New research identifies risk factors for physician suicide

By Christopher Cheney

Compared to the general population, physicians who die by suicide are more likely to experience job and civil legal problems, recent research indicates.

It is estimated that a doctor commits suicide every day. Research published in 2018 indicates that nearly half of physicians nationwide are experiencing burnout symptoms. There are overlapping risk factors for suicide and burnout, including depressed mood and job problems, according to the Maslach Burnout Inventory and the National Violent Death Reporting System (NVDRS).

The recent research, which was published by JAMA Surgery, examines NVDRS data collected from January 2003 to December 2016. More than 170,000 individuals who died by suicide were identified. Of that total, 767 individuals (0.5%) were physicians. Non-surgeon physicians accounted for 63.2% of doctors who committed suicide, dentists accounted for 23.3%, and surgeons accounted for 13.4%.

The research generated several other key data points:

• Compared with the general population, suicide risk factors among physicians included Asian or Pacific Islander ancestry (2.80 odds ratio), job problems (1.79 odds ratio), civil legal problems (1.61 odds ratio), physical health problems (1.40 odds ratio), and treatment for mental illness (1.45 odds ratio)
• Among the 103 surgeons, orthopedic surgeons (18.5%) and neurosurgeons (12.6%) accounted for the highest number of suicides
• The mean age of physicians who died by suicide was 59.6 years, compared to a mean age of 46.8 years in the general population
• Compared to the general population, suicide risk factors for non-surgeon physicians included Asian or Pacific Islander ancestry (2.29 odds ratio), civil legal problems (1.80 odds ratio), job problems (1.72 odds ratio), physical health problems (1.53 odds ratio), older age (1.003 odds ratio per year), and receiving treatment for mental illness (1.32 odds ratio)
• Compared to the general population, suicide risk factors for surgeons included Asian or Pacific Islander ancestry (5.41 odds ratio), job problems (2.19 odds ratio), older age (1.004 odds ratio per year), and receiving treatment for mental illness (2.12 odds ratio)

Interpreting the data

The JAMA Surgery researchers hypothesized about why physicians had higher suicide risk factors than the general population.

• Older age: “One hypothesis is that the transition into a senior career position or retirement introduces new challenges regarding sense of purpose, finances, changes in routine, and restructuring of family dynamics,” the researchers wrote.
• Asian and Pacific Islander ancestry: “The cultural stigma of experiencing mental health challenges among this population may contribute to low rates of diagnosis and treatment of mental illness,” they wrote.
• Job problems: All three physician subgroups—surgeons, non-surgeons, and dentists—were at higher risk for suicide than the general population if they had job stressors. “Given the time and economic investment expended in training to become a healthcare professional, the inability to practice may carry a larger burden of emotional distress,” the researchers wrote.
• Civil legal problems: The link between civil legal problems and suicide was strongest for non-surgeon physicians. “Physicians who practice in specialties that have a high risk of incurring malpractice claims may be more accustomed to handling such claims. In contrast, physicians who practice in specialties in which malpractice litigation is less common may experience more emotional distress when malpractice claims occur,” they wrote.

Suicide prevention opportunities

The researchers identified two primary opportunities for healthcare organizations to improve suicide prevention.

• “Our data suggest a need for increased screening of healthcare professionals, particularly among the high-risk groups comprising racial minorities and those in the late stages of their careers,” the researchers wrote.
• “Because job problems and civil legal problems were associated with a significantly higher likelihood of suicide among healthcare professionals, institutions can aim to ensure sufficient human resource and legal support for professionals experiencing litigation,” they wrote.

Physicians in crisis can seek help by calling the National Suicide Prevention Lifeline at 800-273-8255.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.