Preventing Suicide: Physician Risk, Screening, and Current Trends
Rosie Bauder, PhD, MPH, LPC
The fourth of September marked the first day of National Suicide Prevention week in the United States and will culminate with World Suicide Prevention Day on Saturday, the 10th. National organizations such as the American Foundation for Suicide Prevention (AFSP), the National Alliance on Mental Illness (NAMI), and the Suicide Prevention Resource Center (SPRC) are culling together events, resources, and lived-experience stories to create awareness and better understanding of suicide to inspire others to reduce the stigma around suicide and inspire more people to play a role in preventing suicide in their communities.
It’s estimated that for each suicide death, over 135 people are impacted, and for each suicide death, there are more than 25 attempts(1). In the US, more than one million people will seriously consider suicide within the year. Suicide touches many of us, yet it can be difficult to speak openly about suicide with our patients, within our organizations, and among our peers.
Current Trends
Though suicide rates in the US appear to be declining — there was a three-percent decline in the age-adjusted suicide rate from 2019 to 2020 — it persists as a leading preventable cause of death, with approximately 46,000 people losing their lives to suicide in 2020(2). Suicide deaths in Ohio also appeared to decline, with 1,642 Ohioans dying by suicide in 2020, however, suicide remains the second leading cause of death among Ohioans 10-14 and the third leading cause of death among Ohioans 15-34(3).
Suicide disparately impacts youth and adults with minoritized racial, ethnic, and sexual identities. Suicide deaths in Ohio have increased by 8 and 14 percent among Black non-Hispanic males and females, respectively(3). Results from the 2019 Ohio Youth Risk Behavior Survey (YRBS) revealed that lesbian, gay, or bisexual (LGB) youth had higher odds of reporting suicidal thoughts and behaviors, such as strongly considering suicide, making a suicide plan, or attempting suicide, when compared to their counterparts(4).
Firearms have become the most common mechanism by which people die by suicide, with more than half of all suicide deaths in the United States dying by firearms(2). There is increased recognition that firearms are associated with increased suicide risk as they are fatal in nine out of ten suicide attempts(5), however, firearms mean safety counseling and safe storage practices are strongly associated with reduced suicide risk(6-8). Additionally, there is an association between suicide deaths using a firearm in states with less restrictive gun laws and policies; approximately four times as many women died by suicide using a firearm in Ohio than in New Jersey between 2010 and 2020(9).
Screening and Risk Assessment
People who attempt suicide or die by suicide are more likely to use health care services, such as meeting with a primary care provider or visiting the emergency department, more than specialized mental health services(10). As such, physicians can play a vital role in recognizing when their patients may be at risk for suicide. Physicians are more likely to talk about suicide with their patients if they are familiar with warning signs of suicide, risk factors, such as a history of suicide attempts or substance use, and brief, suicide-specific interventions to increase safety among patients at risk. Zero Suicide, a framework to improve suicide care within health and behavioral health care systems, provides a toolkit to implement key suicide prevention principles across levels of care.
Preventing Physician Suicide
Just as physicians are poised in many ways to prevent suicide among their patients, they are also known to have higher rates of suicide in comparison to the general population. Physicians are more likely to experience depression, burnout, and emotional exhaustion, and often engage in fewer help-seeking behaviors. They are also more likely to hold multiple risk factors, which in combination with social and external factors, such as the stigma around help-seeking for psychological disorders and stressful work environments, may make physicians more vulnerable(11,12). It is crucial that physicians prioritize their well-being and cultivate practices that reduce burnout and exhaustion. Physicians should acquaint themselves with preventative steps they can take to care for themselves or support others who may be at risk, such as through learning unique warning signs among physicians, understanding structural barriers, and preparing before a crisis occurs.
National Physician Suicide Awareness Day will take place next Saturday, September 17th. #NPSADay, a collaboration between The Physicians Foundation, Dr. Lorna Breen Heroes’ Foundation, and First Responders First, is a call to action to prevent physician suicide by learning the signs, starting the conversations, understanding the underlying barriers, and sharing the resources that can help those in distress seek mental health care.
In reading this, you may have taken the first steps to prevent suicide- thank you. Hopefully, we can foster the impact of suicide prevention among physicians year-round.
Rosie Bauder, PhD, MPH, LPC is a postdoctoral scholar with The Ohio State University College of Medicine’s Suicide and Trauma Reduction Initiative (STRIVE). She is a Licensed Professional Counselor in the state of Ohio and serves as a research clinician on several clinical trials evaluating the effectiveness of suicide and trauma-specific evidence-based practices. Her research focuses on components of crisis response planning and suicide prevention among high-risk groups, including youth with oppressed identities and gun owners.
Dr. Bauder will be part of our Emerging Trends in Healthcare panel on the evening of Tuesday, December 6th. She will be joined by Dr. Ahmad Mostafavifar, Dr. Jonathan Groner, Marian Stuckey and Malcolm Porter as part of the presentation of “Firearm Diseases in Central Ohio”. More information soon!
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