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Stressors of life require understanding, extra effort to mitigate their impact
Last month, a famous actor and comedian who was born in Chicago 63 years ago took his own life. Many people were shocked to learn that this man, who dedicated his adult life to entertaining the world, did this to himself. Additional investigation revealed he repeatedly struggled with mental health issues, including severe depression and substance abuse.
Suicide is not a comfortable subject to discuss. We never fully know or understand why someone would decide to end his or her life prematurely. Pain, rejection, sadness, depression and lack of self-worth all come into the equation. Oftentimes, there is a major depressive episode when people develop a belief that the world and those who love and support them are better off without them. There could be feelings of hopelessness, no control over life and being burdensome to family, friends and colleagues. While critics may mistakenly suggest these people “took the easy way out,” in fact their mental health has been distorted to the point that they believed it was a difficult choice, but one that needed to be made to end personal sadness as well as the sadness of those around them.
When you experience the untimely death of someone you know — whether it be a friend, colleague, relative or significant other — your mind is filled with unanswered questions. You recognize the person was “hurting inside,” displaying a sense of sadness and hinting at a loss of purpose in life. Typical of physicians’ desire to help others find a healthy life, we question what we could have done to better recognize the signs and symptoms. However, the signs are not easy to detect, as everyone manages moments of sadness, stress, disappointment and even despair throughout their lives without considering the possibility of suicide.
Anthony A. Romeo
Physicians, psychological distress
The overall prevalence of suicide in the general population is estimated to be 1% to 2%, or 12 people per 100,000 people. However for physicians, the prevalence has been estimated to be two times greater than that of the general population, or otherwise stated as 2% to 4% of all physicians. To put that in perspective, up to 400 physicians are estimated to commit suicide each year in the United States. This means we lose two to three medical school classes on an annual basis. It is difficult to comprehend, but statistically another physician will take his or her life today. While there are no published estimates specific for orthopedic surgeons, we need to remember that whenever there is a survey of the professions with the highest suicide rates, physicians routinely top the list, which includes orthopedic surgeons.
In an analysis of two academic training programs, high levels of burnout were seen in 58% of residents and 28% of faculty. One of every five faculty members reported psychological distress. Furthermore, 18% of resident spouses reported psychological distress, while 10% of the faculty spouses reported the same. Decreased satisfaction with a spouse was correlated to an increased irritability among spouses as well as increased fatigue that reduced personal or family interaction. It is not surprising that divorce rates among physicians has been reported to be 10% to 20% higher than that of the general population.
Stressors common during an orthopedic surgeon’s professional life require an understanding and efforts to mitigate their impact on loved ones to reduce the risks of depression, loss of purpose in life and suicide. Family members, especially spouses or significant others, are affected by the lives and work habits that many orthopedic surgeons have become accustomed. Long hours away from home, mental and physical fatigue when arriving home, sleep deprivation, stress related to the work environment and the intense efforts to achieve success affect loved ones, friends, colleagues and other individuals with whom we daily come in contact. Sometimes, orthopedic surgeons fail to recognize how our driven, purposeful, ambitious and dedicated lives affect those around us.
Physicians are often perceived as privileged and affluent, with the ability to afford comfortable lives for their dependents. However, affluence does not protect against stress, depression or other mental health issues. Studies suggest the risk of mental health issues may be elevated among physicians, and other potential causes of mental illness, such as substance abuse, remain common affecting up to one in 15 physicians during their lifetimes.
Many physicians personally affected by mental illnesses do not seek professional help due to concerns of how they would be perceived. They are often concerned about being humiliated by their peers if the information were to become public, thus creating perceived barrier to effective treatment. Further restraints to seeking help include concerns about losing the privilege to practice medicine, although state licensing boards routinely consider mental conditions such as major depression in the same category as routine medical conditions as long as patient care is not adversely affected. In addition, recognizing and seeking care for family members and friends also may be restricted due to the stigma of mental illness for some physicians.
Understand the risks
We must accept that, as human beings, physicians are susceptible to mental illness. The profession of medicine, which provides many personal rewards, also can be a source of mental illness in our own lives as well as the lives of our families, friends and peers. By understanding the risks, physicians can be proactive to manage the challenges of life.
We should live a healthy lifestyle, including regular exercise, as well as avoid substance abuse and sleep deprivation. We need to make time for loved ones and have the ability to participate in their lives without distractions and fatigue. Positive relationships with spouses, family, friends and peers — combined with a healthy lifestyle — is the most effective way to minimize the impact of mental illness in our lives.
Despite these efforts, mental health issues are still likely to affect all physicians, including orthopedic surgeons, during one’s lifetime. Orthopedic surgeons need be aware of the subtle signs of depression, anxiety, mood and personality disorders. We need to champion the efforts of our mental health colleagues in the treatment of these conditions. If a mental illness progresses, then take suicidal ideations seriously and signal the need for professional help. A number of valuable resources can be accessed, including the American Foundation for Suicide Prevention.
Be aware of the warning signs and risks of suicide as 50% to 70% of all people who attempt suicide have told someone of their intentions. Do not ignore comments about the desire to commit suicide, especially when there is a history of depression, severe anxiety or other mental illnesses or when specific plans for suicide have been envisioned. Other concerning signs include the belief that there is no purpose in life and that the world would be a better place without that person. Do not ignore more subtle signs as well, including gradual social isolation from peers, friends and ultimately family. If suicide seems imminent, then it is best not to argue alone. Instead, let people know they are surrounded by others who love them, their lives have purpose, that you care for them and together, you can get help.
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Anthony A. Romeo, MD, is the Chief Medical Editor of Orthopedics Today. He can be reached at Orthopedics Today, 6900 Grove Rd., Thorofare, NJ 08086; email: orthopedics@healio.com.
Disclosures: Romeo receives royalties, is on the speakers bureau and a consultant for Arthrex Inc.; does contracted research for Arthrex Inc. and DJO Surgical; receives institutional grants from AANA and MLB; and receives institutional research support from Arthrex Inc., Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Miomed.