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Suicide rate soaring among US physicians

Robin Wulffson MD's picture
suicide, physicians, job stress, suicide methods, substance abuse

Although suicide is a significant public health problem in the United States, the suicide rate is higher among physicians than the general public. Investigators affiliated with the University of Michigan in Ann Arbor examined factors involved in physician suicide; they published their findings online on November 5 in the journal General Hospital Psychiatry.

The researchers noted that only a few studies have evaluated information about mental health comorbidities and psychosocial stressors which may contribute to physician suicide. Therefore, they attempted to evaluate these factors among physicians and compared them to non-physician suicide victims. The investigators accessed data from the United States National Violent Death Reporting System (NVDRS) to evaluate demographics, mental health variables, recent stressors, and suicide methods among physician versus non-physician suicide victims in 17 states. They noted that the NVDRS offers “rarely-available data on psychosocial, psychiatric, mental health care, medical comorbidity and substance abuse variables associated with suicide.”

The study group comprised 31,636 suicide victims; 203 were identified as physicians. Using multivariable logistic regression, the investigators found that having a known mental health disorder or a job problem which contributed to the suicide significantly predicted being a physician. Multivariate analysis is a form of statistics encompassing the simultaneous observation and analysis of more than one outcome variable. In this study, it was factors contributing to suicide. The investigators found that physicians were significantly more likely than non-physicians to have antipsychotics, benzodiazepines, and barbiturates present on toxicology testing but not antidepressants.

The investigators found that there were no significant differences in current mental health disorders between physicians and individuals in other occupations (46% vs. 41%) or in individuals with current depression (42% vs. 39%). Furthermore, they found no difference between physician and the general public in regard to comorbid current depression, substance or alcohol abuse disorder, or known mental illness. For both groups, firearms were the most common method of suicide (physicians: 48%; non-physicians: 54%). For physicians, this method was followed by poisoning (23.5%), blunt trauma (14.5%), and asphyxia, which included hanging (14%). For the general public, firearms, the most common cause of death was asphyxia (22%), followed by poisoning (18%) and blunt trauma (6%).

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The authors concluded that mental illness is an important comorbidity for physicians who complete a suicide; however, postmortem toxicology data shows low rates of medication treatment. They suggested that inadequate treatment and increased problems related to job stress may be potentially modifiable risk factors to reduce suicidal death among physicians.

Take home message:
This study evaluated factors involved in suicide among physicians and the general public. Many physicians are subject to significant job-related stress and long hours. This begins in medical school. When I was a medical student at UCLA, one of my classmates committed suicide in his senior year, despite the fact that he was performing well academically. After counseling, it was decided that instead of progressing on to his internship, he would take a year off as a laboratory assistant. At his last session, he informed his counselor that all was in order in his life. He then went home to his apartment and hung himself. This incident points out one of the warning signs of suicide: the individual is no longer conflicted; he or she is ready to go forward with suicide plans.

Although the statistics provided by this study are disturbing, the actual US suicide rate is higher. An accidental death actually be a suicide (i.e., car crash, small plane crash, or river rafting accident). Another warning sign for suicide in an individual is if he or she takes an increased risk in high-risk activities.

Reference: General Hospital Psychiatry

See also:
Will we have enough primary care physicians in upcoming years?
Physician expert offers guidelines for dealing with post-traumatic stress disorder
US economic downturn has produced sharp uptick in suicide