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Mental Illness and Suicide in Dental School: Fighting the Stigma

Mental Illness
This article originally appeared in the 2014 winter issue of Mouth and is reprinted with the permission of the American Student Dental Association. For more dental student news, visit ASDAnet.orgPlease note the views expressed in the article are strictly those of the author.

“He had a terrific pain in his head that pain killers couldn’t reach, an airiness in his voice that was only becoming more hollow, and other mysteries of despair I didn’t want to see or hear. I knew where he was headed, as we all did, but I didn’t know why. And I didn’t want to know.” 

This quote is taken from author David Vann’s “Legend of a Suicide” a short story which follows the estranged relationship a son has with his father, who ultimately commits suicide. The book is loosely based on Vann’s life as both Vann’s father and the father in the story were dentists. The son in “Legend of a Suicide” notices something wrong with his father, but doesn’t want to address it. You may see loved ones, friends and classmates suffering but it’s hard to admit that someone close to you is hurting.  

I have suffered through bouts of depression and anxiety. I began dental school as part of the class of 2015, but took a leave of absence in January of my first year. With the advice of friends and family, I recognized that I needed time to heal and recover away from school. By taking a leave of absence, I made one of the most difficult, yet rewarding, decisions of my life. During my time away, I developed lifelong coping skills that have helped me be successful both in and out of dental school. 

A great deal of research suggests that suicide has plagued the dental profession more than any other. A November 2011 article from the Journal of Affective Disorders found that the risk of suicide is increased among health professionals and dentists held the highest suicide rate at 7.18 percent for men and women combined. The national average for men and women was reported as 0.42 percent. Male dentists hold the highest suicide rate at 8.02 percent. Female dentists hold the fourth highest suicide rate at 5.28 percent. Physicians (7.87 percent), pharmacists (7.19 percent) and nurses (6.56 percent) also hold suicide rates much higher than the national average. 

A May 2014 article in the Spanish journal, Medicina Oral, Patologia Oral and Citugia Bucal, compared burnout, depression and suicide ideation among second, fourth and fifth year dental students at a dental school in Seville. In comparison to fifth year students, second and fourth year students showed double the amount of burnout. Second and fourth years also experienced triple the amount of depression and suicidal ideation when compared to their fifth year classmates. Suicide ideation was highest in fourth year. There were no gender-related differences found. A link was discovered between burnout and depression and between depression and suicidal ideation, but no association was found between burnout and suicidal ideation. 

Changing the perception of mental illness is one way some groups are working at suicide prevention. A September 2014 article in the Journal of Dental Education suggests a program designed for dental students in British Columbia called Professionalism and Community Service (PACS). PACS is a module that features community-based dental education and includes opportunities to discuss suicide prevention and stress management. The program addresses these topics through guest lectures, video presentations, standardized patients and self-reflection. Hopefully programs such as PACS spread to the United States for integration into the dental school curriculum.  

Awareness of mental health and suicide has improved, but there are still negative connotations around mental illness. Many suffer in silence, ashamed and afraid of the stigma a diagnosis of depression, anxiety or bipolar disorder will create. It may be difficult to recognize that you are suffering in more ways than your classmates and need outside assistance. For me, I was too ashamed to admit my depression and felt isolated. I avoided my classmates and my friends until I returned to school. I discovered that closing myself off did not help me. After my leave of absence I learned to share my sentiments with my family and friends. I realize now that talking about the daily grind is a great outlet. Talking also helps assess whether you need to seek additional support. Being open to expressing the deep sadness, fear or anxiety you experience is the first step to admitting a fragile mental state. 

It is imperative to notice and address warning signs of depression and suicide in patients, loved ones and ourselves. Some warning signs may be changes in behavior such as increased silence, withdrawal and loss of interest. If you or someone you know is suffering in any aspect of life, do not be ashamed or afraid to speak about it openly. Be confident that you will change and may even save someone’s life, including your own.

Additional Resources:

ASDA Dental Student Health & Wellness
If you’re having thoughts of suicide or thinking of hurting yourself, call the National Suicide Prevention Lifeline at 800-273-8255

SAVE (Suicide Awareness Voices of Education) has resources and support groups for those grieving after loss due to suicide.

• The University of Georgia offers advice for managing stress while in college, including sleep habits, healthy eating, healthy relationships and more.
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