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| JOURNAL SCAN |
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| Year : 2023 | Volume
: 4
| Issue : 1 | Page : 88-90 |
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Suicide deaths among medical students, residents and physicians in India
K Tushar, Samiran Nundy
Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| Date of Submission | 19-Feb-2023 |
| Date of Decision | 22-Feb-2023 |
| Date of Acceptance | 28-Feb-2023 |
| Date of Web Publication | 26-Apr-2023 |
Correspondence Address:
Dr. K Tushar
Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JME.JME_25_23
How to cite this article:
Tushar K, Nundy S. Suicide deaths among medical students, residents and physicians in India. J Med Evid 2023;4:88-90 |
| Article Information | |  |
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.
| Background | | |
According to the World Health Organization,[1] India's suicide rate in 2019 was 12.9/100,000 people and was much higher than the global average suicide death rate of 9/100,000 population. India also had the highest suicide rate for females (11.1) and the second highest suicide rate for males (14.7) in the South-East Asian region, second only to Sri Lanka with (20.9% male suicide rate). Medical students and physicians are at a higher risk of suicide than the general population[2] attributable to academic pressure, work stress, burnout and depression, especially in younger physicians. Doctors in India also have to choose to work in an uncaring, underfunded public system or in rapacious private hospitals, where they witness patients dying or leaving against medical advice because they cannot afford the treatment offered or, the other spectrum, rude patients and their relatives.
India has imprecise death registration system and it was difficult to extract accurate suicide statistics on medical students and physicians from the National Crime Records Bureau due to the use of broad category descriptors in its data. Hence, the authors of the present study had to take a painstakingly broader route of going through reports on doctor suicides carried out on online news portals and publicly available websites. The inclusion criteria were limited to MBBS doctors and specialists, who were Indian citizens and pursuing medical education in Indian medical colleges or working in India.
A list of all leading Indian online news portals in the English and Hindi languages between January 2010 and December 2019 was prepared and each of them was thoroughly searched for news of suicides amongst medical students, residents and physicians retrospectively using the search query 'doctor suicides'. A detailed list of all Indian medical colleges in the states and union territories was obtained from the site of the Medical Council of India and the Government of India. The Google database was also searched individually for each medical college and each state and union territory of India. Two of the authors individually extracted the data from the links and thoroughly screened for their eligibility criteria.
They excluded attempted suicide, suicide by dentists, physicians of the allied health sciences, doctors serving in the armed forces and non-resident Indian physicians. Further, autopsy results ruling out suicide and dubious cases not clear whether it was suicide, homicide or an accident were not included in the study.
A total of 2081 links were explored and 358 suicide deaths were found to be in accordance with the eligibility criteria. The demographic distribution showed that 125 medical students, 105 resident doctors and 128 practicing physicians committed suicide during this period.
A higher male-to-female ratio was found (1.7:1) amongst students and practicing physicians while the 'residents' group had more females. Another finding amongst the practicing physicians was that a lot of the females were young (7 out of 10 were <30 years of age) compared to their male counterparts. The regional distribution showed Andhra Pradesh to have the largest number of suicides amongst students. Amongst residents, Delhi had the most followed by Maharashtra, and amongst physicians, Uttar Pradesh, Maharashtra and Tamil Nadu reported the maximum number of suicides.
With regard to the means of suicide, hanging was the most common. Non-violent methods (poisoning) were found more amongst residents (40.0%) and physicians (36.7%), and amongst the specialities, anaesthesiology had the largest number of suicides followed by obstetrics and gynaecology. Twenty-six per cent had exhibited suicide warning signs and only 13% had ever sought psychiatric help before ending their lives. A total of nine reports of a suicide pact were found with the average deaths per pact being 2.4 and predominantly driven by financial reasons.
Putative reasons were enlisted and, unsurprisingly amongst medical students, academic stress was the most important reason followed by mental health problems. With respect to the residents, academic stress was again the most common reason followed by harassment at their place of work. Amongst physicians, marital discord topped the list followed closely by mental health problems.
| Discussion | | |
Six doctors, from different parts of India and from different specialities, have published this important yet piteous paper entitled 'Suicide deaths amongst medical students, residents and physicians in India, spanning a decade' in a very reputable journal which has an impact factor of more than 10. Their unique study has been designed and compiled meticulously with in-depth details regarding the manner of deaths, demographics and putative reasons.
Doctors everywhere in the world often work under stressful conditions, often expecting them to make life-or-death decisions under considerable pressure. With increasing expectations from the patients and the society, these pressures have only risen. For a few decades, it has been reported that the rates of psychiatric disorders, especially suicide, are considerably higher in doctors than the general population. The literature reflects that medical students are also at a high risk of suicide. India has the world's largest medical education system but lacks definite, structured working hours and conditions. Hence, such a paper outlining suicidal deaths amongst medical students, residents and practicing physicians, is the need of the hour.
Even though suicide amongst doctors gets reported in Indian media, this fact usually does not greatly interest the common public and hence will barely make the headlines. There are very few scientific studies which detail the mental health and suicides amongst doctors in India, mostly due to the fact that the death registry fails to incorporate key details regarding the cause, manner, work demographics, etc.
Suicidal ideation, i.e. having suicidal thoughts, is regarded as one of the most important variables in predicting suicide and a lot of papers published outside India, elaborate about suicidal ideation. Burnout and longer work hours were attributed to most suicidal ideations in a study from Japan[3] whereas depression was the most important reason in Ethiopia.[4] Long working hours which increased the risk of mental health problems, and hence the risk of suicide, was reported by a paper from Australia.[5]
Warning signs were exhibited in 93 out of 358 Indians before committing suicide in this study and 6% had attempted suicide in the past. Suicidal ideations were also noted in 5.6% in Japan,[3] 12.3% in Australia,[5] 8% in Canada[6] and 23.7% in Ethiopia.[4]
The Japanese study includes a term called 'Karoshi', which means death from overwork. It is used irrespective of the kind of occupation in Japan due to the work pattern and stress amongst workers. Working over 60 h/week over a period of several months is considered an occupational hazard and criteria for 'Karoshi' because it is strongly associated with the development of mental disorders and cardiovascular disease owing to the psychological burden. It is vital to have a similar concept and a definition for the Indian subcontinent as the work hours regularly range between 72 and 110 h/week. Deaths due to sudden cardiac arrests have been increasing amongst young doctors in the country and are probably being mislabelled as genetic or lifestyle related rather than occupational.
According to an article published in the Canadian Medical Association Journal, it was estimated that about 400 doctors die by suicide in the United States each year, but it is difficult to be certain as many deaths may have been mislabelled as 'accidents'. Dr. Pamela Wible, a family physician, noted over 700 suicides in the past 5 years amongst physicians in her extended network. Medical schools and hospitals in the USA do not track or investigate these deaths.[6] In the United Kingdom, 430 doctors committed suicide between the years 2011 and 2015.[7] In China, 51 doctors committed suicide between the years 2008 and 2016.[7]
Mental health and suicidal ideations amongst doctors have not been studied or reported enough to significantly affect the outcomes such as seeking professional help. Studies overseas have meticulous tools such as the Japanese Burnout Scale derived from the Maslach Burnout Inventory, General Health Questionnaire-28 in Australia and Depression, Anxiety and Stress Scale used in Ethiopian study which standardises the response and helps bring out statistically significant results.
Suicide amongst young doctors is a major loss to any society. In one of the largest populated countries of the world, i.e. India, where a large segment of the population still has limited access to healthcare and there is a dire shortage of doctors, we cannot afford to lose potential and qualified doctors to a preventable and avoidable cause such as suicide. Our authorities have shown little interest in the mental health of doctors, though some progress has been made with regard to the general public. Every suicidal death amongst doctors needs to be notified and scrutinised and attempts to rectify the leading causes have to be made. Doctors and medical students have to be screened regularly with standardised questionnaires and professional help should be made available to those in need.
The mental health issue of doctors was taken up at an annual International Practitioner Health Summit Conference in the year 2018 in London,[8] with the theme, 'The wounded healer'. Such issues need to be discussed amongst medical forums and conferences in India.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | World Health Organization. Suicide Worldwide in 2019: Global Health Estimates. Geneva: World Health Organization; 2021.  |
| 2. | Duarte D, El-Hagrassy MM, Couto TC, Gurgel W, Fregni F, Correa H. Male and female physician suicidality: A systematic review and meta-analysis. JAMA Psychiatry 2020;77:587-97. |
| 3. | Ishikawa M. Relationships between overwork, burnout and suicidal ideation among resident physicians in hospitals in Japan with medical residency programmes: A nationwide questionnaire-based survey. BMJ Open 2022;12:e056283. |
| 4. | Asfaw H, Yigzaw N, Yohannis Z, Fekadu G, Alemayehu Y. Prevalence and associated factors of suicidal ideation and attempt among undergraduate medical students of Haramaya University, Ethiopia. A cross sectional study. PLoS One 2020;15:e0236398. |
| 5. | Petrie K, Crawford J, LaMontagne AD, Milner A, Dean J, Veness BG, et al. Working hours, common mental disorder and suicidal ideation among junior doctors in Australia: A cross-sectional survey. BMJ Open 2020;10:e033525. |
| 6. | Vogel L. US doctors call for tracking of suicides among medical trainees. CMAJ 2019;191:E26. |
| 7. | Kishor M, Chandran S, Vinay HR, Ram D. Suicide among Indian doctors. Indian J Psychiatry 2021;63:279-84. [Full text] |
| 8. | Ventriglio A, Watson C, Bhugra D. Suicide among doctors: A narrative review. Indian J Psychiatry 2020;62:114-20. [Full text] |
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