Prevención del suicidio en médicos

  1. José Carlos Mingote Adán 1
  2. Dolores Crespo Hervás 2
  3. Matilde Hernández Álvarez 3
  4. Mercedes Navío 4
  5. Consuelo Rodrigo García-Pando 5
  1. 1 Programa de Atención Integral al Personal Sanitario Enfermo de la Comunidad Autónoma de Madrid
  2. 2 Ilustre Colegio de Médicos de Madrid
  3. 3 Universidad Autónoma de Madrid
    info

    Universidad Autónoma de Madrid

    Madrid, España

    ROR https://ror.org/01cby8j38

  4. 4 Oficina Regional de Salud Mental de la Comunidad Autónoma de Madrid
  5. 5 Hospital Severo Ochoa
    info

    Hospital Severo Ochoa

    Madrid, España

    ROR https://ror.org/05s3h8004

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Revista:
Medicina y seguridad del trabajo

ISSN: 0465-546X,  1989-7790

Año de publicación: 2013

Volumen: 59

Número: 231

Páginas: 176-204

Tipo: Artículo

DOI: 10.4321/S0465-546X2013000200002 DIALNET GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Medicina y seguridad del trabajo

Resumen

Se sabe que la tasa de suicidio en médicos es mayor que en la población general. La salud de los médicos ha recibido escasa atención de sus colegas, a pesar de la considerable y creciente evidencia de que la morbilidad es alta en la profesión. Cuidar de otras personas genera estrés en los cuidadores. El estrés por la incertidumbre clínica y el temor al fracaso son rasgos importantes de la cultura médica. La paradoja es que el cuidado de los pacientes genera estrés pero es también la fuente de gratificación más importante del médico. Se sabe que aquellos que cuidan de los demás a menudo tienen grandes dificultades para buscar y recibir ayuda para ellos mismos. Las tasas de suicidio de los médicos en Estados Unidos, Inglaterra y otros países son más altas que las de la población general y las de otras profesiones. La tasa de suicidio de los médicos es ligeramente mayor que la de la población general, mientras que la de las médicas es claramente superior. Esta tendencia es más pronunciada entre psiquiatras y anestesistas. Los médicos tienen unas necesidades asistenciales específicas por sufrir elevados niveles de alcoholismo, dependencia de drogas, rupturas matrimoniales, enfermedad mental y suicidio. La automedicación es muy frecuente entre los médicos, en especial con hipnóticos, antidepresivos y analgésicos opiáceos. Muchas de estas dificultades están relacionadas con el estrés, elevada responsabilidad y tiempo insuficiente para trabajar y vivir conciliando las demandas laborales y familiares. Muchos médicos tienen grandes dificultades para discutir sus problemas con los colegas y se tratan a ellos mismos, de forma notablemente peligrosa. El fácil acceso de los médicos a las drogas implica que el abuso de drogas sea un riesgo ocupacional potencial de hombres y mujeres.

Referencias bibliográficas

  • Aasland OG, Ekeberg O, Schweder T. Suicide rates from 1960 to 1989 in Norwegian physicians compared with other educational groups. Social Science Medicine 52 (2): 259-265, 2001.
  • Agerbo E, Gunnell D, Bonde JP et al. Suicide and occupation: the impact of socio-economic, demographic and Psychiatric differences. Psychological Medicine 37: 1131-1140, 2007.
  • Aguilar Shea AL, Vera García M, Outumuro Cadavid A et al. La salud de los médicos de familia: ¿practicamos lo que predicamos? Atención Primaria 43 (6):305-311, 2011.
  • American Academy of Family Physicians. Lifestyle/Personal Health Care in Diferent Occupations. Kansas City, Mo, 1979.
  • American Medical Association. Council on Mental Health. The sick physician. Impairment by psychiatric disorders. JAMA 223: 684687, 1973.
  • American Medical Association. Council on Scientific Affairs. Physician mortality and suicide: results and implicatios of the AMA-APA pilot study. Conn Med 50:37-43, 1986.
  • Arendt H. Sears in Understanding. Ed. Harcourt Brace. New York, 1994.
  • Arensman E, Kerkhof A, Hengeveld M. et al. Medically treated suicide attempts: a four year monitoring study of the epidemiology in the Netherlands. Journal of Epidemiology and Community Health, 49: 285-289, 1995.
  • Arnetz BB, Horte LG, Hedberg A, et al. Suicide patterns among physicians related to other academics as well as to the general population. Results from a national long-term prospective study and a retrospective study. Acta Psychiatrica Scandinavica 75 (2): 139-143, 1987.
  • Bandura A. Teoría del Aprendizaje Social. Ed. Espasa Calpe, Madrid, 1987.
  • Barcia D. Necesidad de una medicina antropológica. Publicaciones Universidad de Murcia, 1979.
  • Barraclough B, Bunch J, Nelson B, Sainsbury P. British Journal Psychiatry 112. 355, 1974. Citado en rucinski y Cybulska, 1985.
  • Beck AT, Steer RA, Kovacs M, Garrison B. Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation. American Journal Psychiatry 142 (5): 559-563, 1985.
  • Blach CM, Oreskovich MR, Dyrbye LN et al. Personal consequences of malpractice lawsuits on American surgeons. Journal College Surgeons 213(5): 657-667, 2011.
  • Blazer DG, Kessler RC, McGonagle KA et al. The prevalence and distribution of major depression in a national community sample: the National comorbidity Survey. American Journal Psychiatry 151: 979-986, 1994.
  • Blumenthal D, Gokhale M, Campbell E, Wissman J. Preparedness for clinical practice. JAMA: 1027-1034, 2006.
  • Bovier PA, Arigoni F, Schneider M, Gallachi MB. Relatioships between work satisfaction, emotional exhaustation and mental Health among Swiss primary care physicians. European Journal Public Health 19 (6): 611-617, 2009.
  • Bobes García J, Sáiz Martínez PA, García-Portilla MP, Bascarán Fernández MT, Bousoño García M. Comportamientos suicidas. Prevención y tratamiento. Ars Medica, Barcelona, 2004
  • Bousoño García M, García prieto A, Bascarán Fernández MT. Aspectos bioéticos y morales, en: Julio Bobes
  • García, Pilar Alejandra Sáiz Martínez, María Paz García-Portilla González, María Teresa Bascarán
  • Fernández, Manuel Bousoño García. Comportamientos suicidas. Prevención y Tratamiento. Ed. Ars Médica. Barcelona, 2004.
  • Boyd JH & Weissman MM. The epidemiology of affective disorders: A reexamination and future directions. Archives of General Psychiatry 38, 1039-1046, 1981.
  • Center C, Davis M, Detre T, et al. Confronting depression and suicide in physicians: a consensus statement. JAMA 289: 3161-3166, 2003.
  • Chan AO, Huak CY. Influence of work environment on emotional health in a health care settings. Occupational Medicine 54 (3):207-212, 2004.
  • Charlton J, Kelly S, Dunnell K et al. Suicide deaths in England and Wales: trends in factors associated with suicide deaths. Populations Trends 71: 34-42,1993.
  • Chiles JA, Strosahl Kd. The suicidal patient. American Psychiatric Press. Inc. Washington, 1995.
  • Cornette MM, deroon-Cassini TA, Fosco GM, et al. Application of an interpersonal-psychological model of suicidal behavior to physicians and medical traines. Archives Suicide Research 13 (1): 1-14, 2009.
  • Croasdale M. Women foun more likely to burn out from practice stress. American Medical News 48.1-2, 2005. de la Cruz C, Corominas A, Sarró B. El suicidio en la profesión médica: revisión bibliográfica. Monografías Médicas Jano, 2 (nº 9), 1988.
  • De la Monte SM, Hutchins GM. Is suicide a special occupational hazard for physicians? JAMA 251 (15):1952-3.
  • Dublin LI, Spiegelman M. The longevity and mortality of American physicians. JAMA 9: 1211-1215, 1947.
  • Ducker DG. Role conflict for women for women physicians. En CD Scott and JE Hawks (eds), Heal Thyself: The Health of two sources of the Health Professional, Brunner-Mazel, New York. 1987.
  • Epstein, RM, Hundert, EM. Defining ans assessing professional competente. JAMA 2002, Jan 9; 287 (2): 226-235.
  • Epstein, RM et al. Comprenhensive assessemante of professional competente: the Rochester experiement. Teach learn med. 16 (2): 186-196, 2004.
  • Firth-Cozens J. Emotional distress in junior house officers. British Medical Journal 295: 533-536, 1987.
  • Ford De, Mead LA, Chang PP et al. Depression is a risk factor for coeonary artery disease in men: the precursors study. Archives Internal Medicine 158: 1422-1426, 1998.
  • Frank E, Dingle AD. Self-reported depression and suicide attemts among US women physicians. American Journal Psychiatry 156: 1887-1894, 1999.
  • Fridner A, Belkic K, Marini M. et al. Survey on recent suicidal ideation among female university hospital physicians in Sweden and Italy (the HOUPE study): cross-sectional associations with work stressors.
  • Gender Medicine 6 (1): 314-328, 2009.
  • Fridner A, Belkic K, Minucci D et al . Work Environment and recent Suicidal Thoughts Among Male University Hospital physicians in Sweden and Italy: The health and organization among University Hospital physician in Europe (HOUPE) Study. Gender Medicine 8 (4): 269-279, 2011.
  • Gabbard GO. The role of Compulsiveness en the Normal Physician. JAMA 254: 2926-2929, 1985.
  • Gabbard GO. Psiquiatría Psicodinámica en la Práctica Clínica. Ed. Médica Panamericana. Buenos Aires, 2002.
  • Gabbard GO, Allison SE. Psychodinamic treatment, en American Psychiatric Publishing Textbook of Suicide. Assessment and Management. Ed. Simon RI, Hales RE. Washington, DC, American Psychiatric Publishing, 2006.
  • Gagné P, Moamai J, Bourget D. Psychopatology and Suicide among Quebec Physicians: A Nested Case Control Study. Depression Research and Treatment. 2011.
  • Gist ME, Mitchell TR. Self-efficacy: a theoretical analysis of its determinants and malleability. Academy of Management Review 17(2): 183-211, 1992.
  • Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting System. General Hospital Psychiatry 35:45-49, 2013.
  • Gracia D. Fundamentos de bioética. Ed. Eudema, Madrid, 2007.
  • Gyorffy Z, Adám S, Csoboth C, Kopp M. The prevalence of suicide ideas and their psychological backgrounds among physicians. Psychiatrie Hungarian 20 (5): 370-379, 2005.
  • Hassan TM, Ahmed SO, White AC, Galbraih N: A postal survey of doctors’ attitudes to becoming mentally ill. Clinical Medicine 9 (4): 327-332, 2009.
  • Hawton K. and Catalan J. Attempted suicide: a practical guide to its nature and management (2nd edn). Oxford University Press, 1987.
  • Hawton K, Clements A, Sakarovitch C et al. Suicide in doctors: a study of risk according to gender, seniority and speciality in medical practitioners in England and Wales 1979-1995. Journal Epidemiology Community Health 55:296-300, 2001.
  • Hawton K, van Heeringen K. Suicide. The Lancet 373: 1372-1381, 2009.
  • Heikkinen M, Aro H, Lonnqvist J. Recent life events, social support and suicide. Acta Psychiatrica Scandinavica Suppl. 377: 65-72, 1994.
  • Heim E. Job stressors and Coping in Health Professions. Psychotherapy and psychosomatics 55: 90-99, 1991. Hem E, Gronvold NT, Aasland OG et al. The prevalence of suicidal ideation and suicidal attempts among
  • Norwegian physicians. Results from a cross-sectional survey of a national sample. European Psychiatry 15 (3): 183-189, 2000.
  • Hem E, Haldorsen T, Aasland OG et al Suicide rates according to education with a particular focus on physicians in Norway 1960-2000 psychological medicine 35 (6): 873-880, 2005.
  • Hernández M, Ayuso Mateos JL. Programa de Formación profesionales Sanitarios de la CAM que trabajan con pacientes en edad geriátrica sobre detwección y Prevención de la Depresión y el Suicidio. Ministerio de Sanidad, Madrid, 2010.
  • Joiner T, Brown JS, Wingate LR. The psychology and Neurobiology of suicidal behavior. Annual Review Psychology 56: 287-314, 2005.
  • Karasek et al. Jobs demands, job decision latitude and mental strain: Implications for job desing. Administrative Science Quarterly 24. 285-308, 1979.
  • Kauppinen-Toropainen K. et al. Job dissatisfaction and work-related exhaustion in male and female work. Journal of Occupational Behavior 4: 193-207, 1983.
  • Kelly S and Bunting J. Trends in suicide in England and Wales, 1982-96. Populatios Trends 92: 29-41, 1998.
  • Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. 2005. Lifetime prevalence and age-ofonset distributions of DSM-IV disordes in the National Comorbidity Survey Replication. Arch. Gen. Psychiatry 62(6):593-602.
  • King H. Health in the medical and other learned professions. Journal chronic Disease 23: 257-281, 1970.
  • Kotler M, Iancu i, Efroni R et al. Anger, impulsivity, social support, and suicide risk in patients with posttraumatic stress disorder. Journal Nervous Mental Disorder 189: 162-167, 2001.
  • Lagro-Janssen AL, Luijs HD. Suicide in female and male physicians. Ned Tijdschr Geneeskd. 152 (40): 2177-2181, 2008.
  • Lindeman S, Laara E, Hakko H et al 1996. A sistematic review on Gender-specific suicide mortality in medical doctors. British Journal Psychiatry 168: 274-279, 1996.
  • Lindeman S, Heinanen H, Vaisanen E et al. Suicide among medical doctors: Psychological aurtopsy on seven cases. Archives Suicide Research 4: 135-141, 1998.
  • Lindfors PM, Meretoja OA, Luukkonen RA et al. Suicidality among Finnish anaesthesiologists. Acta Anaesthesioloigy Scandinavian 53: 1027-1035, 2009.
  • López Sánchez F, Carpintero Raimundez E, del Campo Sánchez A, Lázaro Visa S, Soriano Rubio S. El bienestar personal y social y la prevención del malestar y la violencia. Ed. Pirámide. Madrid, 2006.
  • Maltsberger JT. Outpatient treatment en The American Psychiatric Publihing Textbook of Suicide Assessment and Management. Ed. Simon RI, Hales RE. Washington, DC, American Publishing, 2006.
  • Mann JJ, Oquendo MA, Underwood MD, Arango V. The neurobiology of suicide risk: A review for the clinician. Journal Clinical Psychiatry 60: 7-11,1999.
  • Mann JJ, Waternaux C, Haas GL, et al. Toward a clinical model of suicidal behavior in Psychiatric patients. American Journal Psychiatry 156: 181-189, 1999.
  • Marina JA. Dictamen sobre Dios. Ed. Anagrama. Barcelona, 2001.
  • Marina JA, de la Válgoma M. La magia de leer. Ed. Plaza Janés, Random House Mondadori, SA. Barcelona, 2005.
  • May HJ, Revicki DA. Professional Stress Among Family Physicians. The Journal of Family Practice 20: 165-171, 1985.
  • Mc Murray JE, Linzer M, Konrad TR, et al. The work lives of women physician: a results from the physician work life Study. The SGIM Career Satsfaction Study Group. Journal General Internal Medicine 15: 372-380, 2000.
  • Mingote Adán JC. Satisfacción, estrés laboral y calidad de vida del médico. Tesis Doctoral, Universidad Autónoma de Madrid, 1995.
  • Mingote Adán JC, Jiménez Arriero MA, Osorio Suárez R, Palomo T. Suicidio. Asistencia clínica. Guía práctica de psiquiatría médica. Ed. Diaz de Santos, Madrid, 2004.
  • Mingote C, Requena M (Editores). El malestar de los jóvenes. Contextos, Raíces y Experiencias. Ed. Díaz de Santos, Madrid, 2008.
  • Mingote Adán JC, del Pino Cuadrado P, Gálvez Herrer M y cols. Utilidad preventiva del constructo “trastorno mental grave” en el ámbito sociosanitario. Medicina y Seguridad del Trabajo 56 (221): 306-322, 2010.
  • Müller N, Myint AM, Schwarz MJ. Inflammatory Biomarkers and Depression, en: Tomás Palomo, Richard M
  • Kostrzewa, Richard J Beninger (Eds.). Staging Neuropsychiatric Disorders. Implications for Etiopathogenesis and Treatment. Springer. Madrid, 2012.
  • Myers MF. Physician suicides leave many victims in their wake. Winnipeg Free Press, October 1, 2006.
  • Myers MF, Gabbard GO. The Physician as Patient. A Clinical Handbook for Mental Health Professionals. Ed. American Psychiatric Publishing, Inc. Washington, 2008.
  • Neighbour R. La Consulta Interior. Ed. J&C S.L. Esplugues de Llobregat, 1998.
  • Nogales, A., García-Seoane, J., Calvo, E. y Grupo de Trabajo Para la Definición de Competencias. Competencias para el Grado de Medicina de la Universidad Complutense de Madrid. Documento Base. Unión Editorial: Madrid 2008.
  • New Zealand Guidelines Group and Ministry of Health. The assessment and management of people at risk of suicide, Wellington: New Zealand Guidelines Group and Ministry of Health. 2003.
  • Nierenberg AA, Gray SM, Grandin LD. Mood disorders and suicide. Journal Clinical Psychiatry 62 (Suppl 25): 27-30, 2001.
  • Ortega y Gasset J. La rebelión de las masas. Ed. Austral, Madrid, 1929.
  • Owen D. Diseased, demented, depressed: serious illness in Heads of State. Ocupacional Medicine 53: 491-501, 2003.
  • Petersen MR, Burnett CA. The suicide mortality of working physicians and dentists. Occupational Medicine (Lond.) 58 (1): 25-29, 2008.
  • Pompili M, Innamorati M, Narciso V. et al. burnout, hopelessness and suicide Risk in medical doctors. Clínica Terapeutica 161 (6): 511-514, 2010.
  • Post RM. Mechanisms of Illness Progression in the Recurrent Affective Disorders, en: Tomás Palomo, Richard
  • M Kostrzewa, Richard J Beninger (Eds.). Staging Neuropsychiatric Disorders. Implications for Etiopathogenesis and Treatment. Springer. Madrid, 2012.
  • Preven DW. Physician Suicide. The Psychiatrist´s Role, en The Impaired Physician (ed) Stephen C Scheiber and Brian B Doyle Plenum Medical Book Co., New York, 1983.
  • Registrar General. Decenial Supplement, England and Gales 1959-63 on Occupational Mortality, HMOS, London, 1978.
  • Retorta J. El poder y sus conflictos. Ed. Plural Paidós. Barcelona, 2005.
  • Sadock, B.J. y Sadock, V.A. Sinopsis de Psiquiatría. Waverly Hispánica S.A. Barcelona, 2004.
  • Revicki DA, May HJ. Development and Validation of the Physician Stress Inventory Family Practice Research Journal 2:211-225, 1983.
  • Revicki DA, May HJ. Occupational stress, Social Support, and Depression. Health Psychology 4: 61-77, 1985.
  • Revicki DA, May HJ, Whitley TW. Reliability and Validity of the work-Related Strain Inventory Among Health Professionals. Behavioral Medicine 12: 111-120,1991.
  • Reynolds Ch, Clayton P. Out of the Silence: Confronting Depression in Medical Students and Residents. Academic Medicine 84 (2): 159-160, 2009.
  • Rich CL, Pitts FN. Suicide by male physicians during a five-year period. American Journal psychiatry 136.1089-1090, 1979.
  • Rich CL, Pitts FN. Suicide by psychiatrist: A study of medical specialists among 18,730 consecutive physician deaths during a 5 year period (1967-1972). Journal Clinical Psychiatry 41: 261-263, 1980.
  • Richards C. The health of doctors. King Edward`s Hospital Fund for London, 1989.
  • Rose KD and Rosow I. Physicians who kill themselves. Archives General Psychiatry 29: 800, 1973.
  • Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. 121: 31-49, 2003.
  • Ross M. Suicide and the psychiatrist. American Journal Psychiatry 130: 937, 1973.
  • Roskar S, Podlesek A, Zorko M, et al. Effects of training on recognition and management of drpression and suicide risk evaluation for Slovenian primary-care physicians: follow-up study. Croatian Medical Journal 51 (3): 237-242, 2010.
  • Rucinski J and Cybulska E. Mentally ill doctors British Journal Hospital Medicine, II, 1985.
  • Sarró B y de la Cruz C. Los suicidios. Martínez Roca, Barcelona, 1991.
  • Shanafelt TD, Balch CM, Dyrbye L, et al. Special report: suicidal ideation among American surgeons. Archives Surgery 146 (1): 54-62. 2011.
  • Satcher D. From the Surgeon General. JAMA, 284: 950, 2000
  • Schmidtke A, Bille Brahe U, De Leo D et al. Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989-1992. Results of the WHO/EURO Multicentre Study on Parasuicide: Acta Psychiatrica Scandinavica 93, 327-338, 1996.
  • Schernhammer ES, Colditz GA: Suicide rates among physicians: a quantitative and gender assessment (metaanalysis). American Journal Psychiatry 161: 2295-2302, 2004.
  • Siegrist J, Rödel A. Work stress and health risk behavior. Scandinavian Journal Work Environmental Health 32 (6): 473-481, 2006.
  • Silverman M. Physicians and suicide, en The Handbook of Physician Health: An Essential Guide to Understanding the Healthcare Needs of Physicians. Ed. Goldman LS, Myers M, Dickstein LJ. Chicago, IL, American Medical Association, 2000.
  • Simon RI. Patient safety versus freedom of movement: coping with uncertainty, en The American Psychiatric Publihing Textbook of Suicide Assessment and Management. Ed. Simon RI, Hales RE. Washington, DC, American Publishing, 2006.
  • Spector PE. Behavior in Organizations as a function of employee`s locus of control. Psychological Bulletin 91 (3):482-497, 1982.
  • Steppacher RC and Mausner JS. JAMA 228. 323,1974. Citado en Rucinski y Cybulska (1985).
  • Torre D, Wang NY, Mead LA, et al. Mortality in a prospective study of physicians. Journal General International Medicine 15 (suppl): 150, 2000.
  • Tyssen R, Hem E, Vaglum P, et al. The process of suicidal planning among medical doctors: predictors in a longitudinal Norwegian sample. Journal Affective Disoeders 80 (2-3): 191-198, 2004.
  • Vaillant GE. Adaptation to Life. Little Brown and Co. Inc. Boston, 1977.
  • Vaillant GE, Vaillant CO. Natural History of Male psychological health XII: A 45 Year Study of Predictors of Successful Aging at Age 65. American Journal of Psychiatry 147: 31-37, 1991.
  • Van der Heijden F, Dillingh G, Bakker A, et al. Suicidal Thoughts Among Medical Residents with Burnout. Archives of Suicide Research 12: 344-346, 2008.
  • Wada K, Yoshikawa T, Goto T et al. Association of Depression and Suicidal Ideation with Unreasonable Patient Demands and Complaints Among Japanese Physicians: A National Cross-sectional survey International Journal Behavioral medicine 18: 384-390, 2011.
  • Williams JMG and Pollock LR. The psychology of suicidal behavior, en The internal handbook of suicide (ed.
  • K Hawton and C Van Heeringen). Wiley, Chichester, 2000.
  • Wortman C, Biernat M, Lang P. Coping with Role Overload en Frankerhaeuser M, Lundberg E, Chesney M.
  • Women, Work and Health. Stress and Opportunities. Plenum Press, New York 1991.
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