Longitudinal analysis of suicides among pharmacists during 2003-2018

Pharmacist homicides in the United States: A retrospective review of NVDRS data from 2003 to 2020

PURPOSE

Workplace and work-related violence are growing concerns in the healthcare community and among healthcare professionals. A gap exists in our understanding of the most extreme form of violence, homicide, against pharmacists and the contributing factors leading to their tragic deaths. The objective of this study was to identify homicides of pharmacists and characterize potential patterns, including, but not limited to, the connection to pharmacists' work.

METHODS

Data from the Centers for Disease Control and Prevention's National Violent Death Reporting System (NVDRS) were analyzed to explore the number and characteristics of homicides of pharmacists that occurred between 2003 and 2020.

RESULTS

Between 2003 and 2020, 33 homicides of pharmacists were reported to the NVDRS. A slight majority (n = 17, 52%) of victims were female. Six (18%) were determined to be workplace or work-related homicides; only 2 homicides were related to the work of a pharmacist. Nearly two-thirds (n = 21, 64%) were perpetrated with a firearm. The suspects for most of these homicides were male (n = 28, 85%), and many were either a current or former partner of the decedent (n = 14, 42%).

CONCLUSION

In the US, homicides of pharmacists occur infrequently relative to the general population. Homicides in pharmacists' workplaces are uncommon, and homicides of pharmacists appear to be tied most often to domestic violence and firearms.

Pharmacists as gate keepers in suicide prevention: Assessing support needs of pharmacy teams

BACKGROUND

Gatekeeper training is an effective suicide prevention strategy. Pharmacy teams are among the most visible and accessible health care providers, making them important as possible gatekeepers. Given the pharmacists' role in dispensing medication, which is a common method of suicide and suicide attempts in Flanders and internationally, they are uniquely positioned to contribute to suicide prevention-not only by restriction or management of means but also by engaging with individuals at risk and facilitating referrals to appropriate care.

OBJECTIVES

This study aimed to assess pharmacy teams' support needs regarding their role as gatekeepers in suicide prevention.

METHODS

Participants completed an online questionnaire examining their perceptions, attitudes, perceived barriers in suicide prevention, self-efficacy, and need for gatekeeper training. Furthermore, experience with suicide(prevention) and suicidal behavior among pharmacists was investigated.

RESULTS

A total of 110 participants gave an informed consent, of whom 69 (62.7%) completed the questionnaire. Although nearly three-quarters (73.6%) had encountered suicidal individuals in their pharmacy, only 9.7% felt confident addressing potential suicide risk. Moreover, many indicated that they lacked training in screening mental health issues (81.8%) and did not know which actions to undertake with suicidal individuals (64.8%) or how to ask about suicidal thoughts (63.6%). Most participants indicated the need for training (91.3%), and nearly all (97.1%) were willing to follow such a training. They preferred an online training, including topics such as recognizing signs, starting a conversation about suicide and referring to other caregivers.

CONCLUSION

These findings contribute to the growing body of evidence on the important role of pharmacists as gatekeepers in suicide prevention and provide insight into their current perceptions, attitudes, and barriers. The study identifies the topics of importance for inclusion in a gatekeeper training. Overall, this study shows a clear need and willingness to participate in such a training among pharmacists.

Suicidal Thoughts and Behaviors Among Health Care Trainees, Staff and Faculty at an Academic Medical Center

Background/Objectives: Health care workers are at greater risk for death by suicide compared to the general population and are less likely to seek assistance. More information about correlates of suicidality and treatment-seeking behavior are needed to reduce risk. Methods: The American Foundation for Suicide Prevention developed an Interactive Screening Program to identify and engage at-risk staff and trainees in health care settings. The study reports on the prevalence and demographic and clinical predictors of current suicidal thoughts, behaviors and mental health treatment at a single site (n = 5898) from 2009 to 2024. Results: The study found that 18.2% of respondents reported current suicidal thoughts and behaviors. These were more common among respondents who were younger, male, and who identified as a race/ethnicity other than non-Hispanic White. Suicidal thoughts and behaviors were more likely among those with higher PHQ-8 scores (OR = 1.23, p < 0.01) and those who endorsed maladaptive coping behaviors, hopelessness, loneliness, stress and nervousness (ORs 1.36-3.04, ps < 0.01). Current mental health treatment was more likely among women, non-Hispanic White respondents compared with Asian or Pacific Islander respondents, and nurses relative to physicians. Mental health treatment was also associated with higher PHQ-8 scores, lifetime suicide attempts, difficulty controlling eating and alcohol consumption, and recent feelings of anxiety, stress and nervousness. Conclusions: Findings suggest a continued need to identify and engage health care trainees and staff who are at risk for suicide and to establish new approaches to linking these individuals to resources or interventions aimed at reducing risk. The study identified male and/or Asian/Pacific Islander-identifying health care workers who reported intense loneliness and/or hopelessness, use of non-prescription drugs and recent suicidal thoughts and/or behaviors as high-risk individuals who may require enhanced methods of outreach, identification, acceptance and accessibility of treatment.

Suicide rates among health-care professionals in Norway 1980-2021

BACKGROUND

Suicide rates have been high in several health-care professions. Suicide rates were described in physicians, dentists, veterinarians, psychologists, pharmacists, nurses, as well as theologians, other graduates and the general population in Norway.

METHODS

Data on educational attainment were linked to data on suicide and all-cause mortality from 1980 to 2021. Suicide rates were reported per 100,000 person-years. The total number of person-years included in the study was 66.4 and 67.2 million for males and females, respectively.

RESULTS

Between 1980 and 2021, male veterinarians (35.9, 95 % CI 19.3-52.4), physicians (25.7, 21.3-30.2) and nurses (22.2, 16.6-27.7) had higher suicide rates compared others with higher education (11.7, 10.7-12.7). For females, this was the case for psychologists (15.0, 8.2-21.7) and nurses (9.3, 8.3-10.3), vs. others with higher education (5.1, 4.2-6.0). Suicide rates declined over the four decades for most groups. For physicians, suicide rates declined and approached the suicide rate of others with higher education. Suicide rates among physicians increased with age, with physicians over 60 years having twice as high suicide rates compared to others with higher education.

LIMITATIONS

The study included only educational status, not current occupation or employment status. This is a descriptive study, with some known risk factors for suicide not accounted for.

CONCLUSIONS

Suicide rates for physicians declined over time, but not for nurses. From 2010 to 2021, nurses of both genders was the only group with higher suicide rates compared to other graduates. The increased suicide rates among veterinarians, nurses, female psychologists and elderly physicians are concerning.

Ohio pharmacy personnel's burnout and wellbeing: The impact of the COVID-19 pandemic

BACKGROUND

While burnout is a well-known phenomenon among physicians and nurses, burnout among pharmacists and pharmacy personnel is understudied and less recognized.

OBJECTIVES

The primary objectives of this study were to describe and compare Ohio pharmacy personnel's self-reports of burnout and wellbeing prior to and during the COVID-19 pandemic.

METHODS

A one-time online survey was completed by over 13,000 health care professionals in Ohio in July and August 2021. This brief report describes a subanalysis of the 1452 participating pharmacy professionals licensed by the State of Ohio Board of Pharmacy.

RESULTS

Most survey respondents identified as White (90.84%) and female (70.04%), including pharmacists (59.16%) and pharmacy technicians (38.15%). Findings demonstrated a 360.55% increase in feeling emotionally drained "every day" during the pandemic. Participants felt emotionally drained more frequently; cared less about what happened to patients; felt less accomplished; felt down, depressed, or hopeless more frequently; had more thoughts of suicide; and were more concerned about their substance use during the pandemic than prior to it.

CONCLUSION

Pharmacy personnel are experiencing some dimensions of burnout and poor wellbeing more frequently. These issues were present prior to the COVID-19 pandemic and now require even swifter attention as outcomes have worsened. Increased awareness of burnout among pharmacy personnel is required. Additionally, policy and organizational interventions are recommended to improve pharmacy personnel wellbeing.

Resources and interventions to support psychological health and wellbeing in the pharmacy workforce: Analysis and use of a health worker 'burnout' toolkit

Background

Pharmacists have experienced declines in psychological health and wellbeing post-pandemic. The phenomena of moral distress, disengagement and burnout are associated with workforce attrition, unfitness to practice and inferior quality of patient care. A working group of the Canadian Pharmacists Association (CPhA) was formed to identify resources and interventions (R&I) for occupational psychological health and wellbeing.

Objective

To characterize R&I from an evidence-based national health worker 'burnout' Toolkit with potential to support the pharmacy workforce.

Methods

All R&I included within a draft 'burnout' Toolkit from the Canadian Health Workforce Network (CHWN) were screened to determine relevancy and usefulness for the pharmacy workforce. R&I with higher grades were data-charted to capture information on topic and content delivery. Final R&I were determined through consensus meetings where 'highly rated' R&I were discussed and selected.

Results

Of 140 original CHWN Toolkit R&I, 53 (37.8%) were of potential relevance or usefulness to improve well-being for most in the pharmacy workforce. Of those 53 R&I, 28 (20% of original) were final selections. The majority of R&I at each stage were focused on 'preventing burnout' and 'promoting mental health' (>60%) rather than 'addressing burnout', 'supporting recovery' or managing specific issues in the workplace (i.e. stigma, discrimination, bullying, hostility, workload). No R&I were specifically developed or studied within the pharmacy workforce.

Conclusions

Health professions may benefit from the CHWN Toolkit and the knowledge translation activity described here. R&I relevant and useful to the pharmacy workforce generally require adaptation for dissemination and/or implementation. The set of final R&I form the basis for orchestrated plans to support the pharmacy workforce with respect to psychological health and wellbeing. There is a relative lack of R&I devoted to addressing and recovering from burnout and workload management issues.

Causes of Death Among Health Care Professionals in the United States

Specific causes of mortality among various types of health care professionals (HCPs), including those characterized by age, gender, and race, have not been well described. The National Occupational Mortality Surveillance data for deaths in 26 US states in 1999, 2003-2004, and 2007-2014 were queried to address this question. Proportionate mortality ratios (PMRs) were calculated to compare specific causes of mortality among HCPs compared with those among the general population. HCPs were less likely to die from heart disease (PMR 93, 95% confidence intervals [CI] 92-94), alcoholism (PMR 62, 95% CI 57-68), drugs (PMR 80, 95% CI 70-90), and more likely to die from cerebrovascular disease (PMR 105, 95% CI 104-107) and diabetes (PMR 107, 95% CI 105-109). HCPs aged 18-64 years were more likely to die by suicide (PMR 104, 95% CI 101-107), whereas those aged 65-90 years were less likely to die by suicide (PMR 84, 95% CI 77-91), with physicians (PMR 251, 95% CI 229-275) and other HCPs having high PMR for suicide. Among all HCPs, suicide PMR was similarly increased, whereas heart disease PMRs are similarly decreased among Black compared with those among White HCPs and those among male compared with those among female HCPs. HCPs as a group and specific types of HCPs demonstrate causes of mortality that differ in important ways from the general population. Race and gender-based trends in PMRs for key causes of mortality among HCPs suggest that employment in a health care field may not alter race and gender disparities noted among the general population.

Understanding and Fostering Mental Health and Well-Being among University Faculty: A Narrative Review

In recent years, there has been increasing recognition of mental health concerns in academia, with stress, burnout, anxiety, and depression being reported among faculty members. The demanding work environment, the need to balance personal and professional duties, and the constant pressure of productivity while navigating multiple tasks of teaching, research, mentorship, professional development, and service all impact the mental health and overall well-being of faculty. Higher education institutions have structurally changed as has the research landscape. These changes as well as faculty-specific and student-specific factors coupled to the effect of the COVID-19 pandemic have led to profound effects on the mental health of academics. This paper is a narrative review of the pertinent literature describing faculty mental health and well-being. It summarizes the available evidence on factors influencing faculty mental health and shows the prevalence of anxiety, depression, stress, and burnout among faculty from various academic fields and along the whole academic ladder. Using a suggested framework that collates the efforts of leaders and faculty, the paper concludes by exploring strategies that promote work-life balance among academics and suggesting effective interventions to improve their mental health outcomes.

"Why Didn't They Teach Us This?" A Qualitative Investigation of Pharmacist Stakeholder Perspectives of Business Management for Community Pharmacists

Expanding the scope of practice has provided an opportunity to reflect on the business management role of the community pharmacist. This study aimed to determine stakeholder perspectives of what business management skills are required for the community pharmacist, potential barriers impeding changes to management in the pharmacy program or community pharmacy setting, and strategies to improve the business management role of the profession. Purposively selected community pharmacists across two states in Australia were invited to participate in semi-structured phone interviews. A hybrid approach of inductive and deductive coding was used to transcribe and thematically analyse interviews. Twelve stakeholders described 35 business management skills in a community pharmacy, with 13 skills consistently used by participants. Thematic analysis revealed two barriers and two strategies to improve business management skills in both the pharmacy curriculum and community pharmacy. Strategies to improve business management across the profession include pharmacy programs covering recommended managerial content, learning from experience-based education and creation of a standardised mentorship program. There is an opportunity for business management culture change within the profession, and this may require community pharmacists developing a dual thinking process to appropriately balance professionalism and business management.

Suicide and homicide deaths of PAs: Analysis of the National Violent Death Reporting System

OBJECTIVE

This study describes physician associate/assistant (PA) deaths in the US CDC's National Violent Death Reporting System (NVDRS) from 2003 to 2020.

METHODS

PAs' violent deaths were analyzed and summarized in terms of decedents' numbers and demographics, methods of death, locations of death, and relationships with assailants.

RESULTS

The NVDRS identified 93 suicides and 9 homicides in this period. PAs who died by suicide were mostly White (93.5%) and male (67.7%); mean age was 49.7 years. A third of the PAs who died by homicide were Black; most were female (55.6%), and the mean age was 48.7 years. Firearms (41.7%) were most commonly involved in deaths by suicide, and blunt impact (33.3%) was most commonly seen in deaths by homicide. A plurality (46.1%) of suicides and homicides occurred in the South. Homes (72.5%) were the most frequent location. No homicides were reported in medical settings. Known perpetrators were mainly relatives and male; none were patients.

CONCLUSIONS

Incidence of PA death by suicide or homicide is low relative to the general population. These deaths generally are not related to PAs' work. Delineating the incidence of violent deaths is a step toward informing preventive efforts.

Suicide mortality among physicians, dentists, veterinarians, and pharmacists as well as other high-skilled occupations in Austria from 1986 through 2020

Some evidence puts health professionals at increased risk of suicide, especially females, whereas other research suggests a lower risk in high-skilled occupations. This study investigated the suicide risk of four health professions (physicians, dentists, veterinarians, pharmacists) and three other high-skilled occupations (notaries, lawyers, tax advisors/public accountants) in Austria compared to the general population, and analyzed suicide methods across occupations. Data was collected from professional associations and Austrian cause-of-death statistics to determine suicide cases. Gender-specific standardized mortality ratios (SMRs), crude and age-adjusted suicide rates and frequencies for suicide methods were calculated for each profession (maximum time span 1986-2020). Among males, only veterinarians had a significantly elevated suicide risk compared to the general population. Physicians and tax advisors/public accountants had a significantly lower suicide risk. Among females, the veterinarians, physicians, and pharmacists had a significantly elevated suicide risk; for dentists, it was also elevated, though non-significantly. Age-adjusted suicide rates showed a smaller gap between men and women in all professions compared to the general population. Poisoning was the predominant suicide method among health professions, except dentists. These findings are consistent with some of the prior literature and call for specific suicide prevention efforts in health professions, focusing on women.

Reflexive thematic analysis of job-related problems associated with pharmacist suicide, 2003-2019

BACKGROUND

Few qualitative studies have focused on suicide and specific job-related problems associated with suicide in pharmacists. Greater knowledge of specific work-related stressors amongst pharmacists could inform suicide prevention strategies.

OBJECTIVE

To identify job-related stressors associated with pharmacist suicides and compare stressors to those previously reported in physicians and nurses.

METHODS

Free-text law enforcement and medical examiner data for pharmacist suicides were extracted from the National Violent Death Registry (NVDRS) for 2003-2019. Reflexive thematic analysis was deployed via a deductive approach utilizing codes and themes found in previous research on nurse and physician suicides. New codes were also identified through inductive coding.

RESULTS

A total of 291,872 suicides occurred between 2003 and 2019, of which 392 were pharmacist deaths. Of these, 62 pharmacist suicides were coded with job-related problems. Almost all deductive themes/codes extracted from nurses and physicians were present in pharmacists. Common codes found in the pharmacist dataset that were also found previously in physicians and nurses were: history of mental health, substance use disorder, hopelessness impending or proceeding job loss, and access to lethal weapons and/or drugs. Novel codes were added through inductive content analysis. Codes novel to pharmacists were: verbalized suicidal ideation (SI) or intent, diversion for the purpose of suicide, and the fear of job loss. Disciplinary action at the institutional level was associated with the fear of job loss and cited as the event triggering suicide completion.

CONCLUSION

Pharmacists have similar job-related stressors associated with suicide as physicians and nurses. Evaluating the process of disciplinary action is warranted. Future research is indicated to evaluate causal relationship between work-related stressors and mental health outcomes leading to suicide in pharmacists.

Experience and attitudes of pharmacy teams towards suicide prevention: A cross-sectional survey

BACKGROUND

Community pharmacists are increasingly recognized as integral members in suicide prevention programs, as part of a multidisciplinary and multifaceted approach. However, further research is required to understand then optimize the whole pharmacy teams' role across sectors.

OBJECTIVE

To explore pharmacy teams' experience of, and attitudes towards, suicide prevention in England.

METHODS

A cross-sectional survey was purposively distributed to pharmacy staff in England before accessing an optional suicide awareness raising video, hosted by Centre for Pharmacy Postgraduate Education (CPPE), in September 2019-March 2021. Questions included demographics and experience of, attitudes towards, and preparedness for, suicide prevention. The 14-item Attitudes to Suicide Prevention (ASP) scale was used (possible range 14-70 with lower scores representing positive attitudes). Descriptive and comparative statistics were reported. Free-text comments were invited to explore respondents' experience of suicide prevention and reflexive thematic analysis used.

RESULTS

Of 403 respondents, 82% were female; most were pharmacists (59%) or pharmacy technicians (21%), with the remainder having other roles. Eighty-five percent worked in community pharmacy. Eleven percent had prior suicide prevention training, and 71% reported interacting with at least one patient about suicide. Most often, suicidality was disclosed by the patient (40%), with 6% of pharmacy staff having directly asked a patient about suicidal behavior or plans. The aggregated ASP score was 31.51 (SD 6.23), and role did not affect experience or attitude. Pharmacy teams' experiences of suicide prevention can be summarized by three major themes i) Exposure to suicide; ii) Responsibility for action; and iii) Access to means of suicide.

CONCLUSIONS

Pharmacy teams felt responsibility in caring for those at risk of suicide and had experience of this. Further training should include understanding of medicines means restriction and involve all roles and sectors of pharmacy. Pharmacy teams should be integrated into the 'circle of care' to access referral pathways.

Pharmacy Workplace Wellbeing and Resilience: Themes Identified from a Hermeneutic Phenomenological Analysis with Future Recommendations

This study applied a hermeneutic phenomenological approach to better understand pharmacy workplace wellbeing and resilience using respondents' written comments along with a blend of the researchers' understanding of the phenomenon and the published literature. Our goal was to apply this understanding to recommendations for the pharmacy workforce and corresponding future research. Data were obtained from the 2021 APhA/NASPA National State-Based Pharmacy Workplace Survey, launched in the United States in April 2021. Promotion of the online survey to pharmacy personnel was accomplished through social media, email, and online periodicals. Responses continued to be received through the end of 2021. A data file containing 6973 responses was downloaded on 7 January 2022 for analysis. Usable responses were from those who wrote an in-depth comment detailing stories and experiences related to pharmacy workplace and resilience. There were 614 respondents who wrote such comments. The findings revealed that business models driven by mechanized assembly line processes, business metrics that supersede patient outcomes, and reduction of pharmacy personnel's professional judgement have contributed to the decline in the experience of providing patient care in today's health systems. The portrait of respondents' lived experiences regarding pharmacy workplace wellbeing and resilience was beyond the individual level and revealed the need for systems change. We propose several areas for expanded inquiry in this domain: (1) shared trauma, (2) professional responsibility and autonomy, (3) learned subjection, (4) moral injury and moral distress, (5) sociocultural effects, and (6) health systems change.