Wednesday, March 4, 2020

Meta-Analysis Spotlights Challenge of Physician Suicide

The risk of suicide among physicians who are women appears to be higher than women in the general population, according to a meta-analysis appearing in JAMA Psychiatry. In contrast, men who are physicians appear to have lower suicide rates than men in the general population.

“Our meta-analysis showed decreasing suicide rates [since 1980], but the datasets showed paradoxical trends that may be affected by gender, race, location, and time,” Dante Duarte, M.D., Ph.D., of Harvard University and colleagues wrote.

Duarte and colleagues searched the medical literature for original articles from around the world that assessed male and/or female physician suicide from 1980 to the present. They used data from before 1980 to compare pre-1980 suicide rates with post-1980 rates. Of the 32 articles reviewed by the authors, nine were included in the meta-analysis.

The researchers found that women physicians were 46% more likely than women in the general population to die by suicide. By comparison, men physicians were 33% less likely than men in the general population to die by suicide. The risk of death by suicide for both groups fell from 1980, according to the report.

The authors noted that psychiatric illnesses, mainly depression, substance abuse, or both, were reported as risk factors in only four articles. Work or training demands were indirectly hinted at by six studies: men physicians in the United States mostly died by suicide when professionally productive, during early training, when they had work problems, or were working in isolation. Findings regarding the association of suicide with physicians’ race and ethnicity were mixed, with different groups affected by different factors, the authors reported. Consistently, the studies found increased risk of suicide associated with interpersonal relationship factors—especially divorce—but also with being widowed, single, or having relationship problems.

“Studies need to be systematized to clarify underlying patterns, identify vulnerable subsets of physicians at risk, and explore suicide prevention by addressing the modifiable risk factors suggested by this research,” Duarte and colleagues concluded.

The findings by “Duarte and colleagues provide a much-needed update on physician suicide rates in a meta-analysis of global studies,” wrote Katherine J. Gold, M.D., M.S.W., M.S., and Thomas L. Schwenk, M.D., of the University of Michigan in an accompanying editorial.

They continued, “The medical profession must address the root causes of physician distress. The profession must 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.”

For related information, see the Psychiatric News article “Preventing Physician Suicide Requires Changing the Culture of Medicine.”

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