Challenges and potential solutions for physician suicide risk factors in the COVID-19 era: psychiatric comorbidities, judicialization of medicine, and burnout.

INTRODUCTION: Suicide among physicians constitutes a public health problem that deserves more consideration. A recently performed meta-analysis and systematic review evaluated suicide mortality in physicians by gender and investigated several related risk factors. It showed that the post-1980 suicide mortality was 46% higher in female physicians than among women in the general population, while the risk in male physicians was 33% lower than among men in general, despite an overall contraction in physician mortality rates in both genders. METHODS: This narrative review was conducted by searching and analyzing articles/databases that were relevant to addressing questions raised by a prior meta-analysis and how they might be affected by COVID-19. This process included unstructured searches on Pubmed for physician suicide, burnout, judicialization of medicine, healthcare organizations, and COVID-19, and Google searches for relevant databases and medical society, expert, and media commentaries on these topics. We focus on three factors critical to addressing physician suicides: epidemiological data limitations, psychiatric comorbidities, and professional overload. RESULTS: We found relevant articles on suicide reporting, physician mental health, the effects of healthcare judicialization, and organizational involvement on physician and patient health, and how COVID-19 may impact such factors. This review addresses information sources, underreporting/misreporting of physician suicide rates, inadequate diagnosis and management of psychiatric comorbidities and the chronic effects on physicians' work capacity, and, finally, judicialization of medicine and organizational failures increasing physician burnout. We discuss these factors in general and in relation to the COVID-19 pandemic. CONCLUSIONS: We present an overview of the above factors, discuss possible solutions, and specifically address how COVID-19 may impact such factors.

Challenges and potential solutions for physician suicide risk factors in the COVID-19 era: psychiatric comorbidities, judicialization of medicine, and burnout

Abstract Introduction Suicide among physicians constitutes a public health problem that deserves more consideration. A recently performed meta-analysis and systematic review evaluated suicide mortality in physicians by gender and investigated several related risk factors. It showed that the post-1980 suicide mortality was 46% higher in female physicians than among women in the general population, while the risk in male physicians was 33% lower than among men in general, despite an overall contraction in physician mortality rates in both genders. Methods This narrative review was conducted by searching and analyzing articles/databases that were relevant to addressing questions raised by a prior meta-analysis and how they might be affected by COVID-19. This process included unstructured searches on Pubmed for physician suicide, burnout, judicialization of medicine, healthcare organizations, and COVID-19, and Google searches for relevant databases and medical society, expert, and media commentaries on these topics. We focus on three factors critical to addressing physician suicides: epidemiological data limitations, psychiatric comorbidities, and professional overload. Results We found relevant articles on suicide reporting, physician mental health, the effects of healthcare judicialization, and organizational involvement on physician and patient health, and how COVID-19 may impact such factors. This review addresses information sources, underreporting/misreporting of physician suicide rates, inadequate diagnosis and management of psychiatric comorbidities and the chronic effects on physicians' work capacity, and, finally, judicialization of medicine and organizational failures increasing physician burnout. We discuss these factors in general and in relation to the COVID-19 pandemic. Conclusions We present an overview of the above factors, discuss possible solutions, and specifically address how COVID-19 may impact such factors.

Physician suicide demographics and the COVID-19 pandemic

Objective: To identify suicide rates and how they relate to demographic factors (sex, race and ethnicity, age, location) among physicians compared to the general population when aggravated by the coronavirus disease 2019 (COVID-19) pandemic. Methods: We searched U.S. databases to report global suicide rates and proportionate mortality ratios (PMRs) among U.S. physicians (and non-physicians in health occupations) using National Occupational Mortality Surveillance (NOMS) data and using Wide-ranging Online Data for Epidemiologic Research (WONDER) in the general population. We also reviewed the effects of age, suicide methods and locations, COVID-19 considerations, and potential solutions to current challenges. Results: Between NOMS1 (1985-1998) and NOMS2 (1999-2013), the PMRs for suicide increased in White male physicians (1.77 to 2.03) and Black male physicians (2.50 to 4.24) but decreased in White female physicians (2.66 to 2.42). Conclusions: The interaction of non-modifiable risk factors, such as sex, race and ethnicity, age, education level/healthcare career, and location, require further investigation. Addressing systemic and organizational problems and personal resilience training are highly recommended, particularly during the additional strain from the COVID-19 pandemic.

Physician suicide demographics and the COVID-19 pandemic.

OBJECTIVE: To identify suicide rates and how they relate to demographic factors (sex, race and ethnicity, age, location) among physicians compared to the general population when aggravated by the coronavirus disease 2019 (COVID-19) pandemic. METHODS: We searched U.S. databases to report global suicide rates and proportionate mortality ratios (PMRs) among U.S. physicians (and non-physicians in health occupations) using National Occupational Mortality Surveillance (NOMS) data and using Wide-ranging Online Data for Epidemiologic Research (WONDER) in the general population. We also reviewed the effects of age, suicide methods and locations, COVID-19 considerations, and potential solutions to current challenges. RESULTS: Between NOMS1 (1985-1998) and NOMS2 (1999-2013), the PMRs for suicide increased in White male physicians (1.77 to 2.03) and Black male physicians (2.50 to 4.24) but decreased in White female physicians (2.66 to 2.42). CONCLUSIONS: The interaction of non-modifiable risk factors, such as sex, race and ethnicity, age, education level/healthcare career, and location, require further investigation. Addressing systemic and organizational problems and personal resilience training are highly recommended, particularly during the additional strain from the COVID-19 pandemic.

A proposal for a new Brazilian six-item version of the Edinburgh Postnatal Depression Scale.

INTRODUCTION:: Factor analysis of the Edinburgh Postnatal Depression Scale (EPDS) could result in a shorter and easier to handle screening tool. Therefore, the aim of this study was to check and compare the metrics of two different 6-item EPDS subscales. METHODS:: We administered the EPDS to a total of 3,891 women who had given birth between 1 and 3 months previously. We conducted confirmatory and exploratory factor analyses and plotted receiver-operating characteristics (ROC) curves to, respectively, determine construct validity, scale items' fit to the data, and ideal cutoff scores for the short versions. RESULTS:: A previously defined 6-item scale did not exhibit construct validity for our sample. Nevertheless, we used exploratory factor analysis to derive a new 6-item scale with very good construct validity. The area under the ROC curve of the new 6-item scale was 0.986 and the ideal cutoff score was ≥ 6. CONCLUSIONS:: The new 6-item scale has adequate psychometric properties and similar ROC curve values to the10-item version and offers a means of reducing the cost and time taken to administer the instrument.

A proposal for a new Brazilian six-item version of the Edinburgh Postnatal Depression Scale / Proposta para uma nova versão brasileira de seis itens da Escala de Depressão Pós-Parto de Edimburgo

Abstract Introduction: Factor analysis of the Edinburgh Postnatal Depression Scale (EPDS) could result in a shorter and easier to handle screening tool. Therefore, the aim of this study was to check and compare the metrics of two different 6-item EPDS subscales. Methods: We administered the EPDS to a total of 3,891 women who had given birth between 1 and 3 months previously. We conducted confirmatory and exploratory factor analyses and plotted receiver-operating characteristics (ROC) curves to, respectively, determine construct validity, scale items' fit to the data, and ideal cutoff scores for the short versions. Results: A previously defined 6-item scale did not exhibit construct validity for our sample. Nevertheless, we used exploratory factor analysis to derive a new 6-item scale with very good construct validity. The area under the ROC curve of the new 6-item scale was 0.986 and the ideal cutoff score was ≥ 6. Conclusions: The new 6-item scale has adequate psychometric properties and similar ROC curve values to the10-item version and offers a means of reducing the cost and time taken to administer the instrument.

Resumo Introdução: A análise fatorial da Escala de Depressão Pós-Parto de Edimburgo (Edinburgh Postnatal Depression Scale, EPDS) poderia resultar em uma ferramenta de triagem mais curta e mais fácil de aplicar. Portanto, o objetivo deste estudo foi verificar e comparar as métricas de duas subescalas EPDS de 6 itens. Métodos: Administramos a EPDS a um total de 3.891 mulheres que deram à luz entre 1 e 3 meses antes da aplicação. Foram realizadas análises fatoriais confirmatórias e exploratórias e geradas curvas ROC (receiver-operating characteristics) para determinar, respectivamente, a validade do construto, o ajuste dos itens da escala aos dados, e os pontos de corte ideais para as versões curtas. Resultados: A escala de 6 itens previamente publicada não apresentou validade de construto para nossa amostra. No entanto, utilizamos a análise fatorial exploratória para derivar uma nova escala de 6 itens, que apresentou boa validade de construto. A área sob a curva ROC da nova escala de 6 itens foi 0,986, e o ponto de corte ideal foi ≥ 6. Conclusão: A nova escala de 6 itens possui propriedades psicométricas adequadas e valores de curva ROC semelhantes à versão de 10 itens e oferece um meio de reduzir o custo e o tempo necessário para administrar o instrumento.

Suicidality among pregnant women in Brazil: prevalence and risk factors.

Suicide is one of the major causes of preventable death. We evaluated suicidality among pregnant women who participated in prenatal care in Brazil. A total of 255 patients were assessed using semi-structured interviews as well as the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI), and Mini-International Neuropsychiatric Interview (MINI) Plus. Thereafter, Stata 12 was used to identify the significant predictors of current suicide risk (CSR) among participants using univariate and multivariate analyses (p < 0.05). According to MINI Plus module C, the lifetime suicide attempt rate was 12.55%. The overall CSR was 23.53%, distributed across risk levels of low (12.55%), moderate (1.18%), and high (9.80%). Our rates approximate those found in another Brazilian study (18.4%). Antenatal depression (AD), lifetime bipolar disorder, and any current anxiety disorder (as measured using the MINI) as well as BDI scores ≥15 and EPDS scores ≥11 were identified as positive risk factors in a univariate analysis (p < 0.001). These factors changed after a multivariate analysis was employed, and only years of education [odds ratio (OR) = 0.45; 95% confidence intervals (CIs) = 0.21-0.99], AD (OR = 3.42; 95% CIs = 1.37-8.53), and EPDS scores ≥11 (OR = 4.44; 95% CIs = 1.97-9.97) remained independent risk factors. AD and other psychiatric disorders were the primary risk factors for suicidality, although only the former remained an independent factor after a multivariate analysis. More than 10 years of education and EPDS scores ≥11 were also independent factors; the latter can be used as a screening tool for suicide risk.

Postpartum depression: A systematic review of the genetics involved.

Postpartum depression is one of the most prevalent psychopathologies. Its prevalence is estimated to be between 10% and 15%. Despite its multifactorial etiology, it is known that genetics play an important role in the genesis of this disorder. This paper reviews epidemiological evidence supporting the role of genetics in postpartum depression (PPD). The main objectives of this review are to determine which genes and polymorphisms are associated with PPD and discuss how this association may occur. In addition, this paper explores whether these genes are somehow related to or even the same as those linked to Major Depression (MD). To identify gaps in the current knowledge that require investigation, a systematic review was conducted in the electronic databases PubMed, LILACS and SciELO using the index terms "postpartum depression" and "genetics". Literature searches for articles in peer-reviewed journals were made until April 2014. PPD was indexed 56 times with genetics. The inclusion criteria were articles in Portuguese, Spanish or English that were available by institutional means or sent by authors upon request; this search resulted in 20 papers. Genes and polymorphisms traditionally related to MD, which are those involved in the serotonin, catecholamine, brain-derived neurotrophic factor and tryptophan metabolism, have been the most studied, and some have been related to PPD. The results are conflicting and some depend on epigenetics, which makes the data incipient. Further studies are required to determine the genes that are involved in PPD and establish the nature of the relationship between these genes and PPD.

What is the best tool for screening antenatal depression?

BACKGROUND: Antenatal depression (AD) can have devastating consequences. No existing scales are specifically designed to measure it. Common practice is to adapt scales originally developed for other circumstances. We designed this study to validate and determine the psychometric values for AD screening in Brazil. METHODS: We collected clinical and socio-demographic data in the second gestational trimester. The following instruments were also administered during that period: MINI-PLUS, EPDS, BDI and HAM-D. RESULTS: At the time of assessment, 17.34% of the patients were depressed, and 31.98% met the diagnostic criteria for lifetime major depression. All instruments showed an area under the curve in a receiver operating characteristic analysis greater than 0.85, with the BDI achieving a 0.90 and being the best-performing screening instrument. A score ≥11 on the EPDS (81.58% sensitivity, 73.33% specificity), ≥15 on the BDI (82.00% sensitivity, 84.26% specificity) and ≥9 on the HAM-D (87.76% sensitivity, 74.60% specificity) revealed great dichotomy between depressed and non-depressed patients. Spearman׳s rank correlation coefficients (ρ) among the scales had good values (EPDS vs. BDI 0.79; BDI vs. HAM-D 0.70, and EPDS vs. HAM-D 0.67). LIMITATIONS: This study was transversal, assessing only women in the second gestational trimester. Results may be applicable only to the Brazilian population since psychometric properties may vary with the population under study. Major depression can amplify somatic symptomatology, affecting depressive rating scale data. CONCLUSION: AD is highly prevalent in Brazil. To address the problem of under-recognition, physicians can use the EPDS, BDI and HAM-D to identify AD.