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Christine Yu Moutier, MD, could have launched into her session on suicide prevention at the AAMC’s annual meeting from any number of professional perspectives: psychiatrist, researcher, consultant to the U.S. government, or chief medical officer of the American Foundation for Suicide Prevention, among others.
Instead, she chose to share her personal story.
“First, I am a human being,” she told listeners at Learn Serve Lead 2022: The Annual Meeting on November 13 in Nashville. “[I] had my own genetic loading and environmental influences that led to my lived experience of mental health struggles that were life-threatening” while in medical school, she said. “When your cultural environment does not give you the ability, the language, or permission to speak of the things you went through … that is an experience you never forget.”
In a session titled “Preventing Suicide During COVID and Beyond: Science, Culture, and Solutions” and moderated by Sarah Vinson, MD, associate clinical professor of psychiatry and pediatrics at Morehouse School of Medicine, Moutier went on to share additional thoughts from her personal journey, as well as evidenced-based insights for saving lives from suicide.
After her own painful experience, Moutier took a year off from school and received treatment that she called lifechanging. Eventually, as she became more open about what she had gone through, more people shared their own stories with her. “I knew that the experience I’d had that I thought I was so alone in was not actually the case,” she said.
In fact, from 1999 to 2018, the U.S. suicide rate rose 35%. And though there was a slight dip in recent years, early data for 2021 from the Centers for Disease Control and Prevention also show an increase. In addition, certain groups have been experiencing greater risks, including youth and young adults and Black and Brown populations.
The pandemic also took a tremendous mental health toll. More than 2000 children lost a parent or caregiver, alcohol consumption rose — “the list goes on and on,” Moutier said.
But science has shed greater light on suicide risk detection and prevention in recent years. Now the world of medicine — and the nation — must increase efforts to apply that science to save lives, Moutier said.
A key way to do that is to increase understanding of what leads to a risk of suicide. Significantly, she noted, no one incident or trait is the cause.
There can be a precipitating event, but other risk factors are at play as well, including genes and epigenetics, mental health conditions, and lethal means. “Lethal means is a big one,” she noted.
Above all, suicide is a health issue. In the face of that fact, some language, such as “commit suicide” doesn’t make sense, Moutier argued. “We don’t say, ‘commit cancer.’ That comes from a time when suicide was viewed as a morally reprehensible act or a characterological weakness.”
Moutier went on to lay out specific steps health care institutions can take to advance the prevention of suicide.
For one, leaders should provide education to all staff members. If a patient screens positive for suicide risk, providers should ensure that they have a plan for staying safe and provide them with crisis resources.
Ideally, institutions would also connect patients with an approach called Caring Contacts that facilitates connections with others. Initiated in the 1970s, patients receive a personal follow-up contact with a provider or other concerned individual, such as someone with their own experience with suicide. Moutier pointed to research showing that an individual at risk of suicide who receives caring cards, calls, or texts is 40% to 70% less likely to attempt suicide.
But as providers focus on caring for patients, they also cannot forget the mental health challenges of those working right beside them, Moutier said.
Ironically, many traits that make for good physicians also make for greater suicide risk. Those traits include perfectionism, self-sufficiency, and an exaggerated sense of responsibility.
Pointing to a 2022 study, Moutier noted that suicide among physicians looks different from that among the general population. For example, physicians who had died by suicide were three times more likely to have had a job-related problem when they died.
Physicians also tend to avoid mental health treatment, instead self-prescribing or obtaining psychiatric medications from a colleague. Part of that motivation comes from fear of stigma or losing one’s medical license. “We are depriving ourselves of potentially lifesaving treatment,” she said.
Moutier went on to urge listeners to reach out to any coworker they fear may be struggling.
“You don’t have to be a mental health professional to be a caring colleague, to notice, and to trust your gut.” What’s more, concerned individuals need not worry that asking will increase the risk of suicide since a number of studies indicate otherwise.
If possible, a conversation about suicidality should help the person involved take the next step forward, such as starting mental health treatment. But any compassionate, nonjudgmental interaction is significant.
“A supportive conversation can be a gamechanger,” said Moutier. “Something very freeing happens.”
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