Study IDs Physicians at Highest Risk of Suicide
Physicians at greatest risk of suicide tend to be older and near the end of their careers; of Asian or Pacific Islander ancestry; or those dealing with physical, mental health or medical malpractice issues, according to a new study published in the journal JAMA Surgery.
Physicians have the highest suicide rates of any profession with up to 40 suicides for every 100,000 doctors (more than twice that of the general population).
For the study, researchers from Massachusetts General Hospital identified modifiable and behavioral risk factors that can lead to burnout and suicide among three groups of health care providers (surgeons, nonsurgeon physicians and dentists) as a way of informing hospitals and residency training programs of potential areas for intervention through increased screening and treatment.
“Our study highlights the fact we have to be concerned about a larger physician population than we originally thought, including individuals facing civil legal, marital and cultural risk factors, as well as those receiving treatment for mental illness,” said Yisi Daisy Ji, D.M.D., with the Department of Oral and Maxillofacial Surgery and lead author of the study.
“Providers are comfortable advising patients when to seek help but are often reluctant to do so themselves. Part of that is the perceived stigma of being a health care professional with a mental health problem, as well as concern it could adversely affect their medical licensure.”
The ongoing COVID-19 pandemic raises the importance of physician mental health and suicide prevention.
“With physicians across the country facing uncharted challenges in working conditions, redeployment and physical and emotional stress, we must be more vigilant than ever,” said Faith Robertson, M.D., with the Department of Neurosurgery, and co-author of the study.
“We are calling on all physicians to recognize the signs of mental health difficulties in their colleagues, as well as in themselves, and take early action.”
To identify which physicians are most at risk, the research team analyzed data from the National Violent Death Reporting System from 2003 through 2016. Of the more than 170,000 individuals who died of suicide, 767 were health care professionals.
The Mass General study is the first national evaluation of suicide risk factors and outcomes in the health care provider sub-groups of surgeons, nonsurgeon physicians and dentists.
One surprising finding of the study was that physicians who died of suicide were substantially older (mean age, 59.6 years) compared to the general population of suicide victims (mean age, 46.8) years.
“This is a previously unrecognized demographic to be at risk,” said Ji. “Our hypothesis is that the transition into a senior career position or retirement introduces new and often unsettling challenges of purpose, finances and restructuring of routine and family dynamics.”
Another unexpected finding was that physicians of Asian and Pacific Islander ancestry were at greater risk of suicide than those of white ancestry. Researchers theorized that the cultural stigma of experiencing mental health problems among this health care population may contribute to low rates of diagnosis and treatment.
Civil legal problems were also found to be a significant risk factor for suicide in physicians compared to the general population, and more so in the nonsurgeon than the surgeon cohort.
One potential reason is that physicians in specialties where malpractice litigation is less common (such as nonsurgical) may experience more emotional distress when claims occur, compounded by the duration and uncertainty of each case.
The researchers propose that hospitals would benefit from offering additional psychological as well as legal and human resource support to physicians during times of litigation-induced stress.
With reported cases of physician burnout on the rise nationwide, the study emphasizes the need for more intense screening and support of health care professionals across all high risk groups.
“Our study underscores the need for more targeted intervention and support to fit the risk factors of health care professionals,” Ji said. “And that support, including mental health screenings and more open conversations among colleagues about warning signs, needs to continue throughout the physician’s career if we’re going to mitigate burnout and decrease the rate of suicides in the field of medicine.”
Source: Massachusetts General Hospital
Pedersen, T. (2020). Study IDs Physicians at Highest Risk of Suicide. Psych Central. Retrieved on December 3, 2020, from https://psychcentral.com/news/2020/06/13/study-ids-physicians-at-highest-risk-of-suicide/157272.html