COVID-19, burnout and suicide

 In February 2020, on Jama Psychiatry, it was published the article “The Loss of Social Connectedness as a Major Contributor to Physician Burnout – Applying Organizational and Teamwork Principles for Prevention and Recovery” (LINK HERE). 

In this period, in which medical teams from all over the world are engaged to fight against COVID-19 pandemic, the necessity for psychological support is a hot topic. 

Physicians are called to work many hours everyday, with a huge number of unknown patients, with individual protections and, when they come back home, they prefer to stay alone to protect their families. All of these factors can produce feelings of loneliness, sadness and tiredness. Moreover, everyday they could face off with death and feelings of impotence against a disease still not well known. All these feelings may enhance the risk of anxiety, depression, burnout and suicide. 

The study published on Jama stresses the association between burnout, loneliness and social isolation; inadequate support from colleagues and leaders, community and so on.  

During this pandemic it is essential not to forget that in order to reduce burnout and permit professionists to give their best it is essential to prioritize human connections and teamwork so they can give optimal patient care. 

  • Southwick SM, Southwick FS. The Loss of Social Connectedness as a Major Contributor to Physician BurnoutApplying Organizational and Teamwork Principles for Prevention and RecoveryJAMA Psychiatry. 2020;77(5):449–450. doi:10.1001/jamapsychiatry.2019.4800

Social Network and Suicide

An increasingly interesting research topic of the recent literature on suicide is about the relationship between use of social network and suicide rates among young people. A recent narrative review published online by Nassir Ghaemi, “Digital Depression: A New Disease of the Millennium?” (Ghaemi, 2020) has reviewed the last data about this subject, finding that in the last decade there has been a rise of suicide rates among teenagers and young adults, correlated with the massive use of smartphones and social networks. Author reports that in this last period depressive symptoms have risen, and suicide has become more frequent especially among teenage girls in the USA. The specific correlation between suicidality and use of social networks has been investigated by studies that tested depressive symptoms in college students and observed a decrease of these symptoms in students that accepted a reduction of social media use. On this track many works identified a correlation between these two phenomena, for example a review published on Current Opinion in Psychiatry in November 2019 titled “Social media, internet use and suicide attempts in adolescents”, found an independent direct association between problematic social media use and suicide attempts in young people. These findings suggest the importance of further studies on this problem, in order to create suicide preventive programs that consider this correlation. Another interesting fact is that the role of social media has shown to be also protective in some cases, because adolescents frequently use this media to communicate suffering and distress as shown by other recent studies (Marchant et al, 2017). 

  • Ghaemi SN (2020) Digital depression: a new disease of the millennium? Acta Psychiatr Scand. 2020 Jan 18. doi: 10.1111/acps.13151.
  • Marchant A, Hawton K, Stewart A, Montgomery P, Singaravelu V, Lloyd K, et al. (2017) A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown. PLoS ONE 12(8): e0181722. pmid:28813437

UNICEF: “An open letter to the world’s children”

Henrietta H. Fore, the UNICEF Executive Director, in her recent “An open letter to the world’s children”, described the 8 reasons why she’s worried, and hopeful, about the next generation. In the third place (after the need of clean water, air and safe climate, life in conflict and disaster zone) it is listed the need to talk about mental health and, more specifically, about the vulnerability of young people, the high risk of depression, self harm and suicide. “The World Health Organization (WHO) estimates that 62,000 adolescents died in 2016 because of self-harm, which is now the third leading cause of death for adolescents aged 15 –19. This is not just a rich country problem – WHO estimates that more than 90 per cent of adolescent suicides in 2016 were in low or middle-income countries. And while young people with severe mental disorders in lower-income countries often miss out on treatment and support, there is no country in the world that can claim to have conquered this challenge. To quote the WHO’s mental health expert Shekhar Saxena, “when it comes to mental health, all countries are developing countries.” 

The Kazakhstan experience in suicide prevention is then described: “For example, in Kazakhstan, which has one of the highest suicide rates among adolescents worldwide, UNICEF stepped up efforts to improve the mental well-being of adolescents through a large-scale pilot programme in over 450 schools. The programme raised awareness, trained staff to identify high-risk cases, and ensured referral of vulnerable adolescents to health specialists. Nearly 50,000 young people participated in the pilot with many significant improvements in well-being. The programme has since been scaled up to over 3,000 schools”. 

We are proud to remind that the UNICEF programme involved the EPA-SSSP Chair, Marco Sarchiapone (LINK)

World Mental Health Day

On 10 October 2019, every year, the World Mental Health Day is celebrated to raise awareness about mental health issues around the world and to foster efforts in support of mental health. This year the main theme of the World Mental Health Day is suicide prevention. 

Our section, represented by the Section Chair Marco Sarchiapone, participated in drafting the EPA statement for both the World Suicide Prevention Day and the World Mental Health Day 2019. These statements will be circulated to the NPAs, which will be invited to inform the EPA offices about their activities and initiatives for October 10th, in order to develop a communication strategy to raise visibility and support them.




Scientific News and Reading Suggestion #31

Prof. Zoltan Rihmer shared with us his recent paper published 2 weeks ago on the JOURNAL OF PSYCHOPATHOLOGY

“Suicide in obsessive-compulsive related disorders: prevalence rates and psychopathological risk factors”
U. Albert, L. Pellegrini, G. Maina, A.-R. Atti, D. De Ronchi, Z. Rhimer

The article is a systematic review, stresses that people who suffer from Obsessive-compulsive related disorders (OCRDs) may be at risk for suicide attempts and suicidal ideation independently from comorbid disorders.

Thanks to Prof. Zoltan Rihmer

Scientific News and Reading Suggestion #30

Many interesting articles about suicide have been published during August 2019 on different scientific journals. We talked about high risk of suicide in medical doctors, trainees and specialists, and recently the topic is highlited in many international journals (our previous articles: Scientific News and Reading Suggestion #28Scientific News and Reading Suggestions #22; #CrazySocks4Docs).

Effects of suicide on psychiatry trainees”, published on the BJPsych Bullettin by M.Calcia ( examines the need to support clinicians who deal with suicidal patients, referring to a survey by Gibbons et al. (Gibbons R, Brand F, Carbonnier A, Croft A. Effects of patient suicide on psychiatrists: survey of experiences and support required. BJPsych Bull 2019; doi: 10.1192/bjb.2019.26.). “…having experienced a patient suicide as a trainee had a significant influence on the responder’s choice of subspecialty… we hope that mental health trusts and postgraduate training departments continue working to develop formal and informal support structures for doctors experiencing this difficult event”.

Young doctors are often well trained and skilled in managing organic conditions, but they may have received less training and education in the management of suicidal patients, and may find it difficult to treat them. 

The Journal of Adolescent Health recently published a paper “A Call to Reorient Pediatric Residency Education to Address the Emerging Threat of Suicide”, by M. Townsend Cooper Jr., ( stressing the importance of training pediatric residents to approach suicidality: “As a pediatric community, we are woefully unprepared for this unfolding epidemic”. The article by Schoen et al., Suicide Risk Assessment and Management Training Practices in Pediatric Residency Programs: A Nationwide Needs Assessment Survey (, has highlighted a gap in residents’ training needs that calls for immediate attention: “Although 82% of respondents rated suicide prevention training in residency as “very” or “extremely” important, a minority (18% PDs and 10% CRs) reported adequate preparation relative to need”. 

The most common barrier mentioned to deliver appropriate training about this topic was lack of time:

How do we as a medical community not have time to treat an epidemic that is staring us squarely in the face? Would we accept a similar excuse from ourselves if this was a threat from an infectious disease?”. 

Academic Psychiatry published the article “Preclinical Medical Student Attitudes Toward Use of Psychiatry Residents as Actors in a Suicide and Violence Risk Assessment Simulation Activity” ( stressing the importance of medical students training in suicide prevention “to transform classroom knowledge into clinical skills”; simulation was suggested as a good practice for learning, as it gives students the possibility to get involved in situations resembling clinical practice.

Sources (image)

Scientific News and Reading Suggestion #29

Our Section member Federico M. Daray shared with us some recent papers published with his research group in Argentina:

  • How lipids may affect risk for suicidal behavior (Journal of Psychiatric Research, 104, 2018)
  • Suicidal ideation is associated with cardiovascular disease in a large, urban cohort of adults in the Southern Cone of Latin America (General Hospital Psychiatry, 57, 2019)
  • Serotonin transporter gene polymorphism as a predictor of short-term risk of suicide reattempts (European Psychiatry, 54, 2018)
  • Factors associated with postpartum depression in women from low socioeconomic level in Argentina: A hierarchical model approach (Journal of Affective Disorders 227, 2017)
  • Lethality of Previous Suicidal Behavior among Patients Hospitalized for Suicide Risk Predicts Lethality of Future Suicide Attempts (Suicide and Life-Threatening Behavior, 2018)

Suicide and suicidal behaviors can be influenced, among the others, by individual risk factors. The role of diet and metabolism is still poorly understood. Daray and coworkers describe in their work a theoretical model linking cholesterol and poly-unsaturated fatty acids (PUFA) status to 5-HT neurotrasmission and suicide risk. They also studied the relationships between cardiovascular disease (CVD) and suicidal risk in Southern Cone of Latin America: “There is a significant association between suicidal ideation and CVD, particularly among women, which may be driven, at least in part, by depression and physical functional impairment”.

In the literature there are many other works about metabolic syndrome, its correlates and suicide: for example, in 2013 Chang and coworkers (LINK) published the article “Metabolic Syndrome and the Risk of Suicide: A Community-Based Integrated Screening Samples Cohort Study” reporting that “Metabolic Syndrome was associated with an increased risk of suicide risk by 16% per MetS component, adjusting for demographics, life-style factors, and clinical correlates. Of the metabolic syndrome components, elevated blood pressure was independently associated with suicide-related mortality” (10-year follow-up period, 76.297 people recruited, 12.094 with Metabolic Syndrome, 146 death for suicide).

Maslov and coworkers (2009) (LINK ) investigated these factors in patients affected by Post-Traumatic Stress Disorder and Schizophrenia while D’Ambrosio et al. (2012) (LINK) in patients with bipolar disorder. It is widely acknowledged that these patients have higher rates of substances abuse, smoking, obesity, diabetes and cardiovascular disease (metabolic syndrome) and are at-risk for suicide, so the possible correlation among these variables was investigated.

Public mental health interventions targeting also these individuals factors may be warranted.  

Thanks to F. Daray

Scientific News and Reading Suggestion #28

On March 2019, Lancet Psychiatry published the following article: “Interventions to reduce symptoms of common mental disorders and suicidal ideation in physicians: a systematic review and meta-analysis” (Petrie, K). It deals with a current topic, which is the increased prevalence of common mental disorders (depression, anxiety) and suicide among physicians. The authors identified 2992 articles, of which 8 were included in the systematic review and 7 in the meta-analysis. The results suggest that “physician-directed interventions are associated with small reductions in symptoms of common mental health disorders among physicians” and that “modification of the work environment is urgently needed”.

We proposed the topic of physician and mental health in other reading suggestions in the past year. In September on Jama Psychiatry it was published the article “A Physician’s Suffering – Facing Depression as a Trainee”, which focused on the impact that a physician suicide may have on colleagues; in May 2018 on BMJ it was published the free meta-analysis and systematic review “Psychosocial job stressors and suicidality: a meta-analysis and systematic review”.

As stressed in our previous suggestions, the medical profession is one of the occupations with the highest risk of death by suicide (one physician is estimated to die by suicide each day in the USA) and this is often an “uncomfortable” topic for discussion.

Also our Secretary C. Gramaglia and our member P. Zeppegno published on April 2018 an Opinion on Frontiers in Psychology, edited by our Co-Chair J. L. Castroman titled “Medical Students and Suicide Prevention: Training, Education, and Personal Risks”. The article stresses the importance of a specific training focusing on the risk of depression and suicide risk among medical students and practitioners. The article is open access HERE.

See our previous reading suggestions to know more:


Scientific News and Reading Suggestion #27

On 1st January 2019 on JAMA Psychiatry it was published the article “Risk of Suicide After Cancer Diagnosis in England”. In the literature it is widely acknowledged that a diagnosis of cancer maybe a risk factor for psychological distress, depression, anxiety and suicide: there are many resources that may be used in order to prevent these events, and all clinicians (not only psychiatrists) should quantify the risk of any patients using prevention strategies. In the study published on JAMA, of the 4 722 099 cancer patients enrolled, 2491 patients died by suicide, representing 0.08% of all deaths during the follow-up period.

The article “Incidence of Suicide in Persons With Cancer” published on the Journal of Clinical Oncology in 2008 reported that the incidence of suicide in patients with cancer was approximately twice that of the general US population.

Both articles found that suicide risk was different for different types of cancer (highest among patients with mesothelioma, pancreatic, esophageal, lung and stomach cancer) and that it was highest in the first 6 months following cancer diagnosis. Perhaps, lower quality of life in patients with some kind of cancer may be related to emotional distress; others could have a devastating effect on quality of life through their impact on physical appearance and essential functions such as speech, swallowing, and breathing.

Researchers stress that suicide in cancer patients can be considered as a potentially preventable death cause, and that patients may need psychological support during the first 6 months after cancer diagnosis.

Last, cancer diagnosis potentially involves  end-of-life decisions; there are different studies about this topic; for example, the article “End-of-life decision-making across cancer types: results from a nationwide retrospective survey among treating physicians”, published on the British Journal of Cancer in 2018. This study was about a large random sample of all deaths in Flanders and Belgium in which all cancer deaths were selected (n = 2392): euthanasia or physician-assisted suicide were chosen in 8.7-12.6% of the cases, independent of cancer types.


Scientific News and Reading Suggestion #26

Does psychopathology vary due to the influence of Christmas holidays? Since we are approaching Christmas and the arrival of the new year, the question is timely. We found an article published on Innovations in Clinical Neuroscience in 2011, “The Christmas Effect on Psychopathology” (Sansone et al), which offers an overview of the literature about this topic. The article reports about different issues in the field of mental health, such as access to emergency room services on behalf of psychiatric patients, depressive symptoms, substance abuse and also self-harm behaviors, suicide attempts and suicide. The Authors report that according to the literature, deliberate self-harm decreases around Christmas holidays, in particular in younger patients; suicide attempts rate decreases during Christmas period, but some studies reports that it may increases during the New Year holiday.

On Psychology Today, it is suggested a correlation between the reduction of these events and a protective effect exerted by the proximity of relatives and the hope of ‘things getting better from here’.

A previous reading suggestion (#17, March 2018) was about a recent publication by our member Christina Van der Feltz-Cornelis on Frontiers in Psychiatry, “Springtime Peaks and Christmas Troughs: A National Longitudinal Population-Based Study into Suicide Incidence Time Trends in the Netherlands” in which it is stressed that suicide incidence was 42% lower at Christmas, compared to the December-average (IRR = 0.580, p < 0.001), but after Christmas, a substantial increase occurred on January 1, which remained high during the first weeks of the new year.



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