Abstract
Suicide rates are thought to be increased in physicians [1–3]; although this is undoubtedly related to complex psychosocial factors, a number of barriers may prevent physicians from asking for help when experiencing suicidal ideation. Stigma attached to mental illness is greater within the field of medicine than in the general public. Its existence reinforces denial and delays care seeking, leading to unnecessary suffering, self-medication, and isolation from medical colleagues [4]. Easy access to potential lethal means (i.e. medications) may dangerously heighten the risk of suicide in this professional group [3,4]. In fact, although a recent study about suicide by occupation in New Zealand found that doctors were not at high risk of suicide, some health-related professionals (including physicians) were more likely to use poisoning when committing suicide than other employed groups [5].
In practice, suicide is not only hard to predict but its prevention is even harder [6]. Suicide prevention can be primary, secondary, or tertiary [7]. Primary prevention aims to reduce the number of new cases in the general population. Secondary prevention aims to decrease the likelihood of a suicide in high risk patients. Tertiary prevention occurs in response to completed suicides and attempts to diminish suicide contagion and copycat suicides.
A universal approach to suicide prevention more closely resembles primary prevention because it involves everyone within a defined population regardless of their risk for suicide. A selective approach to suicide prevention is best for subgroups at increased risk for suicide, e.g. physicians.
According to the 2002 consensus statement on depression and suicide in physicians of the American Foundation for Suicide Prevention [2], the main prevention strategies to reduce suicide risk in doctors can be summarized as follows:
Primary prevention: offer a regular source of help, learn to recognize depression and risk of suicide in oneself and in other colleagues, and enhance referral to health care programs for sick physicians when needed.
Secondary prevention: identify and treat high risk patients.
Tertiary prevention: no specific recommendations are proposed.
Secondary prevention strategies for physicians at risk of attempting suicide could be enriched in specialized programmes for sick doctors with interventions such as:
offering 24 hour phone contact if needed;
providing emergency assistance if needed;
limiting access to lethal means (mainly self-prescription and easy availability of pharmaceutical drugs);
trying to establish contact with family and affective bonds if possible.
With regard to tertiary prevention, some strategies could be implemented across specific programs:
offering bereavement group therapy to peers and to family/affective bonds;
providing 24 hour phone contact to peers and/or to family/affective bonds if needed;
offering emergency assistance to peers and/or to family/affective bonds if needed;
helping to identify in oneself and in others diagnostic and psychosocial conditions that augment the risk of suicidal behaviour.
In summary, prevention strategies to decrease suicidal behaviour in physicians should not only focus on primary and secondary prevention programmes but also on tertiary prevention interventions, and can be enriched with more specific interventions for that group of professionals.