The unspoken death toll of COVID-19: suicide


Today I woke up to the news that a fellow physician died by suicide. As I read the article, I felt a sharp pain in my chest. My eyes watered. They still do, as I write this piece. Although I did not personally know Dr. Lorna M. Breen, an ER doctor in New York City, the loss feels near and dear to my heart. She was one of us, a member of the medical community. I know my colleagues are feeling the pain as well. We are all posting about it on social media. We are all in shock.

Regrettably, this is not the first time a physician has died by suicide. Before the COVID-19 pandemic, studies have demonstrated that the rate of suicide among doctors is much higher than the rate of suicide in the general population. For male doctors, the rate is 40 percent higher than that of other men. For female doctors, the rate of suicide is 127 percent higher than that of other females. Approximately 300-400 physicians die by suicide in the United States per year. This number is already too high. How much higher will it get if we do not begin to take a more active stance to protect our frontline workers?  What will it take for the system to protect their workers? What are we doing as a community and a society to protect the emotional wellbeing of physicians and other frontline workers?

Over the past weeks, we have read about how physicians have to work with suboptimal personal protective equipment. They do not have enough beds nor enough respirators to take care of patients. They face ethically and morally complex decisions such as which patients get treatment, and which do not. They see their patients die alone—some of those patients are their own colleagues and coworkers. However, the distress is not only at work. Frontline workers have to decide whether to go home and expose their families to COVID-19 or isolate themselves in an attempt to protect them—some have even slept in tents. Many continue to struggle to find reliable and safe childcare while wondering whether that will be the last time they will see their family. Sadly, most have already signed a living will.

As if that were not enough, physicians and other frontline workers are experiencing xenophobia and racism daily. They are having to do their work while being called derogatory terms. Physicians and other frontline workers are feeling exhausted, angry, sad, and scared. They are feeling ignored and betrayed by the system, by the government, by their employers. Dr. Lorna M. Breen’s suicide is an unfortunate and painful reminder of what physicians and other health care workers are experiencing and feeling right now.

As a psychiatrist, I am appalled by the lack of response to protect the mental health of our frontline workers. Physicians and other frontline workers need to feel that the government and their own organizations are actively listening to their concerns, actively working to protect and support them and their families. They need to feel that we all are caring for them, just as they are giving their all to care for us.

What are some ways that we can begin to care for our frontline workers? First, we need to pay attention to what their needs are. We need to have more open conversations about their wellbeing and mental health. We need to meet their basic needs, including:

  1. Access to PPE to safely and adequately do their job.
  2. Access to food and hydration—some may not have the time to cook or go grocery shopping.
  3. Time to rest in between shifts and time off duty to recuperate.
  4. Access to comfortable and safe places to rest.
  5. Support with making arrangements to protect their families, including childcare.
  6. Access to reliable and secure systems for check-ins, psychological first aid, and feedback.

This is just the beginning of a long list of things we need to be doing to support our frontline workers. This list needs to be continuously adapted and revised as we learn more about their needs.

Every single one of us can do something to support frontline workers. Every little bit helps. For example, individuals need to ensure they stay home and keep a safe distance until told otherwise to continue to flatten the curve. Staying at home may seem like a small thing to do, but we have seen it prevent hospital systems from being overwhelmed.

For those of you who know a frontline worker, make sure to check-in with them, ask them what they need, let them know how much you care about them. If you can, offer to listen to them, go grocery shopping for them, or send them a thank you message. Frontline workers may have a hard time asking for help. In general, asking for help is hard, but it is even harder when we are under stress.

Dr. Breen’s suicide shook the medical community. Her death reminds us that the COVID-19 crisis has unspoken ramifications. We need to ensure that we do not lose any more physicians and other frontline workers to either COVID-19 or suicide. We must all come together to protect our frontline workers. There is so much we can do at the societal and individual level, but we must act soon before it is too late. The wellbeing of frontline workers needs to be our priority right now.

The National Suicide Prevention Lifeline is a hotline for individuals in crisis or for those looking to help someone else. To speak with a certified listener, call 1-800-273-8255.

Crisis Text Line is a texting service for emotional crisis support. To speak with a trained listener, text HELLO to 741741. It is free, available 24/7, and confidential.

Amalia Londono Tobon is a child psychiatry fellow. 

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