Suicide of Doctors During the COVID-19 Pandemic

Prim Care Companion CNS Disord 2021;23(1):20com02867

To cite: Uvais NA. Suicide of doctors during the COVID-19 pandemic. Prim Care Companion CNS Disord. 2021;23(1):20com02867.
To share: https://doi.org/10.4088/PCC.20com0286

© Copyright 2021 Physicians Postgraduate Press, Inc.

^aDepartment of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
*Corresponding author: N. A. Uvais, MBBS, DPM, Iqraa International Hospital and Research Centre, Malaparamba, Calicut, Kerala, India (druvaisna@gmail.com).

The coronavirus disease 2019 (COVID-19) pandemic has pushed health care systems across the globe to their breaking point and health care professionals, especially doctors, are experiencing unprecedented levels of psychological stress while working with their patients.¹ Health care professionals experience higher levels of work stress than the general population, even under normal circumstances, and studies^2,3 have reported a significantly higher risk of suicide among health care professionals compared with other occupational groups. The suicide of a New York City physician caring for COVID-19 patients has been widely discussed recently.⁴ Work-related stress has been found to be a common factor among physicians who complete suicide, and many of them might also have undiagnosed or untreated mental illness.⁵ The COVID-19 pandemic has put doctors under significant pressure, as there is an exponential increase in patient numbers. Moreover, many doctors, especially in developing countries, perceive a greater risk of contracting the infection from their patients due to the shortage of personal protective equipment (PPE). Stigma, the risk of transmitting infection to loved ones, moral injury, burnout, and posttraumatic stress disorder are other factors compounding stress levels and the risk of suicide.⁶

In India, the first suicide case by a 24-year-old postgraduate doctor in the department of orthopedics was reported in Chennai City on July 21, 2020.⁷ According to media reports, the physician was directly involved in handling COVID-19 cases and was seen working with patients until 1:30 am on the day of the suicide.⁷ He ended his life by jumping from the third floor of the hostel where he was staying. Although, police registered a case of unnatural death and investigations are ongoing, the media reported a few internal social media chats of doctors working in the same hospital expressing work pressure as the cause leading to suicide.⁷

Although there are other physician suicide cases that have been reported during the pandemic, it is believed that this is the first case for which the primary reason for the suicide was COVID-19 work-related stress.^8,9 The doctor was working in one of the most COVID-19–affected districts in Tamil Nadu (India), with 88,377 cases and 1,475 deaths as of July 22, 2020. Given the steady increase in COVID-19 cases across India, there is reason to believe that physician work stress will increase significantly. Thus, there is an urgent need for preventive strategies to avoid physician suicide occurring in the coming months.

Interventions to manage physician stress and suicide should be planned at governmental, organizational, peer group, and individual levels to be effective. Governments should provide adequate manpower, testing facilities, and enough PPE at all COVID-19 treatment facilities so that doctors can work in a comfortable environment. At the organizational level, employers should support physicians by providing the highest-quality PPE and care for those doctors who become ill.¹⁰ Hospitals should also extend medical and financial support for doctors’ families. Leaders of the organizations should also appreciate the hard work done by doctors during the  COVID-19 pandemic and communicate effectively with them to reduce work-related stress.¹⁰ Proactive steps have to be taken at the organizational level to reduce stigma faced by doctors and their families during this crisis. Peer groups can also play a significant role not only in reducing stress, stigma, and burnout, but also in preventing moral injury. Doctors should be able to consult their peers using video-conferencing technology to reduce professional isolation and ethical dilemmas regarding critical clinical decisions.⁶ At the individual level, doctors should be aware of their mental state and be proactive in seeking help from colleagues, senior staff members, or mental health professionals if they feel excessive stress and suicidal thoughts. There is evidence for various psychological interventions such as cognitive-behavioral therapy and mindfulness-based interventions in reducing work stress and suicide ideation, and there are many online platforms providing such help.¹⁰ Those doctors with preexisting mental health problems should consult mental health professionals for adequate treatment of their illness either through psychotherapy or pharmacotherapy.

Received: November 14, 2020.
Published online: February 18, 2021.
Potential conflicts of interest: None.
Funding/support: None.