” to just stay in bed and rest.|
|Substance Abuse||Substance abuse is the act of using a particular substance,such as alcohol or drugs,in a manner that constitutes abuse. This might include overuse,becoming addicted to the substance,doing what it takes to get more of it (even through illegal means),and allowing it to eventually affect your day-to-day life.||More than 100,000 healthcare workers struggle with addiction. They tend to have easier access to a variety of substances that can lead to addiction,including narcotics. Approximately 20% of nurses and about 10% of physicians will struggle with drugs or alcohol at some point in their lives.|
Finding the Words: How to Talk About Suicide
When someone begins to show concerning signs, talking to them about it becomes imperative. But how do you begin that conversation? What are the right things to say – and just as importantly, what are the wrong things? Let’s look at what might open the door to a very important, life-saving discussion.
Getting Help for Yourself
Sometimes the first step is the hardest one. But taking that first step by reaching out for help is the most important move you can make. It’s absolutely the right thing to do, which is why there are so many people there waiting to help the moment that call comes in. Fear of the unknown can be a strong motivator in preventing that all-important call, so let’s clear that up right now with a detailed look at what happens next.
What to Expect When You Call
When someone calls a suicide hotline, it usually goes like this:
- You will likely get an automated system that asks you to press a button to continue in the language of your choosing.
- The call is then routed to a local crisis center. This might take a minute or two.
- A trained professional will answer the phone with a warm greeting.
- They might ask for your first name, and tell you they are ready to listen. (Keep in mind: “You do not need to disclose your job type or title,” Dr. Estes says.)
- The conversation will usually start however you want it to. The professional will likely ask a few questions to clarify the situation and help the ease of conversation.
- If you are calling about someone else, the person who answers will guide you through the proper steps.
- If you seem to be in imminent danger, crisis workers will try to help you find solutions.
Though situations can often be handled by the crisis worker, someone who is in severe distress might need an intervention by someone in their local area. In that case, the professional will try to get the information necessary to get you the help you need.
5 Ways You Can Support Suicide Prevention
Sign up to be a suicide prevention field advocate for the American Foundation for Suicide Prevention
When an opportunity comes up in your local or regional area to help out with the good work of the AFSP, you’ll be contacted via email or phone.
Ask your representatives to fund suicide research
The more we learn about suicide and the factors that cause it, the better prepared we are to fight it. Asking for funding from local, state, and federal governments can help with this valuable research.
Donate your data to support suicide research
Do you have data collected over the course of your medical training that can help researchers? Do your part by offering that data to those who can use it to calculate the numbers and come up with solutions.
Train to be a suicide prevention ally
Taking courses and training programs that teach you how to spot and talk about difficult issues, including suicide, can be a good way to build your confidence in speaking with colleagues, friends, those in your community, and even loved ones who are struggling.
Talk about your experience
Though it can be tough to talk about your own experiences with suicidal thoughts, it’s vitally important to let others know they are not alone. Your experiences – told from the perspective of someone who came through to the other side – can help others understand just how important it is to get help themselves.
Finding Professional Treatment
Calling a suicide hotline is the first important step to getting help, but it doesn’t stop there. Fellow healthcare professionals can be your secret weapon in fighting the anxiety, depression, and other mental health issues that can contribute to suicidal thoughts. These professionals can evaluate what therapies or treatments would be best for your situation and help you find exactly what you need. Here are some of the helpers you might encounter.
To provide additional insight into suicidal behavior and actions in healthcare professionals and how to find and receive the proper help, we’ve asked our expert some important questions.
Cali Estes, Ph.D is a highly sought after Celebrity Addiction Therapist, Life Coach, Recovery Coach and Wellness Guru that blends talk therapy with forward and positive change to assist her clients in unlocking their true potential. Dr. Estes has over 20 years’ experience working with drug, alcohol and food addictions.
Dr. Tasha Holland-Kornegay is passionate about helping others reach their maximum potential. She is an author, motivational speaker, and entrepreneur. She created Wellness In Real Life to help decrease health care provider burnout.
- ACGME: Symposium on Physician Well-Being
- After a Suicide: A Toolkit for Medical Schools
- After a Suicide: A Toolkit for Physician Residency/Fellowship Programs
- American Foundation for Suicide Prevention
- Breaking the Culture of Silence on Physician Suicide
- Burnout Prevention and Treatment
- Creating a Safety Net: Preventing Physician Suicide
- HelpGuide: Suicide Prevention
- Mental Health First Aid
- Mental Illness Policy.org
- National Alliance on Mental Illness
- Nurse Suicide: Breaking the Silence
- Physician Suicide and Support
- QPR Institute