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EDITORIAL

Increasing suicides in trainee doctors: Time to stem the tide!

Singh, Om Prakash1,2,

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doi: 10.4103/indianjpsychiatry.indianjpsychiatry_355_22
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There has been a recent spurt in deaths by suicide among medical professionals in India. On 8 March 2022, two medical students died by suicide at Palanpur and Vadnagar medical colleges. A medical student, who had received admission to the MD (Medicine) course at BJ Medical College, Ahmedabad, died by suicide on 10 March, within 24 hours of admission.[1] In another incident, a 21-year-old medical student of Government Medical College, Chandigarh, was found hanging in her residence on 18 April.[2] There seems to be no end to this list of untimely deaths in a country where the medical community fought tooth and nail over the last two years to save thousands of lives from the clutches of the deadly COVID-19!

India has the highest number of medical colleges in the world and one of the highest populations of doctors worldwide. Every year 80,000 medical graduates come out from 529 medical colleges in India.[3] With the government initiative of one medical college in each district, the number of medical professionals is set to increase further. Moreover, we have doctors coming back to India after graduating in medicine from other countries. It is known that medical professionals are at a higher risk of suicide than the general population. The national figures on suicide are usually obtained from the National Crime Records Bureau (NCRB). NCRB data provides an occupation-wise breakup, though there is no separate entry for medical professionals. Thus, our source of information remains news reports and published research papers based on these reports. Chahal et al.[4] explored suicidal deaths among medical professionals between 2010 and 2019 based on news reports and found that 358 deaths by suicide in 10 years, 70% of which occurred before the age of 30 years and 26% of which had shown warning signs prior to the act. Another Indian study reported 30 suicidal deaths between 2016 and 2019, 80% of which occurred in those younger than 40 years.[3] Anesthesiology as a specialty had the highest number of victims in both studies: 22.4% in the former study and 20% in the latter.[34] Academic stress, marital discord and mental health problems (mainly depression) were reported as the most important causes. Reports of physician suicides during and after the COVID pandemic surfaced across the world, including India, and several causes have been highlighted including work-related stress, risk of getting infected and transmitting the infection to near and dear ones, stigma, burnout and post-traumatic stress disorder.[5]

The time has come to take urgent steps to prevent premature loss of young and productive lives. Introduction of psychiatry and mental health issues from the very first year of the academic curriculum would go a long way in increasing awareness regarding mental health, reducing stigma and consequently increasing help-seeking behavior. Frequent sessions on stress management and how physicians should take care of their own mental health may be organized during the residency period. This will have to be done through active collaboration of college and university authorities and psychiatry departments of the medical colleges. Gatekeeper training programs have been found to be useful in building awareness among students regarding how to identify early warning signs in their friends so that they can provide proper emotional support and encourage seeking help. It was already pointed out that as much as 26% of doctors had shown warning signs prior to the suicidal act. The union and the state health authorities must take immediate steps to conduct gatekeeper training programs in medical institutions across the country and the Indian Psychiatric Society (IPS) may take leadership role in providing necessary training and manpower. This can help reduce physician suicides on campus. Fear of being stigmatized by their own colleagues often turns out to be the reason for avoiding psychiatric consultation. This issue may be addressed by departmental heads and seniors by addressing the issue confidentially with the resident and assuring full support from the department. If necessary, online sources of support and care may be provided so that confidentiality does not become a barrier in seeking help.

Academic stress is one of the major reasons for physician suicide across the country and specific changes in the system are necessary in this direction. NEXT exam is one positive step in this direction, where a single exit exam will also serve as a licensing exam as well as a gateway to postgraduate courses. Prolonged day/night shifts with disruption of sleep/wake cycle often leads to excessive stress. Hence, the departments should schedule their rosters to avoid this as much as possible.

Familial issues and marital discord have consistently been found to be an important cause of suicide among physicians. Regular seminars and workshops promoting work–life balance and providing tips for effective time management could go a long way in reducing excessive stress stemming from marital disharmony. This model could be effectively borrowed from all major corporate houses which have an effective system in place to take care of the mental health issues of their employees.

Prior to any community-level intervention, availability of good quality data is important. It is essential to develop a system of detailed reporting and audit of suicides by medical professionals. Conducting psychological autopsy of suicidal deaths by physicians will reveal much more valuable information than those available through police or newspaper reports. The IPS, in collaboration with the Indian Medical Association, could play a major role in this regard. Till such a system is in place, adding a category for medical professionals in the occupational break up of NCRB data would draw attention of the state and central governments to the rising menace of suicidal deaths among the healers of the nation!

REFERENCES

1. Medico kills self within 24 hours of getting PG admission Available from: https://timesofindia.indiatimes.com/city/ahmedabad/medico-kills-self -within-24-hours-of-getting-pg-admission/articleshow/90137198.cms [Last accessed on:2022 Apr 25]
2. MBBS student found hanging inside Sector 22 residence, police recover note, claim suicide Available from: https://indianexpress.com/article/cities/chandigarh/mbbs-student-found-hanging-inside-sector-22 -residence-police-recover-note-claim-suicide-7875914 [Last accessed on:2022 Apr 25]
3. Kishor M, Chandran S, Vinay HR, Ram D Suicide among Indian doctors Indian J Psychiatry 2020 63 279 84
4. Chahal S, Nadda A, Govil N, Gupta N, Nadda D, Goel K, et al. Suicide deaths among medical students, residents and physicians in India spanning a decade (2010–2019):An exploratory study using on line news portals and Google database Int J Soc Psychiatry 2022 68 718 28
5. Uvais NA Suicide of doctors during the COVID-19 pandemic Prim Care Companion CNS Disord 2021 23 20com02867
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