Recognizing the face of suicide

Would you recognize the signs and know how to help a friend or colleague?

By Jennifer M. Kreft

Actor Robin WilliamsIn the wake of Robin Williams’ death, discussions about suicide have risen to the forefront of our nation’s consciousness. While the face of suicide is about as varied as the characters Williams played over the course of his lifetime, various statistics tell us which segments of the population are at risk.

It may or may not surprise you that physicians are among those with the highest risk of suicide, according to some reports. An estimated 400 physicians will succumb this year alone in the United States, and 15-30% of medical students and residents screen positive for depressive symptoms. Worldwide, suicide is in danger of overtaking stroke, war and accidents as the leading cause of disability and death by 2030 (as projected by the World Health Organization). However, occupation may not be as great a predictor as other factors, such as diagnosable mental disorder, comorbid substance use, loss of social support, and availability of and access to a firearm. (Sources: Medscape, APA, CDC)

As with any medical condition, it is possible to reduce mortality rates by raising public awareness and educating the general population – especially those at risk – about the Warning Signs and Risk Factors. Treatment becomes a bit more difficult, however, when those responsible for education and diagnosis are also the ones at risk.

“In recent years after becoming more aware of these issues, medical schools, residencies and hospitals established well-being committees and options for counseling, even within medical school,” said Brenda Lepisto PsyD, a faculty member of Hurley’s Internal Medicine Residency Training Program. “Unfortunately, for the healer to ask for help continues to be a challenge.”

CDC graph: 20 leading causes of death in US, 2009Although they seem to have mastered self-diagnosis and early detection for both cancer and heart disease, leading to lower mortality risk, physicans fall between the cracks when it comes to diagnosing depression. The stigma around the illness may be a roadblock for all sufferers seeking help, especially physicians.

“The culture of medicine often rewards and admires selflessness to the point of viewing asking for help or taking time for oneself as being a weakness,” said Lepisto. “Cultural attitudes like these promote physician burnout, depression and at times, unfortunately, suicide.”

While physicians are generally perceived to enjoy comfortable financial status, respect in the community, career opportunities that often go beyond the medical profession (e.g., becoming medical experts for media, submitting articles for publication in journals), an equal number of stressors should be considered.

Q&A with Dr. Lepisto (sidebar)In some cases, there is lingering debt from medical school. Plus long work hours isolate physicians from supportive networks, making it hard to discern whether or not colleagues are withdrawing from friends and family as a result of depression or because they’re simply immersed in their demanding careers.

“Physicians derive their greatest satisfaction and joy from relationships with patients. With more technology, demands on time, and other administrative/paperwork tasks, patient time and relationships can suffer,” Lepisto said.

The difficult decisions physicians and those in training face each day also contribute to depressive symptoms. The perception that one error could sabotage a lifetime of hard work certainly doesn’t help. When a job is also a calling – as most physicians would describe their careers – there never seems to be enough down time to truly distance oneself from the demands. Like Robin Williams, physicians might feel the need to be always “on”: always ready to give advice, to have the answer, to save the day. The job becomes their identity.

Throw in the daily face-off with mortality, the inevitable changes in workplace necessary to secure residencies and higher education, and the potential for harsh treatment by professors and others in the medical field, and it’s no wonder those training to be physicians are at a higher risk for developing depression.

Even positive changes, such as job advancement and participation in research, may trigger job-related stress and begin a downward spiral.

So how can one ward off these grim statistics in the medical community? While it’s no simple task, it is one for which physicians are highly trained, so long as they are willing to turn their training upon themselves.

The first step is to recognize the threat. Then diligence must be employed to spot symptoms and recommend treatment. Physicians and medical students should watch out for colleagues, since they are the only ones who truly understand the demands of the profession. Finally, the stigma surrounding mental disorders must be removed to clear the way for better communication about family history and other risk factors. Seeking treatment must never endanger a physician’s reputation or be taken as a sign of weakness.

After all, mental and physical well-being have a symbiotic relationship. Preventative mental measures are as vital as other mandated health screenings in determining whether physicians defy the statistic. With a concerted effort and support from peers, family and patients, all physicians can learn to recognize the warning signs before the face of suicide appears in the mirror.

Warning signs and risk factors

According to the American Foundation for Suicide Prevention, people who kill themselves exhibit one or more warning signs, either through what they say or what they do. The higher the number of warning signs, the higher the risk.

Warning Signs: What they say

If a person talks about any of the following, then he or she may be considering suicide.

  • Killing themselves
  • Having no reason to live
  • Being a burden to others
  • Seeking revenge
  • Feeling trapped
  • Unbearable pain

Warning Signs: What they do

If a person’s behavior includes some of the following, then he or she may be considering suicide, especially if the behavior is new or increased – or if it is related to a painful event, loss or change.

  • Increased use of alcohol or drugs
  • Looking for a way to kill themselves, such as searching online or buying a gun
  • Acting recklessly
  • Withdrawing from activities
  • Sleeping too much or too little
  • Visiting or calling people to say goodbye
  • Giving away prized possession
  • Suffering from panic attacks

Environmental Risk Factors:

  • Contagion, including exposure to another person’s suicide, or to graphic or sensationalized accounts of suicide
  • Access to lethal means, including firearms and drugs
  • Prolonged stress factors, such as harassment, bullying, relationship problems, and unemployment
  • Stressful life events, such as a death, divorce, or job loss

Medical Risk Factors:

  • Mental health problems
  • Alcohol and drug abuse

Historical Risk Factors:

  • Previous Suicide Attempts
  • Family History of Suicide Attempts

How to help

If you suspect someone is at risk for suicide:

  • Take it seriously.
  • Do not leave them alone.
  • Have them call the Suicide Prevention Lifeline: 1-800-273-TALK (8255).
  • Help them remove lethal means like firearms and drugs.
  • Call or escort them to an emergency room, counseling service, or psychiatrist.
  • In an emergency, call 911.

Source: American Foundation for Suicide Prevention, Warning Signs and Risk Factors. Available here: (Retrieved 11-SEP-2014)


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Jennifer M. Kreft is a writer from Oxford, Michigan.