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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 1  |  Issue : 1  |  Page : 3-7

Are dentists suicide prone? The current scenario


Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India

Date of Submission11-Dec-2020
Date of Acceptance13-Dec-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Gunjan Kumar
Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT University, Campus – 5, Patia, Bhubaneswar - 751 024, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcdoh.jpcdoh_5_20

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  Abstract 


There is a widely discussed belief that dentist are at a high risk for suicide. Since 1960, dental journal have been carrying articles with headline like “The suicidal professions.” While this claim is often accepted without question, there are little reliable data that support the alleged risk and on the contrary few data even suggest the opposite. In India, few cases of suicide among dental student have been reported, but not much data are available. This paper aims at presenting a review of literature related to this complex issue and it shows that occupation is not a major predictor of suicide and it does not explain about why person commit suicide.

Keywords: Dentist, risk, suicide


How to cite this article:
Kumar G, Dash P. Are dentists suicide prone? The current scenario. J Prim Care Dent Oral Health 2020;1:3-7

How to cite this URL:
Kumar G, Dash P. Are dentists suicide prone? The current scenario. J Prim Care Dent Oral Health [serial online] 2020 [cited 2021 Jun 23];1:3-7. Available from: http://www.jpcdoh.org/text.asp?2020/1/1/3/305895




  Introduction Top


Every suicide is a catastrophe. Suicide has been one of the most controversial areas in the field of dentistry and is a global health problem. Suicide originally from Latin means the act of taking one's own life. India with a vast population of 1.38 billion has been accounted for being one of the developing countries prone to suicide along with China. According to the World Health Organization (WHO) in 2012, India and China account for 40% or more of the 800,000 annual suicide deaths globally that is one person per 40 s. The global age standardized suicide rate per 100,000 population was estimated as 11.4, with rates of 15.0 for males and 8.0 for females.[1] Countries from the WHO South-East Asia Region, accounted for 314,000 suicides in 2012, that accounted for 39% of all global suicides.[1] In May 2013, the 66th World Health Assembly officially adopted the first-ever Mental Health Action Plan of the WHO. Suicide prevention was an intrinsic part of the program, with the goal of reducing the rate of suicide in countries by 10% by 2020. Later, it was extended to 2030 at the 72nd World Health Assembly to ensure its alliance with the 2030 Agenda for Sustainable Development.[2]

There is a widely obstinate belief that has been held long enough both inside and outside the profession, that dental professionals are at an extremely high risk for suicide.[3] This is one of those guileful things that “EVERYBODY KNOWS,” and its not just the uninformed public even dentists themselves believe it. The professional media and journalism often depicts dentists as a group more prone to suicide. Since 1960s dental journals have been carrying articles with headlines like “THE SUICIDAL PROFESSIONS.” YOU BETTER NOT LEAVE THESE GUYS IN A ROOM ALONE.[4] [Table 1] depicts the distribution of suicide in India profession wise of 5 years since 2000. In 1997, suicide was the seventh leading cause of death in the United States. In India, suicide is the leading cause of death in the 15–39-years of age group with 37% of the total global suicide deaths among women coming from the country.[5]
Table 1: Distribution of suicide in India according to profession (data from the national crime records bureau rate of suicides)[6],[7]

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  Risk Factors Top


The link between suicide and mental stress, anxiety, or depression is well established distinctly in high-income countries. Suicides mostly occur when a person is not able to cope with day-to-day life activities, financial stress, chronic pain, or illness. As reported by the National Health Profile 2018, out of over 2.7 lakh dentists registered with the Dental Council of India (DCI), the authorities employs only 7239 dentists, that is merely 2.7%. The average population served by a government-employed dentist is thus 1.76 lakh compared to roughly 11,082 people per government doctor. Yet, while the government bewails the deficit of dental services that rural populations face, it has done little or nothing to appoint the facilities or recruit dentists in these particular areas. Moreover, now it might even divert dentists into MBBS courses. It is not possible for everyone to hold a government job. Ultimately, they are constrained to work in private college with minimum salary.[8]

In dentistry, factors found to influence suicide range from known occupational stressors, to toxins and drug abuse, and untreated mental disorders. Stressors in dentistry might include managing a single-handed clinical practice, lost appointments, patient discontentment with mode of treatment, trouble with insurance, invasion, and regulations of governmental agencies and the lack of quality time like not having leisure time. Risk factors when combined with stressors, symptoms become more evidenced in an individual. Depression stands out as one of the most common risk factors for this unforgivable deed. Psychological case studies disclose that more than 90% of suicides have depression or other identifiable mental health problems or substance abuse.[7],[8],[9],[10] Mostly, all suicidal groups are highly depressed.[9],[10],[11] Some of the symptoms of depression and signs of suicide are discussed in [Table 2] and [Table 3], respectively.
Table 2: Symptoms of depression (adapted from the American Association of Suicidology)[13]

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Table 3: Early signs of suicidal ideation[14]

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Dentists as a group may also tend toward perfectionistic tendencies which make for precise restorations but lead to queer in life and practice when dealing with imperfectible patients. Dentistry is one of the many occupations that has come under scrutiny in terms of personal reaction to undesirable or stressful conditions. Statements about which occupation has the most suicides float around like urban legends.[5] According to the analyst of the National Centre for Health Statistics, Jim Weed statistics on suicides related to occupation are not clear. There is no relevant national data set available on occupation and suicide.[1]

Suicide by occupation research is inherently difficult. Statistics are actually difficult to gather in such cases because only about half the states put occupation on their death certificates and when they do, there are questions of accuracy. Statistical conclusions are also hampered by the fact that when the annual suicides are divided into occupations the number for many job categories are relatively small.[1]

Dentists represent only a tiny portion of the total population and only a petite fraction of them die in a single year out of which a little fraction are suicides. Therefore, much of the research is flawed by conclusions based on these minute samples.

On December 2019, when the WHO identified a new virus named Coronavirus, various cases were detected in Wuhan after which it started spreading globally.[15] It was declared as a pandemic on March 11, 2020,[16] by WHO after which a series of lockdown followed in India. This phenomenon resulted in conciliating the services and became a stellar cause of break in global supply, affecting the economy. During the initial spread of the infection in China, 72% health-care workers reported general distress and almost 34% suffered from insomnia.[17] Most of the employees started working from home, students attending online classes and postponing their exams which all-together led to create a stressful environment around both adults and children. Even dental professionals had to shut down their clinical practices to prevent the outspread of the deadly virus, as dentists are considered primary personnel to be spreading the infection if not cautious while dealing with the oral cavity. While performing any dental procedure, use of high speed instruments with water jets in the oral cavity leads to splashing of the water particles on the dentist and the assistants face directly, increasing the chance of infection up to 80%.[18] The dentists are provided with guidelines by the DCI to prevent the spread of the disease. Delaying the nonemergency treatment is recommended by the DCI to all the dentists to avoid unnecessary exposure.[19]

The spread and emergence has also caused confusion and anxiety among the general population and the health-care workers including dentists. The WHO has also provided expert guidance and answers to questions to help manage fear, anxiety, and discrimination during this pandemic.[19],[21],[22] In these times, where social media plays a major role in news and awareness, fake news regarding COVID-19 has also played a major role in creating havoc in many parts of the world. This in turn leads to fear and mental stress.[23] To avoid all such waver, the WHO has promulgated proper guidelines for its prevention of spread and awareness about limiting the spread for COVID-19. The governments are also urging people through news and social media to not respond to such fake news without confirming its authenticity and to only follow the news that will be displayed on the trusted news channels addressed by the government itself. The fear and anxiety and concerns globally are affecting every individual to variable extent as the recent evidence showed that individuals who are kept in isolation or quarantine stress in the form of fear, anger, and confusion.[24],[25],[26],[27] Hence, it is very important to study the mental health of the dentists, so that proper measures can be taken to help with the mental stress and depression in severe cases. Dentists mostly fear about their jobs, as their private practices are closed leading to zero income, as their income fully depends upon their practice. This had led to anxiety and depression, mood swings and frustration among many dentists. Furthermore, dentistry being a money demanding branch of health care, the falling economy also fears the dentists. A report by Pandey et al. said that a considerable percentage of dentists did not want to work in these times and a considerable percentage among them were also not willing to treat the patient having flu and directly refer them to the hospital. Around 55.4% of people were also afraid about losing their jobs due to the recession following the coronavirus pandemic.[21]


  Discussion Top


Occupation alone has never been mentioned as a major leading cause for suicide. According to the Director of Center for Study of Suicide and Life Threatening Behavior of South Carolina University, Mr. Ronald Morris occupation is not a major predictor of suicide and it does not explain much about why the person commits suicide. He reported it as a combination of factors such as age, gender, marital status, mental health, and adverse life events and not alone the profession that determines the level of risk.[16]

Researchers have evaluated whether people are affected because of stress associated with occupation or due to its demographic composition. Moreover, few studies which have been conducted between occupation and suicide, they have unfortunately been clubbed together with the dentists, physicians, and nurses under a general category as the healthcare workers. Further, it has been concluded that health-care workers take their own lives at a higher rate. There could be some relation, but yet there is no reliable evidence to support that dentists are number one when it comes to suicides among professionals. However, the fact is that the physicians do.[6]

Alexander RE[5] conducted a thorough review of written material on dentists and suicide. He mentioned about the previous studies which have claimed that dentists have a higher suicide rate were flawed by the use of perception of the patients, their expectations, assumptions, and currently outdated clinical practice.

Glass conducted an exhaustive study on “mortality of England dentists, 1921–1960.” His results showed significantly fewer deaths than expected for dentists from all causes when compared with the general population.[28] Another literature review in the year 2012, it was also found that some relevant studies pointed toward higher suicide rate among dentists, yet the authors concluded that they “lacked the correct scientific weight.” Further debunking of the suicide myth was presented in a 2012 article by Lange et al., which challenged previous articles pointing to increased risk.[13]

The most recent report in 2016 by Center for Disease Control's on “Suicide Rates by Industry and Occupation” does not list dentists separately, but rather groups them in with other health-care workers as mentioned before, ranking eleventh.[29],[30] And yet, despite the lack of any hard evidence, the myth regarding dentists being the number one suicide occupation stubbornly persists, casting a negative light on the profession. Not only can this affect the well-being of practitioners, but it can also negatively influence perceptions by patients and by students considering dentistry as a prospective career.

Regardless of where dentists rank in various reports, they are vulnerable nonetheless and should not hesitate to reach out for help when facing difficult times.


  Prevention Top


Suicide has typically and religiously been marked as a mental issue that is best addressed through clinical interventions, such as treating depression. However, in low-and middle-income countries, the extensive persona of mental disorders in suicide is not as evidential as it is in high-income countries. Other factors in support of a public health approach include the fact that social reasons for suicide are more readily received than mental health reasons, and countries in this region have a limited number of qualified mental health professionals. Stress among dentists can be resolved by identifying problems and emotional processing. This will permit everyone around them to establish a series of accepted realistic objectives and protocols to deal with the serious issues.[31] [Table 4] briefly depicts prevention of suicide among health-care workers.
Table 4: Preventing suicide among healthcare workers

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  Recommendation Top


Dentistry distinctly needs more updated data on and an amended understanding of the justification of stress-related suicide before solutions can be projected and to ascertain whether solutions are even necessary. Various questions need to be clarified in future studies like whether the incidence of dental suicides has changed over time or not. If female dentists are more susceptible to stress-related suicide or if suicides are related to personal stressors such as divorces and malpractice suits.[31]

Apart from the questions, Indian and State Government can play a major role in preventing suicides among dentists by creating jobs for the budding undergraduates. The bridge course from BDS to MBBS that allows Dental Science graduates to practice as general physicians in various hospitals, clinics, and organizations across India should be implemented as soon as possible. On successful completion of this course, the graduates can spend a minimum 3 years in rural areas. Dental schools, along with dental hygiene and graduate student programs, need to incorporate contemporary stress management lectures in their curriculum, so students can learn the skills necessary to buffer stress early in their careers and take those skills into their practices. In fact, such programs also might help identify stress-prone people early in their esteemed careers.


  Conclusion Top


Every single life squandered to suicide is one too many. The foremost way forward is to act together, and now is the time to act. Suicides are preventable and countries should continue putting suicide prevention on high demand. With timely and trenchant evidence-based interventions, treatment and support, attempt to suicides and suicides can be intercepted.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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