Welcome back.  If you haven’t had a chance to view last week’s blog on Suicide, please take a moment and do so.  It will set the tone for this month-long series ahead of us.  Click here for last week’s blog. For many, the holiday season is anything but happy.  It may be the weather, or the loss of loved ones, or something one simply can’t put their finger on, yet there it is.  Heavy.  Dark.  Nagging.  It’s a depression that doesn’t pass, no matter how hard one tries to “fake it ’til you make it”.  It’s been described to this writer as “walking around and watching everyone else live their life, but I didn’t feel attached to what they were experiencing”.
Please welcome this months Guest DO, Dr. Pamela S.N. Goldman, DO, MHSA, FACOI.  She will lead this discussion for the rest of December.  We will hear from a woman who struggles with depression on a daily basis, we will visit with a family who lost their brother to suicide, and we will take an inventory of ourselves, to make sure that we are feeling healthy in mind, body, and spirit.
And now, I’d like to introduce Dr. Goldman…

Suicidal Ideation: Let’s Start The Conversation

Broken relationship.

Missed opportunity.

Family tragedy.

Overwhelmed by life.

Sometimes there are warning signs, sometimes there are not.  The reasons for an individual to take their own life are a varied as the means by which to complete suicide.   

The biggest risk for suicidal ideation and completion is not addressing the underlying cause of such a desperate desire for relief.  It’s time to start talking about well-being and bring mental health to the front of the conversation. 

It is well known the risk factors of suicidal ideation include depression and mood disorders as well as substance abuse.  Can you recognize the signs or symptoms leading to depression?  Many describe feelings of hopelessness, anxiety, or severe remorse.  Sometimes the person will sleep too much and other times not enough.  Appetite will be altered and present as over-eating or lack of eating.  There may be telltale “cries for help” as a person may make an incomplete attempt at self-harm, but not always.  In the United States, a survey performed in 2008-2009 by the CDC found that approximately 8.3 millions adults reported having suicidal thoughts, of which 2.2 million had a plan and approximately 1 million report suicide attempts.¹

The Mind-body-spirit connection as part of the osteopathic philosophy plays a key role in awareness and identification of risk factors of those suffering from suicidal ideation.

Care for our patients. 

When caring for our patients, we need to remember the whole person and their family.  The stressors that may be at the root of deep depression and despair may directly effect the patient’s health. 

As a physician, when we interact with our patients, can you tell if there is deep hurt or pain that goes beyond the surface?  Through building relationship with the people around you, as excellent observers of the human body and its dysfunction, are you able to pick up subtle changes in posture or affect or musculoskeletal dysfunction that may lead you to ask more probing questions to someone who may be at risk? 

As an Osteopathic Physician, I see many people hurting and in need of relief of their life stress.  Polysubstance abuse and psychiatric disorders are often underlying difficulties they face.  Getting the help our patients need to resolve their underlying mental health concerns is challenging.  Resources in the community are available, though some areas have limited mental health professionals and are reliant on limited government support. 

Care for our colleagues.

The rate of physician burn-out and depression is increasing as more regulatory and professional requirements are heaped on physicians every election cycle.  In a study of physicians in 2012, 45.8% of respondents screened positive for at least one symptom of burn-out.  This leads to suicidal ideation, alcohol abuse, and potential of decreased quality care to our patients.²  Without recognizing the signs of burn-out, physicians are at risk of suicidal ideation and completion.  Domains of many surveys on burn-out include emotional state and perspective, professional accomplishment and fulfillment, and personal and relationship satisfaction.  We need to ask the difficult questions. 

Care for ourselves.

Currently, the concept of mental health wellness and overall well-being are discussed in many aspects of life, in particular within the medical community.  The lifestyle of a physician is such that we often have self-neglect.  Poor eating habits.  Poor sleep routines.  Poor exercise regimes.  Starting in medical school with frequent testing and study for exams, finding time in your day to eat and to sleep becomes difficult.  The stressors aren’t removed as you progress in your career; they just change. 

We need to start the conversation.  We live in communities that are often more isolating than welcoming, even when in close proximity to each other.  Whether your community is on a social media platform or the people with whom you live and work, we need to reach out to those among us who need help.

1 Crosby, Alex; Beth, Han (October 2011). “Suicidal Thoughts and Behaviors Among Adults Aged ≥18 Years — United States, 2008-2009”. Morbidity and Mortality Weekly Report (MMWR). 60 (13). Accessed November 1, 2017.

2 Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, West CP, Sloan J, Oreskovich MR. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 2012;172(18):1377–1385. doi:10.1001/archinternmed.2012.3199