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Meta-Analysis
. 2019 Dec 12;14(12):e0226361.
doi: 10.1371/journal.pone.0226361. eCollection 2019.

Suicide among physicians and health-care workers: A systematic review and meta-analysis

Frédéric Dutheil  1   2 , Claire Aubert  3 , Bruno Pereira  4 , Michael Dambrun  5 , Fares Moustafa  6 , Martial Mermillod  7   8 , Julien S Baker  9 , Marion Trousselard  10 , François-Xavier Lesage  11 , Valentin Navel  12
Affiliations
Meta-Analysis

Suicide among physicians and health-care workers: A systematic review and meta-analysis

Frédéric Dutheil et al. PLoS One. .

Abstract

Background: Medical-related professions are at high suicide risk. However, data are contradictory and comparisons were not made between gender, occupation and specialties, epochs of times. Thus, we conducted a systematic review and meta-analysis on suicide risk among health-care workers.

Method: The PubMed, Cochrane Library, Science Direct and Embase databases were searched without language restriction on April 2019, with the following keywords: suicide* AND (« health care worker* » OR physician* OR nurse*). When possible, we stratified results by gender, countries, time, and specialties. Estimates were pooled using random-effect meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Suicides, suicidal attempts, and suicidal ideation were retrieved from national or local specific registers or case records. In addition, suicide attempts and suicidal ideation were also retrieved from questionnaires (paper or internet).

Results: The overall SMR for suicide in physicians was 1.44 (95CI 1.16, 1.72) with an important heterogeneity (I2 = 93.9%, p<0.001). Female were at higher risk (SMR = 1.9; 95CI 1.49, 2.58; and ES = 0.67; 95CI 0.19, 1.14; p<0.001 compared to male). US physicians were at higher risk (ES = 1.34; 95CI 1.28, 1.55; p <0.001 vs Rest of the world). Suicide decreased over time, especially in Europe (ES = -0.18; 95CI -0.37, -0.01; p = 0.044). Some specialties might be at higher risk such as anesthesiologists, psychiatrists, general practitioners and general surgeons. There were 1.0% (95CI 1.0, 2.0; p<0.001) of suicide attempts and 17% (95CI 12, 21; p<0.001) of suicidal ideation in physicians. Insufficient data precluded meta-analysis on other health-care workers.

Conclusion: Physicians are an at-risk profession of suicide, with women particularly at risk. The rate of suicide in physicians decreased over time, especially in Europe. The high prevalence of physicians who committed suicide attempt as well as those with suicidal ideation should benefits for preventive strategies at the workplace. Finally, the lack of data on other health-care workers suggest to implement studies investigating those occupations.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Search strategy.
Fig 2
Fig 2. Methodological quality of included articles using Newcastle–Ottawa Quality Assessment Scale.
Fig 3
Fig 3. Summary bias risk of included articles using the Newcastle–Ottawa Quality Assessment Scale model.
Fig 4
Fig 4. Meta-analysis of standardized mortality rate for suicides among physicians by gender.
Fig 5
Fig 5. Meta-regression of standardized mortality rate for suicides among physicians.
Fig 6
Fig 6. Meta-analysis of standardized mortality rate for suicides by geographic zones.
Fig 7
Fig 7. Meta-analysis of percentages of suicide in physicians by group of specialties.
Fig 8
Fig 8. Meta-analysis of percentages of suicide in physicians by category of surgical specialties.
Fig 9
Fig 9. Meta-analysis of percentages of suicide in physicians by category of medical specialties.
Fig 10
Fig 10. Meta-analysis of prevalence of physicians died by suicide among all deaths in physicians.
Fig 11
Fig 11. Meta-analysis of prevalence of physicians with suicidal ideation among all the physicians.
See this image and copyright information in PMC

References

    1. Hawton K, Agerbo E, Simkin S, Platt B, Mellanby RJ (2011) Risk of suicide in medical and related occupational groups: a national study based on Danish case population-based registers. J Affect Disord 134: 320–326. 10.1016/j.jad.2011.05.044 - DOI - PubMed
    1. Hawton K, Simkin S, Rue J, Haw C, Barbour F, Clements A, et al. (2002) Suicide in female nurses in England and Wales. Psychol Med 32: 239–250. 10.1017/s0033291701005165 - DOI - PubMed
    1. Katz RM (1983) Causes of death among registered nurses. J Occup Med 25: 760–762. 10.1097/00043764-198310000-00017 - DOI - PubMed
    1. Agerbo E, Gunnell D, Bonde JP, Mortensen PB, Nordentoft M (2007) Suicide and occupation: the impact of socio-economic, demographic and psychiatric differences. Psychol Med 37: 1131–1140. - PubMed
    1. Hem E, Haldorsen T, Aasland OG, Tyssen R, Vaglum P, Ekeberg O (2005) Suicide rates according to education with a particular focus on physicians in Norway 1960–2000. Psychol Med 35: 873–880. 10.1017/s0033291704003344 - DOI - PubMed