title: Suicidal behavior among physicians referred for fitness-for-duty evaluation.
abstract: OBJECTIVE
  We compared fitness-for-duty assessment findings of physicians who subsequently engaged in suicidal behavior and those who did not.
  
  
  METHODS
  Assessments of 141 physicians evaluated at the Vanderbilt Comprehensive Assessment Program were retrospectively compared between those who later either attempted (n = 2) or completed (n = 5) suicide versus the remainder of the sample.
  
  
  RESULTS
  Subsequent suicidal behaviors were associated with being found unfit to practice (86% vs. 31%, P < .05), being in solo practice (71% vs. 33%) and chronically using benzodiazepines (57% vs. 11%, Fisher's Exact Test, P < .05).
  
  
  CONCLUSIONS
  Being found unfit for practice may trigger a cascade of adverse social and financial consequences. Those engaged in solo practice may be particularly vulnerable due to isolation and lack of oversight by supportive colleagues. Finally, chronic benzodiazepine use may impair resilience due to associated brain dysfunction. Although these characteristics must be investigated prospectively, our observations suggest that they may be important signals of increased risk for suicidal behavior in physicians. The intense stress associated with medical practice and the relatively high rates of suicidal behavior among physicians make it important to be able to identify physicians who are at risk, so that appropriate preventive actions can be taken.
authors.affiliation: Departments of Psychiatry and Psychology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Iannelli
authors.affiliation: Departments of Psychiatry and Psychology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA. Electronic address: reid.finlayson@vanderbilt.edu.
authors.forename: A J Reid
authors.initials: AJ
authors.lastname: Finlayson
authors.affiliation: Departments of Psychiatry and Psychology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors.forename: Kimberly P
authors.initials: KP
authors.lastname: Brown
authors.affiliation: Departments of Psychiatry and Psychology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Neufeld
authors.affiliation: Departments of Psychiatry and Psychology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors.forename: Roland
authors.initials: R
authors.lastname: Gray
authors.affiliation: Departments of Psychiatry and Psychology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.affiliation: Departments of Psychiatry and Psychology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D004650:Employee Performance Appraisal / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D010815:Physician Impairment / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data
keywords: Benzodiazepine; Fit to practice; Fitness for duty; Physician suicide; Solo practice
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