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Assessment of Risk Factors for Suicide Among US Health Care Professionals

Education Objective To identify risk factors for suicide among health care professionals compared with the general population.
1 Credit CME
Key Points

Question  Are there differences in risk factors for suicide among health care professionals (surgeons, nonsurgeon physicians, and dentists) compared with the general population?

Findings  In this cohort study of 170 030 individuals who died by suicide, health care professionals who died by suicide were more likely to have problems with their jobs, physical health, and civil legal issues and to have Asian or Pacific Islander ancestry compared with individuals in the general population who died by suicide. A direct comparison between surgeons and nonsurgeon physicians revealed that surgeons had a higher risk of suicide if they were older, male, married, or currently receiving treatment for mental illness.

Meaning  Results of this study suggest that, of those who died by suicide, health care professionals have a higher likelihood of experiencing problems with their jobs and physical health compared with the general population.

Abstract

Importance  Burnout among health care professionals has been increasingly associated with suicide risk. An examination of possible risk factors may help in the prevention of suicide among health care professionals.

Objective  To assess suicide risk factors for 3 categories of health care professionals (surgeons, nonsurgeon physicians, and dentists) compared with non–health care professionals.

Design, Setting, and Participants  Data from the National Violent Death Reporting System were reviewed to identify all individuals who died by suicide in the United States between January 1, 2003, and December 31, 2016. Individuals were divided into health care professionals and non–health care professionals (general population), with the health care professionals further categorized into surgeons, nonsurgeon physicians, and dentists. The covariates of suicide decedents included demographic characteristics (age, sex, race, and marital status), medical history (mental illness, substance use, and physical health), and documented factors associated with the suicide death (job, intimate partner, financial, legal, and other problems). Data were analyzed from October 2 to December 17, 2019.

Main Outcomes and Measures  In this analysis, the outcome variable was occupation, with health care professionals overall and by category compared with the general population. Multiple logistic regression analyses with backward stepwise selection were performed.

Results  A total of 170 030 individuals who died by suicide between 2003 and 2016 were identified. Of those, 767 individuals (0.5%) were health care professionals (mean [SD] age, 59.6 [15.6] years; 675 men [88.0%]; 688 white [89.7%]), with the remainder of the sample (95.5%) comprising the general population (mean [SD] age, 46.8 [31.5] years; 77.7% men; 87.8% white). A total of 485 health care professionals (63.2%) were nonsurgeon physicians, 179 professionals (23.3%) were dentists, and 103 professionals (13.4%) were surgeons. Compared with the general population, risk factors for suicide among health care professionals included having Asian or Pacific Islander ancestry (odds ratio [OR], 2.80; 95% CI, 1.96-3.99; P < .001), job problems (OR, 1.79; 95% CI, 1.49-2.17; P < .001), civil legal problems (OR, 1.61; 95% CI, 1.15-2.26; P = .006), and physical health problems (OR, 1.40; 95% CI, 1.19-1.64; P < .001) and currently receiving treatment for mental illness (OR, 1.45; 95% CI, 1.24-1.69; P < .001). Compared with the general population, health care professionals had a lower risk of suicide if they had black ancestry (OR, 0.55; 95% CI, 0.36-0.84; P < .001) or were female (OR, 0.44; 95% CI, 0.35-0.55; P < .001) or unmarried (OR, 0.36; 95% CI, 0.31-0.42; P < .001). Health care professionals who died by suicide were also less likely to have problems with intimate partners (OR, 0.71; 95% CI, 0.60-0.86; P < .001) or alcohol use (OR, 0.58; 95% CI, 0.45-0.73; P < .001) compared with the general population. Surgeons had a higher risk of suicide compared with the general population if they were older, male, married, had Asian or Pacific Islander ancestry, were currently receiving treatment for mental illness, or had problems with their job or alcohol use. Compared with their nonsurgeon physician colleagues, surgeons had a higher risk of suicide if they were male, older, married, or currently receiving treatment for mental illness.

Conclusions and Relevance  This study highlights risk factors for suicide among health care professionals, with additional analyses of surgeon-specific risk factors. The results may be useful in improving the detection of burnout and the development of suicide prevention interventions among health care professionals.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: March 5, 2020.

Corresponding Author: Yisi D. Ji, DMD, Harvard Medical School, 260 Longwood Ave, Boston, MA 02115 (yisi_ji@hms.harvard.edu).

Published Online: June 10, 2020. doi:10.1001/jamasurg.2020.1338

Author Contributions: Dr Ji had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Ji, Peacock, Resnick.

Acquisition, analysis, or interpretation of data: Ji, Robertson, Patel, Peacock.

Drafting of the manuscript: Ji, Robertson, Patel.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Ji, Robertson, Patel.

Administrative, technical, or material support: Ji, Peacock, Resnick.

Supervision: Peacock, Resnick.

Conflict of Interest Disclosures: Dr Patel reported receiving personal consultancy fees from Bessemer Venture Partners and being a cofounder and shareholder of Memora Health.

Additional Contributions: The staff members of the National Violent Death Reporting System at the Centers for Disease Control and Prevention provided data, feedback, and guidance for this manuscript.

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