Pediatric resident Dr. Poulami Saha suffered from depression. In May, She jumped off the 11th floor of her hospital in Calcutta. In March, Daniela Trezzi, an ICU nurse in the hard-hit Lombardy region of Italy, took her own life. Reports indicate she could not move on from the fear that she may have infected patients under her care.

As National Suicide Prevention Awareness Month comes to a close in the midst of a global pandemic, a focus on the health needs of medical professionals (often a taboo subject) feels overdue. As the leader of a large OB-GYN practice in Texas, I see the mental health impact on doctors, nurses, and other health care workers every day.

A crisis intensified

Suicide is the 10th leading cause of death in the United States. Health care providers are not immune. In fact, physicians take their own lives at twice the rate of the general population. One doctor per day dies by suicide in the United States. Long before the pandemic, stressful working conditions, excessively long hours, and sleep deprivation led to a surge in physician burnout. Pandemic stress puts health care providers at an even higher risk of despair.

Quarantines, school closings, social isolation, and shelter-in-place orders have changed the way we live. Frontline health workers in hard-hit areas are exhausted and often traumatized from treating Covid-19. But health care providers in all areas struggle to cope with the complicated politics that now surround the pandemic and the lack of a national, strategic plan to fight it.

While my city is not experiencing an overwhelmed hospital capacity, I understand what Breen, Saha, Trezzi, and other providers must have felt. With empathy, I recognize the feelings of hopelessness that can lead one to think the only way to make the pain stop is to die.

Not only does the incidence of suicide signal unbearable conditions for doctors and health care workers, but when suicide happens in the industry, it creates a new layer of trauma and stress for everyone in medicine. Our colleagues’ suicide stories place us at increased risk of post-traumatic stress, anxiety, depression, and insomnia.

Physicians take their own lives at twice the rate of the general population.

In March, JAMA published a study evaluating the pandemic effects on health providers’ mental health in Wuhan, China. In this cross-sectional study of 1,257 health care workers, investigators demonstrated the high incidence of depression, anxiety, insomnia, and distress in frontline health care workers. Early in the pandemic, many health care workers around the world felt betrayed by the lack of PPE, ventilators, and ICU capacity. As Covid-19 drags on, physician workloads have increased, and general hospital morale has plummeted. Health providers worry about catching the coronavirus but also live in fear of infecting their families.

Health care workers and those who love them must be aware of the factors increasing the risk of suicide. Hopefully, improving our risk factor awareness will increase our capacity for recognition, early intervention, and prevention.

According to the National Alliance on Mental illness, risk factors for suicide include:

1. Mental health condition. Forty-six percent of suicide victims had a known mental health condition such as depression, anxiety, insomnia, or substance abuse.
2. Family history of suicide.
3. Substance use.
4. Intoxication. More than one in three people who die from suicide are under the influence of alcohol at the time of death.
5. Access to firearms.
6. A serious or chronic medical illness.
7. Gender. Women are more at risk of attempting suicide, while men are nearly four times more likely to succeed.
8. A history of trauma or abuse.
9. Prolonged stress.
10. A recent tragedy or loss.

The Covid-19 pandemic pushes health care workers to operate at peak performance levels. Patients are sicker, which requires a higher level of care. Covid-19 management guidelines are changing at a rapid pace. While the mortality rate is decreasing, physician workload is increasing.

The constant barrage of bad news, political turmoil, mask noncompliance, and social media toxicity strains our ability to get through each day.

I see firsthand how we are pushing ourselves to serve our patients better, and yet we are of no use to others if we do not first take care of ourselves. We all need a mental break, some moments of peace and tranquility — which can be challenging to come by in a time marked by paramount hardship.The National Alliance on Mental Illness offers the following five warning signs to look out for, as signals of the need for professional guidance and support:

1. Increased alcohol and drug use.
2. Aggressive behavior.
3. Withdrawal from friends, family, and community.
4. Dramatic mood swings.
5. Impulsive or reckless behavior.

The National Institute of Health offers a more extensive list of behavioral changes indicating someone may be thinking about suicide. Some people considering suicide may express their intent directly by talking about wanting to die or wanting to take their own lives. They may give away possessions, say goodbye to friends and family, or put affairs in order in the shape of a will.

Other at-risk individuals may express feelings of guilt, emptiness, or hopelessness. Some talk about feeling trapped or being a burden to loved ones. Anxiety and depression may lead to mood swings, agitation, and even rage.

Some people change their behavior by withdrawing from family and friends, drinking alcohol, using drugs or medications, or changing their eating and sleeping habits.

Not only does the incidence of suicide signal unbearable conditions for doctors and health care workers, but when suicide happens in the industry, it creates a new layer of trauma and stress for everyone in medicine.

Caring for health care workers

If you recognize any of these signs or symptoms in a friend, colleague, or family member, it is critical (and potentially life-saving) to reach out with compassion and empathy. Active listening techniques can help someone struggling with suicidal ideas to feel heard and not worry that their feelings are wrong.

If you recognize any of these signs or symptoms in yourself, please know it is safe to reach out and speak up. Schedule a telehealth visit. Reach out to a doctor, a colleague, or a friend.

If you are struggling with thoughts of self-harm or suicide, please do not hesitate to contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). This is a free 24/7 confidential service that can provide people in suicidal crisis or emotional distress, or those around them, with support, information, and local resources. For more information, call or visit SuicidePreventionHotline.org.

The post Physician Suicide Is a Daily Occurrence appeared first on Medika Life.

In my last article (Debunking 1 in 5 COVID-19 Patients Develop Mental Illness), I debunked a claim circulating around the world — that a Lancet Psychiatry study found 1 in 5 COVID-19 patients would become mentally ill in the first 3 months after diagnosis.

Researchers drew on the electronic health records (EHRs) from a US managed health care system to match 62,354 patients COVID-19 with patients with 6 other medical diagnoses.

Claims about mental illness were based on recording in the electronic health records of mental health diagnoses 14–90 days after diagnosis of COVID-19 or the comparison health conditions. These diagnoses of mental illness were originally made for administrative purposes — billing and documentation — and would be considered poor quality for scientific purposes.

I pointed out that the excess of mental health diagnoses associated with COVID-19 was almost entirely due to more adjustment disorders.

Patients diagnosed with COVID-19 were likely to be experiencing some anxiety (worried) or depressive symptoms (sad, pessimistic) that were not serious enough to justify a diagnosis of major depression or a serious anxiety disorder. So, a diagnosis of adjustment disorder was entered into their EHRs.

These do not seem like abnormal reactions to me. In fact, adjustment disorders were formerly called adjustment reactions and clinicians could not be reimbursed for treating them.

Dissenting from the portrayal of the study in the media

Why was my interpretation of the Lancet Psychiatry article at odds with almost all of the media coverage I could find, which proved to be remarkably similar?

I arrived at my conclusions by looking at the study design and closely examining the tables of numbers.

I applied knowledge that any journalist should have in writing about a topic that has great importance to readers facing a profound public health crisis like COVID-19.

America is facing a profound crisis of faith in democracy and in science. It desperately needs media filled with articles by journalists who think for themselves and consult experts when they need to.

In an ideal world, journalists should have called up their own independent experts and asked them about their impression of the study. Were these experts expecting a tsunami of mental health problems or did they think these authors might have overstated the importance of their findings a bit?

Journalists should have had the curiosity to ask how serious a mental illness an adjustment disorder and why there was not more depression associated with COVID-19.

In a bygone era, journalists were better able to play an important function in society. At their best, journalists buffered laypersons and policymakers from the self-promotion, conflicts of interest, and sheer overenthusiasm of researchers for their own work. Journalists provided independent assessments of science to satisfy readers’ curiosity, but also to guide their personal and collective decision making.

But journalists face different challenges than only a few years ago.

Most newspapers and magazines have laid off their full-time staff and depend on freelance journalists. Journalists can no longer assume researching articles will be reimbursed.

Often, journalists will not have the time to look at a scientific paper carefully or to consult their trusted sources. Few will have the courage or the recklessness to say that the authors of the Lancet Psychiatry study (from Oxford University, after all) are exaggerating the significance of their findings.

Editors will also not be pleased with a story on which they cannot slap a clickbait, screaming headline like “1 in 9 mentally ill!!”

Media have gone online, some abandoning print editions altogether. They need clickbait to attract and retain readers’ interest. Traffic to a media website and readers’ time spent there are tracked as altmetrics, which determine the advertisements the media get and what they can charge for ads.

This consideration matters for which articles from which journalists are published.

Science Media Centre of London (SMC_L)

Media coverage of the Lancet Psychiatry article was almost identical worldwide. If articles quoted an expert, it would likely be identical quotes from the same experts. A lot of the articles credited Reuters News Service. The articles that did not credit Reuters but named a journalist in the byline were generally quite similar, even having the same quotes.

Noting that some authors of the Lancet Psychiatry article were at Oxford University, I immediately suspected the Science Media Centre of London (SMC_L) was involved.

The SMC_L website welcomes journalists.

When science hits the news agenda, it’s our job to pass on to journalists as much accurate information as we can, as quickly as possible. In order to do this, we send out quotes from experts and statistical analyses of scientific studies, in addition to running regular press briefings on the latest hot topics. Find our most recent Roundups and Rapid Reactions, briefings and ‘Before the Headlines’ analyses below…

Who are the experts that SMC_L consults? Can anyone submit their credentials and expect to be called?

We are always on the lookout for top experts, but it’s important that each scientist knows us before we call them. So, we generally don’t add scientists before we’ve worked with them at least once.

It sounds like British English for “Don’t call us, we will call you.”

SMC_L warns of storms around science stories in the media.

When science hits the headlines, it’s not only journalists and scientists who find themselves in the eye of the storm, but also press, media and communications officers, working to support their scientists and engineers whilst also providing journalists with what they need.

I expect that bad science will get into the media and even good science will get misrepresented. Such occurrences are inevitable. When it happens, controversy and criticism are healthy and necessary parts of fixing things.

You might get a sense that SMC_L disagrees. They seem to be offering shelter from such “storms.”

Expert reaction to study looking at psychiatric diagnoses after COVID-19

I don’t like authorities telling me how to think or what to write, even if, like Ringo Starr, they can call themselves Sir or Dame or wear medals at breakfast.

Searching for the Lancet Psychiatry study, I found a past Briefing and an Expert Reaction with seven of SMC_L’s usual suspects as experts.

Six of the seven mostly sounded like experts, but really did not get into the nitty-gritty of the study, content enough to demonstrate expertise.

One expert had “Sir” between “Prof” and his name. Another had “Dame” between “Prof” and her name.

I cannot understand why Brits bring up knighthood and damehood in these contexts. When Ringo Starr got to call himself Sir, it did not improve my appreciation of the Beatles.

There was not very much reference in this Expert Reaction to crucial methodological details of the study and the limitations of EHRs as scientific data.

It would seem that a grasp of these details should temper any recommendations for clinic or public health policy based on the study.

No expert conveyed any sense of the messiness of big data from an American health care system, especially if one is intent on making policy recommendations for organizing a response to mental illness associated with COVID.

Six of the Expert Reactions sounded like a string sextet accustomed to playing together, mostly without creating a fuss. The seventh, however, arrived like a tuba player, oblivious to not contributing to the harmony.

Prof David Curtis politely alluded to a lot of problems with the Lancet Psychiatry study. He seemed to wonder aloud why such a fuss is being made about it. He injects some uncommon common sense into the discussion

“It may be unsurprising that this happens a bit more often in people with COVID-19, who may understandably have been worried that they might become seriously unwell and who will also have had to endure a period of isolation.”

If there is any doubt about where he stands, he clarifies at the end:

“Overall, the results reported seem broadly plausible but I’m not sure that they have specific implications for patients or health services.”

My kind of expert. I hope Prof Curtis gets invited back by SMC_L.

Getting personal

I think my humility is still intact after decades of writing hundreds of scientific papers, some that deserve more criticism than they received. I welcome criticism from experts. I welcome peer-review by academics, but also feedback from patients who are experts on their experience and who have had to live with the modest clinical and public health implications of what I have written.

Yet, I think there is a vital distinction to be drawn between expertise and authorities. The good experts have the credibility to gain our attention by showing things we might not know, but that we would agree we should. The not-always-good authorities believe they have the power to enforce rules and tell us how to think and what to write.

I think that is what SMC-London is doing here. I am biased by my experience with them, but that bias is valuable because it is grounded in experience. I have seen their ways too often for my liking.

• One of the experts being cited in this Expert Reaction — the Dame — also endorsed an awful study that she claimed showed cognitive therapy for psychosis was effective for psychosis in the absence of medication. The study did not show that, but such claims encouraged some patients to refuse medication. The Cochrane Collaboration showed twice in systematic reviews that cognitive behavior therapy was ineffective.

• One of the experts who was cited — the Sir — advocated cognitive behavior therapy and graded exercise for chronic fatigue syndrome, which patients insisted was ineffective and harmful. Fiona Fox, Director of SMC_L organized a campaign that media that condemned the patients as militant terrorists. The press releases were picked up in British media. The patients were subject to considerable abuse and harassment as a result.

Whiskey, tango, foxtrot! The patients were often bedbound or confined to wheelchairs. I do not think anyone would recruit them as suicide bombers or even assassins.

• I decided to look into the matter. I requested data from the PACE clinical trial for reanalysis. I believed the PACE investigators were legally bound to make these data available. Fiona Fox, Director of SMC_L organized a letter-writing campaign to Parliament calling for researchers to be exempt from such requests.

As promised, SMC_L tried to provide shelter from the storm.

• More recently, patients with chronic fatigue syndrome and professionals from around the world convinced the UK National Institute for Clinical Excellence to issue draft recommendations that no longer endorsed GET as a safe and effective treatment. SMC_L has organized resistance from academics strongly invested in this treatment, including the Sir.

I am exceptionally lucky. I came out of public housing on a shitty mudflat in Chelsea, MA, and spent my high school years on welfare. By many accidents of circumstances, I somehow ended up an emeritus Ivy League med school professor.

I am painfully aware of my deficiencies in preparation and seek my corrective expertise where I can find it. But I don’t like authorities telling me how to think, even if, like Ringo Starr, they can call themselves Sir or Dame or wear medals at breakfast.

America is facing a profound crisis in its faith in democracy and in science. It desperately needs media filled with articles by journalists who think for themselves and consult whatever independent expertise they feel they need.

I don’t care that SMC_L gives lots of stuff away free and does not mind if journalists plagiarize them.

Journos, please find your own experts and write your own articles on which you can proudly stick your byline.

The post No Tsunami of Mental Illness Accompanies Covid-19 appeared first on Medika Life.

“Honey, I’m home.”

This announcement as you walk through the door is often followed by a question that years of marriage can bring you to dread. The “How was you day?” question.

It has become an ingrained response in most couple’s lives, asked out of courtesy, out of concern, out of genuine interest and out of habit. Doctors nurses and other healthcare workers, both men and women, are experiencing a side effect of the pandemic few have had to deal with before and that many are ill-equipped to face.

The problem of how to best communicate their day to their spouses or partners, most of whom are not medically trained and exist in another bubble, away from the horrors of the Covid frontline. How can someone not intimately engaged with the medical profession express an understanding for their working conditions and the associated trauma they endure on a daily basis. Most front liners now choose to remain silent. They internalize.

for doctors, the more personal and germane impacts of the pandemic on their psyche are internalized and this can have disastrous consequences for their home life as well as impacting their health, both physical and mental

Many of these professionals are feeling more and more isolated as the separation between home and work becomes more pronounced for a number of reasons we’ll examine below. They feel unable or are unwilling to share their problems with their partner. The inability of their partners to grasp the scale of death and frustration they now confront each day, lies at the heart of the problem.

Although they can and do discuss the less personal aspects with colleagues, the more personal and germane impacts of the pandemic on their psyche are internalized and this can have disastrous consequences for their home life and wreck havoc with their health, both physically and mentally.

So just how do these professionals cope with these two distinct existences, the family life and loving partner and a professional life, now filled with death and despair on a daily basis? Before we go any further, I feel its is essential to point out that while many of you may find help and advice that is pertinent to your situation in this article, there is no one simple solution that resolves all relationship issues.

We are all fundamentally different and each relationship is unique and special in its own way. There are however a few fundamental perceptions that we all apply to life that are of relevance here and I will examine each below in turn. If these bear relevance to your situation, they may offer you food for thought and allow for insight and empathy into the factors that influence your partner, and by consequence, you.

You may choose to address your issues on your own or engage your partner in the process. There is no one simple solution, merely paths to follow and choices to make that are relevant to your life, your personality and your situation. These are yours to make and if they are beyond the scope of your abilities, I strongly encourage you to seek help from a responsible, professionally registered therapist.

Life from your partners point of view

Living with Dr Covid

Even if you’re not directly on the frontlines, you’re still out there engaging with sick people on a daily basis. It’s what doctors do. Your partner has accepted the long days, long nights and varying levels of exhaustion you bring home. It is part and parcel of being married to a doctor. It is a lonely life and not suited to everyone. Many fill the space you leave with children and their own careers.

the fear of death is something unique to all humans, we all suffer from it and deal with it in our own ways

The pandemic has added a new element to this already difficult dynamic. Danger. Every time you walk through your front door, that embrace and kiss hello could prove fatal, to both your partner and your children. You have become a vector for the spread of Covid and your partner knows this, even if the awareness is on a subconscious level and they have not articulated it. The potential for internal conflict around this one simple fact is vast.

Your partner loves you, they understand your need for empathy and a safe nest to return to and yet, your very presence now threatens their health and if you have children, by association, their health and safety. You can work out for yourself the paths available to someone following this train of thought.

They will at different times view you with anger (why do you continue to expose them to risk) or with love and empathy (understanding for how difficult your situation must be) or with admiration (your commitment to your patients despite the dangers). Any or all of these emotions can surface at different times and your partner may not be aware of why.

Covid Overload

Find me a person who isn’t sick and tired of seeing and hearing about Covid everywhere they turn and I’ll show you a nun that mud wrestles vertically challenged (see, I can be politically correct)individuals on her days off. We are all fed up with it. It is everywhere and your partner is not immune to covid fatigue.

Imagine then their joy on your return home to be regaled with yet more tales of Covid and doom and gloom. They may even, of late, have refrained from the standard “how was your day” response in the hopes of avoiding these dreaded conversations. It isn’t the same for everyone and some partners have far more empathy and tolerance than others, we are all so very different. If you aren’t partnered with a saint, then keep this in mind.

You may also choose not to share out of choice, a protective instinct to shield your partner from the horrors of the pandemic you face each day. This is noble, but not well thought through. You are cutting off the very life line that may offer you salvation should you need it.

You are also depriving your partner of the ability to properly assess, understand and support your varying moods and needs. If everything is rosy, why are you constantly in a foul mood or alternatively, why have you’ve suddenly clammed up and don’t say much or isolate yourself from the family. We interpret our situations based on the information we have to hand. Limit your partners understanding of your life and you’re asking for trouble.

The medically challenged

Your partner didn’t fall in love with a doctor, they fell in love with you. The doctor is merely along for the bumpy ride and medical partnerships are difficult, make no mistake. Building a strong relationship requires time, a luxury most doctors don’t have in abundance.

Most non-medical partners find discussions around medical topics difficult and challenging, particularly if they exist in an isolated family based bubble, away from your life. Police and the military suffer a similar fate and it causes very similar problems for them, problems that many doctors and healthcare professionals now face. How much of your work do you choose to bring home and how much of it chooses to come with you.

How to best resolve personal issues away from the safety of the relationship without jeopardizing the relationship itself.

Why do you need to speak out?

This is a very important question and goes to the heart of why you are experiencing emotional and relationship issues. You need to try and answer this honestly and it will require more than a little introspection.

If you’re used to openly discussing and sharing things with your partner and you suddenly, because of the above and other factors, find yourself unable or unwilling to do so, you have an issue that needs addressing. Any changes to the dynamic between you and your partner will affect both of you. It’s important you identify your needs correctly, only then can you set about correcting the problem without aggravating it.

Resolution through dialogue

If you find you have a real need to confide in your partner and currently don’t or cannot, this is easily addressed. Honesty helps. Sit down with them in a quiet safe space where you wont be interrupted and explain slowly what is happening in your life and how you feel. Then ask them about their life and how they feel. Allow them the space to speak openly and avoid being confrontational. You’re trying to find common ground, not dictate policy, so LISTEN.

Most issues in relationships that develop over time are the result of miscommunication and assumption. They are often resolved simply by open, honest, respectful and caring dialogue. This requires time and effort, both worthwhile investments for your future happiness and wellbeing. If your partner is willing and desires to help you, it is selfish of you to prevent them from doing so. Imagine, if you will, if the roles were reversed. We are designed to want to care for the wellbeing of those closest to us.

Keep this fact in mind

No matter how supportive or loving your partner is, they are often not qualified to assist you in resolving complex metal issues that are troubling you. They are not in a position to offer you strategies you can engage to resolve these issues.

A professionally trained therapist can. If you are still facing issues despite a loving and supportive partner or spouse, then you must seek professional help. It is often easier acknowledging things to a stranger, than to those we live with. Particularly if we perceive these things to be flaws or weaknesses.

Go solo Joe

If you’re not in the habit of seeking solace and resolution from within your relationship, then you are left with the option of self-therapy and this can often manifest in an activity away from the confines of work and home that allows you time to process your thoughts on your own. Its a difficult balancing act as it encourages separation between the partners and reduces their reliance on each other, but for some, this option is the preferable choice.

In practice, an activity like fishing for instance, fits the bill. It’s outdoors, provides fresh air, is hugely therapeutic and offers plenty of time to think. It’s also an acceptable activity that wont drive a wedge between you and your partner. You can even drag them with, settle them on a blanket with a book or let them wonder around the lake or river with the kids, leaving you free to enjoy the absent fish and your own thoughts.

Perhaps find a colleague of the same sex to drag along instead for company if you don’t do well on your own This will also offer you an opportunity beyond the confines of work to discuss issues surrounding the pandemic that bother you. Chances are the same things bother your colleague.

you aren’t looking for sympathy, but rather to make sense of the situation that you are currently embroiled in

You can choose to live two separate lives, leaving the doctor at the door when you enter your home, but this will not resolve your internal conflicts and the need you have to verbalize them to someone.

Speaking about our issues, putting thoughts into words, helps us formalize the issues that swirl around in our heads. It allows the listener, if they are so inclined, to provide their perspective. At the end of the day, you aren’t looking for sympathy, but rather to make sense of the situation that you are currently embroiled in. Most importantly, you are looking to develop strategies that will enable you to make it through the pandemic with both body and soul intact.

Any solutions that can be arrived at with the involvement of your partner are, in my opinion, always your better option. We are stronger together, but as I’ve said above, this route isn’t always suited to an individual. You may also find your partner lacks the stomach for the position you’ve been placed in. It doesn’t make them terrible partners, we all have our limits.

Writing is another option that can offer solace and inner peace for some and is cathartic for the resolution of internal problems, but we aren’t all writers. If you’re feeling confused, depressed, disillusioned and disheartened and your spouse or partner is unable or unwilling to act as a sounding board for the problems you face in your profession, it is critical you find a solution that best fits your unique situation and personality.

Don’t ignore these issues, but address them with the importance they deserve. The slippery slope into the darker side of our personalities is greased with good intentions. Find a friend, catch a fish and most importantly, find your sounding board. If need be, pay a therapist to listen. There is no shame in acknowledging that some things cannot be resolved on your own. Failure lies in not addressing the issues in the first place. They will resolve on their own, but you will not like the outcomes.

A quick note on feel good medication

Don’t, just don’t. I cannot be more clear about this. There is no solution to be found in a bottle of meds that will benefit you in way. None. You’re not exhibiting psychopathic tendencies and your not bipolar. You’re having issues dealing with a really difficult situation that has spilled over into your home life.

There isn’t a chemical imbalance in your brain and unless you want to create one with medication, please avoid pills. These won’t improve your life. They will simply dull your senses and alter your personality, whilst increasing your risk to suicide and severe depression. It is even more difficult for medical professionals to avoid the temptation of medication, as most have free access to prescriptions.

You’re far better off seeking the advice and counsel of friends who have both empathy and a working understanding for your environment and situation. For the most part, this isn’t going to be your partner, unless you‘re fortunate or living with a health professional. Obtaining and developing coping skills and mechanisms to deal with your issues will last you a life time, pills are simply problems you’ll need to address tomorrow and every day thereafter.

Best of luck and thank you for your service to our communities.

The post Covid’s Silent and Sinister Effect on the Married Lives of Healthcare Workers appeared first on Medika Life.