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Work-related stressors have been associated with physician suicide. Physician burnout and depression were exacerbated by the COVID-19 pandemic, remain unresolved and of national concern. Future pandemics are predicted. This study is the first to characterize professional and pandemic-related stressors in physician suicides during the COVID-19 pandemic.
This study aimed to evaluate whether there was a change in reported job-related stressors after the beginning of the COVID-19 pandemic.
Physician suicides were identified within the National Violent Death Reporting System dataset (March 1, 2020 to December 31, 2021). Free-text law enforcement and medical examiner notes for physician suicides were analyzed using reflexive thematic analysis.
Of 307 physician suicides, 70 included professional or pandemic-related stressors associated with death. Themes included pandemic-related dysregulation, financial distress, relationship issues, mental/physical/substance use problems, grief, and discipline.
While loss of employment, physical, mental health, legal, and substance use issues continue to be associated with suicide, grief and pandemic-specific stress were novel findings. Fear of disease, quarantine, and prolonged illness due to contracting COVID warrant psychological support. Psychological support is also indicated for recent discharge, grief management, transition into retirement, and during disciplinary processes. The stress of a pandemic may exacerbate previous risks. Proactive physician suicide prevention measures remain indicated.
Burnout and mental health concerns are prevalent among healthcare workers. Female physicians, nurses, and healthcare staff are at a higher risk of suicide than the general population. Burnout and depression have been known to coexist with suicidal ideation and behaviors.
To identify what is known about the relationship between burnout and depression in the context of suicide among healthcare workers.
Registered scoping review of English language articles indexed to CINAHL, PubMed, and PsychInfo databases with date of publication prior to March 5, 2024.
The review yielded nine eligible studies, all employing observational or descriptive methodologies. Depression was found to be a predictor of suicidal ideation. While burnout was associated with depressive symptoms and found to coexist with suicidal ideation, it was not predictive of ideation. Emotional exhaustion and depersonalization were key components of burnout linked to depression. No studies were found exploring survivorship factors in healthcare professionals. Suggested prevention strategies that need to be tested include mindfulness and cognitive-behavioral skills training, improved workplace conditions, addressing loneliness, and fostering resilience.
Interventional studies are needed to test strategies addressing burnout, depression, suicidal behaviors, and survivorship of suicide attempts. Depression should be considered and evaluated when healthcare workers exhibit symptoms of burnout. Moreover, the Socio-economic Model of Suicide Prevention (i.e., SESM) can be used to categorize suicide prevention measures in healthcare. Burnout and depression interact to influence mental health outcomes among healthcare professionals, with depression playing a more significant role in predicting suicidal ideation. Despite the demonstrated relationships, critical gaps in knowledge exist in understanding survivorship and in the development and testing of effective interventions. Future interventional multisite research is needed using validated tools to identify best practices in suicide prevention for healthcare professionals.
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