Counterintuitive Findings for Physician
Suicide by Sex

Megan Brooks

March 10, 2020

Female physicians are more likely than women in the general population to die by suicide, new research shows. However, the same does hold not true for male physicians, who have a lower rate of suicide than males in the general population.

Results of a systematic literature review and meta-analysis show women physicians are 46% more likely than their female counterparts in the general population to die by their own hands. In contrast, male physicians are 33% less likely to die by suicide vs men in the general population. However, the research also showed that there has been a decline in physician suicide risk in both men and women since 1980.

"In the general population, men die of suicide at higher rates than women, so there are known sex-related trends. Those trends seem to be reversed for physicians," lead authors Dante Duarte, MD, PhD, and Mirret El-Hagrassy, MD, both from Harvard Medical School in Boston, Massachusetts, told Medscape Medical News via email.  

The study was published online March 4 in JAMA Psychiatry.

A Taboo Issue

The meta-analysis of nine British and US studies included a total of 162 female physician suicides and 547 male physician suicides. 

The data show that suicide risk is significantly higher in female physicians compared with women in the general population (suicide standardized mortality ratio [SMR], 1.46; 95% confidence interval [CI], 1.02 - 1.91) and significantly lower in male physicians compared with men in general (SMR, 0.67; 95% CI, 0.55 - 0.79).

When comparing the periods before and after 1980, both male and female physician SMRs decreased significantly after 1980, but much more for female physicians (SMR, −1.96; 95% CI, −3.09 to −0.84; P = .002) than for male physicians (SMR, −0.84; 95% CI, −1.26 to −0.42; P < .001). The risk of suicide in female physicians, however, remained higher than that of females in general.

The investigators report they had initially thought that suicide risk in female physicians would decrease after 1980 as more females enrolled in medical school and entered the physician workforce; indeed, this seemed to be the case.

"However, we cannot say it is true with confidence because of the limited pre-1980 data on female physician suicides. Female physicians still seem at much higher risk than women in general, and it is possible that career-related factors might contribute to this risk," Duarte and El-Hagrassy said.

Meanwhile, the data suggest male physician suicides did actually decrease after 1980 in parallel with an increase of suicide among men in the general population.

"Again, we cannot tell if this is real — in which case male physicians might have a better buffer against the global rise in unemployment — or if it might be related to variations in reporting methods, or to underreporting of physician suicides — for example, to reduce the suffering of a colleague's spouse and children, or to keep them from losing out on life insurance," Duarte and El-Hagrassy said.

The "complex topic" of suicide in physicians and the modifiable risks vulnerabilities in physician subpopulations deserves greater attention, they note.  

"There seems to be intrinsic resistance to address physician suicides in the medical community and healthcare organizations as well as medical boards," Duarte and El-Hagrassy said.

Personal, Professional Tragedy

The authors of an accompanying editorial note the study provides a "much-needed update on physician suicide rates in a meta-analysis of global studies." 

"But ultimately, physician suicide is more than a matter of standardized mortality ratios; rather, it is a tragedy both personally and professionally. Any discussion of physician suicide deaths needs to recognize the far-reaching influence that even a single suicide has on the physician's community," write Katherine Gold, MD, from University of Michigan, Ann Arbor, and Thomas Schwenk, MD, of University of Nevada, Reno.

They call for the medical profession to address the root causes of physician distress and "adopt, as a core professional value, a more sustainable approach to managing the burdens of medical practice."

"Educational and work environments are needed that support rather than stigmatize physicians who seek help. Barriers to accessing mental health care must be removed. Individual physicians, their colleagues and patients, and their communities deserve no less," Gold and Schwenk add.

The study was conducted with statistical consultation support from Harvard Catalyst/The Harvard Clinical and Translational Science Center and financial contributions from Harvard University and its affiliated academic healthcare centers. Duarte, El-Hagrassy, Gold, and Schwenk have disclosed no relevant financial relationships.

JAMA. Published online March 4, 2020. Abstract, Editorial

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