I won a grant years back to produce a podcast series from NYU’s Rudin Master Scholars Program in Ethics and Humanities. I am proud of that work. This episode never made it on the air. It is presented for your consideration. Suicide is discussed, frankly. Both my friend and guest, Lara J. Cox, M.S., M.D, and I discussed extensively that her name should be used. That personal disclosure was the healing element, as we understood it.
I presented this work on May 6th, my birthday, in 2018, at the APA annual meeting. That morning, a psychiatric resident in a local program died by suicide. It was devastating. This is a challenging disclosure to write— because of my worries about contagion effects. This issue around contagion was the difficulty in editing these stories to begin with.
These stories aimed to REDUCE suicide risk by providing stories of hope. These stories offer support for vulnerable medical trainees. Otherwise, they learn the lesson…as part of the hidden curriculum of medical training:
“It’s unsafe to talk about your struggles, even in the past.”
We lose hundreds of physicians to completed suicide every year, and the numbers on ideation are dispiriting:
A 2015 meta-analysis of 54 studies examined the prevalence of depression and depressive symptoms in resident physicians across decades and around the globe.2 They found a 15.8% increase in depressive symptoms during the first year of residency, across all specialties and countries of training. Over the course of training 20.9% to 43.2% of residents reported depressive symptoms, with symptoms increasing over time. This finding could be extrapolated to fellows, attendings, and other post-training physicians. Currently, the actual data for post-training programs is sparse. 1
When we refuse to speak—using best practices—we are also heard. I have long argued this is not the way.
The physician interviewed in my podcast above is brave, outspoken, and a personal hero. Lara J. Cox, M.S., M.D., has served on the Board of Trustees of the American Psychiatric Association and is herself a scholar2 of suicide prevention.3
Kalmoe MC, Chapman MB, Gold JA, Giedinghagen AM. Physician Suicide: A Call to Action. Mo Med. 2019 May-Jun;116(3):211-216. PMID: 31527944; PMCID: PMC6690303.
Cox LJ, Stanley BH, Melhem NM, Oquendo MA, Birmaher B, Burke A, Kolko DJ, Zelazny JM, Mann JJ, Porta G, Brent DA. A longitudinal study of nonsuicidal self-injury in offspring at high risk for mood disorder. J Clin Psychiatry. 2012 Jun;73(6):821-8. doi: 10.4088/JCP.11m07250. Epub 2012 May 15. PMID: 22687609; PMCID: PMC3563355.
Cox LJ, Stanley BH, Melhem NM, Oquendo MA, Birmaher B, Burke A, Kolko DJ, Zelazny JM, Mann JJ, Porta G, Brent DA. Familial and individual correlates of nonsuicidal self-injury in the offspring of mood-disordered parents. J Clin Psychiatry. 2012 Jun;73(6):813-20. doi: 10.4088/JCP.11m07196. PMID: 22795206; PMCID: PMC3545478.
The Once-Suicidal Psychiatrist...A Self-Disclosure, Deferred.