South African Psychiatry - February 2019

SASOP HEADLINE
He completed his medical degree and psychiatry
specialization at the University of KwaZulu-Natal
and his PhD at Stellenbosch University. His research
interests include schizophrenia, consultation-liaison
psychiatry, health services and medical education.
He is the Deputy Editor of the South African Journal
of Psychiatry.
2.2 MEDICAL PRACTITIONERS AND EMPLOYEE
WELLNESS
Wellness, in particular mental wellness, of medical
practitioners and students has attracted much
media and other attention during the past year
following, for example, successful and public
suicides by prominent professionals and students
on several campuses. Statistics are quoted which
rate the suicide figure at 10,7 per 100 000 people
for the South African general population as the 6 th
highest in Africa. 1
AS FAR AS SUICIDE AND MEDICAL
PRACTITIONERS ARE CONCERNED, A
SYSTEMATIC REVIEW OF PUBLISHED
STUDIES ON SUICIDE AMONG PHYSICIANS
SHOWED THAT THESE PROFESSIONALS
HAVE A 2.5 TIMES HIGHER CHANCE
OF COMMITTING SUICIDE THAN THE
GENERAL POPULATION (DAMASCENO,
2017). 2
Similarly, another meta-analysis on the topic
reported elevated physician’s suicide ratios (higher
for women) compared with the general population
(Schernhammer, ES, 2004). 3 Details on suicide
among US physicians in seven states included that
having a known mental health disorder, or a job
problem, contributed significantly to the increased
risk of physicians successfully committing suicide
(Gold et al., 2013). 4 In a cohort of about 20,000
doctors employed by the National Health Service of
the UK who died between 1962 and 1979, the death
rate from accidental poisoning involving prescription
drugs (overdose) were significantly raised among
male consultants (most apparent in obstetricians
and gynaecologists), while the death rate from
(self) injury and poisoning for female consultants,
were largely a twofold excess of suicide (significantly
raised for anaesthetists), Carpenter et al. (1997). 5
Sheikhmoonesi and Zarghami (2014) noted that
some studies identified certain specialties such as
psychiatry, anaesthesiology and dentistry as higher
risk for physician suicide. 6 They also reported on
risk factors/attributes in women physicians who
had attempted suicide to include the history of
depression, alcohol abuse or dependence, sexual
abuse, domestic violence, poor current mental
health and family history of psychiatric disorder. 8
Furthermore, those who suffer from obesity, chronic
fatigue syndrome, worsening health, eating
disorders, overworking, career displeasure, and
job stressors have also been reported as high
risk physicians. 8 Kõlves and De Leo reported on
suicide in medical doctors and nurses compared
to educational professionals in Queensland,
Australia, and found that female medical doctors
in this study had significantly higher suicide rates
than educational professionals, similarly for nurse
of both sexes. 7 Studies included in the mentioned
systematic reviews also reported expressive levels
of psychic suffering while concluding that suicide
among physicians is associated with the exercise on
their professional role in the society and workplace
(Damasceno et al., 2017) and were calling for
more information about suicide among health
professionals.
IN TERMS OF DEPRESSION, MAJOR
DEPRESSIVE DISORDER AND OTHER
MENTAL DISORDERS, SHEIKHMOONESI
AND ZARGHAMI (2014) OBSERVED
THAT THE LITERATURE ALSO SUGGESTS
THAT PHYSICIANS WHO KILL THEMSELVES
ARE MORE CRITICAL OF OTHERS AND
OF THEMSELVES AND MORE LIKELY TO
BLAME THEMSELVES FOR THEIR OWN
ILLNESSES.
Furthermore, there is some evidence that physicians
do not welcome the idea of approaching colleagues
for help, and instead utilize alcohol or drugs, while
resorting to isolation. 8 Some of the “ten facts” about
physician suicide and mental health listed by the
American Foundation for Suicide Prevention (www.
afsp.org) include that: (1) suicide is generally
caused by the convergence of multiple risk factors,
the most common being untreated or inadequately
managed mental health conditions; (2) in cases
where physicians died by suicide, depression is
found to be a significant risk factor leading to their
death at approximately the same rate as among
non-physician suicide deaths; and (3) drivers of
burnout include work load, work inefficiency, lack
of autonomy and meaning in work, and work-home
conflict
Burnout per se, consisting of the three dimensions
of emotional exhaustion, depersonalization and
reduced professional accomplishment (Maslach
et al., 2001), 8 does not constitute a clinical medical
diagnosis, but nevertheless has a significant impact
on sufferers, their work environment and productivity.
Collier 10 and Dr Sandra Roman, advisor to the Quebec
Physicians Health Program, both cited a 2012 study 10
which found that 45.8% of physicians in the US over
time reported at least one symptom of burnout.
Furthermore, burnout is a leading cause of medical
82 * SOUTH AFRICAN PSYCHIATRY ISSUE 18 2019