Job Stress a Major Factor in High Rates of Physician Suicide

Caroline Cassels

November 13, 2012

Job stress, coupled with inadequate treatment for mental illness, may account for the higher than average rate of suicide among US physicians, new research suggests.

Investigators at the University of Michigan in Ann Arbor found that among individuals who died by suicide, having a mental health disorder or a job problem was significantly associated with being a physician.

They also found that physicians who died by suicide were much more likely than their nonphysician counterparts to have antipsychotics, benzodiazepines, and barbiturates, but not antidepressants, present on toxicology testing.

"This [study] paints a more detailed picture of external events and risk factors in a physician's life before a suicide, rather than just looking at a death certificate," lead author Katherine J. Gold, MD, MSW, said in a statement.

The study was published online November 5 in General Hospital Psychiatry.

Lack of Action

The researchers point out that the suicide rate among physicians is significantly higher than that of the general population, and although there has been some previous research looking at mental health issues in medical students, relatively few studies have examined mental illness and suicide risk among practicing physicians.

"We've seen a number of studies now that show a high rate of anxiety, depression, and burnout among both medical students and physicians, but we haven't done very much to develop programs to reduce or treat these factors and to increase mental health–seeking among physicians," said Dr. Gold.

To investigate risk factors and comorbidities associated with physician suicide and to compare potential differences between physician and nonphysician suicide victims, the researchers used data from the National Violent Death Reporting System (NVDRS).

The NVDRS, they note, offers "rarely-available data on psychosocial, psychiatric, mental health care, medical comorbidity and substance abuse variables associated with suicide."

The study included data on 31,636 suicide victims aged 18 years and older from 17 states. Of these, 203 were physicians.

The researchers found that there were no significant differences in current mental health disorders between physicians and persons in other occupations (46% vs 41%) or in persons with current depression (42% vs 39%).

In addition, there was no difference between physician and nonphysician groups with respect to comorbid current depression, substance or alcohol abuse disorder, or known mental illness.

At 48% for physicians and 54% for nonphysicians, firearms were the most common method of suicide for both groups. For physicians, this was followed by poisoning (23.5%), blunt trauma (14.5%), and asphyxia, which included hanging (14%).

After firearms, the most common cause of death in nonphysicians was asphyxia (22%), followed by poisoning (18%) and blunt trauma (6%).

Need for Change

Among suicide victims, having a known mental illness was mildly associated with higher odds of being a physician (odds ratio [OR], 1.34; confidence interval [CI], 1.01 - 1.82; P = .045). However, among physicians, the greater likelihood of having a known mental illness was not matched by a greater likelihood of antidepressant therapy, the investigators note.

However, having a job problem that contributed to the suicide significantly predicted the likelihood of being a physician (OR, 3.12; CI, 2.10 - 4.63; P < .0005).

Toxicology testing revealed that physicians were significantly more likely than nonphysicians to have antipsychotics (OR, 28.7; CI, 7.94 - 103.9; P < .0005), benzodiazepines (OR, 2:10; CI, 11.4 - 38.6; P < .0005), or barbiturates (OR, 3.95; CI, 15.8 - 99.0; P< .0005) present.

"There needs to be greater effort to address the stigma, underdiagnosis, and treatment of depression among physicians and understand how we can reduce the stress related to work. We need to make mental health treatment more available, safe, and confidential," said Dr. Gold.

In an accompanying editorial, Olaf Gjerløw Aasland, MD, PhD, from the Institute of Health and Society, University of Oslo in Norway, describes the study as "an impressive piece of work."

Dr. Aasland notes that the findings highlight the need for "good management of mental imbalance and psychiatric disorders, reduce[d] workplace and work—home balance stressors, and restriction of access to means for physicians who are in situations in which the two other factors are acute."

The authors and Dr. Aasland have disclosed no relevant financial relationships.

Gen Hosp Psychiatry. Published online November 5, 2012. Abstract