S4 E02: Mental Wellness and Suicide in Dentistry

Wright: [00:00:00] This episode contains discussions of depression and suicide. Please take care when listening. If you're struggling, help is available. Please call 988 -The Suicide and Crisis Lifeline. It's available 24 hours a day. I'm Dr. Arnell Wright.

Ioannidou: [00:00:25] And I'm Dr. Effie Ioannidou. Join us as we talk about very serious issues today in our dental profession,depression and suicide. We explore what can be done to support our mental health as well as our friends, colleagues, and peers.

Announcer: [00:00:36] From the American Dental Association, this is Dental Soundbites, created for dentists by dentists. Ready? Let's dive right into real talk on Dentistry's daily wins and sticky situations.

Wright: [00:00:52] Hello, everyone. Today, we're having what we hope will be an informative conversation with some real advice and support that can help all of us address depression and suicide.

Ioannidou: [00:01:05] It's such an important and topical issue that recently the White House launched a suicide awareness program. So to talk about this topic in the context of our profession, we have invited Dr. Karen Foster. Dr. Foster, welcome to the show. And why don't you please tell us a little bit about yourself and where you practice?

Foster: [00:01:25] Thanks for having me. I am a pediatric dentist and I currently work in Denver as faculty at the Denver Health Pediatric Residency and Internship. I trained dental school at Baylor, which is now Texas A &M in Dallas and then residency in Houston at UT Houston. I've pretty much practiced in every modality that you can. I've been an associate, I've been in public health, I have been a practice owner and also in academics and that's where I find myself now. I currently serve as the president of the Metropolitan Denver Dental Society. I am a past president of the Colorado Dental Association. I am a wellness ambassador in the first cohort for the ADA, and I also serve on the Council of Ethics, Bylaws, and Judicial Affairs.

Ioannidou: [00:02:19] Oh, wow. So you have seen the profession from many angles, right? As you said, as an associate, in public health and academics. You have seen it all.

Foster: [00:02:28] I think I've covered most of the bases.

Ioannidou: [00:02:31] That's right. So, how did you end up having this interest in wellness?

Foster: [00:02:37] Unfortunately, it's a little bit of a sad story. One of my best friends in residency, one of my colleagues that I studied with the most, he actually went to practice in California and I opened a practice in the south metro area of Denver. And he and his wife were planning to move to Colorado and he reached out to ask if I would have any job opportunities and I was able to incorporate him one day in my practice. And then he also had an additional associateship. I think he practiced with me for about three years and unfortunately was having troubles in his life. And I lost him to suicide in 2017.

Ioannidou: [00:03:16] Oh, that's a sad story.

Foster: [00:03:18] It is. From then on, in his honor, I really do everything that I can to prevent suicide in our profession going forward. And I brought the resolution to the ADA House as a delegate to prioritize mental health in our profession. And I'm really happy with how the Council on Dental Practice and the Dental Wellness Advisory Council have really taken that charge and have done their best to prioritize mental health for our colleagues.

Like I said, I was in the first cohort of Wellness Ambassadors and several of my projects centered around suicide prevention. And I think as we go into the conversation, we'll talk about some of those.

Ioannidou: [00:04:01] Well, this is amazing. I had, first of all, I had no idea. And I'm really impressed by the fact that you took a personal experience and you really shaped it up for the common good. And you really looked to influence the entire society now and the entire profession. This is amazing. Thank you so much for what you're doing.

Wright: [00:04:22] Yeah. And Dr. Foster, how did you get into this work of reducing the stigma around mental health?

Ioannidou: [00:04:32] Because there is a stigma. I mean, I'm sure in different areas of the country, the stigma is more prominent than others. But I mean, we definitely recognize that it exists.

Foster: [00:04:41] Absolutely. You know, in just learning more and more about mental health issues and especially suicide, the best thing we can do for prevention is going to be talking about it.

And because of the stigma around being in a profession where there could potentially be issues with your ability to practice if you own up to having any type of issues, and of course, it doesn't have to be all the way to the spectrum of suicide idolization, but any mental health crisis that we might experience as dentists, there's a huge stigma against even reaching out for help talking about it, just because of the potential of not being able to practice. So for me, that's, that's an avenue of advocacy that I've taken on since my colleague's passing in trying to help with suicide prevention in our profession.

Ioannidou: [00:05:41] When you were saying with the risk of not being able to practice, is it a liability dimension? Speak about this a little bit more. Like, is it the personal risk of recognizing the personal limitation for practicing or it's something that comes outside, like in terms of insurance malpractice this dimension?

Foster: [00:06:02] I think it's a whole spectrum. You know, we are community leaders and so if, you know, just word of mouth, if as the dentist in a community, you might be having issues that could lend to public perception issues all the way to credentialing and state licensure, which I know has been a priority of several of the wellness ambassadors to work on the licensing process and make sure that if you are in recovery from say, substance use or any mental health issue, honestly, that it doesn't affect your ability to maintain your credentials and/or get insured.

Ioannidou: [00:06:42] Yeah, this is an excellent point. And I'm sure there is a variability among states, right? In terms of regulation, correct?

Foster: [00:06:50] Yeah, there is.

Ioannidou: [00:06:51] Yeah. Yeah. No, that's really interesting.

Wright: [00:06:53] How do you think the unique challenges of the dental profession contribute to mental health issues like depression?

Foster: [00:07:00] It is not evidence based as of yet. I believe there will be future research into it. My hypothesis is solely the personality type that goes into dentistry tends to be perfectionist. We tend to be proverbial Type A, very empathetic people. We see people that don't want to see us on a daily basis. 

Ioannidou: True. That's absolutely true. You're right. 

Foster: I think that contributes. Yeah. I mean, it's almost on a daily basis in our offices. We're told, I would rather be anywhere else but here. And if you're the practitioner that's trying to serve that patient that chips away at your psyche a bit.

Ioannidou: [00:07:44] It's funny that you're bringing this up because the other day I was in the drive and the Uber driver turned to me. I don't know how we engaged in this conversation. And I said that I'm a dentist. And he said, really, you don't look like a dentist. And I'm like, why? What do dentists look like? And he said, oh, they are mean people.

I'm like, no, we are not mean people! How dare you? So, no, no, I get what you're saying. It's hard to cope with the notion that they prefer to be anywhere else but in your office.

Wright: [00:08:10] Yeah. Dr. Foster, where can someone turn if they've been impacted by the unexpected loss of a colleague or a friend?

Foster: [00:08:19] We've had enough suicide in our profession that there are colleagues that have been through this. So definitely reach out to your dental association. We are close to having wellness ambassadors in every state. We definitely have them in every district. And those people are great contacts as first steps. 

There is an After a Suicide Postvention Toolkit produced by the ADA in conjunction with AFSP, the American Foundation for Suicide Prevention. And it has a fairly step-by-step what to do in the case of an unexpected loss in your office. I know that when I found out my colleague had passed away, it definitely was a, oh my goodness, what do I do now situation with having to notify the public, the team, all the way to how do you properly grieve and do you close the office?

You know, all the questions. And hopefully the Postvention Toolkit kind of touches on those questions immediately after a loss, and then look to your dental association for resources and colleagues that can be helpful. The American Foundation of Suicide Prevention is actually a really great website with lots of resources also.

Ioannidou: [00:09:41] Yeah, that's great. It's good to know. Thank you so much. And as you said that there are logistics that someone has to deal with, but also the grief and the coping with all this. I mean, it's a huge matter to tackle. And I'm sure that most of us, the vast majority of us, are not prepared, not even close to being prepared for something like this. It's a huge shock.

Wright: [00:10:09] Yeah.

Ioannidou: [00:10:10] So I completely get it. And I'm really glad that the ADA has developed that toolkit and offers this, which obviously confirms that we all, as a profession, recognize that that's an important struggle and noticeable struggle that we have to deal with.

So if we have someone, a colleague, a friend that we know that is struggling with depression or burnout, what advice would you give to a person like this? And can we as friends and coworkers, can we do something to support each other? How does this work? I mean, I'm really clueless. I have not experienced this. I never had anybody close to me that experienced this. So I truly and honestly would love to know more.

Foster: [00:10:55] For me, that's kind of a two part question. If you recognize in yourself that you're having burnout or depression, anxiety, anything just seems off, there are resources available on the ADA website. But take a step back. Engage in self care. If that means just going and getting a pedicure or setting aside some time for meditation. There's lots of resources for that. The Well-Being Index also is a great tool to use in order to kind of see where you land, and then it also has resources for you if you might need some help.

I've done more personal research in recognizing what to do about a colleague or a friend that you're concerned about. Because, let's face it, in our offices we spend more time with our colleagues than we probably do at home with our families. So we're in a unique situation to see if someone is, you know, seemingly having something change in their life.

It is appropriate to have a conversation with someone and to be fairly blunt about, you know, how are you doing? Are you okay? What can I do to support you? I'm noticing a behavior change. It seems like you're, you know, coming in with wrinkled clothes each day or, you know, whatever it might be. It's absolutely appropriate if you feel comfortable going to that person and checking on their wellbeing. And then offering whatever support they might need in order to do something for their wellbeing, be it helping them get an appointment with a therapist or giving them an afternoon off for that pedicure or some self care that we talked about, depending on where in the spectrum they might be as far as having some issues.

Ioannidou: [00:12:55] That's so great. In your opinion, from the knowledge that you have built throughout the years on this, it's great that you brought up the wrinkle clothes. What is a sign? Where should we look, like, this is a great example, but what are the most common behavioral changes that we might observe?

Foster: [00:13:14] You know, warning signs are if they have increased alcohol or any type of drug use, lack of motivation, lack of communication, or you just see a change in how they communicate, attendance issues, that's a huge red flag, increased aggression or agitation, any changes in performance, that disheveled appearance like we talked about, or inability to concentrate, all warning signs of someone at risk.

And just trust your gut. If you feel like something is off, in my own personal story, I knew something was wrong that day and I was personally moving. So I was at my home watching movers pack boxes and I was like, you know, I need to call and check on my colleague that evening. And it just, it slipped my mind.

I was in the midst of a move, chaotic events, and just, I didn't call and check on him that night. And I will forever be sad that I didn't. Now I've come to realize that it wouldn't have changed the outcome. It might've changed the date. You know, a phone call when someone is in the throes of that is probably not going to change things. But earlier on, I could have noticed there had been some issues. Now, of course, with hindsight is 2020, I think is the saying, I can look back on that and go, Oh yeah, that was a warning sign that I didn't catch. Because to your point, we do get busy and life just goes on.

But my point is trust your gut. If you  have that gut feeling that something is amiss, do investigate. We all are human and we all want to be checked in on and connected with other humans. So it's okay to go up to someone and say, Hey, you okay? What's going on? Anything I can help with?

Ioannidou: [00:15:32] Yeah, I liked what you said. We are indeed all human. And we actually own it. If we feel that there is, that we, you know, we trust our gut and we think that something is wrong, it’s nice to make this extra move and make this call. I think that you're absolutely right. This is really very true.

Wright: [00:15:53] Of course, when I'm in the office, we start our work day with a morning huddle. But that's not the only touch point that I have with my team, obviously. I mean, we're, we're surrounded by each other all day. But one of the things that I do with my team is, I ask how they're doing because I want to be the leader that not only wants my team to come to work and perform for me, I don't want them to just come to work and collect a paycheck, I want them to be healthy. I want them to want to be there. I want them to know that their health and wellbeing is just as important to me as mine is to myself. 

I feel like long gone are the days where it's just like, you know, you come to work and do what I said, because I'm the boss. But one of the things that I really like to do is I just ask them like, how are you doing? How are you feeling? When they experience a loss in their lives, I like to know it. And of course, you know, if they're grieving or having to take off for bereavement, of course I do know it. But once they return. I like to check in often.

And one of the reasons why I do that is because I want to be proactive as opposed to reactive. I want to notice, you know, if their mood changes or if they're lacking, not necessarily in confidence, but if they're feeling like they're just kind of meh. and if they're a little meh, it kind of makes me just lean in a little bit more and just pay attention. Sometimes I don't always say something, and I don't know if that's the right thing to do or not. But I am always, like, on the lookout for signs of, just not necessarily self harm, but I'm always on the lookout for signs of if they're just not their normal selves or the self that I know them to be.

Ioannidou: [00:17:40] Yeah, we will be right back.

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Wright: [00:18:31] Welcome back to Dental Sound Bites. We are having a conversation about depression and suicide with Dr. Karen Foster.

Ioannidou: [00:18:39] Dr. Foster, do you find that our dental community could do better in supporting each other in terms of the mental health and the well-being issues?

Foster: [00:18:48] I don't know if it's a factor of having had personal experience, so I'm more in tune to it now than I ever have been. And I've gotten a lot more phone calls and have an opportunity to speak more often just because of personal experience. But I feel like we definitely have turned the corner and are trying to prioritize mental health in our profession. Could we do better? My heart tells me that there is room for improvement because unfortunately we are still losing colleagues.

So, yes. Are we having conversations that we didn't used to have? I think so. This podcast being one of them. You know, I don't think you'll find a library full of people talking about suicide prevention on podcasts. But here we are, and back to the stigma question, that's step one. We have to be able to have these conversations. So that was kind of a nebulous answer to your question, but I feel like we're working on it.

Wright: [00:19:44] Of course.

Ioannidou: [00:19:44] It's a great answer.

Wright: [00:19:45] And Dr. Foster, what are some effective ways we can manage stress and prevent burnout?

Foster: [00:19:51] I definitely feel like self care. Being self aware, learning how to say no, that's a good one for me. 

Ioannidou: And for me.

Foster: And I listened to several of the other Sound Bites podcasts talking about burnout and depression, and I would point listeners to those. They have even more resources in this arena. And leaning on our colleagues, I would say.

Ioannidou: [00:20:17] Yeah, and communicating. I agree with you leaning and feeling comfortable to even, you know, it's one thing that we reached out to the, you know, following our gut feeling and reaching out to a colleague and say, Hey, how are you feeling? But also it will be nice if, you know, we, as we struggle with mental health issues to feel comfortable to reach out to colleagues and say, Hey, I don't think I can come to work today. I don't feel well. And it's not because I have a fever. Like my grandmother used to say, if you don't have a fever, you're not sick. But that's not only it. There are so many other things that can be happening and we need to give space to people to breathe. 

Foster: You’re spot on.

Wright: [00:20:59] And I think just having even the bare minimum knowledge about mental health disorders and just the stigmas related to mental health, depression, suicide, I feel like there's something that we can do if we take notice and if we take notice early on. And so that's really important to me too.

Ioannidou: [00:21:16] As we assess our efforts on suicide prevention, what more do you think can be done? I know you're hopeful and I know we have positive vibes, but where do you see, what are your hopes for the future of suicide prevention in our society, in our profession and in our society?

[00:21:34] Foster: I think we should continue to do research. Just like the question you raised earlier about, you know, can we identify characteristics or anything within our profession? Then there could be some sort of mitigation created. It takes resources and sometimes that's literally financial resources. So I would ask that we, as members of the ADA, continue to support efforts from the ADA and our components and constituents as well.

Because I think a lot of this has to be on the local level amongst our near colleagues, friend to friend, if you will. Peer to peer. But those connections need to be supported. And so I would ask that we continue to put financial resources towards developing all of our well being products.

Ioannidou: [00:22:29] You're absolutely right. I think that it's really important to invest resources on this type of research. I mean, if we have such a well defined high suicidal rate in the profession, we need to know details about this. And certainly, already we see some differences in terms of sex and gender compared to the general population, but I'm sure if we dive into this and, and again, to dive into the details and develop hypotheses, we really need to have resources.

We don't know if there is a specialty trend. We don't know if it's a geographical trend. We don't know if it's a practice mode trend. I mean, there are so many things that one can look into. So yeah. I mean, I agree with you, but I think that the good thing is that we have Wright: [00:00:00] This episode contains discussions of depression and suicide. Please take care when listening. If you're struggling, help is available. Please call 988 – THE SUICIDE AND CRISIS LIFELINE. It's available 24 hours a day. I'm Dr. ArNelle Wright.

Ioannidou: [00:00:18] and I'm Dr. Effie Ioannidou. Join us as we talk about very serious issues today in our dental profession, depression and suicide.

We explore what can be done to support our mental health as well as our friends’, colleagues’ and peers’.

Announcer: [00:00:36] From the American Dental Association, this is Dental Sound Bites, created for dentists by dentists. Ready? Let's dive right into real talk on dentistry's daily wins and sticky situations.

Wright: [00:00:52] Hello everyone. Today we're having what we hope will be an informative conversation with some real advice and support that can help all of us address depression and suicide.

Ioannidou: [00:01:05] It's such an important and topical issue that recently the White House launched a suicide awareness program. So to talk about this topic in the context of our profession, we have invited Dr. Karen Foster. 

Dr. Foster, welcome to the show. And why don't you please tell us a little bit about yourself and where you practice?

Foster: [00:01:26] Thanks for having me. I am a pediatric dentist and I currently work in Denver as faculty at the Denver Health Pediatric Residency and Internship. I trained dental school at Baylor, which is now Texas A&M in Dallas, and then residency in Houston at UT Houston.

I've pretty much practiced in every modality that you can. I've been an associate. I've been in public health. I have been a practice owner and also in academics. And that's where I find myself now. I currently serve as the president of the Metropolitan Denver Dental Society. I am a past president of the Colorado Dental Association.

I was a wellness ambassador in the first cohort for the ADA. And I also serve on the Council of Ethics, Bylaws, and Judicial Affairs.

Ioannidou: [00:02:18] Oh, wow. So, you have seen the profession from many angles, right? 

started. Right? I mean, there is an initial hypothesis. There is the first step done. And usually this is how research is developed. It's the first observational finding. And then we tap into this and we grow more. So I think this is a great thought to develop on for sure.

Foster: [00:23:40] I frequently reference a quote that we have to stop pulling people out of the river. We have to figure out why they're falling in in the first place.

Wright: [00:23:48] So good.

Foster: [00:23:49] And I don't exactly know what that means as far as, you know, what do we exactly do for suicide prevention efforts in our industry. But I think we have to keep exploring. We have to keep having the conversations.

Ioannidou: [00:24:03] I mean, this is such an interesting conversation. I really enjoyed it. And, you know, I wanted to say it's interesting that you’re coming from pediatric dentistry, a pediatric dentist that has developed this particular interest. I mean, I find it even more interesting because one would think that your environment, with the kids and all this happy, jumpy, you know, no problems there. You would, I would predict that, you know, perhaps someone within the different specialty will be looking there again. That's maybe a stereotype that we have to overcome as a community, as a profession. But that's really refreshing and I'm really happy that we met and we had this conversation.

Announcer: [00:24:46] On the next Dental Sound Bites.

Ioannidou: [00:24:48] In our next episode, we are exploring the impact of marijuana on oral health.

Wright: [00:24:52] Dr. Barry Taylor joins us to discuss trends in marijuana use and their implications when treating your patient.

Dr. Foster, is there anything else you want to add that we didn't cover?

Foster: [00:25:08] No, I'm just grateful to the ADA for having the courage to have a platform to talk about suicide prevention and to have some tough conversations.

Ioannidou: [00:25:19] I personally thank you so much for joining us. I learned a lot. You know, I wasn't born in the U.S. I was born in Greece. And if we're talking about stigma here, the stigma in Greece is like, multiply by a hundred. So, I learned a lot and I really enjoyed talking to you. So we thank you for making the time to be with us today. And I think it's important to let us know where our listeners can find you and learn more about you or follow you online.

Foster: [00:25:50] I am on Instagram as kdfdoc, and my email is kdfdoc@gmail. com. And if you have any questions, you need any support, I am available at all times.

Ioannidou: [00:26:04] Thank you so much for everything. And thank you for sharing your Instagram and your email with our listeners. This is great.

Wright: [00:26:13] Thank you, Dr. Foster, for being here on Dental Sound Bites with us.

Ioannidou: [00:26:17] If you like this episode or you think that you can help someone, please share it with a friend.

Wright: [00:26:23] And remember, if you're struggling, help is available. Please call 988 – THE SUICIDE AND CRISIS LIFELINE. It's available 24 hours a day. Our conversation continues on the ADA Member App. Catch all the bonus content and things you didn't hear on the show.

Announcer: [00:26:43] Thank you for joining us. Dental Sound Bites is an American Dental Association podcast. You can also find this show, resources, and more on the ADA member app and online at ADA.org/podcast.