Suicide among Indian doctors – High Incidence

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One of the major public health problems worldwide today is suicide. Every year, there are about 1million suicides and 10 to 20 million attempted suicides. In the USA, suicide is the third-largest cause of death in the age group of 10 to 24 years. The suicide index in India is the highest in the world, as about 21% of the total suicides committed around the world happen in India! This has only increased in the last two decades. At the rate it is increasing, there will come a day when suicide will become the number one killer in India.

It is a well-known fact that doctors often do shifts that sometimes last 24 hours without any break or time to eat in between. Practicing physicians and medical students sometimes have to bear punishing workloads. They may also end up taking the blame if something goes wrong or even become frustrated with the changing work culture. There is another fact that is no longer a secret for many in the medical community – the high suicide rate amongst professionals and medical students. According to evidence, doctors are about 1.87 times as likely to commit suicide than those in other areas of work.

There has recently been an increase in the rate of suicides among medical professionals (students and doctors). In India, about 37.8% suicides happen in the age group of 15 to 29 years and 51% of these are committed by students and young professionals, the future of our country. In a study conducted in 1996, and again in 2005, it was found that the rate of committing suicide is more likely in female physicians than the males. Medical professionals are also not very comfortable seeking help for the fear of losing licenses or simply because of the feeling that patients may not trust them with their life.

A look at the factors leading to suicide

Medical students often suffer from depression. Their training is extremely taxing and can take a toll on their mental and physical health. A student may have been a topper in school but things change when they enter medical college. Not being able to score as well can also lead to depression after a point. It is estimated that about 15% to 30% of the medical students and residents suffer from depression. In a study, it was found that a large number of students either contemplated suicide or actually attempted it! Many students resort to non-prescription drug use such as eating painkillers or antidepressants. This could be another factor. Here is a look at some of the risk factors in various groups.

1) Students: lack of competence, poor performance and failing repeatedly in exams, problems with the medium of instruction, use of drugs and painkillers, inability to cope with the stress of studies or practical work. 2) Residents: stress due to long working hours of residency, ragging and harassment by seniors, not getting their choice of subjects, use of drugs and painkillers 3) Senior Doctors: stress of professional life, reputation at stake, self-medication, and inability to recognize the symptoms of depression or fatigue Some warning signs It is possible to avert many a suicide attempt if the warning signs are recognized at the onset. Here are some signs to watch out for. 1) Extreme anxiety or depression, insomnia, agitation, loss of interest in activities, a feeling of hopelessness, persistent negative thoughts, etc. 2) Isolation, self-criticism, self-hatred, despair, and no desire to live 3) Desire to make a will, sudden purchase of things like a gun, rope, pills, or anything else signifying suicidal tendencies. What can be done? It is important to address the concerns of students and healthcare professionals and identify the signs of depression, etc. in the early stages if suicides are to be prevented. 1) Time for rest and recreation: Stress and long working hours can cause burnout. This is one of the main reasons for physical and mental attrition. There should be adequate manpower for staff to work in shifts and get enough rest and recreation. 2) Medical students and patients should take care to indulge in physical activities in order to keep fit. They should take care to eat healthy and accept support and help from peers and family. They should also not feel hesitant in asking for professional help if they suffer from depression. 3) Small groups can be made in colleges, which can meet regularly to discuss the issues that students or seniors face in their day-to-day life. Picnics can be organized to have some time off from the heavy schedule. 4) Colleges and hospitals can have Suicide Hotline / Counseling Services 5) Doctors are aware of what medications to take and this use of non-prescription drugs should be regulated through appropriate measures.

Every medical professional is different. Most doctors usually will have a below-average likelihood of committing suicide. This is because they take good care of their physical and mental health, being in the profession that they are.

Having said this, it is still important for the medical students and professionals to feel empowered to voice their doubts and fears. It is good to vent feelings: be it about the sadness that engulfed you while signing a death certificate, or about an incorrect prescription made, or the embarrassment of not knowing an answer in class.

Dr K.K Aggarwal and Nilesh Aggarwal