Male and Female Physician Suicidality: A Systematic Review and Meta-analysis

Abstract

Importance: Population-based findings on physician suicide are of great relevance because this is an important and understudied topic.

Objective: To evaluate male and female physician suicide risks compared with the general population from 1980 to date and test whether there is a reduction of SMR in cohorts after 1980 compared with before 1980 via a meta-analysis, modeling studies, and a systematic review emphasizing physician suicide risk factors.

Data sources: This study uses studies retrieved from PubMed, Scielo, PsycINFO, and Lilacs for human studies published by October 3, 2019, using the search term "(((suicide) OR (self-harm) OR (suicidality)) AND ((physicians) OR (doctors)))." Databases were also searched from countries listed in articles selected for review. Data were also extracted from an existing article by other authors to facilitate comparisons of the pre-1980 suicide rate with the post-1980 changes.

Study selection: Original articles assessing male and/or female physician suicide were included; for the meta-analysis, only cohorts from 1980 to the present were included.

Data extraction and synthesis: The preregistered systematic review and meta-analysis followed Cochrane, PRISMA, and MOOSE guidelines. Data were extracted into standardized tables per a prespecified structured checklist, and quality scores were added. Heterogeneity was tested via Q test, I2, and τ2. For pooled effect estimates, we used random-effects models. The Begg and Egger tests, sensitivity analyses, and meta-regression were performed. Proportional mortality ratios were presented when SMR data could not be extracted.

Main outcomes and measures: Suicide SMRs for male and female physicians from 1980 to the present and changes over time (before and after 1980).

Results: Of 7877 search results, 32 articles were included in the systematic review and 9 articles and data sets in the meta-analysis. Meta-analysis showed a significantly higher suicide SMR in female physicians compared with women in general (1.46 [95% CI, 1.02-1.91]) and a significantly lower suicide SMR in male physicians compared with men in general (0.67 [95% CI, 0.55-0.79]). Male and female physician SMRs significantly decreased after 1980 vs before 1980 (male physicians: SMR, -0.84 [95% CI, -1.26 to -0.42]; P < .001; female physicians: SMR, -1.96 [95% CI, -3.09 to -0.84]; P = .002). No evidence of publication bias was found.

Conclusions and relevance: In this study, suicide SMR was found to be high in female physicians and low in male physicians since 1980 but also to have decreased over time in both groups. Physician suicides are multifactorial, and further research into these factors is critical.

Figure 1.. Forest Plots of Random-Effects Models

A, Male physicians. B, Female physicians. C, Age-standardized mortality ratio suicide in male physicians. D, Age-standardized mortality ratio for suicide in female physicians. ES indicates effect size.

Figure 2.. Sensitivity Analyses on Pooled Effects on Removing Individual Studies

A, Male physicians. B, Female physicians. C, Funnel plots showing no publication bias for male physician suicide age-standardized mortality ratio for suicide (SMRs). D, Funnel plots showing no publication bias for female physician suicide SMRs.

Figure 3.. Age-Standardized Mortality Ratio (SMR) for Suicide Trends Over Time

A, Male physicians. B, Female physicians. Cohort years reflect the first year of each cohort, except for 2015, which reflects the last year of the last cohort. Pre-1980 cohort data were taken from a meta-analysis by Schernhammer and Colditz; all post-1980 data were taken from the meta-analysis data sets, except for 3 studies in Schernhammer and Colditz.