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Web-based CBT program effective for suicidal ideation among medical interns
Results from a randomized clinical trial show a web-based cognitive behavioral therapy program delivered prior to internship year was effective in preventing suicidal ideation among medical interns.
“Physicians are at high risk for suicide compared with the general population. A meta-analysis of physician suicide revealed that male physicians are 1.41 times more likely and female physicians are 2.27 times more likely to die by suicide compared with their counterparts in the general population,” Constance Guille, MD, of Medical University of South Carolina, Charleston, and colleagues wrote. “According to the American Foundation for Suicide Prevention, 300 to 400 physicians die by suicide each year, equating to approximately one physician dying by suicide every day.”
To determine efficacy of a web-based cognitive behavioral therapy (CBT) program for prevention of suicidal ideation among medical interns, researchers conducted a randomized clinical trial at two university hospitals with 199 interns from multiple specialties. The program was delivered prior to the start of internship year. Interns were randomly assigned to the web-based CBT program (n = 100) or an attention-control group (n = 99). Researchers used the Patient Health Questionnaire-9 (PHQ-9) to assess suicidal ideation prior to internship start and at 3-month intervals during internship year.
Following randomization, participants in the control group received a weekly email with information on mental illness, including symptoms of depression, suicide and where to obtain mental health treatment, for 4 weeks prior to internship. Participants in the intervention group received weekly emails that prompted them to complete a web-based CBT module. At months 2, 5, 8 and 11 of internship year, the intervention group were asked via email to review a web-based CBT module of their choice. The control group received information on mental illness, including symptoms of depression, suicide and where to obtain mental health treatment at these time periods.
Twelve percent of the intervention group endorsed suicidal ideation at at least one point during internship year, compared with 21.2% of the control group.
Interns receiving web-based CBT were less likely to endorse suicidal ideation during internship year compared with the control group (RR = 0.4; 95% CI, 0.17-0.91; P = .03), after adjusting for sex, pre-internship PHQ-6 scores, history of depression, neuroticism and early family environment, which were previously shown to increase risk for suicidal ideation.
“Some medical schools and academic health centers have responded by curriculum reform (eg, including material on physician depression and suicide in lectures), use of depression-screening instruments to fill out privately and confidentially as a learning experience (eg, Patient Health Questionnaire-9), and education about stress and how to get help. These are important steps. They address the need for early education about depression and can address stigma as a barrier to seeking help. However, many students and young physicians do not want to take time for treatment, have limited ability to pay for care, and worry about issues of confidentiality, medical licensability and clinical referrals,” Charles F. Reynolds III, MD, of University of Pittsburgh School of Medicine, wrote in an accompanying editorial. “Going forward, one can anticipate that as issues of work-life balance and self-care are addressed and as physicians adopt wellness strategies that promote well-being, patient care will also benefit.” – by Amanda Oldt
Disclosure: The researchers report no relevant financial disclosures.
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This JAMA article highlights physician suicide and introduces an intervention targeted at early post-graduate physicians.
The authors note that in the United States about physician commits suicide every day.
The study also states that suicide risk is evident in medical interns. These trainees who have serious thoughts about suicide during their first year of training may be at 10 times the risk of a future suicide attempt and 100 times the risk of suicide completion in the future.
This study presents the results of a trial of two different internet-based programs for interns. One program provided a regular schedule of information about mental illness, including treatment referrals, while the other program offered a cognitive therapy intervention. The participants in the former program were more likely to endorse suicidal ideation.
I am not surprised the study found suicide risk is present in physicians even during their very first few months of training but alarming when you consider how the early risk may relate to later risk of suicide attempts and completions. More studies of this nature will help to elucidate the factors related to suicide and provide effective, low-cost interventions that will reduce the incidence of suicide in physicians and other high-risk groups.