STRESS AND SUICIDAL IDEATION IN HEALTHCARE PROFESSIONALS

Suicide rates among healthcare professionals have reached staggering levels. Therefore, experts are warning healthcare systems to focus more on emotional support programs designed to reduce stress, burnout, and compassion and empathy fatigue (Chard, 2021).

A study conducted by the University of Michigan determined that the incidence of death by suicide between 2017–2018 (per 100,000) was:

• Nurses: 17.1 (women), 31.1 (men)
• Physicians: 10.1 (women), 31.5 (men)
• General population: 8.6 (women), 32.6 (men)
  (Davis et al., 2021)

In any given year, almost 7% of physicians report suicidal ideation or impulses (Chard, 2021). Female nurses die by suicide at about twice the rate of females in the general population. One of the strongest characteristics linked to nurse suicide is workplace problems (Davidson et al., 2020).

Risk Factors for Suicidal Ideation

The risk factors for suicidal ideation among healthcare professionals can be subdivided into the categories of workplace stressors and home-life stressors:

Workplace stressors:

• Shift work/working hours
• Management issues
• Lateral violence (horizontal violence)
• Workplace conflict
• Inadequate preparation for role

Home life stressors:

• Financial stressors
• Relationship stressors
• Drug/alcohol use by self, family, and/or significant others
• Being the primary caregiver for children and/or parents
• Lack of an adequate support system
  (Davidson et al., 2020)

Warning Signs of Suicidal Ideation

The American Foundation for Suicide Prevention has published the following list of warning signs for suicide attempts:

SUICIDE WARNING SIGNS

(AFSP, 2021)
Verbal comments (topics an individual talks about)	Killing or hurting oneself Feeling hopeless Having no reason to live Feelings about being a burden to others Feeling trapped Having unbearable pain
Behaviors	Increased drug and alcohol use Investigating how to die by suicide Withdrawing from social activities Isolating from family and friends Sleep disturbances Communicating with people to say goodbye Giving away prized possessions Aggression Fatigue
Moods	Depression Anxiety Irritability Humiliation Shame Agitation Anger

It is also important to take note if a coworker has a sudden improvement in mood and behaviors. This may indicate that the person has made the decision to die by suicide and is relieved about the decision.

What to Do When Someone Is Suicidal

Healthcare professionals begin an assessment for potential suicide by asking the individual direct questions about suicidal thoughts or feelings. Asking direct questions will not prompt someone do something that is self-destructive. On the contrary, it may help the healthcare professional to identify persons at risk for death by suicide. Examples of questions to ask include:

• Are you thinking about hurting yourself?
• Have you ever thought about suicide?
• Are you thinking about dying?
• Do you have a plan to harm yourself?
• Do you have access to weapons or things that can be used to harm yourself?
  (Mayo Clinic, 2018)

It is also important to be alert to warning signs described previously. If someone is on the verge of death by suicide, immediate help is needed.

• Do not leave the person alone.
• Call 911. The person needs emergency intervention.
• Assess whether the person is under the influence of drugs or alcohol or has taken an overdose.

If someone talks about suicide and suicide is a possibility, help should be obtained from a trained professional as quickly as possible. The person may need hospitalization until the suicidal crisis has resolved. The person is also encouraged to call a suicide hotline number (see “Resources” at the end of this course) (Mayo Clinic, 2018).