Building resilience to combat stress, burnout, and suicidal ideation among pharmacists

The ASHP House of Delegates recently approved a critical policy for suicide awareness and prevention, a necessary first step in improving the ability of pharmacists to care not only for the communities in which they serve but also for their colleagues.¹ The suicide rate is rising in the U.S. general population, with nearly 45,000 people dying from suicide in 2016.² The rate of suicide among pharmacists is higher than that of the general population,^3,4 with one report noting a rate 1.29 times higher.⁵

Literature focused specifically on suicide among pharmacists is scarce; however, it is well documented that physicians, medical residents, and medical students, who have training and work requirements similar to pharmacists’, have increased risks of depression, burnout, and suicidal ideation.^6–11 Although research indicates that matriculating medical students (i.e., those entering the first year of medical school) have lower rates of burnout and depression symptoms than the general population,¹² these rates escalate and surpass those in the general population during medical education,^6,11 residency,^7-9,13-15 and practice.¹⁰ In addition to the long years of training, multiple factors place healthcare providers at risk for burnout, including witnessing patient suffering.¹⁶ Nearly half of physicians experience at least 1 symptom of burnout,¹⁰ and it has been observed that as burnout increases in medical interns and physicians, suicidal ideation also increases.^11,17,18

Pharmacists report lower health-related quality of life and higher levels of depression than the general population and other health professionals, including medical residents and physicians.^19–,21 This is particularly alarming since the risk of suicide among depressed medical residents and physicians is high, with 1 physician dying by suicide every day.¹⁶ Although multiple studies have examined stress, quality of work life, and job performance in pharmacists,^22–24 additional studies are needed to specifically assess burnout, suicidal ideation, and other risk factors in this population.

To complicate the problem of healthcare provider burnout and suicidal ideation further, healthcare professionals are resistant to assuming the role of patient.¹⁵ Concerns about how breaches in confidentiality could impact their relationships with supervisors have prevented many from seeking treatment, particularly for mental health problems.¹⁵ Over one-third of medical professionals use informal, or “corridor,” consultations rather than formal office visits with a general practitioner,²⁵ and those who commit suicide are more likely to self-prescribe medication instead of seeking treatment, particularly for mental health issues.²⁶ Barriers to seeking treatment include embarrassment, time and cost issues, personality factors, and having an understanding of how specific diagnoses, including depression, could impact their ability to practice.^18,25 Additional research is needed to better understand help-seeking behaviors (including barriers) among pharmacists and pharmacy students. We must also strive to create environments that facilitate an atmosphere of belonging and help-seeking and promote attitudes and perspectives of acceptance that make it routine to discuss stressful and overwhelming issues.

To become effective contributors to suicide awareness and prevention, we must begin within our own profession by creating a culture that promotes resilience in the workplace. Resilience acts as a protective factor against emotional exhaustion, a symptom of burnout,²⁷ which as stated above can increase suicidal ideation.^11,17 A survey of physicians conducted by Jensen et al.²⁸ identified 4 areas of emphasis for promoting resilience: (1) attitudes and perspectives, (2) balance and prioritization, (3) practice management style, and (4) supportive relations. Valuing the professional role while still maintaining a focus on setting limits and taking time for personal activities allows for greater opportunity to deal positively with stressful times and hardships.²⁸ Greater resilience and job satisfaction are found in those who prioritize self-care, cultivate relationships, and limit working hours.^29,30 Additionally, several techniques can be used to promote resilience, including Mindfulness-Based Resilience Training (MBRT), which was found effective in improving resilience and decreasing burnout in first responders,³¹ and a web-based cognitive therapy program, which reduced suicidal ideation by 60% in a study of medical interns.³² Techniques such as these can improve self-efficacy, flexibility, empowerment, and mood while reducing stress, anxiety, and depression through in-person sessions or online courses focused on mindfulness and meditation practices.^31–38 Introducing these techniques into continuing-education modules could be 1 step in making our pharmacy practice environments less stressful, thereby reducing burnout and suicidal tendencies.

ASHP has taken a leadership role in this area, as illustrated by its sponsorship of the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience³⁹ and a recent survey, conducted by The Harris Poll on ASHP’s behalf, on public perceptions of burnout in healthcare professionals.⁴⁰ The ASHP House of Delegates policy on the pharmacist’s role in suicide awareness and prevention—which is similar to a policy enacted by the American Medical Association in 2017⁴¹—is another crucial step in enabling current and future pharmacists to recognize suicide risk factors in both patients and colleagues with whom they interact. Improving the resiliency of the pharmacy community will not only increase the well-being of our workforce but also improve our ability to empathize with and care for our patients.

Disclosures: The author has declared no potential conflicts of interest.

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