The Hidden Toll: Suicide among Honor Professions

By Robert Frantz, MD, President, West Group

A Personal Story of Loss

My sister-in-law's life was filled with promise. She was funny, kind, an incredibly hard worker. So, it's no surprise she was also her high school's valedictorian. At her core, she cared deeply for others. Her life had just started to take off.

We lost her when she was just 25 years old. She was fighting depression and facing difficult life events when she overdosed on antidepressants.

It is a massive understatement to say her death shattered our family. Her story serves as a tragic reminder of the silent struggles faced by so many in our society, but specifically doctors and healthcare workers. Her untimely death underscores the need to address the mental health crisis in this country, especially for those who dedicate their lives to caring for others.

The Alarming Statistics

For over 150 years, it has been recognized that doctors and healthcare workers have an increased likelihood of dying by suicide. An estimated 300 to 400 physicians per year die by suicide, equivalent to two full medical school classes. The same is true for all "Safety Net Workers" - a group of people including soldiers, police, firefighters, paramedics, nurses, and APCs. In short, workers who make up the "safety net" of our society. This represents an astronomical and irreplaceable loss to society, especially considering that physicians have a lower-than-average risk of death from virtually every other preventable cause. The risk of death from suicide is even higher among women colleagues.

Understanding the Risk Factors

Suicide is often the terminal event in untreated depression. Despite healthcare workers' access to care, many do not seek treatment. Factors contributing to this include the culture of honor in healthcare professions, the stigma associated with mental health disclosures on licensure applications, and the constant exposure to high-stress environments. These challenges make it difficult for healthcare workers to recognize and address their own mental health needs.

The Concept of "Honor Professions"

Recent research in the Journal of Social Psychology has introduced the idea of "honor professions," which include roles that are seen as honorable by society and by the individuals themselves. This cultural mindset likely contributes to higher rates of depression and suicide in these professions, as reputation damage and the stigma of seeking help can deter individuals from addressing their mental health concerns.

The Environmental Toll

The work required of safety net workers is not something humans were designed to do for prolonged periods. The constant stress and emotional toll can lead to mental and physical health issues, exacerbated by unhealthy coping mechanisms which at least are band aids and at most can become extremely harmful. Our training addresses the issue by encouraging harder work, but the emotional distancing we carefully cultivate to be effective caregivers can become a barrier to intimacy and seeking much needed help.

Recognizing the Signs

The warning signs are always there-emotional exhaustion, depersonalization, a decline in professional performance, physical symptoms, and expressions of hopelessness or despair- we just have to pay attention to see them. They are often the silent cries for help that go unnoticed in the fast-paced world of healthcare. It's crucial to remember that even the most resilient professionals can be struggling beneath the surface.

At one point in my life, I found myself dealing with a persistent issue that seemed minor at first, but no matter what I did, it just wouldn't resolve. It became increasingly frustrating, especially as I tried different approaches without success. One day, a colleague casually pointed out the real cause, something I had completely overlooked. This moment of clarity was a stark reminder of how easily I could miss signs of a deeper problem, especially when, later on, I found myself struggling with overwhelming work demands and emotional turmoil. It wasn't until then that I understood I needed help. Recognizing these signs in ourselves and others is the first step toward providing the support that could save a life.

Earlier this month, I attended the funeral of an RN/paramedic friend. It was heartbreaking to know that this bright, young man with a small son and a whole wonderful life in front of him could become so disconnected from those who loved and admired him. While standing at the graveside, I started to mentally tally the number of friends in healthcare I have lost to suicide. The number is five. One I tried hard to save but failed. I live with the fact that for most I wasn't sensitive enough to see the warning signs that were so clearly there.

Let's Break the Stigma

If you think you might need help, then you certainly do. Your life matters and there are better options than a permanent solution to a temporary problem. The Suicide and Crisis Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources and best practices for professionals.

If you notice a colleague or friend struggling, start the conversation. It could make a significant difference in their life. Let's work together to break down the barriers for seeking help and support our safety net workers, who dedicate their lives to protecting and caring for others.

Hope for the Future

We named our middle daughter after my sister-in-law, which makes me think of her often. My daughter recently completed her first shift as a tech in an emergency department. She is in nursing school and, like my sister-in-law, is smart, kind, and cares deeply about others. While I am extremely proud of her, I am also greatly concerned about the challenges she will face in her career.

Let's work together to ensure that the next generation of safety net workers has the knowledge and resources to handle stress and prevent burnout. Let's pay attention to the signs, break the stigma, and give them the support they deserve.

National Suicide Prevention Lifeline: 988

Physician Support Line: 1 (888) 409-0141

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