The pandemic has increased stressors on physicians such as being redeployed to new care settings and anxiety over potential virus exposures.
Already an at-risk group, doctors are at increased risk of suicide during the coronavirus pandemic, a physician suicide researcher says.
Physicians and other frontline healthcare workers on the frontline of the coronavirus disease 2019 (COVID-19) pandemic are under physical and psychological strain. As of April 9, more than 9,000 healthcare workers had tested positive for coronavirus, the Centers for Disease Control and Prevention reported.
The April 26 suicide death of a New York emergency room physician appears to be related to the pandemic, according to the New York Times.
Lorna Breen, MD, was the medical director of the emergency department at New York-Presbyterian Allen Hospital. She died in Charlottesville, Virginia, where she was staying with family, the Times reported.
Breen's father, Philip Breen, MD, told the Times that his daughter was afflicted with COVID-19 and returned to work after recuperating for about a week and a half. He told the Times his daughter had witnessed grim conditions at Allen Hospital and appeared detached the last time he spoke with her. "She was truly in the trenches of the frontline," he told the Times.
Physicians and others in crisis can contact the National Suicide Prevention Lifeline at 800-273-8255.
The COVID-19 pandemic is placing doctors at higher risk of suicide, says Mirret El-Hagrassy, MD, a postdoctoral research fellow at Spaulding Rehabilitation Hospital's Neuromodulation Center and Harvard Medical School in Boston.
"It has increased the risk, considering all the risk factors and underlying mental health vulnerabilities. The pandemic increases the social stressors. The career-associated stressors are being exacerbated in a way that they were not before," says El-Hagrassy, co-author of a research article on physician suicide published by JAMA Psychiatry in March.
The research article found that female physicians have a higher suicide risk than the general female population by two statistical measures. Male physicians were found to have a higher suicide risk than the general male population by one statistical measure.
Physician suicide and the pandemic
The pandemic is associated with several physician suicide risks, El-Hagrassy says.
- The moral injury and fear from having insufficient personal protective equipment (PPE)
- The risk of physicians exposing themselves and vulnerable family members to the virus
- Physicians isolating themselves from others to lower the risk of spreading the virus
- Physicians being redeployed to work in unfamiliar care settings such as anesthesiologists being reassigned to work in ICUs, which heightens concern over legal liability
- Pressure from the business aspects of medicine, including physician practices being pushed to the brink of financial ruin
- Layoffs, furloughs, and cutbacks in pay and raises as healthcare organizations teeter from the financial blows of the pandemic such as cancelation of elective surgery
- Some residents and fellows are struggling to find jobs, which heavily impacts physicians in the United States on visas
- In their JAMA Psychiatry article, El-Hagrassy and her co-authors found physicians who were divorced, widowed, or single faced higher suicide risk, and the pandemic will likely exacerbate this risk
There are ways to ease physician suicide risk during the coronavirus pandemic, El-Hagrassy says.
- Provide adequate PPE: "The biggest factor is making sure physicians and other frontline workers are protected. Physicians need to get their personal protective equipment, so there is less risk of them getting infected or infecting their families. It is not just the fear of getting infected—it is the fear of spreading the virus to patients," she says.
- Lenders could put physician's student loan debt on hold during the pandemic.
- Mitigate legal liability: "The judicialization of medicine should be eased because it is a major factor for physician mental health disorders and suicide," El-Hagrassy says.
- Employers could reduce or eliminate requirements for physicians to disclose mental health history on job applications.
- Privacy should be enhanced for physicians for who want to seek mental health help. "Telemedicine psychiatry can be helpful for physicians because they don't have to go into an office, where they can be seen in a waiting area," she says.
- Prejudice against those who seek mental health services in general and among physicians particularly should be addressed.
- Physicians can conduct virtual daily check-ins with their colleagues on mobile devices or home computers.
"If we use this time of the pandemic to establish measures that protect physicians, it might lead to better outcomes down the line. We should move in that direction. There are a host of factors that could be improved during this period that might reduce the stressors and the potential for physician suicide both for the short-term and the long-term," El-Hagrassy says.
Doctors can call the Physician Support Line (888-409-0141) for free and anonymous psychiatric counseling.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
On April 26, an emergency room physician in New York who had worked with coronavirus patients committed suicide.
For physicians, suicide risk factors during the coronavirus pandemic include moral injury and fear from having insufficient personal protection equipment.
Putting student loans into forbearance and mitigating legal liability would ease stressors on physicians.