Ciddi, Öncelikli ve Önlenebilir Bir Halk Sağlığı Sorunu: Ölümle Sonuçlanan Hekim İntiharları
Özet
İntihara bağlı ölümler ülkemizde ve tüm dünyada her geçen gün artmakta olup, ciddi, öncelikli ve önlenebilir bir halk sağlığı sorunu olarak karşımıza çıkmaktadır. İntiharın sebepleri tam olarak anlaşılmamış olup, birçok faktör intihar eylemleri için risk oluşturmaktadır. Hekimler ve diğer sağlık çalışanları da intihar eylemleri için riskli grupta yer almaktadır. Hekimlerin intihar oranları genel popülasyona göre oldukça yüksektir. Bu çalışmamızda olayın ciddiyetine vurgu yaparak toplumsal farkındalık oluşturmayı, çözüm önerileri sunmayı ve literatüre katkı sağlamayı amaçladık.
Hekimleri intihara yönlendiren faktörlerin başında yoğun çalışma şartları, sağlıkta şiddet ve mesleki stres faktörlerinin tetiklediği ruhsal bozukluklar gelmektedir. Dolayısıyla hekimlerin iş yoğunluğu azaltılmalı, çevresel sorunları ve sağlıkta şiddeti önleyecek etkin politikalar geliştirilmeli, mesleki stresten kaynaklı ruhsal problemleri meslek riski olarak kabul edip destek hizmetleri güçlendirilmelidir. Ayrıca ülkemizde hekim intiharları üzerine yapılan çalışmalar ve veriler oldukça kısıtlı olup, bu konuda geniş çaplı araştırmalar ve resmi dokümantasyonlara ihtiyaç vardır.
Deaths due to suicide actions are increasing day by day in our country and all over the world, and appear as a serious, priority and preventable public health problem. The causes of suicide are not fully understood, and many factors create risks for suicidal acts. Physicians and other healthcare professionals are also in the risk group for suicide attempts. Physicians' suicide rates are significantly higher than the general population. In this study, we aimed to raise social awareness, offer solution suggestions and contribute to the literature by emphasizing the seriousness of the incident.
The main factors that lead physicians to suicide are intense working conditions, violence in healthcare, and mental disorders triggered by professional stress factors. Therefore, the workload of physicians should be reduced, effective policies should be developed to prevent environmental problems and violence in healthcare, mental problems caused by occupational stress should be accepted as a professional risk and support services should be strengthened. In addition, studies and data on physician suicides are very limited in our country, and there is a need for large-scale research and official documentation on this subject.
Referanslar
Hawton K, Saunders KEA, O’Connor RC. Self-harm and suicide in adolescents. The Lancet. 2012;379 (9834):2373-2382. doi:10.1016/S0140-6736(12)60322-5
World Health Organization. 17 June 2021 Home/Newsroom/Fact sheets/Detail/Suicide.[Online] https://www.who.int/news-room/fact-sheets/detail/suicide. [Acessed:04 th June 2023].
Turecki G, Brent DA. Suicide and suicidal behaviour. The Lancet.2016; 387(10024):1227-1239. Doi:10.1016/S0140-6736(15)00234-2
Patterson PD, Weaver MD, Frank R, et al. Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers. Prehospital Emergency Care. 2012;16(1): 86-97. doi:10.3109/10903127.2011.616261
Dutheil F, Aubert C, Pereira B, et al. Suicide among physicians and health-care workers: A systematic review and meta-analysis. PloS One. 2019;14(12). doi.org/10.1371/journal.pone.0226361e0226361
Sağlık istatistiği yıllığı 2022.[Online]. https://dosyasb.saglik.gov.tr/Eklenti/48054/0/siy202205042024pdf.pdf. [Acessed:25 th June 2023].
OECD Data. Doctors. [Online]. https://data.oecd.org/healthres/doctors.htm [Acessed:25 th July 2023].
Türkiye İstatistik Kurumu. İntihar İstatistikleri. [Online]. https://data.tuik.gov.tr/Search/Search?text=intihar&dil=1 [Acessed:5 th August2023].
Duarte D, El-Hagrassy MM, e Couto TC, et al. Male and female physician suicidality: a systematic review and meta-analysis. JAMA Psychiatry. 2020; 77(6): 587-597. doi:10.1001/jamapsychiatry.2020.0011
Duarte D, El-Hagrassy MM, Couto T, et al. Physician suicide demographics and the COVID-19 pandemic. Brazilian Journal of Psychiatry. 2022;44:124-135. doi:10.1590/1516-4446-2021-1865
Kalmoe M, Chapman MB, Gold JA, et al. Physician suicide: a call to action. Missouri Medicine. 2019; 116(3):211.
Das N, Khar P, Karia S, et al. Suicide among Health Care Professionals—An Indian Perspective. In: Healthcare. MDPI, 2022. p. 354. doi:10.3390/healthcare10020354
Aydoğdu Hİ, Balcı Y. Türkiye’de Son On Yılda Medyada Bildirilen Hekim İntiharları. Nöropsikiyatri Arşivi. 2022;59(1): 83-83.
SÖZCÜ. Haberler- sağlık. [Online]. https://www.sozcu.com.tr/bir-gun-icinde-3-doktor-yasamina-son-verdi-wp7814812 [Acessed:20th August 2023].
Torre DM, Wang NY, Meoni LA, et al. Suicide compared to other causes of mortality in physicians. Suicide and Life-Threatening Behavior. 2005;35(2):146-153.
Carpenter LM, Swerdlow AJ, Fear NT. Mortality of doctors in different specialties: findings from a cohort of 20000 NHS hospital consultants. Occupational and Environmental Medicine. 1997;54(6):388-395. doi:10.1136/oem.54.6.388
Mayall RM. Substance abuse in anaesthetists. Bja Education. 2016; 16(7): 236-241. doi.org/10.1093/bjaed/mkv054
Howard R, Kirkley C, Baylis N. Personal resilience in psychiatrists: systematic review. BJPsych Bull. 2019;43(5):209-215. doi:10.1192/bjb.2019.12
Ramesh P, Taylor PJ, McPhillips R, et al. A scoping review of gender differences in suicide in India. Front. Psychiatry. 2022;13: 884657. doi:10.3389/fpsyt.2022.884657
Yaghmour NA, Brigham TP, Richter T, et al. Causes of death of residents in ACGME-accredited programs 2000 through 2014: implications for the learning environment. Academic Medicine. 2017;92(7): 976-983. doi: 10.1097/ACM.0000000000001736
Schwenk TL. Resident depression: the tip of a graduate medical education iceberg. JAMA 2015; 314 (22):2357-2358. doi:10.1001/jama.2015.15408
Iannelli RJ, Finlayson AR, Brown KP, et al. Suicidal behavior among physicians referred for fitness-for-duty evaluation. General Hospital Psychiatry. 2014;36(6):732-736. Doi:10.1016/j.genhosppsych.2014.06.008
Sansone RA, Sansone LA. Physician suicide: a fleeting moment of despair. Psychiatry (Edgmont). 2009;6(1):18-22.
El-Hagrassy MM, Jones F, Rosa G, et al. CNS non-invasive brain stimulation. Adult and Pediatric Neuromodulation. 2018; 151-184.
Stein MK, Fryhofer GW, Blumenthal S, et al. Objects in mirror are closer than they appear: symptoms of depression and suicidality in orthopaedic surgeons. The Journal of Bone and Joint Surgery.2022; 104(11): 959-970. doi: 10.2106/JBJS.21.00666
Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). American Journal of Psychiatry. 2004; 161(12):2295-2302. Doi:10.1176/appi.ajp.161.12.2295
Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008; 336(7642):488-491. doi:10.1136/bmj.39469.763218.BE.
Tomioka K, Morita N, Saeki K, et al. Working hours, occupational stress and depression among physicians. Occupational Medicine. 2011;61(3):163-170. doi: 10.1093/occmed/kqr004
Gold KJ, Andrew LB, Goldman EB, et al. “I would never want to have a mental health diagnosis on my record”: a survey of female physicians on mental health diagnosis, treatment, and reporting. General hospital psychiatry. 2016;43:51-57. doi:10.1016/j.genhosppsych.2016.09.004
Shanafelt TD, Balch CM, Dyrbye L, et al. Special report: suicidal ideation among American surgeons. Archives of surgery. 2011; 146(1):54-62. doi:10.1001/archsurg.2010.292
Referanslar
Hawton K, Saunders KEA, O’Connor RC. Self-harm and suicide in adolescents. The Lancet. 2012;379 (9834):2373-2382. doi:10.1016/S0140-6736(12)60322-5
World Health Organization. 17 June 2021 Home/Newsroom/Fact sheets/Detail/Suicide.[Online] https://www.who.int/news-room/fact-sheets/detail/suicide. [Acessed:04 th June 2023].
Turecki G, Brent DA. Suicide and suicidal behaviour. The Lancet.2016; 387(10024):1227-1239. Doi:10.1016/S0140-6736(15)00234-2
Patterson PD, Weaver MD, Frank R, et al. Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers. Prehospital Emergency Care. 2012;16(1): 86-97. doi:10.3109/10903127.2011.616261
Dutheil F, Aubert C, Pereira B, et al. Suicide among physicians and health-care workers: A systematic review and meta-analysis. PloS One. 2019;14(12). doi.org/10.1371/journal.pone.0226361e0226361
Sağlık istatistiği yıllığı 2022.[Online]. https://dosyasb.saglik.gov.tr/Eklenti/48054/0/siy202205042024pdf.pdf. [Acessed:25 th June 2023].
OECD Data. Doctors. [Online]. https://data.oecd.org/healthres/doctors.htm [Acessed:25 th July 2023].
Türkiye İstatistik Kurumu. İntihar İstatistikleri. [Online]. https://data.tuik.gov.tr/Search/Search?text=intihar&dil=1 [Acessed:5 th August2023].
Duarte D, El-Hagrassy MM, e Couto TC, et al. Male and female physician suicidality: a systematic review and meta-analysis. JAMA Psychiatry. 2020; 77(6): 587-597. doi:10.1001/jamapsychiatry.2020.0011
Duarte D, El-Hagrassy MM, Couto T, et al. Physician suicide demographics and the COVID-19 pandemic. Brazilian Journal of Psychiatry. 2022;44:124-135. doi:10.1590/1516-4446-2021-1865
Kalmoe M, Chapman MB, Gold JA, et al. Physician suicide: a call to action. Missouri Medicine. 2019; 116(3):211.
Das N, Khar P, Karia S, et al. Suicide among Health Care Professionals—An Indian Perspective. In: Healthcare. MDPI, 2022. p. 354. doi:10.3390/healthcare10020354
Aydoğdu Hİ, Balcı Y. Türkiye’de Son On Yılda Medyada Bildirilen Hekim İntiharları. Nöropsikiyatri Arşivi. 2022;59(1): 83-83.
SÖZCÜ. Haberler- sağlık. [Online]. https://www.sozcu.com.tr/bir-gun-icinde-3-doktor-yasamina-son-verdi-wp7814812 [Acessed:20th August 2023].
Torre DM, Wang NY, Meoni LA, et al. Suicide compared to other causes of mortality in physicians. Suicide and Life-Threatening Behavior. 2005;35(2):146-153.
Carpenter LM, Swerdlow AJ, Fear NT. Mortality of doctors in different specialties: findings from a cohort of 20000 NHS hospital consultants. Occupational and Environmental Medicine. 1997;54(6):388-395. doi:10.1136/oem.54.6.388
Mayall RM. Substance abuse in anaesthetists. Bja Education. 2016; 16(7): 236-241. doi.org/10.1093/bjaed/mkv054
Howard R, Kirkley C, Baylis N. Personal resilience in psychiatrists: systematic review. BJPsych Bull. 2019;43(5):209-215. doi:10.1192/bjb.2019.12
Ramesh P, Taylor PJ, McPhillips R, et al. A scoping review of gender differences in suicide in India. Front. Psychiatry. 2022;13: 884657. doi:10.3389/fpsyt.2022.884657
Yaghmour NA, Brigham TP, Richter T, et al. Causes of death of residents in ACGME-accredited programs 2000 through 2014: implications for the learning environment. Academic Medicine. 2017;92(7): 976-983. doi: 10.1097/ACM.0000000000001736
Schwenk TL. Resident depression: the tip of a graduate medical education iceberg. JAMA 2015; 314 (22):2357-2358. doi:10.1001/jama.2015.15408
Iannelli RJ, Finlayson AR, Brown KP, et al. Suicidal behavior among physicians referred for fitness-for-duty evaluation. General Hospital Psychiatry. 2014;36(6):732-736. Doi:10.1016/j.genhosppsych.2014.06.008
Sansone RA, Sansone LA. Physician suicide: a fleeting moment of despair. Psychiatry (Edgmont). 2009;6(1):18-22.
El-Hagrassy MM, Jones F, Rosa G, et al. CNS non-invasive brain stimulation. Adult and Pediatric Neuromodulation. 2018; 151-184.
Stein MK, Fryhofer GW, Blumenthal S, et al. Objects in mirror are closer than they appear: symptoms of depression and suicidality in orthopaedic surgeons. The Journal of Bone and Joint Surgery.2022; 104(11): 959-970. doi: 10.2106/JBJS.21.00666
Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). American Journal of Psychiatry. 2004; 161(12):2295-2302. Doi:10.1176/appi.ajp.161.12.2295
Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008; 336(7642):488-491. doi:10.1136/bmj.39469.763218.BE.
Tomioka K, Morita N, Saeki K, et al. Working hours, occupational stress and depression among physicians. Occupational Medicine. 2011;61(3):163-170. doi: 10.1093/occmed/kqr004
Gold KJ, Andrew LB, Goldman EB, et al. “I would never want to have a mental health diagnosis on my record”: a survey of female physicians on mental health diagnosis, treatment, and reporting. General hospital psychiatry. 2016;43:51-57. doi:10.1016/j.genhosppsych.2016.09.004
Shanafelt TD, Balch CM, Dyrbye L, et al. Special report: suicidal ideation among American surgeons. Archives of surgery. 2011; 146(1):54-62. doi:10.1001/archsurg.2010.292
