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Suicide among doctors

 

Suicide rates among doctors have declined over time but remain higher than those of other academics.



Suicide in the medical profession has been studied for decades (1). Traditionally, the results have been surprisingly consistent. Doctors have exhibited higher suicide rates both over time and across various countries (2).


Positive development


In Norway, a study covering the period from 1960 to 2000 found that the suicide rate rose from the 1960s to the 1980s before declining in the 1990s. While this represented a positive trend, the suicide rate among female doctors in the 1990s was still twice that of women in the general population (3).


The decline in the suicide rate during the 1990s was encouraging, and we recently studied the trends in suicide among doctors and other healthcare professionals in Norway for the period from 1980 to 2021 (4). The rate for male doctors decreased over the four decades. Moreover, the rates for both male and female doctors in Norway were similar to those of the general population for the entire period. However, doctors' suicide rates were approximately twice as high as those of other academics (4).


A total of 157 suicides were registered among doctors in Norway during the period from 1980 to 2021: 130 men and 27 women. The suicide rate among male doctors was 25.7 (95% confidence interval 21.3 to 30.2) and among female doctors, 9.5 (95% CI 5.9 to 13.0), compared to 11.7 (95% CI 10.7 to 12.7) and 5.1 (95% CI 4.2 to 6.0) for male and female academics, respectively (4).


It is encouraging that the suicide rate among doctors has decreased. However, although the suicide rate for doctors is comparable to that of the general population, doctors have historically had lower mortality rates for all other causes (5). Therefore, we would expect the suicide rate to be lower than that of the general population. Additionally, there should be no reason for doctors to have a higher suicide rate than other academics.


The positive development aligns with studies from other countries (6–8). The most recent meta-analysis, which included studies from 20 countries between 1960 and 2024, also showed a decline in suicide rates over time. However, the figures remained higher than those of other academics and were notably elevated among female doctors (8).


Physician suicide – why?


The factors contributing to higher suicide rates in specific occupational groups are multifaceted. Both personal and work-related elements play a role. The common risk factors for suicide, such as depression, personality disorders, and substance abuse, are similar for doctors and others (2). However, more profession-specific factors likely account for the increased suicide rate, particularly the knowledge of and access to means of suicide. The specific use of medications by doctors to take their own lives is a recurring phenomenon (9).


The suicide rate among doctors increases with age (2, 4). In the recent study from Norway, doctors over the age of 60 had a suicide rate that was approximately double that of other highly educated individuals (4). What makes being an older doctor challenging? The answer remains unclear. It is possible that doctors’ identity and self-esteem are more closely tied to their profession than those in other fields, and for some, the transition from a hectic work life to retirement may feel overwhelming. However, a cohort effect could be at play, suggesting that younger doctors may not have the same tendency toward suicide as their older counterparts (2).


It is encouraging that the suicide rate among doctors has decreased. However, although the suicide rate for doctors is comparable to that of the general population, doctors have historically had lower mortality rates for all other causes. Image by Unsplash.
It is encouraging that the suicide rate among doctors has decreased. However, although the suicide rate for doctors is comparable to that of the general population, doctors have historically had lower mortality rates for all other causes. Image by Unsplash.

What to do?


Preventing suicide among doctors may present greater challenges than in other professions. Generally, doctors are hesitant to seek help (10). When faced with difficulties, they often try to resolve issues independently, sometimes resorting to self-prescribing and self-medication. Providing assistance is an intrinsic aspect of the medical profession, while receiving help is not. Furthermore, the rate of attempted suicide among doctors is relatively low (11). Given the high suicide rate, this may suggest that doctors seldom 'cry for help' and instead act on their suicidal thoughts (1).


We can reduce the suicide risk among doctors in two key areas. It is crucial to facilitate a more effective way for doctors to seek help. In this regard, considerable progress has been made over the past few decades. In Norway, two low-threshold services were established by the Norwegian Medical Association in the 1990s, allowing all doctors under stress to seek advice and support. Peer supporters are available for discussions in every county, and at Villa Sana in Modum Bad, doctors from across the country can obtain guidance and participate in courses (2). In recent years, Villa Sana has experienced a notable increase in inquiries.


It is essential for each of us to play a role in reducing stigma, encouraging help-seeking behavior, and fostering healthy work environments. We should pay particular attention to colleagues who are struggling and assist them in accessing treatment, which may include temporarily relieving them of specific work responsibilities. It is crucial that those in distress receive help early—before their problems escalate to the point where suicide risk emerges (2).


It is promising that suicide rates among doctors have declined over time, but still one doctor dies by suicide every day in the US and one about every 10 days in the UK, stated an editor in the BMJ recently, adding: "In any time of uncertainty and instability, we must hold on to hope. Hope needs action, and it’s all our responsibility to act" (12).



References


  1. Hem E. Suicidal behaviour in some human service occupations with special emphasis on physicians and police: a nationwide study. PhD thesis. Oslo: University of Oslo, 2004. https://www.legeforeningen.no/lefo/alle-publikasjoner/Doktoravhandlinger/suicidal-behaviour-in-some-human-occupations-with-special-emphasis-on-physicians-and-police.-a-nationwide-study (1.11.2024).

  2. Hem E. Suicide among doctors. Tidsskr Nor Legeforen 2015; 135: 305. https://doi.org/10.4045/tidsskr.15.0176

  3. Hem E, Haldorsen T, Aasland OG et al. Suicide rates according to education with a particular focus on physicians in Norway 1960–2000. Psychol Med 2005; 35: 873–80. https://doi.org/10.1017/s0033291704003344

  4. Dalum HS, Hem E, Ekeberg Ø et al. Suicide rates among health-care professionals in Norway 1980-2021. J Affect Disord 2024; 355: 399–405. https://doi.org/10.1016/j.jad.2024.03.128

  5. Aasland OG, Hem E, Haldorsen T et al. Mortality among Norwegian doctors 1960–2000. BMC Public Health 2011; 11: 173. https://doi.org/10.1186/1471-2458-11-173

  6. Dutheil F, Aubert C, Pereira B et al. Suicide among physicians and health-care workers: a systematic review and meta-analysis. PLoS One 2019; 14: e0226361. https://doi.org/10.1371/journal.pone.0226361

  7. Duarte D, El-Hagrassy MM, Couto TCE et al. Male and female physician suicidality: a systematic review and meta-analysis. JAMA Psychiatry 2020; 77: 587–97. https://doi.org/10.1001/jamapsychiatry.2020.0011

  8. Zimmermann C, Strohmaier S, Herkner H et al. Suicide rates among physicians compared with the general population in studies from 20 countries: gender stratified systematic review and meta-analysis. BMJ 2024; 386: e078964. https://doi.org/10.1136/bmj-2023-078964

  9. Hawton K, Agerbo E, Simkin S et al. Risk of suicide in medical and related occupational groups: a national study based on Danish case population-based registers. J Affect Disord 2011; 134: 320–6. https://doi.org/1016/j.jad.2011.05.044

  10. Harvey SB, Epstein RM, Glozier N et al. Mental illness and suicide among physicians. Lancet 2021; 398: 920–30. https://doi.org/10.1016/S0140-6736(21)01596-8

  11. Rosta J, Aasland OG. Changes in the lifetime prevalence of suicidal feelings and thoughts among Norwegian doctors from 2000 to 2010: a longitudinal study based on national samples. BMC Psychiatry 2013; 13: 322. https://doi.org/10.1186/1471-244X-13-322

  12. Clark J. Hope is not passive – it needs action. BMJ 2024; 386: q1837. https://doi.org/10.1136/bmj.q1837

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