September is Suicide Prevention Awareness Month and September 17th is National Physician Suicide Awareness Day.

Every suicide is an unspeakable tragedy, a loss that ripples outward in waves of pain and grief.

The Council of Residency Directors in Emergency Medicine estimates that up to 400 physicians take their own lives every year. While estimates of the actual number of physician suicides vary, the relative risk for suicide is 2.27 times greater among female physicians and 1.41 times higher among male physicians versus the general population.

This is an unspeakable tragedy writ large.

Before going any further, I want to note some resources for those in acute distress or crisis:

• 988 is the National Suicide and Crisis Lifeline. It is available 24/7, 365 days per year. If you prefer, you can text rather than calling. A chat option is also available.
• 988, press 1 connects callers to the Veterans Crisis Line.
• The Physician Support Line (1-800-409-0141) is a free and confidential support line run by volunteer psychiatrists. It is open Mon-Fri (except federal holidays) 8:00 AM-12:00 AM EST. https://www.physiciansupportline.com/
• In situations of imminent or impending risk, call 911.

There are also some apps that are widely available and are designed to help decrease suicide risk and manage suicidal crisis. It should be noted that these apps are intended to be used in conjunction with treatment from a medical or mental health provider. These are tools, not complete solutions.

One is the Virtual Hope Box. 

Initially developed by VA for use with Veterans, the Virtual Hope Box is an empirically tested app for addressing suicidality. It is free to download and does not have a subscription plan. The Virtual Hope Box helps users access several types of coping skills including distraction and relaxation. These efforts create a “Hope box” that is a tangible representation of coping skills to help remind users of positive aspects of their lives and reduce their distress. 

Notably, an American Psychological Association article reviewing this app did note many positive features overall, but found that the “Inspire Me” section overrepresented white males as inspirational figures. Individuals may find it more helpful to focus on the other skill sections offered, which have robust empirical support.

Another app is Suicide Safety Plan. 

Like the Virtual Hope Box, it was designed for use in conjunction with treatment. It is also geared towards managing more chronic suicide risk and is not intended for crisis response. Its “Plan” section guides users through identifying warning signs of crisis and coping strategies to be used at those times (including contacts). This section is customizable and individualized; users input their own resources that will work well for them. There is also a psychoeducational “Guide” section with information on recovery, safety planning, and other topics.

I want to close by talking about helplessness, which is frequently associated with suicide risk (often by way of depression). A 2022 study on physicians in China during the early days of COVID found that high work meaningfulness can actually intensify feelings of helplessness in a significant crisis situation. Healthcare administrators and managers and others who may have wanted to be encouraging to physicians by reminding them of their essential role in responding to the pandemic may have actually been making the burden heavier for those physicians.

Interestingly, the same study found that being able to psychologically detach from work during off time gave the physicians opportunities to exercise control in other domains of their lives, reaffirming their sense of self-worth, which then helped them recover from helplessness at work.

So please consider this both an invitation and an encouragement to disengage from your professional responsibilities and re-engage with what and who you love outside of work. 

And if you or someone you care about is in crisis, please reach out to available resources.