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#5 - Suicide et PROFESSIONNELS DE LA SANTÉ - 17 octobre 2011

Dans notre liste de nouveautés, nous portons une attention particulière aux professionnels de la santé, qu’ils soient médecins ou infirmières, pharmaciens ou dentistes. Ils jouent un rôle important dans la prévention, l’intervention et le traitement du suicide. Dans cette liste, nous aborderons le sujet du suicide, non pas dans la perspective de ce qu’ils peuvent faire pour leurs patients, mais bien dans la perspective où le suicide les affecte. Des articles récents traitent du sujet d’un point de vue épidémiologique, des facteurs de risque auprès de ces professions, des besoins qu’ils ont en matière de prévention, de l’impact du suicide d’un de leurs patients. Par ailleurs, une nouvelle étude épidémiologique vient d’être publiée portant sur le suicide chez les médecins québécois. Même s’ils sont des acteurs de premier plan dans la lutte contre le suicide, il ne faut pas oublier qu’ils n’en sont pas à l’abri.

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Gagné, P., Moamai, J., & Bourget, D. (2011). Psychopathology and suicide among Quebec physicians: A nested case control study . Depression Research and Treatment, 2011, 936327.
Résumé: Objective. To describe a psychiatric profile and characteristics of physicians who killed themselves in Quebec between 1992 and 2009. Method. The cases of 36 physicians (7 females and 29 males) and 36 nonphysicians who committed suicide were matched for age and gender and examined in a nested case control design. All subjects were judged as definite suicide by the Quebec Coroner Head Office. Consensus regarding DSM-IV diagnoses was established by two forensic psychiatrists. Results. Rates of all Axis I diagnoses were 83% for physicians and 91% for nonphysicians at the time of suicide. Major depressive disorders were the most frequently observed pathology in both groups (61% and 56%, resp.). Conclusions. Physicians and nonphysicians who committed suicide in Quebec suffered from the same type of psychiatric disorder at the time of killing themselves. The findings advocate strongly for more efficient suicide prevention measures including early detection and treatment of mood disorders for the physicians.
http://dx.doi.org/10.1155/2011/936327

Therrien, P. (2011). Le suicide chez les médecins. Santé inc., 7(5), 24-27.
Résumé: C'est une tendance forte observée depuis les 40 dernières années. Dans tous les pays où l'on a pris la peine de se pencher sur le sujet, le taux de suicide des médecins par rapport au reste de la population se maintient à un niveau alarmant. Symptôme extrême d'une culture institutionnelle qui pousse trop souvent ses meilleurs éléments au bout du rouleau, le suicide des médecins a longtemps été un tabou impénétrable, ce qui a contribué à perpétuer un mal de vivre chez un nombre trop élevé de soignants. Heureusement, le stigmate commence à s'atténuer; des solutions se présentent pour contrer la détresse et permettent d'éviter des fins de vie tragiques.
http://www.santeinc.com/file/mai11-05.pdf

Chocard, A. S., & Juan, F. (2007). Suicide et tentatives de suicide chez les médecins. La Lettre du Psychiatre, 3(1-2), 10-14.
Résumé: Si on ne retrouve pas de données épidémiologiques françaises sur le suicide chez les médecins, il existe de nombreuses études étrangères qui permettent d’objectiver l’importance de ce phénomène. La majorité de ces travaux rapportent un taux de suicide plus élevé chez les médecins que dans la population générale. Après une synthèse des données de la littérature sur le suicide des médecins en fonction du sexe, de la tranche d’âge, du type d’exercice, des moyens employés pour se suicider et de l’association, dans certains cas, à des troubles psychiques, la spécifcité de la personnalité du médecin et les “risques” de la profession médicale sont abordés. La difficile prise en charge des médecins suicidants et/ou suicidaires est soulignée. Quelques pistes de réfexion sur la prévention du suicide en milieu médical sont proposées.
http://www.edimark.fr/publications/articles/suicide-et-tentatives-de-suicide-chez-les-medecins-ndash-suicide-and-suicide-attempts-among-physicians/12900


Aasland, O. G., Hem, E., Haldorsen, T., & Ekeberg, O. (2011). Mortality among Norwegian medical doctors 1960-2000. BMC Public Health, 11(1), 173.
Résumé: BACKGROUND: To study the mortality pattern of Norwegian doctors, people in human service occupations, other graduates and the general population during the period 1960-2000 by decade, gender and age. The total number of deaths in the study population was 1 583 559. METHODS: Census data from 1960, 1970, 1980 and 1990 relating to education were linked to data on 14 main causes of death from Statistics Norway, followed up for two five-year periods after census, and analyzed as stratified incidence-rate data. Mortality rate ratios were computed as combined Mantel-Haenzel estimates for each sex, adjusting for both age and period when appropriate. RESULTS: The doctors had a lower mortality rate than the general population for all causes of death except suicide. The mortality rate ratios for other graduates and human service occupations were 0.7-0.8 compared with the general population. However, doctors have a higher mortality than other graduates. The lowest estimates of mortality for doctors were for endocrine, nutritional and metabolic diseases, diseases in the urogenital tract or genitalia, digestive diseases and sudden death, for which the numbers were nearly half of those for the general population. The differences in mortality between doctors and the general population increased during the periods. CONCLUSIONS: Between 1960 and 2000 mortality for doctors converged towards the mortality for other university graduates and for people in human service occupations. However, there was a parallel increase in the gap between these groups and the rest of the population. The slightly higher mortality for doctors compared with mortality for other university graduates may be explained by the higher suicide rate for doctors.
http://dx.doi.org/10.1186/1471-2458-11-173

Sher, L. (2011). Towards a model of suicidal behavior among physicians. Revista Brassileira de Psiquiatria, 33(2), 111-112.
Résumé: Suicide is a disproportionate cause of death for physicians relative to both the general population and other professionals1. Death by suicide is about 70 percent more likely among male physicians in the U.S. than among other professionals, and 250-400 percent higher among female physicians. About 300-400 physicians, the equivalent of at least one entire medical school class, commit suicide in the U.S. every year. A recent international systematic review suggests that physicians' relative suicide risk is 1.1 to 3.4 for men and 2.5 to 5.7 for women when the rates are compared with those for the general population and at 1.5 to 3.8 for men and 3.7 to 4.5 for women when the rates are compared with those for other professionals1. In all reviewed studies the suicide rates among physicians were higher than those in the general population and among other academic occupational groups.
http://www.scielo.br/scielo.php?pid=S1516-44462011000200002&script=sci_arttext

Shanafelt, T. D., Balch, C. M., Dyrbye, L., Bechamps, G., Russell, T., Satele, D., et al. (2011). Special report: suicidal ideation among American surgeons. Archives of Surgery, 146(1), 54-62.
Résumé: BACKGROUND: Suicide is a disproportionate cause of death for US physicians. The prevalence of suicidal ideation (SI) among surgeons and their use of mental health resources are unknown. STUDY DESIGN: Members of the American College of Surgeons were sent an anonymous cross-sectional survey in June 2008. The survey included questions regarding SI and use of mental health resources, a validated depression screening tool, and standardized assessments of burnout and quality of life. RESULTS: Of 7905 participating surgeons (response rate, 31.7%), 501 (6.3%) reported SI during the previous 12 months. Among individuals 45 years and older, SI was 1.5 to 3.0 times more common among surgeons than the general population (P < .02). Only 130 surgeons (26.0%) with recent SI had sought psychiatric or psychologic help, while 301 (60.1%) were reluctant to seek help due to concern that it could affect their medical license. Recent SI had a large, statistically significant adverse relationship with all 3 domains of burnout (emotional exhaustion, depersonalization, and low personal accomplishment) and symptoms of depression. Burnout and depression were independently associated with SI after controlling for personal and professional characteristics. Other personal and professional characteristics also related to the prevalence of SI. CONCLUSIONS: Although 1 of 16 surgeons reported SI in the previous year, few sought psychiatric or psychologic help. Recent SI among surgeons was strongly related to symptoms of depression and a surgeon's degree of burnout. Studies are needed to determine how to reduce SI among surgeons and how to eliminate barriers to their use of mental health resources.
http://dx.doi.org/10.1001/archsurg.2010.292

Sancho, F. M., & Ruiz, C. N. (2010). Risk of suicide amongst dentists: myth or reality?International Dental Journal, 60(6), 411-418.
Résumé: OBJECTIVES: To analyse the scientific weight of the studies about reports of suicide rates in dentistry and decide the possible stressors caused by dental clinical activity, their consequences and their treatment. DISCUSSION: The previous literature treats the high suicide rate associated with the dental profession in different ways: myth for some, important statistical data which needs further research for others. The possible errors repeated in the literature as a result of not introducing certain indispensable variables are analysed and a report given of the main stressors linked to the profession. The results showed that the absence of treatment of the disorders arising from these stressors by qualified professionals along with the lack of preventative measures developed by universities and clinicians to be one of the main problems. CONCLUSIONS: In the literature we find systematically a suicide rate among dentists higher than those of other occupations. These studies lack the correct scientific weight and new studies are required that introduce the demographic variables, the psiquiatric morbidity previous to the development of the profession, the opportunity factor, the stressors not related to work and the relative emphasis to these are necessary to for the profession to decrease the risk of suicide.

Pompili, M., Innamorati, M., Narciso, V., Kotzalidis, G. D., Dominici, G., Talamo, A., et al. (2010). Burnout, hopelessness and suicide risk in medical doctors. La Clinica terapeutica, 161(6), 511-514.
Résumé: Objectives. The aim of the present study was to investigate the association between burnout and hopelessness in medical doctors. Materials and Methods. We conducted an investigation of 133 medical doctors working either in a hospital setting or in general practice to explore the relationship between the level of burnout and hopelessness, a psychometric marker for suicide risk. The participants were administered the Oldenburg Burnout Inventory (OBI) and Beck's Hopelessness Scale (BHS). Results. Burnout is an important issue in mediating the level of hopelessness. Doctors with high hopelessness had higher scores on the disengagement factor, and on the exhaustion factor than doctors with low hopelessness. A multivariate regression analysis confirmed that disengagement and exhaustion are significant predictors of the BHS scores. Conclusions. People in charge of workers' health should pay particular attention to the level of burnout in doctors, intervene with changes in the work environment and evaluate the impact of such procedures.

Skegg, K., Firth, H., Gray, A., & Cox, B. (2010). Suicide by occupation: does access to means increase the risk?Australian and New Zealand Journal of Psychiatry, 44(5), 429-434.
Résumé: OBJECTIVE: To examine suicide by identified occupational groups in New Zealand over a period of 30 years, focusing on groups predicted to have high suicide rates because of access to and familiarity with particular methods of suicide. METHOD: Suicide data (including open verdicts) for the period 1973-2004 were examined, excluding 1996 and 1997 for which occupational data were not available. Occupational groups of interest were dentists, doctors, farmers (including farm workers), hunters and cullers, military personnel, nurses, pharmacists, police and veterinarians. Crude mortality rates were calculated based on numbers in each occupational group at each quinquennial census, 1976-2001. Standardized mortality ratios were calculated using suicide rates in all employed groups (the standard population). RESULTS: Few of the occupations investigated had high risks of suicide as assessed by standardized mortality ratios, and some were at lower risk than the total employed population. Standardized mortality ratios were elevated for male nurses, female nurses, male hunters and cullers, and female pharmacists. Doctors, farmers and veterinarians were not at high risk, and men in the police and armed forces were at low risk. Access to means appeared to have influenced the method chosen. Nurses, doctors and pharmacists were more likely to use poisoning than were other employed people (3, 4 and 5 times respectively, compared with all others employed). Farmers and hunters and cullers were more than twice as likely as all others employed to use firearms. CONCLUSIONS: Access to means may be less important in some circumstances than in others, perhaps because of the presence of other factors that confer protection. Nevertheless, among the groups we studied with access to lethal means were three groups whose risk of suicide has so far received little attention in New Zealand: nurses, female pharmacists, and hunters and cullers.
http://dx.doi.org/10.3109/00048670903487191

Hawton, K., Agerbo, E., Simkin, S., Platt, B., & Mellanby, R. J. (2011). Risk of suicide in medical and related occupational groups: A national study based on Danish case population-based registers. Journal of Affective Disorders, 134(1-3), 320-326.
Résumé: BACKGROUND: Suicide risk may be elevated in 'medical' occupational groups, although results of studies are inconsistent. National data are required to examine this issue. It is also important to investigate the possible contribution of psychiatric disorder and access to specific suicide methods. METHODS: In a nested case-control design we used data from Danish national registers for 1981-2006 to examine risk of suicide in nurses, physicians, dentists, pharmacists and veterinary surgeons compared to teachers and the general population, and associations with psychiatric service contact and suicide methods. RESULTS: Crude age- and gender-adjusted rate ratios for suicide compared to teachers were significantly elevated in nurses, physicians, dentists and pharmacists, but not veterinary surgeons. Risk was also elevated in nurses, physicians and dentists compared with the rest of the general population, the relative risk increasing following adjustments for psychiatric service contact, marital status, gross income and labour market status. Results were similar in both genders. The elevated risk in nurses and dentists decreased during the study period. Elevated risks were not associated with greater psychiatric service contact. Medicinal drugs were commonly used for suicide by nurses, physicians and pharmacists. LIMITATIONS: The study was based in one country. CONCLUSIONS: Risk of suicide is increased in nurses, physicians, dentists and pharmacists in Denmark. This is not reflected in excess psychiatric service contact. Ready access to medicinal drugs may influence risk in nurses, physicians and pharmacists.
http://dx.doi.org/10.1016/j.jad.2011.05.044

Dyrbye, L. N., Harper, W., Durning, S. J., Moutier, C., Thomas, M. R., Massie, F. S., et al. (2011). Patterns of distress in US medical students. Medical Teacher, 33(10), 834-839.
Résumé: Background: How multiple forms of psychological distress coexist in individual medical students has not been formally studied. Aim: To explore the prevalence of various forms of distress in medical students and their relationship to recent suicidal ideation or serious thoughts of dropping out of school. Methods: All medical students at seven US schools were surveyed with standardized instruments to evaluate burnout, depression, stress, mental quality of life (QOL), physical QOL, and fatigue. Additional items explored recent suicidal ideation and serious thoughts of dropping out of medical school. Results: Nearly all (1846/2246, 82%) of medical students had at least one form of distress with 1066 (58%) having >/=3 forms of distress. A dose-response relationship was found between the number of manifestations of distress and recent suicidal ideation or serious thoughts of dropping out. For example, students with 2, 4, or 6 forms of distress were 5, 15, and 24 fold, respectively, more likely to have suicidal ideation than students with no forms of distress assessed. All forms of distress were independently associated with suicidal ideation or serious thoughts of dropping out on multivariable analysis. Conclusions: Most medical students experience >/=1 manifestation of distress with many experiencing multiple forms of distress simultaneously. The more forms of distress experienced the greater the risk for suicidal ideation and thoughts of dropping out of medical school.
http://dx.doi.org/10.3109/0142159x.2010.531158

Dyrbye, L. N., & Shanafelt, T. D. (2011). Commentary: medical student distress: a call to action. Academic Medicine, 86(7), 801-803.
Résumé: Studies have found a high prevalence of psychological distress among medical students both in the United States and abroad. Distress among medical students has serious professional ramifications, including damaging effects on empathy, ethical conduct, and professionalism, as well as personal consequences such as substance abuse, broken relationships, and suicidal ideation. Given the effect of physician distress on quality of care, self-care (including personal appraisal of well-being, wellness promotion, and recognition of when help is needed) should be recognized as a core competency for physicians. In this issue of Academic Medicine, investigators at the Northwestern University Feinberg School of Medicine explore the benefits of teaching students to employ a cognitive behavioral approach to improving self-care. Beyond its demonstrated short-term efficacy, the approach they propose also has potential to help students develop the skills necessary to assess and promote resilience throughout their careers. Medical schools' responsibility to promote student wellness, however, goes beyond teaching students self-care skills and includes establishing an appropriate organizational culture and learning environment to promote student health. Achieving competency in self-care is a shared responsibility of the individual physician/resident/medical student and the organizational environment in which he or she functions.
http://dx.doi.org/10.1097/ACM.0b013e31821da481

Takahashi, C., Chida, F., Nakamura, H., Akasaka, H., Yagi, J., Koeda, A., et al. (2011). The impact of inpatient suicide on psychiatric nurses and their need for support. BMC Psychiatry, 11, 38.
Résumé: BACKGROUND: The nurses working in psychiatric hospitals and wards are prone to encounter completed suicides. The research was conducted to examine post-suicide stress in nurses and the availability of suicide-related mental health care services and education. METHODS: Experiences with inpatient suicide were investigated using an anonymous, self-reported questionnaire, which was, along with the Impact of Event Scale-Revised, administered to 531 psychiatric nurses. RESULTS: The rate of nurses who had encountered patient suicide was 55.0%. The mean Impact of Event Scale-Revised (IES-R) score was 11.4. The proportion of respondents at a high risk (>/= 25 on the 88-point IES-R score) for post-traumatic stress disorder (PTSD) was 13.7%. However, only 15.8% of respondents indicated that they had access to post-suicide mental health care programmes. The survey also revealed a low rate of nurses who reported attending in-hospital seminars on suicide prevention or mental health care for nurses (26.4% and 12.8%, respectively). CONCLUSIONS: These results indicated that nurses exposed to inpatient suicide suffer significant mental distress. However, the low availability of systematic post-suicide mental health care programmes for such nurses and the lack of suicide-related education initiatives and mental health care for nurses are problematic. The situation is likely related to the fact that there are no formal systems in place for identifying and evaluating the psychological effects of patient suicide in nurses and to the pressures stemming from the public perception of nurses as suppliers rather than recipients of health care.
http://dx.doi.org/10.1186/1471-244x-11-38

Davidsen, A. S. (2011). 'And then one day he'd shot himself. Then I was really shocked': General practitioners' reaction to patient suicide. Patient Education and Counselling, 85(1), 113-118.
Résumé: OBJECTIVE: Patients who commit suicide have often seen their GP shortly before the suicide. This study explored the emotional effect of patients' suicides on GPs, and whether this effect was linked to the GPs' propensity to explore suicide risk. METHODS: Semi-structured interviews were carried out with 14 GPs sampled purposively aiming at maximum variation. Analysis by Interpretative Phenomenological Analysis. RESULTS: Patients' suicides had a substantial emotional effect on all GPs. Some developed a feeling of guilt and of having failed. If patients had contacted the GP about physical symptoms and the suicide ideation had not been diagnosed, this led to considerable self-scrutiny. GPs differed in their propensity to explore suicide ideation, but all were emotionally shaken and struck by guilt, failure, and self-scrutiny if a patient committed suicide. CONCLUSION: A patient's suicide can be experienced as a 'critical case' that greatly affects all GPs irrespective of other differences among the GPs. The feeling of insufficiency was linked to not having realized during the visit that the patient may have had suicidal thoughts. PRACTICE IMPLICATIONS: GPs' need for support in emotionally stressful situations should be investigated, and training should be directed towards discovering suicide ideation masked by vague physical symptoms.
http://dx.doi.org/10.1016/j.pec.2010.08.020

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