Postmortem qualitative analysis of psychological, occupational and environmental factors associated with lethal anesthetic and/or opioid abuse among anesthesiologists: case series
Análise qualitativa pós-morte de fatores psicológicos, ocupacionais e ambientais associados ao abuso letal de anestésicos e / ou opioides entre anestesiologistas: uma série de casos.
Anesthetic and/or opioid abuse is more prevalent among anesthesiologists than in other medical specialties and it has been associated with high mortality. The aim of this study was to evaluate factors associated with lethal anesthetic and/or opioid abuse among anesthesiologists.
We evaluated psychological factors, and occupational history and circumstances of death of anesthesiologists who died from anesthetic abuse. Data were obtainedpost-mortem from colleagues, and relatives. After finding eligible cases, we identified the key informants, who were interviewed personally or via email, through the qualitative method known as “Psychological Autopsy”.
Eighteen cases of death were identified, but we were able to interview 44% of them (n = 8), most of whom were young males. They died at home or at the hospital and were found “at the scene”. Being an introspective person who did not share personal issues at workplace was the most prevalent personal characteristic. At work, they seemed to perform very well their functions, but some presented subtle changes such as to staying more than usual at the workplace and and/or neglecting some of their responsibilities. The main reported factors to explain their substance abuse were emotional problems including psychiatric, excessive hours of work, and other health factors.
This study identified that emotional disturbances, compulsive work, and general health problems were the more prominent factors involved with those deaths. Further, larger studies are needed to better understand how these factors could be early identified in order to timely prevent anesthetic and/or opioid abuse and several deaths among anesthesiologists.
Introdução: O uso abusivo de anestésicos e / ou opioides é mais prevalente entre anestesiologistas do que em outras especialidades médicas e tem sido associado a alta mortalidade. O objetivo deste estudo foi avaliar os fatores associados ao abuso letal de anestésicos e / ou opioides entre anestesiologistas. Métodos: Avaliamos fatores psicológicos, história ocupacional e circunstâncias de morte de anestesiologistas que morreram por abuso de anestésico. Os dados foram obtidos post-mortem de colegas e parentes. Após a localização dos casos elegíveis, foram identificados os informantes-chave, que foram entrevistados pessoalmente ou via e-mail, por meio do método qualitativo conhecido como “Autópsia Psicológica”. Resultados: Foram identificados 18 casos de morte, mas pudemos entrevistar 44% deles (n = 8), a maioria jovens do sexo masculino. Eles morreram em casa ou no hospital e foram encontrados “no local”. Ser uma pessoa introspectiva que não compartilhava de questões pessoais no local de trabalho foi a característica pessoal mais prevalente. No trabalho, pareciam desempenhar muito bem suas funções, mas alguns apresentaram mudanças sutis, como permanecer mais do que o normal no ambiente de trabalho e / ou negligenciar algumas de suas responsabilidades. Os principais fatores relatados para explicar o abuso de substâncias foram problemas emocionais, incluindo psiquiátricos, excesso de horas de trabalho e outros fatores de saúde. Conclusão: Este estudo identificou que distúrbios emocionais, trabalho compulsivo e problemas gerais de saúde foram os fatores mais proeminentes envolvidos nessas mortes. Além disso, estudos maiores são necessários para entender melhor como esses fatores podem ser identificados precocemente a fim de prevenir o abuso de anestésicos e / ou opioides e várias mortes entre os anestesiologistas.
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