Suicide Prevention with Medical Residents: Barriers and Facilitators to Help-Seeking through Workplace Behavioral Health Programs

Body of Abstract: Research Aims
While not always considered an at-risk population, medical residents often work in very stressful work environments and commonly experience poor work-life integration. Both situations contribute to burnout and depression. These working conditions and poor mental health outcomes are also associated with higher incidence of suicidal ideation and barriers to mental health help-seeking. Given the risks and lack of research on medical residents, this study examined suicide risk along with facilitators and barriers to mental health help-seeking among residents from four healthcare employers located in the U.S. West Coast.

Methods
The researchers used open coding qualitative methods to analyze online, anonymous, written dialogue from 694 residents at 4 different healthcare systems located throughout the West Coast of the U.S. Data included responses to the Interactive Screening Program (ISP) online survey and online intervention that is provided to workplaces by the American Foundation for Suicide Prevention. The ISP allows employees (in this study, all medical residents) to complete an anonymous online screening for suicide risk and behavioral health and then provides an option for employees to anonymously dialogue with trained ISP counselors. The ISP counselors are trained to provide empathic responses that encourage help-seeking and use of crisis services, especially for employees who screen at higher risk. All data was de-identified, as the screening and dialogue is anonymous, and the University of Maryland, Baltimore, Institutional Review Board reviewed the study protocol and concluded this project was non-human subjects research. Three researchers independently coded data and a fourth researcher reviewed any differences in coding to complete data cleaning and prepare for final analysis. Data included responses to the general open-ended question on the survey that asked residents to comment on what was troubling the residents at the time of the initial online survey. Additional data included anonymous dialogue back and forth from residents to ISP counselors discussing personal and workplace problems, recommendations for support services, and facilitators and barriers to help-seeking. The process of inductive thematic analysis identified patterns and themes in the data with inter-rater reliability coefficients greater than 90%.

Results
The average age of residents was 29 years (18-65 years) and 60% identified as female, 38% identified as male, and 2% identified as genderqueer, gender non-conforming, or preferred not to answer. Fifty percent identified as White, 22% identified as Asian, 5% as Black or African American, 4% as Hispanic/Latinx, 3% multi-racial, and 7% reported other and 6% preferred not to answer. On the PHQ-9, residents scored between 0 and 23 with an average score of 4.6. When asked about how often they had thoughts about taking one’s own life, planned ways of taking one’s own life, or done things to hurt themselves, residents responded with the following scores on a scale from 0=not at all to 3=most of the time, .48 for suicidal thoughts, .65 for suicidal plans, and .51 for suicidal actions. 7% reported having a suicide attempt in the past.

A total of eight primary codes emerged from the data: Mental Health Concerns, Physical Health Concerns, Questions/Doubts about Professional Identity, Work Environment, Interpersonal Relationships, Burnout, Finances, and Other. Within each theme, there were several sub-themes emerged and many of them were risks for help-seeking. Some of the risks to help-seeking were more personal in nature as described in this quote, “My work feels unrewarding, I don't get much joy in it, stressful a majority of the time, I feel overworked and overwhelmed most days, I feel down most days.” Fear and threat of personal failure was another commonly reported sentiment. One resident wrote, “I think about leaving my position at least 3-4x a week and have lost satisfaction in the work that I do. Sometimes I think the only thing keeping me at work is not wanting to look like a failure to family and friends.” Other responses related to systemic problems with residency that contributed to barriers to help-seeking. One example was “Only getting the hell out of this program is going to fix the core issues, and I can tough it out till then. I can't go on psych meds, I can't get more sleep, more exercise maybe (but that takes from already minimal sleep), I have no time for hobbies, social life, or loved ones, and I really don't know what counselling is practically going to add (and when am I going to do it? I can't even get time off to go see my PCP for my own medical care which I've been putting off for months now)…They say all the right words about if you're feeling stressed, or if you need help, but the implicit culture and the systemic barriers to actual good self-care make this laughable.”

Conclusion
This research is in progress and final analysis of coding and theme development with supportive quotes will be completed by the time of the conference. From the 75% of the data coded thus far, it is clear that there are both individual/interpersonal and workplace factors contributing to risk and increasing barriers to help-seeking. The researchers will discuss upstream approaches, based on the National Guidelines for Workplace Suicide Prevention and workplace research as ways to minimize risks and improve the overall culture of the workplace and programs for residents.

Learning Objectives:

• After attending this presentation, attendees will be able to: Communicate personal and workplace related risks that contribute to poor mental health, burnout and suicide risk among residents.
• After attending this presentation, attendees will be able to: Identify barriers and facilitators to mental health and suicide prevention help-seeking services among medical residents.
• After attending this presentation, attendees will be able to: Describe upstream interventions that can be used to reduce risk while improve overall workplace systems.